Implementing Infection Prevention Research Articles

How Effective Are In-Hospital Training Workshops on Infection Control for Physicians? First Report in Iran

Background: The treatment staff should properly understand infection prevention and control (IPC) methods. Adherence to IPC has significant implications and outcomes for maintaining treatment staff safety, patient protection, and environmental care. Objectives: This study was conducted to examine infection control training in doctors. Methods: This study was conducted in Imam Khomeini Hospital in Tehran, Iran, and practitioners in internal and surgical departments participated. The research focused on infection prevention and control (IPC) through specialized workshops and questionnaires using a pre-and post-test design. The sessions included topics such as infection control, transmission, hospital-acquired infections, and components of the IPC program. Questionnaires based on the KAP method evaluated participants' knowledge, attitude, and performance. This study was approved by the university's research vice department and the research ethics committee. Data were analyzed using SPSS software, and the significance of P < 0.05 was emphasized. Results: Of the 251 medical residents, 189 completed the study, 122 of whom were in internal medicine and 67 in surgery. Among the 158 faculty members, 60 completed the study, 39 were in internal medicine, and 21 were in surgery. The mean pre-test scores for internal medicine residents were 15.63 (out of 30) and 13.11 for surgical residents, respectively, which increased to 22.41 and 18.09 in the post-test. Conclusions: The results showed that regular and standard periodic training can improve doctors' knowledge and performance in implementing infection prevention and control programs.

A cross-sectional study of SARS-CoV-2 antibodies among healthcare workers in a tertiary care hospital in Taiwan: implications for protection against the Omicron variants

BackgroundTaiwan, deeply impacted by the 2003 SARS outbreak, promptly implemented rigorous infection control and prevention (ICP) measures in January 2020 to combat the global COVID-19 pandemic. This cross-sectional serologic study was conducted among healthcare workers (HCWs) in a tertiary care hospital in Taiwan from August 1, 2022, to February 28, 2023. The study aimed to assess HCWs’ antibody responses to COVID-19 vaccination against Omicron subvariants BA.1, BA.4, and BA.5, considering variations in prior infection. Additionally, it evaluated the effectiveness of ICP and vaccination policies within the hospital setting in Taiwan.MethodsA cross-sectional serology study was conducted in Taiwan to investigate the seroprevalence rates of Omicron subvariants BA.1, BA.4, and BA.5 among HCWs. A total of 777 HCWs participated in this study. A structured questionnaire was collected to obtain the epidemiological characteristics and risk factors for potential exposure. Enzyme-linked immunosorbent assay was used to detect antibody responses. Serum samples were selected for protection against Omicron subvariants BA.1, BA.4, and BA.5 by using a pseudotyped-based neutralization assay.ResultsMore than 99% of the participants had received SARS-CoV-2 vaccination. Overall, 57.7% had been infected with SARS-CoV-2, with some being asymptomatic. The SARS-CoV-2 Anti-Spike S1 protein IgG (Anti-S) distribution was 40,000 AU/mL for 20.2% (157/777) of participants, with a mean ± standard deviation of 23,442 ± 22,086. The decay curve for Anti-S was less than 20,000 AU/ml after 120 days. The probability curve of 50% neutralization showed an Anti-S of 55,000 AU/ml. The optimum Anti-S was 41,328 AU/mL (equal to 5,869 WHO’s standard BAU/mL), with 86.1% sensitivity and 63.5% specificity.ConclusionsIn this significant study, 20.2% of HCWs achieved seroprotection against Omicron subvariants BA.1, BA.4, and BA.5. Their immunity against Omicron subvariants was further reinforced through recommended vaccinations and the development of natural immunity from SARS-CoV-2 exposure, collectively enhancing their protection against Omicron.

Striving for Improved Infection Prevention and Control Practice: A Grounded Theory of Healthcare Workers' Struggles in Implementing Infection Prevention and Control Guidance in Uganda.

There is a scarcity of qualitative research focusing on the implementation of infection prevention and control (IPC) guidance in low-income countries. This study aimed to address this gap by exploring the perspectives of healthcare workers (HCWs) regarding the implementation of IPC guidance at the healthcare facility level in Uganda. The study also sought to generate a theoretical understanding of the processes involved in implementing IPC guidance in these settings. This robust qualitative research employed a design based on constructivist grounded theory methodology, conducting individual interviews with 13 frontline health workers such as doctors, nurses, nurse interns, and laboratory staff. The key findings of the study revealed that HCWs undergo a process of 'striving for improved practice' in their efforts to implement IPC guidance. This process involved four phases: recognising the importance of IPC, playing a role, encountering challenges, and overcoming challenges. However, achieving full implementation proved difficult due to various individual and organisational barriers presented by the low-income setting. HCWs employed improvisation as a means to overcome these obstacles. Additionally, the study identified enabling factors that facilitated the implementation of IPC guidance within these settings. This study is significant as it applies robust qualitative research methods to provide valuable evidence of HCWs' perspectives on an important topic in an under-researched context, with findings transferable to similar settings.

Relationship between oral health literacy and changes in self-assessment of oral health during COVID-19

Background/purposeHealth literacy is thought to play a major role in implementing health behaviors, such as preventing coronavirus disease 2019 (COVID-19). In this study, we aimed to examine the relationship between oral health literacy (OHL), dietary literacy (DL), and changes in oral health and eating habits during the COVID-19 pandemic. Materials and methodsThe self-assessment questionnaire, including questions on oral and dietary conditions for each period of the COVID-19 pandemic, sources of information, OHL, DL, and frequency of COVID-19 prevention measures, was administered using a web research company. All participants were divided into low- and high-literacy groups based on the median scores: those who scored above the median in the high group and those who scored at or below the median in the low group. Comparisons were conducted between the two groups. ResultsThe median OHL and DL scores were 16 and 17 for the 344 participants included in the study (168 males and 176 females); 160 (46.5%) participants had high OHL scores, and 157 (45.6%) had high DL scores. The group with high OHL or DL tended to collect information sent by medical professionals compared to the group with low OHL or DL, had significantly higher scores on self-assessment of oral and dietary conditions, and tended to implement infection control actions more frequently in eating situations. ConclusionThe high OHL and DL groups gathered information from professionals to have attain oral and dietary conditions regardless of COVID-19 and tended to implement infection prevention measures in oral health and diet.

Prevalence of surgical site infection in orthopedic procedures, in an institution in the municipality of Pereira, 2022

Background The acquisition of healthcare-associated infections (HAI) is characterized by developing during the patient’s hospital stay and even after the hospital stay during the recovery period, as long as it is due to factors intrinsic to the hospitalization or medical treatment of the entity, as well as surgical techniques that require prophylactic treatment and medical surveillance. Methods Type and design of research: Quantitative, observational, descriptive, cross-sectional, retrospective. The population and sample is made up of patients who underwent orthopedic surgery in an institution in the municipality of Pereira, between January and December 2022. Results The results showed that there are significant differences between genders in the incidence of certain medical conditions and response to certain treatments. Women appear to be more prone to deep infections, use more chlorhexidine as an antiseptic, and show a higher prevalence of pathologic conditions compared to men. In addition, differences in the distribution of ASA classification and surgical wound type suggest possible health disparities between genders in the context of orthopedic surgery. Conclusions The importance of implementing infection prevention and control strategies adapted to specific contexts is evident. Despite the differences in the risk factors identified, both studies highlight the importance of optimizing antibiotic prophylaxis and adequately managing specific comorbidities to reduce the incidence of postsurgical infections. Furthermore, attention to perioperative surveillance and surgical time management are suggested as key areas to improve surgical outcomes in both cohorts of patients, as they can contribute significantly to the reduction of the incidence of SSIs in patients undergoing orthopedic procedures.

Difficult-to-treat (DTR) Pseudomonas aeruginosa harboring Verona-Integron metallo-β-lactamase (blaVIM): infection management and molecular analysis.

Pseudomonas aeruginosa harboring Verona Integron-encoded metallo-β-lactamase enzymes (VIM-CRPA) have been associated with infection outbreaks in several parts of the world. In the US, however, VIM-CRPA remain rare. Starting in December 2018, we identified a cluster of cases in our institution. Herein, we present our epidemiological investigation and strategies to control/manage these challenging infections. This study was conducted in a large academic healthcare system in Miami, FL, between December 2018 and January 2022. Patients were prospectively identified via rapid molecular diagnostics when cultures revealed carbapenem-resistant P. aeruginosa. Alerts were received in real time by the antimicrobial stewardship program and infection prevention teams. Upon alert recognition, a series of interventions were performed as a coordinated effort. A retrospective chart review was conducted to collect patient demographics, antimicrobial therapy, and clinical outcomes. Thirty-nine VIM-CRPA isolates led to infection in 21 patients. The majority were male (76.2%); the median age was 52 years. The majority were mechanically ventilated (n = 15/21; 71.4%); 47.6% (n = 10/21) received renal replacement therapy at the time of index culture. Respiratory (n = 20/39; 51.3%) or bloodstream (n = 13/39; 33.3%) were the most common sources. Most infections (n = 23/37; 62.2%) were treated with an aztreonam-avibactam regimen. Six patients (28.6%) expired within 30 days of index VIM-CRPA infection. Fourteen isolates were selected for whole genome sequencing. Most of them belonged to ST111 (12/14), and they all carried blaVIM-2 chromosomally. This report describes the clinical experience treating serious VIM-CRPA infections with either aztreonam-ceftazidime/avibactam or cefiderocol in combination with other agents. The importance of implementing infection prevention strategies to curb VIM-CRPA outbreaks is also demonstrated.

Clinical and immunologic features of co-infection in COVID-19 patients, along with potential traditional Chinese medicine treatments.

With the increasing number of people worldwide infected with SARS-CoV-2, the likelihood of co-infection and/or comorbidities is rising. The impact of these co-infections on the patient's immune system remains unclear. This study aims to investigate the immunological characteristics of secondary infections in hospitalized COVID-19 patients, and preliminarily predict potential therapeutic effects of traditional Chinese medicine and their derivatives for the treatment of co-infections. In this retrospective cohort study, we included 131 hospitalized patients with laboratory-confirmed COVID-19, of whom there were 64 mild and 67 severe cases. We analyzed clinical characteristics and immunologic data, including circulating immune cell numbers, levels of inflammatory factors and viral load, comparing COVID-19 patients with and without co-infection. Among 131 hospitalized COVID-19 patients, 41 (31.3%) were co-infection positive, with 33 (80.5%) having severe disease and 14 (34.1%) of them resulting in fatalities. Co-infected patients exhibited significantly higher severity and mortality rates compared to non-co-infected counterparts. Co-infected patients had significantly lower absolute counts of lymphocytes, total T lymphocytes, CD4+ T cells, CD8+ T cells and B lymphocytes, while levels of hs-CRP, PCT and IL-6 were significantly elevated compared to non-co-infected patients. Additionally, the viral load of co-infected patients was significantly higher than non-co-infected patients. Co-infection emerges as a dangerous factor for COVID-19 patients, elevating the risk of severe pneumonia and mortality. Co-infection suppresses the host's immune response by reducing the number of lymphocytes and increasing inflammation, thereby diminishing the antiviral and anti-infective effects of the immune system, which promotes the severity of the disease. Therefore, it is crucial to implement infection prevention measures to minimize the spread of co-infections among COVID-19 hospitalized patients. Additionally, changes in these biomarkers provide a theoretical basis for the effective treatment of co-infections with traditional Chinese medicine.

Unraveling the epidemiology of urinary tract infections in neonates: Perspective from a Brazilian NICU

BackgroundUrinary tract infections (UTIs) can lead to neonatal complications like sepsis, worsened by empirical treatment, contributing to antimicrobial resistance (AMR). This study examined the incidence, etiology, risk factors, and antimicrobial susceptibility of uropathogens in a Neonatal Intensive Care Unit (NICU) in Brazil. MethodsMedical records of neonates hospitalized in the NICU from January 2015 to June 2022 were retrospectively analyzed through the National Healthcare Safety Network system. ResultsAmong 1,474 neonates, 3.9% developed UTI, with an alarming 24-fold increase in incidence from 2015 to 2021. Genitourinary complications (odds ratio = 4.8) were a major risk factor. Of the 71 uropathogens, 74.6% were Gram-negative bacteria (GNB), 21.2% Gram-positive bacteria (GPB), and 4.2% Candida albicans. AMR was notable, with 13.3% of GPB and 20.7% of GNB exhibiting multidrug-resistant (MDR), while 6.6% of GPB and 1.9% of GNB showed extensive drug-resistant (XDR). UTI was associated with prolonged hospitalization (16-59 days). In 57 neonates with UTI, 40.3% had bloodstream infections, elevating the risk of death (odds ratio = 1.8). ConclusionsThe study underscores the urgency of implementing infection prevention and control measures in the NICU to curb rising UTI incidences, combat AMR, and mitigate severe complications in critically ill neonates.

Link of Infection Prevention Climate to Patient-Centered Care: Role of Workplace Safety and Risk Mitigation.

Healthcare-associated infections pose a substantial threat to the quality of healthcare services. Consequently, it is imperative for hospital organizations to actively support an infection prevention climate, fostering workplace safety and risk mitigation, thereby promoting patient-centered care. This study aims to explore the interconnectedness between the infection prevention climate, workplace safety, risk mitigation, and patient-centered care. A cross-sectional study design was employed, utilizing a questionnaire administered to 235 healthcare professionals in intensive care and inpatient units at Bandung Kiwari Regional General Hospital. Data analysis was conducted using partial least squares structural equation modeling (PLS-SEM) with SmartPLS 4 and SPSS 25. The study revealed several significant relationships, including (1) between infection prevention climate and patient-centered care; (2) infection prevention climate and workplace safety; (3) workplace safety and patient-centered care; (4) infection prevention climate and patient-centered care mediated by workplace safety; (5) infection prevention climate and risk mitigation; (6) risk mitigation and patient-centered care; (7) and the relationship between infection prevention climate and patient-centered care mediated by risk mitigation. Infection prevention climate emerges as a crucial intangible value that hospital organizations can cultivate to shape workplace safety. This, in turn, encourages healthcare workers' compliance in implementing infection prevention controls as a form of risk mitigation, ultimately contributing to the provision of patient-centered care.

High Gastrointestinal Colonization Rate of Vancomycin-Resistant Enterococci among Hospitalized Patients: Potential Source for Resistant Gene.

Vancomycin-resistant Enterococci (VRE) is a global health problem and responsible for healthcare-associated infections (HAIs) in patients with prolonged hospital stay, severe underlying disease, and previous broad-spectrum antibiotic therapy. These bacteria can cross-resist and transfer drug-resistant genes to other potentially pathogenic bacteria. Therefore; this study was aimed to determine the gastrointestinal colonization rate of VRE, its antimicrobial susceptibility profile, and associated factors among hospitalized patients. Prospective cross-sectional study was conducted using stool samples from 223 patients admitted to different wards at Hawassa University Comprehensive Specialized Hospital, from April 1 to June 30, 2021. Patients admitted to the hospital for more than 48 hours for various medical conditions were included. Sociodemographic and clinical characteristics were collected using a structured questionnaire. Fecal specimens were cultured on Enterococci selective media. Enterococcus species were identified using their growth and mannitol fermentation properties. Vancomycin resistance was screened using both the Kirby-Bauer disk diffusion method and a vancomycin E-test strip. Data were entered and analyzed using SPSS version 25. Descriptive and logistic regressions were used to determine the frequency and association of factors with the VRE colonization rate. A p value of <0.05 was considered statistically significant. A total of 223 fecal specimens were collected and processed, and 141 (63.2%) them were positive for Enterococci. The predominant species was E. faecalis 65 (46.1%) followed by E. faecium 76 (53.9%). In this study, the gastrointestinal colonization rate of VRE was 15 (6.7%) and all the species belong to E. faecium. Study participants who had no formal education (AOR = 4.26, 95% CI: 1.01, 18.06), hospitalized patients for >2 weeks (AOR = 4.10, 95% CI: 1.08, 15.57), and those who had a history of treatment with vancomycin (AOR = 4.77, 95% CI: 1.26, 18.09) were more likely to be colonized with vancomycin-resistant Enterococci. More than 95% of Enterococci isolates were susceptible to linezolid, whereas 70.2%, 63.1%, 56.7%, and 53.9% were resistant to tetracycline, erythromycin, penicillin, and ampicillin, respectively. Among the total Enterococci isolated, 141 (54.6%) were multidrug resistant. In our study, high proportion of vancomycin-resistant Enterococci was found. Previous exposure to antibiotics and hospital stay were significant factors for VRE gut colonization. The isolated Enterococci showed variable degrees of resistance to commonly prescribed antibiotics which leads to a worldwide problem multidrug resistance. Therefore, periodic surveillance on antimicrobial resistance pattern, adhering to rational use of antibiotics, and implementing infection prevention protocols may reduce colonization by VRE.

Phenotypic detection of carbapenem-resistant Enterobacterales in clinical isolates at a tertiary care hospital

Abstract Background: In the past decade, there has been a global emergence of carbapenem-resistant Gram-negative bacilli, especially Enterobacterales. Carbapenem resistance is attributed to the ability of the bacteria to produce carbapenemases. The aim of the study is to detect carbapenem-resistant Enterobacterales (CRE) in different clinical isolates and study carbapenemase production by phenotypic methods in CRE. Materials and Methods: A total of 379 Enterobacterales were isolated from different clinical samples from patients attending outpatient departments and admitted in wards and intensive care units (ICUs). They were tested for carbapenem resistance by Kirby–Bauer disk diffusion method and then tested for carbapenemase production by ethylenediaminetetraacetic acid (EDTA)–disk synergy test and Modified Carbapenem Inactivation Method (mCIM). Results: This study was conducted from February 2021 to August 2022. Out of 379 Enterobacterales, 70 (18.47%) were CRE, out of which maximum carbapenem resistance of 23.53% was shown by Klebsiella pneumoniae isolates. The maximum carbapenem resistance was seen in the age group of 16–45 years and the most number of CRE isolates were from ICUs. Phenotypic test results indicated that 54.28% (38/70) of isolates were positive for carbapenemase production by either of the phenotypic methods. Conclusion: About one-fifth of the Enterobacterales isolates were carbapenem resistant. This study highlights the use of phenotypic methods to detect carbapenemase production in CRE, which is responsible for multidrug resistance. This information is relevant for surveillance, to implement infection prevention and control practices and antibiotic policies.

Program of All-Inclusive Care for the Elderly (PACE) Organizations Flip the Script in Response to the COVID-19 Pandemic

ObjectivesProgram of All-Inclusive Care (PACE) organizations faced unique challenges during the COVID-19 pandemic, particularly given PACE participants are frail older adults who often live with multiple disabilities and chronic conditions. This study describes how PACE programs leveraged their unique program flexibilities and adapted services to manage this crisis. DesignMixed methods. Setting and ParticipantsThis study leveraged 2 national surveys of PACE directors (with response rates of 71.2% and 67.8%) and 6 qualitative interviews. MethodsDescriptive and univariate analyses of survey response data and thematic analyses of qualitative data from interviews and open-ended survey questions were conducted. ResultsResults indicated that PACE organizations responded rapidly to the COVID-19 pandemic, implementing a range of adaptations that shifted the PACE model from primarily center-based to a home-based model of care. Most PACE organizations reported increasing the in-home services they provided, often accomplishing this through the redeployment of center-based staff. PACE organizations likewise leveraged telehealth and remote monitoring to increase support to beneficiaries in their home, implemented various COVID-19 vaccine and infection prevention efforts, increased food and nutrition services provided in the home, and took steps to address social isolation and boredom, among other initiatives. Most PACE organizations indicated they plan to continue delivering more services in the home, consistent with participant preferences. Conclusions and ImplicationsThe findings from this study indicate that PACE organizations continued to keep participants at the forefront as they transitioned to a home-based model during the COVID-19 pandemic. Key characteristics of PACE, including its strong emphasis on person-centered team-based care, its fully integrated service model, and its flexible capitated payment structure, contributed to the resilience of the program. These findings highlight PACE organizations' ability to empower nursing home–eligible older adults to remain living in their preferred residential setting and have implications for how best to serve this population.

An overview of Candida auris in Iraq: the silent killer

Candida auris is an emerging pathogen known for its high mortality compared to other fungal diseases in healthcare units. Since its initial description in Japan in 2009, C. auris has been reported worldwide, including in Middle Eastern countries. Iraq, one of the Middle Eastern countries, does not seem to have adequately addressed C. auris as a serious emergent pathogen in the healthcare units, especially since numerous healthcare facilities in the Middle Eastern region have reported C. auris infections. Additionally, this pathogen poses unique challenges in the area due to its ability to resist multiple antifungal agents, causing serious invasive infections with high mortality rates. Efforts to control C. auris in Middle Eastern countries have primarily focused on infection surveillance, implementing infection prevention and control measures, and developing regional guidelines for diagnosis and management. However, the challenges associated with its detection, including misidentification and a lack of standardized diagnostic methods, have complicated these efforts. Understanding the epidemiology and molecular characteristics of C. auris in the Middle East is crucial for effective management and control. In conclusion, the combination of its multidrug resistance, high mortality rate, and the challenges of detecting and treating C. auris requires immediate attention and the implementation of comprehensive surveillance and prevention strategies, especially in Iraq. Despite concerted efforts by health agencies and national authorities, Iraq lacks a comprehensive surveillance system and a clear strategy to combat this pathogen effectively, making this fungus a significant threat to Iraq's healthcare systems.

1248. Implementing Infection Prevention and Control with Antimicrobial Stewardship in a Tertiary Care Hospital in India: An Interprofessional Education and Collaborative Practice Approach

Abstract Background Infection Prevention &amp; Control (IPC) along with Antimicrobial Resistance (AMR) has complex problems, it requires distinctive disciplinary efforts. There are few data concerning the facilitators and barriers in India. Interprofessional practice and education (IPE &amp; IPP) initiatives amongst various stakeholders is one amongst them. Current approaches to IPC &amp; AMR are fragmented and unidisciplinary, more like ''An Elephant and the Blind Men'. Hence the need of this structured study. Methods We conducted a prospective interventional study for one year with an interprofessional team. After institutional ethical committee clearance, an Antimicrobial Stewardship team was formed which devised training modules validated by Delphi technique /&amp; ADDIE (Analyze, Design, Develop, Implement &amp; Evaluate) approach by the Infection Control Committee and external resource persons. Simulated sessions, case based discussions, patient education videos &amp; pamphlets, online interactive classrooms, ward &amp; laboratory rounds were instituted for all doctors, staff nurses, laboratory technicians, pharmacists, and patients. Key quality indicators for antimicrobials prescription &amp; consumption was defined and monitored. High end antimicrobial policy was implemented. Checklists &amp; surveillance forms were put in use. Feedback surveys and audits were conducted to assess the effectiveness of these interventions. Results We observed a statistically significant increase in compliance to hand hygiene, health care associated infections (HAI) monitoring, reporting of needle stick injury, adherence to isolation protocols, and antibiotic policy (P value&amp;lt; 0.001) across all units. Maximum compliance to antibiotic policy was observed in medical intensive care units, least in nephrology &amp; neonatal intensive care. Pre-test &amp; post-test questionnaires were used for assessment. An improvement of ∼78 % in the knowledge domain was seen after the sessions. Key quality indicators for HAIs showed statistically significant improvement (P value&amp;lt; 0.001). Conclusion A multimodal interprofessional approach aids the training aspect of IPC &amp; AMSP. Such structured programs in the curriculum addresses the silent pandemic of health care associated infections and antimicrobial resistance. Disclosures All Authors: No reported disclosures

An Overview on Candida auris in Healthcare Settings.

Candida auris has become a major concern in critical care medicine due to the increasing number of immunocompromised patients and candidiasis is the most frequent cause of fungal infections. C. auris and other fungal pathogens are responsible for at least 13 million infections and 1.5 million deaths globally per year. In immunocompromised patients, infections can quickly become severe, causing wound infections, otitis and candidemia, resulting in high morbidity and mortality. The clinical presentation of C. auris is often non-specific and similar to other types of systemic infections; in addition, it is harder to identify from cultures than other, more common types of Candida spp. Some infections are particularly difficult to treat due to multi-resistance to several antifungal agents, including fluconazole (and other azoles), amphotericin B and echinocandins. This entails treatment with more drugs and at higher doses. Even after treatment for invasive infections, patients generally remain colonized for long periods, so all infection control measures must be followed during and after treatment of the C. auris infection. Screening patients for C. auris colonization enables facilities to identify individuals with C. auris colonization and to implement infection prevention and control measures. This pathogenic fungus shows an innate resilience, enabling survival and persistence in healthcare environment and the ability to rapidly colonize the patient's skin and be easily transmitted within the healthcare setting, thus leading to a serious and prolonged outbreak.

Central Line Associated Bloodstream Infections in Critical Ill Patients during and before the COVID-19 Pandemic.

(1) Background: The purpose of this study was to evaluate the impact of the COVID-19 pandemic on the rates of central line-associated bloodstream infections (CLABSI), its etiology, and risk factors in critically ill patients, because Slovakia was one of the countries experiencing a high burden of COVID-19 infections, and hospitals faced greater challenges in preventing and managing CLABSI; (2) Methods: A retrospective analysis of CLABSI data from all patients admitted to adult respiratory intensive care units before and during COVID-19 pandemic was conducted. We followed the guidelines of the Center for Disease Control surveillance methodology for CLABSI. Data were analyzed using STATISTICA 13.1; (3) Results: We analyzed the data of 803 ICU patients hospitalized for 8385 bed days, with 7803 central line days. Forty-five CLABSI events were identified. The CLABSI rate significantly increased during the COVID-19 pandemic compared to before the COVID-19 pandemic (2.81 versus 7.47 events per 1000 central line days, (p < 0.001). The most frequently identified pathogens causing CLABSI were Gram-negative organisms (60.20%). The risk factors found to increase the probability of developing CLABSI were length of stay (OR = 1.080; 95% Cl: 1.057-1.103; p < 0.001) and COVID-19 (OR = 5.485; 95% Cl: 32.706-11.116; p < 0.001). (4) Conclusions: The COVID-19 pandemic was associated with increases in CLABSI in ICUs. These data underscore the need to increase efforts in providing surveillance of CLABSI and implementing infection prevention measures.

Study on the prevention and nursing intervention of infection after flap transfer for hand trauma.

To analyze the factors associated with infection after flap transfer for hand trauma and use them to develop nursing strategies and observe the effects of their application. Eighty-two patients admitted to our hospital for flap transfer for hand trauma from January 2020 to May 2020 were selected for the retrospective analysis. Logistic regression analysis was performed to analyze the factors associated with postoperative infections to develop care strategies. Another 88 patients admitted for flap transfer for hand trauma from September 2020 to June 2021 were retrospectively analyzed and divided into the observation (n = 44) and control groups (n = 44) according nursing strategies that they received. The operative time, intraoperative bleeding, incision healing time, first postoperative time to get out of bed on their own and hospital stay were compared between the 2 groups. The patients postoperative adverse effects and flap survival rates were also counted. visual analogue score, total active motion, manual muscle test, Barthel index, self-rating anxiety scale, self-rating depression scale scores were used to assess patients pain, hand function recovery and psychology before and after treatment. Logistic regression analysis manifested that postoperative bed rest time, affected limb immobilization, and pain were independent factors affecting postoperative infection after flap transfer (P < .05). After using targeted care strategies, the observation group had dramatically shorter operative time, intraoperative bleeding, incision healing time, time to first postoperative bed release on their own, and hospital stay, less postoperative pain and adverse effects, and higher flap survival rate than the control group (P < .05). Total active motion, manual muscle test, and Barthel index were higher in the observation group than in the control group after treatment, while self-rating anxiety scale and self-rating depression scale scores were lower than in the control group (P < .05). Finally, total satisfaction was higher in the observation group than in the control group (P < .05). Postoperative bedtime, fixation of the affected limb, and pain are independent factors affecting postoperative infection after flap transfer for hand trauma. Implementing infection prevention care strategies based on these factors can effectively improve the safety of flap transfer, reduce the possibility of infection, and shorten the recovery period of patients, which has high clinical application value.

Perceptions of organizational culture among infection preventionists in Israel, the United States, and Thailand: Results from national infection prevention surveys

In national surveys of infection preventionists in Israel (n=15), the United States (n=415), and Thailand (n=100), we found that views of organizational culture track well with these countries' cultural dimension scores of power distance and individualism. Our findings highlight the importance of considering cultural dimensions when implementing infection prevention efforts.

Determinants of Nurse Performance in Implementation of Infection Prevention and Control Using Employee Engagement Theory in Pandemic Period: A Literature Review

Nurse performance is an important parameter in improving the quality of health services. Nurse performance is influenced by several factors such as individual factors, psychological and organizational factors. The need for support for nurse performance can also be increased through an employee engagement approach. This study aims to identify the determinants factors of nurse performance in implementing infection prevention and control using the theory of employee engagement during a pandemic. This study uses the literature review method. Article search uses 4 journal databases from 2019-2023 which were reviewed including Garuda, Google Scholar, Pubmed and Scient Direct and fifteen articles met the criteria. The results showed that the determinants of nurse performance using employee engagement theory were leadership and organization. Nurse performance influences employee engagement, engaged nurses will have high work engagement and nurses who are not engaged will have low work engagement. The implementation of employee engagement during the pandemic there were still several factors that had not been widely intervened, so further research is needed to find out how the theory of employee engagement is applied to find out the performance factors of nurses in implementing infection prevention and control.

Improvement in Infection Prevention and Control Compliance at the Three Tertiary Hospitals of Sierra Leone following an Operational Research Study.

Implementing infection prevention and control (IPC) programmes in line with the World Health Organization's (WHO) eight core components has been challenging in Sierra Leone. In 2021, a baseline study found that IPC compliance in three tertiary hospitals was sub-optimal. We aimed to measure the change in IPC compliance and describe recommended actions at these hospitals in 2023. This was a 'before and after' observational study using two routine cross-sectional assessments of IPC compliance using the WHO IPC Assessment Framework tool. IPC compliance was graded as inadequate (0-200), basic (201-400), intermediate (401-600), and advanced (601-800). The overall compliance scores for each hospital showed an improvement from 'Basic' in 2021 to 'Intermediate' in 2023, with a percentage increase in scores of 16.9%, 18.7%, and 26.9% in these hospitals. There was improved compliance in all core components, with the majority in the 'Intermediate' level for each hospital IPC programme. Recommended actions including the training of healthcare workers and revision of IPC guidelines were undertaken, but a dedicated IPC budget and healthcare-associated infection surveillance remained as gaps in 2023. Operational research is valuable in monitoring and improving IPC programme implementation. To reach the 'Advanced' level, these hospitals should establish a dedicated IPC budget and develop long-term implementation plans.