Infection Control Plan Research Articles

Comparison of genotypic features between two groups of antibiotic resistant Klebsiella pneumoniae clinical isolates obtained before and after the COVID-19 pandemic from Egypt

Klebsiella pneumoniae is a common pathogen capable of causing a wide range of infections. Antibiotic resistance complicates treatment of these infections significantly. We are comparing resistance levels and genotypes among two collections of K. pneumoniae clinical isolates from Alexandria Main University Hospital (AMUH). We used disc diffusion and Minimum Inhibitory Concentration (MIC) by microbroth dilution to assess resistance levels and performed whole genome sequencing (WGS) to describe multilocus sequence types (MLST) and resistance gene presence. Among a collection of 56 K. pneumoniae clinical isolates (19 from 2019 to 37 from 2021), multidrug resistance (MDR) was 33% and 10%, extended drug resistance (XDR) was 24% and 46% and pan-drug resistance (PDR) was 43% and 43%, respectively. We identified 15 MLST STs including two novel types (ST-6118 and ST-6119 ). ST-101 and ST-383 were common between the two collections; ST-101 was the most common genotype in 2019 (28.6%) and ST-147 was most common in 2021 (25%). Ampicillin/sulbactam, amikacin, cefepime, ceftriaxone and ertapenem MICs were significantly higher in 2021. Prevalence of aph(3’) – Ia, aph(3’)-VI, mphA was significantly higher in 2021. The increasing resistance levels and the persistence of some MDR/XDR genotypes is concerning. Understanding mechanisms of resistance will inform infection control and antimicrobial stewardship plans to prevent evolution and spread of XDR and PDR strains.

A-278 Prevalence of Clostridium Difficile in Long-Term Care Facilities Using BD Max Cdiff Molecular Assay

Abstract Background Clostridium difficile (C.Diff) is a gram positive anaerobe producing Enterotoxin and Cytotoxin (toxin A and B respectively); more than half of million infection is diagnosed yearly with more than 10% of the cases are in patients over 65 years old. Residents in Long-Term Care Facilities (LTCF) are more prone to have C. Diff infection (CDI) because of their age, the frequent use of antibiotics, fragilities, co-morbidity, and living environment. Diagnosing CDI is based on clinical signs and symptoms as well as laboratory tests; however, the enzyme immunoassays are reliable, the tissue culture cytotoxicity is labor intensive. The nucleic acid amplification tests are becoming more the standard as first step in the diagnosis. The BD MAX™ System is a PCR walkaway instrument that provides the sensitivity, specificity and faster turnaround for the C. diff. Methods The BD MAX™ System is an automated in-vitro diagnostic test for the direct qualitative detection of the C. difficile toxin B gene (tcdB) in human liquid or soft stool specimens from patients suspected of having Clostridium difficile Infection (CDI). Premier Toxins A & B is an enzyme immunoassay for the direct detection of Clostridium difficile toxin A and toxin B in stool samples. We collected data from 5,267 samples were collected from resident in LTCF and were run using the EIA assay, 275 samples were ran using the BD Max molecular assay. We had 31 samples that were run using both assays. Statistical analyses were done using Analyse-it. Results Female accounted for 60% of the patients tested; the positivity rate was 13.2% for female and 17.2 for male using the EIA. The positivity rate was 19.2% for female and 30.6% for male when using the molecular assay. The agreement between the EIA and the PCR was 87% based on 31 samples that were run for both assays. Conclusions The BD Max gave the benefit of a fully automated with high sensitivity and specificity for the presence of toxin B producing C. Diff. The difference between the methods could be due to the lack of the sensitivity in the EIA and the fact that the molecular assay might be picking up colonized specimen or the beginning or end of infection. However, the ability to diagnose CDI early and prevent spreading of the disease to other patients is a huge benefit to the facilities. We have to keep in mind also that C.diff infection can be prevented with appropriate use of antibiotics and implementing antibiotic stewardship and infection control plan to prevent and stop spreading of the infection.

Assessment of airborne infection control practices at health care facilities of Tumkur District, Karnataka: A descriptive study

IntroductionTuberculosis (TB) is a major health hazard in India and is one of the leading causes of death worldwide. Airborne transmission of infectious disease is a major public health concern. Adherence to the airborne infection control (AIC) is crucial to prevent spread of TB among patients who visit health care facilities and among the health care staff. ObjectivesTo assess the airborne infection control practices at health care facilities of Tumkur Methodology: This descriptive study was conducted in 85 public health institutes in 5 TB units of Tumkur. Data was collected using pre-tested; semi-structured questionnaire through personal interview, verification of records and inspection using WHO check-list. ResultsThe present study showed infection control committee and infection control plan were present in 97.65% and 90.59%, clinical staff underwent periodic TBIC training in 91.76% of PHIs. Waiting area and sputum sample collection area were well-ventilated in 97.65% & 97.65% of PHIs. Health workers practiced hand hygiene in 90.59%, PPEs were available in 85.06% PHIs. ConclusionThe study concludes that, airborne infection control measures which includes administrative, environmental, and use of personal protective equipment were satisfactory among the PHIs but still there is scope for improvement.

Exploring hospital resilience protective or risk factors: lessons for future disaster response efforts.

Hospital resilience is essential in responding to disasters, but current research focuses mainly on frameworks and models rather than the protection of resilience and analysis of risk factors during public health emergencies. This study aims to examine the development of resilience in Chinese frontline hospitals during the initial COVID-19 outbreak in 2020, providing insights for future disaster response efforts. We conducted interviews with 26 hospital staff members who were involved in the initial response to the COVID-19 outbreak in China. We used a semi-structured interview approach and employed purposive sampling and snowball sampling techniques. The interview outline was guided by the 'Action Framework' proposed by the World Health Organization (WHO) for responding to infectious disease emergencies. This framework includes dimensions such as command, surveillance, risk communication, medical response, and public health response. We analyzed the collected data using Colaizzi's seven-step data analysis method and the template analysis method. WHO's 'action framework' effectively highlights the factors that contribute to hospital resilience. While medical response, including the availability of materials and facilities, the use of information technology, and the capacity for infectious disease diagnosis and treatment, remains crucial, other important aspects include awareness and beliefs about infections, treatment experience, interdisciplinary collaboration, and more. Additionally, it is essential to establish an intelligent command system, foster trusting partnerships between teams, improve monitoring capabilities for infectious disease agents, enhance risk communication through information synchronization and transparency, strengthen infection control planning, and improve environmental disinfection capabilities for effective public health emergency response. These contradictions significantly impact the enhancement of hospital resilience in dealing with major infectious disease outbreaks. In responding to sudden major infectious diseases, hospitals play a vital role within the healthcare system. Enhancing hospital resilience involves more than just improving treatment capabilities. It also requires effective command coordination at the hospital level, infection control planning, and the deployment of intelligent equipment. Additionally, planning for effective communication and coordination between hospitals, communities, and the national healthcare system can further enhance hospital resilience.

Healthcare Workers' Assessment of a Visual Triage System (VTS).

Overcrowding and extended waiting times in the emergency department (ED) can pose a significant risk of COVID-19 transmission from patients to healthy individuals. In 2017, the Saudi Ministry of Health (MOH) introduced a visual triage system (VTS) with scoring to notify healthcare workers (HCWs) in EDs about the Middle East respiratory syndrome coronavirus (MERS-CoV) infection risk. During the COVID-19 pandemic, the MOH employed a VTS to classify patients according to their potential risk of COVID-19 infection upon their admission to the ED. Suspected patients were then directed along specific pathways to reduce their contact with healthy individuals. This study assessed HCWs' satisfaction with the VTS in the ED of two major government hospitals within the Riyadh region. Additionally, it assessed HCWs' perceptions of VTS effectiveness. This study used a cross-sectional, observational design and relied on surveys for data collection. A total of 127 participants completed the survey, of which 87 (68.5%) were based in the EDs of the two hospitals. Among the ED participants, 18.1% expressed satisfaction with the VTS, 46.4% were neutral, and 33.1% reported dissatisfaction. ED participants provided feedback on the system's effectiveness, with 24.1% finding it effective, 66.7% considering it somewhat effective, and 9.2% deeming it ineffective. Of the total (127) study participants (70.1%) reported that the HCWs required better training to effectively implement the VTS infection control plans for suspected cases. Fewer than half of the participants (35.4%) deemed the time spent by VTS personnel to identify COVID-19 cases to be reasonable, whereas 22% found it too short and 27.6% considered it too long. Of the total 127 participants, 63% reported that language differences between patients and HCWs constituted barriers to the effective application of the VTS. Our study findings indicated that most ED participants had a neutral outlook on their satisfaction with the VTS and a neutral perspective on the effectiveness of VTS, viewing it as only somewhat effective. Reported weaknesses and key obstacles to the successful implementation of the VTS included language barriers. and insufficient training for HCWs, andunclear VTS pathways. The reported strengths of the VTS included its effectiveness in reducing crowds and identification of COVID-19 patients.

Cross-Sectional Survey of Horse Owners to Assess Their Knowledge and Use of Biosecurity Practices for Equine Infectious Diseases in the United States.

Horses are transported in the United States more than any other livestock species and co-mingle at various events; therefore, they are considered to be at an increased risk for infectious disease transmission. The fragmented movement of horses combined with numerous sites of co-mingling makes tracing the potential spread of a disease outbreak a necessary part of an infection control plan, both locally and nationally. The cross-movement of personnel with horses and the persistence of endemic diseases make biosecurity implementation an ongoing challenge. Although many of the risks for infection are known, there is limited documentation about the usefulness of prospective control measures. The objective of this survey was to determine horse owners' understanding and knowledge of biosecurity practices for preventing infectious diseases in the United States. Questions covered owner demographic information, including horse use which was divided into 10 categories as follows: Pleasure/Trail Riding, Lessons/School, Western Show, English Show, Breeding, Farm/Ranch, Retired, Racing, Driving and Other. The survey was distributed by sending requests to a list of horse owner organizations, which then sent emails to their members. The email request described the survey and provided a website link to start the survey. A total of 2413 responses were collected. Analysis of the results included cross-tabulation to identify significant differences in biosecurity knowledge and awareness by horse use. Significant differences by horse use were identified for vaccination, biosecurity planning, use of isolation, disease risk, monitoring for diseases, co-mingling of horses, sanitation, medical decision making and health record requirements for horse events. In summary, the results suggest that most owners are not highly concerned about the risk of disease or the use of biosecurity. There are several biosecurity applications and techniques which can be increased and will benefit horse health and welfare. These include reliance on temperature monitoring, isolation of new horses at facilities, risks of horse mingling, entry requirements such as vaccination and health certificates at events, and an emphasis on having biosecurity plans for facilities and events where horses co-mingle. The information from this study will be used to create tools and information that horse owners and veterinarians can use to implement appropriate biosecurity practices for different types of horse uses and events.

A-286 Performance Evaluation of Molecular Clostridium Difficile Assay using BD MaxTM System

Abstract Background Clostridium difficile (C.Diff) is a gram positive anaerobe producing Enterotoxin and Cytotoxin (toxin A and B respectively); toxin B has been reported to be essential for its virulence. It is estimated that C. Diff will cause over half a million infection yearly and one in 11 people over the age of 65 diagnosed with healthcare-associated C.Diff infection die within one month. It is the most common cause of acute diarrhea; residents in Long-Term Care Facilities (LTCF) are more prone to have C. Diff infection (CDI) because of their age, the frequent use of antibiotics, fragilities, co-morbidity, and living environment. Diagnosing CDI is based on clinical signs and symptoms as well as laboratory tests. Several tests available for diagnosing the infection which include: enzyme immunoassays, tissue culture cytotoxicity, anaerobic culture, glutamate dehydrogenase antigen and nucleic acid amplification. The BD MAX™ System is a PCR based assay that provides the sensitivity, specificity and faster turnaround. Methods The MAX™ System is an automated in vitro diagnostic test for the direct qualitative detection of the C. difficile toxin B gene (tcdB) in human liquid or soft stool specimens from patients suspected of having Clostridium difficile Infection (CDI).The test is performed directly on the specimen, utilizing real-time polymerase chain reaction (PCR) for the amplification of C. difficile toxin B gene (tcdB). The test utilizes fluorogenic sequence-specific hybridization probes for detection of the amplified DNA. The test was validated for accuracy, precision, and patient correlation to enzyme-immunoassay using Premier Toxins A & B is an enzyme immunoassay for the direct detection of Clostridium difficile toxin A and toxin B in stool samples. Statistical analyses were done using Analyse-it. Results The percentage agreement for precision, reproducibility, and accuracy were 100%. We had 100% agreement for positive patients on EIA and 85% for negative patients on EIA; however, upon investigation we found the discrepancies were due to false negative EIA results. Conclusion The BD Max gave the benefit of a fully automated with high sensitivity and specificity for the presence of toxin B producing C. Diff. The faster turnaround gives the physician the ability to diagnose CDI and prevent spreading of the disease to other patients. It is very important to remember that C.diff infection can be prevented with appropriate use of antibiotics and implementing antibiotic stewardship and infection control plan to prevent and stop spreading of the infection.

Planning for Next Time: The Challenges Faced by a Veterinary Teaching Hospital During the COVID-19 Pandemic.

The COVID-19 pandemic challenged critical services to maintain operations while facing a highly transmissible human pathogen. As public health officials worked to manage the crisis, initial guidelines focused on the continuation of services in the human health care setting. However, through state-mandated stay-at-home orders, the Michigan State University veterinary teaching hospital remained open to provide emergency services to both large and small animal patients. This was accomplished by distilling pertinent safety information from the available human health care guidance to safely maintain operation. Challenges faced when pivoting the delivery of veterinary education from in-person to virtual format were addressed and in-person clinical rotations were resumed as soon as possible. Strategies to effectively communicate information that is both immediately critical and broadly applicable should be considered and planned before they are needed. Infection control and disaster management plans should be revisited often to ensure they include all known risks and potential challenges. Plans to maintain staffing capacity and student safety when faced with an unexpected surge in patients should be laid out with clearly defined metrics on which to act. The lessons we have learned from the pandemic would improve the delivery of care and teaching in a veterinary teaching hospital in both day-to-day circumstances and future emergencies.

Antimicrobial resistance patterns of Gram-negative bacteria in an Iranian referral pediatric hospital: A present danger of New Delhi metallo-β-lactamase.

Antimicrobial resistance among gram-negative bacteria has been growing, particularly in developing countries, like Iran. The emergence and spread of carbapenem-resistance mechanisms is a major public health concern because no definite treatments have yet been established for this problem. This study aimed to evaluate antibiotic susceptibility of gram-negative bacteria, metallo-β-lactamases (MBLs) and carbapenemase-producing genes, including bla NDM, bla VIM, and bla IMP in patients referred to Children's Medical Center, Tehran, Iran. In this cross-sectional study, a total of 944 gram-negative isolates were tested in the study, and antimicrobial susceptibility testing was performed. Moreover, MBL production of carbapenem-resistant isolates, as well as the presence of bla NDM, bla VIM, and bla IMP, was investigated. The most common gram-negative isolated bacteria were Escherichia coli (489 samples, 52%), followed by Klebsiella pneumoniae (167 samples, 18%), Pseudomonas aeruginosa (101 samples, 11%), Enterobacter spp. (64 samples, 7%), Pseudomonas spp. (35 samples, 4%), Acinetobacter baumannii (18 samples, 2%), and Burkholderia cepacia (17 samples, 2%). Imipenem-resistant was found in 75%, 61%, and 60% of Stenotrophomonas maltophilia, Enterobacter spp., and A. baumannii isolates, respectively. Moreover, the highest resistance to meropenem was observed in S. maltophilia, A. baumannii, P. aeruginosa, and B. cepacia (100%, 96%, 83%, and 61.5%, respectively). Double disk synergy test (DDST) results showed that 112 out of 255 carbapenem-resistant isolates (44%) were MBL-producing ones. The presence of the bla NDM gene was identified in 32 (29%) of MBL-producing isolates, 13 of which were K. pneumoniae, 7 P. aeruginosa, and 7 E. coli, 3 Enterobacter spp., and 2 Klebsiella spp, respectively. The presence of the bla IMP and bla VIM genes was detected in 2 (2%) and 1 (1%) of MBL-producing isolates. These genes were detected in only MBL-producing P. aeruginosa isolates. Our findings suggest the emergence of NDM-producing strains in our hospital, and bla NDM was the most frequently detected carbapenemase gene in MBL-producing P. aeruginosa, K. pneumoniae, and Klebsiella spp. Since such bacteria can easily spread among patients in the hospital, a strong infection control and prevention plan is highly recommended.

The Infection Control Measures Taken in MRI Examination During the COVID-19 Pandemic Prevention and Control Period

Objective: To optimize the magnetic resonance imaging (MRI) detection process in view of the COVID-19 pandemic, standardize and strengthen the infection control and management MRI rooms. Methods: According to the Technical Guide for COVID-19 Prevention and Control in Medical Institutions (3rd Edition), with reference to the current COVID-19 infection control plan, there are three aspects involved in the planning of MRI examination: MRI room management, medical staff management and protection, and patient management, especially the use of full plastic nose strip medical masks. Infection prevention measures are formulated, scientific prevention and control are made, and accurate policies are implemented. Results: MRI examination was carried out according to the infection control and management of MRI room plan during the epidemic, so as to ensure the safety of examination, the safety of patients and the safety of medical staff and no cross infection in hospital. Conclusion: The implementation of proper infection prevention measures during MRI examination in light of COVID-19 ensures that patients wear medical surgical masks with full plastic nose strips throughout the process to avoid cross-infection, ensure the safety of doctors and patients, and maintain the health of the population.

2352. Analysis of National Infection Prevention and Control Programs on Sepsis Incidence: An Ecological Study

Abstract Background Annually, the World Health Organization (WHO), World Organization for Animal Health, and the Food and Agriculture Organization of the United Nations jointly administer the Tripartite Antimicrobial Resistance (AMR) country self-assessment survey (TrACSS), which asks participating countries to evaluate themselves on their progress in implementing policies to prevent and control AMR. Question 8.1 in the survey asks whether there is a functional national infection prevention and control (IPC) program or plan in human healthcare (question 8.1 in the survey). Our aim was to evaluate whether having an IPC plan correlates with a reduction in a country’s sepsis incidence. Methods We used 2017 estimates of total sepsis incidence per 100,000 people published previously by Rudd et al. We matched this data to a country’s respective response to question 8.1 of the 2016–2017 TrACSS. Table 1 lists the potential answers to question 8.1. Additional details about the survey methodology are available on the WHO TrACSS website. We compared the sepsis incidence in countries where IPC plans were implemented nationwide (answer D or E) to countries that did not implement a nationwide IPC plan (answer A, B, or C). Results 154 countries were surveyed, 140 of which responded to question 8.1 and had available sepsis data. 47 countries (33.6%) had nationwide implementation of IPC plans and 93 (66.4%) did not. Globally, countries who implemented nationwide IPC plans had lower sepsis incidence with less inter-country variability (median: 201, interquartile range [IQR]: 165–272) compared to countries who did not implement an IPC plan (439, IQR: 290–682). (Figure 1). Similar trends were observed when broken down by each individual WHO region (Figure 2). Multivariate Poisson regression adjusting for region found that countries who implemented nationwide IPC plans had a 37.2% (95% CI 35.7–38.9%, p < 0.001) lower incidence of sepsis. The height of the box represents the interquartile range (IQR). The solid line within each box represents the median. The whiskers represent the minimum and maximum for each respective group, excluding outliers. Outliers are defined as any data point that is greater or less than 1.5 x IQR from the third or first quartile, respectively. Outliers are depicted as individual data points outside of each box and whiskers. The red box represents countries that answered either a, b, or c. The turquoise box includes countries that answered either d or e. Box plot parameters are similar to that of figure 1. Each pair of red (countries answering a, b, or c) and turquoise boxes (countries answering d or e) represent a different WHO region, as listed on the x-axis. AFRO is the African Region. AMRO is the Region of the Americas. EMRO is the Eastern Mediterranean Region. EURO is the European Region. SEARO is the South-East Asian Region and WPRO is the Western Pacific Region. Conclusion This ecological study suggests that broad implementation of an IPC plan is associated with lower sepsis incidence. Additional time-series analysis and adjusting for gross domestic product would be important next steps to ascertain the true benefit of implementing a national IPC plan on rates of sepsis. Disclosures All Authors: No reported disclosures.

Knowledge, Attitude, And Practice Regarding Use of Face Mask Among Health Care Workers as a Measure of Covid-19 Infection Prevention in Federal Medical Centre, Asaba, Delta State Nigeria

Introduction: Effective use of Face mask is very important to protect healthcare workers (HCWs) against respiratory hazards including COVID-19.Several countries are presently using face masks in their infection control plans, besides, incorrect use and disposal may actually increase the rate of transmission. The purpose of this study was to investigate the knowledge, attitude, and practices of healthcare workers (HCWs) regarding the use of face mask as a measure to COVID-19 infection prevention. Materials and Methods: This survey was conducted by interviewing 345 HCWs using a questionnaire consisting of the demographic characteristics, questions regarding the knowledge, attitude, and practices of use of face mask. Each correct answer was scored 1 and each incorrect answer scored 0. The total number of questions were 25; 10 for Knowledge, 8 for Practice and 7 for Attitude of heath care workers on the use of face mask. The final aggregate score was calculated and then labeled according to the percentage of correct responses as good >50% and poor < 50% for Knowledge, Practice and Attitude of health care workers on use of face mask. Data were gathered, analyzed using SPSS software version 25. Results: A total of 345 participants with a mean age of 36.0 years (108 males and 237 females) were included in the study. The Health care workers were good in Knowledge 324 (93.9%), attitude 250 (72.5%), and practice 282(81.7%) regarding use of face mask. However clinical HCW had good knowledge(X2 = 13.84, P value = 0.001, 95% CI= 0.08-0.51) and attitude(X2= 13.80, p value = 0.0001, 95% CI=0.21-0.6) of use of face mask than Non Clinical HCW when compared with their practice(X2=1.10, p value = 0.30, 95 % CI=0.40-1.35) Conclusions: Knowledge, attitude of HCWs regarding the use of face masks were found to be adequate. but moderate-to-poor level of practice regarding the use of face mask. HCWs and general public to create awareness regarding the proper use of face mask by utilizing all social media. Provision of user friendly mask by government to the hospitals and at affordable rate to the public in order to improve their level of practice in wearing the masks.

Successful Control of an Outbreak by Phenotypically Identified Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit.

Premature newborns represent a vulnerable population, at high risk of acquiring nosocomial infections during neonatal intensive care unit (NICU) admission. Multidrug-resistant organisms represent the greatest concern due to their intrinsic virulence and the limited therapeutic options. Resistant Enterobacterales are a growing threat for critically ill neonates, with increasing numbers of NICU outbreaks caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacterales being described. This study reports the early detection and successful control of an outbreak caused by ESBL-producing Klebsiella pneumoniae (ESBL-KP) in an Italian NICU in February 2021. A total of 13 newborns tested positive for ESBL-KP between 2-9 February 2021, of whom four (31%) had a bloodstream infection. Two were critically ill, extremely premature newborns who died because of multiple comorbidities, and two were cured after treatment with meropenem. All other patients survived and were either discharged home or moved to other hospitals/wards in good clinical condition. ESBL-KP ST45 was found in all isolates by multilocus sequence typing (MLST) analysis. An outbreak control plan was set, including surveillance cultures for all neonates, NICU environments, and medical devices, along with the extended use of contact precautions and cohorting. In addition, the infection control plan was carried out through reinforcement and enhancement measures to guarantee maximal compliance. The outbreak was successfully controlled in seven days, given that no further cases were identified after 9 February. The source of the ESBL-KP outbreak was not identified through environmental sampling. Thanks to multidisciplinary management, a threatening outbreak of ESBL-KP in a NICU was controlled in few days. The prompt recognition of the event onset and the adoption of infection control interventions helped contain the bacteria spread on the ward.

What is the Fee for Infection Prevention and Control? Current Status and Prospect

Infection control is an essential factor for improving the quality of acute and long-term care facilities, including patient safety. Infection control should be implemented in all medical facility sectors, and participation of all healthcare workers is required. For efficient infection control, securing and maintaining professionals with sufficient experience and training to establish and implement infection control plans focusing the infection control unit is imperative. Moreover, there should be no shortage of infection control supplies, including consumables and disposables necessary for hand hygiene, personal protective equipment, and isolation. The fee for infection prevention and control should be resourced as necessary funding to establish such infection control infrastructure. Moreover, re-evaluating whether the standard for the fee for infection prevention and control is appropriate, improving the current payment mode, and monitoring whether the fee used is executed as infection control costs are necessary.

Whole-Genome Sequencing of Staphylococcus aureus and Staphylococcus haemolyticus Clinical Isolates from Egypt.

ABSTRACTInfections caused by antibiotic-resistant Staphylococcus are a global concern. This is true in the Middle East, where increasingly resistant Staphylococcus aureus and Staphylococcus haemolyticus strains have been detected. While extensive surveys have revealed the prevalence of infections caused by antibiotic-resistant staphylococci in Europe, Asia, and North America, the population structure of antibiotic-resistant staphylococci recovered from patients and clinical settings in Egypt remains uncharacterized. We performed whole-genome sequencing of 56 S. aureus and 10 S. haemolyticus isolates from Alexandria Main University Hospital; 46 of the S. aureus genomes and all 10 of the S. haemolyticus genomes carry mecA, which confers methicillin resistance. Supplemented with additional publicly available genomes from the other parts of the Middle East (34 S. aureus and 6 S. haemolyticus), we present the largest genomic study to date of staphylococcal isolates from the Middle East. These genomes include 20 S. aureus multilocus sequence types (MLST), including 3 new ones. They also include 9 S. haemolyticus MLSTs, including 1 new one. Phylogenomic analyses of each species’ core genome largely mirrored those of the MLSTs, irrespective of geographical origin. The hospital-acquired spa t037/ST239-SCCmec III/MLST CC8 clone represented the largest clade, comprising 22% of the S. aureus isolates. Like S. aureus genome surveys of other regions, these isolates from the Middle East have an open pangenome, a strong indicator of gene exchange of virulence factors and antibiotic resistance genes with other reservoirs. Our genome analyses will inform antibiotic stewardship and infection control plans in the Middle East.IMPORTANCE Staphylococci are understudied despite their prevalence within the Middle East. Methicillin-resistant Staphylococcus aureus (MRSA) is endemic to hospitals in Egypt, as are other antibiotic-resistant strains of S. aureus and S. haemolyticus. To provide insight into the strains circulating in Egypt, we performed whole-genome sequencing of 56 S. aureus and 10 S. haemolyticus isolates from Alexandria Main University Hospital. Through analysis of these genomes, as well as all available S. aureus and S. haemolyticus genomes from the Middle East (n = 40), we were able to produce a picture of the diversity in this region more complete than those afforded by traditional molecular typing strategies. For example, we identified 4 new MLSTs. Most strains harbored genes associated with multidrug resistance, toxin production, biofilm formation, and immune evasion. These data provide invaluable insight for future antibiotic stewardship and infection control within the Middle East.

Implementation of a COVID-19 Infection Control Plan in a Large Urban Jail System.

When the COVID-19 pandemic hit the United States, the number of people confined in correctional facilities on a single day numbered 1.8 million. Incarcerated people are at an increased risk of contracting and spreading SARS-CoV-2. Recommendations from the Centers for Disease Control and Prevention on case recognition, management, isolation, and contact tracing are particularly challenging in jails because of the high turnover of incarcerated people. Beginning in late February 2020, the Department of Correctional Health Services in the Los Angeles County Jail system implemented a multipronged COVID-19 mitigation plan that was progressively amended in accordance with local and national recommendations. This plan entailed the creation of housing for people under investigation, SARS-CoV-2 screening upon entry, a mass-testing program, and identification and monitoring of medically vulnerable people. After the identification of the first laboratory-confirmed case on March 29, 2020, predictive models were generated to visualize potential disease spread and gain support for mitigation strategy planning, which forecasted approximately 3300-4600 cumulative cases during a 278-day period. From March 7 through December 31, 2020, the percentage positivity among unique people tested for SARS-CoV-2 was 11.6% (3933 of 33 921 tested). Among those screened at intake, the percentage positivity was 2.0% (502 of 25 702 tested). The ethnic distribution among people with a positive SARS-CoV-2 test result was largely representative of the overall jail population, and most people were asymptomatic. A sustainable, multifaceted mitigation plan that relies on collaboration among medical, custodial, and local public health personnel is essential for limiting the spread of SARS-CoV-2 infection in correctional facilities.

Changes in nursing homes and home-based nursing care during the COVID-19 pandemic

RNs in the primary healthcare service showed that they can be highly adaptable in a crisis. Preparedness, infection control plans and support in their daily work were critical to how well they dealt with the pandemic.

Tuberculosis infection control measures in healthcare facilities in Moyen-Ogoou\xe9 Province, Gabon

BackgroundHealthcare workers (HCW) are at higher risk of tuberculosis (TB) than the general population. We assessed healthcare facilities for their TB infection control standards and priorities.MethodsA standardised tool was applied. The assessment was conducted by direct observation, documents review and interviews with the facility heads.ResultsTwenty healthcare facilities were assessed; 17 dispensaries, an HIV-clinic, a private not-for-profit hospital and a public regional hospital. In both hospitals, outpatient departments, internal medicine wards, paediatric wards, emergency departments; and the MDR-TB unit of the public regional hospital were assessed. In Gabon, there are currently no national guidelines for TB infection control (TBIC) in healthcare settings. Consequently, none of the facilities had an infection control plan or TBIC focal point. In three departments of two facilities (2/20 facilities), TB patients and presumed TB cases were observed to be consistently provided with surgical masks. One structure reported to regularly test some of its personnel for TB. Consultation rooms were adequately ventilated in six primary care level facilities (6/17 dispensaries) and in none of the hospitals, due to the use of air conditioning. Adequate personal protective equipment was not provided regularly by the facilities and was only found to be supplied in the MDR-TB unit and one of the paediatric wards.ConclusionsIn Moyen-Ogooué province, implementation of TBIC in healthcare settings is generally low. Consequently, HCW are not sufficiently protected and therefore at risk for M. tuberculosis infection. There is an urgent need for national TBIC guidelines and training of health workers to safeguard implementation.

Epidemiology of healthcare-associated infection reported from a hospital-wide incidence study: considerations for infection prevention and control planning

The measure of disease frequency most widely used to report healthcare-associated infection (HAI) is the point-prevalence survey. Incidence studies are rarely performed due to time and cost constraints; they show which patients are affected by HAI, when and where, and inform planning and design of infection prevention and control (IPC) measures. To determine the epidemiology of HAI within a general and a teaching hospital in Scotland. A prospective observational incidence study was undertaken for one year from April 2018 using data collected as part of the Evaluation of Cost of Nosocomial Infection (ECONI) study. A novel, robust approach was undertaken, using record linkage to national administrative data to provide full admission and discharge information. Cases were recorded if they met international HAI definitions. Incidence of HAI for the combined hospitals was 250 HAI cases per 100,000 acute occupied bed-days (AOBD). Highest frequency was in urinary tract (51.2 per 100,000 AOBD), bloodstream (44.7), and lower respiratory tract infection (42.2). The most frequently reported organisms were Escherichia coli, Staphylococcus aureus, and norovirus. Incidence of HAI was higher in older people and emergency cases. There was an increase in the rate of HAI in summer months (pneumonia, respiratory, surgical, and gastrointestinal infection) and in winter months norovirus gastrointestinal infection (P < 0.0001). The highest incidence specialties were intensive care, renal medicine, and cardiothoracic surgery. HAI occurred at a median of 9 days (interquartile range: 4-19) after admission. Incidence data were extrapolated to provide an annual national estimate of HAI in NHS Scotland of 7437 (95% confidence interval: 7021-7849) cases. This study provides a unique overview of incidence of HAI and identifies the burden of HAI at the national level for the first time. Understanding the incidence in different clinical settings, at different times, will allow targeting of IPC measures to those patients who would benefit the most.

Prevalence of active tuberculosis disease among healthcare workers and support staff in healthcare settings of the Amhara region, Ethiopia.

Health care workers (HCWs) are at an increased risk of acquiring tuberculosis (TB) compared to the general population, because of the frequent face to face contact or potential exposure to TB through shared air or space with infectious patient(s), regardless of economic setting and local TB incidence. Information on the burden of active TB disease among HCWs will help guide control measures, can be utilized to evaluate the effectiveness of TB infection prevention programs in the health care setting, and guide necessary actions. However, data on TB among HCW in Ethiopia is limited. Therefore, this study aimed to determine the prevalence of active TB disease among healthcare workers and support staff in healthcare settings in the Amhara region of Ethiopia. A cross-sectional study design was used to recruit a total of 580 randomly selected study participants in the Amhara region. Data were collected over four months in selected hospitals and health centers. Implementation of TB prevention and control measures was evaluated using a standardized checklist. The main outcome indicator was active TB as measured by a laboratory diagnosis using GeneXpert technology. A total of 580 study participants were enrolled. The mean age was 31.3 (±7.8 standard deviation) years, with about two-thirds (65.3%) aged between 18-24 years. A total of 9 (1.6%) MTB cases were detected, 4 (1.4%) in HCWs and 5 (1.7%) in support staff, which did not significantly differ (P = 0.50). About 90% of the participants had not received TB infection prevention and control training ever. More than half (54%) of the study participants worked in poorly ventilated rooms. Triage of coughing patients was not practiced in 32% of the studied facilities (health centers and hospitals). The magnitude of TB among healthcare workers and support staff in healthcare settings was higher than in the general population (140 per 100000 population). The status of implementation of tuberculosis prevention and control measures indicated missed opportunities. Hence, strict implementation of developed infection control plans of TB in healthcare settings needs to be improved.