Infection Control Programs Research Articles

Point Prevalence Survey of HAIs as a key component of Infection Prevention and Control programs

Abstract Healthcare-Associated Infections (HAIs) are a global concern, requiring surveillance strategies as Point Prevalence Surveys (PPS) to estimate their burden and investigate associated risk factors for targeted interventions in high-risk areas. This study aims to assess the prevalence of HAIs, identify determinants and evaluate antimicrobial use in a teaching hospital in Rome. A PPS was carried out from June 19th to 23rd, 2023, in accordance with the European Centre for Disease Prevention and Control (ECDC) protocol for HAIs and antimicrobial use in European acute care hospitals (version 6.1). Pearson’s chi-squared test was employed to investigate correlations between potential risk factors and HAIs. The survey included 829 patients with an average age of 56.3 years (SD: ±24.6). Of these, 48.4% were female and over half had visited the hospital’s Emergency Department (53.7%). The prevalence of active HAIs was 8.7%, with 72 patients diagnosed. Furthermore, 51.0% of all patients received at least one systemic antimicrobial agent, and 16.7% of those treated had an HAI. Penicillins (39.7%) and third-generation cephalosporins (37.8%) were the most frequently prescribed antimicrobials. The primary HAIs were bloodstream infections (34.1%), followed by urinary tract (27.3%), surgical site (23.9%), lower respiratory tract (6.8%), and gastrointestinal infections (7.9%). Escherichia coli (13.2%), Staphylococcus aureus (9.2%), and Clostridium difficile (6.6%) were the most frequently isolated pathogens. Intensive Care Unit admission, use of medical device, recent antibiotic therapy and prior hospitalization or surgery significantly correlated (p < 0.05) with increased HAIs risk. The detected prevalence of HAIs is lower than the national rates observed in 2022 (10.2%), which have increased since 2016. HAIs surveillance is essential for developing effective infection prevention and control programs and for optimizing resource allocation in hospital settings. Key messages • Surveillance of Healthcare-Associated Infections is crucial for developing targeted Infection Prevention and Control programs and optimizing hospital resource allocation. • Point Prevalence Surveys offer essential information for assessing the burden of Healthcare-Associated Infections and directing intervention strategies in hospitals.

Antimicrobial resistance in Enterobacterales, Acinetobacter spp. and Pseudomonas aeruginosa isolates from bloodstream infections in Australian children, 2013-2021.

Gram-negative bloodstream infections are associated with significant morbidity and mortality in children. Increasing antimicrobial resistance (AMR) is reported globally, yet efforts to track pediatric AMR at a national level over time are lacking. The Australian Group on Antimicrobial Resistance (AGAR) surveillance program captures clinical and microbiological data of isolates detected in blood cultures across Australia. EUCAST 2022 was used for MIC interpretation and the AMR package in R for data analysis. Over a nine-year period, there were 3,145 bloodstream infections with 3,266 gram-negative isolates reported in hospitalized children aged <18 years; 21.0% were from neonates. The median length of stay was 9 days, and 30-day all-cause mortality was 5.2%. A greater odds of death was observed in those with a multi-drug resistant organism (aOR: 2.1, 95%CI: 1.3, 3.3, p: 0.001). Escherichia coli (44.5%) and Klebsiella pneumoniae complex (12.6%) were the two most frequently reported organisms. Overall resistance in Enterobacterales to gentamicin/tobramycin was 11.6%, to ceftazidime/ceftriaxone was 12.9%, and 13.2% to ciprofloxacin. Resistance increased over time.Of 201 Pseudomonas aeruginosa isolates reported, 19.7% were resistant to piperacillin-tazobactam, 13.1% resistant to cefepime/ceftazidime and 9.8% to ciprofloxacin. Of 108 Acinetobacter spp. isolates, one was resistant to meropenem, and two were resistant to ciprofloxacin. Resistance did not increase over time. AMR in gram-negative organisms causing bloodstream infections in Australian children is increasing which should be considered when updating guidelines and empiric treatment regimens. Ongoing pediatric-specific national surveillance with pediatric reporting must remain a priority to strengthen antimicrobial stewardship and infection control programs.

Effectiveness of an Infection Control Program Among the Ysleta del Sur Pueblo in Preventing COVID-19-Related Hospitalizations and Deaths.

In response to the SARS-CoV-2 pandemic, the United States declared a state of emergency and implemented large-scale shutdowns and public health initiatives to prevent overwhelming public resources. The success of these prevention methods remains unresolved as restrictions and implementation varied from national, state, and local levels. Despite national and local regulations, individual adherence to preventative guidelines presented an additional layer of variability. Cases of COVID-19 continued to rise and fall over a two-year period on a national level, despite masking recommendations, ease of testing, and availability of vaccines. The Ysleta del Sur Pueblo is a Native American tribal community and sovereign nation located in El Paso, Texas. Speaking Rock Entertainment Center is a major business operated by the tribe, employing many tribal and non-tribal members from the El Paso area. Following nationwide re-openings of non-essential businesses, Speaking Rock implemented an infection control program with strict adherence to recommendations provided by the Center for Disease Control and Prevention (CDC) and additional disease control. This response would result in a fully vaccinated workforce within the wider community of El Paso, where the vaccination rate was less than 80%. Herein, we examine the efficacy of these measures and report on the success of the program resulting in zero hospitalizations or deaths compared with rates of 1 in 250 and 1 in 40, respectively, in the surrounding community.

Breaking Down Silos Within a Multihospital System: Lessons From the California Department of State Hospitals Response to the COVID-19 Pandemic.

The California Department of State Hospitals and Department of Public Health collaborated to develop infection control programs in five inpatient psychiatric hospitals in response to COVID-19. In the retrospective observational study described here, conducted from March 2020 through February 2023, we calculated seven-day rolling averages of COVID-19 cases overlaid with key interventions, communication strategies, and policies implemented to break down silos for a consistent and coordinated response. Our findings may inform others regarding effective strategies and partnerships with public health experts during future outbreaks. (Am J Public Health. Published online ahead of print October 3, 2024:e1-e5. https://doi.org/10.2105/AJPH.2024.307846).

The challenging concept of eradication: A core concept guiding and frustrating public health.

The celebrated 1980 announcement that smallpox had been eradicated was made using the following definition of eradication: "Permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts: intervention measures are no longer needed." Public health around the world works with this definition of "eradication," setting it as a goal for other infectious disease control programs. The definition is simple. Its application, however, has produced long-running and complex public health campaigns that threaten the commitment of funders, health care providers, and governments. In this paper, the authors demonstrate the disease-specific challenges of eradication through the example of the Global Polio Eradication Initiative (GPEI). While many deem eradication worth its high costs because it is the end of morbidity and mortality from a disease, it does not mean the end of disease control efforts. Public health must be prepared for the possibility of disease reoccurrence in the form of undetected natural reservoirs of disease, lab leaks from stored samples, bioterror attacks using stolen samples, and the synthetic recreation of microbes. This paper clarifies the role of reoccurrence prevention in eradication, calling for its addition in the definition of eradication.

B-205 Performance of a Novel Fluorogenic Assay for Detection of Carbapenemase-producing Enterbacteriaceae

Abstract Background In recent years, under the selective challenge of antibiotics, the variety and number of drugresistant pathogenic microorganisms have increased significantly, which brings great challenges to clinical diagnosis and treatment, especially the infection caused by carbapenem resistant Enterobacteriaceae (CRE). Carbapenemases production is the main mechanism of drug resistance of Enterobacteriaceae to carbapenems. Drug resistance of Carbapenems can be caused by three mechanisms, resulting in the production of five major Carbapenemases. These are Klebsiella pneumoniae enzyme (KPC), New Delhi metal β-lactamase (NDM), carbapenem hydrolyzed oxalase (OXA-48 like), integrin-encoded metal β- lactamase (VIM) and IMP (Imipenemase). The real-time fluorescence quantitative PCR (qPCR) method based on molecular beacons was combined with the melting curve analysis to identify five drug resistance genes simultaneously by a single PCR reaction, with rapid detection, high sensitivity and strong specificity. Based on this principle, we developed the novel fluorogenic assay for rapid detection of Carbapenemases in multidrug-resistant Enterobacteriaceae (Dynamiker Biotechnology (Tianjin) Co., Ltd.). Methods We evaluated the performance of the novel fluorogenic assay for rapid detection of Carbapenemases in multidrug-resistant Enterobacteriaceae, including the limit of detection (LoD) and cross-reactivity, and compared it with the lateral flow immunochromatography assay (LFA). Results The LoD ranged from 75-450 CFU/mL for the five carbapenemase genes. The analytical specificity for target genes was 100%, as assessed with a panel of 15 pathogens, which indicated no cross-reactions. Comparison of qPCR and LFA results from twenty-three CRE clinical isolates with characterized carbapenemase content demonstrated a complete agreement (Table 1). Conclusions The novel fluorogenic assay for rapid detection of Carbapenemases in multidrug-resistant Enterobacteriaceae is an accurate and rapid method to identify KPC, NDM, VIM, IMP and OXA-48-like carbapenemases in the clinical microbiology laboratory, which can guide infection control programs to limit the spread of these organisms.

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

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

INFECTION CONTROL AMONG ANESETHSIA PRACTICE

Nosocomial infections, or hospital-acquired infections, are complex and have multiple causes. They interfere with patient recovery, increase hospital stays, and lead to higher morbidity, mortality, and costs. The CDC estimates that a third of these infections result from not following established infection control practices. Anesthesia practices are critical in controlling the spread of these infections due to the invasive nature of procedures like catheter and airway management. Although direct cause-and-effect data is limited, most anesthesia-related infections are preventable. Anesthesia personnel must understand the epidemiology and pathogens to implement preventive measures. Risk factors include invasive procedures, cross-contamination, and hand transmission. Common signs of infection include fever, tachycardia, tachypnea, skin rash, and general malaise. The main sources of healthcare-associated infections are bloodstream infections (28%), pneumonia (21%), and urinary tract infections (15%), often linked to invasive devices. Standard precautions should be applied to all patients to prevent infection transmission. Additional transmission-based precautions are necessary for patients with specific pathogens. Infection control programs in the US are mandated by the Joint Commission for Accreditation of Healthcare Organizations (TCAHO) and guided by the CDC.

Baseline evaluation of the World Health Organization (WHO) infection prevention and control (IPC) core components in Pacific Island Countries and Territories (PICTs)

BackgroundComprehensive infection prevention and control (IPC) programmes are proven to reduce the spread of healthcare-associated infections (HAIs) and antimicrobial resistance (AMR). However, published assessments of IPC programmes against the World Health Organization (WHO) IPC Core Components in Pacific Island Countries and Territories (PICTs) at the national and acute healthcare facility level are currently unavailable.MethodsFrom January 2022 to April 2023, a multi-country, cross-sectional study was conducted in PICTs. The self reporting survey was based on the WHO Infection Prevention Assessment Framework (IPCAF) that supports implementing the minimum requirements of the WHO eight core components of IPC programmes at both the national and facility level. The results were presented as a ‘traffic light’ (present, in progress, not present) matrix. Each PICT’s overall status in achieving IPC core components was summarised using descriptive statistics.ResultsFifteen PICTs participated in this study. Ten (67%) PICTs had national IPC programmes, supported mainly by IPC focal points (87%, n = 13), updated national IPC guidelines (80%, n = 12), IPC monitoring and feedback mechanisms (80%, n = 12), and waste management plans (87%, n = 13). Significant gaps were identified in education and training (20%, n = 3). Despite being a defined component in 67% (n = 10) of national IPC programmes, HAI surveillance and monitoring was the lowest scoring core component (13%, n = 2). National and facility level IPC guidelines had been adapted and implemented in 67% (n = 10) PICTs; however, only 40% (n = 6) of PICTs had a dedicated IPC budget, 40% (n = 6) had multimodal strategies for IPC, and 33% (n = 5) had daily environmental cleaning records.ConclusionsIdentifying IPC strengths, gaps, and challenges across PICTs will inform future IPC programme priorities and contribute to regional efforts in strengthening IPC capacity. This will promote global public health through the prevention of HAIs and AMR.

Extended and expanded role of nurses in antimicrobial stewardship program: A review

Antimicrobial resistance is a significant healthcare concern in this century, marked by the emergence of multidrug-resistant microorganisms. An antimicrobial stewardship program, while an innovative approach to mitigating the global threat of antimicrobial resistance and its effects on public health, is also an absolute need of the hour. When implemented effectively, such a program, in conjunction with selecting the appropriate drug, determining the correct dosage and route of administration, and integrating with an infection control program, has proven to be an effective method for curbing the rapid emergence and transmission of antimicrobial-resistant pathogens. Partnerships with nurses to strengthen antimicrobial stewardship programs in healthcare have recently gained recognition, especially in the backdrop of increased antimicrobial resistance in developing countries. Traditionally, stewardship activities have involved only prescribers and pharmacists, but including nurses in these efforts has become increasingly important. Highlights of nurse-driven antimicrobial stewardship activities include effective assessment of allergies, meticulous sampling for blood and urine cultures, antibiotic de-escalation, and 24-hour monitoring of patient status. Antibiotic or general ward rounds provide unique opportunities for nurses to influence the indication and duration of antimicrobial treatment. Including nurses in antimicrobial stewardship programs will make the management of antimicrobial therapy robust and empower healthcare institutions to approach the prevention of AMR with truly multi-disciplinary strategies. Antimicrobial stewardship is often redundant and centered around doctors in tertiary care centers. However, active participation by nurses in both healthcare facilities and community settings is crucial for making Antimicrobial stewardship practice (AMSP) a reality. Scalable nursing involvement in antimicrobial stewardship is essential for developing and developed nations to combat AMR effectively.

A peer-to-peer infection prevention and control programme in neglected settings: The case of home care and nursing homes in North Italy

A peer-to-peer infection prevention and control programme in neglected settings: The case of home care and nursing homes in North Italy

Prevalence, risk factors, and characterisation of extended-spectrum β-lactamase -producing Enterobacterales (ESBL-E) in horses entering an equine hospital and description of longitudinal excretion

BackgroundExtended-spectrum β-lactamase -producing Enterobacterales (ESBL-E) are important zoonotic pathogens that can cause serious clinical infections, also in horses. Preventing the spread of ESBL-E, especially in the equine hospital environment, is key to reducing the number of difficult-to-treat infections. Estimating the local prevalence of ESBL-E in horses is crucial to establish targeted infection control programs at equine hospitals. We conducted a prevalence and risk factor study in equine patients on admission to an equine teaching hospital in Finland through a rectal ESBL-E screening specimen of the horse and a questionnaire.ResultsThe prevalence of ESBL-E in admitted horses was 3% (5/161, 95% CI 1–7%); none of the tested factors remained statistically significant in multivariate analysis, although antimicrobial treatment within three months was borderline significant (p = 0.052). Extended-spectrum β-lactamase -producing Klebsiella pneumoniae ST6179:CTX-M-15 was detected in three horses using whole-genome sequencing, which in combination with patient records suggested nosocomial transmission. Escherichia coli isolates were ST1250:CTX-M-1 (n = 1), ST1079:CTX-M-1 (n = 1), and ST1245:CTX-M-14 (n = 1). Multiple virulence genes were detected in the ESBL-E isolates. In the ESBL-E positive horses enrolled in a one-year follow-up study, ESBL-E were unlikely to be isolated in rectal screening specimens after the initial positive specimen.ConclusionsThe prevalence of ESBL-E in horses visiting a veterinary teaching hospital in Finland is low, indicating an overall low prevalence estimate in the country’s equine population. No statistically significant risk factors were identified, likely due to the low number of cases. The duration of ESBL-E carriage is likely to be very short in horses.

COVID-19 infection prevention and control program for aged care providers: a quasi-experimental study of Telegram-based training

ABSTRACT Given the high turnover of care workers in residential aged care facilities, continuous training on infection prevention and control (IPC) remains essential even after the COVID-19 pandemic. This study examined the impact of a Telegram-based training on aged care providers’ IPC knowledge, attitudes, self-efficacy. A two-arm, pre-post quasi-experimental study with repeated measures at week 2 (T1) and week 4 (T2) was conducted for seventy-two (72) participants from 14 residential aged care facilities in Malaysia, with 60 completing the study (30 per arm). All instructional activities and data collection for both groups were delivered through Telegram. The intervention group received a 2-day synchronous workshop (3 h/day) alongside e-materials for a 10-unit IPC module. Primary outcomes were measured using a knowledge test, COVID-19 Elderly Caregiver Questionnaire (attitude component), and an adapted General Self-Efficacy Scale. Telegram’s acceptability was also assessed using an adapted Technology Acceptance Model questionnaire. Results showed that the intervention group had a faster knowledge transfer (91.3%–93.5%; T0-T2 = ∆22.9; p ≤ .002;), higher knowledge scores (∆7.2–16; p ≤ .002; large effect sizes 0.9–1.7), and a small-to-modest increments in self-efficacy (∆13.2; p = .002) and attitude (∆5.2; p = .045). Integrating synchronous sessions into an online program improved knowledge transfer, enhanced self-efficacy and promoted positive attitudes by enabling real-time interpersonal communication and instant feedback. Telegram proved effective for mobile learning in aged care settings with limited resources.

The Etiology of Bloodstream Infections at an Italian Pediatric Tertiary Care Hospital: A 17-Year-Long Series.

Knowledge of epidemiology is essential for guiding correct antibiotic prescription, reducing bacteremia-associated mortality, and implementing targeted infection control programs. However, only a few studies have reported on the epidemiology of bloodstream infections (BSIs) in pediatrics. We performed a retrospective analysis of all BSIs (excluding those caused by common skin contaminants) diagnosed from 2006 to 2022 in patients younger than 18 years who were treated at an Italian pediatric tertiary care hospital. Overall, 2395 BSIs were recorded, including 2207 (92.15%) due to bacteria and 188 (7.85%) due to fungi. The incidence rate (BSIs/10,000 hospital discharges, IR) of bacterial BSIs significantly increased during the study period. In particular, BSIs caused by S. aureus (including MRSA), Enterobacterales (including ESBL and AmpC producers), Enterococcus spp., and P. aeruginosa became more common. The frequency of carbapenem-resistant strains was <1% and stable over time. Conversely, there was a significant reduction in the incidence of BSIs due to S. pneumoniae. The BSIs were stratified by patient age, and S. aureus was the most frequent cause of BSIs in all age groups, while E. coli was the most frequent in the Enterobacterales family. S. agalactiae was the third most frequent cause of neonatal early-onset BSIs. The prevalence of Enterococcus spp. increased in the subgroups from 8 days to 5 years of age, while P. aeruginosa became more prevalent in children over 5 years of age. S. aureus was also the most frequent isolate in both community- and hospital-onset BSIs, followed by E. coli. The prevalence of multidrug-resistant (MDR) pathogens was very low. It was <5% for both Gram-positive (i.e., MRSA and VRE) and Gram-negative (ESBL, AmpC, and carbapenem-resistant) pathogens, and MDR pathogens were almost exclusively detected in hospital-onset BSIs. Fungi accounted for just under 8% of BSIs. C. albicans was the most frequently isolated strain, followed by C. parapsilosis. Notably, the IR of fungemia did not change significantly during the study period, in spite of an increase in the absolute number of events. The continuous monitoring of local epidemiology is essential to identify changes in the IRs of pathogens and antibiotic susceptibility and to guide antibiotic treatments, especially in the phase when antibiograms are not yet available.

Cumulative Analysis of Device-associated Hospital-acquired Infection Quality Indicators in a Teaching Hospital in Telangana

Background and Aims: In the realm of healthcare, device-associated hospital-acquired infections (DA-HAIs) pose significant challenges. These infections occur due to invasive medical devices and can lead to serious complications for patients. This study intends to assess the trends in device-associated infections over time in order to improve patient safety and quality through measurements and improvements in device-associated infections. Methods: The Department of Microbiology conducted a routine surveillance using a specific infection surveillance proforma for various healthcare-associated infections, including ventilator-associated events (VAEs), central line–associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). The data were examined at the end of each month, and the infection rate was determined using CDC guidelines. Results: The overall rate of HAI was found to be 1.69 HAI cases per 1,000 patient days. The cumulative DAI rates for the years 2021 and 2022 were CAUTI 6.14/1,000 urinary catheter days, CLABSI 4.5/1,000 central line catheter days and VAE 16.3/1,000 ventilator days. Discussion: It was observed that the CAUTI and CLABSI rates in our institution were comparable to or slightly higher than the national standard benchmark and INICC report and were significantly higher compared to the CDC/NHSN benchmark. The VAE rate was comparable to INICC report but was significantly higher compared to the NSB and the CDC/NHSN reports. Conclusion: Individual hospitals should make efforts to generate and evaluate their DAI trends and overall HAI rates and implement and improve their infection control programme to collectively achieve the target in our country in bringing down HAIs.

Prevalence of Healthcare-Associated Infections in a Tertiary Hospital in Casablanca, Morocco, 2021.

During the COVID-19 pandemic, healthcare professionals experienced an increased workload, which may have affected infection prevention and control (IPC) programs and consequently healthcare-associated infection (HAI) rates. The objective of this study was to estimate the prevalence of HAI in Ibn Rochd University Hospital Center (IRUHC) and identify associated factors. A survey was conducted on November 30, 2021 at IRUHC, including all patients hospitalized for at least 48 hours. Data was collected using a questionnaire, and analyzed using SPSS IBM software version 16. The significance level was set at 0.05. Among 887 patients, the prevalence of HAI was 9.7% (7.7%; 11.6%). The highest prevalence was observed in intensive care units (ICUs) (44.2%). Nosocomial pneumonia was the most common site (26.8%). The main isolated microorganisms were Acinetobacter baumannii (18.0%) and Escherichia coli (16.0%). All Acinetobacter baumannii isolated strains were imipenem-resistant. The presence of HAI was significantly associated with the presence of an invasive medical device (p<0.001), a higher physical status score of American Society of Anesthesiologists (ASA) (p<0.001), and a longer hospital stay (p<0.001). Conclusion: The emergence of imipenem-resistant Acinetobacter baumannii(IRAB) represents a serious therapeutic and epidemiological problem requiring the establishment of a system for monitoring the microbial environment and the application of strict hygiene measures.

Distribution and Antibiotic Resistance Profiles of MRSA Clinical Strains Across Different Age Groups and Genders: Implications for Targeted Infection Control and Antibiotic Stewardship Programs

Distribution and Antibiotic Resistance Profiles of MRSA Clinical Strains Across Different Age Groups and Genders: Implications for Targeted Infection Control and Antibiotic Stewardship Programs

Head Nurse Leadership: Facilitators and Barriers to Adherence to Infection Prevention and Control Programs-A Qualitative Study Protocol.

The effective management of Healthcare-Associated Infections (HAIs) relies on the implementation of good practice across the entire multidisciplinary team. The organizational context and the role of head nurses influence the team's performance and behavior. Understanding how decision-making processes influence healthcare professionals' behavior in the management of HAIs could help identify alternative interventions for reducing the risk of infection in healthcare organizations. This study aims to explore how the behaviors promoted and actions implemented by the head nurse can influence healthcare professionals' adherence to Infection Prevention and Control (IPC) programs. A multi-center qualitative study will be conducted using a Grounded Theory approach. Observations will be conducted, followed by individual interviews and/or focus groups. A constructive and representative sample of healthcare professionals who care directly for patients will be enrolled in the study. The COnsolidated criteria for REporting Qualitative research (COREQ) checklist will be followed to ensure the quality of this study protocol. A multistep inductive process will be used to analyze the data. The study results will provide an understanding of how nurses perceive the influence of leadership and how they modify their behaviors and activities toward patients according to IPC programs. The study will identify barriers and facilitators to IPC compliance and suggest strategies to minimize negative patient outcomes, such as the development of an HAI.

High Prevalence of ESBL Genes in Commensal Escherichia coli of the Urinary Tract: Implications for Antibiotic Stewardship among Residents of Ghanaian Elderly Nursing Care Homes.

The emergence and spread of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli) pose significant challenges to the treatment and control of urinary tract infections, particularly among vulnerable populations, such as the elderly living in nursing care homes. In this study, we investigated the occurrence of ESBL genes in commensal E. coli isolated from urine samples of 118 elderly individuals residing in Ghanaian nursing care homes. A total of 195 ESBL genes were detected among 41 E. coli isolated from the study participants. All the isolates harboured at least one ESBL gene, and the majority of them (70.1%) carried at least four ESBL genes. Among the ESBL genes detected, CTXM825 was the predominant (14.1%). In antimicrobial susceptibility testing, 65.9% of the isolates showed resistance to cefepime, a fourth-generation cephalosporin, while 56.1% showed resistance to cefotaxime, a third-generation cephalosporin. Additionally, 46.3% of the isolates were multidrug-resistant, indicating resistance to antibiotics from multiple classes. In summary, we observed relatively high rates of resistance to antibiotics as well as alarming rates of ESBL genes in the isolated pathogens. These findings emphasise the urgent need for antimicrobial stewardship and infection control programmes to mitigate the spread of multidrug-resistant pathogens in nursing care homes.

Performance and acceptability of the STREAM Disinfectant Generator for infection prevention and control practices in primary health care facilities in Uganda

BackgroundEffective infection prevention and control programs can positively influence quality of care, increase patient safety, and protect health care providers. Chlorine, a widely used and effective chemical disinfectant, is recommended for infection prevention and control in health care settings. However, lack of consistent chlorine availability limits its use. Electrolytic chlorine generators can address limited chlorine supply and stockouts by enabling onsite production of readily usable, high-quality chlorine cost-effectively. We report the feasibility (i.e., performance, acceptability, chlorine availability, and cost) of the electrolytic STREAM Disinfectant Generator (Aqua Research, New Mexico, USA) device for infection prevention and control in primary health care facilities in Uganda.MethodsWe installed STREAM devices in 10 primary health care facilities in central and western Uganda. Commercial chlorine inventory records (stock cards) were reviewed in each facility to calculate average liters of chlorine received and used per month. These values were compared with actual STREAM chlorine production volumes over the study period to determine its impact on chlorine availability. We collected acceptability data from a purposive sample of device users (n = 16), hospital administrators (n = 10), and district health officers (n = 6) who had been directly involved in the operation or supervision of the STREAM device. We descriptively analyzed the acceptability data by user group and evaluated qualitative responses manually using a thematic approach. Cost data were normalized and modeled to determine a break-even and cost-savings analysis across a five-year period (the minimum expected lifespan of the STREAM device).ResultsChlorine was consistently available without any reported stockouts during the evaluation period. STREAM chlorine production resulted in a 36.9 percent cost-savings over a five-year period compared to commercial chlorine. User acceptability of the STREAM device was high among STREAM operators, hospital administrators, and district health officers, with all respondents reporting that STREAM moderately or significantly improved infection prevention and control practices in the health facility. Overall, 88 percent of device users and 100 percent of hospital administrators wished to continue using the STREAM device instead of commercial chlorine products.ConclusionThe STREAM device has demonstrated significant potential to strengthen infection prevention and control practices in health care facilities in Uganda. Based on the preliminary results, the STREAM device should be considered a promising tool for district hospitals and large health centers facing infection prevention and control challenges in Uganda and elsewhere, provided water and electricity are available. Going forward, implementation of the STREAM device could also be considered in smaller health care facilities in Uganda and elsewhere.