Healthcare-acquired Infections Research Articles

Nurses’ Perception, Barriers and Associated Factors towards Hand Hygiene Practices for Prevention of Healthcare Acquired Infections in the Intensive Care Units

Introduction: Healthcare-Acquired Infections occur within 72 hours of hospitalization, surgical-related infections, and surgical site infections that develop 30 to 90 days after the procedure. They particularly impact critically ill patients due to their weakened immune systems, with hand washing being the most effective prevention method. Objective of the study: Assessing nurses’ perceptions, barriers, and the impact of socio-demographic factors towards hand hygiene practices in ICUs. Methods: The study included 65 ICU nurses from three referral hospitals, using a quantitative descriptive cross-sectional design and whole population sampling. The data were collected from 05th November 2021 to 11th Feb 2022. Data analysis was conducted with SPSS software version 21. Results: Seventy percent of participants viewed health-acquired infections (HAIs) as serious and susceptible, while 83.1% recognized the benefits of hand hygiene. The most commonly cited barrier to hand hygiene was allergies to products, reported by 32.3% of respondents. Positive perceptions of hand hygiene were significantly associated with the working institution and in-service training, with a P-value of less than 0.05. Conclusion: The study investigated nurses' perceptions, barriers, and factors influencing hand hygiene practices in ICUs. It revealed that allergies to hand hygiene products hinder the hand hygiene adherence, while institutional policies and in service training boost It. Recommendations: There is a need for conducting research using an observational checklist to assess HH adherence among ICU nurses, enhancing nursing education on HH, and improving in-service training for managerial teams in three hospitals.

The impact of enhanced cleaning on bacterial contamination of the hospital environmental surfaces: a clinical trial in critical care unit in an Egyptian hospital.

Contaminated environmental surfaces play an important role in the transmission of pathogens that cause healthcare acquired infection (HAI). The present study aimed to assess the effect of enhanced cleaning techniques on bacterial contamination in high-touch areas compared to routine cleaning at the intensive care units (ICU) of the neurosurgery department of Alexandria Main University Hospital, Egypt. The assessment of the knowledge and practices of healthcare cleaning workers and nurses was conducted through a questionnaire and an observational checklist. An educational program about enhanced cleaning was carried out for healthcare cleaning workers and nurses in one room of the ICU unit. Environmental surface swabs were taken from the two rooms of the ICU before and after cleaning (room A and room B). Room A was selected to apply the enhanced cleaning, and room B was selected for routine cleaning. A significant decrease in bacterial counts in the high-touch areas around the patients after the application of enhanced cleaning compared to routine cleaning (p < 0.001) was observed. Gram-negative bacteria isolated from high-touch areas accounted for 45.6% of the samples collected before enhanced cleaning, and they became 16.3% after enhanced cleaning (p < 0.001), while they accounted for 40% after routine cleaning. The enhanced cleaning intervention in Room A resulted in a significant reduction in total infections, decreasing from 18 cases in the six months prior to the intervention to 11 cases in the six months following its implementation. (p < 0.05). The effect of enhanced cleaning was evident in decreasing bacterial counts in the high-touch areas around the patient and consequently in the records of the HAI rate inside the ICU. PACTR202402531001186, date: 15 February 2024, 'retrospectively registered'.

Loop-Mediated Isothermal Amplification Coupled with Reverse Line Blot Hybridization for the Detection of Pseudomonas aeruginosa.

Pseudomonas aeruginosa is a pathogen of critical priority importance according to the WHO. Due to its multi-resistance and expression of various virulence factors, it is the causal agent of severe healthcare-acquired infections (HAIs). Effective strategies to control infections caused by P. aeruginosa must include early and specific detection of the pathogen for early and timely antibiotic prescription. The need to develop a specific and reproducible diagnostic technique is urgent, which must often be more sensitive and faster than current clinical diagnostic methods. In this study, we implement and standardize the loop-mediated isothermal amplification (LAMP) technique, coupled with the reverse line blot hybridization (RLBH) technique for the detection of P. aeruginosa. A set of primers and probes was designed to amplify a specific region of the P. aeruginosa 16s rRNA gene. The sensitivity of the LAMP-RLBH method was 3 × 10-4 ng/μL, 1000 times more sensitive than the PCR and LAMP technique (this work), with a sensitivity of 3 × 10-3 ng/μL. The LAMP-RLBH and LAMP techniques showed specific amplification and no cross-reaction with members of the ESKAPE group and other Pseudomonas species. The present investigation provides a technique that can be easily performed in less time, achieving a faster and more reliable alternative compared to traditional microbial diagnostic methods for the detection of P. aeruginosa.

Prescription Practices and Usage of Antimicrobials in a Tertiary Teaching Hospital in Rwanda: A Call for Antimicrobial Stewardship.

Background: Antimicrobial resistance (AMR) is a global problem that results in high morbidity and mortality, particularly in low- and middle-income countries. Inappropriate use of antimicrobials is a major driver of AMR. This study aimed to evaluate the rate and quality of antimicrobial prescription and use at the University Teaching Hospital of Kigali (CHUK), a tertiary-referral teaching hospital. Methodology: A point prevalence survey (PPS) of antimicrobial prescription was conducted using the Global PPS tool, including a healthcare-acquired infection (HAI) module. Results: On the day of the PPS, 39.3% (145/369) of inpatients were prescribed at least one antimicrobial. Out of the 259 prescribed antimicrobials, 232 (89.6%) were antibacterials, of which 151 (65.1%) belonged to the watch group of the WHO AWaRe classification. The top three antibiotics prescribed were cefotaxime (87; 37.5%), parenteral metronidazole (31; 13.4%), and meropenem (23; 9.9%). Stop or review dates for the prescribed antimicrobials were documented in 27/259 prescriptions (10.4%). Surgical prophylaxis (SP) was prescribed for longer than one day in 83.3% of 61 patients. Samples for culture were sent for 27.1% (63/232) of all the patients prescribed antibiotics. Conclusion: This PPS demonstrates multiple indicators of the poor use of antimicrobials, including the high prevalence usage of watch antibiotics and prolonged surgical prophylaxis and other poor-quality indicators. Thus, there is an urgent need for intervention to improve antimicrobial stewardship.

Substrate identification of putative NCS1 and NCS2 nucleobase transporters in Pseudomonas aeruginosa.

Pseudomonas aeruginosa is a frequently multidrug-resistant opportunistic pathogen and one of the most common causes of healthcare-acquired infections. While nucleobases are known to support growth in nutrient-limited conditions, recent work showed that adenine and hypoxanthine can also decrease P. aeruginosa biofilm formation by disrupting c-di-GMP metabolism. Thus, nucleobase transport may be relevant to multiple aspects of P. aeruginosa biology and pathogenesis. However, there is currently little known about the transport of nucleobases in P. aeruginosa. Our work reports initial substrate identifications for 10 putative nucleobase transporters in P. aeruginosa, providing new tools to address previously difficult-to-test hypotheses relating to nucleobase transport in this organism.

Interventions to prevent Neonatal Healthcare-associated Infection: a systematic review of RCT

Abstract Background Healthcare-acquired infections (HAI) in neonatal intensive care unit (NICU) specifically refer to infections that occur in newborn infants within the healthcare environment. Preterm infants, often more vulnerable to infections, in the NICU may be exposed to various medical interventions, devices, and environments that can increase the risk of infections. This systematic review aims to evaluate the effectiveness of interventions proposed to prevent neonatal healthcare-associated infections. Methods PubMed, Scopus and Web of Science databases were searched to identify any RCT study coming from high income countries, published from 2004, that investigated the efficacy of any intervention to prevent HAI in NICU. All type of HAI were considered. Results A total of seven studies were included (2 from USA, 5 from UE). Three studies focused on: administration of donor milk; probiotic Bifidobacterium breve; intravenous Staphylococcus aureus immune globulin; all failed to demonstrate any protective action. Of the four remaining studies that investigate different aspect of the vascular catheterization process only two lead a a statistical significant reduction of HAI. Garland et al. demonstrate in 85 neonates how vancomycin-heparin lock solution is capable to reduce catheter related blood stream infection (CRBSI) 8/43 neonates (18.6%) in the control group vs 0/42 in the vancomycin-heparin-lock group (P = 0.006). Bertini et al. demonstrate in 86 preterm infants how utilization of AgION catheter in Umbelical vein catheterization (UVC) lead to CRBSI rate reduction (2 vs. 22%; p = 0.005), shorter hospital stay (p = 0.04), lower case fatality rate due to Blood stream infection (p = 0.01). Conclusions Among the proposed methodology only the one acting on the catheterization process provide a statistical significant reduction of HAI onset. Widespread observation of proposed protocol may results in reduction of HAI in NICU. Key messages • Modfiication on the catheterization process provide a statistical significant reduction of HAI onset. • Knowing these measures assure reduction of HAI.

Wristwatches in bare-below-the-elbows out-of-hospital policies: time for a review

Background: Bare-below-the-elbows (BBE) policies are common in infection prevention and control strategies but the evidence relating to wristwatch prohibition is slim and varied in quality. No dispensation is considered for those working outside hospital, which poses unique infection prevention and control challenges. Blanket approaches may be putting patients at further risk of healthcare-acquired infections (HCAIs). Aims: This review aimed to collate evidence and bring clarity to the ongoing debate surrounding mandated BBE policy, specifically relating to wristwatches worn within the prehospital setting. Methods: Three searches were undertaken, and results refined against an inclusion criterion to ensure relevance. Findings: Wristwatches can be considered a vector for HCAI; however, most data on this are confounded by other known risk factors. No studies were conducted outside a hospital environment. Alternative time sources used by clinicians such as touchscreen phones are a significant pathogen vector. Conclusion: Four policy evidence-based recommendations are made in relation to this topic. The National Institute for Health and Care Excellence (NICE) should review this topic as the evidence base underpinning its guidance is inadequate.

The anti-biofilm efficacy of copper and zinc doped borate bioactive glasses.

Aim: Healthcare-acquired infections (HAIs) pose significant challenges in medical settings due to their resistance to conventional treatment methods. The role of bacterial biofilms in exacerbating these infections is well-documented, making HAIs particularly difficult to eradicate. Despite numerous research efforts, an effective solution to combat these infections remains elusive. This study aims to explore the potential of metal-ion (copper and zinc) doped borate bioactive glasses (BBGs) as a novel treatment modality to inhibit bacterial species commonly implicated in HAIs: Staphylococcus epidermidis, Escherichia coli, and Pseudomonas aeruginosa.Methods: The study analyzed the efficacy of both direct and indirect applications of BBGs on severe biofilms pre-formed under static and dynamic growth conditions; a comprehensive predictive modeling was developed, simulating diverse clinically relevant conditions.Results: Results demonstrate more than 4 log reduction in bacterial growth within 2days for direct application and 3days for indirect application of copper and zinc-doped BBGs. These findings were consistent across the three bacterial species, in both static and dynamic conditions.Conclusion: Copper and zinc-doped BBGs can be an effective approach in combating HAIs complicated by biofilms.

Occurrence and Antimicrobial Susceptibility Profile of Vancomycin Resistance among Clinical Isolates of Staphylococcus aureus in Enugu Metropolis, Nigeria

Introduction: Staphylococcus aureus is a significant cause of community-acquired and healthcare-acquired infections worldwide. Methicillin-resistant Staphylococcus aureus infections have been treated with vancomycin, a last-resort antibiotic. This study aimed to investigate the occurrence of vancomycin resistance among Staphylococcus aureus isolates obtained from different clinical samples. Materials and Methods: The study was conducted from February to August 2022 in the Microbiology Laboratory of the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu. A total of 150 Staphylococcus aureus isolates from different clinical samples were used for the study. The antimicrobial susceptibility profile was done using the Kirby-Bauer disc diffusion procedure. Methicillin resistance was detected using the cefoxitin disc diffusion technique. VRSA was confirmed using the broth dilution method. Results: Isolates showed high resistance to cephalosporins; 100% resistance to cefixime, to cefotaxime 98.7%, to cefuroxime 93.3%, and to ceftriaxone 80%. There was also high resistance of isolates to imipenem 98.7%, Augmentin 92.2%, erythromycin, and azithromycin 81.3% and 80.0% respectively. Of the 150 isolates, 51(34.0%) were methicillin-sensitive Staphylococcus aureus (MSSA) and 99(66.0%) were MRSA. Of the 99 MRSA strains, 9 (9.1%) were vancomycin-resistant (VRSA), 24 (24.2%) were vancomycin intermediate (VISA) and 66 (66.7%) were vancomycin-sensitive (VSSA). The overall prevalence of VRSA was 6%. Conclusion: The isolates had a high resistance to the antibiotics used in our study. The proportion of MRSA was high. A high percentage of VRSA/VISA was also detected. To prevent the further spread of VRSA, rigorous monitoring of vancomycin treatment, response, and the development of appropriate control guidelines are strongly recommended and required.

Retrospective analysis of Acinetobacter baumannii bacteraemia risk factors, complications and mortality in a tertiary university hospital in Saudi Arabia.

Introduction. There are many multidrug-resistant isolates of the nosocomial pathogen, Acinetobacter baumannii, causing severe healthcare-acquired infections in terminally ill patients with high mortality and morbidity rates. Aim. This study aims to retrospectively analyse A. baumannii bacteraemia (ABB) cases in Saudi Arabia, where the information is sparse regarding the prevalence, risk factors, clinical disease, antibiotic regimen, antibiotic susceptibility, treatment outcomes and mortality associated with this infection. Methods. A retrospective chart review was conducted between 1 January 2015 and 31 December 2022 to identify all patients aged 14 years and above with ABB. Demographic and clinical data, as well as results from laboratory analyses, were collected from patients' electronic charts. Statistical analyses were performed on the data to identify factors associated with 90-day mortality. Results. Of the 122 ABB cases, 71 (63.4%) died. The factors that were found to be associated with 90-day mortality were the Charlson Comorbidity Index, Pitt bacteraemia score, quick Sequential Organ Failure Assessment score (P<0.001 for each), hospital ward (P<0.02), short duration of antibiotic treatment (P<0.01) and higher age (P<0.05). The most common source of infection was central line-associated bloodstream infection in 52.7%. Also associated with mortality were inappropriate antimicrobial therapy (P<0.02) and empirical use of colistin (P<0.05). In many patients, ABB was caused by carbapenem-resistant A. baumannii [(CRAB), 69.6%], and 74.4% of those patients died. Conclusion. To prevent ABB-associated mortality, an appropriate regimen and duration of treatment are necessary. Hospitals should also practice proper hygiene to prevent the spread of ABB. CRAB is a growing threat in hospitals in Saudi Arabia, especially in the critical care setting, and carries a very high risk of mortality.

Visualized and pH-responsive hydrogel antibacterial coating for ventilator-associated pneumonia

Ventilator-associated pneumonia (VAP) is a common healthcare-acquired infection often arising during artificial ventilation using endotracheal intubation (ETT), which offers a platform for bacterial colonization and biofilm development. In particular, the effects of prolonged COVID-19 on the respiratory system. Herein, we developed an antimicrobial coating (FK-MEM@CMCO-CS) capable of visualizing pH changes based on bacterial infection and releasing meropenem (MEM) and FK13-a1 in a controlled manner. Using a simple dip-coating process with controlled loading, chitosan was cross-linked with sodium carboxymethyl cellulose oxidation (CMCO) and coated onto PVC-based ETT to form a hydrogel coating. Subsequently, the coated segments were immersed in an indicator solution containing bromothymol blue (BTB), MEM, and FK13-a1 to fabricate the FK-MEM@CMCO-CS coating. In vitro studies have shown that MEM and FK13-a1 can be released from coatings in a pH-responsive manner. Moreover, anti-biofilm and antibacterial adhesion results showed that FK-MEM@CMCO-CS coating significantly inhibited biofilm formation and prevented their colonization of the coating surface. In the VAP rat model, the coating inhibited bacterial growth, reduced lung inflammation, and had good biocompatibility. The coating can be applied to the entire ETT and has the potential for industrial production.

Data Preparation for Supervised Learning: Improving Nursing Situation Awareness to Reduce Healthcare-Acquired Urinary Tract Infection.

Situation awareness (SA) is an important non-technical skill for nurses. Nurses interact directly with patients and review their clinical signs. If we improve nurses' SA, they will likely detect clinical changes and prevent patient harm. A clinical endeavor that can benefit from improved nurses' SA is the prevention of Healthcare-Acquired Urinary Tract Infection (HAUTI). Electronic Health Records contain comprehensive nursing assessment data that researchers can use to analyze trends and provide a context-based understanding of the infection risk factors. We conducted a study that involved extracting nursing assessment data and preparing it for supervised learning algorithms and predicting HAUTI. In this paper, we share the methods we used to prepare the data for supervised learning algorithms and present the challenges related to data missingness.

Literature Review: Potential of Chinese Ketepeng Leaves (Cassia alata L.) as an Antibacterial Agent

Infectious diseases are diseases caused by bacteria. Several bacterial infectious diseases include bacteria that cause skin infections such as Staphylococcus aureus, Staphylococcus epidermidis, Propionibacterium acnes and Streptococcus pyogene, nosocomial pneumonia infections of the urinary tract by Pseudomonas aeruginosa and Klebsiella pneumoniae that cause Healthcare-Acquired Infections (HAIs). The drugs usually used to treat bacterial infections are antibiotics. Along with the increase in cases of infection, there is also an increase in the use of antibiotics. Widespread or irrational use of antibiotics can cause resistance, so alternatives are needed to overcome them. One plant that has potential as an antibacterial agent is the leaves of Chinese Ketepeng (Cassia alata L.). Chinese ketepeng leaves contain phytochemical compounds, namely flavonoids, saponins, tannins, alkaloids and phenols. Therefore, this literature review aims to determine the potential of Chinese Ketepeng (Cassia alata L.) leaf extract as an antibacterial agent. The method used is the Systematic Literature Review method by collecting data through databases such as Publish or Perish, PubMed, and Google Scholar. The search method uses the keywords "Chinese Ketepeng Plant", "Skin infection", "Antibacterial", "Disc diffusion", "Well diffusion", "Staphylococcus aureus", "Staphylococcus epidermidis", "Klebsiella pneumonia", "Shigella dysentriae", ”Propionibacterium acnes”, “Streptococcus sobrinus”, and “Pseudomonas aerugenosa”. The results of this review article show that ke tepeng china leaf extract is proven to have potential as an antibacterial agent which is characterized by the presence of an inhibition zone formed. The phytochemical content in Chinese ketepeng leaves such as flavonoids, saponins, tannins, alkaloids and phenols are thought to be antimicrobial. The difference in the diameter of the inhibition zone formed is influenced by the concentration of the extract, the type of solvent and the type of test microorganisms used. The types of solvents used are ethanol and methanol which are extracted by sonication and maceration.

Analysis of bacteraemia caused by group C and G Streptococcus (Streptococcus dysgalactiae subsp. equisimilis) in Western Sydney over a 6-year period (2015-2020).

Streptococcus dysgalactiae subsp. equisimilis (SDSE) has increasingly been recognised as a significant pathogen that causes a myriad of infections, ranging from cellulitis to invasive infections, including bacteraemia and even toxic shock syndrome. The aim of this study was to examine the epidemiology and disease manifestations of bacteraemia caused by SDSE. We retrospectively reviewed cases of SDSE bacteraemia in adults aged ≥ 18 years admitted to four public hospitals in Western Sydney, Australia, between January 2015 and December 2020. We reviewed demographics, comorbidities, disease manifestations, management, and outcomes. There were 108 patients with SDSE bacteraemia over a six-year period. The median age of individuals with SDSE bacteraemia was 70 years (interquartile range, IQR, 58-85 years). Cardiovascular disease (46%), chronic skin conditions (44%) and diabetes (37%) were the most common comorbidities. Ten patients (9%) with SDSE bacteraemia had healthcare-acquired infections. Skin and skin structure infections (SSTIs) were the most common presentations (59%), while bone and joint infections (BJIs) represented 13% of the cases. Twenty patients (19%) had septic shock on presentation. Fifteen patients (14%) were prescribed clindamycin, while one patient received intravenous immunoglobulin (IVIg). Infective endocarditis (IE) was present in 3% of patients; however, only 44% of the total patients had an echocardiogram. The 30-day mortality rate was 13%, but it was greater in those aged > 75 years (21%). The average length of hospital stay for patients who survived was 15 days, and the average duration of intravenous therapy was 12 days. SDSE bacteraemia is typically a community-onset infection with a fifth of patients in our cohort presenting with septic shock. Though complications such as BJI (13%) and IE (3%) are infrequent, 30-day mortality is high at 21% in those aged > 75 years.

Function and contribution of two putative Enterococcus faecalis glycosaminoglycan degrading enzymes to bacteremia and catheter-associated urinary tract infection.

Enterococcus faecalis is a common cause of healthcare-acquired bloodstream infections and catheter-associated urinary tract infections (CAUTIs) in both adults and children. Treatment of E. faecalis infection is frequently complicated by multi-drug resistance. Based on protein homology, E. faecalis encodes two putative hyaluronidases, EF3023 (HylA) and EF0818 (HylB). In other Gram-positive pathogens, hyaluronidases have been shown to contribute to tissue damage and immune evasion, but the function in E. faecalis has yet to be explored. Here, we show that both hylA and hylB contribute to E. faecalis pathogenesis. In a CAUTI model, ΔhylA exhibited defects in bladder colonization and dissemination to the bloodstream, and ΔhylB exhibited a defect in kidney colonization. Furthermore, a ΔhylAΔhylB double mutant exhibited a severe colonization defect in a model of bacteremia while the single mutants colonized to a similar level as the wild-type strain, suggesting potential functional redundancy within the bloodstream. We next examined enzymatic activity, and demonstrate that HylB is capable of digesting both hyaluronic acid (HA) and chondroitin sulfate in vitro, while HylA exhibits only a very modest activity against heparin. Importantly, HA degradation by HylB provided a modest increase in cell density during the stationary phase and also contributed to dampening of lipopolysaccharide-mediated NF-κB activation. Overall, these data demonstrate that glycosaminoglycan degradation is important for E. faecalis pathogenesis in the urinary tract and during bloodstream infection.

Filtered handheld far-ultraviolet disinfection device in reducing environmental pathogens from high-touch clinical surfaces

Background: Healthcare-acquired infections (HAIs) continue to be a major challenge. In fact, an increased risk of HAIs has been linked to high-touch surfaces contaminated with multidrug-resistant organisms (MDROs), and enhanced environmental disinfection is linked to reduced HAI rates. Recently, more focus has been placed on emerging disinfection technologies, such as UV light-producing portable device that emits light at a wavelength of 222 nm, which has previously demonstrated germicidal capabilities at short contact times. In this study, we aim i) to evaluate the efficacy of a filtered far-UV-C handheld device (FFUHH) to reduce bacterial loads on high-touch surfaces in clinical workrooms in a cancer center, and ii) to isolate, identify and establish a genetic relationship between these environmental clinically significant pathogens and the ones recovered from patients. Methods: Samples were collected weekly on a rotating schedule over a 24-week period from five high-touch items (dictation device, mouse, armchair, desk, and keyboard) in multiple clinical work rooms on hematologic malignancy and stem cell transplant units. Contact plates for colony count and swabs were collected pre- and post-intervention with the FFUHH on standardized adjacent areas respectively for each surface. The swabs were enriched and cultured on selective media to isolate clinically significant pathogens. Whole genome sequencing (WGS) was then performed on environmental pathogens validated by MALDI-TOF as well as clinical samples collected from patients in the same unit around the time of environmental sample collection. Results: A total of 440 plates, 220 pre- and 220 post-interventions, were collected and analyzed. The highest mean colony count pre-treatment was detected from the armchairs and the lowest for the keyboards. The mean reduction of colony forming units (CFUs) ranged between 53% for the keyboard and 83% for the mouse. The reduction was statistically significant across all surfaces with P values &lt; 0.05, except for the keyboard (Figure 1). We isolated many pathogens of the human microbiota identified by MALDI-TOF such as Micrococcus luteus, S. capitis as well as methicillin-resistant S. epidermidis, S. haemolyticus and S. hominis. We also identified several Candida parapsilosis, Pseudomonas stutzeri, one Listeria grayi and one Acinetobacter baumanni. Finally, WSG allowed us to further characterize an environmental multi-drug resistant S. epidermidis ST5 strain associated with patient bacteremia, and ST16 strains detected on surfaces both pre- and post-FFUHH treatment. Conclusion: The FFUHH effectively reduced the microbial burden on high-touch surfaces in clinical workrooms on hematologic malignancy and stem cell units.

Investigation of Healthcare-Acquired Infections and Antimicrobial Resistance in an Italian Hematology Department before and during the COVID-19 Pandemic.

The COVID-19 pandemic has made antibiotic resistance (AMR) and healthcare-acquired infections (HAIs) increasingly serious problems. Point-prevalence Surveys (PPS) and other surveillance techniques are essential for antimicrobial management and prevention. In a hematology department of an Italian hospital, the prevalence of HAI, microbiology, and AMR were examined in this retrospective study in two different periods, namely 2019 and 2021 (pre-pandemic and during the pandemic, respectively). Comparisons were made between patient demographics, hospitalization duration, surveillance swabs, and HAIs. There was no discernible variation in the prevalence of HAI between 2019 and 2021. Higher rates of HAI were connected with longer hospital stays. Variations in antimicrobial susceptibility and species distribution were found by microbiological analysis. The incidence of HAI stayed constant during the epidemic. Nevertheless, shifts in antibiotic susceptibility and microbiological profiles highlight the necessity of continuous monitoring and care. Despite the difficulties of COVID-19, ongoing surveillance and infection control initiatives are crucial for halting HAIs and battling antimicrobial resistance (AMR) in healthcare environments. To fully understand the pandemic's long-term impact on the spread of infectious diseases and antibiotic resistance, more research is required.

Rise to the Challenge: Master the Management of Clostridioides difficile Infection.

Clostridioides difficile infection (CDI) is a significant public health challenge in the developed world. Although previously CDI was primarily a health care-acquired infection, there are now rising numbers of community-acquired cases in patients without traditional risk factors, such as antibiotic exposure. The landscape for the treatment of CDI has changed significantly during the past decade, including newer diagnostic tests, novel antibiotic regimens, and strategies for microbiome restoration in the form of traditional fecal microbiota transplant and approved live biotherapeutics in an effort to address the underlying pathophysiologic process of gut microbial dysbiosis. We present a concise review for clinicians on the diagnosis and management of both primary and recurrent CDI.

Effect of a Water, Sanitation, and Hygiene Program on Handwashing with a Cleansing Agent among Diarrhea Patients and Attendants in Healthcare Facilities in the Democratic Republic of the Congo: A Randomized Pilot of the PICHA7 Program.

Healthcare-acquired infections are a major problem in healthcare facility settings around the world. The Democratic Republic of the Congo (DRC) has over 2 million diarrhea patients hospitalized each year. These healthcare settings become high-risk environments for spreading diarrheal illnesses such as cholera. The objective of the Preventative Intervention for Cholera for 7 Days (PICHA7) program is to develop evidence-based water, sanitation, and hygiene (WASH) interventions to reduce cholera and other severe diarrheal diseases in the DRC. The study objective was to evaluate the effectiveness of PICHA7 program delivery in increasing handwashing with a cleansing agent at stool/vomit- and food-related events in a healthcare facility setting among diarrhea patients and patient attendants. A pilot of the PICHA7 program was conducted among 284 participants in 27 healthcare facilities from March 2020 to November 2021 in urban Bukavu in the South Kivu Province of the DRC. The standard arm received the standard message provided in the DRC to diarrhea patients on the use of oral rehydration solution and a basic WASH message at healthcare facility discharge. The PICHA7 arm received the PICHA7 WASH pictorial module delivered by a health promoter focused on handwashing with a cleansing agent at the bedside of the diarrhea patient in the healthcare facility and provision of a soapy water bottle (water and detergent powder). Within 24 h of intervention delivery, a three-hour structured observation of handwashing practices at stool/vomit- and food-related events (key events) was conducted in healthcare facilities of diarrhea patients and their attendants. Compared to the standard arm, there was significantly more handwashing with a cleansing agent at key events in the PICHA7 arm (40% vs. 15%) (odds ratio: 5.04; (95% confidence interval (CI): 2.01, 12.7)). These findings demonstrate that delivery of the PICHA7 WASH pictorial module and provision of a soapy water bottle to diarrhea patients and their attendants presents a promising approach to increase handwashing with a cleansing agent among this high-risk population in healthcare facilities in the eastern DRC.

Live biotherapeutic products: a capstone for prevention of recurrent Clostridiodes difficile infection

Clostridiodes difficile infection (CDI) continues to be one of the leading causes of healthcare-acquired diarrhea and infections, and recurrence is the biggest challenge in its management. As technology and research have led to a better understanding of the pathophysiology of C. difficile, we have come to appreciate the role that the gastrointestinal microbiota plays in infection onset and the prevention of recurrence. The gut microbiota is disrupted in those with CDI, which allows further propagation of the infection leading to recurrence, if the microbiota deficiency is unable to regrow itself. While antimicrobial therapy is necessary for treatment of any CDI, these therapeutics do not address the underlying disturbance of microbiota. Microbial remodulation therapies have been developed supplementing the microbiota deficiency that exists after the standard of care antimicrobial resulting in a reduction of recurrence. Fecal microbiota transplantation (FMT) was the initial attempt for this type of therapeutic and proved to be safe and effective, however never achieved FDA approval. In light of this, live biotherapeutic products (LBPs) were developed by pharmaceutical companies through a more standardized and regulated process. These products are safe and efficacious in reducing CDI recurrence when given after a standard of care antimicrobial, eventually leading to FDA approval of two products that can now be used widely in clinical practice.