Healthcare-associated Infections Research Articles

Advancing Patient Safety: The Future of Artificial Intelligence in Mitigating Healthcare-Associated Infections: A Systematic Review.

Healthcare-associated infections are infections that patients acquire during hospitalization or while receiving healthcare in other facilities. They represent the most frequent negative outcome in healthcare, can be entirely prevented, and pose a burden in terms of financial and human costs. With the development of new AI and ML algorithms, hospitals could develop new and automated surveillance and prevention models for HAIs, leading to improved patient safety. The aim of this review is to systematically retrieve, collect, and summarize all available information on the application and impact of AI in HAI surveillance and/or prevention. We conducted a systematic review of the literature using PubMed and Scopus to find articles related to the implementation of artificial intelligence in the surveillance and/or prevention of HAIs. We identified a total of 218 articles, of which only 35 were included in the review. Most studies were conducted in the US (n = 10, 28.6%) and China (n = 5; 14.3%) and were published between 2021 and 2023 (26 articles, 74.3%) with an increasing trend over time. Most focused on the development of ML algorithms for the identification/prevention of surgical site infections (n = 18; 51%), followed by HAIs in general (n = 9; 26%), hospital-acquired urinary tract infections (n = 5; 9%), and healthcare-associated pneumonia (n = 3; 9%). Only one study focused on the proper use of personal protective equipment (PPE) and included healthcare workers as the study population. Overall, the trend indicates that several AI/ML models can effectively assist clinicians in everyday decisions, by identifying HAIs early or preventing them through personalized risk factors with good performance. However, only a few studies have reported an actual implementation of these models, which proved highly successful. In one case, manual workload was reduced by nearly 85%, while another study observed a decrease in the local hospital's HAI incidence from 1.31% to 0.58%. AI has significant potential to improve the prevention, diagnosis, and management of healthcare-associated infections, offering benefits such as increased accuracy, reduced workloads, and cost savings. Although some AI applications have already been tested and validated, adoption in healthcare is hindered by barriers such as high implementation costs, technological limitations, and resistance from healthcare workers. Overcoming these challenges could allow AI to be more widely and cost-effectively integrated, ultimately improving patient care and infection management.

The burden of healthcare-associated infections in New Zealand public hospitals 2021.

There are no contemporary data on the burden of healthcare-associated infections (HAIs) in New Zealand. To estimate the economic burden of HAIs in adults in New Zealand public hospitals by number and monetary value of bed days lost; number of deaths, number of life years lost, and the monetary value (in NZ dollars); Accident Compensation Commission (ACC) HAI treatment injury payments; and disability-adjusted life years (DALYs). The annual incidence rate was calculated from the observed prevalence of HAIs in New Zealand, and length of patient stays. Total HAIs for 2021 were estimated by multiplying adult admissions by incidence rates. The excess length of stay and mortality risk attributed to those with HAI was calculated using a multistate model. Payments for treatment injuries were obtained from the ACC. DALYs for HAIs were estimated from the literature. The incidence rate of HAI was 4.74%, predicting 24,191 HAIs for 2021, resulting in 76,861 lost bed days, 699 deaths, with 9,371 years of life lost (YoLL). The annual economic burden was estimated to be $955m comprised of $121m for lost bed days, $792m for cost of YoLL, and $43m ACC claims. There were 24,165 DALY which is greater than many other measured injuries in New Zealand, eg motor vehicle traffic crashes with 20,328 DALY. HAIs are a significant burden for patients, their families, and the public health system. Preventive guidelines for many HAIs exist and a strategic plan is needed to reduce HAIs in New Zealand.

Impact of age on antimicrobial prescriptions in hospitalized children at three academic centres in South Africa: a point prevalence survey.

Antimicrobial resistance is a global threat in children, and the emergence of multi-drug-resistant organisms is of concern. This secondary analysis of an antimicrobial point prevalence survey (PPS) in children evaluates the impact of age on antimicrobial use. The mean antimicrobial prescriptions were assessed in neonates, infants, young children (1-5 years), school-going children (6-12 years), and adolescents (13-15 years) from a cross-sectional PPS at three academic hospitals between September 2021 and January 2022. Primary and secondary diagnoses, antibiotic type (World Health Organization AWaRe and Anatomical Therapeutic Chemical classifications), and the incidence of healthcare-associated infections (HAI) were evaluated per age category. Multiple regression models were used to analyse age-related risk factors for HAI. The number of antimicrobials per child (1.7-1.9 per patient) was higher in neonates and infants compared to children 6-12 years old (1.4 per patient). Watch antibiotics, especially carbapenems, were commonly prescribed in neonates (32.5%) and infants (42.2%). Reserve antimicrobial use was notable in neonates (4.7%) and infants (4.1%). The incidence risk ratio (IRR) of HAI was higher in neonates and infants (IRR 2.13; 95% CI 1.23-3.70, IRR 2.20; 95% CI 1.40-3.45, respectively) compared to 6- to 12-year-olds. On multivariate analysis of participants according to age, being HIV infected, length of stay >6 days, high McCabe severity score, having surgery and receipt of blood transfusion were associated with an increased risk of HAI (P < .001 for all) while on univariate analysis only, being premature and/or underweight was associated with an increased risk of HAI in infants (P < .001 for both). Infants with risk factors for HAI significantly influenced antimicrobial prescribing, underscoring the necessity for tailored antimicrobial stewardship and enhanced surveillance. The increased use of Watch antibiotics, particularly carbapenems, in infants warrants closer scrutiny. Further research is required to identify inappropriate antimicrobial use in high-risk hospitalized young children.

Potenciar as práticas pedagógicas dos docentes e tutores de Enfermagem na Prevenção de Infeções Associadas aos Cuidados de Saúde: Estudo Piloto PrevInf

Background: Healthcare-associated infections (HAIs) pose a significant challenge in Southeast Asia. Despite various reforms in the curricula of this region, health courses have not adequately addressed the prevention of HAIs. Objective: To evaluate the perceptions of nursing educators in Southeast Asia regarding an innovative educational approach developed by the PrevInf project consortium. Methods: A pilot study was conducted using a quantitative approach and descriptive design at two universities in Cambodia and two in Vietnam. Nursing educators were invited to participate in a training session that included a presentation of the PrevInf Model, the pedagogical materials, and the simulation scenarios developed by the project consortium. After the session, the nursing educators completed a questionnaire to assess their agreement with a set of statements concerning the outputs’ feasibility, adequacy, and applicability. Results: The study included 121 nursing educators who reported high agreement regarding the feasibility of the PrevInf Model and its acceptability in various contexts, with no statistically significant differences observed between countries. Across both countries, participants expressed moderate to high agreement that the simulation scenarios represent an appropriate pedagogical strategy and adequately cover essential topics related to the prevention of HAIs. Conclusion: Nursing educators believe that the PrevInf Model, along with its pedagogical materials and simulation scenarios, demonstrates high adequacy, acceptability, and feasibility, with the potential to enhance students' knowledge and skills in HAI prevention. Further research is needed to refine the cultural relevance of the PrevInf Model when compared to traditional teaching methods.

Team-based infection preventionist review improves inter-rater reliability in identification of healthcare-associated infections.

Accurate reporting of healthcare-associated infections (HAIs) to the National Healthcare Safety Network (NHSN) is a critical function of infection prevention and control (IPC) teams. Validation was performed to increase inter-rater reliability in HAI adjudication among infection preventionists. Benefits included improved data integrity, enhanced team performance, and individual growth.

Medical Healthcare Student's Knowledge, Attitude, and Practices Regarding Hand Hygiene and Its Relation to Patient Safety - A Global Scoping Review.

For more than a century, Hand hygiene (HH) has been known to be the most cost-effective hygienic method to minimize infection transmission and risk in healthcare settings. Even though 50% of healthcare-associated infections (HAIs) can be prevented with proper HH, globally 7 per 100 patients from acute-care hospitals in high-income countries (HIC) and 15 per 100 patients in low and middle-income countries (LMIC) acquire at least one HAI during their hospital stay. Even though medical healthcare students do not have the primary responsibility of providing patient care, it is necessary to train, assess, and monitor HH as their interaction with patients could lead to an increased number of HAIs. By conducting this global scoping review, we aim to summarize the global trends surrounding the knowledge, attitude, and practice (KAP) of medical healthcare students regarding HH, and how it affects patient safety. We followed the five stages of Arksey and O'Malley's Scoping Review Methodology. The literature search was done in three databases, specifically, EMBASE, Web of Science, and PubMed. Original published research in credible journals in English conducted between 2012 and 2023 discussing HH amongst medical healthcare students all over the world were included. Twenty-three studies were included in the final analysis. The overall knowledge of medical students regarding HH was low, with some studies reporting scores as low as 10.1%. However, the attitude towards HH was generally positive, with mean scores ranging from 55% to 93%. Notably, nursing students and females exhibited better attitudes and self-reported HH practices. Furthermore, studies indicated that providing training on HH resulted in an increase in positive attitudes towards and improved practices of HH. By focusing on training and facilitating improved HH practices, future generations of doctors and nurses can contribute to minimizing HAIs and enhancing patient safety. Standardized approaches and comprehensive data collection are crucial for implementing effective HH interventions.

Inverse probability weighting leads to more accurate incidence estimates for healthcare-associated infections in intensive care units – results from two national surveillance systems

Two main approaches are employed to monitor healthcare associated infections (HAIs): longitudinal surveillance, which allows to measure incidence rates, and point prevalence surveys (PPS). PPS are less time-consuming; however, they are affected by length-biased sampling, which can be corrected through inverse probability weighting. We assessed the accuracy of this method by analysing data from two Italian national surveillance systems. Ventilator associated pneumonia (VAP) and central-line associated bloodstream infection (CLABSI) incidence measured through a prospective surveillance system (GiViTI) was compared to incidence estimates obtained through conversion of crude and inverse probability weighted prevalence of the same HAIs in intensive care units (ICUs) measured through a PPS. Weighted prevalence rates were obtained after weighting all patients inversely proportional to their time-at-risk. Prevalence rates were converted into incidence per 100 admissions using an adapted version of the Rhame and Sudderth formula. Overall, 30988 patients monitored through GiViTI, and 1435 patients monitored through the PPS were included. A significant difference was found between incidence rates estimated based on crude VAP and CLABSI prevalence and measured through GiViTI (relative risk, RR 2.5 and 3.36; 95% confidence interval, CI 1.42 - 4.39 and 1.33 - 8.53, p = 0.006 and 0.05 respectively). Conversely, no significant difference was found between incidence rates estimated based on weighted VAP and CLABSI prevalence and measured through GiViTI (p = 0.927 and 0.503 respectively). When prospective surveillance is not feasible, our simple method could be useful to obtain more accurate incidence rates from PPS data.

Antibiotic Resistance in Morganella morganii Species: Mechanisms, Prevalence and Clinical Implication

: Morganella morganii, a member of the Enterobacteriaceae family, has gained increasing recognition as an important pathogen due to its multidrug resistance. In addition to its intrinsic resistance, it carries various resistance genes and mobile genetic elements, facilitating the spread of resistance genes. M. morganii develops its mechanisms of resistance through different genetic elements, and its pathogenicity is supported by several virulence factors. Its rate of resistance has attended high levels in a number of studies. The global prevalence of M. morganii-associated infections is observed with nosocomial and healthcare-associated infections. The spectrum of diseases caused by M. morganii is diverse, ranging from sepsis and urinary tract infections, abscess, purple urine bag syndrome, chorioamnionitis, and cellulitis to wound infections and bacteremia. Mortality rates associated with M. morganii infections remain high, emphasizing the need for effective treatment strategies. Thus, this article aimed to provide an overview of the evolving multidrug resistance, resistance genes, risk factors, spectrum diseases, and clinical significance of M. morganii, and the challenges associated with the diagnosis and treatment of M. morganii infections.

Multicentre external validation of the Neonatal Healthcare-associated infectiOn Prediction (NeoHoP) score: a retrospective case–control study

Background and objectivesNeonatal mortality due to severe bacterial infections is a pressing global issue, especially in low-middle-income countries (LMICs) with constrained healthcare resources. This study aims to validate the Neonatal...

Healthcare workers’ perceptions about infection prevention and control in Latin America

BackgroundLimited information exists regarding healthcare workers’ (HCWs) perceptions about infection prevention and control (IPC) in Latin America. MethodsWe conducted an electronic voluntary anonymous survey to assess HCWs’ perceptions towards IPC in 30 hospitals in Latin America during August-September 2022. Nurses, physicians, and environmental cleaning (EVC) staff were prioritized for recruitment. ResultsOverall, 1,340 HCWs completed the survey. Of these, 28% were physicians, 49% nurses, 8% EVC staff, and 15% had “other” roles. Self-compliance with hand hygiene (HH) and prevention bundles was perceived to be high by 95% and 89% of respondents, respectively; however, ratings were lower when asked about compliance by their peers (reported as high by 81% and 75%, respectively). Regular training on IPC and access to healthcare-associated infections (HAI) rates were more limited among physicians than other HCWs (e.g., 87% of EVC staff and 45% of physicians reported training upon hiring and thereafter, 60% of nurses and 51% of physicians reported regular access to HAI rate reports). ConclusionsWe identified several opportunities to strengthen IPC practices in Latin American hospitals, including improving HCW education and training on IPC and their awareness of HAI rates and compliance with prevention measures.

Guidelines for diagnosis,treatment and prevention of clostridium difficile infection in China(2024)

Clostridium difficile infection(CDI) is an intestinal infection caused by Clostridium difficile,characterized by clinical symptoms such as fever,abdominal pain,watery diarrhea,and loose stools. Mild cases present with diarrhea,while severe cases can progress to pseudomembranous colitis,often accompany by complications such as toxic megacolon,intestinal perforation,and septic shock. CDI is a significant cause of complications and mortality,especially among elderly patients,and is one of the most common hospital-acquired infections. The purpose of this guideline is to provide guidance on the diagnosis,treatment,and prevention of CDI,covering a total of 20 clinical questions across three domains: diagnosis,treatment,and prevention. The guideline was developed by a collaborative effort of a guideline expert group and a guideline working group. The guideline expert group consists of 37 clinical experts in 18 specialties related to the diagnosis and treatment of CDI and healthcare associated infection control. This guideline was developed using the internationally recognized GRADE method. It includes evidence evaluation and recommendation grading. It categorizes the quality of evidence into four levels: high,medium,low and very low. When formulating recommendations,it considers factors such as the balance of benefits and harms of intervention,quality of evidence,values and preferences,as well as cost and resource consumption. The recommendations are classified into strong and weak recommendations(conditional recommendations). The target audience of this guideline includes Chinese doctors and patients.

Becoming Hand Hygiene Heroes: implementation of an infection prevention and control campaign for patient and family hospital safety

BackgroundThe COVID-19 pandemic highlighted that hand hygiene is key in preventing healthcare-associated infections. Patients and families are understudied targets for infection prevention and control practices. Previous campaigns to change hand hygiene behavior have been effective, but often face systemic challenges with implementation. MethodsThe “Hand Hygiene Heroes” educational campaign was developed to improve patient and family hand hygiene at two tertiary care pediatric and obstetrics hospitals. Its multiple phases included visual materials, tailored activities for nine hospital units, and long-term evaluation during a two-year period. Hand hygiene rates among patients/families and healthcare workers were measured at baseline and throughout the campaign via direct observation. ResultsOverall, hand hygiene significantly increased for both patients/families (OR 1.82, p 0.041) and healthcare workers (OR 2.15, p <0.001) after campaign initiation. However, individual units had varying degrees of sustainment on follow-up evaluations. DiscussionDuration of intervention, activity simplicity, active participation, and resource availability may affect success of campaign initiatives. Positive prognostic factors included mixed leadership support from administration and front-line workers, pre-determined sustainability plans, and tailored activities by target audience. ConclusionsImplementation of hospital educational campaigns can be resource-intensive but can positively impact patient and family hand hygiene.

Early deep-to-light sedation versus continuous light sedation for ICU patients with mechanical ventilation: A cohort study

BackgroundSedation strategies have not been well established for patients being treated with invasive mechanical ventilation (MV). This study aimed to compare the potential effects of alternative sedation strategies – including early deep-to-light sedation (DTLS), continuous deep sedation (CDS) and continuous light sedation (CLS, the currently recommended strategy) – on ventilator, intensive care unit (ICU) or hospital mortality. MethodsA cohort study was conducted using two large validated ICU databases, including the Registry of Healthcare-associated Infections in ICUs in China (ICU-HAI) and the Medical Information Mart for Intensive Care (MIMIC). Patients who received MV for more than 3 days with one of three sedation strategies were included. Multivariable survival analyses with inverse probability-weighted competing risk models were conducted separately for ICU-HAI and MIMIC cohorts. Adjusted estimates were pooled using fixed-effects models. ResultsIn total, 6700 patients (2627 ICU-HAI, 4073 MIMIC) were included in the cohort study, of whom 2689 received CLS, 2079 CDS and 1932 DTLS. Compared to CLS, DTLS was associated with lower ICU mortality (9.3% vs. 11.0%; pooled adjusted HR 0.78, 95% CI 0.66−0.94) and hospital mortality (16.0% vs. 14.1%; 0.86, CI 0.74–1.00); and CDS was associated with higher ventilator mortality (32.8% vs. 7.0%; 4.65, 3.91–5.53), ICU mortality (40.6% vs. 11.0%; 3.39, 2.95–3.90) and hospital mortality (46.8% vs. 14.1%; 3.27, 2.89–3.71) than CLS. All HRs were qualitatively consistent in both cohorts. ConclusionsCompared to the continuous light sedation, early deep-to-light sedation strategy was associated with improved patient outcomes, and continuous deep sedation was confirmed with poorer patient outcomes.

Clinical experience with ceftazidime/avibactam for the treatment of extensively drug-resistant or pandrug-resistant Klebsiella pneumoniae in neonates and children.

Klebsiella pneumoniae is a significant cause of healthcare-associated infections, resulting in high morbidity and mortality rates due to limited treatment options. In this study, we aimed to evaluate the treatment outcomes and the safety of Ceftazidime-avibactam in infections caused by extensively drug-resistant or pandrug-resistant Klebsiella pneumoniae in pediatric patients. This study included pediatric patients who received ceftazidime-avibactam treatment due to extensively drug-resistant or pandrug-resistant Klebsiella pneumoniae infections, monitored in the pediatric intensive care, neonatal intensive care, and pediatric wards of Cukurova University Faculty of Medicine between 2022 and 2023. Patients' microbiological responses, clinical responses, medication side effects, and 30-day survival rates were evaluated. Eleven pediatric patients were included in the study, of whom nine were male (81.8%). The median age at the initiation of ceftazidime-avibactam treatment was 15months (range: 14days-183months). Sepsis was diagnosed in 9 patients (81.8%). Two premature infants (27 and 35weeks) were admitted to the neonatal ICU. Regarding the Klebsiella pneumoniae strains, 10 (91%) were extensively drug-resistant (XDR), and 1 (9%) was pandrug-resistant (PDR). Eight strains (72.7%) were carbapenem-resistant, and 9 (81.8%) were colistin-resistant. Microbiological response was noted in 8 patients (72.7%), clinical response was evident in 6 patients (54.5%). The 30-day survival rate was 54.5%, with six patients surviving. In our study, ceftazidime-avibactam has been identified as a significant treatment option for resistant Klebsiella pneumoniae infection in critically ill children and premature infants with sepsis and organ failure, and it has been found to be well tolerated.

Interactive hygiene training using free open source software.

Regular hygiene trainings are an important way to refresh and improve knowledge about hygiene measures and the prevention of healthcare-associated infections. We aimed to develop an e-learning course to allow healthcare workers (HCWs) to learn these contents through a self-paced online format. We developed an interactive hygiene training for HCWs of a tertiary care hospital using different content types of the HTML-5 package (H5P) plugin embedded into a Moodle-based learning management system. We evaluated the course using a short online questionnaire. We present various suitable topics for online hygiene trainings as well as their implementation in an e-learning course. Examples include content on hand hygiene indications and techniques, information on multidrug-resistant organisms and other current topics in infection control. HCWs reported high overall satisfaction, perceived increase in knowledge, practical relevance as well as good usability and comprehensibility. Currently available commercial and non-commercial hygiene trainings present a number of specific advantages but also drawbacks. The presented approach combines the advantages of both approaches. The majority of the presented content can be readily adapted to suit various hospitals and care facilities or serve as inspiration for creating similar courses while remaining cost-effective. H5P course presentations are a low-threshold, cost-effective way to implement digital hygiene trainings in a wide variety of clinical settings.

Healthcare-associated infections in patients with COVID-19: is it different from the pre-pandemic period?

Healthcare-associated infections (HAIs) are common in intensive care unit (ICU) patients and may cause devastating consequences. However, the prevalence of HAI and its effects on in-hospital mortality among critically ill COVID-19 patients is ambiguous. We determined the prevalence of HAI and the rate of mortality in critically ill COVID-19 patients and compared it with pre-pandemic ICU patients. This retrospective study was conducted with adult ICU patients admitted to Gazi Yaşargil Training and Research Hospital (Diyarbakir,Turkey) in April-November 2019 (defined as the pre-pandemic period) and in April-November 2020 (defined as the pandemic period). All patients in the pandemic period had COVID-19, while none in the pre-pandemic period did. Patients diagnosed with HAIs during the in-hospital follow-up period were recorded. Of 4596 enrollees, 3386 (73.7%) were pandemic-period patients and 1210 (26.3%) were pre-pandemic-period patients. HAI prevalence was significantly higher at 5.9% (n = 71) in the pandemic-period patients and 2.7% (n = 91) in the pre-pandemic-period patients (p < 0.001). Comorbidities including hypertension (63.4% vs 14.2%, p < 0.001), diabetes mellitus (39.4% vs 8.8%, p < 0.001), and coronary artery disease (30.9% vs 10.9%, p = 0.002) were significantly more frequent in pandemic-period HAI-positive patients. The most common HAI was catheter-related bloodstream infection in both groups, with similar frequency (p = 0.652). In-hospital mortality rate was 85.9% versus 65.9% in pandemic- versus pre-pandemic-period HAI-positive patients (p < 0,05). The prevalence of HAI and the in-hospital mortality rate was significantly higher among pandemic-period patients.

ROLE OF PERFORMANCE IMPROVEMENT MEASURES TO IMPROVE THE QUALITY OF INFECTION PREVENTION PROGRAMS IN TERTIARY CARE HOSPITAL

Healthcare-associated infections (HAIs) pose a significant risk in hospital settings. Performance improvement measures can enhance the quality of infection prevention programs, leading to better outcomes for patients. Objective: To assess the impact of performance improvement measures on enhancing the quality of infection prevention programs in a tertiary care hospital. Methods: This quasi-experimental study was conducted with healthcare workers (HCWs), including doctors, nurses, infection prevention officers, and support staff, at a tertiary care hospital. The intervention included comprehensive performance improvement measures: rigorous training, educational initiatives, regular audits with feedback, adherence to standard operating procedures (SOPs), checklists, monitoring tools, and hand hygiene promotion. Quantitative data on infection rates, infection control compliance, hand hygiene adherence, and antibiotic usage were collected at baseline and 3, 6, and 12 months post-intervention. Qualitative data were gathered from semi-structured interviews and focus groups to explore barriers and facilitators to infection prevention. Results: The intervention group showed a significant reduction in HAIs per 1,000 patient days compared to the control group (3.06 ± 1.09 vs. 8.23 ± 5.18; p = 0.00). Compliance with infection control practices (71.0% vs. 61.0%; p = 0.13) and hand hygiene adherence (64.0% vs. 48.0%; p = 0.02) were also higher in the intervention group. However, no statistically significant difference in antibiotic usage was observed between the two groups (59.0% vs. 49.0%; p = 0.1). Conclusion: The study demonstrates that performance improvement measures significantly reduce HAIs and improve compliance with infection control protocols. These targeted strategies are essential for enhancing infection prevention in healthcare settings and improving overall patient safety.

Antibiotic susceptibility of Pseudomonas aeruginosa in Saudi Arabia: a national antimicrobial resistance surveillance study.

Pseudomonas aeruginosa is a common pathogen causing healthcare-associated infections. Most surveillance studies from Saudi Arabia that assessed the resistance by P. aeruginosa were conducted in single centers or did not use broth microdilution (BMD), the gold standard test. This is the first national multicenter study to assess the resistance profiles of P. aeruginosa isolates in Saudi Arabia using BMD. Between 2022 and 2023, isolates from various infection sites were collected from seven hospitals in seven different regions of Saudi Arabia. The isolates were shipped to an academic microbiology lab, where their susceptibility was tested by BMD following Clinical Laboratory Standards Institute guidelines using Sensititre GNX3F plates. %Susceptibility to each antibiotic, and MIC50 and MIC90 were determined. In total, 185 P. aeruginosa isolates were collected. Most isolates came from respiratory specimens (34.1%), followed by urine (21.1%) and skin/soft tissue (17.8%). The highest susceptibility was to amikacin (76.8%). Concurrently, susceptibility to meropenem was 52%, but it was 43.8% to colistin. While all P. aeruginosa isolates met the definition of multidrug-resistance, 41 (22.2%) were difficult-to-treat and 10 (5.4%) were pandrug-resistant. Difficult-to-treat isolates made up 30.3% of skin and soft tissue isolates, 25.4% of respiratory isolates, 21.7% of blood isolates, and 17.9% of urine isolates. Pseudomonas aeruginosa demonstrated an unexpectedly high level of resistance to several commonly used antibiotics. Therefore, antimicrobial stewardship and infection control policies should be strictly enforced by hospitals across the country to optimize treatment, prevent the emergence and spread of resistant strains, and track resistance trends with local antibiograms.

Microbial Diversity and Antimicrobial Susceptibility from Wound Dehiscence Isolates in an Indonesian Tertiary Referral Hospital

Healthcare-associated infections (HAIs) remain a critical issue for public health in Indonesia, with wound dehiscence associated with surgical site infections (SSIs) being one of them. Globally, SSIs are known as the most common postoperative complications with a heightened prevalence, particularly in low to middle-income countries. With its retrospective and descriptive design, this study aimed to illustrate the microbial patterns identified in Prof. Dr. I.G.N.G. Ngoerah General Hospital from 12 January 2020 to 12 December 2022. The study includes all patients who underwent surgery and were subsequently diagnosed with wound dehiscence and SSIs. Specimens were collected from patients and submitted to the Microbiology Laboratory at the hospital above. Bacterial identification and susceptibility testing to antimicrobials were performed using the Vitek 2 Compact System (bioMerieux, Marcy l'Etoile, France). Patient information was sourced from medical records. Out of 172 samples, 151 (87.8%) yielded positive cultures. Among these, 151 (87.8%) were found to be positive. Gram-negative bacteria were found to be most prevalent, with Escherichia coli (20.2%) and Pseudomonas aeruginosa (19.6%) being the most frequently isolated bacteria. The bacteria isolated were mostly susceptible to amikacin (72.1%), followed closely by meropenem (71.4%). This information could contribute to the development of an empirical antibiotic therapy protocol for wound dehiscence or SSI cases in this local context.

INFECTION CONTROL AMONG ANESETHSIA PRACTICE

Nosocomial infections, or hospital-acquired infections, are complex and have multiple causes. They interfere with patient recovery, increase hospital stays, and lead to higher morbidity, mortality, and costs. The CDC estimates that a third of these infections result from not following established infection control practices. Anesthesia practices are critical in controlling the spread of these infections due to the invasive nature of procedures like catheter and airway management. Although direct cause-and-effect data is limited, most anesthesia-related infections are preventable. Anesthesia personnel must understand the epidemiology and pathogens to implement preventive measures. Risk factors include invasive procedures, cross-contamination, and hand transmission. Common signs of infection include fever, tachycardia, tachypnea, skin rash, and general malaise. The main sources of healthcare-associated infections are bloodstream infections (28%), pneumonia (21%), and urinary tract infections (15%), often linked to invasive devices. Standard precautions should be applied to all patients to prevent infection transmission. Additional transmission-based precautions are necessary for patients with specific pathogens. Infection control programs in the US are mandated by the Joint Commission for Accreditation of Healthcare Organizations (TCAHO) and guided by the CDC.