Infection Control Guidelines Research Articles

Knowledge, Attitudes, and Practices Toward the Prevention of Hepatitis B Virus Infection Among Medical Students in Medina City, Kingdom of Saudi Arabia.

This study focuses on assessing the knowledge, attitudes, and practices related to Hepatitis B virus (HBV) prevention among medical students in Medina, Saudi Arabia. HBV is a significant global health concern, with a high prevalence in Saudi Arabia. Medical studentsdue to their field, are at higher risk of exposure. Prior studies in Saudi Arabia show varied levels of awareness. This research aims to provide insights that can inform educational initiatives for this specific population. This was a cross-sectional studyconducted from June 2023 to September 2023by using a pre-designed online questionnaire that was distributed among medical students in Medina. Data was analyzed using IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp. This study included 307 participants. 67.8% of the participants correctly identified the link between HBV and liver cancer, and 77.5% recognized the transmission risk from carriers. 91.9% acknowledged the transmission via contaminated blood and fluids, and 88.9% recognized the risk from unsterilized instruments. Positive attitudes were observed, with 92.2% agreeing that following infection control guidelines would protect them at work. Practice scores were generally positive, including high rates of screening (57.3%) and adherence to infection control measures (90.2%). Knowledge scores correlated positively with attitude (rho = 0.204) and practice scores (rho = 0.390). A significant proportion of participants had a strong understanding of HBV transmission and the importance of infection control measures. Positive attitudes towards infection control were prevalent, although some reluctance to provide care to HBV-infected individuals was noted.

Detection of Antimicrobial Resistance and Biofilm Production Among Staphylococcus pseudintermedius from Canine Skin Lesions.

Aims: Staphylococcus pseudintermedius is an opportunistic pathogen also indicated as one of the major causes of skin infections in dogs. This study aimed to identify S. pseudintermedius isolated from canine skin lesions, evaluate their antibiotic resistance profile and biofilm production ability. Methodology: Lesions from 50 rural dogs with different skin lesions were sampled after pyoderma diagnosis by private practices. Bacterial species determination was investigated and susceptibility to nine antimicrobials were determined by means of Kirby-Bauer assay. Then seven antibiotic resistance genes, including mecA, blaZ, tetK, tetM, blaSHV, blaOXA-1, and blaTEM were screened by PCR. Moreover, biofilm formation ability of the strains was determined using the microtiter plate assay along with the presence of icaADBC genes. Results: A total of 37 (74%) isolates were identified as S. pseudintermedius. All S. pseudintermedius isolates were resistant to multiple drugs. Resistance to penicillin, amoxicillin-clavulanic acid, and cefazolin were higher than other antimicrobials. All the beta-lactam-resistant isolates carried blaZ, whereas mecA was found in 6 (16.21%) of them. Among tetracycline-resistant strains, the frequency of tetK and tetM determinants were 19 (90.47%) and 21 (100%), respectively. Finally, most cefazolin-resistant strains 31 (91.89%) were positive for blaTEM gene. The rate of biofilm production ability among S. pseudintermedius isolates was 35 (94.59%). Furthermore, the presence of icaA/D genes was detected in 35 (100%) and 29 (82.85%) of S. pseudintermedius strains, respectively. Conclusion: The high rates of antimicrobial resistance and biofilm production ability among S. pseudintermedius isolates, emphasize the urgent need to use more effective infection control policies and guidelines for antimicrobial use.

Generation of Aerosols by Noninvasive Respiratory Support Modalities

Infection control guidelines have historically classified high-flow nasal oxygen and noninvasive ventilation as aerosol-generating procedures that require specialized infection prevention and control measures. To evaluate the current evidence that high-flow nasal oxygen and noninvasive ventilation are associated with pathogen-laden aerosols and aerosol generation. A systematic search of EMBASE and PubMed/MEDLINE up to March 15, 2023, and CINAHL and ClinicalTrials.gov up to August 1, 2023, was performed. Observational and (quasi-)experimental studies of patients or healthy volunteers supported with high-flow nasal oxygen or noninvasive ventilation were selected. Three reviewers were involved in independent study screening, assessment of risk of bias, and data extraction. Data from observational studies were pooled using a random-effects model at both sample and patient levels. Sensitivity analyses were performed to assess the influence of model choice. The main outcomes were the detection of pathogens in air samples and the quantity of aerosol particles. Twenty-four studies were included, of which 12 involved measurements in patients and 15 in healthy volunteers. Five observational studies on SARS-CoV-2 detection in a total of 212 air samples during high-flow nasal oxygen in 152 patients with COVID-19 were pooled for meta-analysis. There was no association between high-flow nasal oxygen and pathogen-laden aerosols (odds ratios for positive samples, 0.73 [95% CI, 0.15-3.55] at the sample level and 0.80 [95% CI, 0.14-4.59] at the patient level). Two studies assessed SARS-CoV-2 detection during noninvasive ventilation (84 air samples from 72 patients). There was no association between noninvasive ventilation and pathogen-laden aerosols (odds ratios for positive samples, 0.38 [95% CI, 0.03-4.63] at the sample level and 0.43 [95% CI, 0.01-27.12] at the patient level). None of the studies in healthy volunteers reported clinically relevant increases in aerosol particle production by high-flow nasal oxygen or noninvasive ventilation. This systematic review and meta-analysis found no association between high-flow nasal oxygen or noninvasive ventilation and increased airborne pathogen detection or aerosol generation. These findings argue against classifying high-flow nasal oxygen or noninvasive ventilation as aerosol-generating procedures or differentiating infection prevention and control practices for patients receiving these modalities.

Compliance with Burns Treatment Protocol by Nurses at Kabwe Central Hospital, Kabwe, Zambia

Background: Annually, burns result in more than 7.1 million injuries and more than 250,000 deaths, with the vast majority being in low and middle income countries. In Zambia, at Kabwe Central Hospital, burn trauma is one of the commonest causes of trauma admissions in surgical wards. To mitigate the trend, Ministry of Health distributed infection prevention and control guidelines and emphasized on the need to manage all patients with burns in accordance with national guidelines. Main Objective: To assess the level of compliance with Burns treatment protocol by nurses at Kabwe Central Hospital. Materials and Methods: A cross sectional study design was used in the study. A self-administered questionnaire was used to obtain data from 60 nurses and 55 nurses observed using an observational checklist. Convenient sampling was used to recruit nurses for the study. Results: Findings showed that observed compliance to burns treatment protocol is very low and stood at 51%. This was despite high knowledge, good management support and positive attitudes expressed by the majority nurses. This can be attributed to rare availability of most medical surgical supplies at the institution. Conclusion and Recommendations: The findings suggests the need of the hospital to improve on the supply of resources to the burns units as most nurses reported resource inadequacy in the management of burns. There is also need of building an ideal burns unit.

Breastfeeding vs. breast milk transmission during COVID-19 pandemic, which is more important?

The catastrophic coronavirus disease 2019 (COVID-19) pandemic has raised many health questions, and whether breast milk from SARS-CoV-2 infected mothers may be a vector for SARS-CoV-2 transmission has become a hot topic of concern worldwide. Currently, there are extremely limited and conflicting data on the risk of infection in infants through breastfeeding. For this reason, we investigated almost all current clinical studies and systematically analyzed the presence of SARS-CoV-2 and antibodies in the breast milk of mothers infected with SARS-CoV-2, their effects on newborns, and the mechanisms involved. A total of 82 studies were included in this review, of which 66 examined the presence of SARS-CoV-2 in breast milk samples from mothers diagnosed with COVID-19, 29 reported results of antibody detection of SARS-CoV-2 in breast milk, and 13 reported both nucleic acid and antibody test results. Seventeen studies indicated the presence of detectable SARS-CoV-2 nucleic acid in breast milk samples, and only two studies monitored viral activity, both of which reported that infectious viruses could not be cultured from RNA-positive breast milk samples. All 29 studies indicated the presence of at least one of the three antibodies, IgA, IgG and IgM, in breast milk. Five studies indicated the presence of at least one antibody in the serum of breastfed newborns. No COVID-19-related deaths were reported in all 1,346 newborns. Our study suggests that direct breastfeeding does not pose an additional risk of infection to newborns and that breast milk is a beneficial source of anti-SARS-CoV-2 antibodies that provide passive immune protection to infants. In addition, direct breastfeeding would provide maternal benefits. Our review supports the recommendation to encourage direct breastfeeding under appropriate infection control guidelines. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier: 458043.

First Emergence of NDM-5 and OqxAB Efflux Pumps Among Multidrug-Resistant Klebsiella pneumoniae Isolated from Pediatric Patients in Assiut, Egypt.

New Delhi metallo-β-lactamase (NDM)-producing K. pneumoniae poses a high risk, especially among Egyptian pediatric patients who consume carbapenems antibiotics very widely and without adequate diagnostic sources. In addition, presence of efflux pump genes such as OqxAB increases resistance against many groups of antimicrobials which exacerbates the problem faced for human health. This study aimed to determine NDM variants among K. pneumoniae strains isolated from pediatric patients in Egypt, analyze the presence of OqxAB genes, and molecular characterization ofblaNDM-5-positiveK. pneumoniae. Fifty-six K. pneumoniaeisolates were recovered from pediatric patients, and tested for carbapenemase by modified carbapenem inactivation methods (mCIM) test. Minimum inhibitory concentrations of meropenem and colistin were determined by meropenem E-test strips and broth microdilution, respectively. PCR was used for the detection of the resistant genes (ESBL gene (blaCTX-M), carbapenemase genes (blaNDM, blaKPC) colistin resistant (mcr1, mcr2)) and genes for efflux pump (oqxA and oqxB). BlaNDM was sequenced. The effect of efflux pump in NDM-5-producing isolates was assessed by measuring MIC of ciprofloxacin and meropenem before and after exposure to the carbonyl cyanide 3-chlorophenylhydrazone (CCCP). The horizontal gene transfer ability ofblaNDM-5 was determined using liquid mating assay and PCR-based replicon typing (PBRT) was done to determine the major plasmid incompatibility group. Twenty-nine isolates were positive for blaNDM-1, nine isolates were positive for blaNDM-5, and 15 isolates were positive for blaKPC. There is a significant increase of meropenem MIC of NDM-5-positive isolates compared with NDM-1-positive isolates. In addition, 38 isolates were positive for CTX-M, and 15 isolates were positive for mcr1. Both OqxA and OqxB were detected in 26 isolates and 13 isolates were positive for OqxA while 11 isolates were positive for OqxB only. All NDM-5-producing isolates except one isolate could transfer their plasmids by conjugation to their corresponding transconjugants (E. coli J53). Plasmid replicon typing showed that FII was predominant in NDM-5-producing K. pneumoniae. Similar strains were found between the three isolates and similarity was also detected between the two isolates. The highly resistant K. pneumoniae producing blaNDM-5 type was firstly isolated from pediatric patients. The association of efflux pump genes such as OqxAB is involved in resistance to ciprofloxacin. This highlighted the severity risk ofblaNDM-5-positiveK. pneumonia as it could transfer blaNDM-5 to other bacteria and has more resistance against carbapenems. This underlines the importance of continuous monitoring of infection control guidelines, and the urgent need for a national antimicrobial stewardship plan in Egyptian hospitals.

Public Health Experts Ask CDC Director to Broaden Input on Revisions to Key Infection Control Guidelines.

On July 20, 2023 a letter was sent to the Director of the Centers for Disease Control and Prevention requesting the agency's Healthcare Infection Control Practice Advisory Committee seek input from more stakeholders and the public, recognize the importance of infectious disease transmission by inhalation of human-generated aerosols, and ensure the application of interventions from all levels of the control hierarchy.

To Study the Carriage and Antimicrobial Sensitivity Profile of MRSA among Nursing Staff of Rural Tertiary Health Care Centre of North India

The present study is carried to determine nasal carriage of MRSA among nursing staff posted in Medicine and allied wards of a rural tertiary healthcare center in North India and antibiotic sensitivity profile of the isolated MRSA strains. Many of the carriers of MRSA harbour pathogen in areas like nares, hand surfaces, axilla and are generally asymptomatic. Colonisation in healthcare workers has increased the incidence of serious nosocomial infection wherein healthcare workers act as vectors for transmission of infection in already immuno-compromised patients. The study undertaken was a cross sectional type where in nursing staff was analysed for nasal carriage of MRSA and antibiotic sensitivity profile of MRSA. A total of A total of 60 nursing staff members posted in medicine and allied wards were recruited in this study. A total of 34 (56.6%) were females and 26 (43.3%) were males. our study showed considerable MRSA carriage among the nurses and also reported a decreased sensitivity to commonly used drugs. Also, no resistance was detected against higher antibiotics like Vancomycin, Teicoplanin and Linezolid which points to their use in eradication of infection caused by MRSA. There is a need to strictly implement and follow the hospital infection control guidelines so as to reduce the spread of MRSA to susceptible persons.

Adherence of Primary Care Dentists to Infection Prevention and Control Guidelines at Oral Health Services in Semarang City

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top"><p><em>Primary care dentists are the first destination for patients having dental and oral health problems. The primary dental health service also functions as a referral filter to advanced health facilities. Implementation of Infection Prevention and Control (IPC) in primary health care facilities has not been optimal, such as surveillance is not running well, data on infection incidence in primary health care has not been collected, and there is no supervision. This study aims to analyze the adherence of primary care dentists to the Infection Prevention and Control Guidelines at dental and oral health services. The research design was descriptive-analytic research with quantitative methods based on a cross-sectional study. Data collection was conducted from November to December 2022. The sampling technique used purposive sampling with a total sample of 102 primary care dentists who had been collected from a total population of 147 primary care dentists in Semarang City. The research was conducted by filling out a closed questionnaire.<strong> </strong>Data were analyzed by Chi-Square test and logistic regression test.<strong> </strong>There were significant relationships between perception (p=0.019), attitude (p=0.000), organizational support (p=0.011), clinic owner support (p=0.004), and dental facilities and </em><em>health </em><em>infrastructure (p=0.000) with adherence of primary care dentists to the Infection Prevention and Control Guidelines, whereas knowledge (p=0.748) had no relationship with the adherence of primary care dentists to the Infection Prevention and Control Guidelines. It concludes that primary care dentists in Semarang City have good adherence to Infection Prevention Control Guideline but that guidelines have not been implemented optimally.</em><em></em></p><p><em> </em></p></td></tr></tbody></table></div><p><strong><em>Keywords: Adherence Dentist, Healthcare-Associated Infections, Infection Control</em></strong></p>

Knowledge, attitude, implementation and satisfaction levels regarding availability of resources for airborne infection control among the nursing staff of a medical college in central India during the COVID-19 pandemic

Implementing airborne infection control measures as per guidelines are very important in preventing the spread of airborne infections. Therefore the purpose of this study was to evaluate the gaps in knowledge, attitude, implementation and satisfaction levels regarding the availability of resources for airborne infection control among the nursing staff of a medical college in central India during the COVID-19 pandemic. A cross-sectional survey was done in which 109 nurses participated. This self-administrable questionnaire contained five parts (General information, knowledge, attitude, implementation and satisfaction regarding available resources) and was distributed to the participants. The correct responses as per the National airborne infection control guideline, Ministry of Health and family Welfare, Government of India, 2010 (NAIC) were scored and assessed. The mean age of the participants was 28.9 + 3.02 years. The mean scores out of total score of 10 were 5.48 + 1.2 for knowledge, 6.78 +1.0 for attitude, 5.21 + 1.1 for implementation, and 4.28 + 0.9 for satisfaction of available resources. The knowledge was adequate in 46.8%, the attitude was positive in 89.9 %, the guideline implementation was adequate in 45.9% and the resource satisfaction was only in 9.2% of study participants. Although the nurses had a positive attitude to airborne infection control practices, the overall knowledge and implementation of NAIC were barely adequate and the majority of subjects felt gaps in the availability of resources in implementations of these guidelines. Therefore, it is recommended to enforce their training, ensuring better availability of resources and strict monitoring from hospital administrations for better implementation of NAIC.

The management of Clostridioides difficile infection: from empirism to evidence.

Clostridioides difficile infection (CDI) in clinical practice represents a challenge for its management and also prevention of recurrence. Even though there are updated guidelines for infection prevention, control and treatment, CDI remains a leading cause of healthcare acquired diarrhea with increasing incidence in the community. We present here a synthesis of the most recent international guidelines on the management of CDI. In 2021 updated guidelines on the treatment of CDI in adults were published by the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA), American College of Gastroenterology (ACG) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID). These guidelines focused on CDI management in adults, including new data on the clinical efficacy of Fidaxomicin (FDX) and Bezlotoxumab. The 2017 publication of IDSA and SHEA - Clinical Practice Guidelines for Clostridium difficile infection also included pediatric treatment recommendations that are not a part of the 2021 update. Vancomycin (VAN) treatment for an initial CDI episode remains an acceptable alternative to FDX, considering the monetary and logistical challenge of acquiring FDX. There is growing literature on fecal microbiota transplantation (FMT) and the 2021 guidelines describe its role in severe complicated refractory CDI cases and for which surgical management is not feasible. Moreover, there are new data on the secondary prophylaxis with VAN in refractory CDI in patients with risk factors who receive broad spectrum antibiotics.

Knowledge of Infection Control among Female Dental Assistants in Riyadh City, Saudi Arabia

Infection prevention must be a top concern in all dental settings, regardless of the level of care offered, and all settings must be set up to follow standard precautions and other infection prevention guidelines. This study's objective was to evaluate dental assistants' knowledge with infection control guidelines. In Riyadh, Saudi Arabia, a cross-sectional survey of female dental assistants was carried out. To collect information on knowledge of infection control, a 27-question survey was given out from January to March 2023. Comparisons that were both descriptive and statistical were made. The sample for the study included 125 female dental assistants. Among participants, correctly knew the essentials of infection control scored 88%. The percentage of correct responses for the understanding of personal protective equipment (PPE) was high (97%). The least amount of knowledge (82%) was possessed about sterilizing dental equipment. No statistically significant differences were found between any of the comparisons. With limitations, we concluded from the study that, with an overall score of 88%, the participants were knowledgeable on ways to decrease infection in dental clinics. Promoting infection control practices, risk awareness education, and initiatives that encourage the adoption of all precautions should be prioritized. Dental assistants need to have more information given how crucial infection control is to their field of work.

Infection Prevention and Control Practices and Associated Factors Among Healthcare Cleaners in Gondar City: An Analysis of a Cross-Sectional Survey in Ethiopia.

Healthcare-associated infections are a global health problem and are more prevalent in developing countries such as Ethiopia, but there is a paucity of research on the infection prevention practices of cleaning staff. Therefore, this study aimed to assess infection prevention and control practices and associated factors among cleaners working in healthcare facilities in Gondar City, Ethiopia. A cross-sectional survey was conducted among healthcare cleaning staff from May to June 2022. A total of 428 cleaners took part in the survey. Data were collected using a semi-structured interviewer-administered questionnaire. The data were entered into EpiData version 4.6 and analyzed using Stata version 14 software. A multivariable binary logistic regression analysis was used to ascertain the significance of associations at <0.05 p-value and the adjusted odds ratio (AOR) with a 95% confidence interval (CI). Among the 390 study participants included, 294 (75.1%) were female. Of the surveyed participants, 186 (47.7%) had good knowledge of infection prevention and control practices. This study revealed that out of the 390 healthcare cleaners, 204 (52.3%) had good infection prevention and control practices with 52.3% [95% CI (47.2, 56.4)]. Good knowledge of infection prevention and control [AOR: 1.56, 95% CI (1.03, 2.37)] and the availability of infection prevention and control guidelines in the workplace [AOR: 1.54, 95% CI (1.01, 2.33)] were significant factors associated with infection prevention and control practice. The present study found that almost half of the healthcare cleaners had poor IPC practices. The finding underlines the importance of good IPC knowledge and the accessibility of IPC guidelines to improve IPC practices among healthcare cleaning staff. The findings of this study also highlight that behavioral change interventions and paying attention, particularly to nonclinical staff such as cleaners in health care settings, are critical to reducing infection in health care settings.

PATIENT’S PERCEPTION ABOUT CROSS-INFECTION PREVENTION IN NISHTER INSTITUTE OF DENTISTRY (NID), MULTAN, PAKISTAN

Cross-contamination is the transmission of microbial agents from one subject to another. It can be spread from individual to individual or through infected agents. The source of cross-infection can be saliva, blood, body secretions, infected instruments with blood, and necrotic tissue debris. Every year lives are lost because of the spread of infections in hospitals becomes a serious cause of world public health issues. In this descriptive cross-sectional study, a consecutive sampling technique was applied in the periodontology department of Nishter Institute of Dentistry, Multan. 450 participants completed a questionnaire. Self-administered close-ended questionnaire in the English language was used and used local language to familiarize with the questionnaire. Results of the study revealed that 68 – 89% of the participants had a satisfactory level of knowledge about infection and infection prevention and most of them were well educated. 239 participants perceived that AIDS and Hepatitis can be transmitted during dental treatment. Regarding self-reported practice, most of the participants were aware of the fact that sterilized instruments should be used during dental treatment. 89.8% of participants stated that dentists should wear gloves and facemasks to prevent cross-infection from dentist to patient and vice versa. There was a statistically significant difference between occupation and personal protective equipment. There was enough knowledge and awareness of patients presented to the periodontology department of Nishter Institute of Dentistry regarding the infections which can spread in dental clinics like hepatitis and AIDS. There is an increased need in enhancing the awareness of the patients through social media, and also a need to provide knowledge of patients about cross-infection and how can it be prevented through educational programs both for the patients and service providers. It can also be done through awareness campaigns in different shopping places and educational institutes and public places. Key Words: Infection control guidelines, Personal protective equipment, Health care workers, World Health Organization, Centre of Disease Control

Psychosocial Problems among Psychiatric Nurses for Caring Patients with Mental Disorders during the COVID-19 Pandemic.

COVID-19 has a negative effect on the psychological well-being of psychiatric nurses. Thus, examining the psychosocial response of nurses is important for preventing more serious mental health problems and disruption of the quality of nursing care. This study aimed to evaluate the psychosocial problems of nurses who provided nursing care to patients with mental health disorders during the COVID-19 pandemic. A quantitative study with a cross-sectional design was conducted. The 101 nurses at Central Mental Health Hospital who provide nursing care to patients with mental health disorders were recruited through consecutive sampling. The instruments used were the demographic questionnaire, the Expanded Nursing Stress Scale, Zung Self-Rating Anxiety Scale, and The Connor-Davidson Resilience Scale 25. Univariate and bivariate analyses were used to process the data. The mean score of 45.1 (±24.3) was obtained for the ENSS; around 97% of nurses have a work stress score below the average, 4.95% have mild-moderate anxiety, and 28.7% have a low level of resilience. Work stress and contact frequency, work stress and gender, anxiety and contact frequency, as well as resilience and contact frequency all correlated significantly (p value <0.05). The Pearson test showed a significant positive correlation between work stress and anxiety (p: 0.002, r: 0.299). However, there was no significant correlation between anxiety and resilience (p: 0.643, r: 0.47), nor between work stress and resilience (p: 0.643; r: 0.47). Psychosocial disorders that psychiatric nurses face include occupational stress, mild-moderate anxiety, and low resilience. The government can create specific infection control guidelines for the mental health setting, and hospital management or ward leaders can also provide support to psychiatric nurses to increase resilience in reducing psychosocial problems.

Potent antibacterial activity in surgical wounds with local administration of D-PLEX100

Despite significant advances in infection control guidelines and practices, surgical site infections remain a substantial cause of morbidity, prolonged hospitalization, and mortality. The most effective component of SSI reduction strategies is the preoperative administration of intravenous antibiotics; however, systemic antibiotics drug exposure diminishes rapidly and may result in insufficient prophylactic activity against susceptible and resistant SSI pathogens at the wound. D-PLEX100 (D-PLEX) is an antibiotic-releasing drug (doxycycline) that is supplied as a sterile powder for paste reconstitution with sterile saline. D-PLEX paste is administered locally into the incision site along the entire length of soft tissue and sternal bone wound surfaces prior to skin closure. A single D-PLEX administration is intended for 30 days of constant antimicrobial prophylaxis in the prevention of incisional SSIs. We evaluated D-PLEX minimal bactericidal concentration (MBC) against a panel of bacteria that is prevalent in the abdominal wall and sternal surgical procedures including doxycycline susceptible and resistant strains. D-PLEX in vivo efficacy was assessed in incisional infection rabbit models (abdominal wall and sternal) challenged with a similar bacterial panel. The D-PLEX drug exposure profile was determined by in vitro release assay, and in vivo by quantitative pharmacokinetic parameters of local and systemic doxycycline concentrations released from D-PLEX after local administration in incisional rabbit models. Analyses of pathogens and variations in antibiotic resistance from wound isolates were determined from patients who participated in a previously reported prospective randomized trial that assessed the SSI rate in D-PLEX plus standard of care (SOC) versus SOC alone in colorectal resection surgery. The D-PLEX MBC values demonstrated >3- Log10 reduction in all the organisms tested relative to untreated controls, including doxycycline-resistant bacteria (i.e., Methicillin-resistant Staphylococcus aureus (MRSA), K. pneumoniae, and P. aeruginosa). In vivo, D-PLEX significantly reduced the bacterial loads in all the bacteria tested in both animal models (p=0.0001) with a marked impact observed in E. Coli (>6.5 Log10 reduction). D-PLEX exhibited a zero-order release kinetics profile in vitro for 30 days (R2 = 0.971) and the matched in vivo release profile indicated a constant local release of protein-unbound doxycycline for 30 days at 3-5 mcg/mL with significantly lower (>3 orders of magnitudes) systemic levels. In colorectal surgery patients, where significant SSI reduction was observed, analysis of the positive cultures in the overall population indicated similar pathogen diversity and antibiotic resistance rates in both treatment arms. However, almost all the patients with positive culture in the SOC arm were adjudicated as SSI (94%) compared to only 28% in the D-PLEX arm. The SSI-adjudicated D-PLEX patients also exhibited lower resistance rates to the SOC antibiotics and to MDRs compared to patients in the SOC arm. Thus, D-PLEX provides safe and effective prophylaxis activity against the most prevalent SSI pathogens including doxycycline-susceptible and resistant bacteria. Our findings suggest that D-PLEX is a promising addition to SSI prophylactic bundles and may address the gaps in current SSI prophylaxis. D-PLEX is now evaluated in Phase 3 clinical trial.

Outbreak of carbapenem-resistant Enterobacterales at a long-term care facility in Seoul, Korea: surveillance and intervention mitigation strategies.

Because effective decolonization options are not available, and treatment options are limited, carbapenem-resistant Enterobacterales (CRE) constitute increasingly threatening nosocomial pathogens. To prevent CRE-associated transmission and ensure patient safety, healthcare personnel and everyone in contact with CRE-infected patients must implement stringent infection control practices. This report describes a CRE outbreak, possibly related to a caregiver at a long-term care facility (LTCF), and presents a new surveillance model to improve the infection control of CRE in Seoul, Korea. The Seoul Metropolitan Government surveillance system identified an outbreak of CRE in an LTCF in 2022. We obtained data on the demographic characteristics and contact histories of the inpatients, medical staff, and caregivers. To isolate the inpatients and employees exposed to CRE, we used rectal swab samples and environmental sampling during the study period (May-December 2022). We identified 18 cluster cases (1 caregiver and 17 inpatients) and 12 sporadic cases with CRE, and conducted a complete 197-day follow-up of all cases in the LTCF's isolation wards. This investigation demonstrated that our surveillance model and targeted intervention, based on the cooperation of the municipal government, public health center, and infection control advisory committee, effectively contained the epidemic at the LTCF. Measures to improve the compliance of all employees in LTCFs with infection control guidelines should also be adopted.

Modeling methicillin-resistant Staphylococcus aureus (MRSA) acquisitions in the intensive care unit with different staffing levels and finite direct-care tasks

Background: Modeling is a cost-effective way to evaluate interventions pertaining to hospital infection acquisitions, such as staffing levels. Increasing the number of nurses in an intensive care unit affects rates of HAI transmission. The way compartmental models are often formulated assumes that there is a never-ending series of tasks for workers to perform. Our previous models used a baseline of 1:3 nurse:patient ratio, and we kept the number of tasks the same across staffing ratios. We wanted to understand how having a finite number of tasks, using this baseline number, across staffing levels affected HAI acquisitions. Methods: We used a stochastic mathematical model of methicillin-resistant Staphylococcus aureus (MRSA) to study the impact of changes in staffing and a finite pool of tasks on hospital-associated acquisitions. For a 15-bed intensive care unit (ICU), we have 1 intensivist, and we set the nurse:patient ratios at 1:1, 1:1.5, 1:2.5, 1:3, 1:5, and 1:7.5, to represent the extreme ends of staffing levels and more moderate values in line with critical care society guidelines. Each model was run 1,000 times. The outcome of each scenario is the median number of hospital-associated MRSA acquisitions in 1 year from those 1,000 runs. Results: Treating the 1:3 nurse:patient ratio as the baseline, with 45 MRSA acquisitions per year, increasing the number of nurses from 5 to 6 (moving to a 1:2.5 nurse:patient ratio) had a relative risk (RR) of 0.77, suggesting that a small change in nurse staffing levels might have an outsized impact on rates. More dramatic changes had correspondingly larger swings in MRSA acquisition rates, with 1:1 nurse:patient ratio scenarios having an RR of 0.17, and at the other extreme, a 1:7.5 nurse:patient ratio having an RR of 4.66. Comparing the infinite to finite models, the ratios with more nurses had lower acquisition rates, with decreases ranging from 20% to 50%. Ratios with fewer nurses in the ICU showed 100%–400% increases in the number of acquisitions. All results were statistically significant. Conclusions: As nurse:patient ratios go up, the burden of direct-care tasks fall on fewer people, which has a direct impact on HAI rates. Our model demonstrates this hypothesis. Therefore, appropriate staffing should be considered in infection control guidelines, and the cost of staffing should be weighed against its impact on infection prevention as well as other areas of patient care. In this study, we considered only the impact from changes in contact patterns emerging from different staffing levels. Further insights may exist when considering other outcomes that also accompany increased staffing.Disclosures: None

Role of Attitude in Influencing Compliance with Tuberculosis Infection Prevention and Control Guidelines among Healthcare Workers

Role of Attitude in Influencing Compliance with Tuberculosis Infection Prevention and Control Guidelines among Healthcare Workers

Implementation fidelity of infection prevention practices at Debre Tabor comprehensive specialized hospital, Northwest Ethiopia

BackgroundHealthcare-Acquired Infections are a major problem in the world and within the healthcare delivery system. An estimated 5–10% and around 25% of hospitalized patients have healthcare-acquired infections in developed and developing countries, respectively. Infection prevention and control programs have proven to be successful in lowering the incidence and spread of infections. Thus, this evaluation aims to evaluate the implementation fidelity of infection prevention practices at Debre Tabor comprehensive specialized hospital in Northwest Ethiopia.MethodsA facility-based cross-sectional design with a concurrent mixed method was used to evaluate the implementation fidelity of infection prevention practices. A total of 36 indicators were used to measure adherence, participant responsiveness, and facilitation strategy dimensions. A total of 423 clients were administered for an interview, an inventory checklist, a document review, 35 non-participatory observations, and 11 key informant interviews were conducted. A multivariable logistic regression analysis was used to identify factors significantly associated with the satisfaction of clients. The findings were presented using descriptions, tables, and graphs.ResultThe overall implementation fidelity of the infection prevention practices was 61.8%. The dimensions of adherence to infection prevention and control guidelines were 71.4%, participant responsiveness was 60.6%, and facilitation strategy was 48%. In multivariable analysis, ward admission and educational level had a p-value of below 0.05 and were significantly associated with the satisfaction of clients with infection prevention practices at the hospital. The major themes that emerged in qualitative data analysis were healthcare worker-related factors, management-related factors, and patient- and visitor-related factors.ConclusionThe evaluation result of this study concluded that the overall implementation fidelity of infection prevention practice was judged to be medium and needed improvement. It included dimensions of adherence and participant responsiveness that were rated as medium, as well as a facilitation strategy that was rated as low. Enablers and barriers were thematized into factors related to healthcare providers, management, institutions, and patient and visitor relations.