Infection Prevention Practices Research Articles

Barriers to Infection Prevention and Control Practices in the Labor and Delivery Setting

Barriers to Infection Prevention and Control Practices in the Labor and Delivery Setting

An Image-Based Rapid Appraisal on Infection Prevention and Control Practices- the Call to Improvement at one Hospital in Eastern Province, Zambia

An Image-Based Rapid Appraisal on Infection Prevention and Control Practices- the Call to Improvement at one Hospital in Eastern Province, Zambia

Direct Gloving May Improve Adherence to Infection Prevention Practices.

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Perinatal colonization with extended-spectrum beta-lactamase-producing and carbapenem-resistant Gram-negative bacteria: a hospital-based cohort study

BackgroundAntimicrobial resistance (AMR) is a growing global health threat that contributes to substantial neonatal mortality. Bangladesh has reported some of the highest rates of AMR among bacteria causing neonatal sepsis. As AMR colonization among newborns can predispose to infection with these bacteria, we aimed to characterize the frequency of and risk factors for colonization of mothers and newborns during hospitalization for delivery.MethodsWe enrolled pregnant women presenting for delivery to a tertiary care hospital in Faridpur, Bangladesh. We collected vaginal and rectal swabs from mothers pre- and post-delivery, rectal swabs from newborns, and swabs from the hospital environment. Swabs were plated on agars selective for extended-spectrum-beta-lactamase producing bacteria (ESBL-PB) and carbapenem-resistant bacteria (CRB). We performed logistic regression to determine factors associated with ESBL-PB/CRB colonization.ResultsWe enrolled 177 women and their newborns during February-October 2020. Prior to delivery, 77% of mothers were colonized with ESBL-PB and 15% with CRB. 79% of women underwent cesarean deliveries (C-section). 98% of women received antibiotics. Following delivery, 98% of mothers and 89% of newborns were colonized with ESBL-PB and 89% of mothers and 72% of newborns with CRB. Of 290 environmental samples, 77% were positive for ESBL-PB and 69% for CRB. Maternal pre-delivery colonization was associated with hospitalization during pregnancy (RR for ESBL-PB 1.24, 95% CI 1.10–1.40; CRB 2.46, 95% CI 1.39–4.37). Maternal post-delivery and newborn colonization were associated with C-section (RR for maternal CRB 1.31, 95% CI 1.08–1.59; newborn ESBL-PB 1.34, 95% CI 1.09–1.64; newborn CRB 1.73, 95% CI 1.20–2.47).ConclusionsIn this study, we observed high rates of colonization with ESBL-PB/CRB among mothers and newborns, with pre-delivery colonization linked to prior healthcare exposure. Our results demonstrate this trend may be driven by intense use of antibiotics, frequent C-sections, and a contaminated hospital environment. These findings highlight that greater attention should be given to the use of perinatal antibiotics, improved surgical stewardship for C-sections, and infection prevention practices in healthcare settings to reduce the high prevalence of colonization with AMR organisms.

Bacterial Resistance in Nephrology

Bacterial resistance to antibiotics (ABR) is a major threat to public health, particularly in nephrology, with far-reaching consequences, including longer hospital stays, higher healthcare costs and increased mortality. Indeed, patients with chronic kidney disease (CKD) are a population at risk of developing infections caused by antibiotic-resistant bacteria (ARBs), given their overexposure to healthcare facilities and the quality of their gut microbiota already damaged by CKD. It is a population with very high rates of colonization and ARB infection worldwide. The mechanisms deployed by these AROs to counteract the effect of antibiotics are multiple. This may include the production of antibiotic-inhibiting enzyme (ATB), waterproofing of the bacterial membrane, or modification of the antibiotic target. They include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) species, and several multidrug-resistant Gram-negative organisms. The emergence and global spread of these ARBs is facilitated by ATB selection pressure, inter-agency transmission of resistance determinants, suboptimal infection control practices, and frequency of international travel, among other factors. The spread of this veritable pandemic highlights the urgent need for new treatment options, the implementation of awareness campaigns to properly prescribe antibiotics and improve infection prevention practices, particularly at hemodialysis centers.

Infection prevention and control practices in the Pediatrics and Child Health Department of Tikur Anbessa Specialized Hospital, Ethiopia.

Infection prevention and control (IPC) is a set of practices that are designed to minimize the risk of healthcare-associated infections (HAIs) spreading among patients, healthcare workers, and visitors. Implementation of IPC is essential for reducing infection incidences, preventing antibiotic use, and minimizing antimicrobial resistance (AMR). The aim of the study was to assess IPC practices and associated factors in Pediatrics and Child Health at Tikur Anbessa Specialized Hospital. In this study, we used a cross-sectional study design with a simple random sampling method. We determined the sample size using a single population proportion formula with the assumption of a 55% good IPC practice, a 5% accepted margin of error, and a 15% non-response rate and adjusted with the correction formula. The final sample size was 284 healthcare workers. The binary logistic regression model was used for analysis. The World Health Organization (WHO) Infection Prevention and Control Assessment Framework (IPCAF) tool was used to assess IPC core components. A total of 272 healthcare workers participated in the study, with a response rate of 96%. Of the total participants, 65.8% were female and 75.7% were nurses. The overall composite score showed that the prevalence of good IPC practices among healthcare workers was 50.4% (95% CI: 44.3-56.5). The final model revealed that nursing professionals and healthcare workers who received IPC training had AORs of 2.84 (95% CI: 1.34-6.05) and 2.48 (95% CI: 1.36-4.52), respectively. The final average total IPCAF score for the IPC level was 247.5 out of 800 points. The prevalence of good IPC practice was suboptimal. The study participants, who were nursing professionals and healthcare workers who received IPC training, showed a statistically significant association with the IPC practice level. The facility-level IPCAF result showed a "Basic" level of practice based on the WHO categorization. These evidences can inform healthcare workers and decision-makers to identify areas for improvement in IPC practice at all levels. Training of healthcare workers and effective implementation of the eight IPC core components should be strengthened to improve suboptimal practices.

'Family members screaming for help makes it very difficult to don PPE'. A qualitative study on UK ambulance staff experiences of infection prevention and control practices during the COVID-19 pandemic.

During the first wave of the COVID-19 pandemic in the UK, ambulance staff continued to deliver direct patient care whilst simultaneously adapting to a considerable escalation in evolving infection prevention and control (IPC) practices. To enable learning to benefit future planning, this qualitative article aims to describe ambulance staff's experiences of this rapid escalation of IPC practices. Three online surveys were presented during the acceleration, peak, and deceleration phases of the pandemic's first wave in the UK (2020). Overall, 18 questions contributed 14,237 free text responses that were examined using inductive thematic analysis at both descriptive and interpretive levels. Many participants lacked confidence in policies related to the use of personal protective equipment (PPE) because of perceived inadequate supporting evidence, confusing communication, and low familiarity with items. Compliance with policy and confidence in PPE use were further influenced by discomfort, urgency, and perceptions of risk. Various suggestions were made to improve IPC practices within the work environment, including reducing unnecessary exposure through public education and remote triage improvements. Some participants' poor experiences of escalating IPC practices were shared with health care workers studied in other environments and in previous epidemics, emphasising the need for lessons to be learnt. PPE should be developed with consideration of ambulance staff's unique working environment and regular familiarisation training could be beneficial. Pragmatic, evidence-based, clearly communicated policies implemented with sufficient resources may protect staff and facilitate them to maintain standards of care delivery during a pandemic.

The effectiveness and efficiency of asymptomatic SARS-CoV-2 testing strategies for patient and healthcare workers within acute NHS hospitals during an omicron-like period

BackgroundAsymptomatic SARS-CoV-2 testing of hospitalised patients began in April-2020, with twice weekly healthcare worker (HCW) testing introduced in November-2020. Guidance recommending asymptomatic testing was withdrawn in August-2022. Assessing the impact of this decision from data alone is challenging due to concurrent changes in infection prevention and control practices, community transmission rates, and a reduction in ascertainment rate from reduced testing. Computational modelling is an effective tool for estimating the impact of this change.MethodsUsing a computational model of SARS-CoV-2 transmission in an English hospital we estimate the effectiveness of several asymptomatic testing strategies, namely; (1) Symptomatic testing of patients and HCWs, (2) testing of all patients on admission with/without repeat testing on days 3 and 5–7, and (3) symptomatic testing plus twice weekly asymptomatic HCW testing with 70% compliance. We estimate the number of patient and HCW infections, HCW absences, number of tests, and tests per case averted or absence avoided, with differing community prevalence rates over a 12-week period.ResultsTesting asymptomatic patients on admission reduces the rate of nosocomial SARS-CoV-2 infection by 8.1–21.5%. Additional testing at days 3 and 5–7 post admission does not significantly reduce infection rates. Twice weekly asymptomatic HCW testing can reduce the proportion of HCWs infected by 1.0-4.4% and monthly absences by 0.4–0.8%. Testing asymptomatic patients repeatedly requires up to 5.5 million patient tests over the period, and twice weekly asymptomatic HCW testing increases the total tests to almost 30 million. The most efficient patient testing strategy (in terms of tests required to prevent a single patient infection) was testing asymptomatic patients on admission across all prevalence levels. The least efficient was repeated testing of patients with twice weekly asymptomatic HCW testing in a low prevalence scenario, and in all other prevalence levels symptomatic patient testing with regular HCW testing was least efficient.ConclusionsTesting patients on admission can reduce the rate of nosocomial SARS-CoV-2 infection but there is little benefit of additional post-admission testing. Asymptomatic HCW testing has little incremental benefit for reducing patient cases at low prevalence but has a potential role at higher prevalence or with low community transmission. A full health-economic evaluation is required to determine the cost-effectiveness of these strategies.

Mothers' knowledge and practice of infection prevention at Ridge Hospital, Ghana

Background/Aims Neonatal infection is one of the most common health challenges for newborn care globally. It is also a common contributory reason for admission to neonatal intensive care units in low- and middle-income countries and one of the main causes of mortality and morbidity. This study aimed to assess mothers’ knowledge, practice and perception of factors affecting infection prevention. Methods A descriptive cross-sectional study was conducted among 193 neonatal mothers from August to September 2021. A structured questionnaire was used to collect data on knowledge and practice of infection prevention, as well as factors the participants felt impacted infection prevention. Data were analysed using descriptive statistics. Results The majority of mothers had good knowledge (93.3%) and practice (92.7%) of infection prevention. The participants reported multiple factors that they felt impacted neonatal infection prevention, including the mother's education (84.5%), home birth practices (89.1%), poor economic state (85.0%), poor antenatal attendance (93.3%), negative cultural and belief systems (94.8%) and a lack of knowledge of infection prevention (90.7%). Conclusions Overall, the majority of neonatal mothers had good knowledge and practice of infection prevention. The Ghana Health Service and Ministry of Health should encourage women to give birth at a health facility, to increase their knowledge of infection prevention, which will then be reflected in improved practice.

Health and safety of health workers in the Suame Municipality of Ghana - Lessons learnt from the COVID-19 outbreak in infection prevention and control for future pandemics.

Effective adherence to infection prevention and control practices is needed to reduce the rate of healthcare-acquired infections among healthcare workers. Policies to control healthcare-acquired infections among healthcare workers can be designed and implemented using information on adherence to infection prevention and control practices adherence and its determinants. This study, therefore, sought to assess the adherence to infection prevention and control practices among healthcare workers during the 2019 Coronavirus disease pandemic. A multicentre cross-sectional study was conducted among 323 randomly selected healthcare workers in four health facilities in the Suame Municipality, Ghana. Data on participants' socio-demographics, knowledge of infection prevention and control practices and adherence to infection prevention and control practices were collected using a pre-tested structured questionnaire. Multivariate logistic regression analysis was used to examine the effect of demographic characteristics and knowledge of infection prevention and control on adherence to infection prevention and control practices among study participants. Over three-quarters (75.9%) of the study participants had adequate knowledge of infection prevention and control practices with a significant knowledge gap in the colour coding of bin liners for waste segregation (35.6%). The proportion of study participants who reported good adherence to infection prevention and control practices was 86.7%. Healthcare workers who were 33 years and above (Adjusted odds ratio (AOR): 0.27; 95% Confidence interval (CI): 0.08-0.92) and absence of an infection prevention and control committee at the facility AOR: 0.25; 95% CI: 0.08-0.73) had reduced odds of good adherence to infection prevention and control practices. Nursing staff (AOR: 9.49, 95% CI: 2.51-35.87) and having adequate knowledge of infection prevention and control practices (AOR: 2.66; 95% CI: 1.19-5.97) were associated with increased odds of good adherence to infection prevention and control practices. Adherence to infection prevention and control practices was high among this sample of Ghanaian healthcare workers. Interventions and strategies to improve adherence should include the setting up of infection prevention and control committees, education and strict observance of colour coding of bin liners for waste segregation and intensification of training of healthcare workers in infection prevention and control practices.

Practice of Infection Prevention and Control Strategies in Risk Departments during the COVID-19 Epidemic

Practice of Infection Prevention and Control Strategies in Risk Departments during the COVID-19 Epidemic

Knowledge and Practice of Infection Prevention and Control among Healthcare Workers in Secondary Healthcare Facilities in Southern Cross River State Nigeria

Abstract Background: Globally, millions of people are affected annually by health-care-associated infections, many of which could be avoided by strict compliance with standard infection prevention and control (IPC) protocols. Aim: This study assessed the knowledge and practice of IPC among secondary health-care workers (HCWs) in Southern Cross River State. Materials and methods: A structured questionnaire was used in conjunction with a descriptive cross-sectional design to collect data from 336 health-care personnel. IBM SPSS Statistics version 25 was used to analyse the generated data. Results: The results show that 58% of the respondents had a high knowledge level of IPC and 52.4% exhibited a high level of standard IPC practice. About 53% reported that IPC protocols were available in their facility. No association was found between sociodemographic characteristics of HCWs and their practice of standard IPC practice except for sex. A significant association was found between sex and level of IPC practice (P = 0.015), the male HCWs had higher practice of IPC than their female counterparts. Although no association was found between knowledge and practice of IPC among the HCWs, the level of practice was, however, higher among the doctors than the nurses who had a higher level of knowledge on IPC. A logistic regression analysis further showed that only sex was significant (P = 0.021) in influencing a high level of IPC practice among the HCWs in this study. Conclusion: It is, therefore, imperative for health-care facility leadership to organise training and retraining programs on IPC to improve knowledge and compliance among HCWs, especially in the face of emerging infectious diseases in Nigeria.

Investigating Infection Prevention and Control Practices among Healthcare Workers in Kasese District, Uganda: Factors and Implications for Ebola Preparedness

The World Health Organization (WHO) African region often faces numerous public health emergencies, with a significant proportion caused by infectious diseases. Ebola virus disease (EVD) is a high-consequence pathogen of particular concern due to its high mortality rate and potential for global transmission. The study aimed to investigate infection prevention and control (IPC) practices with factors associated with the practice among health care workers (HCWs) in Kasese district, Uganda. The study design was cross-sectional, utilizing both qualitative and quantitative methods. The study population consisted of HCWs working in six selected Health Centre III facilities in sub-counties bordering the Democratic Republic of Congo (DRC). A sample of 106 HCWs was purposively selected and data collection involved structured questionnaires, and then data analysis was done using descriptive statistics and logistic regression. The study reveals that a majority of HCWs were female (55.7%), worked in outpatient departments (49.1%), had 6-10 years of service (43.4%), held certificates as their highest education level (48.1%), and were predominantly nurses (53.8%). IPC practices were found to be low, with 72.6% of participants exhibiting inappropriate IPC practices. Individual factors influencing low IPC practices included the duration of IPC training, knowledge, attitude towards IPC, and education level, all statistically significant (P < 0.05). Similarly, health facility factors such as the accessibility of IPC guidelines and personal protective equipment (PPE), availability of sanitizer/soap, and proper and continuous IPC training/continuing medical education (CME) were associated with low IPC practice (P < 0.05). In conclusion, the study highlights a low level of IPC practice among HCWs in Health Centre Threes in Kasese District, with both individual and health facility factors contributing to this issue. Recommendations include training HCWs in IPC and organizing regular cascade training, providing IPC knowledge as part of their daily duties, ensuring confidence in managing Ebola during outbreaks, maintaining IPC strategies implemented during EVD outbreaks, and supplying IPC materials to healthcare facilities. These efforts, coupled with increased staffing, can significantly enhance protection and performance in public healthcare services.

Assessment of nursing knowledge and practice toward prevention of acquired infections in the emergency department of King Faisal Medical Complex in Taif.

Hospital-acquired infections constitute a significant source of morbidity and mortality for both patients and healthcare professionals. Nursing professionals constitute an integral component of any quality-related program in a hospital, given their oversight and provision of nearly all healthcare services. Nurses' knowledge and attitudes play a significant role in healthcare delivery. Within Saudi Arabia, the prevalence of hospital-acquired infections in hospital settings has prompted a growing emphasis on evaluating nursing knowledge and adherence to practice standards aimed at hospital-acquired infection prevention. This single-center cross-sectional study was conducted at the emergency department of King Faisal Medical Complex, Taif, between October and December 2022, involving 168 nurses. The study utilized a pre-validated structured online questionnaire comprising three sections: demographics, knowledge assessment, and practice evaluation. Knowledge and practice levels were categorized as good, moderate, and poor using quartiles. The study encompassed 168 nurses employed in the emergency department of the hospital, revealing their proficiency in standard practices for preventing hospital-acquired infections. Notably, 63.8% of participants demonstrated a commendable "Good" level of knowledge, while 10.6% exhibited a "Moderate" level and 25.5% manifested a "Poor" level in terms of knowledge. Similarly, concerning practice levels, 56.4% showcased a commendable "Good" practice level, 22.3% maintained a "Moderate" practice level, and 21.3% presented a "Poor" practice level. Chi-square analysis unveiled a significant association between age and knowledge levels (p = 0.000). In addition, age (p = 0.000) and years of clinical experience (p = 0.000) were significantly linked to nurses' practice levels The nurses aged 40-50 years (82%) and those with 10-15 years of clinical experience (83.3%) showed good levels of knowledge and practice, respectively. Overall, most of the nurses demonstrated effective knowledge and compliance with infection prevention practices. Sociodemographic factors such as age and clinical experience exert a notable impact on nurses' knowledge and practices regarding hospital-acquired infections.

Information-Seeking and Risk Perception to Explain Infection-Prevention Behaviors: Conditional Analysis on Trust in Media and Government as Moderator.

This study aims to explore how the relationship between information-seeking and infection-prevention behaviors through risk perception changes according to the level of trust in the media and government. The study is a secondary data analysis of data from a cross-sectional national survey of 700 adults living in the community, representing different age groups, genders, and geographic regions. A validated questionnaire was used to assess information-seeking behaviors, trust in media and government, and risk perception to explain infection-prevention behaviors in response to the COVID-19 pandemic. A conditional analysis was conducted using SPSS and PROCESS macro (Model 7) to identify the effect of moderated mediation. The participants were fairly balanced by gender and age group. Most participants learned about COVID-19 through major broadcasts and television (56.7%) followed by internet media (21.7%). Information-seeking and risk perception together explained 17% of the variance in infection-prevention behaviors (F=63.95, p<0.01). The standardized indirect effect (β=0.04, BootCI 0.02, 0.06) was significant at 95% CI. The moderated mediation index (M=-0.04, CI -0.05, -0.01) indicates that trust in media and government influences the effect of information-seeking on risk perception and infection-prevention behavior even after controlling for age and gender. Information-seeking behaviors affect infection-prevention behaviors directly and indirectly through risk perception. Trust in media and government modulates this relationship, emphasizing the importance of establishing trust to promote effective risk communication and long-term public compliance with infection-prevention practices. Health authorities should focus on building trust through transparent risk communication and integrating diverse media perspectives. Further research is needed to explore the psychological and social mechanisms underlying trust in media and government through qualitative, cross-cultural comparisons.

Prevalence of typhoid fever and its associated factors among febrile patients visiting Arerti Primary Hospital, Amhara Region, north east Ethiopia.

Typhoid fever is one of the major public health concerns in developing countries, including Ethiopia. Understanding the burden and factors contributing to the transmission and development of the disease is crucial to applying appropriate preventive and therapeutic interventions. To assess the prevalence of typhoid fever and its associated factors among febrile patients visiting Arerti Primary Hospital from 1 March to 30 May 2022. A facility-based cross-sectional study was employed among 326 febrile patients visiting Arerti Primary Hospital for health services. The data were collected using laboratory procedures (widal test) and a structured interviewer-administered questionnaire. The data were entered using Epi Data version 3.1 and analyzed by SPSS version 25. Logistic regression was used to determine associations between variables. P-value < 0.05 and adjusted odds ratio with 95% confidence interval were used to measure the presence and strength of associations. In this study, of the total 317 cases that participated, the majority (64.4%) of them were males with age ranges from 13 to 63 years. The overall prevalence of positive antigen tests for typhoid infection was 30.0% (95% CI: 25.0%-35.3%). About 66.9% of the study participants had good knowledge, 75.7% had favorable perception, and 42.3% had good infection prevention practice. Being unemployed [AOR = 7.57, 95% CI (1.98, 28.93)], being a farmer [AOR = 2.73, 95% CI (1.01, 7.41)], and having a body mass index (BMI) below 18.5 kg/m2 [AOR = 5.12, 95%CI (2.45, 10.68)] were significantly associated with typhoid fever infection. The prevalence of typhoid fever among febrile patients was high. Typhoid fever infection was significantly associated with occupational status (being unemployed and being a farmer) and lower BMI. The level of knowledge, perception, and practice of typhoid fever infection prevention were found inadequate. Therefore, behavioral change interventions are needed at the community level.

KNOWLEDGE AND PREDICTORS OF IMPLEMENTATION OF STANDARD PRECAUTIONS FOR INFECTION PREVENTION AND CONTROL AMONG HEALTH CARE PRACTITIONERS.

Infection prevention and control involve health care practitioners, who are saddled with the duty of ensuring implementation of standard preventive measures to prevent healthcare associated infections. To assess the knowledge and predictors of implementation of standard precautions for infection prevention and control among health care practitioners (HCPs). A questionnaire-based cross-sectional design was employed in assessing HCPs in Uganda in from April - October 2023. Data were analyzed using descriptive, Pearsons' correlation, linear and binary logistic regression with the aid of SPSS Version 22. Among the 222 healthcare practitioners assessed, 127 (57.2%) and 115 (51.8 %) had good knowledge and practice towards implementation of standard infection prevention and control precautions respectively. Chi square analysis indicated that age of healthcare practitioner (p=0.02; CI: 0.018 - 0.23), hospital unit of practice (p=0.003; CI: 0.002 - 0.004) and the type of facility where the health care practitioner works is significantly associated with their knowledge, while profession of the healthcare practitioner (p=0.002; CI: 0.001-0.003) and hospital unit of practice (p=0.002; CI: 0.001-0.003) were associated with implementation of the standard infection prevention and control precautions. Linear regression revealed knowledge is a significant predictor of good practice towards implementation of preventive measures (OR = 0.19; CI 0.102 - 0.272; p < 0.001). Healthcare practitioners had poor knowledge and practice towards infection prevention. Thus, emphasizing continuous education and training for all healthcare professionals about infection prevention and control interventions as well as strict adherence to proper infection prevention and control practices.

Quality of TB diagnostic services at primary healthcare clinics in eThekwini district, South Africa.

Overcoming the TB epidemic requires moving past expanding the coverage of healthcare services and looking to improve the quality of TB services. During COVID-19, the suboptimal state of TB services has further deteriorated, and little is known about how these services have fared after the pandemic. The study aims to assess the quality TB diagnostic services in primary health care (PHC) clinics in the eThekwini district, South Africa. Twenty-one clinics with the lowest and highest headcounts from each region of eThekwini were purposively selected. An audit tool adapted from the United States Agency for International Development (USAID) and the national TB guidelines was used to collect data on six different audit components. To assess quality, a 3-point scale was used where clinics could get a rating of either excellent, moderate, or poor performance. Descriptive statistics were employed to summarize and analyze clinic scores in Stata v15.1. Additionally, associations between clinic scores and clinic characteristics were investigated using Pearson's pairwise correlation coefficient and a linear regression model, where p < 0.05 was the measure of statistical significance. The audit found that the quality of diagnostic services in eThekwini was moderate. The gaps that required addressing were the lack of TB training among staff, adherence to infection prevention and control practices, and contact screening. Without feasible solutions, these will hinder current TB management strategies and slow progress toward ending the TB epidemic.

Phenotypic detection of carbapenem-resistant Enterobacterales in clinical isolates at a tertiary care hospital

Abstract Background: In the past decade, there has been a global emergence of carbapenem-resistant Gram-negative bacilli, especially Enterobacterales. Carbapenem resistance is attributed to the ability of the bacteria to produce carbapenemases. The aim of the study is to detect carbapenem-resistant Enterobacterales (CRE) in different clinical isolates and study carbapenemase production by phenotypic methods in CRE. Materials and Methods: A total of 379 Enterobacterales were isolated from different clinical samples from patients attending outpatient departments and admitted in wards and intensive care units (ICUs). They were tested for carbapenem resistance by Kirby–Bauer disk diffusion method and then tested for carbapenemase production by ethylenediaminetetraacetic acid (EDTA)–disk synergy test and Modified Carbapenem Inactivation Method (mCIM). Results: This study was conducted from February 2021 to August 2022. Out of 379 Enterobacterales, 70 (18.47%) were CRE, out of which maximum carbapenem resistance of 23.53% was shown by Klebsiella pneumoniae isolates. The maximum carbapenem resistance was seen in the age group of 16–45 years and the most number of CRE isolates were from ICUs. Phenotypic test results indicated that 54.28% (38/70) of isolates were positive for carbapenemase production by either of the phenotypic methods. Conclusion: About one-fifth of the Enterobacterales isolates were carbapenem resistant. This study highlights the use of phenotypic methods to detect carbapenemase production in CRE, which is responsible for multidrug resistance. This information is relevant for surveillance, to implement infection prevention and control practices and antibiotic policies.

Antibiotic usage within cesarean section procedures in resourced-limited Kenya: A study of 23 facilities

Introduction: In Kenyan cesarean sections (CS), antibiotics play a crucial role in preventing surgical site infections. In Kenya, where maternal health care is a pivotal public health concern, understanding the efficacy and appropriateness of antibiotic prophylaxis in CS is crucial. This study seeks to address this gap by understanding antibiotic prophylaxis practices and the classes of antibiotics utilized for prophylaxis during CS in Kenya. Methods: We conducted a cross-sectional survey on infection prevention and control (IPC) practices by adapting the World Health Organization (WHO) IPC assessment framework. One component of this survey included questions on antibiotic prophylaxis for CS. Purposive sampling was used to identify 23 hospitals across seven districts in Kenya that provided CS. Results: All 23 facilities used a form of systemic antibiotic prophylaxis. Preoperative systemic antibiotic prophylaxis was used by 78.2%, and postoperative prophylaxis was universal. The mean duration of postoperative antibiotic prophylaxis was 3.87 days. Ceftriaxone (91.3%), metronidazole (82.6%), and gentamicin (26.1%) were the most common systemic antibiotics. In addition, 91.3% administered oral antibiotics postoperatively, with a mean duration of 5.6 days. Predominant oral antibiotics included metronidazole (82.6%), amoxicillin–clavulanate (60.9%), and ceftriaxone (13.0%). Conclusion: The antibiotic practices utilized within the Kenya setting do not follow either the American College of Obstetricians and Gynecologists (ACOG) or WHO recommendations. Both organizations recommend pre-CS administration of a first-generation cephalosporin 60 min before incision. This class of antibiotics is not used at any of the study sites. In addition, all of the study sites provide postantibiotic prophylaxis, which is not recommended by either ACOG or WHO for prophylaxis.