Hospital Infection Research Articles

[Translated article] Descriptive study of spinal instrumentation-related infections in a tertiary hospital

IntroductionSpinal instrumentation-related infections (SIRI) are one of the main causes of post-surgical complication and comorbidity. Our objective was to describe the clinical and microbiological characteristics, treatment and prognosis of these infections. Material and methodsWe conducted a retrospective study in our institution (2011–2018) including adult patients undergoing spinal instrumentation who met the diagnostic criteria for confirmed infection. Superficial surgical wound and deep intraoperative samples were processed for microbiological culture. The medical and orthopaedic team was always the same. ResultsForty-one cases were diagnosed of which 39 patients (95.1%) presented early infection (<3 months after initial surgery) with symptoms in the first two weeks, mean CRP at diagnosis was 133mg/dl and 23% associated bacteremia. The remaining two patients (4.8%) were chronic infections (symptoms >3 months after surgery). The treatment of choice in early infections was the Debridement, Antibiotics and Implant Retention (DAIR) strategy without removal of the bone graft, which successfully resolved 84.2% of the infections. The main aetiology was gram-positive (Staphylococcus aureus: 31.7%), followed by gram-negative and polymicrobial flora. Antibiotics were optimised according to cultures with a mean duration of 12 weeks. ConclusionsIn early infections, early diagnosis and DAIR strategy (with bone graft retention) demonstrated a healing rate higher than 80%.

Clinico-mycological profile of fungal infections in a tertiary care hospital

The fungal infections are increasing at high rate especially in immune-compromised patients and elderly population. In high risk population, antifungal resistance is becoming a major concern. Antifungal susceptibility testing is important for appropriate management and better outcome of patients. The aim of the study was to know clinico-Mycological profile of fungal infections in admitted patients.This prospective study was carried out in a tertiary care hospital. Various samples were received from patients with suspected fungal infections. All samples were inoculated on SDA except blood &amp; body fluids which were directly inoculated into blood culture bottles and processed in BACTEK/BacTAlert system. Fungal infections were characterized and antifungal susceptibility was done for yeast isolates with VITEK-AST panel. : Out of total 19698 patients suspected of fungal infection, fungal infection was seen in 365 patients , 100% susceptibility was seen to Fluconazole and Echinocandins. Whereas in NAC (non-albicans ), 72.5% susceptibility was seen to fluconazole and Voriconazole (82.5%). Antifungal resistance is major cause of morbidity and mortality. Prompt diagnosis and antifungal susceptibility will offer the early appropriate treatment and better clinical outcome of patient.

The next frontier of healthcare-associated infection (HAI) surveillance metrics: Beyond device-associated infections.

In recent years, it has become increasingly evident that surveillance metrics for invasive device-associated infections (ie, central-line-associated bloodstream infections, ventilator-associated pneumonias, and catheter-associated urinary tract infections) do not capture all harms; they capture only a subset of healthcare-associated infections (HAIs). Although prevention of device-associated infections remains critical, we need to address the full spectrum of potential harms from device use and non-device-associated infections. These include complications associated with additional devices, such as peripheral venous and arterial catheters, non-device-associated infections such as nonventilator hospital-acquired pneumonia, and noninfectious device complications such as trauma, thrombosis, and acute lung injury. As authors of the device-associated infection sections in the SHEA/IDSA/APIC Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals, we highlight catheter-associated urinary tract infection as an example of the strengths and limitations of the current emphasis on device-associated infection surveillance, suggest performance metrics that present a more comprehensive picture of patient harm, and provide a high-level overview of similar issues with other infection surveillance measures.

Frequency And Risk Factors For Developing Surgical Site Infection In Abbasi Shaheed Hospital

Introduction: Surgical site infections are the most common nosocomial infections worldwide and are also the common problem in developing countries. The impact of its prevalence contributes to morbidity and mortality and therefore the need to determine its prevalence is necessary. Finding out the prevalence of surgical site infections and the frequency of risk variables for surgical site infections in patients undergoing abdominal surgeries at Abbasi Shaheed Hospital in Karachi is the aim of this study. Methodology: This descriptive study was carried out from February 22, 2022- August 22, 2022 at the Abbasi Shaheed Hospital in Karachi with a sample size of 157 subjects with abdominal surgery fulfilling the inclusion criteria. Results: In our study, the mean age, length of operation and BMI were 49.87±8.74 years, 2.14±1.87 hours, 29.72±3 respectively with 61.1% of female and 38.9% male subjects. Out of 157 patients, 22 (14%) and 135 (86%) had and did not have surgical site infection. Conclusion: Patients and the healthcare systems are both heavily impacted by the effects of SSIs. A comprehensive strategy addressing pre-, intra-, and postoperative variables is necessary for the prevention of SSI. In order to lower SSI, hospital infection control procedures should be developed in conjunction with the establishment of an ongoing, long-term surveillance system to detect risk factors.

Attitudes of Health Workers Towards Management of Hepatitis B Infection in General Hospitals in Kwara State, Nigeria

Hepatitis B is one of the most dangerous diseases in the world and it has become a serious threat to public health. Health workers are mostly at risk of contracting the disease as they remain the first point of call to the victims. This study examined the attitudes of health workers towards management of HBV infection and the difference in attitudes of health workers based on area of specialization. An ex-post facto research design sampling 412 health workers across different areas of specialization which include doctors, nurses, laboratory scientists and laboratory technicians. Majority of the health workers had negative attitudes towards HBV patients. However, doctors (mean score=3.72) and nurses (mean score=3.54) had mild negative attitudes towards HBV patients, while laboratory scientists (mean score=3.02) and laboratory technicians (mean score=3.04) had the poorest attitudes towards HBV patients. There is need to improve the attitudes of the different cadres of health workers in the state, in order to improve the quality of life of HBV patients and reduce stigma which may impact negatively on patients’ mental health.

Ralstoniapickettii bloodstream infection in the patient with Guillain-Barre syndrome under plasmapheresis

Ralstonia pickettii is a rare Gram-negative opportunistic bacterium that causes rare infections such as bacteremia, neonatal sepsis, endocarditis, and meningitis in hospitalized or immunocompromised patients. In this study, we identified and reported bloodstream infection caused by R. pickettii in a 15 -year-old boy patient with an autoimmune disease, Guillain-Barré syndrome, under plasmapheresis and intravenous immune globulin (IVIG) therapy. He was referred for admission to the neurology center of the teaching hospital of Shiraz, Iran for inability to walk, and lower extremity muscle weakness. After he was treated with plasmapheresis once during hospitalization, and after severe fever besides shivering blood cultures using BACT/ALERT®3D instrument were positive for R. pickettii.According to antibiotic susceptibility test reports, Ciprofloxacin (5 μg) was prescribed. Fortunately, after starting antibiotic treatment, blood culture results reported no growth after 5 days. Indeed, the patient was infected with nosocomial hepatitis A and URSOBIL (300 mg/BID/Po) was administered. Hence, after reporting the infection occurrence to the hospital infection control unit, initial and possible measures such as device infection control, replacement of potentially polluted plasmapheresis fluids, disinfecting the environment and replacing old sterile washing water with new sources were carried out in plasmapheresis unit. In conclusion, R. pickettii is a rare nosocomial infection that is responsible for the contamination of medical equipment, especially in hemodialysis, plasmapheresis devices and sterile solutions. Also, it is suggested that the role and importance of rare environmental bacteria as the causative agents of human infections should not be ignored in medical centers.

Explaining the Performance of Nurses in Order to Prevent Nosocomial Infections in Urmia City Hospitals: Application of the Health Belief Model

Background Nosocomial infections (NIs) are one of the medical, social, and economic problems in developing countries and can be prevented. Studying the etiology of NI is one of the most essential activities for designing prevention programs. The purpose of this study was to explain the constructs of the health belief model (HBM) regarding nurses' compliance with standard precautions for the prevention of NI in Urmia hospitals. Methods This cross-sectional study was conducted on 224 nurses of Urmia hospitals who were selected by employing the multi-stage method. The data collection tool was a questionnaire containing demographic characteristics, an HBM questionnaire associated with the prevention of NI, and questions related to the observance of nurses in the field of standard precautions to prevent NI. Data were analyzed using descriptive and inferential statistical methods in SPSS software version 22. Results The results of this study showed the average performance score of nurses in relation to adopting preventive behaviors against NI (71.97 ± 11.08) as acceptable. Also, the results of the study showed that among the constructs of the HBM, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cue to action, and self-efficacy are the most important predictors of adopting preventive behaviors against NI with a variance of 52% among the nurses. Conclusion According to the results of this study, the constructs of self-efficacy, perceived barriers, cue to action, perceived benefits, and perceived intensity are, respectively, the strongest predictors of compliance with standard precautions to prevent hospital infections. Therefore, the results of this study can be useful for health service providers in planning and designing interventions, and determining appropriate strategies for the prevention and control of NI.

Research on the relationship between nurses' compliance with standard precautions, servant leadership and emotional exhaustion: A cross-sectional survey.

This study aimed to analyse the effects of servant leadership on nurses' emotional failure and compliance with standard precautions and to explore the moderating effect of individual resilience. A cross-sectional survey. This descriptive cross-sectional study was conducted from October 9 to November 1, 2022. The convenience sampling method was used to collect questionnaire data from 924 clinical nurses in a third-class general hospital in Chongqing, China. The emotional exhaustion and compliance with standard precautions were at the general level. Servant leadership mediated by emotional exhaustion had a significant positive predictive effect on compliance with standard precautions. Personal resilience played a negative moderating role in the relationship between servant leadership and emotional exhaustion. For nurses with low resilience, servant leadership had a greater impact on emotional exhaustion. The current compliance with standard precautions for clinical nurses is not high due to emotional exhaustion. The level of servant leadership can alleviate nurses' emotional exhaustion and improve compliance with standard precautions. Especially for nurses with low personal resilience, the care and support of department leaders are needed. We found that the compliance with standard precautions is not high, and the link between emotional exhaustion, servant leadership and compliance with standard precautions provides a basis for further patient care. There was no patient or public involvement. Nurses are the key population for hospital infection prevention and control, and their level of compliance with standard precautions is of great significance for hospital infection prevention and control. However, in practice, nurses' compliance with standard precautions is generally low. Most of the previous studies on nurses' compliance with standard precautions were conducted from the perspective of individual nurses, based on the staff's 'knowledge, belief, and action' to study the current status of compliance with standard precautions and the factors affecting adherence, with less attention paid to the influence of psychological, environmental, and organizational factors. Therefore, the study focuses on the impact of servant leadership and emotional exhaustion on standard precautionary adherence, which is of great significance for good care management at the organizational level. It also explored how the impact of servant leadership on emotional exhaustion varies across levels of resilience, which is important for accurately identifying different types of nursing staff and targeting assistance.

Draft genome sequence including the capsule operon of a Bacillus cereus strain isolated from a patient with bacteremia in Japan.

Bacillus cereus, which causes opportunistic infections in hospitals as well as food poisoning, is genetically similar to Bacillus anthracis. We herein report the draft genome including the capsule operon of B. cereus BCER1 isolated from the blood of a hospital patient in Japan.

Molecular Detection and Identification of Candida Species Isolates from Oral by RFLP-PCR

In this study, 10 local isolates from a total of 50 samples of Candida sp. were collected from oral swabs of patients with oral infections in Mosul hospitals. The isolates were diagnosed based on culturing, microscopic and biochemical characteristics, and then molecular methods. The first diagnosis by culturing, microscopic and biochemical tests found the isolates were identified as Candida sp. The ITS region was amplified using universal primers (ITS4-ITS5), The PCR product was size (510-721) bp. Performing RFLP-PCR using MspI, HhaI,and EcoRI, restriction enzyme to detect and identify Candida species, the results showed the presence of the cutting sequence of MspI and HhaI enzymes in the genomic DNA content of local isolate and the absence of the sequences for the EcoRI restriction enzyme. Two Candida species were identified (C. krusei and C. the basis of size and fragment sequences then compared with sequences of standard strains from the gene bank in previous studies. Therefore, it can be observed that there is a genetic variation between the local isolates and that there are different genotypes of rDNA 5.8S have been diagnosed in 10 isolates after the cutting process with three restriction enzymes. We conclude from this study that the RFLP-PCR technique was the best in diagnosing and identifying Candida species compared with traditional methods. and we are d the genetic variation between local isolates.

The Development of a Clinical Registry Digital Database on Invasive Fungal Infections in India: Advancing Epidemiological Understanding and Patient Care.

A well-structured digital database is essential for any national priority project as it can provide real-time data analysis and facilitate quick decision making. In recent times, particularly after the COVID-19 pandemic, invasive fungal infections (IFIs) have emerged as a significant public health challenge in India, affecting vulnerable population, including immunocompromised individuals. The lack of comprehensive and well-structured data on IFIs has hindered efforts to understand their true burden and optimize patient care. To address this critical knowledge gap, the ICMR has undertaken a Pan-India pioneer initiative to develop a network of Advanced Mycology Diagnostic research centres in different geographical zones of the country (ICMR-MycoNet). Under the aegis of this project, a clinical registry on IFIs in the ICUs is initiated. This process paper presents a detailed account of the steps involved in the establishment of a web-based data entering and monitoring platform to capture data electronically, ensuring robust and secure data collection and management. This system not only allows participating ICMR-MycoNet centres to enter patient information directly into the database using standardized Case Report Form (CRF) but also includes data validation checks to ensure the accuracy and completeness of entered data. It is complemented by a real-time, web-based, and adaptable data visualization platform. This registry aims to provide crucial epidemiological insights, promote evidence-based hospital infection control programs, and ultimately improve patient outcomes in the face of this formidable healthcare challenge.

Gram-Negative ESKAPE Bacteria Surveillance in COVID-19 Pandemic Exposes High-Risk Sequence Types of Acinetobacter baumannii MDR in a Tertiary Care Hospital.

The interruption of bacteriological surveillance due to the COVID-19 pandemic brought serious consequences, such as the collapse of health systems and the possible increase in antimicrobial resistance. Therefore, it is necessary to know the rate of resistance and its associated mechanisms in bacteria causing hospital infections during the pandemic. The aim of this work was to show the phenotypic and molecular characteristics of antimicrobial resistance in ESKAPE bacteria in a Mexican tertiary care hospital in the second and third years of the pandemic. For this purpose, during 2021 and 2022, two hundred unduplicated strains of the ESKAPE group (Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii) were collected from various clinical sources and categorized by resistance according to the CLSI. An analysis of variance (ANOVA) complemented by the Tukey test was performed to search for changes in antimicrobial susceptibility profiles during the study period. Finally, the mechanisms of resistance involved in carbapenem resistance were analyzed, and the search for efflux pumps and high-risk sequence types in A. baumannii was performed by multilocus analysis (MLST). The results showed no changes in K. pneumoniae resistance during the period analyzed. Decreases in quinolone resistance were identified in E. coli (p = 0.039) and P. aeruginosa (p = 0.03). Interestingly, A. baumannii showed increases in resistance to penicillins (p = 0.004), aminoglycosides (p < 0.001, p = 0.027), carbapenems (p = 0.027), and folate inhibitors (p = 0.001). Several genes involved in carbapenem resistance were identified (blaNDM, blaVIM, blaOXA, blaKPC, blaOXA-40, and blaOXA-48) with a predominance of blaOXA-40 and the adeABCRS efflux pump in A. baumannii. Finally, MLST analysis revealed the presence of globally distributed sequence types (ST369 and ST758) related to hospital outbreaks in other parts of the world. The results presented demonstrate that the ESKAPE group has played an important role during the COVID-19 pandemic as nosocomial antibiotic-resistant pathogens and in particular A. baumannii MDR as a potential reservoir of resistance genes. The implications of the increases in antimicrobial resistance in pathogens of the ESKAPE group and mainly in A. baumannii during the COVID-19 pandemic are analyzed and discussed.

Clinical and microbiological profile of health care–associated infections in a tertiary hospital: Comparison between a cohort of hospitalized patients during prepandemic and COVID-19 pandemic periods

During the COVID-19 pandemic, health service practices underwent significant changes, impacting the occurrence of health care-associated infections (HAIs). This study presents the epidemiology of bacterial infections and compares clinical data on nosocomial infections in hospitalized patients before and during the pandemic. A unicentric, observational, retrospective cohort study was conducted with descriptive analyses on the microorganism identification and resistance profile. Patient's clinical data who had hospital-acquired infection (HAI), during their hospitalization in a tertiary hospital before and during the COVID-19 pandemic was compared by descriptive and inferential analyses. A total of 1,581 bacteria were isolated from 1,183 hospitalized patients. Among patients coinfected with COVID-19, there was a statistically significant increase in HAI-related deaths (P<.001) and HAI caused by multidrug-resistant organisms (P<.001), mainly by Acinetobacter baumannii and Staphylococcus aureus. A higher odds ratio of HAI-related deaths compared to the prepandemic period was observed (odds ratio 6.98 [95% confidence interval 3.97-12.64]). The higher incidence of multidrug-resistant bacteria and increased deaths due to HAI, especially in patients with COVID-19 coinfection, might be related to various factors such as increased workload, broad-spectrum antibiotic use, and limited resources. The pandemic has changed the profile of circulating bacteria and antimicrobial resistance. Prevention strategies should be considered to reduce the impact of these infections.

Azvudine versus paxlovid for oral treatment of COVID-19 in Chinese patients

PurposeTo explore the effect of azvudine as compared to paxlovid for oral treatment of hospitalized patients with SARS-CoV-2 infection.MethodsWe analyzed data from a cohort of patients with SARS-CoV-2 infection in Shandong provincial hospital between February 15 and March 15, 2023. The primary outcome was time to sustained clinical recovery through Day 28 and secondary outcomes included the percentage of participants who died from any cause by Day 28, the average hospitilization time and expenses, the changes in liver and kidney function and adverse events. The Kaplan–Meier method and Cox regression model was used for statistical analysis.ResultsThere was no significant difference between azvudine and paxlovid in terms of time to sustained clinical recovery (p = 0.429) and death rates (p = 0.687). As for hospitalization time and fee, no significant differences were observed between azvudine group and paxlovid group (Hospitalization time: p = 0.633; Hospitalization fee: p = 0.820). In addition, there were no significant differences in the effects of the two drugs on liver and kidney function (p > 0.05).ConclusionAmong adults who were hospitalised with SARS-CoV-2 infection, azvudine was noninferior to paxlovid in terms of time to sustained clinical recovery, death rates, hospitalization time and cost, with few safety concerns.Trial registrationChiCTR2300071309; Registered 11 May 2023.Level of evidenceLevel III; Retrospective cohort study.

Nurses’ attıtudes to the cleanıng of pulse oxımeter probes

Purpose: This study aims to determine nurses'attitudes toward cleaning pulse oximetry probes inTurkey.Materials and Methods: This research was carriedout descriptively between January and May 2023.This study was conducted with 319 nurses with 93%power. The questionnaire consists of 12 questionsabout the participants' demographic characteristicsand attitudes toward cleaning the saturation devices.Results: All nurses (n=319) stated that saturationdevices should be cleaned. It was found that 91.5%(n=292) of the nurses stated that saturation deviceswere a source of infection for healthcare workers,and 95.3% (n=304) stated that they were one of the causes of hospital infections. It was stated that 27.0%of the nurses (n=86) performed saturation cleaningseveral times a month, and 51.1% (n=163) stated thatthe substances they used to clean the saturationdevices were insufficient.Conclusions: It is seen that the nurses highly agreethat the saturation devices should be cleaned and thatit is a source of infection for patients and staff.However, despite this, it is seen that the frequency ofcleaning the saturation device is low, and there arequite different cleaning frequencies from each other.

Relevance and antimicrobial resistance profile of Klebsiella pneumoniae in neonatal sepsis

Background Newborns are particularly susceptible to infection in hospitals, with neonatal sepsis being the most common infection symptom and the third leading cause of neonatal death. Klebsiella pneumoniae is a gram-negative bacterium of Enterobacteriaceae, which is a common pathogen of neonatal septicemia. In this study, we will analyze and evaluate the current status, clinical characteristics, and drug resistance of Klebsiella pneumoniaesepsis infection in Neonatal Intensive Care Unit (NICU), with the aim of providing effective basis for timely and accurate clinical diagnosis and treatment in clinical practice. Methods Statistical analysis was performed on 75 cases of Enterobacteriaceae septicemia in infants admitted to NICU in a special obstetrics and gynecology hospital in Shanghai from January 2020 to June 2022. Based on bacterial identification, isolates were divided into the Klebsiella pneumoniae (KP) group (n = 49) and the non-KP Enterobacteriaceae group (n = 26). The infection, clinical characteristics, and bacterial resistance of the two groups of infected patients were compared. Results Comparing the clinical characteristics of the two groups, the results showed that most of the subjects in the KP and non-KP groups were premature infants, accounting for 100% and 92.3% of subjects, respectively; late onset was the main disease in both groups, accounting for 93.9% and 80.8% of subjects, respectively. All patients received Peripherally Inserted Central Catheter(PICC). The levels of pro calcitonin and CRP (C-reactive protein) were significantly higher in the KP group compared with those in the non-KP group (p < .05). At the same time, the incidence of thrombocytopenia in the KP group was significantly higher than that in the non-KP group (p < .05). The proportion of antimicrobial drug exposure in the KP group is higher than that in the non-KP group. The drug resistance of the KP group to ceftazidime, ceftriaxone, cefepime, ampicillin/sulbactam, aztreonam, ciprofloxacin and compound sulfamethoxazole was significantly higher than that of the non-KP group, whereas the drug resistance rate to cefotetan, gentamycin and to bramycin was significantly lower than that of the non-KP group, Statistically significant differences (p < .05). 38 cases of Klebsiella pneumoniae producing ESBLs were tested for related resistance genes. The results showed that the main resistance types were SHV and TEM, with detection rates of 60.6% and 28.9%. Conclusions This study shows that neonatal sepsis caused by Klebsiella pneumoniae infection has a high incidence and drug resistance in premature and low birth weight infants, and has become a serious public health problem; Clinicians should pay attention to differential diagnosis, Reasonable selection of antibiotics to reduce the generation of drug-resistant bacteria.

Examining the Frequency of Carbapenem Resistance Genes and Its Relationship with Different Classes of Integrons Including Classes I and II in Pseudomonas aeruginosa Isolates of Burn Patients

Background: Pseudomonas aeruginosa is one of the most important opportunistic pathogens causing hospital infections. Objectives: This study aimed to investigate the abundance of integrons and the pattern of resistance to carbapenems (metallo-β-lactamases including Spm, Imp, and Vim) and its relationship with the presence of integrons classes I and II in P. aeruginosa isolates. Methods: This study was conducted on 73 samples of P. aeruginosa isolated from burn wounds of patients admitted to the burn center of Velayat Hospital, Rasht, Iran. To confirm the phenotype of P. aeruginosa, Gram staining and diagnostic biochemical tests, including oxidation-fermentation (OF), pigment production, citrate utilization, catalase activity, oxidase test, and growth at 42°C, were used. After identification and confirmation, molecular diagnosis was conducted to identify strains producing genes classes I and II using the polymerase chain reaction (PCR) method. Results: In this research, the frequency of carbapenem resistance genes in clinical isolates of P. aeruginosa was found to be zero, 13.7%, and 21.9% for blaSpm, blaImp, and blaVim genes, respectively. Integrons of classes I and II were present in 53.4% of isolates of class I and 17.8% of isolates of class II. Also, 4.1% of the total integrin-positive isolates had both integron classes. Conclusions: There was a statistically significant relationship between class I integron and the blaImp gene. Importantly, the mechanisms of other integrons play a role in the development of resistance and the presence of these genes involved in this project.

COVID-19 outcomes in patients with pre-existing cardiovascular disease and risk factors: perspectives from a hospital in Ireland

Background/Aims COVID-19 has led to substantial changes in the provision of emergency healthcare services. International data suggest that COVID-19 is associated with increased morbidity and mortality in patients with pre-existing cardiovascular disease and cardiovascular risk factors. This study aimed to explore the association between pre-existing cardiovascular disease and/or cardiovascular risk factors and COVID-19 disease severity and outcomes in an Irish hospital. Methods This retrospective study obtained data from a bioresource database of patients with confirmed COVID-19 infection (n=649) in a large hospital in Dublin. Data were collected on patients' demographic characteristics, cardiovascular diseases, cardiovascular disease risk factors and medications taken for cardiovascular conditions. The World Health Organization progression scale was used to assess the severity of COVID-19 infection in each patient. Cross-tabulation analysis was used to analyse associations between variables, with a P value of ≤0.05 indicating significance. Results Mortality rates were six times greater in patients with cardiovascular disease compared to those without cardiovascular disease (18.6% vs 3.1%). A higher percentage of patients with one or more cardiovascular risk factors had moderate (53.4%) or severe (19.1%) COVID-19 and higher mortality rates (10.7%) than those without cardiovascular risk factors. Of the patients who died from COVID-19 (n=40), 60.0% (n=24) had one or more cardiovascular diseases, while 80.0% (n=32) had one or more cardiovascular risk factors. Conclusions Existing cardiovascular disease and cardiovascular risk factors increase the risk of more severe disease and worse clinical outcomes in patients with COVID-19. Many cardiovascular risk factors are modifiable, so it is important to consider preventative education strategies designed to reduce modifiable risk factors to improve outcomes for patients with COVID-19.

Investigation of hospital-acquired infections prevalence and analysis of influencing factors: a case study of a specialized infectious disease hospital in Chongqing, 2017-2023.

This study aimed to investigate the prevalence of hospital-acquired infections (HAIs) and their main influencing factors in a specialized infectious disease hospital in Chongqing from 2017 to 2023, providing reference for the formulation of precise infection control measures. A retrospective cross-sectional survey method was employed, combining bedside investigations with medical record reviews. Surveys were conducted on all hospitalized patients on a certain day of the last week of October each year from 2017 to 2023. Data collected included patients' basic information, diagnosis, and hospital infection status. Statistical analysis, including retrospective case-control and multivariable logistic regression analysis, was performed to identify the risk factors for hospital infections. The investigation compliance rate for the prevalence of HAIs in the specialized infectious disease hospital in Chongqing from 2017 to 2023 was greater than 96% each year. The prevalence rate of HAIs ranged from 0.89 to 2.52%. Hospital infection departments were mainly concentrated in general internal medicine, tuberculosis, and HIV/AIDS departments, accounting for 31.25, 26.25, and 23.75%, respectively. The most common infection site was the lower respiratory tract (54.22%), followed by bloodstream and urinary tract infections, each accounting for 9.64%. The predominant pathogens of hospital infections were Klebsiella pneumoniae and fungi. The utilization rate of antimicrobial drugs ranged from 20.75 to 33.25%, primarily for monotherapy. The rate of pathogen testing for therapeutic antimicrobial drug use was 82.84%, meeting national requirements. Multivariable logistic regression analysis revealed that the use of antibiotic (OR = 7.46, 95%CI 2.54-21.89, p < 0.001) and the presence of cardiovascular diseases (OR = 26.69, 95%CI 6.69-106.54, p < 0.001) increased the risk of HAIs. The prevalence of HAIs in specialized infectious disease hospitals remains stable, primarily concentrated in departments such as general internal medicine, tuberculosis, and HIV/AIDS. The lower respiratory tract is the main infection site, and comorbid cardiovascular diseases and antibiotic use are risk factors for HAIs. Therefore, to reduce the risk of hospital infections, it is necessary to strengthen the daily monitoring of key departments and the care of key patients. Further implementation of precise and effective infection control measures, including rational antibiotic use, regular infection monitoring and pathogen culture is warranted.

After-action Review of Hospital Environments Exploring the ‘New Normal,’ Focusing on Structural Management Aspects and Bacterial Culture in Thai Hospitals Amid the COVID-19 Pandemic

OBJECTIVE This study aimed to explore the management of hospital environments during the COVID-19 pandemic, focusing on the structural aspects of ‘new normal’ health services delivery practices and bacterial culture in hospital rooms. METHODS This study employed a cross-sectional design that involved the evaluation of hospital environment management, the detection of indoor bacterial colonies in hospitals, and interviews with healthcare administrators on the ‘new normal’ measures. RESULTS The evaluation form was completed by 543 healthcare division heads from 30 hospitals. Respondents in each group reported that hospitals where they worked had effectively implemented new normal measures, making changes to the structure, processes, and personnel management components in line with the ‘new normal’ concept. The majority of the hospitals investigated, accounting for 71.7%, were found to have pathogenic bacterial counts lower than the permissible limits. The statistical analysis identified a significant association between ventilation, structural management under the ‘new normal’, and bacterial counts (p &lt; 0.05). CONCLUSIONS The incorporation of the structural aspects of new normal practices for managing the workplace environment should be a routine and integral part of efforts to control healthcare-associated infections in hospitals. KEYWORDS hospital environment, the new normal, COVID-19, bacterial culture