Healthcare-associated Infections Research Articles

Multicentre, double-blind, randomised controlled clinical trial comparing intermittent cefoxitin administration versus loading bolus followed by continuous infusion for the prevention of surgical site infection in colorectal surgery: the PROPHYLOXITIN study protocol

IntroductionSurgical site infections (SSIs) are the second leading cause of healthcare-associated infections in Europe with the highest rates being reported in colorectal surgery (ranging from 9% to 30%). Surgical antibiotic...

Bacterial Contamination and Antimicrobial Resistance Patterns of Healthcare Workers' Mobile Phones in Hospitals at Khartoum City

Background: Mobile phones used by healthcare workers (HCWs) have emerged as potential reservoirs for pathogens, posing a risk of healthcare-associated infections (HAIs). This study aimed to investigate the prevalence of bacterial contamination on HCWs' mobile phones, determine the antimicrobial susceptibility patterns, and compare findings with global data. Methods: We collected swabs from 94 mobile phones of HCWs across two hospitals in Khartoum. We identified bacterial isolates using standard microbiological techniques and evaluated antimicrobial resistance using the Kirby-Bauer disk diffusion method. Results: Bacterial contamination appeared in 93.6% of mobile phones. Gram-positive bacteria, such as Coagulase-negative staphylococci (36%) and S. aureus (31.8%) were prevalent. Gram-negative organisms were isolated. The predominant organisms were Klebsiella pneumoniae 15 (37%) isolates followed by Pseudomonas aeruginosa 12 (30%) isolates, Proteus mirabilis 5 (12%) isolates, Acintobacter baumannii 4 (10%), Enterobacter spp 3(8%) and Escherichia coli 1 (3%). Antimicrobial susceptibility tests revealed high resistance to penicillin among Gram-positive isolates. The tests revealed no multidrug-resistant (MDR) or extended-spectrum beta-lactamase (ESBL) production. Conclusion: HCWs' mobile phones represent a critical vector for bacterial transmission in hospitals. Stringent infection control measures and regular disinfection should mitigate the associated risks.

Healthcare Settings and Infection Prevention: Today’s Procedures in Light of the “Instructions for Disinfection” Issued During the 1817 Typhus Epidemic in the Grand Duchy of Tuscany (Pre-Unification Italy)

Even today, healthcare-associated infections (HCAIs) remain the most frequent and serious complications in healthcare, with a significant clinical and economic impact. The authors of this manuscript address the causes and conditions that determine this situation and describe them in comparison with the situation in the Grand Duchy of Tuscany more than two centuries ago and with the instructions that were issued at the time to contain the typhus epidemic of 1817, increase hospital sanitation, and disinfect houses. Today, we know that a crucial element in the fight against healthcare-associated infections (HCAIs) is the definition and implementation of best care practices and other measures, according to a combined program that must be tailored to each healthcare setting. In the early nineteenth century, these approaches originated from experience and chemical knowledge that were becoming established, opening the way to the ideas and experiments of Ignác Fülöp Semmelweis and later of Joseph Lister, who traced the path for the birth of hygiene. Two centuries later the pioneering vision of the Grand Duchy of Tuscany at the beginning of the 19th century, when preventive measures in the field of public health were still backward and underdeveloped, is still enlightening and surprisingly topical.

Surveillance and Reporting of Hospital-Associated Infections—A Document Analysis of Romanian Healthcare Legislation Evolution over 20 Years

Background/Objectives: The objective of this study is to evaluate the evolution of Romanian legislation related to HAIs. The evolution of healthcare-associated infections (HAIs)’s definitions and surveillance frameworks in Romania reflects progressive advancement in diagnostic criteria, reporting, and prevention. Recent changes emphasize the need for accurate and centralized electronic reporting, inclusion of medico-social and palliative care institutions, and modernized hospital infrastructure standards. However, workforce deficits, insufficient infrastructure, and punitive sanctions remain barriers to effective implementation. Methods: This study analyzed publicly available Romanian legislative texts and their evolution, comparing definitions, diagnostic criteria, and surveillance structures. Key informant insights supplemented findings to contextualize legislative impacts. Legislative acts were reviewed sequentially to identify updates in regulatory frameworks and barriers to effective HAI management. Results: The legislative evolution demonstrates a shift from basic diagnostic criteria to a comprehensive surveillance framework aligned with European standards. However, challenges persist, including workforce capacity deficits, under-reporting due to fear of sanctions, and infrastructure inadequacies. The prevalence of HAIs remains largely under-reported (4.1%), with studies revealing rates well below the European average (7.1%). Manual and isolated reporting systems further hinder real-time surveillance and accuracy. Legislative advancements in Romania reflect progress in HAI management but highlight systemic barriers that impede effective implementation. Conclusions: Collaborative efforts across individual, organizational, and system levels are required to address workforce training, reduce under-reporting, and invest in infrastructure and electronic reporting systems. Promoting a blame-free organizational culture, combined with training, is essential to encourage behavior of accurate reporting and improve HAI prevention strategies.

Down syndrome and outcomes in critically ill pediatric patients

IntroductionInformation regarding children with Down syndrome (DS) in the Pediatric Intensive Care Unit (PICU) is limited and conflicting. We aimed to investigate the association between DS and clinical outcomes in pediatric patients admitted to the PICU at the Instituto Nacional de Salud del Niño (National Institute for Child Health, INSN for the acronym in Spanish) and to assess nutritional status within the study cohort.MethodsThis study involved the secondary analysis of a database. We included patients consecutively admitted to INSN, a tertiary care children's hospital in Lima, Peru. We collected demographic data, clinical characteristics, and nutritional status using standardized tables. The outcomes assessed included mortality, length of stay, duration of mechanical ventilation (DMV), ventilator-free days (VFD), and healthcare-associated infections (HAI). We applied Cox regression and Poisson regression analyses to explore the relationship between Down syndrome and clinical outcomes, providing both crude and adjusted results.ResultsA total of 525 children (average age 71.3 months, range 1–218 months) were analyzed. Children with DS were younger and had a higher prevalence of comorbidities, congenital heart disease, and underweight. Both crude bivariate and multivariate analyses demonstrated that children with DS had higher mortality rates, increased frequency of HAIs, longer DMV, longer PICU stay, and fewer VFD. Adjusted multivariate analysis revealed that children with DS had a significantly higher risk of developing HAIs (RR 2.95; 95% CI 1.10, 7.87) and longer DMV (RR 1.43; 95% CI 1.24, 1.65). Among the 525 children, underweight was associated with increased risk of mechanical ventilation (MV) use and longer DMV.DiscussionCritically ill children with DS are at increased risk of developing HAIs and longer DMV. In all 525 children, underweight is associated with higher risk of MV use and longer duration of MV.

Antimicrobial Stewardship in Ireland (2010-2021): a scoping review protocol

Background Antimicrobial stewardship programmes (ASP) are essential in promoting responsible antimicrobial use, reducing antimicrobial resistance (AMR) and health care-associated infections. In 2009 the Strategy for the Control of Antimicrobial Resistance in Ireland (SARI), Hospital Antimicrobial Stewardship Working Group published guidance on antimicrobial stewardship (AMS) in hospitals. This paper presents a protocol for a scoping review which aims to examine the current literature to evaluate progress related to the implementation of the SARI (2009) guidance on antimicrobial stewardship in hospitals in Ireland. Methods This scoping review will be conducted in line with the five-stage methodological framework by Arksey & O’Mally 2005. We will search the following databases (PubMed, CINAHL, Embase, Web of Science) and targeted websites for articles and reports for possible inclusion in our review. Studies pertaining to AMS undertaken or related to the Republic of Ireland from January 2010 until December 2021 will be included. We will include all study designs. We will map all selected publications to the recommendations of the SARI (2009) guidance document. The protocol follows the guidance of Peters et al., 2022. Two reviewers will independently screen studies and reports to assess eligibility with any discrepancies resolved by consensus discussion with a third reviewer. Results These will be reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR)and this checklist will be included when the scoping review is published. Conclusion This scoping review will map studies and reports to evaluate AMS in relation to national guidelines without restriction on study design or outcomes in the Republic of Ireland. This information has the potential to provide a valuable resource for the implementation of future AMS research and interventions.

Exploring the Relationship Between Knowledge, Attitudes, Self-Efficacy, and Infection Control Practices Among Saudi Arabian Nurses: A Multi-Center Study

Introduction: Healthcare-associated infections are a significant risk to patients and the healthcare system. Differences in knowledge, attitudes, and practices among nurses have limited standardized precautions. Improving self-efficacy can enhance compliance with standard precautions, protect patients, and preserve the credibility of healthcare institutions. Aim: This study aimed to determine the mediating effects of self-efficacy on nurses’ knowledge, attitude, and compliance with standard precautions in Saudi Arabia. Methods: This cross-sectional study was conducted in four hospitals in Dharan, Saudi Arabia, between July and October 2023. The respondents were selected through a multistage sampling of 305 nurses from wards and special areas. Results: participants demonstrated a moderate level of knowledge (M = 19.00, SD = 2.17), positive attitudes (M = 55.86, SD = 10.22), intermediate compliance (M = 72.44, SD = 11.47), and moderate self-efficacy (M = 29.99, SD = 11.40). Respondents who possessed more knowledge demonstrated positive attitudes toward standard precautions (r = 0.256, p < 0.001) and were more likely to comply (r = 0.376, p < 0.001). Higher self-efficacy levels were significantly positively correlated with knowledge (r = 0.391, p < 0.001), attitude (r = 0.311, p < 0.001), and compliance (r = 0.385, p < 0.001). The direct effect of knowledge on compliance was estimated to be 0.115 (p < 0.001), while the direct effect of attitude was slightly weaker (0.014, p = 0.049). Self-efficacy indirectly increased compliance through its influence on knowledge and attitude, with indirect effects of 0.039 (p < 0.001) and 0.008 (p = 0.002), respectively. Conclusions: Nurses with higher knowledge of infection control and positive attitudes toward established protocols were more likely to comply consistently. This association is further strengthened by self-efficacy. This confidence enhanced their understanding of the specific procedures, reinforced their positive beliefs about the importance of protocols, and ultimately led to greater adherence.

Poor quality care in healthcare settings: an overlooked epidemic

Adverse events in healthcare settings, including medical errors, healthcare-associated infections (HAIs), and surgical complications, have been a persistent challenge globally, contributing significantly to patient morbidity and mortality. Over the past decade, these events have remained prevalent despite increasing efforts to improve patient safety. This narrative literature review explores the burden of poor-quality care. It examines the trends in adverse events and associated mortalities from 2015 to 2024, highlighting the impact of these events on global health outcomes and identifying potential strategies for reducing their occurrence. Data were collected from various sources such as PubMed, Google Scholar, Scopus, and Ebscohost. The analysis revealed that ~10%−12% of hospitalized patients in high-income countries experienced adverse events annually from 2015 to 2024. Globally, the WHO estimated that 134 million adverse events occurred each year, with ~2.6 million deaths attributed to these events. Adverse events in healthcare settings remain a significant public health challenge, contributing to millions of preventable deaths annually. The persistence of these events highlights systemic issues within healthcare delivery, including inadequate safety protocols, underreporting, and workforce challenges.

Multimodal strategies for the implementation of infection prevention and control (IPC) interventions - update of a systematic review for the WHO guidelines on core components of IPC programmes at the facility level.

Healthcare-associated infections (HAIs) remain a significant challenge worldwide, and the use of multimodal strategies is recommended by the World Health Organization (WHO) to enhance infection prevention. To update the systematic review on facility-level infection prevention and control (IPC) interventions on the WHO Core Component of using multimodal strategies. Data Sources: Medline (via PubMed), EMBASE, CINAHL, and the Cochrane library. Randomized controlled studies (RCTs), interrupted time series (ITS), and before-after studies in acute care settings, from 24 November 2015 to 30 June 2023. Both paediatric and adult populations. IPC interventions implemented with at least three WHO multimodality elements. HAI, HAI caused by antimicrobial-resistant microorganisms, and hand hygiene (HH) compliance.Assessment of Risk of Bias: Effective practice and organisation of care (EPOC) and integrated quality criteria for review of multiple study designs (ICROMS) tools.Methods of data Synthesis: Descriptive data synthesis. Of 5678 identified titles and abstracts, 32 publications were eligible for data extraction and analysis. Five non-controlled before-after studies (NCBA) were excluded due to an insufficient ICROMS score. Of the remaining 27 studies, nine reported on the effect of multimodal strategies to reduce device-associated HAIs, four on surgical site infections, eight on infections due to AMR and six on HH compliance. Eleven were controlled studies (RCTs or controlled before-after studies (CBAs)), nine ITS and seven NCBA studies. Twenty-two of the studies originated from high-income countries and the overall quality was medium to low. Twenty studies showed either significant HAI-reductions or HH improvement. Most studies demonstrate a significant effect on HAI prevention and HH improvement after applying a multimodal strategy. However, the quality of evidence remains low to moderate with few studies from low- or middle-income countries. Future research should focus on higher quality studies in resource limited settings.

Reduction of the microbial background in the intensive care unit of a surgical hospital with the systematic introduction of the Alpha‑06A pulsed ultraviolet system into disinfection measures (experimental study)

Relevance. Healthcare-associated infections (HAIs) are a significant problem in intensive care units. They contribute to increased mortality, lengthen hospital stays and increase treatment-related costs.The aim of the study was to evaluate the effectiveness of reducing the microbial background and cross-transmission of pathogenic microorganisms associated with the provision of medical care in the intensive care units of surgical hospital with the systemic use of the Alpha‑06A pulsed ultraviolet system with the “Areal” device (Scientific and Production Enterprise «Melitta», Russia).Materials and methods. The Alfa‑06A air, surface and local areas disinfection system with the “Areal” device was used in the intensive care unit for 2 months – August and September 2024. The “Areal” device directs ultraviolet radiation, generated by the pulsed xenon lamp of the Alfa‑06 installation, into a limited sector. The rest of the room is structurally protected from direct UV radiation. It is allowed to use it in the presence of patients and staff. The use of the installation complemented the standard anti-epidemic measures. At the end of the study period, the results of microbiological studies were retrospectively evaluated and compared with the results of the control period.Results. A statistically significant (Fisher’s criterion 0.00383, p<0.05) tenfold decrease in the number of positive samples from surfaces during the treatment period in the «Areal» mode was noted. A decrease in bacterial pollution of the environment led to a distinct tendency to reduce cases of contamination of patients with various bacterial flora, and the acquisition by the patients of multidrug-resistant organisms statistically significantly decreased by 100 % (p<0.5). As a result, the use of the Alpha system in the «Areal» mode reduced the cost of expensive antibacterial drugs by 18.9 % in absolute and 7.4 % in relative terms.Conclusion. The systematic use of Alfa‑06A in conjunction with the “Areal” device in the daily work of the intensive care unit significantly reduces the contamination of surfaces with microorganisms. This is reflected in a decrease in the number of positive samples from various patient loci. The number of cases of persistence of polyresistant problematic bacteria of the ESKAPE group is also decreasing. The improvement of the microbiological background shows a clear economic effect in terms of the cost of expensive antibacterial drugs.

Comparison of the conceive-design-implement-operate model and lecture-based learning in teaching the “healthcare-associated infections” course

BackgroundHealthcare-associated infections (HAI) are infections acquired by patients during treatment in various healthcare institutions. These infections significantly increase morbidity, mortality, and healthcare costs. Enhancing HAI education for nurses can improve patient safety and medical quality.AimThe study aimed to assess the effectiveness of the new conceive-design-implement-operate (CDIO) teaching model on nursing students’ HAI learning outcomes and compare it with the traditional LBL model, providing valuable insights for future HAI education in nursing.MethodsA total of 110 nursing students were randomly assigned to one of two groups for HAI training during the 2022–2023 academic year: a group that engaged in the CDIO model and another that received traditional lecture-based learning (LBL). The effectiveness of these pedagogical approaches was evaluated by comparing pre-and post-training test scores, and we used the Course Experience Questionnaire (CEQ) to collect students’ feedback on the course and teaching.ResultsCompared to traditional LBL method, the CDIO model significantly improved the overall scores and practical application scores of nursing students in the HAI course, with these advantages still retained after 24 weeks. Additionally, preliminary results show that students in the CDIO model scored higher on CEQ categories such as good teaching, clear goals and standards, appropriate assessment, generic skills, and independence, but they also reported an increased workload.ConclusionOur research is the first to apply the CDIO framework to nursing education in HAI courses, enhancing nursing students’ practical application skills, particularly in the sustained retention in this area. Our study indicates that the CDIO teaching model has significant advantages in enhancing course experience and teaching effectiveness.

Personal protective equipment usage and compliance among healthcare workers

This review delves into personal protective equipment (PPE) usage and adherence among healthcare professionals. The research highlights the role of knowledge and awareness in shaping compliance behaviors, stressing the importance of education and training initiatives. Factors like discomfort, perceived risk, and cognitive beliefs at a level with organizational culture, leadership, and a positive safety environment impact compliance result. The benefits of using PPE range from preventing healthcare-associated infections to promoting the well-being of healthcare workers. Successful clinical management involves evidence-based policy creation, thorough education and training programs, strategic resource distribution, and ongoing assessment. Leadership and organizational culture are drivers that cultivate a safety-oriented culture and adherence to PPE protocols. Given the evolving nature of diseases, guidelines need updates alongside contingency plans for potential outbreaks or pandemics. As healthcare institutions aim to enhance compliance levels, the insights from this review offer direction for managers and policymakers by laying a foundation for improving safety standards and strengthening overall healthcare systems.

Theoretical impact of a bedside decision-making tool on antibiotic use for suspected neonatal healthcare-associated infection: an observational study

Background and objectivesHealthcare-associated infections (HAI) are a leading contributor to morbidity and mortality in hospitalised neonates. Diagnosing neonatal HAI is challenging owing to non-specific symptoms and lack of definitive diagnostic markers, contributing to high rates of inappropriate antibiotic use. This study evaluated the theoretical impact of implementing a bedside tool for decision-making on antibiotic length of therapy (LOT).MethodsThis prospective observational physician-blinded study consecutively enrolled patients with suspected HAI events at a large South African neonatal unit from September 2022 to September 2023. The antibiotic decision-making tool included an infection prediction score (NeoHoP), and a point-of-care C-reactive protein test (CRP) performed at HAI diagnosis and 24 h later. The theoretical impact of the tool on antibiotic LOT was calculated.ResultsWe recruited 180 neonates with 214 episodes of suspected HAI, of which 22 (10.3%) were proven HAI, 56 (26.2%) were presumed HAI and 136 (63.6%) had HAI ruled out. The median observed antibiotic LOT was three days (9 days for proven HAI, 7 days for presumed HAI, and 3 days for no HAI). The antibiotic decision-making tool would theoretically reduce overall antibiotic LOT by 2 days (p < 0.001), particularly in neonates where HAI was subsequently excluded.ConclusionWe developed an antibiotic decision-making tool to support the clinical evaluation of suspected neonatal HAI and demonstrated a significant potential impact on reducing antibiotic LOT. Given increasing antibiotic resistance rates globally, this tool should be further evaluated to minimise unnecessary antibiotic use in hospitalised neonates.

Evaluating the Role of Hospital Leadership in Reducing Healthcare-Associated Infections

Healthcare-associated infections (HAIs) remain a major challenge in healthcare systems worldwide, contributing to increased patient morbidity, prolonged hospital stays, and substantial financial burdens. Hospital leadership plays a critical role in mitigating these infections by implementing evidence-based practices, fostering a culture of safety, and ensuring compliance with infection prevention protocols. This review examines the influence of leadership in reducing HAIs, focusing on strategic initiatives such as organizational commitment, multidisciplinary collaboration, and performance monitoring. By integrating robust leadership strategies and accountability frameworks, hospitals can significantly enhance patient safety and reduce the incidence of HAIs. The findings underscore the importance of leadership in driving sustainable change and highlight successful practices for future application.

Clinician views on selective decontamination of the digestive tract in mechanically ventilated patients in intensive care units: A survey.

Selective decontamination of the digestive tract (SDD) has been investigated as a strategy to reduce the incidence of ventilator-associated pneumonia (VAP) and other healthcare-associated infectionsin intensive care unit (ICU) patients receiving mechanical ventilation. There is some evidence to suggest that the use of SDD is associated with a reduction in healthcare-associated infection and mortality; however, the uptake of SDD in ICUs in Australia and New Zealand (ANZ) remains low. To better understand the potential reasons, we designed a questionnaire to gather views from specialists in intensive care medicine, infectious diseases, and medical microbiology. The study incorporated an online survey. An online survey was distributed to specialists in intensive care medicine, infectious diseases, and medical microbiology working in ANZ. The main outcome measures are views about SDD and perceived barriers to implementation in ICUs in ANZ. A total of 103 responses were obtained, of which 55 were from intensive care medicine specialists and the remainder from infectious disease/medical microbiology specialists. No respondents currently used SDD in their hospital ICU. Intensive care medicine specialists self-reported better understanding of the evidence base regarding SDD (P=0.032) and were more likely to believe that SDD was a safe therapy (P<0.001) and that it was associated with a reduction in the incidence of VAP (P<0.001) and ICU mortality (P<0.001). Infectious disease/medical microbiology specialists were more likely to believe there is currently a lack of evidence of benefit (P<0.001) and a risk of harm (P<0.001) associated with SDD. Specialists in intensive care medicine had more positive views about use of SDD in ventilated patients than did specialists in infectious diseases/medical microbiology, but no respondents reported using SDD in their clinical practice.

Umbrella review of economic evaluations of interventions for the prevention and management of healthcare-associated infections in adult hospital patients.

Healthcare-associated infections result in worse outcomes for patients and greater financial burden. An estimated 4.8 million HCAIs occurred in hospitals across Europe in 2022-23. Sixty-four percent of antibiotic-resistant infections in Europe are associated with healthcare. It is therefore vital to identify cost-effective interventions. Our objective was to summarise the cost-effectiveness evidence of interventions addressing HCAIs in hospitals. An umbrella review was conducted to identify evidence on the cost-effectiveness of antimicrobial stewardship, infection prevention and control, and microbiology and diagnostic stewardship interventions for the prevention and clinical management of HCAIs in adult hospital patients. Medline, Embase and EconLit databases were searched. A qualitative synthesis was undertaken. Twenty-four systematic reviews met the inclusion criteria, with 101 separate analyses extracted and grouped into 10 intervention and 14 infection/organism categories, across various countries and settings. Most evidence focussed on screening followed by contact precautions, isolation and/or decolonisation, with selective screening most cost-effective. Most IPC bundles were cost-effective, although interventions were heterogeneous. The evidence base was sparse for the remaining intervention categories, with more research required. The limited evidence suggests standalone environmental cleaning, hand hygiene, diagnostics, surveillance, ABS, and decolonisation interventions were mostly cost-effective. The cost-effectiveness of standalone personal protective equipment, and education and training interventions was mixed. Most interventions focussed on methicillin-resistant Staphylococcus aureus and other Gram-positive infections, with more research needed on Gram-negative infections. The comparator was unclear in many extracted analyses. Cost-effective interventions to address HCAIs in hospitals exist, although more evidence is needed for most interventions.

Impact of an electronic surveillance system on compliance with isolation precaution measures: an interrupted time series study

Background Electronic surveillance systems (ESSs) may assist infection prevention and control (IPC) teams in detecting and monitoring patients infected or colonised by pathogens to prevent healthcare-associated infections. We aimed to assess the impact of implementing an ESS on compliance with isolation precaution measures for bacterial infections or colonizations. Methods A quasi-experimental before-after study was conducted using interrupted time series analysis from 1 March 2018 to 31 July 2024 at the University Hospital of Nancy (France). The ESS was implemented in October 2022. The results of audits conducted by IPC nurses to investigate isolation measures for inpatients that required isolation precautions were aggregated monthly. Results 1379 audits were included in the study. The implementation of the ESS had no significant immediate impact on isolation measures, except for an increase in the presence of adequate hand hygiene products (+10.1%, p < 0.01). After the COVID-19 period, all isolation measures decreased. The implementation of the ESS was associated with positive changes in trends of isolation measures, particularly for the prescription of isolation precautions (+1.1%/month, p < 0.01), the isolation signage (+1.2%/month, p < 0.001), the hand hygiene products (+0.8%/month, p < 0.01), and full compliance with isolation measures (+1.1%/month, p < 0.0001). The audit rate significantly increased in the first 7 months of ESS use but then decreased. Conclusions The positive impact of ESS on compliance with isolation measures was likely due to the increased presence and communication of the IPC team in care wards, which was facilitated by the time saved in the surveillance and detection of carriers through the ESS.

Multidrug Resistant Gram-negative Bacteria in Surgical Site Infections: Antimicrobial Resistance and Preventive Measures

Abstract Multidrug resistant (MDR) gram-negative bacteria (GNB) are responsible for high mortality and morbidity in healthcare settings worldwide. They have been declared as priority pathogens by the WHO for their continuously escalating antimicrobial resistance. Nevertheless, data associated with MDR GNB in healthcare-associated infections are insufficient. Surgical site infections (SSIs) are among the most commonly occurring healthcare-associated infections. Such infections are particularly common when bacteria from the patient's normal microflora are transferred to the surgical sites during surgical procedures. SSIs affect approximately 0.5%-3% of patients undergoing surgery, resulting in prolonged hospital stay compared with patients without SSIs. SSIs result in severe problems and lead to a heavy economic burden. Most SSIs can be avoided if suitable preventive measures are employed. Novel findings support the dedicated usage of oral preoperative surgical antimicrobial prophylaxis for specific surgeries based on sites/organs. Immediate interventions are sought to control the transmission of MDR GNB typically found in hospital settings. The present narrative review aims to describe MDR GNB in SSIs in different sites. Antimicrobial resistance epidemiology and preventive measures for SSIs are also discussed. Different intrinsic and extrinsic factors and control measures are elaborated for curbing SSIs.

Infection prevention and control and water, sanitation, and hygiene status of healthcare facilities in the Greater Kampala Metropolitan region during the COVID-19 pandemic in Uganda

Infection Prevention and Control (IPC) and Water Sanitation and Hygiene (WASH) are critical in preventing the spread of healthcare Associated Infections, including COVID-19. However, there was limited evidence on the status of IPC/WASH in healthcare facilities (HCFs) in Uganda amidst the COVID-19 pandemic which complicated IPC/WASH planning for the COVID-19 response. This study assessed IPC/WASH status for HCFs in the Greater Kampala Metropolitan Area (GKMA), during the COVID-19 pandemic, so as to inform programming and policy. A mixed methods cross-sectional study was conducted in 75 HCFs following the first wave of COVID-19 in Uganda. The mWater tool was used to collect quantitative data which were then analyzed into STATA version 16. A key informants’ guide was used to collect qualitative data, which was analyzed thematically and themes and quotes used to support the quantitative findings. Overall, 86.7% (65/75) of HCFs had an IPC committee and 72.3% (47/65) of these were functional. Besides, 90.7% (68/75) of the HCFs had an IPC focal person, and 49.3% (37/75) had a clear annual IPC activity plan. Unfortunately, only 32.3% (21/65) of the functional IPC committees received budgetary support for their activities. In terms of WASH infrastructure, 96.0% (72/75), 10.7% (8/75), 60.0% (45/75), and 22.7% (17/75) had access to a basic water service, a basic sanitation service, a basic hand hygiene service and a basic environmental cleaning respectively. Our study reveals that while most HCFs have IPC committees and focal persons, functional support remains limited, with half having a clear annual plan and less than a third receiving budgetary support. Nearly all HCFs have basic water services, but there are significant gaps in sanitation and environmental cleanliness domains. These findings highlight the urgent need for improved support and investment in IPC/WASH supplies and infrastructure to enhance infection control and public health outcomes in Uganda.

Knowledge, Attitudes, and Practices of Infection Prevention and Control Nurses in Public Hospitals in the Limpopo Province: A Qualitative Study.

A crucial aspect of delivering healthcare is infection prevention and control (IPC), especially in public hospitals where the high volume of patients and limited resources can heighten the risk of healthcare-associated infections. This qualitative study explores IPC nurses' knowledge, attitudes, and practices in public hospitals within the Limpopo province of South Africa. The study adopted a qualitative descriptive design. This qualitative study utilized self-developed validated semi-structured interviews with IPC nurses from 12 public hospitals (4 tertiary, 4 regional, and 4 district). The interviews were transcribed verbatim and analysed using thematic analysis to identify key themes related to knowledge, attitudes, and practices in IPC. Each interview lasted approximately 15 to 20 min. Themes and subthemes that emerged provided a structured overview of the key aspects discussed. Each theme captures a different facet of the experiences, perceptions, and challenges faced by IPC nurses in their role. The subthemes further break down these views into specific areas of focus, offering deeper insights into the nurses' experiences of their professional responsibilities. This study shows that, although IPC nurses have a good understanding of infection control and a positive attitude toward it, systemic problems and resource constraints make it difficult to consistently implement optimal practices. Affective mood, opportunity cost, coherence of the intervention, burden, perceived efficacy, self-efficacy, and ethics are among the major themes that were found. To improve IPC efforts, there is a clear need for more focused training, resources, and managerial support.