Healthcare-associated Infections Research Articles

Microorganisms isolated from thermoplastic masks and storage racks in head and neck cancer patients with radiation dermatitis.

Healthcare-associated infections (HAIs) remain a critical public health issue, as they contribute to prolonged treatment duration, increased healthcare costs, and heightened risks of morbidity and mortality. In head and neck cancer patients undergoing radiotherapy, thermoplastic masks (TMs), which come into direct contact with the skin, represent a potential vector for infection. Additionally, the storage racks where these masks are kept may also facilitate microorganism transmission. Our study aimed to isolate and identify microorganisms from infective skin lesions secondary to radiation dermatitis in head and neck cancer patients, as well as from the TMs and storage racks, and to evaluate the antibiotic resistance profiles of the isolated microorganisms. The study included 71 locally advanced head and neck cancer patients who underwent radiotherapy between August 2022 and November 2023. Patients were monitored daily, and their skin evaluations were made according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Grade 2 and 3 radiodermatitis was observed in 29 of these 71 patients. Samples were collected using sterile swabs from the skin lesions on the head and neck area, the inner surfaces of the TM, and the storage rack from 29 patients. Samples were inoculated into enrichment and selective media. After the growing microorganisms were identified, antimicrobial susceptibility was evaluated using conventional methods and automated systems according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. At least one type of microorganism was isolated from the skin samples of infected patients, and double growth was detected in two patients. Among the samples, 2 were methicillin-resistant coagulase-negative Staphylococcus (MRCNS), 1 was methicillin-resistant Staphylococcus aureus (MRSA), 1 was Candida albicans (C. albicans), 15 were methicillin-sensitive coagulase-negative Staphylococcus (MSCNS), 1 was methicillin-sensitive Staphylococcus aureus (MSSA), 1 was Bacillus subspecies (Bacillus spp.) and 3 were Corynebacterium diphtheriae (C. diphtheriae). Coagulase-negative Staphylococcus strains were isolated from the skin of 14 of 19 patients with grade 2 radiation dermatitis, whereas CNS strains were isolated from only 2 of 10 patients with grade 3 radiation dermatitis. Among the gram-negative bacteria, 3 Pseudomonas aeruginosa (P. aeruginosa), 2 Enterobacter cloacae (E. cloacae), 1 Klebsiella pneumoniae (K. pneumoniae) and 1 Moraxella catarrhalis (M. catarrhalis) strain were isolated. Sixteen (55.1%) of the TMs used in 29 patients and 20 (68.9%) of the storage racks harbored microorganisms, including HAI agents and flora bacteria. Bacteria colonize TMs and storage racks where they are risk factors for secondary skin infections in radiation dermatitis lesions that develop on the skin of head and neck cancer patients. Decontamination procedures should be meticulously applied to surfaces such as TMs and their storage racks during the course of radiotherapy.

Effects of establishing infection control program with core components of World Health Organization on reducing the risk of residents' infections and improving staff infection control competency in a nursing home.

Nursing homes (NHs) are high-risk facilities with limited infection control resources and residents susceptible to infectious diseases. The evidence regarding World Health Organization (WHO) core components in NHs is lacking. This study evaluates the effectiveness of establishing an infection prevention and control (IPC) program with WHO's core components in an NH. The IPC program, encompassing evidence-based guidelines, education and training, surveillance, multimodal strategies, monitoring and feedback, workload and staffing considerations, and the built environment, was implemented in a 130-bed NH for one year. The effects were assessed based on the number of infections among residents, the level of knowledge, and the performance of infection control among staff. The risk of infection was analyzed across three phases: pre-implementation phase, implementation phase (6 and 12 months after intervention initiation), and sustainability phase (3, 6, and 12 months after intervention was finished). Staff data were analyzed before and after the intervention. Analysis of 18,124 resident-days revealed that during the sustainability phase, the risk of respiratory tract infection was significantly lower than before intervention implementation (odds ratio [OR] 0.51, 95% CI 0.30-0.86, p = 0.012). Moreover, a significant improvement was observed in staff knowledge (p = 0.002) and performance (p < 0.001) after the intervention compared to before. WHO's core components may have a potential effect on reducing healthcare-associated infections among residents and enhancing the infection control competency of staff in the NH with limited IPC resources.

Safety of inpatient care in surgical settings: cohort study

ObjectivesTo estimate the frequency, severity, and preventability of adverse events associated with perioperative care, and to describe the setting and professions concerned.DesignMulticenter retrospective cohort study.Setting11 US hospitals.Participants1009 patients from a...

Patient hand hygiene experiences in a primary care centre in Ireland during COVID-19

The implementation of proper hand hygiene (HH) has been shown to reduce the risk of developing healthcare-associated infections. There is an increased awareness of the importance of HH since the onset of COVID-19. This study used an interpretive descriptive qualitative design to explore patients’ experiences of healthc workers’ (HCWs’) HH practices in a primary care centre in Ireland during COVID-19. The data were collected from 12 participants using in-depth, semi-structured interviews and analysed using reflexive thematic analysis. Two themes were constructed, each with two subthemes. Theme 1, ‘Focus and Awareness’, had the subthemes ‘Hand Hygiene and Patient’s Awareness’ and ‘Positive Effects of COVID-19’. Theme 2, ‘Breaking Barriers’, had the subthemes ‘Fear of Repercussions’ and ‘Responsibility and Empowerment’. Patients believed they should have a role when it comes to ensuring correct HH is performed during their episode of care. Barriers to this included the perceived reaction of HCWs to the feedback and a lack of knowledge of the five moments of hand hygiene.

Occurrence of Plasmid-Mediated Quinolone Resistance and Carbapenemase-Encoding Genes in Pseudomonas aeruginosa Isolates from Nosocomial Patients in Aguascalientes, Mexico

Pseudomonas aeruginosa is a leading cause of healthcare-associated infections, which are related to substantial morbidity and mortality. The incidence of Plasmid-Mediated Quinolone Resistance (PMQR) determinants has been previously reported in this bacterium. However, there is limited information regarding the presence of PMQR and carbapenemase-encoding genes simultaneously. This study aims to analyze the prevalence of these determinants on P. aeruginosa strain isolated from clinical patients in the State of Aguascalientes, Mexico. Fifty-two P. aeruginosa isolates from nosocomial patients were collected from Centenario Hospital Miguel Hidalgo. This is a retrospective observational study conducted at a single center. Antibiotic susceptibility was tested using the Vitek-2 system. Only carbapenem-resistant isolates were included in this study. Carbapenemase-encoding genes and PMQR determinants were screened by polymerase chain reaction (PCR). Resistance rates of 100% were found on tigecycline and ceftriaxone. Of the 52 isolates, 34.6% were positive for the qnr genes, 46.2% for the oqxA gene, and 25% for the aac-(6′)-lb gene. The most frequent carbapenemase genes found in the samples were blaOXA-51 (42.3%), blaOXA-1 (15.4%), and blaVIM (15.4%). blaOXA-51 co-carrying oqxA was detected in 21.1% of the isolates, blaOXA-51 co-carrying aac-(6’)-lb in 11.5%, blaVIM co-carrying aac-(6′)-lb in 3.8%, and blaKPC co-carrying oqxA in 5.8%. Systematic surveillance to detect carbapenemase-encoding genes and PMQR determinants, and rational prescription using the last-line drugs could help in preventing the dissemination of multidrug-resistant determinants.

Prevention and Treatment of Neonatal Infections in Facility and Community Settings of Low- and Middle-Income Countries: A Descriptive Review

Introduction: We present a robust and up-to-date synthesis of evidence on the effectiveness of interventions to prevent and treat newborn infections in low- and middle-income countries (LMICs). Newborn infection prevention interventions included strategies to reduce antimicrobial resistance (AMR), prevention of healthcare-associated infections (HAIs), clean birth kits (CBKs), chlorhexidine cleansing, topical emollients, and probiotic and synbiotic supplementation. Interventions to treat suspected neonatal infections included prophylactic systemic antifungal agents and community-based antibiotic delivery for possible serious bacterial infections (PSBIs). Methods: A descriptive review combining different methodological approaches was conducted. To provide the most suitable recommendations for real-world implementation, our analyses considered the impact of these interventions within three distinct health settings: facility, mixed, and community. Results: In facility settings, the strongest evidence supported the implementation of multimodal stewardship interventions for AMR reduction and device-associated infection prevention bundles for HAI prevention. Emollients in preterm newborns reduced the risk of invasive infection compared to routine skin care. Probiotics in preterm newborns reduced neonatal mortality, invasive infection, and necrotizing enterocolitis (NEC) risks compared to standard care or placebo. There was insufficient evidence for synbiotics and prophylactic systemic antifungals in LMICs. In mixed settings, CBKs reduced neonatal mortality risk compared to standard care. In community settings, chlorhexidine umbilical cord cleansing reduced omphalitis risk compared to dry cord care. For the treatment of PSBIs, purely domiciliary-based antibiotic delivery reduced the risk of all-cause neonatal mortality when compared to the standard hospital referral. Conclusion: Strategies for preventing HAIs and reducing AMR in healthcare facilities should be multimodal, and strategy selection should consider the feasibility of integration within existing newborn care programs. Probiotics are effective for facility-based use in preterm newborns; however, the establishment of high-quality, cost-effective mass production of standardized formulations is needed. Chlorhexidine cord cleansing is effective in community settings to prevent omphalitis in contexts where unhygienic cord applications are prevalent. Community-based antibiotic delivery of simplified regimens for PSBIs is a safe alternative when hospital-based care in LMICs is not possible or is declined by parents. More randomized trial evidence is needed to establish the effectiveness of CBKs, emollients, synbiotics, and prophylactic systemic antifungals in LMICs.

Are we doing enough to control infection risk in Australian small animal veterinary practice? Findings from a mixed methods study

BackgroundManaging risk effectively within small animal veterinary practice is integral for staff, patient and client safety. Veterinary personnel are exposed to many risks, including bites, scratches, sharps injuries and exposure to zoonotic diseases and multi-resistant organisms. Patients may also be exposed to healthcare-associated infections, including multi-resistant organisms. While veterinary owners/managers have a duty of care under legislated Workplace Health and Safety requirements, all staff have a responsibility to contribute to assessing and minimizing risk. The application of standard and transmission precautions will help with risk minimization. This study aimed to determine how small animal veterinary staff understand and perceive infection prevention and control risk and to provide recommendations to assist with risk mitigation.MethodsA mixed methods design was used. A digital questionnaire was administered to small animal veterinary staff in Australia to identify knowledge, attitudes and practices of risk related behaviors. Follow up focus groups were conducted with small animal practitioners to explore factors supporting and preventing veterinary staff from implementing recommended practices identified in the questionnaire.ResultsSmall animal veterinary staff acknowledged they participated in many high-risk activities, including recapping needles and eating and drinking in patient care areas. Injuries were common, with 77% of staff receiving a bite or scratch, and 22% receiving a sharps injury in the preceding six months. Less than one in five of these incidents was reported. Staff agreed effective infection prevention and control was the responsibility of all staff, but a designated staff member should take responsibility for managing it. The practice owner/manager was integral to supporting and promoting recommended strategies, contributing to a positive workplace culture and improving safety for staff and patients.ConclusionSmall animal veterinary staff have some understanding of how to identify, report, manage and mitigate risk but were limited by their knowledge of infection prevention and control principles.

Microbial Trends and their Drug Resistance Responsible for Bloodstream Infections in a Superspeciality Transplant Hospital

Background &amp; Objective: Bloodstream infections (BSIs) are critical healthcare-associated infections that lead to high morbidity and mortality, requiring rapid diagnosis and effective antimicrobial treatment. The increasing prevalence of multidrug-resistant organisms (MDROs) exacerbates this issue, particularly in developing countries. The purpose of this study is to assess the bacteriological profile and antimicrobial susceptibility trends of BSIs to establish an antibiogram for effective empirical treatment. Materials and Methods: This study was conducted retrospectively on 3,300 blood culture samples from a multispecialty hospital over 15 months. Cultures were performed using Bactec FX and identification and antibiotic susceptibility determined by Vitek2 and Kirby-Bauer methods following CLSI guidelines. Results: Overall, the positivity rate was (14.3%) with 473 isolates: (400 bacterial and 73 fungal). Gram-negative bacteria were predominant, led by Klebsiella pneumoniae (113 isolates) and Escherichia coli (100 isolates). Among the Gram-negative bacteria, antimicrobial susceptibility was found to be low for Cephalosporins (21%sensitivity) and Fluoroquinolones (19.3% sensitivity), with moderate susceptibility to Carbapenems (51.3%). Sensitivity was high for Colistin (98.9%), Amikacin (91.05%), Tigecycline (100%), Fosfomycin (100%) and Ceftazidime-avibactum Aztreonam (97.7%). Among Gram-positive bacteria, Coagulase-negative Staphylococcal Species (CONS) and Staphylococcus aureus were the most common. The overall sensitivity of Gram-positive bacteria to antibiotics tested was high compared to the Gram-negative bacteria. Sensitivity to antibiotics such as Linezolid was found to be 94.5% and Vancomycin was found to be 93.5%. Conclusion: The high incidence of MDROs especially among the Gram-negative bacteria highlights the need for continuous monitoring and antibiotic stewardship programs. Empirical therapy must consider local resistance patterns, and a multidisciplinary approach is essential to mitigate antimicrobial resistance.

Prevalence of surgical site infections in a tertiary care teaching hospital in Goa, India: a cross-sectional study

Background: Surgical site infections (SSIs) are a major category of healthcare-associated infections (HAIs), particularly in surgical settings. They lead to extended hospital stays, increased morbidity, and financial burden. The study was conducted in the surgical wards of Goa medical college, a tertiary care hospital, to assess the prevalence of SSIs and identify the key bacterial pathogens and associated risk factors. Methods: A cross-sectional, prospective study design was employed, involving 378 patients aged over 18 years admitted for surgical procedures. Data collection included daily follow-up for signs of infection, identification of bacterial pathogens, and analysis of potential risk factors such as age, type of surgery, duration of postoperative drain, length of hospital stays, and wound classification. Statistical analyses were conducted using SPSS software, with significance set at p&lt;0.05. Results: The study identified an SSI prevalence of 12.69% among the participants, with Pseudomonas being the most common causative agent. Significant risk factors included extended postoperative drain duration, longer hospital stays, emergency surgical procedures, and surgeries involving contaminated or clean-contaminated wounds. Patients with prolonged postoperative drains had a markedly higher incidence of SSIs (63.63%). Conclusions: The findings reveal a considerable burden of SSIs in the studied setting, with high infection rates in patients undergoing prolonged drain usage, emergency surgeries, and surgeries on contaminated wounds. Strengthening infection prevention measures, particularly in high-risk cases, and enforcing strict adherence to hygiene and sterilization practices are critical. Enhanced infection surveillance programs and targeted interventions could help reduce SSI rates, improve patient outcomes, and minimize healthcare costs.

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

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. 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. 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. 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). 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.

Clostridioides difficile infections caused by hypervirulent strains: a single-centre real-life study.

Clostridioides difficile infection (CDI) is a leading cause of healthcare-associated infections worldwide, with hypervirulent strains linked to severe disease and higher mortality. This study aims to analyze the epidemiology of CDI at a tertiary-care hospital in Italy and compare clinical outcomes between patients infected with hypervirulent and non-hypervirulent strains. A retrospective comparative study was conducted on patients diagnosed with CDI at ASST Spedali Civili di Brescia, Italy, from January 2015 to June 2023. Hypervirulent strains were identified using the GeneXpert assay as positive for cytotoxin gene (tcdB), binary toxin genes (tcdA and tcdB) and a single nucleotide deletion at position 117 in the tcdC gene and compared to a randomized matched control group with non-hypervirulent CDI. Clinical data were collected and analyzed, with multivariate logistic regression employed to identify risk factors for hypervirulent CDI. Of 1,059 positive C. difficile specimens, a statistically significant trend between January 2015 to June 2023 was found in the increasing incidence of CDI cases per 1,000 hospital admissions and 10,000 bed-days. Notably, a remarkable increase of hypervirulent strains was recorded in 2021 and 2022 when compared to previous years. A total of 130 patients were analyzed: 62 (47.7%) with hypervirulent CDI and 68 (52.3%) controls. Hypervirulent CDI was associated with higher 30-day mortality (18% vs. 5.8%, p = 0.03). Multivariate analysis showed that hypervirulent CDI significantly increased 30-day mortality risk (OR = 9.915, CI = 2.37-61.05, p = 0.005) and that prior antibiotic therapy was a significant risk factor (OR = 5.49, CI = 1.19-39.96, p = 0.047). Our epidemiological data, while suggesting a potential resurgence in CDI transmission during COVID-19 pandemic, are derived from a single-center experience with limited generalizability to the broader population. Nonetheless, they highlight the need for strengthened antimicrobial stewardship and national surveillance systems to effectively monitor and manage these strains.

A Point Prevalence Survey of Antimicrobial Use in Second-Level Mexican Hospitals: A Multicenter Study

In 2018, the WHO published a methodology for conducting a point prevalence survey (PPS) of antibiotic use in hospitals. The aim of this study is to report the use of antibiotics in six second-level hospitals in Mexico using this methodology. Methods: A multicenter cross-sectional study based on the 2021–2023 adaptation for Latin American hospitals was conducted in internal medicine, surgery, intensive care unit (ICU), obstetrics and gynecology and pediatrics departments of the IMSS in the western region of the state of Mexico. Results: The overall prevalence of antibiotic use was 61%; the services with the highest prevalence of prescription were general surgery (79%) and the ICU (78%). A total of 846 patients were surveyed; there were no differences in antibiotic use or non-use in terms of gender, surgical procedure and invasive devices, but there were differences in median age and comorbidities. Adherence to guidelines was 53.9%. The three main antibiotics used were third-generation cephalosporins (28%), carbapenems (13%) and glycopeptides (9%); for the type of indication, for CAI and prophylaxis, the rates of use of third-generation cephalosporins were 29.2% and 44.5%, respectively, while for healthcare-associated infections, carbapenems were used (23.9%). By AWaRe group, the watch group was predominant for all types (63.9%), for prophylaxis it was the access group (39.3%), and for HAIs it was the reserve group (4.9%).

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.

Investigating the changing taxonomy and antimicrobial resistance of bacteria isolated from door handles in a new infectious disease ward pre- and post-patient admittance.

Healthcare-associated infections (HAIs) are a significant burden to health systems, conferring increased morbidity, mortality, and financial costs to hospital admission. Antimicrobial resistance (AMR) further compounds the issue as viable treatment options are constrained. Previous studies have shown that environmental cleaning interventions reduced HAIs. To ensure the effectiveness of these, it is important to analyze the hospital environment at a microbial level, particularly high-touch surfaces which see frequent human interaction. In addition to identifying infectious microorganisms, it is also beneficial to assess typically non-infectious organisms, as traits including AMR can be transferred between the two. Our study identified that there were high levels of antibiotic resistance in typically non-infectious organisms found on high touch surfaces on a hospital ward. However, the organisms identified suggested that the cleaning protocols in place were sufficient, with their presence being due to repeated recolonization events through human interaction after cleaning had taken place.

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.

Factors related to health care-associated infections in an adult intensive care unit in Peru

Factors related to health care-associated infections in an adult intensive care unit in Peru

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.