Infection Control Procedures Research Articles

Risk Factors and Outcomes of Patients with Pseudomonas aeruginosa Bloodstream Infection in the Intensive Care Unit

Background: Bloodstream infections (BSIs) caused by Pseudomonas aeruginosa have high mortality rates and pose a significant threat to healthcare settings. Objectives: We aimed to investigate the clinical risk factors related to mortality and the development of P. aeruginosa with difficult-to-treat resistance (DTR-PA) BSI in the intensive care unit. Methods: This was a retrospective, single-center study that included patients with P. aeruginosa BSI who were hospitalized between 2020 and 2022. The risk factors affecting 30-day mortality and the development of DTR-PA were investigated using both univariate and multivariate analyses. Results: A total of 140 patients were analyzed. The mean age was (66 ± 17.5) years, and 48% of the patients were male. Previous meropenem use was an independent risk factor for DTR-PA BSI (odds ratio, 2.68; 95% CI, 1.24 to 5.80; P = 0.012). Multivariate analysis demonstrated that the requirement for inotropic support was an independent risk factor for 30-day mortality [hazard ratio, 2.50; 95% confidence interval (CI), 1.33 to 4.68; P = 0.004]. Conclusions: Prior meropenem use was an independent risk factor for DTR-PA development. Strict policies for Carbapenem use and infection control procedures are essential to combat infections caused by DTR-PA.

Risk factors for antimicrobial-resistant Enterobacterales in dogs: a systematic review.

Identifying risk factors associated with the carriage of antimicrobial-resistant (AMR) bacteria in dogs is crucial to understanding their epidemiology and for developing and refining targeted control measures. However, relevant data is scattered and conflicting findings have been reported. This systematic review aimed to compile risk factors associated with the carriage of AMR-Enterobacterales in dogs worldwide and to identify relevant knowledge gaps for directing future research. A systematic review was conducted according to PRISMA guidelines, searching PubMed, CABi, and Scopus databases for studies reporting risk factors for acquiring AMR-Enterobacterales in dogs. After screening peer-reviewed, English-language studies by title/abstract, eligible studies were subjected to a full-text assessment, data extraction, risk-of-bias assessment, and qualitative synthesis. In the initial search, 774 articles were identified, including 274 duplicates. After screening by title/abstract, 77 articles were subjected to full-text review, from which 40 were eventually selected for data extraction, including 29 cross-sectional, six cohort, and five case-control studies. The most frequently investigated risk factors for AMR-Enterobacterales carriage in dogs were antimicrobial use (28 of 40), age (24), sex (22), hospitalization (19), and feeding raw diet (14). Of these, antimicrobial use was the most common risk factor significantly associated with AMR-Enterobacterales (19/28), followed by raw diet (9/14) and hospitalization (8/19). Our synthesis emphasized the importance of increasing awareness regarding the prudent use of critically important antimicrobials (CIAs), such as fluoroquinolones, in companion animal practices, strengthening infection prevention and control procedures in veterinary clinics and hospitals and educating caregivers about the potential risks of feeding raw diets in order to reduce the burden of AMR-bacteria in dogs.

A-326 Testing for Multidrug-Resistant Acinetobacter baumannii with a Microfluidic Device

Abstract Background Multidrug-resistant (MDR) Acinetobacter baumannii in hospitals contribute to high mortality rates and entail expensive infection control procedures. Conventionally, species and resistance determination of MDR bacteria is performed by mass spectrometry and labor-intensive phenotypical assays in clinical microbiology laboratories. Some institutions also apply time-consuming and expensive whole genome sequencing for in-depth resistance and transmission analysis. In contrast, faster and more cost-efficient MDR typing can be achieved by on-site application of real-time PCR-based point-of-care tests (POCTs) that target species- and resistance-specific genes and enable rapid screening of large sample sizes. Methods To construct a real-time PCR-based POCT system for species and resistance determination of MDR A. baumannii, we selected two species-specific genes (rpoB, OXA-51-like) and 18 resistance genes found in MDR A. baumannii (OXA-23-like, OXA-24/40-like, OXA-51-like, OXA-58-like, OXA-143-like, mcr, ADC, NDM, GIM, VIM, IMP, GES, PER, TEM, SHV, VEB, CTX-M, KPC) as targets. For each gene, one to six sets of primers and fluorophore-labeled probes that amplify conserved genetic regions were designed and their functionality was tested in vitro. Parallel, a fully automated system comprising microfluidic chips and a bench-top analyzer able to perform DNA extraction and real-time PCR starting from swab eluate was developed. Results All oligonucleotides tested so far reliably detected 100 to 100,000 copies of DNA extracted from MDR bacteria in single- and multiplex experiments in vitro. Tests with the microfluidic system showed that lysis of different bacterial species could be accomplished via sonication on a membrane located on the microfluidic chip. In addition, chip implementation of all PCR reagents like lyophilized master mix as well as primers and probes was successful and can be stored on chip at least one year. So far, the system delivered detectable fluorescence signals within one hour when performing test runs with bacteria eluted from swabs. Conclusions A real-time PCR-based Point-of-Care screening platform was developed for the detection of antibiotic-resistant A. baumannii from various patient sample materials starting directly from swabs, which detects colonization/infection and at the same time the relevant resistance genes within about an hour.

Antibiotic Susceptibility Pattern of Pseudomonas aeruginosa and Detection of Virulence Genes in a Tertiary Care Hospital, Kathmandu, Nepal

Pseudomonas aeruginosa is one of the most common causes of hospital-acquired infections. It threatens worldwide public health because of its intrinsic antibiotic resistance and virulence. In this context, this research aimed to determine the occurrence of P. aeruginosa in a clinical setting, examine its susceptibility to antibiotics, and detect the presence of virulence genes, viz. exoY, oprL and toxA in all isolates. It was a cross-sectional study carried out from June 2022 to December 2022. A total of 1356 clinical specimens were collected and processed in the laboratory for Gram staining, culture techniques, and biochemical tests. The Kirby-Bauer disk diffusion method was applied to examine the antibiotic susceptibility pattern and conventional PCR was used to detect the virulence genes in all confirmed P. aeruginosa isolates. 40.5% of specimens showed bacterial growth, of which only 3.02% were identified as P. aeruginosa. Among them, 61.0% were multidrug resistant and 29.2% were β-lactamase producers. Aztreonam (70.7%) was the most effective antibiotic. Among all P. aeruginosa isolates, 68.3% isolates were exoY positive, 61.0% were oprL positive and 56.1% were toxA positive. Strategic interventions are required to stop the emergence and spread of antimicrobial resistance as a result of the isolation of multidrug resistant (MDR) isolates carrying these virulence genes. This study can benefit the medical staff and the entire community in building a surveillance system and enhancing infection control procedures.

Vascular Access Related Infections in Hemodialysis Children and the Impact of Implementation of CDC Guidelines and Tools on the Control of these Infections: A Single Centre Experience from Egypt

Background: Vascular access-related infection (VARI) is a serious issue in pediatric end-stage kidney disease (ESKD) patients on regular hemodialysis. Objective: To estimate the frequency of vascular access-related infections in hemodialysis (HD) children and to assess the effect of the implementation of CDC guidelines and tools on the prevention of VARI. Subjects and Methods: This study was conducted on 110 patients with ESKD on regular hemodialysis at the Pediatric Dialysis Unit, Ain Shams University, from August 2019 to September 2021, retrospectively for one year and prospectively for another year after implementing the CDC infection control procedures. Besides full history taking, vascular access history, and thorough clinical examination, lab investigations for VARI diagnosis and echocardiography were performed. CDC infection control procedures were implemented for one year, and VARI was re-evaluated. Results: The total number of patients enrolled in the study was 110, they were 58 males (52.7%) and 52 females (47.3%). The incidence of infection per 1000 vascular access days in both years was highest in patients with NTVCs (10.447 /1000 NTVC days, 6.861 /1000 NTVCs days), followed by patients with TVCs (1.051/1000 TVC days, 0.604 /1000 TVC days) then patients with AVF, (0.141/1000 AVF days, 0.046 /1000 AVF days). The mortality from vascular access-related infections in the first year was higher than in the second year, with 5 patients (10.2%) and 1 patient (3.8%), respectively. The average duration of hospital stays (PPY) due to VARI (total admission days 8.09 and ward admission days 6.41) in the first year were significantly higher than in the second year, 4.04, 3.20 days/PPY, respectively. Conclusion: The incidence of vascular access infection (VAI) is higher with non-tunneled catheters and lowest with Arteriovenous fistulae (AVF). To reduce the risk of VARI and hospitalization, proper infection control procedures must be implemented.

Device associated healthcare associated infection (DA-HAI): a detailed analysis of risk factors and outcomes in a university hospital in Rome, Italy

This study investigates the impact of invasive procedures on healthcare-associated infections (HAI) at Policlinico Universitario Tor Vergata in Rome, Italy, aiming to understand their role in device-associated HAI and to inform prevention strategies. A retrospective cohort analysis was conducted, examining mandatory discharge records and microbiology data from 2018 across all departments. The study focused on adult patients, analysing the correlation between invasive procedures and HAI through univariate and multivariate logistic regression. Of the 12,066 patients reviewed, 1,214 (10.1%) experienced HAI. Univariate analysis indicated an association between invasive procedures and HAI (OR= 1.81, P < 0.001), which was not observed in multivariable analysis. Specific procedures significantly raised HAI risks: temporary tracheostomy (AOR= 22.69, P <0.001), central venous pressure monitoring (AOR= 6.74, P <0.001) prolonged invasive mechanical ventilation (AOR= 4.44, P <0.001), and venous catheterisation (AOR= 1.58, P <0.05). Aggregated high-risk procedures had an increased likelihood of HAI in multivariable analysis (OR= 2.51, P < 0.001). High-risk departments were also notably associated with HAI (OR= 6.13, P < 0.001). This study suggests that specific invasive procedures, such as temporary tracheostomy, significantly increase HAI risks. The results highlighting the need for targeted infection prevention and control procedures and supports the need for innovative methods such as record-linkage in policymaking to address HAI. These findings inform clinical practice and healthcare policy to improve patient safety and care quality.

The effectiveness of interventions to reduce the transmission of acute respiratory infections in care homes: a systematic review.

Care home residents are at high risk from outbreaks of respiratory infections, such as influenza and COVID-19. We conducted a systematic review of randomized controlled trials, to determine which interventions (apart from vaccines) are effective at reducing transmission of acute respiratory illnesses (ARIs) in care homes. We searched CINAHL, Medline, Embase and Cochrane for randomized controlled trials (RCTs) of interventions to prevent transmission of ARIs in care homes (excluding vaccines), to April 2023. A total of 21 articles met inclusion criteria. Two infection control interventions significantly reduced respiratory infections. Oseltamivir significantly reduced risk of symptomatic laboratory-confirmed influenza (OR 0.39, 95%CI 0.16-0.94, three trials), and influenza-like illness (OR 0.50, 95%CI 0.36-0.69), even in a vaccinated population. High dose vitamin D supplementation reduced incidence of ARIs (incidence rate ratio 0.60; 95%CI 0.38-0.94, one trial). Nine other RCTs of vitamin, mineral, probiotic and herbal supplements showed no significant effect. Transmission of respiratory infections in care homes can be reduced by educational interventions to improve infection control procedures and compliance by staff, by antiviral prophylaxis soon after a case of influenza has been detected, and by supplementation with high-dose Vitamin D3. Further research is needed to confirm the effect of high-dose Vitamin D3.

Mobile Applications for Learning Hand Hygiene: A Comparative Analysis.

Infection control is crucial for high-quality patient care. One of the most effective and commonly used infection control procedures is hand hygiene which, it is known, requires repeated refresher training. There are many ways to educate healthcare professionals about hand hygiene, including the use of mobile applications (apps). Our aim is to review such hand hygiene apps, and to identify which have been available since 2021 and to assess their quality. We conducted a review using the PRISMA diagram to document our app selection process in the Google Play Store and Apple store in March 2024. For the evaluation of apps, we used the user version of the Mobile Application Rating Scale questionnaire (uMARS). Of 16 apps only five adhere to WHO hand hygiene guidelines. Timers were included in 12 of the 16 apps and reminders were included in 10 of 16 apps. The highest overall uMARS scoring app was Give Me 5-Hand Hygiene (4.31 ± 0.28), while Wash your hands! (1.17 ± 0.14) had the lowest score. We found that more than half of the apps were unavailable from the 2021 review. We believe that app-based education could effectively sustain hand hygiene knowledge in healthcare settings.

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.

Impact of the COVID-19 Pandemic on Acute Stroke Rehabilitation in Japanese Primary Stroke Centers: A Nationwide Cross-Sectional Study Using a Web-Based Questionnaire Survey

Introduction: Acute stroke rehabilitation is crucial for achieving good functional recovery, even during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to clarify the impact of the COVID-19 pandemic on acute stroke rehabilitation and identify which components in the acute stroke rehabilitation provision system were susceptible to the pandemic. Methods: A web-based questionnaire survey was conducted in all primary stroke centers (PSCs) in Japan between February 7 and April 21, 2022. The survey included questions about the current status of acute stroke rehabilitation and the influence of the pandemic. We classified the influences and investigated the relationship between the influence of the pandemic and the provision of rehabilitation. Additionally, we investigated a group of prefectures divided according to the grade of the pandemic. Results: The survey response rate was 67% (639 of 959 PSCs). Among them, 387 PSCs (61%) reported that the COVID-19 pandemic affected acute stroke rehabilitation. In PSCs affected by the pandemic, more rehabilitation-related staff were working, and the proportion of weekend/holiday rehabilitation implementation was higher compared to those unaffected. In PSCs from highly infected prefectures, no significant relationship was observed between the influence of the pandemic and the rehabilitation provision system. Conclusions: PSCs that provide denser acute stroke rehabilitation may be affected to a greater extent by the pandemic. We conclude that stroke hospitals should formulate infection control procedures for acute stroke rehabilitation in advance, depending on the conditions of the region and facility.

Genome analysis of multidrug resistant Enterococcus faecium and Enterococcus faecalis circulating among hospitalized patients in uMgungundlovu District, KwaZulu-Natal, South Africa

BackgroundVancomycin-resistant enterococci (VRE) are important pathogens categorized as high-priority bacteria in the Global Priority List of Antibiotic-Resistant Bacteria to Guide Research, Discovery, and Development of New Antibiotics published by the World Health Organization. The aim of this study was to determine the risk factors, resistance, virulence, mobilomes associated with multidrug-resistant and clonal lineages of Enterococcus faecium and faecalis circulating among hospitalized patients following the health system in South Africa, using whole genome sequencing (WGS).MethodsA cross-sectional study was conducted during a two-month periods among hospitalized patients in 2017. Rectal swabs were collected from patients admitted to medical and surgical wards in an urban tertiary hospital, and a rural district hospital in uMgungundlovu district, South Africa. Enterococci were screened for vancomycin resistance on bile esculin azide agar supplemented with 6 mg/L of vancomycin and confirmation of VRE was done using ROSCO kits. Conventional and real-time PCR methods were used to ascertain the presence of VanA, VanB, VanC-2/3 and VanC-1 genes. All six multidrug-resistant Enterococcus faecalis and faecium selected were identified using multiplexed paired-end libraries (2 × 300 bp) with the Nextera XT DNA sample preparation kit (Illumina, San Diego, CA, USA) and genome sequencing was done using Illumina MiSeq instrument with 100× coverage at the National Institute of Communicable Diseases Sequencing Core Facility, South Africa. Antibiotic resistance genes, virulence factors, plasmids, integrons and CRISPR were characterized using RAST, ResFinder, VirulenceFinder, PlasmidFinder, PHAST and ISFinder respectively.ResultsSequencing analysis revealed that these strains harbouring numerous resistance genes to glycopeptides (vanC[100%], vex3[100%], vex2[83,33%] and vanG[16,66%]), macrolides, lincosamides, sterptogramine B (ermB[33,32%], Isa[16,66%], emeA[16,66%]) and tetracyclines (tetM[33,32%]) in both district and tertiary hospitals. Multidrug efflux pumps including MATE, MFS and pmrA conferring resistance to several classes of antibiotics were also identified. The main transposable elements observed were in the Tn3 family, specifically Tn1546. Four single sequence types (STs) were identified among E. faecium in the district hospital, namely ST822, ST636, ST97 along with a novel ST assigned ST1386, while one lineage, ST29 was detected in the tertiary hospital.ConclusionThe study reveals the genetic diversity and high pathogenicity of multidrug-resistant Enterococcus faecalis and faecium circulating among hospitalized patients. It underlines the necessity to implement routine screening of admitted patients coupled with infection control procedures, antimicrobial stewardship and awareness should be strengthened to prevent and/or contain the carriage and spread of multidrug resistant E. faecium and E. faecalis in hospitals and communities in South Africa.

The Challenges Experienced by ICU Nurses in Kuwait during the COVID-19 Pandemic

BackgroundThe coronavirus (COVID-19) pandemic presented unprecedented challenges to healthcare systems worldwide, with intensive care unit (ICU) nurses at the forefront of patient care. To date, there is limited evidence into ICU nurses'experiences of the pandemic in Kuwait. Research question/aims/objectivesTo elucidate the challenges faced by ICU nurses in Kuwait during the pandemic, by considering two research questions: “What contributed to intensified pressure for the ICU nurses?” and “How were the nurses affected?”. Research designThis was a qualitative study which utilised semi-structured interviews. Interviews were conducted between January 2021 and June 2022 with ICU nurses who worked during the COVID-19 pandemic. The data were analysed using Charmaz's grounded theory methodology. Participants and research context25 nurses from three ICUs in Kuwait. Ethical considerationsThe study was approved by the University Ethics Committee and by the Ministry of Health in Kuwait. Findings/ResultsThe analysis identified two themes (the factors contributing to intensified pressure in the ICU, and the impact on the nurses) and seven sub-themes. The pressure in the ICU intensified due to the rise in the number of patients, staff shortages, and the requirement to adhere to unrealistic new procedures for infection control. Restricted and cancelled leave, as well as impaired autonomy at work, impeded the nurses’ ability to recover from stress. The heightened stress also contributed to a worsening in interpersonal relationships between the nurses and their colleagues. The nurses’ care was compromised by these challenges, leading to moral distress and a range of mental health symptoms (e.g., stress, anxiety, emotional exhaustion). ConclusionsThe study accords with other research conducted during the pandemic in revealing a significant mental health toll among healthcare workers during the pandemic. The stressors were similar to those which have been reported in other studies, although there were also context-specific effects relating to the environment of the ICU and the Kuwaiti context.

A Label-Free Optical Flow Cytometry Based-Method for Rapid Assay of Disinfectants' Bactericidal Activity.

Selecting the appropriate disinfectant to control and prevent healthcare-associated infections (HAIs) is a challenging task for environmental health experts due to the large number of available disinfectant products. This study aimed to develop a label-free flow cytometry (FCM) method for the rapid evaluation of bactericidal activity and to compare its efficacy with that of standard qualitative/quantitative suspension tests. The bactericidal efficiency of eight commercial disinfectants containing quaternary ammonium compounds (QACs) was evaluated against four strains recommended by EN 13727 (Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus hirae) and four multidrug-resistant pathogens. The proposed FCM protocol measures changes in scattered light and counts following disinfectant exposure, neutralization, and culture steps. Unlike other available FCM-based methods, this approach does not rely on autofluorescence measurements, impedance cytometry, or fluorescent dyes. The FCM scattered light signals revealed both decreased count rates and morphological changes after treatment with minimum inhibitory concentrations (MICs) and higher concentrations for all tested bacteria. The results from the FCM measurements showed excellent correlation with those from standard assays, providing a rapid tool for monitoring the susceptibility profile of clinical, multidrug-resistant pathogens to chemical disinfectants, which could support infection prevention and control procedures for healthcare environments. This label-free FCM protocol offers a novel and rapid tool for environmental health experts, aiding in the optimization of disinfectant selection for the prevention and control of HAIs.

An Investigation of the Knowledge of Infection Control Practices Held by Healthcare Professionals.

Healthcare-associated infections (HAIs), arising from inadequate hygiene practices, significantly increase morbidity and mortality rates in hospitalized patients. This descriptive study involved 350 healthcare workers from private hospitals in Wuhan, China. Participants responded to a questionnaire with close-ended questions, distributed physically and via email. Data were analyzed using SPSS version 25.0. The analysis indicated a gap in healthcare workers' knowledge of infection control, affecting hospital hygiene standards. About 60% of respondents hold a diploma or higher qualification. The findings underscore the importance of targeted training and educational initiatives in infection control procedures. A significant factor in hospitals' inadequate hygiene practices is the gap in staff training and knowledge.

Detection of Metallo β-Lactamase in Acinetobacter Species Using Phenotypic Methods with their Antibiotic Resistance Profile in Tertiary Care Hospital

Background: Acinetobacter species are commonly found in nature, in water, and in soil, and also, and they have been isolated from humans and animals. In the hospital setting, Acinetobacter species has emerged as a major opportunistic pathogen, being able to colonize and develop infections in patients. In Acinetobacter species, β-lactamases and outer membrane alterations are likely to function together to impart resistance. Understanding the epidemiology, and resistance mechanism, and for infection management and preventing a potential global health crisis, techniques for identifying Carbapenem-Resistant-Acinetobacter species are essential. Aim: To detect Metallo β-Lactamase (MBL) in Acinetobacter species with their antimicrobial susceptibility pattern. Material and Methods: 100 Acinetobacter species isolates from various clinical samples such as blood, cerebrospinal fluid, sputum, bronchoalveolar lavage, pus, urine, wound swab, and body fluids were included in the study. Phenotypic tests such as, Disc Potentiation test &amp; Modified Hodge test were used to detect the presence of Metallo β-lactamase in imipenem &amp; meropenem-resistant isolates. Results: The highest prevalence of Acinetobacter was found in blood (37%), followed by sputum (31%) and others [pus, urine, ascitic fluid, cerebrospinal fluid (CSF), bronchoalveolar Lavage (BAL), and pleural fluid]. A maximum number of Acinetobacter were isolated from MICU followed by medicine and surgery. The Modified Hodge test yielded the largest percentage of MBL-positive Acinetobacter isolates (67.26%) when compared to the Disc Potentiation test method (50.45%). Conclusion: Early detection of Metallo β-lactamase production is essential for planning appropriate treatment according to the resistance mechanisms of the multi-drug resistant strains, as well as for efficient infection control procedures to prevent the spread of infection.

Infection Control Attitude, Knowledge and Awareness Level Among Dental Students and Interns in the Removable Prosthodontic Department at the Faculty of Dentistry, University of Benghazi, Libya

Background: Dental students have increased patient contact during their education and clinical practice, putting them, their patient population and Dental Health Care Workers (DHCW) at high risk of cross-infection. Awareness of infection control principles may help in preventing disease transmission; therefore, the purpose of this study was to evaluate the level of infection control knowledge, attitude, and practice among dental students and interns in a removable prosthodontic department at the Faculty of Dentistry, University of Benghazi, Libya. Materials and Methods: In May 2023, we distributed questionnaires containing 33 items to interns, 3rd-year, and 4th-year dental students at the faculty. The questions covered topics such as hepatitis B vaccination, use of personal protective barriers, knowledge of infection control protocols, and practice in the removable prosthodontic department of the faculty. Descriptive statistics were recorded using frequency and percentages. Differences in proportions were assessed using the Chi-square and Fisher exact test. All statistical analyses were performed at a p-value less than 0.05. Results: A total of four hundred and ten (410) participants responded to the questionnaire. Around 21.5% of the students had completed their hepatitis B vaccination, while 41.2% had never been vaccinated. Regarding the self-reported use of protective barriers, intern students showed a significantly higher score than did other study groups (P &lt;0.001). Moreover, the vast majority of 3rd year students reported never wearing eyewear, a face shield, or the head cap (73.2%), (81.1%), or (70.1%), respectively. About two-thirds of intern students (69.4%) showed positive attitudes toward the treatment of patients with infectious diseases. Conclusion: This study showed moderate compliance to infection control procedures among the participants, they have limited orientation and knowledge of the infection control guidelines and policies. Despite a positive attitude toward infection control measures, proper infection control practices were not consistently followed. Consequently, it is essential to take action to ensure that students understand the critical importance of practicing cross-infection control. Higher education institutions should implement effective solutions to address this issue.

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

Emergence of Multidrug-resistant Acinetobacter baumannii: A Growing Health Concern in the Qassim Region, Kingdom of Saudi Arabia

Introduction: Acinetobacter baumannii is a multidrug-resistant bacterium commonly associated with hospital-acquired infections. The rapid spread of A. baumannii has raised concerns, as it has been linked to the emergence of clones in healthcare facilities worldwide. The challenges of treating and controlling infections caused by this bacterium in hospital settings are exacerbated by its resistance profile. The proliferation of clones worldwide highlights the need for careful infection control procedures and new tactics to fight illnesses caused by drug-resistant A. baumannii strains. Materials and Methods: Between January 2019 and December 2020, a total of 26,250 specimens were collected by personnel from the Department of Microbiology at King Fahad Specialist Hospital. Results: Our study highlights a significant surge in antimicrobial resistance, indicating a relative increase in multidrug-resistant A. baumannii isolates. Despite extensive resistance, azithromycin, cefoxitin, norfloxacin, penicillin, piperacillin, tetracycline, ceftriaxone, nitrofurantoin and aztreonam showed 91.2%–100% efficacy against these strains. Conclusions: This study emphasises the critical need for stringent infection control measures and judicious antibiotic strategies to curb multidrug-resistant A. baumannii outbreaks in healthcare settings. The identification of alternative therapies is imperative for improved management of infections caused by multidrug-resistant A. baumannii.

Microbial Pattern of Neonatal Sepsis in the Neonatal Intensive Care Unit of dr. Ramelan Navy Central Hospital.

The morbidity and mortality rates from neonatal sepsis remain high. However, there is limited information about the microbial pattern of neonatal sepsis in Indonesia. Microbial patterns can give an overview of the hygiene of an environment and act as a determinant for choosing definitive antibiotic treatment in neonatal sepsis patients. The organisms that cause neonatal sepsis differ from unit to unit and from time to time within the same unit. This study is aimed at discovering the microbial pattern of neonatal sepsis in the Neonatal Intensive Care Unit (NICU), dr. Ramelan Navy Central Hospital, in 2021-2022. This is a retrospective, cross-sectional study that takes secondary data from the NICU and clinical microbiology department of dr. Ramelan Navy Central Hospital. Data that met the inclusion and exclusion criteria available between January 1, 2021, and December 31, 2022, were collected. Patients whose blood cultures were positive for bacterial growth and diagnosed with sepsis were selected as the study sample. Out of 174 samples, 93 (53.4%) were found positive for bacterial infection and diagnosed as neonatal sepsis. Gram-negative isolates (96.8%) were predominant. Sixty-point-two percent of Klebsiella pneumoniae XDR, 19.4% of Klebsiella pneumoniae ESBL, and 8.6% of Burkholderia cepacia XDR were identified. The gram-positive isolates found in this study were only 3 samples (3.2%). Two-point-one percent of MRSA and 1.1% of Staphylococcus haemolyticus MDR were identified. The most common microorganisms causing neonatal sepsis in our NICU were gram-negative bacteria, particularly Klebsiella pneumoniae XDR. Following the recommended infection control procedures, practicing good hand hygiene, and having access to basic supplies and equipment are important to prevent and reduce the incidence of sepsis.

Traditional healers’ knowledge and infection control practices related to HIV in Bukavu City, Democratic Republic of the Congo

BackgroundPatients with HIV consult traditional healers (THs). These THs can both delay care for people living with HIV (PLHIV) and transmit HIV through poor infection control practices. The main objective of this study was to evaluate knowledge and practices of THs regarding HIV in Bukavu.MethodsA cross-sectional study using quantitative approach was carried out among 71 THs in Bukavu City. The collected data included the following topics: personal and socio-demographic characteristics, HIV knowledge, and infection control practices. Descriptive statistics, independent-samples T-test or F-test, and multiple linear regression were used to analyze the data with a p-value < 0.05.ResultsThe THs’ mean age was 49.2 ± 11.2 years, and the majority were aged 40 to < 60 years. Males constituted 88.7% of THs with a male-to-female ratio of 7.9. In general, 47.9% of study participants had poor knowledge about HIV/AIDS infection, 45.1% of them had fair knowledge, and only 7.0% had good knowledge. Overall, 43.7% of THs had poor infection control practices, 52.1% of THs had fair practices, and only 4.2% of participants had good practices. Results of multiple linear regression analysis revealed that none of the personal and demographic variables studied were significant predictors of their knowledge about HIV/AIDS (p > 0.05). In terms of practices, two variables were significant predictors of infection control practices: living in Ibanda and receiving training in taking care of HIV/AIDS.Conclusion and recommendations: The study revealed that THs’ knowledge about HIV infection was insufficient and that they had poor infection control practices. Formal standardized training on HIV infection should be organized for all THs so that they can always refer their patients to modern, reliable antiretroviral therapy (ART) clinics and reduce the risk of occupational exposure in their practices. Although PPE’s assistance for THs is required in terms of protective measures, the province health authority must also oversee infection control procedures at THs’ offices.