Cases Of Nosocomial Infection Research Articles

Measles immunity in medical workers in Kazan

BACKGROUND: The epidemiological situation with measles remains unstable, with periodic increases in morbidity. In the Russian Federation, as well as in other countries, cases of nosocomial infection continue to be registered. Medical workers may be involved in the epidemic process and serve, among other things, as a source of infection for patients.
 AIMS: assessment of postvaccinal immunity to measles in medical workers in Kazan during its elimination period.
 MATERIALS AND METHODS: A cross-sectional study of immunity to measles was conducted in 515 employees of medical institutions in Kazan. 376 medical staff had documented ever-evidence of immunization against measles. Measles class G immunoglobulin levels were determined, specific immunity strength was assessed as a function of age, and time since the last vaccine dose was administered. Relative values (fractions, %) and standard error of the fraction (%) were calculated. A correlation analysis was performed.
 RESULTS: The proportion of seropositive medical workers was 81% (95% CI 79.382.7) of all those examined. Those over 50 years of age were the most protected: antibodies were detected in 90.3% (95% CI 85.9694.64) of them. Among the 417 persons with antibodies low level was detected in 60.9% (95% CI 56.1265.68), medium level ― in 34.5% (95% CI 29.8439.16), high level ― only in 4.6% (95% CI 2.546.66) of the examined persons. In all age groups, the share of persons with low levels of protective antibodies was the highest. High level of protective antibodies was registered only in the age groups 4049 years and 50 years and older ― 4.8% (95% CI 0.988.62) and 7% (95% CI 3.2610.74), respectively. Antibody levels correlated inversely with time since vaccination (p 0.05).
 CONCLUSIONS: The results of serologic study of health workers demonstrate insufficient protection of health workers against measles, especially in younger groups. Decreased immunity in vaccinated health workers 10 or more years after immunization necessitates the monitoring of antibody levels in this group and consideration of revaccination.

Lassa fever. Part 1. Etiology, epidemiology and clinical manifestations

Lassa fever is a natural focal disease dangerous for humans. In the larger part of sub-Saharan West Africa 37.7 million people in 14 countries live in areas where living conditions are suitable for zoonotic transmission of the virus from secretions of infected rodents of the species Mastomys natalensis. Routes of transmission can be via alimentary, airborne dust or airborne droplet pathways in case of accidental human contact with secretions of infected rodents. Mastomys natalensis penetrates into residence and place of storage of food and drinking water. In addition, the residents use such animals for food, so infection is also possible upon butchering carcasses. The etiological agent of this disease is the Lassa virus being one of the members of the Arenaviridae family. Unlike other arenavirus infections (e.g., Argentine and Bolivian fevers caused by Junin viruses and Machupo, respectively), human infection with Lassa virus can also occur from person to person. Cases of nosocomial infection among patients in conditions of poor hygiene and through contaminated medical equipment are described. Medical workers become infected during surgical operations or through contact with patients, because the pathogen can be transmitted via blood, saliva, vomiting, stool or urine. In endemic territories, Lassa fever is associated with significant morbidity, because 500 thousand clinical cases and due to 5 to 10 thousand fatal outcomes of this disease are registered annually (i.e. 12% mortality). The likelihood that this disease will become a more widespread threat worldwide may be associated with increased globalization as well as climate change leading to the expansion of the Lassa fever endemic zone into regions suitable for the settlement of M. natalensis and other rodent species capable of lifelong pathogen carriage. Among hospitalized persons with severe hemorrhagic symptoms, the mortality rate can be very high ranging from 14 to 89.5%. But in the majority of cases, the disease proceeds asymptomatically, and due to its long-term incubation period all ill subjects may be a source of infection, especially travelling at long distance by plane or train. Clinically evident disease occurs in the form of various nonspecific symptoms from malaise, fever, sore throat and chest, cough, myalgia and gastrointestinal disorders to signs of central nervous system disorders. The diagnosis of Lassa fever is often difficult due to the similarity of its course with other viral diseases common in Africa or malaria or typhoid fever. More specific symptoms for Lassa fever are revealed as conjunctivitis, hepatitis, pharyngitis, tonsillitis as well as developing oropharyngeal ulcers. Severe disease is complicated by abnormal bleeding, generalized edema, respiratory failure, hypotension, proteinuria, transaminitis, encephalopathy. Deafness develops in about 20% of cases. Multiple organ failure and open bleeding lead to death. The review is devoted to analyzing publications on the etiology, epidemiology and clinical picture of Lassa fever due to a threat of its importation with sick subjects to the territory of the Russian Federation.

The Prevalence of Nosocomial Infections and Related Microbial Agents Based on the NNIS System in Sabzevar During 2011-2015

Background: Nosocomial infection is an infection that hospitalized patients get while receiving health care. This study aimed to determine the prevalence and factors involved in the incidence of nosocomial infections, related microbial agents, and antibiotic resistance profiles. Methods: This cross-sectional study was conducted on 390 patients with nosocomial infection admitted to Shahid Beheshti Hospital in Sabzevar from 2011 to 2015. The acquired data were assessed by the standard checklist of the National Nosocomial Infections Surveillance (NNIS) system of the Ministry of Health. The collected data were analyzed using the Stata 12 software. Results: Of the 41979 admitted patients during the mentioned period, 390 patients with an average age of 48.08 years suffered from a hospital-acquired infection. The prevalence of nosocomial infections was 1% with the highest rate related to the respiratory tract in men and surgical sites in women. Intravenous catheters, surgical wounds, urinary catheters, suction, ventilator, tracheotomy, and tracheostomy were the most commonly encountered factors (invasive measures) of nosocomial infection, respectively. The most prevalent causes of nosocomial infections were Klebsiella, Staphylococcus aureus, and Acinetobacter. Conclusions: Based on our findings, several factors play a pivotal role in preventing hospital-associated infections, including proper follow-up and timely reporting of nosocomial infection cases. The other influential factors were accurate identification of microorganisms involved, allocation of sufficient funds to provide appropriate facilities for infection prevention, the appropriate and timely medical interventions, and the rational use of antibiotics.

Clinical characteristics and outcome analysis of COVID-19 patients with pulmonary tuberculosis

Coronavirus disease (COVID-19) and tuberculosis (TB) are two respiratory infectious diseases with a high incidence of transmission, mainly via respiratory droplets and both can weaken the immune system and lower the number of CD4+T cells in patients. COVID-19 can occur before, at the same time or after the diagnosis of TB. Patients with pulmonary TB are more likely to have co-infection when they have a history of epidemiological exposure to COVID-19. At present, many cases of nosocomial infection of COVID-19 caused by ineffective prevention and control measures in tuberculosis hospitals have been reported successively at domestic and overseas. Therefore, it is urgent to strengthen the prevention and control of nosocomial infections in tuberculosis hospitals. The superposition of the two diseases can lead to a worsening prognosis, aggravating the patient's condition and making treatment more difficult. In addition, in the context of the new coronavirus epidemic, early recognition of co-infection with new coronavirus should be made when TB patients in chest hospitals present with symptoms such as aggregated fever or progressive disease. At the same time, we should focus on identifying the clinical and imaging manifestations of TB and COVID-19 co-infection. At present, research on COVID-19 complicated with pulmonary TB is scarce, and there are disputes on many aspects. As a country with a high prevalence of tuberculosis, it is of great practical significance to identify the clinical characteristics, outcomes, and treatment of the two infectious diseases in China.

Complete Genome Sequences of 24 Strains of Bacillus cereus Isolated from Nosocomial Infection and Bacteremia Cases in Japan.

ABSTRACTBacillus cereus is mainly associated with foodborne illness but sometimes causes nosocomial infections. We previously reported that B. cereus strains of a specific sequence type, ST1420, were associated with nosocomial infection. Here, we determined the complete genome sequences of B. cereus strains isolated from nosocomial infection cases in Japanese hospitals.

Multiresistance and endemic status of Corynebacterium striatum associated with nosocomial infections: a critical situation in Intensive Care Units and varied wards of a tertiary care hospital, Rio de Janeiro metropolitan area, Brazil

Nowadays, Corynebacterium striatum has been reported asetiologic agent of mild to severe hospital-acquired infections,including patients undergoing endotracheal intubation withfatal outcome. A continuous survey of infections due multidrug-resistant (MDR) C. striatum in South American countriesremains necessary. This retrospective and prospective studyaimed to analyze clinical-microbiological features of C. striatumclinical isolates from patients attended at a Braziliantertiary care hospital, during a nine-year period. C. striatumstrains (n=130) were isolated from infected patients attended attwenty nosocomial wards, mainly of tracheal aspirate (n=53)and blood and/or intravenous catheter (n=21/n=13). Notably,original cases of nosocomial infections due to C. striatum wereverified in children making use of invasive devices, includingone fatal neonatal case, in addition to a fatal respiratoryinfection in patient with cystic fibrosis, as well as urinarytract infections of kidney transplant recipients. Most of C.striatum strains expressed MDR profiles (88.46%). Emergenceof vancomycin (1.90%) and linezolid (7.41%) resistance wasverified among MDR and non-MDR-strains. In conclusion,endemic condition with wide dissemination among hospitalwards of varied types of infections due to MDR and non-MDRC. striatum strains expressing heterogenic virulence potentialand genetic features may occur in hospital units.

Management and Prevention of Nosocomial Urinary Tract Infections

BACKGROUND: Nosocomial infections are the leading cause of mortality, due to acquired nosocomial infections. Nosocomial urinary tract infections occur during or after hospitalization in patients who did not have an incubation phase of the infection at the time of admission to the hospital. AIM: In this study, we aim to define and manage nosocomial urinary tract infections in intensive care at University Hospital Center “Mother Teresa” Tirana. MATERIALS AND METHODS: 1350 patients were included in the study, of which 115 patients resulted in nosocomial nosocomial infections. The mean age of patients was 62 ± 16.6 years. RESULTS: Out of 1350 patients hospitalized in the Intensive Care during the period October 2019 - December 2020, 4% of patients result in urinary tract infections or 45% of the total for 115 cases of nosocomial infections. We see that men have a higher percentage than women of being affected by urinary tract infections, it is significant (p < 0.001). The etiological cause of nosocomial urinary tract infections was Escherichia coli in 61.5% of cases. For nosocomial urinary tract infections, patients are monitored for fever, examination of urine complete, and uroculture. The mean hospital stay for patients without nosocomial infection of the urinary tract was 4 days, while that of those with urinary tract infection was 18.49 ± 27.68 (from 5 to 180 days). In comparison to the mean mentioned above, it is significant (p < 0.0001). CONCLUSIONS: Nosocomial urinary tract infections are common in patients admitted to intensive care. Key recommendations should be given on diagnostic strategies, testing, selection of antibiotics as well as duration of treatment. We also need to collect data on how to prevent nosocomial infections in general and nosocomial urinary tract infections in particular.

Aetiological Agents in Neonatal Nosocomial Sepsis and their Sensitivity Pattern from a Tertiary Care Hospital, Odisha, India: A Cross-sectional Study

Introduction: Nosocomial infections are a major problem for hospitalised neonates due to increase in morbidity, mortality, duration of hospitalisation and costs of treatment. The magnitude of this problem varies from place to place and is unique to each place as per the organisms and their resistance pattern is concerned. There is need to develop local level surveillance data on incidence of nosocomial sepsis, causative organisms, their sensitivity pattern and periodically review antibiotic policy based on this information. Aim: To determine the aetiological agents of nosocomial sepsis and their antibiotic sensitivity and resistance pattern. Materials and Methods: This was a cross-sectional study in which the cases of nosocomial infections in neonates of > 35 weeks were studied from November 2018-October 2019 at Sriram Chandra Bhanja Medical College and Hospital (S.C.B.M.C.H) and Sardar Vallabh Bhai Patel Postgraduate Institute of Paediatrics (S.V.P.P.G.I.P) based on clinical findings, sepsis screen and blood culture. Blood culture is considered as gold standard for diagnosis of sepsis. Blood sample (1 mL) was collected under strict asepsis in Becton Dickinson and Company (BACTEC) and was sent for performing blood culture. The data was processed and arranged into distribution tables and cross tables using Statistical Package for the Social Sciences (SPSS) version 21.0. Results: Out of total 100 suspected cases of nosocomial sepsis, blood culture was positive in 46 (46%) of cases. Candida spp. was the most common obtained organism 9 (19.5%) followed by Klebsiella pneumoniae 8 (17.3%) and Staphylococcus aureus 8 (17.3%) each respectively. There was increased incidence of bacterial resistance to commonly used antibiotics and combinations of it, like ampicillin, gentamicin, cefotaxime, amikacin and piperacillin+ tazobactam among these bacterial isolates. Among the possible new combinations deduced from the observation, the combination of vancomycin+amikacin had sensitivity of 67.6% and can be considered as initial antibiotic combination of choice while combination with colistin and tigecycline should be reserved only for culture proven resistant cases or babies who continue to be deteriorating and critically sick while on previous combination. Conclusion: Candida spp. is the leading cause of nosocomial sepsis. Among bacterial organisms, Klebsiella pneumoniae and Staphylococcus aureus are most common. Most isolates are resistant to traditional antibiotics, hence new combination like vancomycin+amikacin are more appropriate empiric choice in present context and combination with colistin and tigecycline are reserved only for culture proven resistant sepsis.

Ebola virus disease nosocomial infections in the Democratic Republic of the Congo: a descriptive study of cases during the 2018–2020 outbreak

To describe the characteristics of nosocomial cases of Ebola virus disease (EVD) in the Democratic Republic of the Congo between July 2018 and May 2020 in order to inform future interventions. Nosocomial cases of EVD were identified during outbreak response surveillance, and a retrospective analysis of cases was conducted according to demographic characteristics and type of health facility (HF). Of 3481 cases of EVD, 579 (16.6%) were nosocomial. Of these, 332 cases occurred in women (57.3%). Patients and visitors accounted for 419 cases (72.4%), of which 79 (18.9%) were aged 6-≤18years and 108 (25.8%) were aged ≤5years. Health workers (HWs) accounted for the remaining 160 (27.6%) nosocomial cases. The case fatality rate (CFR) for HWs (66/160, 41.3%) was significantly lower than the CFR for patients and visitors (292/419, 69.7%) (P<0.001). The CFR was higher among cases aged 6-≤18years (54/79, 68.4%) and ≤5years (89/108, 82.4%). Referral HFs (>39beds) had the highest prevalence of nosocomial EVD (148/579, 25.6%). Among HFs with at least one case of nosocomial infection, 50.0% (98/196) were privately owned. Nurses and traditional healers should be targeted for infection prevention and control training, and supportive supervision should be provided to HFs to mitigate EVD transmission.

Molecular Confirmation of Vancomycin-Resistant Staphylococcus aureus with vanA Gene from a Hospital in Kathmandu.

Staphylococcus aureus, a commensal on the skin and in the nasal cavity of humans, is one of the most serious cases of nosocomial infections. Moreover, methicillin-resistant S. aureus (MRSA) is a leading cause of morbidity and mortality worldwide. For the treatment of MRSA infections, vancomycin is considered as a drug of choice. However, the emergence of vancomycin resistance among MRSA isolates has been perceived as a formidable threat in therapeutic management. To estimate the rate of vancomycin-resistant S. aureus (VRSA) and to detect the vancomycin-resistant genes, namely, vanA and vanB, among the isolates, a hospital-based cross-sectional study was conducted from July to December 2018 in Annapurna Neurological Institute and Allied Science, Kathmandu, Nepal. S. aureus was isolated and identified from different clinical samples and processed for antibiotic susceptibility testing by the modified Kirby–Bauer disc diffusion method. The screening of MRSA was performed as per Clinical and Laboratory Standard Institute (CLSI) guidelines. VRSA was confirmed by the minimum inhibitory concentration (MIC) method by employing E-test strips. All the phenotypically confirmed VRSA were further processed to detect the vanA and vanB gene by using the conventional polymerase chain reaction (PCR) method. A total of 74 (20.3%) S. aureus were isolated, and the highest percentage of S. aureus was from the wound samples (36.5%). Of 74 S. aureus isolates, the highest number (89.2%) was resistant to penicillin, and on the other hand, linezolid was found to be an effective drug. Likewise, 45 (60.81%) were found to be MRSA, five (11.11%) were VRSA, and 93.2% of S. aureus isolates showed an MAR index greater than 0.2. Two VRSA isolates (40%) were positive for the vanA gene. The higher prevalence of MRSA and significant rate of VRSA in this study recommend routine surveillance for the MRSA and VRSA in hospital settings before empirical therapy.

Real-Time Recombinase Polymerase Amplification (RPA) Detection of Pseudomonas aeruginosa Using Magnetic Nano-Beads for DNA Extraction

Pseudomonas aeruginosa (P. aeruginosa) is a ubiquitous nonfermentative gram-negative bacillus, residing in nature widely as a conditional pathogen that is commonly isolated from nosocomial infection cases, having a larger genome (5.5–7 Mbp). P. aeruginosa possesses great environmental adaptability and higher mutation rates, which accounts for its ability to resist antibiotics. Furthermore, multi-antibiotics-resistant P. aeruginosa has recently been established to be responsible for increased nosocomial infection incidence. Therefore, to detect, diagnose, and treat this life-threatening infection early enough, we introduced a real-time recombinase polymerase amplification (RPA) method of rapid P. aeruginosa detection, which is time-saving, convenient, highly sensitive, and more specific than the traditional bacterial culture method. System effectiveness and efficiency were then determined by a series of experiments, where specific RPA primers and probes accurately distinguished P. aeruginosa from other common pathogenic bacteria with optimal RPA reaction procedures set at 39 °C for 20 min. Additionally, specific primers and probes were designed based on the oprF gene sequence of P. aeruginosa. Subsequently, a real-time RPA system was used to analyze 20 cases of different clinical samples for P. aeruginosa detection in blood, open wound swab, and sputum. Results indicated that this system was suitable for bacterial analysis of common clinical sample types. The DNA extraction method used in this study was based on the magnetic beads method. In conclusion, this study established that the real-time RPA system was a rapid, specific, and sensitive method for clinical P. aeruginosa detection, which can be integrated into automatic high-throughput detection machines.

Réflexions d’un médecin expert et d’un juriste autour d’un exercice pratique de droit médical

We offer a reflection around a clinical case of nosocomial infection allowing us to address the difficulties faced by experts and lawyers and other jurists in matters of medical liability. This case is the result of an exercise proposed within the framework of the national DIU (interuniversity diploma) in medical accidents for which the two authors are responsible in Amiens and Bordeaux. The writing was enriched with the responses of the students. This clinical case makes it possible to approach the compensation for nosocomial infections, to compare the amicable procedure before the conciliation and compensation commission for medical accidents and the procedure before a judicial or administrative jurisdiction. Finally, the reflection focuses on patient information, especially protected adult, and access to the medical file. It is not a question here of detailing the medical care but of discussing medical responsibility and the rights of the patients.

Factors associated with nosocomial urinary tract infections in maternity wards of public hospitals in Lubumbashi in DR Congo

Introduction: Nosocomial urinary tract infection represents between 30 and 50% of all these nosocomial infections. It occupies the first place and constitutes the third entry point for bacteremia. The objective of our study was to identify the risk factors associated with nosocomial urinary tract infections in maternity wards of public hospitals in Lubumbashi. Method: We carried out an analytical cross-sectional study in which the population consisted of parturients who did not have a urinary tract infection on admission. The urine samples were taken and analyzed in the laboratory of the university clinics of Lubumbashi. A case of nosocomial urinary tract infection was defined according to the WHO definition. To collect this urine, the parturients did it themselves after a health education session. Two samples were taken, one at the entry and the other at the exit of the parturient from the maternity hospital. The univariate analysis used the prevalence ratio as an indicator of risk with a 95% confidence interval and the bivariate analysis included all risk factors that had a significance level p ˂ 0.05 by a regression model binary logistics. Results: Out of the total of 1240 parturients selected and who were distributed in seven maternities of public hospitals in the city of Lubumbashi. It was noted that women who gave birth at HGR Kampemba were up to ten times more likely to develop nosocomial urinary tract infection than those who did at HGR Kisanga. An association was observed between delivery with complications (p = 0.032), long length of stay (p &lt;0.001), delivery with surgical intervention (p &lt;0.001) and antibiotic therapy (p = 0.020). Conclusion: Nosocomial urinary tract infections were varied depending on the characteristics of health structures, characteristics of parturients and health care. It is necessary to improve the hospital hygiene of the personnel, the hospital environment and the materials as well as a good policy of use of the antibacterials.

Thoracic surgery and COVID-19: changes and managements during the pandemic.

BackgroundSeveral articles have been published about the reorganization of surgical activity during the coronavirus disease 2019 (COVID-19) pandemic but little is known about the operative volume, distribution of cases, or capacity of The Department of Thoracic Surgery to deliver surgical services in the time of COVID-19.MethodsA retrospective operative logbook review was completed in department of thoracic in a designated COVID-19 hospital. We reviewed and analyzed the operative logbook and discussed our countermeasures during the outbreak. A prediction model was established to discuss the time consuming about delayed surgeries during the pandemic.ResultsOne thousand two hundred and seventy-five operation records were collected. The thoracic surgeries of this year has decreased (43.4%) during the Wuhan lockdown. From Jan 23rd to Apr 8th in 2020, there were 461 surgeries performed in The Department of Thoracic in our hospital with 0 cases of nosocomial COVID-19 infection. Prediction model showed that it will take 6 weeks to solve the backlog if department can reach the 85% of maximum of operations per week.ConclusionsAn understanding of operative case volume and distribution is essential in facilitating targeted interventions to strengthen surgical capacity in the time of COVID-19. A proper guideline is imperative to ensure access to safe, timely surgical care. By developing a scientific and effective management of hospital, it is possible to ensure optimal surgical safety during this crisis. Regular updates and a further study include multicenter is required.Clinical trial registry numberChiCTR2000034346.

Importance of Preoperative Screening Strategies for Coronavirus Disease 2019 in Patients Undergoing Cesarean Sections: A Retrospective, Large Single-Center, Observational Cohort Study.

During the coronavirus disease 2019 (COVID-19) pandemic, many guidelines have recommended postponing non-emergency operations. However, cesarean sections cannot be indefinitely delayed. Our institution has established a COVID-19 screening strategy for patients undergoing cesarean section. We evaluated the usefulness of this screening strategy. Parturients undergoing cesarean section at our center during the first peak of the COVID-19 outbreak were retrospectively analyzed. Each parturient underwent a questionnaire survey evaluating epidemiological correlation and symptoms at admission. Reverse transcriptase–polymerase chain reaction (RT–PCR) testing and/or chest radiography were performed. In total, 296 parturients underwent cesarean section. All elective and 37 emergency cesarean sections were performed in general operating rooms because they were considered to have a low risk of COVID-19 infection through the screening process. However, 42 emergency cases were performed in negative-pressure operating rooms with full personal protective equipment (PPE) because the RT–PCR results could not be confirmed in a timely manner. None of them were positive for RT–PCR, and there were no cases of nosocomial infection. A comprehensive preoperative screening strategy, including symptomatic and epidemiological correlation, PCR, and/or imaging test, should be performed in patients undergoing cesarian section. Further, cesarean sections in parturients with unconfirmed COVID-19 status should be performed in a negative-pressure operating room with appropriate PPE.

Natural-Focal Viral Fevers in the South of the European Part of Russia. Crimean-Congo Hemorrhagic Fever

Objective of the study was to determine the modern epidemiological peculiarities of Crimean-Congo hemorrhagic fever in the south of the Russian Federation.Materials and methods. Data of statistical documentation (epidemiological survey of the infectious disease focus, annual summary reports dated 2010–2019) and epizootiologic monitoring data submitted by the Rospotrebnadzor Administrations and the Centers of Hygiene and Epidemiology in the constituent entities of the Southern and the North Caucasian Federal Districts were used. Descriptive, genetic, analytical methods and retrospective epidemiological analysis were applied.Results and discussion. The СCHF natural focus in the European south of Russia has an area of 815 thousand square kilometers and it is characterized by persistence, expansion of the territory, and circulation of CCHF virus European genotypes. CCHF virus genetic variants form the local overlapping populations. Over the period of 2010–2019 997 CCHF cases were registered. Moderate forms of the disease clinically prevailed (74.2 per cent). Hemorrhagic symptoms were noted in 29.3 % of patients. The lethal outcome of the disease was registered in 31 CCHF patients (3 %). Two cases of nosocomial infection were identified, nine health workers were infected by CCHF pathogen. The expansion of epizootically active territory of the CCHF natural focus is associated with the expansion of the Hyalomma marginatum ticks area northward due to the aridization of the steppes, in part because of global climate change. The stability of the CCHF virus population was noted. The epidemic core of the CCHF natural focus remains on the adjacent territory of the Rostov Region, Stavropol Territory and the Republic of Kalmykia. The higher efficiency of CCHF prevention measures on the territory of the core is stemming from the targetness and intensity of measures, contributing to the early seeking of medical care by patients, their early hospitalization which in its turn influenced the development of clinical manifestations and outcome of the disease, and also made it possible to minimize the CCHF nosocomial infections number, including those among the medical personnel.

Surveillance of the infection prevention and control practices of healthcare workers by an infection control surveillance-working group and a team of infection control coordinators during the COVID-19 pandemic

BackgroundDuring the ongoing coronavirus disease (COVID-19) pandemic, hospitals have strengthened their guidelines on infection prevention and control (IPC), and a rigorous adherence to these guidelines is crucial. An infection control surveillance-working group (ICS-WG) and infection control coordinators (ICCs) team were created to monitor the IPC practices of the healthcare workers (HCWs) in a regional hospital in Korea. This study analyzed the surveillance results and aimed to identify what IPC practices needed improvement. MethodsDuring phase 1 (March to April 2020), the ICS-WG performed random audits, recorded incidences of improper IPC practices, and provided advice to the violators. During phase 2 (April to July), the ICCs inspected the hospital units and proposed practical ideas about IPC. The surveillance and proposals targeted the following practices: patient screening, usage of personal protective equipment (PPE), hand and respiratory hygiene, equipment reprocessing, environmental cleaning, management of medical waste, and social distancing. ResultsIn phase 1, of the 127 violations observed, most (32.3%) corresponded to hand and respiratory hygiene. In phase 2, the highest proportion of violation per category was observed in the management of medical waste (37.8%); among these, a higher proportion of violation (71.4%) was observed in the collection of medical waste. Of the 106 proposals made by the ICCs, the most addressed practice was patient screening (28.3%). No case of nosocomial infection was reported during the study period. ConclusionAdherence to proper hand and respiratory hygiene was inadequate at the early stage of the COVID-19 pandemic. The results indicate that more attention and further training are needed for the management of medical waste, particularly medical waste collection, and that continuous upgrading of the strategies for patient screening is essential. These results will be useful in helping other healthcare facilities to establish their IPC strategies.

Bacterial contamination of neonatal intensive care units: How safe are the neonates?

BackgroundIntensive care units (ICU) are essential healthcare facility for life threatening conditions. Bacterial contamination of objects/instruments in ICU is an important source of nosocomial infections. This study is aimed to determine the level of bacterial contamination of instruments/objects which are commonly touched by healthcare workers and frequently come in contact with the neonates.MethodsThis hospital based prospective study was conducted in neonatal intensive care unit (NICU) of Manipal Teaching Hospital, Pokhara, Nepal. A total of 146 samples collected from surfaces of incubators, radiant warmers, suction tips, ventilators, stethoscopes, door handles, weighing machines, mothers’ beds, phototherapy beds, laryngoscope, telephone sets, blood pressure machine, etc. formed the material of the study. Isolation, identification and antibiotic susceptibility of the bacterial isolates was performed by standard techniques. Blood culture isolates from NICU patients during the study period were compared with the environmental isolates.ResultsOut of 146 samples, bacterial growth was observed in 109. A total of 119 bacterial isolates were retrieved from 109 samples. Three common potential pathogens isolated were Escherichia coli (n = 27), Klebsiella species (n = 21) and Staphylococcus aureus (n = 18). Majority of E. coli and Klebsiella isolates were from incubators, suction tips and mothers’ beds. Majority of S. aureus isolates were cultured from radiant warmers. Among S. aureus isolates, 33.3% (6/18) were methicillin resistant. Majority of the bacterial isolates were susceptible to gentamicin and amikacin. Common potential pathogens isolated from blood culture of NICU patients were S. aureus and Klebsiella species.ConclusionHigh degree of bacterial contamination of objects/instruments in NICU was recorded. Isolation of potential pathogens like E. coli, Klebsiella species and S. aureus is a major threat of nosocomial infections. Blood culture data of NICU reflects possibility of nosocomial infections from contaminated sites. Gentamicin and amikacin may be used for empirical therapy in suspected cases of nosocomial infections in NICU.

Effects of post-deposition heat treatment on nanostructured TiO2-C composite structure and antimicrobial properties

The growth of cases of nosocomial infections is an urgent issue in health care facilities. Reducing cross-contamination from high-frequency touch surfaces is a key area of interest. Robust TiO2 coatings on touch surfaces could reduce pathogen viability if the material could be modified to increase photocatalytic activity (PCA) under visible light. Research has focused on increasing the bandgap by use of dopants and rutile-anatase heterojunctions, using nanoparticles to increase active surface area, and sensitizing TiO2 with carbon. We have previously reported 11 μm thickness nanostructured anatase and rutile mixed phase TiO2 and carbon composite coatings (NsARC) which are antimicrobial under visible light. Here we investigate the role of the co-deposited carbon in the antibacterial performance. Coatings of 4.0–6.0 μm thicknesses nanostructured anatase were deposited by pulsed-pressure metalorganic chemical vapor deposition (pp-MOCVD) on stainless steel and glass substrates, and one set was heat-treated to remove the co-deposited amorphous carbon. Morphology, phase and adhesion were not affected by the short heat treatment at 500 °C in air. The water contact angle was reduced under visible light to a much greater extent for the carbon-free sample. The antimicrobial performance of the coatings was marginally enhanced by removing the carbon. While the carbon may be enhancing the visible light PCA of the TiO2, we conclude that it is also interfering with the transport of radical oxygen species to the bacteria and reducing the active surface area.

Article Current Status of Nosocomial COVID-19 Cases in Delivery Facilities in Japan

Background: In Japan, there are more than 2000 maternity facilities that provide delivery services for approximately 860 thousand deliveries per year. More than half of all deliveries are managed in private clinics which medical resources are limited and maternal transport is often required. In such condition, we aimed to identify the characteristics of and measures taken by Japanese medical facilities providing maternity services that have recorded cases of nosocomial infection with SARS-CoV-2, which causes (COVID-19).Methods: A nationwide questionnaire survey about nosocomial COVID-19 was conducted in July 2020. A case-control study was conducted by including medical facilities with (Cases) and without (Control) nosocomial COVID-19.Findings: Responses from 1,418 medical facilities were assessed (65% of all delivery facilities in Japan). Seventy-five COVID-19-positive pregnant women were treated in 48 facilities. Nosocomial infection was reported in 4.1% of the facilities. Nine patients developed a nosocomial infection in the maternity ward or obstetric department. Variables that contributed to nosocomial COVID-19 were chest CT on admission (adjusted odds ratio [95% confidence interval], 4.76 [2.44–9.27]), PCR test for SARS-CoV-2 before delivery (2.27 [1.21–4.25]), transfer of pregnant women with fever to another hospital (0.21 [0.06–0.71]), and private clinics (0.17 [0.05–0.60]).Interpretation: Nosocomial infection is likely to occur in large hospitals that treat a higher number of patients than private clinics do. Nosocomial infection can occur even in medical facilities performing COVID-19 screening tests, such as chest CT and PCR test.Funding Statement: Nationwide survey associated with COVID-19 infection, The Japan Association of Obstetricians and Gynecologists (JAOG).Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: This study was approved by the JAOG (No. 80, July 1st, 2020). This investigation was conducted according to the principles of the Declaration of Helsinki. Informed consent was not obtained from patients or their families because this study was based on the analysis of facility forms, and the patient records/information was anonymized prior to the analysis.