Education Of Healthcare Workers Research Articles

An Examination of Health Care Workers’ Education and Training on Their Basic Knowledge, Clinical Preparedness, and Attitudinal Awareness About LGBT Patients

ABSTRACT LGBT individuals experience discrimination in health care settings and report difficulty accessing clinically competent healthcare. This study examined the self-assessed knowledge, clinical preparedness, LGBT health focused education received and attitudinal awareness of health care workers (HCW) (n = 215) toward LGBT patients at an urban hospital in New York City. HCW completed a one-time survey, that included the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale. Forty percent of HCW treated LGB patients and 30% treated transgender patients, 11% and 18% reported they were unaware if their patients were LGB or transgender. Seventy-four percent of HCW received less than two hours of formal education in LGBT health. A slight majority of HCW (51%) reported not receiving adequate clinical training to work with transgender clients. Forty-six percent of HCW reported not receiving adequate clinical training to work with LGB clients. A significant difference in LGBT health knowledge, clinical preparedness, and attitudinal awareness was found by LGBT health education received. HCW that reported more LGBT focused health education reported higher basic LGBT health knowledge, felt more clinically prepared, and reported affirming attitudes regarding LGBT patients. This research suggests that more LGBT health focused education of HCW is needed.

Lumbar Disc Herniation Cases in Herat Regional Hospital in 2021

Background and Objective: Lumbar disc herniation is the most common reason for spine surgery in the working-age population. Understanding the epidemiological pattern of lumbar disc herniation helps identify predisposing factors for this type of injury. Since epidemiological studies on lumbar disc herniation surgery in Afghanistan are scarce, the aim of this study is to investigate the epidemiological aspects of these cases in the neurosurgical department of Herat city.
 Methods: In this cross-sectional descriptive study conducted from March 2021 to March 2022 at the regional hospital in Herat, data on demographic information, occupation, symptoms, and complications related to lumbar disc herniation surgery were collected and analyzed for 68 patients.
 Results: The findings indicate that the majority of lumbar disc herniation surgeries occurred in individuals over 30 years of age (70.6%) and among males (66.2%), with about two-thirds of cases (69.1%) occurring in construction workers. Based on the results, 76.4% of the cases involved the L4-L5 vertebral level, and 88.2% of patients, in addition to lower back pain, experienced sensory disturbances in their legs. Although the majority of patients (89.7%) had no complications, the most significant complication among the patients was urinary incontinence (5.9%).
 Conclusion: The results of this study emphasize the higher prevalence of lumbar disc herniation surgeries in specific age and gender groups. Public and healthcare worker education regarding the factors and risks of lumbar disc herniation could be beneficial. Conducting broader studies nationwide to determine the exact occurrences and complications of lumbar disc herniation is crucial.

Perinatal care and breastfeeding education during the COVID-19 pandemic: Perspectives from Kenyan mothers and healthcare workers.

The impact of the COVID-19 pandemic on breastfeeding (BF) practices in low- and middle-income countries (LMICs) is not well understood.Modifications in BF guidelines and delivery platforms for breastfeeding education during the COVID-19 pandemic are hypothesised to have affected BF practices. We aimed to understand the experiences with perinatal care, BF educationand practice among Kenyan mothers who delivered infants during the COVID-19 pandemic.We conducted in-depth key informant interviews with 45 mothers who delivered infants between March 2020 and December 2021, and 26 health care workers (HCW) from four health facilities in Naivasha, Kenya.While mothers noted that HCWs provided quality care and BF counselling, individual BF counselling was cited to be less frequent than before the pandemic due to altered conditions in health facilities and COVID-19 safety protocols. Mothers stated that some HCW messages emphasised the immunologic importance of BF. However, knowledge among mothers about the safety of BF in the context of COVID-19 was limited, with few participants reporting specific counselling or educational materials on topics such as COVID-19 transmission through human milk and the safety of nursing during a COVID-19 infection. Mothers described COVID-19-related income loss and lack of support from family and friends as the major challenge to practising exclusive breastfeeding (EBF) as they wished or planned. COVID-19 restrictions limited or prevented mothers' access to familial support at facilities and at home, causing them stress and fatigue. In some cases, mothers reported job loss, time spent seeking new means of employmentand food insecurity as causes for milk insufficiency, which contributed to mixed feeding before 6 months.The COVID-19 pandemic created changes to the perinatal experience for mothers. While messages about the importance of practising EBF were provided, altered HCW education delivery methods, reduced social supportand food insecurity limit EBF practices for mothers in this context.

How literature can help develop a nursing perspective: the contribution of the novel “Mend the Living”

Including the humanities in health sciences training is a means of humanizing healthcare practice. The humanities and social sciences, but also artistic disciplines such as dance, film, theater, and literature make it possible to take into account the complexity of lived experiences and to deepen the notion of caring. In this paper, we revisit the relevance and usefulness of literature in educating healthcare workers. We analyze “Mend the Living”, a novel by Maylis de Kerangal that explores the issue of organ harvesting, to show how content of this kind can deepen caregivers’ perspectives. Constantly referring to the text as if it were anthropological field data, we open the door to themes of significant phenomenological, ethical, political, and anthropo-sociological interest that could be used as spaces of encounter and pedagogical reflection.

The Relationship Between Pharmacist Resilience, Burnout, and Job Performance

Background: Resilience aids healthcare professionals in navigating through and bouncing back from stressful situations in the workplace. Resilience can increase job satisfaction, work motivation, and professional commitment while decreasing burnout, and ultimately job turnover. More resilient employees experience lower instances of burnout and greater life satisfaction. Objective: The primary study objective is to determine the relationship that pharmacist resilience has on burnout and job performance. Methods: Licensed pharmacists in Florida were sent a Qualtrics survey (Qualtrics, Provo, UT) via email, which included demographics data, and valid and reliable assessment tools for resilience, burnout, and job performance. Linear regressions were used to test if resilience significantly predicted each of the output variables: burnout and job performance. Results: Survey responses were received from 942 pharmacists. The regressions showed that resilience significantly predicted both burnout (β1 = −.701, P < .001) and job performance (β1 = .35, P < .001). As resilience increased, the levels of burnout decreased, and job performance increased. Resilience explained 29% of the variance in burnout, and 11% of the variance in job performance. Conclusion: The results of this study suggest that resilience significantly predicts both pharmacist work-related burnout and job performance. The more resilient the pharmacist, the lower the chances of work-related burnout and the higher the likelihood of better job performance. Organizations should pursue opportunities to educate healthcare workers on methods to increase resilience and to bring attention to the importance of this topic.

A Novel Approach to the Room of Errors (ROE): A Three-Dimensional Virtual Tour Activity to Spotlight Patient Safety Threats.

Live simulation-based activities are effective tools in teaching situational awareness to improve patient safety training in healthcare settings. The coronavirus disease 2019 (COVID-19) pandemic forced the discontinuation of these in-person sessions. We describe our solution to this challenge: an online interactive activity titled the "Virtual Room of Errors." The aim of this activity is to create an accessible and feasible method of educating healthcare providersabout situational awareness in the hospital. Materials and Methods: We applied existing three-dimensional virtual tour technology used in the real estate sector to a hospital patient room with a standardized patient and 46 intentionally placed hazards. Healthcare providers and students from our institution accessed the room online through a link where they independently navigate, and document observed safety hazards. Results: In 2021 and 2022, a total of 510 learners completed the virtual Room of Errors (ROE). The virtual ROE increased annual participation in the activity, as compared to the in-person Room, and demonstrated learnersatisfaction. Conclusions: The virtual ROE is an accessible, feasible, and cost-effective method of educating healthcare workers on situational awareness of preventable hazards. Furthermore, the activity is a sustainable way to reach a larger number of learners from multiple disciplines, even as in-person activities resume.

Effect on Video Conference’s Education in Mandangin’s Community Health Center’s Healthcare Knowledge about Acute Diarrhea in Children

Introduction: The involvement and ability of health workers in Mandangin Island in early managing acute diarrhea in children to reduce infant mortality due to diarrhea are very important. This study aimed to determine the effect of community development Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital Surabaya in a seminar on Early Management of Acute Diarrhea in Children using video conference to educate health care workers (HCWs) at the Mandangin Community Health Center.&#x0D; Material and Methods: This cross-sectional study was designed on 20 HCWs at the Mandangin community health center. Subjects were evaluated for demographic data (gender, age, occupation, last education), and the knowledge was assessed using a pre-test before the seminar was given. We used questionnaire about acute diarrhea containing 10 questions with maximum score 100. The seminar was given through video conferences with form classical lecturer and a case study on acute diarrhea, and subjects attended the seminar in Community Health Center’s Hall. We assessed knowledge after the seminar using the same questionnaire with randomization in question and answer and compared the pre-and post-test using the Wilcoxon Rank sum test.&#x0D; Results: Most of the subjects were midwifery, with a mean age of 32.4 ± 5.75 years old, 45% with D-3 last education and 80% were female. There was a significant difference between pre-and post-test in acute diarrhea in children (47.89±20.7 vs 64.74±22.94) (p=0.008).&#x0D; Conclusion: Video conference education effectively increased health care workers' knowledge about acute diarrhea in children

Stressors in health care and their association to symptoms experienced by gender diverse people

ObjectivesMany individuals whose gender does not align with the sex they were assigned at birth (gender diverse [GD] people) report stressful health care encounters. We examined the relationship of these stressors to symptoms of emotional distress and impaired physical functioning among GD people. Study designThis study was conducted using a cross-sectional design with data from the 2015 United States Transgender Survey. MethodsComposite metrics of health care stressors and physical impairments were developed, and the Kessler Psychological Distress Scale (K-6) provided a measure of emotional distress. Linear and logistic regression were used to analyze the aims. ResultsA total of 22,705 participants from diverse gender identity subgroups were included. Participants who experienced at least one stressor in health care during the past 12 months had more symptoms of emotional distress (β = 0.14, P < .001) and 85% greater odds of having a physical impairment (odds ratio = 1.85, P < .001). Transgender men exposed to stressors were more likely than transgender women to experience emotional distress and have a physical impairment, with other gender identity subgroups reporting less distress. Black participants exposed to stressful encounters reported more symptoms of emotional distress than White participants. ConclusionsThe results suggest that stressful encounters in health care are associated with symptoms of emotional distress and greater odds of physical impairment for GD people, with transgender men and Black individuals being at greatest risk of emotional distress. The findings indicate the need for assessment of factors that contribute to discriminatory or biased health care for GD people, education of health care workers, and support for GD people to reduce their risk of stressor-related symptoms.

SG-APSIC1209: Risk factors associated with mortality among carbapenem-resistant Enterobacteriaceae inpatient in a tertiary-care teaching hospital in Malaysia

Objectives: Carbapenem-resistant Enterobacteriaceae (CRE) is a multidrug-resistant gram-negative bacteria (MDR-GNB) that is rapidly emerging as a life-threatening nosocomial disease in many countries. We sought to identify the risk factors associated with mortality for carriage of CRE in patients at a tertiary-care teaching hospital. Methods: A retrospective observational study was conducted between January 2020 to December 2021 in a tertiary-care teaching healthcare facility, University Malaya Medical Centre in Malaysia. The study included all inpatients aged ≥18 years who had a CRE infection or were colonized during the study period. The genotype was identified by polymerase chain reaction (PCR). Statistical analysis of data including a multivariate logistic regression analysis was conducted using SPSS version 23.0 software. Results: In total, 176 cases of CRE (130 infection and 46 colonized) were identified, and the mortality rate was 31.8%. The main sources of CRE were rectal swab (61.9%), blood (11.9%), and respiratory sources (11.9%). Klebsiella pneumoniae (55.7%) was the predominant species, followed by Escherichia coli (21.6%). Among the isolates, 17.7% were non–CPE-CRE and 82.3% were CPE-CRE: NDM (69.3%) and OXA (10.8%). In multivariate analysis, the factors associated with mortality were older age (OR, 1.040; 95% CI, 1.012–1.069), longer length of stay (OR, 0.974; 95% CI, 0.955–0.994), use of central venous catheter (OR, 0.287; 95% CI, 0.094–0.878), and arterial lines (OR, 0.292; 95% CI, 0.095–0.891). Conclusion: Patients with CRE had a high mortality rate. Older age, longer duration of stay, indwelling CVC and arterial line were independent risk factors for death. Infection prevention and control measures to reduce CRE, such as active surveillance, contact precautions, compliance to intravenous catheter care bundles, healthcare worker education, and hand hygiene adherence, should be implemented.

Knowledge and Attitudes of Healthcare Professionals Regarding Perinatal Influenza Vaccination during the COVID-19 Pandemic.

Immunizations during pregnancy are an important aspect of perinatal care. Although the influenza vaccine during pregnancy is safe, vaccination rates are low. According to research data, one of the reasons for the low vaccination rates among pregnant women is that they do not receive a clear recommendation from healthcare providers. This study aims to record the knowledge and attitudes about influenza vaccination and investigate healthcare professionals' recommendations during the perinatal period. A cross-sectional study was conducted with convenience sampling in Athens, Greece. Our purposive sample included 240 midwives, Ob/Gs, and pediatricians. Data were collected using an appropriate standardized questionnaire with information about demographics, attitudes towards influenza vaccination, and knowledge about the influenza virus and peripartum vaccination. Statistical analysis was conducted using IBM SPSS-Statistics version 26.0. This study identifies the reasons for the lack of vaccine uptake including a wide range of misconceptions or lack of knowledge about influenza infection, lack of convenient access to get vaccinated, etc. Misconceptions about influenza and influenza vaccines could be improved by better education of healthcare workers. Continuing professional education for health professionals is necessary to improve the level of knowledge, prevent negative beliefs, and promote preventive and therapeutic practices.

Artificial intelligence to enhance clinical value across the spectrum of cardiovascular healthcare.

Artificial intelligence (AI) is increasingly being utilized in healthcare. This article provides clinicians and researchers with a step-wise foundation for high-value AI that can be applied to a variety of different data modalities. The aim is to improve the transparency and application of AI methods, with the potential to benefit patients in routine cardiovascular care. Following a clear research hypothesis, an AI-based workflow begins with data selection and pre-processing prior to analysis, with the type of data (structured, semi-structured, or unstructured) determining what type of pre-processing steps and machine-learning algorithms are required. Algorithmic and data validation should be performed to ensure the robustness of the chosen methodology, followed by an objective evaluation of performance. Seven case studies are provided to highlight the wide variety of data modalities and clinical questions that can benefit from modern AI techniques, with a focus on applying them to cardiovascular disease management. Despite the growing use of AI, further education for healthcare workers, researchers, and the public are needed to aid understanding of how AI works and to close the existing gap in knowledge. In addition, issues regarding data access, sharing, and security must be addressed to ensure full engagement by patients and the public. The application of AI within healthcare provides an opportunity for clinicians to deliver a more personalized approach to medical care by accounting for confounders, interactions, and the rising prevalence of multi-morbidity.

Kritički osvrt na koncept ubrzanog oporavka nakon operacije u vaskularnoj hirurgiji - ERAS protokol u vaskularnoj hirurgiji

The concept of enhanced recovery after surgery (Enhanced Recovery After Surgery-ERAS) represents a multimodal approach to surgical treatment of patients, based on evidence, starting preoperatively and continuing postoperatively. The concept aims to improve patient recovery while reducing complications and reducing length of hospital stay. The ERAS concept has become the standard of care in colorectal surgery. It is also used in vascular surgery, especially aortic and carotid surgery. In 2022, the Society for Vascular Surgery and the ERAS Society published the latest recommendations for vascular surgery for patients undergoing open aortic surgery. The study included 590 abstracts. The recommendations refer to the period before the admission of the patient, as well as to the preoperative, intraoperative and postoperative period. Among the most important recommendations are the introduction of preoperative patient education, screening of anemia and nutritional status, optimization of risk factors, reduction of the use of nasogastric tubes and drainage, use of multimodal analgesia, targeted replacement of fluid, early removal of urinary catheters, active and early mobilization, and early enteral nutrition. There is more and more evidence about the importance of the ERAS protocol in elective vascular surgery, as well as its impact on reducing the length of hospital stay, reducing complications and better recovery of patients, lower treatment costs. Its application depends on the medical staff, so the education of healthcare workers is needed in this field.

Knowledge and Practice Regarding The Administration Of the Pentavalent Vaccine Among Health Care Workers In Vientiane Capital, Lao PDR: A Mixed Method Approach

Knowledge and practice regarding the administration of the pentavalent vaccine among health care workers in Vientiane Capital, Lao PDR: A mixed method approach Abstract Background: The pentavalent vaccine is an essential, cost-effective public health measure to reduce preventable premature child mortality and childhood mobility and contributes to lowering the spread of vaccine-preventable diseases. The aim of this study is to assess the knowledge and practice of providing pentavalent vaccines and its related factors among health care workers (HCWs). Method: This was a cross-sectional analytical study, using the qualitative and quantitative methods. The study was conducted in nine district hospitals and 33 health centers in Vientiane Capital. In total, 184 health care workers were involved in the study and in-depth interviews were conducted with 12 HCWs. Descriptive and inferential statistics were applied to determine the factors associated with the knowledge and the practice of pentavalent vaccines. A thematic analysis was applied to the qualitative data. Results: The results showed that more than half (63.3%) had poor knowledge of the pentavalent vaccine, while about two thirds (65.7%) reported good practices for delivering the pentavalent vaccine. In the multiple logistic regression, significant factors associated with the knowledge of the pentavalent vaccine were the qualification of HCWs (AOR=2.6, 95% CI=1.1 – 6.3, p=0.030), receiving training on vaccines (AOR=3.4, 95% CI=1.7 – 6.8, p&lt;0.001), and incentives of working for vaccination programmes (AOR=2.7, 95% CI=1.2 – 6.1, p=0.020). The qualitative study revealed the need to improve supply-side determinants including increased training to improve the health staff’s competency, knowledge and practice of immunization. Conclusion: The data from this research indicated that more than half of the HCWs had poor knowledge about the pentavalent vaccine, despite vaccination practice being relatively good. There was a correlation between improved knowledge, with those HCWs who had higher education, and received training and incentives. These findings demonstrate there is a need for more efficient training and the continuous education of HCWs in the field of immunization. Keywords: Pentavalent vaccine, health care workers, knowledge and practice, Lao PDR.

Finding the missing children for TB care and prevention in Kenya.

SETTING: One hundred high TB burden facilities in nine counties in Kenya.OBJECTIVES: 1) To increase uptake of TB preventive therapy (TPT) among child contacts aged <5 years, and 2) to increase TB diagnosis in children aged <15 years presenting to health facilities for routine care.DESIGN: For objective 1, a clinic-based child contact management strategy incorporating transport/healthcare cost reimbursement, monitoring and evaluation tools, and healthcare worker education was utilized. For objective 2, community health screeners were established in pediatric outpatient departments to perform verbal screening, flagging symptomatic children for further evaluation.RESULTS: Over 15 months, identification of 8,060 individuals diagnosed with bacteriologically confirmed TB led to 2,022 child contacts. Of these, 1,848 (91%) were evaluated; 149 (8%) were diagnosed with TB disease, leaving 1,699 (92%) eligible for TPT; 1,613 (95%) initiated TPT and 1,335 (83%) completed TPT. In outpatient settings, 140,444 children were screened; 54,236 (39%) had at least two TB symptoms; 2,395 (4%) were diagnosed with TB diseaseCONCLUSION: Health system strengthening supporting a clinic-based child contact management program increased the number of children initiating TPT. Systematic screening in outpatient clinics can lead to increased TB case notifications; however, optimal screening tools and clearer diagnostic pathways for the evaluation of these children are needed.

THE ROLE OF PHARMACISTS IN MINIMIZING MEDICATION ERRORS IN THE NEONATAL INTENSIVE CARE UNIT: A SYSTEMATIC REVIEW

Background: Hospitalized pediatrics, especially neonates, are more prone to excessive medication errors. Implementation of pharmacy services shows a decline in medication errors in hospitals and clinics. In this study, we aimed to demonstrate the role of pharmacists in reducing medication errors in hospitalized neonates Methods: The systematic review of the literature was undertaken through the PubMed database from 2002 to 2022. The search MESH terms were multiple combinations of Medication error, Clinical pharmacist, Clinical pharmacy services, Infant &amp; newborn. Afterward, the results were filtered to include the role of pharmacy services in preventing medication errors for the inpatient neonatal population Results: a total of 15 articles were eligible to be included in the current review, comprising neonatal or whole pediatric population, including neonates. The primary pharmacy interventions were prescription auditing, identification of medication errors, changing preparation and administration, medication reconciliation, educating healthcare workers, and developing policies Conclusions: Our systematic review illustrated that pharmacists integration with other healthcare teams could help minimize medication errors before reaching neonates.

Depression, anxiety, stress and coping strategies in healthcare workers during the second wave of Covid-19 pandemic

Millions of individuals were mentally and physically harmed by the first wave of the COVID-19 pandemic. Health-care workers are those who are most affected by the pandemic's psychological effects. This study examines the psychological effects of the second pandemic wave of Covid-19 on healthcare personnel in India and their coping strategies.During the month of May 2021, a semi-structured online survey of healthcare workers in India was conducted. A total of 1340 healthcare workers participated in the study. SPSS software was used to analyze the data.Most participants (37.61%) were between the ages of 18 and 29, with 856 married (63.88%). Three hundred thirty-seven participants (25.15%) were resident doctors, while 1008 (75.22%) worked in government settings. 561 of the 1340 participants reported anxiety symptoms (41.87%). 536 (40.00%) of the participants reported depressive symptoms. Post-traumatic stress symptoms were also present in 423 participants (31.57%). Our study found a statistically significant difference between male and female depression and post-traumatic stress symptoms (p-value &amp;#60;0.05). Most participants relied on keeping expectations open and hopeful as a coping strategy (66.57%).It is important to develop strategies to address the growing number of mental health problems. It is anticipated that healthcare worker education about coping strategies, effective coping mechanisms, and avenues for practical assistance will be beneficial.

Knowledge, Practice and Attitudes to the Management of Sepsis in Jamaica.

Sepsis is a life-threatening dysfunction resulting from the dysregulated host response to infection. The mortality of sepsis in Jamaica remains high amid the proven efficacy of the Surviving Sepsis Guidelines implementation in some countries. To evaluate the inter-relationship of healthcare workers' attitude towards, knowledge of and practice of sepsis management in Jamaica. A survey was done using an anonymous self-administered validated questionnaire to healthcare workers across Jamaica. Questions on knowledge, attitude, and practice of sepsis within private and public hospitals were answered. A total of 616 healthcare workers were eligible for analysis. Most respondents agree that healthcare workers need more training on sepsis (93.7%) and that formal sepsis training modules should be implemented at their hospitals or practice (93.2%). Several signs of sepsis as outlined by qSOFA were correctly identified as such by most respondents (60.6% to 76.4%), with the exception of a low PaCO2 (34.9%), which was correctly identified by a minority of respondents. While a majority (69.3%) were able to correctly define sepsis, only 8.8% of respondents knew the annual sepsis mortality rate. Postgraduate training (p<0.01) and formal sepsis training (p<0.05) were both predictive of high correct knowledge and practice scores. Specialization in Anaesthesia/ Critical Care Medicine (p<0.05) or Emergency Medicine (p<0.05) was predictive of high knowledge scores and Internal Medicine predictive of high practice scores (p<0.01). This study revealed that education for healthcare workers on sepsis and the implementation of SSC is needed in Jamaica.

An overview of Personalized Medicine landscape and policies in the European Union.

The spread of Personalized Medicine (PM) over the last decade defined a revolution in healthcare systems. PM is among the priorities of the European Commission's research agenda, which funded the IC2PerMed international project aiming to integrate China into the International Consortium of PM (ICPerMed). In the context of this project, we mapped the existing policies related to PM in the European Union (EU) and at the EU Member States (EU-MS) level. PubMed, Google Scholar, Google, Microsoft and national and international institutions' official repositories were searched in order to identify documents on PM-related policies, programmes and action plans at the EU and EU-MS level, published up to December 2020. We identified 28 policies in the EU aimed at improving public health promoting and fostering PM implementation, through some actions including the standardization of good medical practice, use of big data and digital innovation, data sharing and cross-border interoperability, healthcare sustainability, disease prevention and patients'/citizens' engagement. We identified 23 policies at EU-MS level which, notwithstanding national differences, have a common focus, such as patient-tailored treatment and targeted prevention, education of healthcare workers, research and innovation, big data harmonization and healthcare system sustainability. The definition of an integrated regulatory framework is essential to turn PM into an opportunity for citizens and patients with the involvement of all the stakeholders. This work can provide a valuable tool for decision-makers to define common approaches, priorities for research, development and increase international collaboration, which could overcome the fragmented European scenario and align the future direction on PM.

The Future of Palliative Treatment in India: A Review.

The rapid dynamics of the world bring about changes in all aspects of the life of human beings. These dynamics hence call for the need for research and development in the field of the betterment of the life of a human. Palliative care for the patient in need is a field that drastically affects human life and can provide an ethical and more humanitarian way to live. The main objective of this article is to examine the Indian system of palliative care's organizational structure, roles, and applicability in India. By reading various research articles on the internet, mainly PubMed and Google Scholar, we collected enough information on the palliative care facilities in India. After going through the research articles and thorough discussion, it comes to the knowledge that India's existing palliative care facilities are lacking behind the rest of the world. However, some states have better approaches and facilities, but overall research suggests the need for more development in the field of palliative care even more. India needs a systematic approach to improving palliative care. These improvements include increasing the workforce, better application of policies, good political support, and educating health care workers and patients requiring palliative treatment.

P215 Investigation of an outbreak of neonatal Candida emia in the NICU of a 300 -bedded hospital in North India

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectivesNeonatal Candidaemia causes significant morbidity and mortality in very low birth weight neonates. We report the occurrence of an outbreak of neonatal Candidaemia due to Candida krusei in the neonatal intensive care unit (NICU) of a 300-bedded hospital in North India.MethodsA total of 96 blood cultures from 80 neonates admitted in the NICU from October 2020 to April 2021 were received and processed manually in the Microbiology lab. A total of 5 among the 47 yeast isolates were sent to a teaching hospital for identification and antifungal susceptibility testing by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF). Clinical parameters (very low birth weight, gestational age, birth asphyxia, broad-spectrum antimicrobial therapy, intra-uterine growth restriction, and total parenteral nutrition), lab parameters (CRP, platelet count), and patient outcome were evaluated. A total of 26 environmental samples and hand swabs from six health care workers were collected to trace the source of the outbreak. The samples were inoculated on 5% sheep blood agar and MacConkey agar. Regular rounds of the NICU and training sessions were conducted by the infection control team to intensify the infection control measures.ResultsBlood culture results: In all, 57 neonates (71.25%; 57/80) admitted to the NICU had positive blood cultures. A total of 47 blood cultures yielded non-albicans Candida spp. (82.45%; 47/57). The other microorganisms isolated from blood cultures were Pseudomonas aeruginosa (4), MRSA (3), Klebsiella pneumoniae (4) and Acinetobacter baumanni (1). Polymicrobial bloodstream infections were detected in two neonates. All the yeast isolates subjected to MALDI-TOF were identified as Candida krusei and had similar MICs of 0.25, 4, 16, 1, 0.25 and 16 μg/ml for voriconazole, itraconazole, posaconazole, caspofungin, micafungin and fluconazole respectively.Culture results of environmental sampling: Yeast could not be isolated from any environmental sample and hand swabs of health care workers. However, MRSA was isolated from the hands of one health care worker.Observation during the infection control rounds:Sterile gauze pieces soaked in iodine and kept in plastic bottles were being used for skin antisepsis before collecting samples or before introducing an IV cannula.The nursing staff did not wear sterile gloves while collecting blood samples or introducing IV cannula in case of NICU patients.It was observed that the used bottles of IV fluids (eg. Ringer lactate, normal saline) were not capped and kept at room temperature.Intensive infection control measures and training sessions were effective in controlling the outbreak.ConclusionWe report the occurrence of a massive outbreak of neonatal Candidaemia in the NICU of our hospital with a positivity rate of 58.75% (47/80). Identification of yeast and determination of antifungal susceptibility is important for prompt treatment. Though the source of the outbreak could not be traced but intensifying infection control practices could control the outbreak. This study emphasizes the value of educating healthcare workers and regular monitoring of disinfection practices to prevent health-care-associated infections.