Infection Prevention Measures Research Articles

Vaccines and monoclonal antibodies to prevent healthcare-associated bacterial infections.

SUMMARYHealthcare-associated infections (HAIs) represent a burden for public health with a high prevalence and high death rates associated with them. Pathogens with a high potential for antimicrobial resistance, such as ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) and Clostridioides difficile, are responsible for most HAIs. Despite the implementation of infection prevention and control intervention, globally, HAIs prevalence is stable and they are mainly due to endogenous pathogens. It is undeniable that complementary to infection prevention and control measures, prophylactic approaches by active or passive immunization are needed. Specific groups at-risk (elderly people, chronic condition as immunocompromised) and also healthcare workers are key targets. Medical procedures and specific interventions are known to be at risk of HAIs, in addition to hospital environmental exposure. Vaccines or monoclonal antibodies can be seen as attractive preventive approaches for HAIs. In this review, we present an overview of the vaccines and monoclonal antibodies in clinical development for prevention of the major bacterial HAIs pathogens. Based on the current state of knowledge, we look at the challenges and future perspectives to improve prevention by these means.

Nomogram for predicting the risk of nosocomial infections among obstetric inpatients: a large-scale retrospective study in China

ObjectiveThis study aimed to develop and validate a nomogram for assessing the risk of nosocomial infections among obstetric inpatients, providing a valuable reference for predicting and mitigating the risk of postpartum infections.MethodsA retrospective observational study was performed on a cohort of 28,608 obstetric patients admitted for childbirth between 2017 and 2022. Data from the year 2022, comprising 4,153 inpatients, were utilized for model validation. Univariable and multivariable stepwise logistic regression analyses were employed to identify the factors influencing nosocomial infections among obstetric inpatients. A nomogram was subsequently developed based on the final predictive model. The receiver operating characteristic (ROC) curve was utilized to calculate the area under the curve (AUC) to evaluate the predictive accuracy of the nomogram in both the training and validation datasets.ResultsThe gestational weeks > = 37, prenatal anemia, prenatal hypoproteinemia, premature rupture of membranes (PROM), cesarean sction, operative delivery, adverse birth outcomes, length of hospitalization (days) > 5, CVC use and catheterization of ureter were included in the ultimate prediction model. The AUC of the nomogram was 0.828 (0.823, 0.833) in the training dataset and 0.855 (0.844, 0.865) in the validation dataset.ConclusionThrough a large-scale retrospective study conducted in China, we developed and independently validated a nomogram to enable personalized postpartum infections risk estimates for obstetric inpatients. Its clinical application can facilitate early identification of high-risk groups, enabling timely infection prevention and control measures.

Developing a framework for identifying risk factors and estimating direct economic disease burden attributable to healthcare-associated infections: a case study of a Chinese Tuberculosis hospital

Healthcare-associated infections (HAIs) represent a major global health burden, which necessitate effective frameworks to identify potential risk factors and estimate the corresponding direct economic disease burden. In this article, we proposed a framework designed to address these needs through a case study conducted in a Tuberculosis (TB) hospital in Hubei Province, China, using data from 2018 to 2019. A comprehensive multistep procedure was developed, including ethical application, participant inclusion, risk factor identification, and direct economic disease burden estimation. In the case study, ethical approval was obtained, and patient data were anonymized to ensure privacy. All TB hospitalized patients over the study period were included and classified into groups with and without HAIs after screening the inclusion and exclusion criteria. Key risk factors, including gender, age, and invasive procedure were identified through univariate and multivariate analyses. Then, propensity score matching was employed to select the balanced groups with similar characteristics. Comparisons of medical expenditures (total medical expenditure, medicine expenditure, and antibiotics expenditure) and hospitalization days between the balanced groups were calculated as the additional direct economic disease burden measures caused by HAIs. This framework can serve as a tool for not only hospital management and policy-making, but also implementation of targeted infection prevention and control measures. Moreover, it has the potential to be applied in various healthcare settings at local, regional, national, and international levels to identify high-risk areas, optimize resource allocation, and improve hospital management and governance, as well as inter-organizational learning. Challenges to implement the framework are also raised, such as data quality, regulatory compliance, considerations on unique nature of communicable diseases and other diseases, and training need for professionals.

Expanding the use of mathematical modeling in healthcare epidemiology and infection prevention and control.

During the coronavirus disease 2019 pandemic, mathematical modeling has been widely used to understand epidemiological burden, trends, and transmission dynamics, to facilitate policy decisions, and, to a lesser extent, to evaluate infection prevention and control (IPC) measures. This review highlights the added value of using conventional epidemiology and modeling approaches to address the complexity of healthcare-associated infections (HAI) and antimicrobial resistance. It demonstrates how epidemiological surveillance data and modeling can be used to infer transmission dynamics in healthcare settings and to forecast healthcare impact, how modeling can be used to improve the validity of interpretation of epidemiological surveillance data, how modeling can be used to estimate the impact of IPC interventions, and how modeling can be used to guide IPC and antimicrobial treatment and stewardship decision-making. There are several priority areas for expanding the use of modeling in healthcare epidemiology and IPC. Importantly, modeling should be viewed as complementary to conventional healthcare epidemiological approaches, and this requires collaboration and active coordination between IPC, healthcare epidemiology, and mathematical modeling groups.

Positive predictive value of administrative diagnosis codes, for all patient encounters in the electronic health record, to detect postoperative infections: Retrospective cohort study after cesarean delivery

BackgroundPrioritization of anesthetizing locations for infection prevention depends on having a high positive predictive value for the detection of postoperative infection (PPV). Our study goal was to estimate the PPV after cesarean birth using hospital's International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnosis codes. Because earlier studies had low PPV for infection from antibiotic medication administration records, if each prescription had a corresponding diagnosis code, infections must have been listed for presumptive diagnoses (e.g., redness), not literally infection. Our cohort of obstetrical patients was unique for scientific investigation in that the vast majority developing postoperative infection were evaluated postoperatively by the same (surgical) department. MethodsThe population studied were all patients undergoing cesarean delivery from October 2015 through March 2022 at the University of Iowa. The ICD-10-CM codes were obtained from any type of encounter in the health record (e.g., clinic visit or emergency room). The hospital's quality improvement daily surveillance program followed National Healthcare Safety Network (NHSN) definitions. ResultsThe 147 cases studied were 2.9 % of the 5006 cesarean deliveries performed. Every postoperative infection from the daily surveillance program was included among the 147 cases. There were 144 of these patients evaluated by an obstetrician on the date of the ICD-10 diagnosis code(s) detecting postoperative infection. The estimated positive predictive value was 99.3 % (143/144), lower 95 % confidence limit 96.8 %. ConclusionsTo optimize patient benefit and hospital return on investment, infection preventive measures should include operating room/specialty combinations with the most postoperative infections. Automated health record review is needed. Every ICD-10-CM code is based on a clinician's note and thus the clinician's specialty (department) is known from the hospital's diagnosis tables. Using diagnosis codes for 90-day postoperative infection from surgeons' notes, high positive predictive value can be obtained (e.g., for use by anesthesia departments).

Improving Safety and Comfort of Healthcare Workers Caring for Patients With High-Consequence Infectious Diseases in a High-Level Isolation Unit Using Innovative Approaches.

Patients with high-consequence infectious diseases (HCIDs) require high-quality care by specially trained staff in a high-level isolation unit (HLIU) that follows strict infection prevention and control (IPC) measures. Caring for patients with (suspected) HCID is challenging, mainly because of the strict personal protective equipment (PPE) and IPC protocols healthcare workers (HCW) must adhere to for protection. The Radboud University Medical Center, located in Nijmegen, the Netherlands, has been a dedicated HLIU facility since 2008. A newly built HLIU opened in May 2022, and encouraged us to review the existing PPE selection, IPC protocols, and HCID training program to improve safety and comfort for HCWs working in the HLIU. Based on a systematic search through (inter)national HCID PPE guidelines and semistructured interviews with end users, we selected an improved, more comfortable set of PPE. Additionally, we developed a more concise and easier-to-use patient care process flow and implemented a new teaching strategy. The new way of working was tested in October 2022 when the first 2 patients with suspected HCID were admitted to our unit. We used surveys to evaluate the experiences of HCWs involved in this care to further improve the workflow of the unit. When optimizing safety and comfort for HCWs, it is important to consider (inter)national guidelines as well as user preferences. By systematically evaluating recent experiences of patient admission to the HLIU and then adjusting protocols and training, we can ensure that the quality of provided healthcare and the safety of HCWs working in the HLIU remains high.

The Role of High-Level Isolation Units in Response to High-Consequence and Emerging Infectious Diseases: Experience of the German STAKOB Network.

This case study describes the experience of the German Permanent Working Group of Competence and Treatment Centers for High Consequence Infectious Diseases, known as STAKOB (Ständiger Arbeitskreis der Kompetenz- und Behandlungszentren für Krankheiten durch hochpathogene Erreger). STAKOB brings together public health authorities (competence centers) and high-level isolation units (treatment centers) to collaborate on the clinical management of high-consequence infectious diseases (HCIDs) and emerging infectious diseases. The network is coordinated by the Robert Koch Institute, Germany's federal public health institute. The main tasks of STAKOB are to strengthen HCID clinical and public health management and increase expert knowledge on HCID and non-HCID emerging infectious diseases in Germany. STAKOB enables the exchange of knowledge and experiences; development of guidelines on infection prevention and control measures, clinical management, and therapy; and support for the World Health Organization and other outbreak responses internationally. The past years have shown how important the STAKOB network is for Germany-not only in providing critical care for HCID cases but also increasing capacity to support public health and clinical management of emerging infectious disease cases. However, maintaining several high-level isolation units in Germany requires a high commitment of financial, material, and human resources. Due to the rarity of HCID and emerging infectious disease events, maintaining the appropriate level of preparedness and ensuring sufficient investments is an ongoing struggle. Nevertheless, it is essential to have a network ready to react to HCID and non-HCID emerging infectious diseases in times of a changing biosecurity and infectious landscape.

Integrating residents’ rights and infection prevention in nursing homes: Summary of the Infection Control Advocate and Resident Education (ICARE) learning modules pilot for long-term care ombudsmen, residents, and other nursing home advocates

The Infection Control Advocate and Resident Education educational modules integrate and promote infection prevention and control (IPC) measures and residents' rights in nursing homes, targeting long-term care ombudsmen, residents, families, and other resident advocates. Survey respondents (N=102) reported increased knowledge in understanding IPC and preserving resident rights. Integrating these topics and identifying barriers to promoting IPC is necessary for implementing quality IPC in nursing homes.

Qualitative system dynamics modelling to support the design and implementation of tuberculosis infection prevention and control measures in South African primary healthcare facilities.

Tuberculosis infection prevention and control (TB IPC) measures are a cornerstone of policy, but measures are diverse and variably implemented. Limited attention has been paid to the health system environment, which influences successful implementation of these measures. We used qualitative system dynamics and group-model-building methods to (1) develop a qualitative causal map of the interlinked drivers of Mycobacterium tuberculosis (Mtb) transmission in South African primary healthcare facilities, which in turn helped us to (2) identify plausible IPC interventions to reduce risk of transmission. Two 1-day participatory workshops were held in 2019 with policymakers and decision makers at national and provincial levels and patient advocates and health professionals at clinic and district levels. Causal loop diagrams were generated by participants and combined by investigators. The research team reviewed diagrams to identify the drivers of nosocomial transmission of Mtb in primary healthcare facilities. Interventions proposed by participants were mapped onto diagrams to identify anticipated mechanisms of action and effect. Three systemic drivers were identified: (1) Mtb nosocomial transmission is driven by bottlenecks in patient flow at given times; (2) IPC implementation and clinic processes are anchored within a staff 'culture of nominal compliance'; and (3) limited systems learning at the policy level inhibits effective clinic management and IPC implementation. Interventions prioritized by workshop participants included infrastructural, organizational and behavioural strategies that target three areas: (1) improve air quality, (2) improve use of personal protective equipment and (3) reduce the number of individuals in the clinic. In addition to core mechanisms, participants elaborated specific additional enablers who would help sustain implementation. Qualitative system dynamics modelling methods allowed us to capture stakeholder views and potential solutions to address the problem of sub-optimal TB IPC implementation. The participatory elements of system dynamics modelling facilitated problem-solving and inclusion of multiple factors frequently neglected when considering implementation.

Analyzing the Prevalence and Patterns of Antibiotic-Resistant Pathogens Causing Surgical Site Infections

Surgical Site Infections (SSIs) remain a critical healthcare challenge, contributing to increased morbidity, mortality, and healthcare costs. SSIs represent the third most common nosocomial infection globally with an incidence of 19-20%, while their prevalence in Pakistan was significantly higher, ranging up to 33.6%. The emergence of Multidrug-Resistant (MDR) organisms has worsened this issue. Objective: To determine the prevalence of antibiotic-resistant pathogens responsible for SSIs and analyze their antibiotic susceptibility patterns over the past decade. Methods: A systematic review was conducted adhering to PRISMA guidelines. Studies published between 2006 and 2023 were included. Data on the prevalence of antibiotic-resistant organisms associated with SSIs were extracted and analyzed through several databases (PubMed, Google Scholar, Sci-hub and Science Direct) using Boolean logic “AND” and “OR”, and Medical Subject Headings (MeSH Terms) and keywords. A total of 70 articles were retrieved from which 16 articles were considered eligible after applying detailed inclusion/exclusion criteria and removing the duplicates and irrelevant articles. Results: The study identified Staphylococcus aureus, coagulase-negative staphylococci, Pseudomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter spp. as predominant MDR pathogens. A significant increase in the prevalence of antibiotic-resistant strains was observed over the study period. Gram-negative bacteria exhibited a higher resistance rate (66.8%) compared to Gram-positive organisms (51.1%). Conclusions: The increasing prevalence of antibiotic-resistant pathogens underscores the urgent need for comprehensive infection prevention and control measures to address the burden of SSIs. Targeted interventions, antimicrobial stewardship, and continued surveillance were essential to combat this growing challenge.

Critical measures for the prevention and control of respiratory infectious diseases in the workplace: a South African facilities management perspective

PurposeThis study aims to comprehensively examine the respiratory infection prevention and control measures used in South African workplaces, particularly in the context of facilities management (FM), during the 2020–2022 pandemic.Design/methodology/approachThe present research involved pre-crafted semi-structured interviews conducted by University of the Witwatersrand students with FM heads in Johannesburg, South Africa. Recurrent themes were generated using NVIVO software and analysed using frequencies, word counts and word clouds.FindingsThis study identified 119 measures and placed these into two broad categories. Twelve critical measures were found. These measures were further validated by five FM experts, separate from FM heads, who cross-referenced them with WHO guidelines, enhancing the credibility of the findings. Subsequently, challenges with implementing these measures were explored.Practical implicationsThe findings have direct relevance to the work of FM professionals, as they suggest that applying timely and comprehensive infection prevention and control measures can help employees to safely continue to work or return to the workplace during any future epidemic outbreaks.Originality/valueThus far, limited studies have explored critical measures used to prevent and control COVID-19 in the workplaces of developing countries during the 2020–2022 pandemic.

Vaccination Status, Vaccine Awareness and Attitudes, and Infection Control Behaviors of Japanese College Students: A Comparison of 2021 and 2023.

Background: Now that the spread of COVID-19 has been controlled, it is important to investigate changes in young people's perceptions of the vaccine and their behavior toward infection. The objectives of this study were as follows: (1) to investigate the association between Omicron strain vaccination rates among college students, their perceptions of the vaccine, and past adverse reactions to the vaccine; (2) to compare 2021 (when COVID-19 was spreading) and 2023 (when COVID-19 was strained) to identify changes in attitudes toward vaccination and motivations for vaccination and changes in infection prevention behavior. Methods: This cross-sectional survey was conducted via e-mail from 5 January to 30 January 2023. All students at Hiroshima University were sent an e-mail, which provided them access to the survey form and requested their cooperation. The questionnaire consisted of 33 items related to attributes, vaccination status, adverse reactions after vaccination, motivation for vaccination, perception of the vaccine, presence of coronavirus infection, sequelae, and infection prevention measures. Results: A total of 1083 students responded to the survey. Over 50% of the students were vaccinated with the Omicron booster. Regarding trust in vaccines, the majority of both male and female respondents said they had some trust in vaccines, although this was less than that observed in the 2021 survey. As for infection control measures, only 2% of males and 0.3% of females answered that they did not take any infection control measures. The most common response was "wear a mask", as in the 2021 survey, with 476 men (96.6%) and 575 women (99.5%). Conclusions: The survey showed a high Omicron-responsive vaccination rate of more than 50%. In addition, more than 99% of the students were found to be taking measures to prevent infection, such as wearing masks.

Attitude of healthcare professionals in Türkiye to COVID-19 vaccine

Background: The COVID-19 vaccine has been effective in reducing infection rates and disease severity; however, vaccination coverage has been lower than expected because of vaccine hesitancy, even among healthcare workers. Aim: To investigate the attitude of healthcare professionals in Türkiye to the COVID-19 vaccine. Methods: This cross-sectional study was conducted between December 2020 and February 2021 among physicians, nurses, midwives, emergency medical technicians, dieticians, and physiotherapists in Türkiye, using the snowball sampling method for data collection. Data were analysed using SPSS version 23 and correlation analysis was conducted to evaluate linear relationship, and multivariate analysis to examine the cause-effect relationship between the variables (α = 0.05). Results: A total of 1057 healthcare professionals participated; average age 38.98 ± 9.044 (min = 19; max = 71), 71.7% (n = 758) women, 69.9% (n = 739) physicians. Of the respondents, 48.3% wanted to be vaccinated whether the vaccine was free or not, 12.1% (n = 128) did not want to be vaccinated and 36.8% were not decided. The most common reasons for wanting to be vaccinated were to end the pandemic (25%, n = 264), seeing vaccination as a good way to prevent COVID-19 disease (30.1%, n = 318), protecting oneself and high-risk individuals from infection (22.2%, n = 235), and hoping that vaccine would reduce the duration and severity of disease (22.9%, n = 242). The most common reasons for not wanting to be vaccinated were fear of side-effects (26.1%, n = 276) and lack of confidence in the reliability of a new vaccine (27.2%, n = 288). The desire to be vaccinated had relationship with influenza vaccination, pneumococcus vaccination, history of COVID-19 infection or contact with a COVID-19 patient, and adherence to infection prevention measures (P < 0.05). Conclusion: Almost half of the healthcare workers in this study were not decided about being vaccinated. To increase acceptance in Türkiye, it is essential to conduct COVID-19 vaccine awareness and education among healthcare professionals because they are perceived as role models in the society, particularly in the health sector.

Assessing ventilation through ambient carbon dioxide concentrations across multiple healthcare levels in Ghana.

Infection prevention and control (IPC) measures safeguard primary healthcare systems, especially as the infectious disease landscape evolves due to climate and environmental change, increased global mobility, and vaccine hesitancy and inequity, which can introduce unexpected pathogens. This study explores the importance of an "always-on," low-cost IPC approach, focusing on the role of natural ventilation in health facilities, particularly in low-resource settings. Ambient carbon dioxide (CO2) levels are increasingly used as a measure of ventilation effectiveness allowing for spot checks and targeted ventilation improvements. Data were collected through purposive sampling in Northern Ghana over a three-month period. Levels of CO2 ppm (parts per million) were measured by a handheld device in various healthcare settings, including Community-Based Health Planning and Services (CHPS) facilities, municipal and teaching hospitals, and community settings to assess ventilation effectiveness. Analyses compared CO2 readings in community and hospital settings as well as in those settings with and without natural ventilation. A total of 40 facilities were evaluated in this study; 90% were healthcare facilities and 75% had natural ventilation (with an open window, door or wall). Facilities that relied on natural ventilation were mostly community health centers (60% vs 0%) and more commonly had patients present (83% vs 40%) compared with facilities without natural ventilation. Facilities with natural ventilation had significantly lower CO2 concentrations (CO2 ppm: 663 vs 1378, p = 0.0043) and were more likely to meet international thresholds of CO2 < 800 ppm (87% vs 10%, p = <0.0001) and CO2 < 1000 ppm (97% vs 20%, p = <0.0001). The adjusted odds ratio of low CO2 in the natural facilities compared with non-natural were: odds ratios, OR (95% CI): 21.7 (1.89, 247) for CO2 < 800 ppm, and 16.8 (1.55, 183) for CO2 < 1000 ppm. Natural ventilation in these facilities was consistently significantly associated with higher likelihood of low CO2 concentrations. Improved ventilation represents one cost-effective layer of IPC. This study highlights the continuing role natural ventilation can play in health facility design in community health care clinics. Most health facilities met standard CO2 thresholds, particularly in community health facilities. Further research is needed to optimize the use of natural ventilation. The use of a handheld devices to track a simple metric, CO2 levels, could improve appreciation of ventilation among healthcare workers and public health professionals and allow for them to target improvements. This study highlights potential lessons in the built environment of community primary health facilities as a blueprint for low-cost, integrated multi-layer IPC measures to mitigate respiratory illness and anticipate future outbreaks.

Analyzing the worldwide progression of COVID-19 cases and deaths using nonlinear mixed-effects model.

COVID-19 is an infectious disease that continues to spread worldwide. A precise estimation of the cases and deaths due to COVID-19 would allow for appropriate consideration of healthcare resource allocation, public health response, and vaccination and economic planning, to minimize social damage. In this study, we analyzed the progression of COVID-19 cases and deaths until January 2022 in 156 countries using a nonlinear mixed-effect model based on the SIR framework. Given the major changes in mortality from infection, risk of re-infection and social responses, the analysis was limited to the period before the emergence of the Omicron variant. The impact of infection prevention measures in various countries was assessed, with a specific focus on estimating the effectiveness of lockdowns, where the effect was assumed to change over time. By accounting for excess mortality, our analysis allowed the estimation of unreported cases and deaths, and thus providing a more comprehensive understanding of the impact of pandemic. In the analysis, we identified gross domestic product (GDP), proportion of people aged 65 years or older, latitude of the capital city on transmissibility of infection, and city population and cardiovascular death rate on mortality rate as significant influencing factors. Furthermore, the differences in transmissibility and mortality rates by variants and the effect of vaccination on the mortality rate were assessed. The transmissibility has increased by odds ratios of 1.2 to 1.4 in Beta, Gamma, and Delta variants; mortality rate has increased by odds ratios of 1.7, 2.2, and 1.4 in Beta, Gamma, and Delta variants, respectively; and vaccination decreased the mortality rate by odds ratios of 0.4 and 0.1 in Delta and other variants, respectively.

Effectiveness of annual influenza campaigns and vaccination in reducing influenza burden in nursing homes of Canton Vaud in Switzerland

BackgroundInfluenza infections pose significant risks for nursing home (NH) residents. Our aim was to evaluate the impact of the cantonal influenza campaign, and influenza vaccination coverage of residents and healthcare workers (HCWs) on influenza burden in NHs in a context of enhanced infection prevention and control measures (IPC) during the SARS-CoV-2 pandemic.MethodsWe extracted data from epidemic reports provided by our unit to NHs over two consecutive winter seasons (2021-22 and 2022-23) and used linear regression to assess the impact of resident and HCW vaccination coverage, and participation in the campaign, on residents’ cumulative influenza incidence and mortality.ResultsThirty-six NHs reported 155 influenza cases and 21 deaths during the two winter seasons corresponding to 6.2% of infected residents and a case fatality ratio of 13.5%. Median vaccination coverage was 83% for residents, 25.8% for HCWs, while 87% of NHs participated in the campaign. Resident vaccination was significantly associated with a decrease in odds of death (odds ratio (OR) 0.96, 95% confidence interval (CI): 0.93–0.99). There was no significant effect of HCW vaccination coverage on resident infections and deaths. Campaign participation was associated with decreased odds of infection and death among residents (OR: 0.17, 95% CI: 0.06–0.47 and OR: 0.06, 95% CI: 0.02–0.17 respectively).ConclusionOur analysis suggests that in a context of reinforced IPC measures, influenza still represents a significant burden for NH residents. The most effective measures in decreasing resident influenza burden in NHs was participation in the cantonal influenza vaccination campaign and resident vaccination.

Microbiological Landscape of Intensive Care Unit: A Retrospective Analysis of Bacterial Pathogens and Their Implications

Introduction: The intensive care unit (ICU) is a high-risk environment for hospital-acquired infections (HAIs) due to the complex interplay of patient vulnerability, invasive procedures, and the selective pressure of antimicrobial use. Understanding the local epidemiology of bacterial pathogens is crucial for effective infection prevention and control strategies. This study aimed to characterize the bacterial profile in an ICU setting, providing insights into the prevalent pathogens and their potential implications for patient care. Methods: A retrospective cross-sectional study was conducted, encompassing patients admitted to the ICU of Bangli Hospital Bali in 2023 and 2024. Data on patient demographics, sample sources, and microbiological findings were collected from medical records. Samples included blood cultures, sputum cultures (from both endotracheal tubes and spontaneous expectoration), wound swabs, and other sterile site cultures. Microbiological identification was performed using standard laboratory techniques. Results: A total of 219 patients were included in the study. The most common sample source was blood culture (42.9%), followed by sputum culture from endotracheal tubes (39.3%). A significant proportion of cultures showed no growth (34.7%), highlighting the challenges in identifying causative pathogens in the ICU. Among the identified pathogens, Staphylococcus spp. was predominant (15.5%), followed by Stenotrophomonas maltophilia (9.6%) and coagulase-negative staphylococci (8.7%). The distribution of pathogens varied across sample sources, with Staphylococcus spp. being prevalent in sputum cultures from endotracheal tubes and Klebsiella pneumoniae in sputum cultures. Conclusion: This study underscores the dynamic nature of the microbiological landscape in the ICU. The predominance of Staphylococcus spp., Stenotrophomonas maltophilia, and other opportunistic pathogens emphasizes the need for robust infection prevention and control measures. Further research is warranted to explore the impact of these pathogens on patient outcomes and to optimize antimicrobial stewardship in this critical care setting.

SARS-CoV-2 antibody prevalence by industry, workplace characteristics, and workplace infection prevention and control measures, North Carolina, USA, 2021 to 2022.

The COVID-19 pandemic has disproportionately affected workers in certain industries and occupations, and the workplace can be a high-risk setting for SARS-CoV-2 transmission. In this study, we measured SARS-CoV-2 antibody prevalence and identified work-related risk factors in a population primarily working at industrial livestock operations. We used a multiplex salivary SARS-CoV-2 IgG assay to determine infection-induced antibody prevalence among 236 adult (≥18 yr) North Carolina residents between February 2021 and August 2022. We used the National Institute for Occupational Safety and Health Industry and Occupation Computerized Coding System (NIOCCS) to classify employed participants' industry. Most participants (55%, 95% confidence interval [CI] 49% to 62%) were infection-induced IgG positive, including 71% (95% CI 60% to 83%) of animal slaughtering and processing industry workers, 1.5 to 4.3 times North Carolina general population infection-induced seroprevalence estimates during overlapping time periods. Considering self-reported diagnostic test positivity and vaccination history in addition to antibodies, the proportion of participants with evidence of prior infection increased slightly to 61% (95% CI 55% to 67%), including 75% (95% CI 64% to 87%) of animal slaughtering and processing workers. Participants with more than 1000 compared to 10 or fewer coworkers at their jobsite had higher odds of prior infection (adjusted odds ratio 4.5, 95% CI 1.0 to 21.0). This study contributes evidence of the severe and disproportionate impacts of COVID-19 on animal slaughtering and processing workers and workers in large congregate settings.

Nurses’ Knowledge regarding Infection Prevention in Neutropenic Patients at Tertiary Cancer Hospital, Nepal

Background:Neutropenia is one most common risk factor for infection and the leading causes of death in cancer patientsthat may results in unexpected hospitalizations and disruption in treatment plans and regimens.Method: A cross-sectional study was carried out among 100 nurses to assess the knowledge regarding infection preventionin neutropenic patients to those who are working least 6 months in chemotherapy of B.P. Koirala Memorial Cancer Hospital(BPKMCH). A non-probability purposive sampling technique was adopted to select the sample and the data was collectedthrough a structured self- administered questionnaire. Data were analyzed by using Statistical Package for Social Science(SPSS) version 22.Result: The study findings summarized the level of knowledge into three categories where more than half (51%) of therespondents had good level of knowledge, 46% had moderate knowledge and 3% had poor knowledge regarding infectionprevention in neutropenic patients.Conclusion: Though majority of the respondents had good and moderate level of knowledge regarding infection preventionin neutropenic patients but there is still lack of Guideline/Protocol on infection prevention measures and gap in knowledgeregarding daily nursing assessment. So, there is still need to develop and implement infection prevention guidelines/protocols and regular trainings on infection prevention from concern authority of hospital management.

Rethinking ‘collective effervescence,’ post-COVID-19: what Japanese punks can teach us about crowd control

ABSTRACT This paper examines the case of grassroots-level live music in Japan during the height of the global COVID-19 pandemic. Despite imposing restrictions on cross-border movement, the Japanese government refrained from implementing the ‘lockdowns’ seen elsewhere. As such, this study provides an opportunity to examine what happens when infection prevention measures are delegated to the community level. Using qualitative data gathered from ethnographic fieldwork, this case study of punks in the northern city of Sapporo affords a ‘real life’ view of live music practice under such circumstances. Given that governments and policy makers are keen to avoid ‘lockdowns’ or similar measures should there be a future pandemic, a consideration of what actually happens in such a case becomes imperative. Qualitative analysis of this ethnographic case study reveals that whether an audience is able to sufficiently ‘control’ themselves in order to follow infection prevention guidelines is dependent on the social trajectories of those within it, and to what extent they are willing and able to employ their personal (sub)cultural capital to influence the emergent event. For policy makers, this suggests that any ‘community-level’ approach to infection prevention necessitates engagement with the group in question that is simultaneously ‘bottom up’ and ‘top down.’