Inadequate Infection Control Research Articles

ANTIBIOTIC RESISTANCE: A GLOBAL THREAT AND PATHWAYS TO SOLUTIONS

Introduction. Antimicrobial resistance (AMR) represents a critical global health challenge that poses significant threats to public health, food security, and economic stability. AMR occurs when microorganisms such as bacteria, viruses, fungi, and parasites develop resistance to antimicrobial agents, rendering treatments ineffective and leading to persistent infections, higher medical costs, and increased mortality rates. This crisis is exacerbated by factors such as the overuse and misuse of antibiotics in healthcare and agriculture, insufficient regulation, inadequate infection control measures, and limited access to diagnostic tools. As AMR continues to evolve, its impact is felt worldwide, particularly in low- and middle-income countries where resources for combating this issue are often scarce. The growing burden of AMR underscores the urgency for global and regional collaborations, integrated surveillance systems, and the implementation of effective antimicrobial stewardship programs to mitigate its impact. Purpose of the review. This study aims to analyze AMR as a global threat, identify key factors driving its emergence and spread, evaluate existing mitigation strategies, and propose practical recommendations to enhance the effectiveness of AMR management at regional and global levels. Materials and methods: A systematic analysis was conducted using open-access articles published within the last five years from databases such as PubMed, Medline, Google Scholar, eLibrary, and CyberLeninka. Included studies met evidence levels A and B, comprising meta-analyses, systematic reviews, and cohort studies. Key areas of focus included epidemiological data, resistance patterns, and intervention effectiveness. Results: Between 1990 and 2021, AMR was responsible for over one million deaths globally each year, with significant increases in fatalities among individuals aged 70 and older. In 2021, bacterial AMR contributed to an estimated 4.71 million deaths globally, including 1.14 million directly attributable to AMR. Projections suggest AMR-related deaths could reach 10 million annually by 2050 if current trends continue. Factors such as unregulated antibiotic use, limited diagnostic resources, and the spread of multidrug resistance (MDR), extensive drug resistance (XDR), and pan-resistance (PDR) exacerbate the crisis. Regional disparities, particularly in Africa and Asia, emphasize the need for strengthened surveillance and regulatory measures. Conclusion. AMR is a growing global crisis that demands urgent action. Implementing genomic tools for AMR monitoring and adopting the «One Health» approach, which integrates human, animal, and environmental health, are essential to addressing this challenge. Strengthening regional monitoring, increasing public awareness, and fostering global collaborations are pivotal for sustainable AMR control. These measures are crucial to reducing mortality rates, optimizing healthcare outcomes, and mitigating the socioeconomic impacts of AMR.

How to administer a percutaneous endoscopic gastrostomy (PEG) feed.

In hospitals and nursing homes, the maintenance of feeding tubes used in enteral nutrition, such as percutaneous endoscopic gastrostomy (PEG) (the placement of a feeding tube directly into the stomach through the abdominal wall), is often a nursing responsibility. Therefore, it is vital nurses understand how to care for this patient group safely and effectively. Incorrect PEG procedures, inadequate infection prevention and control practices, and a lack of appropriate stoma care, can negatively affect patient outcomes. Nurses administering enteral feeding via PEG must have the knowledge and skills required to do so safely and must work within their level of competence. • Enteral nutrition such as PEG aims to meet the nutritional requirements of patients who have an intact gastrointestinal (GI) tract but whose oral intake is inadequate. • Management of the PEG feeding tube and care of the stoma site are vital, and nurses should be able to recognise common complications of PEG feeding. • A non-touch technique should be used when administering enteral feed via PEG to reduce the risk of bacterial contamination. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when administering enteral feed via PEG. • How you could use this information to educate nursing students or colleagues about safe enteral feeding with PEG.

Gaps and Barriers to the Implementation of Antimicrobial Stewardship Programmes in Hospitals of Pakistan.

Antimicrobial-resistant bacteria are particularly prevalent in Southeast Asia, mainly due to inadequate infection prevention and control (IPC) and the widespread and uncontrolled use of antibiotics. Pakistan is the third largest low-middle-income country (LMIC) user of antibiotics. Antibiotic consumption increased by 65%, from 800 million to 1.3 billion defined daily doses (DDD). Antimicrobial consumption is high and poorly regulated, and an estimated 300,000 people die because of bacterial antimicrobial resistance (AMR) annually. Due to the changing government priorities, antimicrobial stewardship programmes (ASP) implementation is not compulsory for hospitals to acquire national accreditation, which has led to de-prioritisation among hospital managers and clinical teams. Additionally, lack of support from hospital administration, limited nationwide health insurance coverage for bacterial cultures, and a lack of surgical centres and microbiology laboratories, information technology (IT) support to collect and analyse AS-related data, reduced availability of pharmacists, ID physicians, and IPC staff for ASP events are the primary contributing factors creating hindrance to the long-term viability of ASP. Briefly, strong hospital leadership support is the major factor for allocating the resources for ASP structures and activities and also for establishing the key performance indicators (KPIs), enforcing compliance with hospital-specific clinical practice guidelines, as well as addressing friction between ASP team members and prescribers. Key Words: Antimicrobial resistance, Antimicrobial stewardship programmes, Infection prevention and control.

Antibiotic Resistance Trends in Carbapenem-Resistant Gram-Negative Pathogens and Eight-Year Surveillance of XDR Bloodstream Infections in a Western Greece Tertiary Hospital.

Background: The increased prevalence of antibiotic resistance among Gram-negative bacteria presents a severe public health challenge, leading to increased mortality rates, prolonged hospital stays, and higher medical costs. In Greece, the issue of multidrug-resistant Gram-negative bacteria is particularly alarming, exacerbated by overuse of antibiotics and inadequate infection control measures. This study aimed to detect the prevalence of extensively drug-resistant (XDR) Gram-negative bacteria in a tertiary hospital in Western Greece over the last eight years from 2016 to 2023. Materials and Methods: In the present study, all Carbapenem-resistant (CR) Acinetobacter baumannii, K. pneumoniae and Pseudomonas aeruginosa. bloodstream isolates from patients hospitalized in the University General Hospital of Patras in Western Greece, from January 2016 to December 2023, were recorded. XDR strains were defined as non-susceptible to at least one agent in all but two or fewer antimicrobial categories (i.e., bacterial isolates remain susceptible to only one or two categories). The prevalence and distribution of these pathogens across different hospital wards and their susceptibility patterns to key antibiotics (aminoglycosides, trimethoprim-sulfamethoxazole, tigecycline, colistin, ampicillin-sulbactam, ceftolozane-tazobactam and ceftazidime-avibactam) were recorded. Results: A total of 1142 blood cultures growing carbapenem-resistant Klebsiella pneumoniae (CRKp), Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPsA) were studied. In the present study, we found an increased resistance of both A. baumannii and K. pneumoniae in colistin. Acinetobacter baumannii had colistin resistance rates between 8.4% and 49.3%, showing a stable increase during the study period. K. pneumoniae showed an increased colistin-resistance rate in 2022 and 2023 (46.8% and 31.2%, respectively) Regarding P. aeruginosa, amikacin was almost inactive with a rate 68.4% and 87.5% in 2020 and 2023, respectively. Of all CR isolates, 69.3% were extensively drug-resistant (XDR). Acinetobacter baumannii had the highest percentage of XDR isolates (34.3%), followed by K. pneumoniae (26.8%) and P. aeruginosa (8.1%). Most XDR pathogens were isolated from the ICU (73.4%), followed by the internal medicine units (64%) and surgical units (22%). Conclusions: The rate of antimicrobial resistance and extensive drug resistance is alarmingly high, which calls for strict surveillance, control measures, and antibiotic stewardship to prevent the development of further resistance.

NEEDLE STICK INJURIES AMONG NURSES IN LAHORE

Needle stick injuries (NSIs) are a significant occupational hazard for healthcare workers, particularly nurses, as they increase the risk of transmitting bloodborne pathogens such as hepatitis B (HBV), hepatitis C (HCV), and HIV. Objective: This study aimed to assess the prevalence, risk factors, and contributing practices associated with NSIs among nurses at Lahore General Hospital, Pakistan. Methods: A cross-sectional quantitative study was conducted from June to September 2024. A structured, pre-tested questionnaire was used to collect data from 257 nurses selected through non-probability consecutive sampling. Data were analyzed using SPSS version 20, employing descriptive and logistic regression analyses to identify associated factors. Results: The annual prevalence of NSIs among participants was 37.4%, with 12.1% reporting an NSI in the past month. Younger nurses (<30 years) and those with less than five years of experience were at higher risk. High-risk departments, such as ICU/OR (48.2%) and maternal units (44.4%), reported the highest incidence of NSIs. Unsafe practices, including needle recapping (73.2%) and inadequate infection control training (60.3%), were significant contributors. Nurses who received infection control training had a lower prevalence of NSIs (28.8%) compared to untrained staff (43.4%). Conclusion: The study highlights the urgent need for enhanced infection control training, implementation of universal safety protocols, and the use of safety-engineered devices to reduce NSI prevalence among nurses in Pakistan. Targeted interventions in high-risk departments and systemic improvements in workplace safety are critical to mitigating occupational risks for healthcare workers.

Qualitative drivers of postoperative prophylactic antibiotics use and resistance in Ethiopia.

The World Health Organization (WHO) cautions against unnecessary prolongation of postoperative antibiotics to prevent surgical site infections (SSI), however this practice is still common in many countries. This study aims to describe drivers of prolonged postoperative antibiotic prescribing and clinicians' perspectives on antibiotics resistance and stewardship in Ethiopia. We conducted semi-structured interviews of 16 surgeons and nine surgical ward nurses at three academic referral hospitals in Addis Ababa. Audio recordings were transcribed verbatim and coded. Codes were inductively and iteratively derived between two researchers, tested for inter-rater reliability (IRR), and the codebook was consistently applied to all transcripts. Thematic analysis was performed to understand drivers of prolonged prophylactic antibiotic use in surgical patients. Interviews revealed factors contributing to postoperative prophylactic antibiotics overprescribing, including inadequate infection prevention and control (IPC) practices, wide variability in local prescribing practices, and distrust in the applicability of WHO guidelines. Antimicrobial resistance was also identified as a major concern by staff. Barriers to improving stewardship included a lack of multidisciplinary teamwork to inform prescribing decisions, while solutions included constructing appropriate context-specific guidelines and improving evidence-based practices through input from local stakeholders, including surgeons, clinical pharmacists, and nurses. Study participants perceived that existing evidence and guidelines did not apply in their settings due to high rates of surgical site infections and gaps in perioperative IPC practices (e.g., availability of water for handwashing, sterility breaches). These gaps were a key contributor to prophylactic antibiotic overprescribing, reinforcing the need to strengthen upstream and perioperative surgical antisepsis processes. The findings of this study underscore the importance of engaging multidisciplinary teams in strengthening antimicrobial stewardship efforts, aligning processes to achieve compliance with best practices, and the need for rigorous, contextually appropriate studies from these settings to inform policy.

Development and Implementation of Learning Collaboratives for Infection Prevention and Control Education in Long-Term Care Facilities

Infections in long-term care facilities (LTCFs) pose a critical challenge, with one to three million serious infections annually and up to 380,000 associated deaths. The vulnerability of aging populations and inadequate infection prevention and control (IPC) programs underscore the need for intervention. This initiative provided tailored continuing education through eight virtual learning collaboratives serving 541 infection preventionists. The project also developed nine IPC toolkits and a manual to further support LTCFs' infection prevention efforts.

Study of Knowledge, Attitude, and Practices of Use of Masks among Health-care Workers at a Tertiary Care Center in Mumbai

ABSTRACT Introduction: Airborne transmission of infectious diseases poses a significant public health challenge. Nosocomial outbreaks of airborne infections such as influenza H1N1, H5N1, and drug-resistant tuberculosis (TB) variants have been documented, with substantial morbidity and mortality attributed to inadequate airborne infection control strategies. N-95 respirators and surgical masks (face masks) are the examples of personal protective equipment that are used to protect the wearer from airborne particles and liquid contamination of the face. Aim and Objectives: The aim of this study was to assess the knowledge, practices, and attitude of health-care workers (HCWs) regarding the use of mask, especially N-95 mask. Materials and Methods: A prospective, was conducted over a period of 6 months at a tertiary care hospital. This study was carried out in the department of microbiology of a tertiary care hospital over a period of 6 months. A total of 500 HCWs from various departments of the hospital were included in the study. HCWs were given a questionnaire based on N-95 respirator usage, and participation was voluntary. Results: The analysis of survey data provides insightful perspectives on respondents’ comprehension and attitudes toward airborne infection transmission and the usage of N-95 masks. 68.6% of respondents recognized that all listed diseases (measles, TB, and chickenpox) were spread by the airborne route. 55.6% of respondents correctly acknowledged that all masks, including surgical masks, N-95 masks, and cotton masks, do not offer airborne protection. 76.0% of respondents acknowledged that N-95 masks possess a high filtration efficiency against 0.3-micron particles, 58.3% correctly identified that “N” in N-95 stands for “not resistant to oil,” and 90.8% acknowledged that the N-95 respirator as the most common type of respirators. 41.7% correctly acknowledged that N-95 masks with an exhalation valve are not recommended for use. 22.2% of respondents incorrectly believe that wearing a face mask can lead to carbon dioxide poisoning, and 52.1% of respondents correctly identified that pulmonary TB patients need not be provided with N-95 masks in isolation rooms. 76.8% of respondents understood that fit testing is required every time one dons an N-95 mask. 95.5% of respondents recognized the necessity of hand hygiene before donning and after doffing N-95 masks. 82.7% of respondents agreed regarding the necessity for consultation before N-95 mask usage for chronic lung disease and asthma patients. 93.7% are aware that there is a protocol for donning and doffing N-95 masks. 71.3% of respondents understood that extended use involves wearing the same N-95 respirator for repeated close contact encounters without removing the mask between patient encounters, while 64.4% correctly define reuse as using the same N-95 respirator for multiple encounters but removing it after each encounter.

Quackery: A Major Persisting Issue in the Dental Profession of Nepal

Background: Quackery in the dental profession is a significant and persistent issue in Nepal, particularly in urban areas like Hetauda city. This practice involves the provision of dental services by individuals lacking formal education, training, or licensing, posing serious risks to patient health and safety. Objective: This study aims to assess the prevalence of quackery in Hetauda city, Nepal, and its implications for dental care quality and patient safety. It also seeks to understand the reasons behind patients’ continued use of unlicensed dental practitioners and to provide recommendations for addressing this issue. Methods: A cross-sectional study was conducted in 25 dental clinics across Hetauda city. Data collection included structured interviews with licensed dental practitioners, patient surveys, and observational assessments of clinic operations and infection control practices. Quantitative data were analyzed using descriptive statistics, while qualitative data from interviews were thematically analyzed. Results: The study found that 28% of the surveyed clinics employed unlicensed practitioners. Clinics with quacks exhibited significantly lower standards of care, including inadequate infection control and improper procedures. Only 30% of patients were aware of their dental care providers' qualifications, with many opting for quacks due to affordability and accessibility. A higher incidence of complications and adverse outcomes were reported among patients treated by unlicensed practitioners. Qualitative findings highlighted patient trust in quacks, frustrations of licensed practitioners, and regulatory gaps. Conclusion: Quackery remains a major issue in the dental profession in Hetauda city, Nepal. Addressing this problem requires a multifaceted approach, including improved regulation, increased public awareness, and stringent enforcement of licensing standards. Ensuring that all dental practitioners are properly qualified and licensed is essential for protecting patient safety and maintaining the credibility of the dental profession in Nepal.

THE IMPLEMENTATION OF PATIENT SAFETY GOALS FOR PATIENTS' SATISFACTION IN THE HEMODIALYSIS UNIT

Background: Surveys on patient safety in dialysis units uncover a range of significant patient safety issues. Hemodialysis centers are particularly vulnerable to adverse events due to a number of risk factors, such as machine malfunctions, excessive blood loss, patient falls, prescription errors, and inadequate infection control procedures. Aim: Analyze the problem of implementing patient safety goals and describe the patients' satisfaction with the implementation of patient safety goals. Methods: This study employs a concurrent embedded methodology with a mixed-methods design, utilizing quantitative data to complement the qualitative data. Applying the focus group discussion (FGD) technique, questionnaires and observations of hemodialysis patients' satisfaction with implementing patient safety goals were utilized to complete the data collection. Results: According to the patient satisfaction survey, two patients were worried that their dialyzer tubes had been mixed up, earning a negative score of 5.13%. 23.07% of patients had negative results on the infection prevention risk questionnaire; 3 patients (7.69%) only seldom cleaned their hands before starting dialysis, and 6 patients (15.38%) did not. Conclusion: The implementation of patients' identification and the reduction of infection risk through hand hygiene have not been carried out consistently, concerning patient safety goals in the hemodialysis unit. Keywords: hand hygiene, hemodialysis, patient safety goals, patients' satisfaction, patients' identification

Strengthening Bhutanese Traditional Medicine in healthcare service delivery in Bhutan

Bhutanese Traditional Medicine, known as Sowa Rigpa, deeply rooted in the country’s cultural and religious heritage, plays a significant role in healthcare service delivery in Bhutan. This commentary explores the evolution and current landscape of Sowa Rigpa within the context of the nation’s healthcare system. While traditional medicine services have expanded over the years, challenges such as scepticism regarding scientific validity, inadequate infection control measures and concerns about the sustainability of medicinal plants persist. To address these challenges, recommendations, including the integration of modern technology in quality assurance, comprehensive training in infection control, evidence-based practice and conservation efforts for medicinal plants have been adopted. By embracing these strategies, Sowa Rigpa can enhance its efficacy, safety and sustainability, ensuring its continued relevance in meeting the healthcare needs of the Bhutanese population while contributing to the global advancement of Traditional Medicine practices.

Evaluation of factors influencing antibiotic prescribing behaviour by independent nurse prescribers

Antibiotic resistance is an urgent, accelerating global health threat due to inadequate infection prevention and control practices, and sub-optimal prescribing of antibiotics. Health professionals are required to practise antimicrobial stewardship to reduce incidence of antibiotic resistance, and this includes optimal prescribing behaviours. This study aimed to establish factors influencing medical prescribers' and independent nurse prescribers' antibiotic prescribing decisions, and compare the responses between practice settings. Independent nurse prescribers were invited to complete an online questionnaire with 17 antibiotic prescribing statements. Respondents rated their responses on a five-point Likert-type scale ranging from totally disagree to totally agree. A total of 115 questionnaires were completed and analysed. The results showed independent nurse prescribers' antibiotic prescribing decisions may be influenced by patient expectations, diagnostic uncertainty, challenges related to patient follow-up, time pressures and remote consultations. Unlike medical prescribers, they do not report pressure to prescribe antibiotics to maintain a good relationship with the patient. Antibiotic prescribing decisions are influenced by a wide range of factors outside of clinical indication and further research is required to explore these in detail. Independent nurse prescribers require education and training tailored to their specific needs and practice settings.

Survivorship Struggles: Navigating Etiologies and Clinical Parameters of Febrile Neutropenia During Induction Chemotherapy in Acute Leukemia Patients.

Background Acute leukemia, characterized by the uncontrolled proliferation of immature white blood cell precursors, poses significant challenges during induction chemotherapy, including the elevated risk of febrile neutropenia and its associated complications. Our study aims to explain the clinical and etiological parameters of these patients in a resource-limited setting. Methods This retrospective study focused on a total of 102 adult patients with acute leukemia who developed febrile neutropenia during the induction chemotherapy phase. Patients with disease relapse, prior bone marrow transplantation, and cases of acute promyelocytic leukemia were excluded from the study. Demographical characteristics, symptoms at presentation, diagnoses, infectious causes, and outcomes were systematically reported. Infectious etiologies and detailed culture reports were meticulously tabulated, and subsequent data were analyzed. Results Of the 102 patients, 43 (42.2%) were males, with a mean age of 31.9 ± 6.5 years. During the induction chemotherapy, a total of 31 patients died of complicated febrile neutropenia. Severe vomiting was the most common symptom present in 37 (36.2%), followed by cough in 35 (34.3%) and loose stools in 28 (27.5%). Community-acquired pneumonia, neutropenic sepsis, and neutropenic colitis were among the most common etiologies of febrile neutropenia. A total of 72 (70.6%) patients had culture-proven multidrug-resistant Gram-negative bacteremia that contributed to poor outcomes. Conclusions Acute leukemia patients undergoing induction chemotherapy face high infection-associated mortality due to their immunocompromised state. Inadequate infection control measures and antimicrobial resistancecontribute to the emergence of multidrug-resistant organisms. Enhanced infection prevention strategies and evidence-based antibiotic prescription guidelines are need of time in resource-limited settings such as Pakistan to address febrile neutropenia complications and bridge the existing care gap in its management.

A review of colistin-resistant Escherichia coli isolates in the Middle East: mechanisms, epidemiology, and dissemination from different sources in humans, animals, foodand soil.

Escherichia coli is a normal gut inhabitantthat can cause various diseases ,such as intestinal, urinary tract, bladder infections and systemic infections in humans and animals. The alarming increase in profiles for extended-spectrum β-lactamase- and carbapenemase-producing Escherichia coli isolates is a serious problem throughout the world. Colistin is known as a lastresort agent for the treatment of Gram-negative bacterial infections. Inappropriate use of colistin and other classes of antibiotics combined with inadequate infection control, especially in developing countries, can lead to serious public health complications. The global increase in colistin resistance has been reported in many parts of the world, ,including the Middle East. Colistin is used to treat infections caused by extensively drug-resistant Gram-negative bacteria. There are few reliable epidemiologic data on colistin-resistant E. coli isolates, and information on colistin-resistant E. coli from Asia, the largest, most populous, and most diverse continent in the world, is generally limited compared with Europe and the United States. The data in this review article were compiled from related articles associated with isolated colistin-resistant Escherichia coli (E. coli) isolates from humans, animals, and food-producing animals. In the Middle East, colistin-resistant E. coli isolates were reported from Turkey, Egypt, Saudi Arabia, Algeria, Iran, Iraq, Bahrain, Qatar, Oman, Kuwait, Israel, and Lebanon between 2010 and 2023. While colistin resistance is most commonly observed in E. coli isolates, data have shown that mcr genes are the most common genes associated with colistin resistance in E. coli isolatescompared to mutations in pmrAsB, phoQ, and mgrB genes.

Antimicrobial resistance: A looming threat to public health and global well-being

Abstract Antimicrobial resistance (AMR) is a global issue that transcends borders and affects countries at all income levels. Various contributing factors include limited access to clean water, sanitation, and hygiene for both humans and animals; inadequate infection and disease prevention and control in households, health-care facilities, and farms; restricted access to high-quality and affordable vaccines, diagnostics, and medications; insufficient awareness and knowledge; and a lack of enforcement of relevant legislation. People in low-resource settings and vulnerable populations are disproportionately affected by both the causes and consequences of AMR. The identification and subsequent incorporation of antimicrobial agents into clinical medicine marked a significant milestone in 20th-century medical achievements, fundamentally transforming the management of bacterial diseases. Nevertheless, the gradual rise of antibiotic-resistant bacterial populations, stemming from the inappropriate usage, misapplication, and unconditional abuse of antibiotics, has evolved into a substantial global public health challenge. Today, different mechanisms of bacterial resistance have been reported in almost all the present antibiotics on the market. The international community has been striving to address and recognize AMR as a global alarming situation, as considered by the World Health Organization as well as the Centers for Disease Control and Prevention. The unrestrained utilization of antibiotics at public and commercial levels has invigorated the evolution of multi-drug resistant microbiota across the globe, leading to an elevated mortality rate due to microbial infections. This review paper explored the inception and resistance genes, provides a comprehensive overview of global antimicrobial resistance, analyzes factors promoting its dissemination, discusses control strategies, examines control challenges, and underscores the ramifications of an inability to effectively contain antimicrobial resistance in bacteria, effectively.

Risk Factors for Latent Tuberculosis among Health-care Workers in Sri Lanka.

Management of latent tuberculosis infection (LTBI) was introduced as a national policy in Sri Lanka in 2022, targeting high-risk groups, including health-care workers (HCWs). This study aimed to identify the potential risk factors for LTBI among HCWs in government hospitals. A case-control study was conducted. Cases and controls were identified by a screening survey conducted among those tested by the tuberculin skin test (TST). The survey was conducted among HCWs of eight government hospitals in Colombo in 2022. LTBI cases were defined as TST positives (≥10 mm) without a history of pulmonary tuberculosis (TB) and controls were those rated as negative. The cases-to-control ratio was 1:1, with a sample size of 128 cases and 128 controls. Multiple logistic regression analysis was conducted to identify the risk factors. The significant risk factors identified included age ≥40 years (adjusted odds ratio [AOR] - 2.4, 95% confidence interval [CI]: 1.28-4.47) having a service duration of ≥6 years (AOR - 2.92, CI: 1.469-5.82), not maintaining distance (AOR - 2.83, CI: 1.43-5.58) and not wearing face masks when dealing with suspected or diagnosed TB patients (AOR - 3.55, CI: 1.80-7.00), and settings with inadequate TB infection control practices (AOR - 3.47, CI: 1.85-6.47). Improving infection control measures, training HCWs on TB prevention, providing adequate personal protective equipment, and initiating screening for LTBI among HCWs are recommended.

PREVALENCE OF PLASMID MEDIATED QNRA, QNRB AND QNRS AMONG CLINICAL ESCHERICHIA COLI ISOLATED FROM URINARY TRACT INFECTIONS IN DUHOK, KURDISTAN REGION OF IRAQ

Excessive use of antibiotics (such as fluoroquinolone) and inadequate infection control practices have turned antibiotics resistance (AMR) into a global, public health peril. The current study emphasizes on the prevalence of qnrA, qnrB, and qnrS plasmid in fluroquinolone (FQ) resistant Escherichia coli (E. coli) isolates from urinary tract samples and their correlation with the burden of resistance in these isolates. In this research, several E. coli strains were isolated from outpatients having urinary tract infections (UTIs) from Duhok province, Kurdistan Region of Iraq. Biochemical and Molecular confirmations were performed to confirm the isolates. Antibiotics susceptibility test was performed to detect the isolates antibiogram. Furthermore, polymerase chain reaction (PCR) amplification was used to detect the qnrA, B and S genes. Bioinformatics tools were used to perform the analysis of the results and data visualization. Forty isolates (out of 55) have been confirmed as E. coli. Antibiograms revealed that 70%, 65% and 63% of the isolates were resistant to Ciprofloxacin, Enrofloxacin and Levofloxacin, respectively. While there was variation in resistance to other antibiotics tested. The FQ resistant genes were detected in 17 (42.5%) isolates, with some isolates carrying more than one gene. The variant qnrS was the most predominant, as it has been detected in 14 isolates. The increasing rates of multidrug resistance E. coli isolates from UTIs, including FQ antibiotics, emphasizes the importance of carefully monitoring their use for UTI treatment.

EEVALUATION AND QUANTITATIVE ANALYSIS OF OPERATING ROOM PERSONAL KNOWLEDGE, ATTITUDE, AND PRACTICE OF STERILE TECHNIQUES IN KHYBER TEACHING HOSPITAL PESHAWAR

The pivotal aspect of patient care within the operating room is the operating room personnel. Therefore, assessing their knowledge, attitudes, and practices concerning sterile techniques in the operating theatre is crucial, as infections pose a significant risk to post-operative patient morbidity and mortality. Wound infections are the second most prevalent type of hospital-acquired nosocomial infection in the United States. Recognizing that inadequate infection control and sterile technique practices in the operating room can contribute to wound infections, it is imperative to establish infection control principles and adhere to sterile technique standards. The primary aim of this study was to evaluate the knowledge, attitudes, and practices of operating room personnel with respect to sterile techniques at Khyber Teaching Hospital (KTH) in Peshawar. A cross-sectional descriptive study approach was employed to assess the knowledge, attitudes, and practices of operating room personnel in the operating theaters of KTH. One hundred and eighty operating room personnel from the selected hospitals were chosen from the population using a non-probability convenient sampling method. The self-administered questionnaires were used to gauge their understanding of, attitude toward, and adherence to sterile techniques. The study's findings revealed that most respondents (74%) were male, 44.2% fell within the age range of 25-30 years, and most (74.6%) had less than 10 years of experience. Many respondents exhibited good knowledge, a positive attitude, and solid practices regarding sterile techniques. In conclusion, the study found that operating room personnel displayed good knowledge, a positive attitude, and sound practices about sterile techniques. Furthermore, the study established a direct relationship between knowledge, attitude, and practice. As a result, it is recommended that operating room personnel should participate in additional workshops or seminars on sterile techniques to stay updated on new developments in this field.

Simulating infection prevention and control through virtual reality: a vehicle for equity, diversity, and inclusivity in Africa

Endemics in Africa are prominent, especially in countries with low income and inadequate infection prevention and control (IPC) measures. Additionally, poorly trained nurses negatively influence infection-related indicators, and these nurses may require re-training. Re-training is expensive, and due to limited resources, healthcare institutions in Africa may not have the opportunity for their nurses to be re-trained in a critical competence such as IPC. Simulation-based education, including virtual reality (VR), has shown numerous benefits in acquiring critical thinking, communication, and clinical skills. However, VR has been reserved for healthcare education in the global north. Also, no educational programmes currently exist that harness the power of VR in a low-resource context such as Africa. We argue that VR is a possible low-cost simulation modality that can create standardised training resulting in equitable, diverse, and inclusive IPC education for nursing students. However due to a lack of technological training and ongoing support, low to middle-income countries often end up failing to implement the interventions over a longer term than the initial investment. Authors like Hofstede identified dimensions causing problems between various cultures, which might restrict the implementation of newer technologies in a diverse, equitable, and inclusive manner. The design and implementation of an educational innovation must address and integrate the cultural dimensions of the targeted context. Embracing, understanding, and respecting the variations in local culture within African universities is essential to inclusive and diverse education practices and the subsequent designing and implementation of educational innovation such as VR.

Assessment of Infection Control Measures and Risk Factors at Kampala International University Teaching Hospital in Bushenyi District: A Study on Staff Awareness and Implementation

This research delved into the critical role of infection prevention and control in enhancing hospital care quality, particularly at Kampala International University Teaching Hospital. The primary aim was twofold: to identify risk factors associated with inadequate infection control and to evaluate the utilization of existing infection control measures among hospital staff. Conducted as a descriptive cross-sectional study within the hospital premises in Bushenyi District, the research engaged 100 respondents comprising various staff members employed at the institution, assessing their awareness of infection control through structured questionnaires. Although random sampling of 10 staff members was instrumental in refining the questionnaire for suitability, their results weren't incorporated into this study's findings. The respondent demographics showcased a predominant representation of nurses, with a majority being female employees and nearly four-fifths having worked at the hospital for less than four years. Notably, half of the respondents identified airborne infections as the most prevalent in the hospital setting. The study highlighted a positive inclination toward infection control tasks, with over 80% of participants acknowledging the effectiveness of infection control practices in curtailing the spread of infections among patients. Despite this awareness, the findings indicated a moderate level of overall awareness regarding infection control measures. While more than half of the respondents expressed favorable views on infection control practices and the utilization of available resources such as gloves, aprons, and hand hygiene, the implementation and adherence to standard precautions fell short of optimal levels. In conclusion, the study revealed a moderate level of awareness regarding infection control measures among hospital staff, with a majority holding positive attitudes toward the utilization of available resources. However, the actual implementation and adherence to standard precautions appeared suboptimal, signaling the need for enhanced efforts to bolster practice and compliance within the hospital setting. Keywords: Infection, Infection control, Waste management, Hand washing.