Healthcare-associated Infections Research Articles

Bacterial profile and antimicrobial susceptibility patterns of isolates from inanimate objects used by healthcare professionals at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia

Background Healthcare-associated infections occur in patients under medical care, which is a major public health issue in hospitals worldwide. The prevalence is two to three folds higher in developing countries compared to developed countries. Inanimate objects used by healthcare professionals such as gowns, mobile phones, and stethoscopes are highly prone to bacterial contamination from the healthcare setting. In Ethiopia, there is a paucity of published data on the bacterial profile and susceptibility patterns of an isolates. Objective To determine the bacterial profile and antimicrobial susceptibility patterns from inanimate objects used by healthcare professionals and associated factors at Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia. Methods A cross-sectional study was conducted at Debre Markos Comprehensive Specialized Hospital from inanimate objects from April 10, 2023 to June 30, 2023 using simple random sampling technique with lottery method. Socio-demographic data was collected using a structured questionnaire. A swab sample from healthcare professionals’ gowns, mobile phones, and stethoscopes were collected and inoculated onto blood agar, chocolate and MacConkey agar. Isolates were identified and characterized by colony morphology, Gram staining and biochemical tests. Antimicrobial susceptibility testing was performed in all isolates by the disk diffusion technique on Muller Hinton agar according to CLSI, 2022 guidelines. Data was entered into EPI-Data and analyzed using SPSS version 25. Logistic regression model was used. Variables with p-value ≤ 0.25 in bivariable logistic regression was fitted to multivariate logistic regression analysis. A p-value of ≤ 0.05 with 95%CI was considered statistically significant. Result A total of 376 healthcare professionals’ inanimate objects were included from 191 study participants. Overall, 60.1% (226/376) (95%CI: 55.1–65) inanimate objects were contaminated. The proportion of bacterial contamination was (65.1%; 82/126), (60.3%; 76/126) and (54.8%; 68/124) for mobile phones, gowns and stethoscopes, respectively. Staphylococcus aureus was the most frequent isolate accounting (22.1%; 83/376) followed by Staphylococcus epidermidis (17.0%; 64/376), Escherichia coli (8.8%; 33/376) and Pseudomonas aeruginosa (4.9%; 18/376). Working in gynecology/ obstetrics wards (AOR: 8.69; 95%CI: 1.09–69.41, P = 0.041), did not disinfect mobile phones (AOR: 2.69; 95%CI: 1.15–6.25; P = 0.021) and stethoscopes regularly (AOR: 3.06, 95%CI: 1.23–7.59; P = 0.016), carry mobile phones with patient care materials (AOR: 2.72; 95%CI: 1.18–6.29, P = 0.019) and not taken infection prevention training (AOR:3.91; 95%CI:1.71–8.93; P = 0.001) were significantly associated with bacterial contamination.Most Gram-negative bacteria were resistant to ampicillin, trimethoprim-sulfamethoxazole and amoxacilline-clavunic acid, while Gram-positive isolates showed high level of resistant to penicillin. On the other hand, meropenem, for Gram-negative and clindamycin for Gram-positive bacteria showed lower level of resistance. Multidrug resistance among Gram-positive and Gram-negative bacteria were (62.6%; 92/147) and (75.3%; 64/85), respectively with over all MDR (67.2%, 156/232). Conclusion Inanimate objects commonly used by healthcare professionals are important sources of bacterial contamination. S. aureus, S. epidermidis and E. coli were the predominant isolates. Most Gram-negative bacteria were resistant to ampicillin while Gram-positive isolates showed high level of resistant to penicillin. All healthcare professionals should regularly disinfect their inanimate objects to prevent bacterial colonization and potential spread of infection.

Healthcare workers' views on antibiotic prescribing and stewardship during the COVID-19 pandemic at an NHS Foundation Trust in England: a cross-sectional survey

Abstract Introduction Antimicrobial resistance (AMR) is a rapidly escalating global health challenge, projected to cause 10 million deaths annually by 2050.1 In response, the UK Government developed a five-year national action plan, 'Confronting Antimicrobial Resistance 2024 to 2029,' aimed at optimising antimicrobial use and implementing antimicrobial stewardship.2 The COVID-19 pandemic has significantly impacted the healthcare system, jeopardising public health and causing millions of deaths worldwide. The pandemic has exacerbated AMR due to increased antimicrobial therapy and misuse.3 Aim This study explores healthcare workers’ (HCWs) views towards antibiotic prescribing, AMS and AMR during the COVID-19 pandemic in a UK secondary care setting. Methods This cross-sectional study employed an online questionnaire survey conducted at an NHS Foundation Trust in the East of England, targeting doctors, nurses, and pharmacists. The total eligible participants comprised 5,636 doctors, 2,140 nurses, and 206 pharmacists. Data collection was carried out using Qualtrics XM from 12 June to 13 September 2023. Inclusion criteria required healthcare workers (HCWs) to be adults aged 25 or older, registered with relevant professional bodies, and employed during the pandemic. Data analysis involved both descriptive statistics and qualitative methods to interpret participants’ open-ended responses to the question, “What lessons have been learnt during the COVID-19 pandemic?” This study was registered under ISRCTN number 14825813 and received ethical approval from the University of Hertfordshire Ethics and Health Research Authority (HRA) (REC reference number 22/EM/0161). The Citizens Senate reviewed the study protocol to ensure public and patient involvement. Results A total of 23 HCWs completed the survey, including 12 pharmacists, nine doctors, and two nurses. The survey included an open-text section where respondents shared lessons learned during the COVID-19 pandemic. Among pharmacists, 75% (9 out of 12) identified inappropriate antibiotic use without clinical justification as a significant issue, and 67% (8 out of 12) reported an increase in healthcare-associated infections (HCAIs). Additionally, 83% (10 out of 12) noted the positive impact of technology platforms and antibiotic reviews on implementing effective and sustainable AMS. Among doctors, 89% (8 out of 9) emphasised the need for reliable information dissemination, observing that social media often overshadowed evidence-based guidelines. Additionally, 78% (7 out of 9) stressed the importance of staying informed about resistance patterns and antibiotic prescribing trends. All nurses highlighted the significance of AMR awareness and reported that mental fatigue affected decision-making during the pandemic. Discussion/Conclusion This study highlights the essential role of technology platforms in enhancing antimicrobial stewardship practices and the necessity of disseminating reliable information to counter misinformation. The pandemic highlighted the need for clear guidelines and robust communication strategies to support clinical practices. However, this study has limitations, including a small sample size of 23 participants, which may affect the generalisability of the findings. Future research should include larger, more diverse samples to validate these findings and assess specific AMS interventions. The study also revealed the importance of resilient AMS implementation to optimise antibiotic use and improve patient outcomes. Achieving this requires ongoing AMS education, interdisciplinary collaboration, and adaptive strategies to effectively mitigate antimicrobial resistance.

Patterns of handwashing among healthcare workers in APIN Public Health initiatives supported states in Southwest Nigeria

BackgroundEffective hand hygiene is crucial for preventing healthcare-associated infections (HAIs) among healthcare workers (HCWs) and patients. This study aimed to assess handwashing practices among HCWs providing routine HIV care to People Living with HIV (PLHIV) and to compare hand hygiene patterns among clinical and non-clinical health workers in APIN Public Health Initiatives-supported states in Southwest Nigeria.MethodsA cross-sectional study was conducted among HCWs providing routine HIV care to PLHIV in selected healthcare facilities across APIN-supported states (Oyo, Ogun, and Ondo) from January to June 2024. Data on handwashing patterns and compliance factors were collected using a semi-structured questionnaire. A total of 588 respondents were recruited using multi-stage stratified cluster sampling. Descriptive analysis was performed, hand hygiene patterns among clinical and non-clinical health workers were compared, and chi-square statistics determined the associations, with a p-value of < 0.05 considered significant.ResultsThe study found that 56.5% of participants had good awareness of handwashing practices, and 54.6% demonstrated good compliance. Additionally, 65.5% reported washing hands before and after routine activities. Handwashing awareness (60.3%) and compliance (60.5%) rates were highest among clinical professionals. Major barriers to handwashing included inadequate water supply, lack of materials, being too busy, and forgetfulness. Profession was significantly associated with hand hygiene awareness (odds ratio [OR] = 1.504, confidence interval [CI] = 1.075–2.104), while age (OR = 0.613, CI = 0.442–0.851) and profession (OR = 1.888, CI = 1.347–2.645) were significantly associated with compliance.ConclusionThe study highlights suboptimal handwashing practices among healthcare workers, with non-clinical workers demonstrating lower awareness and compliance to hand hygiene standards compared to clinical staff despite working in the same environment. Therefore, future tailored training sessions and interventions should be prioritized for non-clinical health workers.

Enhancing Infection Control Protocols Across Medical Teams: A Comprehensive Approach for Safer Healthcare

Healthcare-associated infections (HAIs) pose significant risks to patient safety and healthcare quality, impacting all levels of medical staff. This article examines the development and implementation of enhanced infection control protocols aimed at reducing infection rates through a unified, multidisciplinary approach. By engaging healthcare providers across roles—including physicians, nurses, support staff, and administrators—we identify key factors affecting protocol adherence and infection control effectiveness. Through a mixed-methods study, we assess quantitative reductions in infection rates alongside qualitative feedback on protocol practicality and ease of use. Results indicate that comprehensive, role-specific infection control measures, paired with continuous training and feedback mechanisms, significantly improve adherence and reduce HAIs. This study underscores the value of adaptable, universally applied protocols to establish safer healthcare environments, advocating for further research and sustained implementation efforts in diverse clinical settings.

ASSESSMENT OF KNOWLEDGE REGARDING EVIDENCE BASED GUIDELINES ON VAP PREVENTION AMONG NURSES

Ventilator-associated pneumonia (VAP) is a serious healthcare-associated infection that increases morbidity, mortality, and healthcare costs, particularly in intensive care units (ICUs). In Pakistan, the high prevalence of VAP in ICUs underscores the importance of adherence to evidence-based preventive practices among nursing staff. However, knowledge gaps and inconsistencies in VAP preventive practices remain a challenge, largely due to limited training resources and high patient-to-nurse ratios. Objective: This study aimed to assess the knowledge of ICU nurses on evidence-based guidelines for VAP prevention at a tertiary care hospital in Lahore, Pakistan. Methods: A descriptive cross-sectional study design was utilized. Data were collected from 140 registered nurses working in the ICU of Sir Ganga Ram Hospital, Lahore, using a structured questionnaire consisting of 17 questions related to VAP prevention guidelines. Convenience sampling was employed to recruit participants who met the inclusion criteria. Data analysis was performed using SPSS, with descriptive statistics applied to summarize findings and identify knowledge gaps. Results: The study revealed varied levels of knowledge among ICU nurses regarding VAP prevention. While the majority demonstrated awareness of core practices, such as semi-recumbent positioning and regular oral care, there were notable gaps in understanding related to the frequency of ventilator circuit changes and the optimal use of suction systems. Approximately 67.9% of nurses were aware of general VAP guidelines, but only 47.1% correctly identified all recommended practices. Additionally, knowledge disparities were observed based on educational background and years of ICU experience.Conclusion: This study highlights critical knowledge gaps among ICU nurses regarding evidence-based VAP prevention practices. The findings underscore the need for targeted educational interventions and standardized training programs to improve adherence to VAP guidelines. Strengthening nurse education on VAP prevention can contribute to reduced infection rates, enhanced patient safety, and better utilization of healthcare resources in Pakistan’s ICUs.

Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: a mixed methods evaluation

BackgroundInfection prevention and control (IPC) programs are essential to prevent and control the spread of multidrug-resistant organisms in healthcare facilities (HCFs). The current implementation of these programs in Latin America remains largely unknown.MethodsWe conducted a mixed-methods evaluation of IPC program implementation in HCFs from Guatemala, Panama, Ecuador, and Argentina, March-July 2022. We used the World Health Organization (WHO) IPC Assessment Framework (IPCAF) survey, a previously validated structured questionnaire with an associated scoring system that evaluates the eight core components of IPC (IPC program; IPC guidelines; IPC education and training; healthcare-associated infection [HAI] surveillance; multimodal strategies; monitoring and audit of IPC practices and feedback; workload, staffing, and bed occupancy; and the built environment and materials and equipment for IPC). Each section generates a score 0–100. According to the final score, the HCF IPC program implementation is categorized into four levels: inadequate (0–200), basic (201–400), intermediate (401–600), or advanced (601–800). Additionally, we conducted semi-structured interviews among IPC personnel and microbiologists using the Systems Engineering Initiative for Patient Safety model to evaluate barriers and facilitators for IPC program implementation. We performed directed content analysis of interview transcripts to identify themes that focused on barriers and facilitators of IPC program implementation which are summarized descriptively.ResultsThirty-seven HCFs (15 for-profit and 22 non-profit) completed the IPCAF survey. The overall median score was 614 (IQR 569, 693) which corresponded to an “advanced” level of IPC implementation (32% [7/22] non-profit vs. 93% [14/15] for-profit HCFs in this category). The lowest scores were in workload, staffing and bed occupancy followed by IPC training and multimodal strategies. Forty individuals from 16 HCFs were interviewed. They perceived inadequate staffing and technical resources, limited leadership support, and cultural determinants as major barriers to effective IPC guideline implementation, while external accreditation and technical support from public health authorities were perceived as facilitators.ConclusionsEfforts to strengthen IPC activities in Latin American HCFs should focus on improving support from hospital leadership and public health authorities to ensure better resource allocation, promoting safety culture, and improving training in quality improvement.

Microbial Spectrum, Antimicrobial Resistance, and Prevalence of MDR/XDR Pathogens in Medical Device-Associated Infections

Background: Medical device-associated infections (MDAIs) are a major healthcare concern due to their high morbidity, mortality, and rising prevalence of MDR and XDR bacteria. This study examined the microbiological composition, antimicrobial susceptibility, and prevalence of MDR/XDR infections in MDAI patients at Dr. D.Y. Patil Medical College, Pune. Methods: One-year retrospective research included 100 MDAI patients. Antimicrobial susceptibility testing was done on microbial isolates from blood, urine, and wound swabs according to CLSI standards. The prevalence of MDR and XDR pathogens was determined. Results: Escherichia coli (30%) and Klebsiella pneumoniae (20%) caused most infections, while Staphylococcus aureus (25%) was the most common Gram-positive bacteria. Antimicrobial susceptibility testing showed that 40% of the isolates were MDR and 15% were XDR. Klebsiella pneumoniae had the highest resistance rate (70%), followed by Pseudomonas aeruginosa. Conclusion: The study shows that MDAIs are dominated by MDR and XDR infections, mainly Gram-negative bacteria, making therapy difficult. These findings highlight the critical need for improved infection control, antimicrobial stewardship, and regular surveillance to address medical device-associated resistance infections. Keywords: Medical device infections, multidrug-resistant, extensively drug-resistant organisms, antimicrobial susceptibility, microbiological profile, healthcare-associated infections.

The Role of Interdisciplinary Collaboration in Combating Infection in Health Facilities: A Systematic Review

Infection control in health facilities is critical for patient safety, with interdisciplinary collaboration emerging as a significant factor in reducing infection rates. This systematic review examines the role of collaborative efforts among healthcare professionals, including doctors, nurses, pharmacists, and laboratory technicians, in combating infections within healthcare settings. Utilizing databases such as PubMed, Scopus, and Cochrane Library, 32 studies published between 2014 and 2024 were analyzed, focusing on collaboration models, infection control outcomes, and the barriers and facilitators of teamwork. The findings reveal that interdisciplinary collaboration enhances adherence to infection control protocols, fosters clear communication, and improves overall compliance with hygiene practices. Key benefits include reduced healthcare-associated infections, faster response to infection outbreaks, and improved patient outcomes. However, challenges such as communication gaps, unclear role definitions, and limited resources hinder effective collaboration. The review suggests that structured interdisciplinary practices, supported by training, leadership engagement, and integrated technology, are essential for effective infection control. These insights can guide healthcare administrators and policymakers in strengthening infection prevention strategies. Future research should focus on evaluating the long-term impact of collaboration on infection rates and examining the roles of specific professionals in infection control.

PP412 Topic: AS14–Infections: Sepsis and Septic Shock/Antimicrobial Stewardship/Tropical and Parasite Infections/Other: LIPOPOLYSACCHARIDE (LPS)-INDUCED TUMOR NECROSIS FACTOR- ALPHA LEVELS AND HEALTH CARE ASSOCIATED INFECTION IN CHILDREN WITH MULTI-ORGAN DYSFUNCTION SYNDROME

PP412 Topic: AS14–Infections: Sepsis and Septic Shock/Antimicrobial Stewardship/Tropical and Parasite Infections/Other: LIPOPOLYSACCHARIDE (LPS)-INDUCED TUMOR NECROSIS FACTOR- ALPHA LEVELS AND HEALTH CARE ASSOCIATED INFECTION IN CHILDREN WITH MULTI-ORGAN DYSFUNCTION SYNDROME

Cold atmospheric plasma as an alternative decontaminant to control healthcare-associated infections and antimicrobial resistance. Significant potential that can be realised globally

Cold atmospheric plasma as an alternative decontaminant to control healthcare-associated infections and antimicrobial resistance. Significant potential that can be realised globally

Biofilm Production in Intensive Care Units: Challenges and Implications

The prevalence of infections amongst intensive care unit (ICU) patients is inevitably high, and the ICU is considered the epicenter for the spread of multidrug-resistant bacteria. Multiple studies have focused on the microbial diversity largely inhabiting ICUs that continues to flourish despite treatment with various antibiotics, investigating the factors that influence the spread of these pathogens, with the aim of implementing sufficient monitoring and infection control methods. Despite joint efforts from healthcare providers and policymakers, ICUs remain a hub for healthcare-associated infections. While persistence is a unique strategy used by these pathogens, multiple other factors can lead to persistent infections and antimicrobial tolerance in the ICU. Despite the recognition of the detrimental effects biofilm-producing pathogens have on ICU patients, overcoming biofilm formation in ICUs continues to be a challenge. This review focuses on various facets of ICUs that may contribute to and/or enhance biofilm production. A comprehensive survey of the literature reveals the apparent need for additional molecular studies to assist in understanding the relationship between biofilm regulation and the adaptive behavior of pathogens in the ICU environment. A better understanding of the interplay between biofilm production and antibiotic resistance within the environmental cues exhibited particularly by the ICU may also reveal ways to limit biofilm production and indivertibly control the spread of antibiotic-resistant pathogens in ICUs.

Surgical site infection and antimicrobial use following caesarean section at QECH in Blantyre, Malawi: a prospective cohort study

BackgroundSurgical site infections (SSIs) are one of the most common healthcare-associated infections and preventable complication of surgical procedure; continue to threaten public health with significant effects on the patients and health care human and financial resources. Therefore, this study aimed to determine the incidence of SSIs, risk factors and common microorganisms associated with SSI and assess the practice of antimicrobial use in women following Caesarean Section (CS) at Queen Elizabeth Central Hospital (QECH).MethodsThis was a hospital-based quantitative prospective study design involving pregnant women who underwent a CS between February, 2023 and July, 2023 at QECH with 30 day-follow-ups. Wound specimens (wound swabs) were collected from all infected CS wounds and processed at QECH main laboratory, and susceptibility testing was conducted using the Kirby-Bauer disk diffusion method with results reported only as susceptible, intermediate, or resistant and the collected data was analyzed using Stata.ResultsThe overall cumulative incidence of SSI recorded at QECH during the study period was 9.61% (20 cases out of 208). Of these, 19 (95%) of them reported superficial SSI following CS. The mean age was 26.1 years with a standard deviation of 6.2. All pregnant women who underwent for CS received antibiotic prophylaxis. This study revealed that 138 (66.35%) patients received both preoperative antibiotics (ceftriaxone) and post-CS antibiotics without knowing the specific bacterial organism isolated. This study revealed that ruptured membrane had twice the incidence of SSIs compared to intact membrane (χ2 = 2.0922), though not statistically significant. The majority of patients with SSIs (n = 12, 60%) were readmitted and 5 (25%) out of 20 with SSIs had antimicrobial resistance following susceptibility testing. Staphylococcus aureus was the most common organism (3, 60%) and other bacterial isolates included were Enterobacteriaceae and Acinetobacter baumanni.ConclusionThe incidence of SSIs and inappropriate antimicrobial use following CS remains a challenge at QECH. Therefore, due to increased number of SSIs following CS with relative emergence of AMR ensure intensive infection prevention and control practices, establishing AMS program and routine surveillance of SSIs at QECH.

Point Prevalence Survey of HAIs as a key component of Infection Prevention and Control programs

Abstract Healthcare-Associated Infections (HAIs) are a global concern, requiring surveillance strategies as Point Prevalence Surveys (PPS) to estimate their burden and investigate associated risk factors for targeted interventions in high-risk areas. This study aims to assess the prevalence of HAIs, identify determinants and evaluate antimicrobial use in a teaching hospital in Rome. A PPS was carried out from June 19th to 23rd, 2023, in accordance with the European Centre for Disease Prevention and Control (ECDC) protocol for HAIs and antimicrobial use in European acute care hospitals (version 6.1). Pearson’s chi-squared test was employed to investigate correlations between potential risk factors and HAIs. The survey included 829 patients with an average age of 56.3 years (SD: ±24.6). Of these, 48.4% were female and over half had visited the hospital’s Emergency Department (53.7%). The prevalence of active HAIs was 8.7%, with 72 patients diagnosed. Furthermore, 51.0% of all patients received at least one systemic antimicrobial agent, and 16.7% of those treated had an HAI. Penicillins (39.7%) and third-generation cephalosporins (37.8%) were the most frequently prescribed antimicrobials. The primary HAIs were bloodstream infections (34.1%), followed by urinary tract (27.3%), surgical site (23.9%), lower respiratory tract (6.8%), and gastrointestinal infections (7.9%). Escherichia coli (13.2%), Staphylococcus aureus (9.2%), and Clostridium difficile (6.6%) were the most frequently isolated pathogens. Intensive Care Unit admission, use of medical device, recent antibiotic therapy and prior hospitalization or surgery significantly correlated (p &amp;lt; 0.05) with increased HAIs risk. The detected prevalence of HAIs is lower than the national rates observed in 2022 (10.2%), which have increased since 2016. HAIs surveillance is essential for developing effective infection prevention and control programs and for optimizing resource allocation in hospital settings. Key messages • Surveillance of Healthcare-Associated Infections is crucial for developing targeted Infection Prevention and Control programs and optimizing hospital resource allocation. • Point Prevalence Surveys offer essential information for assessing the burden of Healthcare-Associated Infections and directing intervention strategies in hospitals.

Hand hygiene intervention in the prevention of healthcare associated infections

Abstract Background Healthcare associated infections are a major cause of morbidity and mortality in intensive care units. Observance hand hygiene is singled out as a key element in interruption of these infections. The present study aimed to assess whether hand hygiene intervention program in intensive care unit at the Sahloul University Hospital of Sousse is able to decrease healthcare associated infections. Methods We carried out a pre-experimental study among patients hospitalized in seven intensive care units at the Sahloul University Hospital of Sousse during two distinct periods of 3 months, the first in 2019 and the second in 2021. During these two periods, we monitored only patients hospitalized in the ICU for more than 48 hours and incidence of healthcare associated infections was compared. Healthcare associted infections were defined as infections occurred at least 48 hours after admission to the intensive care units. The hand hygiene promotion intervention, done during the year 2020, was based on 3 axes (training sessions, procedures writing and professional practicesevaluation). Results Incidence of healthcare associated infections decreased significantly in post-intervention (p = 0.000). The decrease of Ventilator-associated pneumonia was significantly higher than other types of infections(p = 0.042). Extended Spectrum B-Lactamase Producing Enterobacteriaceae infections and Ceftazidim resistant Pseudomonas Aeruginosa infections decreased significantly in after intervention (p = 0.000). Conclusions The results of our study showed that improved hand hygiene resulted in a reduction in healthcare associated infections. Key messages • Observance hand hygiene is singled out as a key element in interruption of healthcare associated infections. • Improved hand hygiene resulted in a reduction in healthcare associated infections.

Do the prevention procedures work in reducing infections?

Abstract Introduction Healthcare-associated infections (HCAIs) pose significant challenges in healthcare settings. Poor environmental hygiene contributes to HCAI. This study aims to evaluate and to assess the effectiveness of HCAI containment practices in nursing homes (NH). Methods The study examined infection prevention procedures in eight NHs supervised by the Multidisciplinary Commission of the Tuscany South-East Local Health Authority of Italy. Infection frequencies were obtained from NHs management and compliance with preventive procedures was assessed by inspection reports. Infection prevention protocols, including cleaning and disinfection procedures, were referenced from ministerial guidelines for hospital and territorial facilities. Comparisons was done whit Mann-Whitney test, using STATA. Results In 2023 more frequent infections were SARS-CoV-2 (19.5%), urinary tract infections (17%), pharyngitis (15.7%), influenza-like syndromes (ILI) (15%), and pneumonia (9%). Compared to 2022, significant improvements were observed in legionellosis surveillance, laundry, sanitary procedures, instrument disinfection, and hairdressing services. Non-compliance to specific procedures revealed differences in infectious onset like cleaning process verification with fungal infections (P = 0.01; M = 2,5), gastrointestinal infections (P = 0.04; M = 1.5); cleaning sanitary pans with Clostridium Difficile gastrointestinal infections (P = 0.04; M = 2); instrument disinfection with gastrointestinal infections (P = 0.04; M = 1.5) conjunctivitis (P = 0.01; M = 8); laundry procedures with pneumonia (P = 0.04; M = 18) and ILI (P = 0.04; M = 35). Conclusions These findings emphasize the importance of well-defined procedures in reducing HCAIs. While preventive measures demonstrate efficacy, continuous efforts are necessary for their consistent implementation. Continuous monitoring and stakeholder engagement are essential for developing sustainable strategies in preventing healthcare-associated infections. Key messages • Healthcare-associated infections are a significant complication in the healthcare sector and require effective practices in nursing homes. • Prevention measures are effective, but continuous and collaborative effort is needed to ensure their uniform implementation and develop more effective strategies in preventing HCAI.

Impact of artificial intelligence on healthcare-associated infection control: a systematic review

Abstract Background Healthcare-associated infections (HAIs) represent a significant public health concern, correlating with increased morbidity, mortality rates and healthcare expenditures. While artificial intelligence (AI) systems offer transformative potential in enhancing HAIs detection and control practices, the actual performance effectiveness of these systems remains uncertain. This systematic review updates a previously published study from 2020 and evaluates the performance of AI-based tools for surveillance, detection, and control of HAIs. Methods PRISMA 2020 guidelines were applied. The study protocol has been registered in PROSPERO (ID: CRD42024513145). PubMed, Embase, Scopus and Web of Science were searched for experimental and observational studies assessing the performance of AI-based tools to detect and control HAIs, published in English. Results From 8,701 articles initially identified, 4,212 records were removed due to duplication. Out of 4,489 papers screened, 147 were included. Studies reported performance measures including sensitivity, specificity, positive and negative predictive values, area under the receiver operating characteristic curve, accuracy, precision, F1 score. Significant heterogeneity was found in the types of technology, infections targeted, health care settings and data sources between studies. Conclusions The increase in published evidence since the previous review reflects the growing interest and use of new technologies such as Large Language Models, showing promising performance in surveillance, early diagnosis and prediction of HAIs. However, the observed heterogeneity in study designs, targeted infections, healthcare settings, and data sources underscores the need for standardised methodologies and robust validation processes to ensure the reliability and comparability of results across different studies. Key messages • The use of AI-based tools has the potential to enhance surveillance, detection, and control of healthcare-associated infections, offering a transformative impact on healthcare systems. • Standardised methodologies and validation processes are needed to ensure comparable results across studies and to maximise the real-world impact of AI tools in HAI surveillance and control efforts.

Risk perception survey for healthcare-associated infections in a large teaching hospital in Rome

Abstract Background Healthcare-associated infections (HAIs) are the main complications of hospitalization. The goal of the study was to enhance awareness, improve risk perception, and facilitate measures to reduce the outcomes of HAIs. A bottom-up approach, in which the healthcare workers involved play a key role, can be adopted to decrease the spread of HAIs. Therefore, a survey was conducted in a large teaching hospital in Rome from 2019 to 2023, excluding 2020 due to COVID-19. Methods A longitudinal study was conducted in all integrated care departments with beds. The data was collected using a standardized, anonymous, self-administered questionnaire for healthcare workers. The questionnaire consisted of 61 items assessing socio-professional features, knowledge of HAIs, attitudes and barriers to hygiene compliance, self-analysis of professional behavior and advice for new interventions. The study lasted 21 days between November and December, which is considered a period of normal care activity. A multivariable logistic regression model was built. Statistical analyses were performed with STATA 18.0. Results There were 384 health workers respondents: female (67.7%) and nurses (56.5%). The most represented areas were internal medicine (37.9%) and surgery (27.3%). The correct frequency of perception of HAIs increased from 33.3% in 2019 to 36.3% in 2023. From 2022 to 2023, the multivariable model showed that physicians (OR 0.48, CI 95% 0.24-0.93, p-value 0.03) and elder staff (OR 1.02, CI 95%, 1.0-1.1, p-value 0.04) seemed to be more aware of the prevalence of HAIs in their ward. Conclusions Targeted training days were organized after the study to discuss the data collected. Staff awareness of the prevalence of HAIs in their ward is improving, even if it is complicated to quantify it by attending HAIs training events. The survey has been included as a corporate goal for 2024 as a useful tool to improve awareness of HAIs and to evaluate the effectiveness of ongoing training. Key messages • A bottom-up approach, in which healthcare workers assume a pivotal role, can be employed to reduce the spread of HAIs as it serves as a valuable tool to evaluate the efficacy of targeted training. • The results indicate that the education of healthcare workers is a crucial factor in enhancing awareness of HAIs. Therefore, there is a need to improve the education of younger and non-medical staff.

Fighting HAIs by monitoring hand hygiene compliance in the Umberto I teaching Hospital in Rome

Abstract Background Healthcare-associated infections (HAIs) are one of the most common preventable complications in hospitalised patients related to increased morbidity and mortality for patients. Proper hand hygiene (HH) can decrease the prevalence of HAIs within care settings. The aim of the study was to evaluate the effects of a monitoring and feedback system on HH compliance (HHC). Methods Three monitoring and feedback studies have been carried out in Umberto I teaching hospital of Rome since 2021. Healthcare workers (HCWs), were trained on how to carry out the direct observation on the 5 WHO moments on HH. The data collection lasted two weeks each year. Following data collection, they were analysed and discussed annually with HCWs. A multivariable logistic regression model was constructed to identify predictors of HH compliance. Results A total of 15874 HH were observed, of which 40.1% in 2023. The recorded HHC was 71.0% in 2021, 75.4% in 2022 and 71.6% in 2023. Multivariable analyses showed that HHC was positively associated with female sex of observed (aOR:1.3, 95% CI:1.1-1.4), during weekend days or holidays (aOR:1.3 95% CI:1.1-1.4) and all indications with respect to ‘before touching a patient’. Regarding the professional category of the observer, compared to physicians, midwives were more likely to report compliant observations (aOR=2.4, 95% CI: 1.4-4.1). On the other hand, a negative association was found with external ward staff and other HCWs and no-HCWs compared to physicians. Ward area and year of observation did not influence the probability of the outcome. Conclusions The results of this study revealed sub-optimal adherence to HH, with the lowest rates observed prior to patient interaction. That, coupled with the variability seen among HCWs, underlines the difficulties in achieving a uniform level of compliance. Therefore, ongoing training to raise awareness among HCWs and to repeat the survey over time identifying any major problems is essential. Key messages • Monitoring the reasons for non-adherence to hand hygiene in healthcare institutions in order to formulate strategies to improve HH adherence among hospital staff is essential. • Hand hygiene (HH) monitoring systems can produce measurable improvements in HH adherence by healthcare personnel, resulting in a reduction in the incidence of healthcare-associated infections.

Multifaceted Control Interventions for Healthcare-associated Infections in a Kidney Transplant Intensive Care Unit: Clinical Outcome Improvement and Bundle Adherence.

Healthcare-associated infections (HAIs) are preventable complications that overwhelm the healthcare system. The implementation of multifaceted control intervention actions in the intensive care setting modifies clinical outcomes, but its effectiveness has not been specifically investigated for high-risk patients, such as kidney transplant recipients (KTRs). This observational retrospective natural experiment evaluated the effectiveness of multifaceted control interventions (bundles) in reducing HAIs in a KTR intensive care unit. We also measured the bundle adherence rate during 16 mo in the after era. We included 1257 KTRs, 684 before and 573 in the postintervention period. After the bundle implementation, the incidence density of device-associated HAIs decreased from 8.5 to 3.9 per 1000 patient-days (relative risk [RR] = 0.46; 95% confidence interval [CI], 0.25-0.85; P = 0.01), primarily because of the reduction in central line-associated bloodstream infection from 8.0 to 3.4 events per 1000 catheter-days (RR = 0.43; 95% CI, 0.22-0.83; P = 0.012). Reductions in catheter-associated urinary tract infection (2.5 versus 0.6 per 1000 catheter-days; RR = 0.22; 95% CI, 0.03-1.92; P = 0.17) and ventilator-associated pneumonia (3.4 versus 1.0 per 1000 ventilator-days; RR = 0.29; 95% CI, 0.03-2.63; P = 0.27) were not significant. Central venous (P = 0.53) and urinary catheter (P = 0.47) insertion adherence were stable during 16 mo, whereas central venous (P < 0.001) and urinary catheter (P = 0.004) maintenance gradually increased. Finally, ventilator-associated pneumonia prevention bundle adherence slightly decreased over time (P = 0.06). The implementation of comprehensive multifaceted control intervention actions in an intensive care unit dedicated to KTR care was effective in significantly reducing device-associated infections. The impact was in line with the reductions observed in populations that have not undergone transplantation, underscoring the effectiveness of these interventions across different patient groups.

Molecular surveillance of A. baumannii in intensive care units: exploration of transmission chains

Abstract Background Multidrug-resistant Acinetobacter baumannii (MDR-Ab) is one of the main causes of healthcare associated infections (HAIs). During the SARS-CoV-2 pandemic there was an increase in MDR-Ab infections, especially in intensive care units (ICUs). This study aimed to assess the potential spread or emergence of specific clusters of MDR-Ab across four different ICUs at the Umberto I teaching hospital of Rome. Methods From January 2020 to January 2022 microbiological surveillance was conducted in four ICUs: two dedicated to COVID-19 patients (ICU-1C, ICU-2C) and two to non-COVID-19 patients (ICU-1R, ICU-2R). The genetic relatedness between A. baumannii isolates was assessed using pulsed-field gel electrophoresis (PFGE). Illumina whole genome sequencing was conducted on 26 representative isolates. Results In total, 178 A. baumannii isolates were obtained from 129 COVID-19 patients and 49 non-COVID-19 patients. The isolates were classified into 17 PFGE pulsotypes, being two major (A, B) and five intermediate (C, D, E, H, Q). Clone A was present in all ICUs, while Clone B was present only in ICU-1C and ICU-2R. Overall, 117 isolates belonged to clone A and exhibited a MDR phenotype; all of them were placed within the international clonal lineage II. All isolates showed carbapenems resistance primarily attributed to the presence of the blaOXA-23 gene, while aminoglycosides resistance observed in almost all isolates was attributed to the presence of the armA gene. Small outbreaks involving intermediate pulsotypes were detected between ICU-1R and ICU-2R, ICU-1C and ICU-2R, ICU-1C and ICU-2C, ICU-1C and ICU-1R. Conclusions The observed outbreaks could be attributed to a decline in attention to normal care practices for the prevention of HAIs during the COVID-19 pandemic, favouring the spread of MDR-Ab. Therefore, it is recommended the strengthen of control measures and the implementation of long-term strategies targeting MDR microorganisms in the ICUs. Key messages • Acinetobacter baumannii was frequently found infecting patients across four different ICUs at the Umberto I teaching hospital of Rome. • Acinetobacter baumanni outbreaks and multidrug resistance were observed. Therefore, the implementation of long-term strategies targeting MDR microorganisms in the ICUs is highly recommended.