Occurrence Of Nosocomial Infections Research Articles

Prevention of Healthcare Associated Infections as an Effort to Increase Knowledge on How to Wash Hands for Patients of Grandmed Lubuk Pakam Hospital

Wash your hands regularly with soap and water or use an alcohol-based hand sanitizer. Hand hygiene must be carried out before and after contact with patients, before carrying out aseptic procedures, after exposure to body fluids, and after touching objects around the patient, which is a crucial step in maintaining the safety of patients, health workers, visitors and the community around health care facilities. This activity took place at Grandmed Lubuk Pakam Hospital. This activity was aimed at 96 patients in the hospital, with the aim of increasing knowledge regarding preventing HAIs by washing hands properly. One very effective method for preventing the spread of infection is washing hands with soap and using hand sanitizer. Lack of knowledge about efforts to prevent exposure to infectious diseases can influence the frequency of disease occurrence. This activity is carried out through counseling which involves the use of learning videos and direct practice using hand sanitizer. In service activities by providing education related to material on the meaning of hand washing, the importance of washing hands in hospitals, the right time and mandatory hand washing for hospital patients, correct hand washing techniques, use of hand sanitizer, visuals and demonstrations, and education for families and visitors. In this activity, patients are asked to practice correct hand washing procedures. The results of the activity were obtained from 96 people, 85 people (89%) understood how to wash their hands properly as an effort to prevent and prevent the risk of infection while in hospital or after leaving the hospital. It is hoped that hospital management will work together with the Infectious Disease Prevention Committee (PPI) officers periodically to prevent and overcome the occurrence of nosocomial infections (HAIs) in the hospital.

Analysis of factors influencing the risk of secondary infection in patients colonized or infected with multidrug-resistant Gram-negative bacteria following hospitalization

We seek to investigate the multifaceted factors influencing secondary infections in patients with multidrug-resistant Gram-negative bacteria (MDR-GNB) colonization or infection post-hospitalization. A total of 100 patients with MDR-GNB colonization or infection were retrospectively reviewed, encompassing those admitted to both the general ward and intensive care unit of our hospital from August 2021 to December 2022. Patients were categorized into the control group (non-nosocomial infection, n = 56) and the observation group (nosocomial infection, n = 44) based on the occurrence of nosocomial infection during hospitalization. Clinical data were compared between the two groups, including the distribution and antibiotic sensitivity of MDR-GNB before nosocomial infection. Significant differences were observed between the two groups in terms of age, underlying diseases, immune status, length of stay, and invasive medical procedures (P < 0.05). The observation group also had fewer patients practicing optimized hygiene, strict isolation, and antibiotic control than the control group (P < 0.05). Factors influencing the risk of secondary infection after hospitalization in patients colonized or infected with MDR-GNB included patient age, underlying diseases, immune status, length of hospitalization, medical invasive procedures, optimized hygiene, strict isolation, and antibiotic control (P < 0.05). The length of hospitalization and treatment cost in the observation group were higher than those in the control group (P < 0.05). This study comprehensively analyzes the intricate mechanisms of secondary infections in patients with MDR-GNB infections post-hospitalization. Key factors influencing infection risk include patient age, underlying diseases, immune status, length of hospitalization, medical invasive procedures, optimized hygiene, strict isolation, and antibiotic control.

Fukuchi-Manabe Score for Infection Control Measures During the Very Early COVID-19 Pandemic Period When Access to Reverse Transcription-Polymerase Chain Reaction Testing Was Poor in Japan: A Single-Center Observational Prospective Cohort Study.

During the early stages of the COVID-19 pandemic in Japan, access to reverse transcription-polymerase chain reaction (RT-PCR) testing was limited. All patients with COVID-19 required hospitalization, and isolation of suspected COVID-19 patients had not yet been implemented. With the recently acquired evidence on COVID-19, it is important to develop a risk stratification system for isolation rooms in the context of limited resources for better resource management. This study aimed to develop and validate a COVID-19 risk-scoring strategy, the Fukuchi-Manabe score, to safely stratify and manage isolation rooms, personal protective equipment (PPE), and RT-PCR testing in the context of limited RT-PCR testing and a short supply of PPE. This single-center prospective study consecutively enrolled suspected COVID-19 adult inpatients between March 1 and August 31, 2020. The primary and secondary outcomes were a positive RT-PCR test and the occurrence of nosocomial infections during the study period, respectively. Factors related to patient history, symptoms, chest computed tomography findings, and laboratory data suggestive of COVID-19 were scored, totaled, and divided into four categories ("probable," "possible," "less likely," and "non-suspicious") based on the likelihood of COVID-19. Sensitivity, specificity, and positive and negative predictive values were evaluated for each probability category. Twenty of 224 inpatients were positive on the RT-PCR test, including 18 "probable" patients (90.0%), one "possible" patient, and one "less likely" patient. The area under the curve (AUC) (95% confidence interval: 0.841-0.977), sensitivity, and specificity were 0.909, 90.0%, and 80.4%, respectively. The positive and negative predictive values and accuracy for the "probable" category were 0.90, 0.80, and 0.82, respectively. The mean and standard deviation of AUCs, validated by bootstrap analysis, were 0.910±0.034. No nosocomial infections were observed. The Fukuchi-Manabe score will be helpful when other novel pathogens emerge in the future before the availability of genetic testing methods.

Immunometabolic features of natural killer cells are associated with infection outcomes in critical illness.

Immunosuppression increases the risk of nosocomial infection in patients with chronic critical illness. This exploratory study aimed to determine the immunometabolic signature associated with nosocomial infection during chronic critical illness. We prospectively recruited patients who were admitted to the respiratory care center and who had received mechanical ventilator support for more than 10 days in the intensive care unit. The study subjects were followed for the occurrence of nosocomial infection until 6 weeks after admission, hospital discharge, or death. The cytokine levels in the plasma samples were measured. Single-cell immunometabolic regulome profiling by mass cytometry, which analyzed 16 metabolic regulators in 21 immune subsets, was performed to identify immunometabolic features associated with the risk of nosocomial infection. During the study period, 37 patients were enrolled, and 16 patients (43.2%) developed nosocomial infection. Unsupervised immunologic clustering using multidimensional scaling and logistic regression analyses revealed that expression of nuclear respiratory factor 1 (NRF1) and carnitine palmitoyltransferase 1a (CPT1a), key regulators of mitochondrial biogenesis and fatty acid transport, respectively, in natural killer (NK) cells was significantly associated with nosocomial infection. Downregulated NRF1 and upregulated CPT1a were found in all subsets of NK cells from patients who developed a nosocomial infection. The risk of nosocomial infection is significantly correlated with the predictive score developed by selecting NK cell-specific features using an elastic net algorithm. Findings were further examined in an independent cohort of COVID-19-infected patients, and the results confirm that COVID-19-related mortality is significantly associated with mitochondria biogenesis and fatty acid oxidation pathways in NK cells. In conclusion, this study uncovers that NK cell-specific immunometabolic features are significantly associated with the occurrence and fatal outcomes of infection in critically ill population, and provides mechanistic insights into NK cell-specific immunity against microbial invasion in critical illness.

Evaluation of the prevention effect of high-quality nursing quality control in disinfection supply center on nosocomial infection.

To explore the application effect of high-quality nursing quality control in disinfection supply center. The control group consisted of 1850 medical devices managed using the conventional quality control mode from January 2021 to December 2021, while the observation group consisted of 1900 medical devices managed using the high-quality nursing quality control mode from January 2022 to December 2022. The qualified rates of equipment cleaning, sterilization, and packaging were analyzed in both the observation and control groups. The occurrence of nosocomial infections in 2021 and 2022 were compared, and the changes in the Beck-Srivaatava stress scale index (BSSI) and Symptom Checklist-90 scores of the staff before and after implementing the high-quality nursing quality control mode were analyzed. The qualified rate of equipment cleaning, sterilization, and packaging in the observation group were 99.08%, 99.73%, and 99.78%, respectively, which were significantly higher than those in the control group (P < .05). The incidence of nosocomial infections in interventional and surgical cases in 2022 was 0.79%, which was significantly lower than that in 2021 (P < .05). The BSSI score of female staff was (68.76 ± 7.81) points, which was higher than that of male staff (P < .05). After the implementation of the high-quality nursing quality control mode, the BSSI score of the staff was (47.76 ± 9.12) points, which was significantly lower than that before implementation (P < .05). After the implementation of the high-quality nursing quality control mode, the staff's Symptom Checklist-90 scores for somatization, compulsion, interpersonal sensitivity, depression, hostility, and paranoia were (1.28 ± 0.29), (1.53 ± 0.24), (1.50 ± 0.21), (1.46 ± 0.32), (1.44 ± 0.26), and (1.38 ± 0.30) points, respectively, showing a decrease compared to before implementation (P < .05). The high-quality nursing quality control mode has great application value in the disinfection supply center. It can effectively improve the qualified rates of equipment cleaning, sterilization, and packaging, prevent nosocomial infections and improve the working pressure and psychological health of staff.

Antibiotic Resistance Pattern Among Isolated Bacteria from Urinary Tract Infection Patients in the Intensive Care Unit

Background: Urinary tract infection (UTI) is one of the most important health care issues with a major role in occurrence of nosocomial infections. Rise in antibiotic resistance rate by UTIs not only lead to morbidity and mortality, but also impose a remarkable financial burden on health care infrastructure. This study was undertaken to evaluate the prevalence of UTIs and identify common microorganisms responsible for infection and their antibiotic resistance profile in our Intensive Care Unit (ICU).&#x0D; Methods: In this perspective cross-sectional study, data from patients admitted to the ICU of two main referral hospitals in Yasouj, Southern-west Iran from 2015- 2016 was collected. Patients were selected in a subsequent manner and were asked to provide a midstream urine sample. Positive cultures were subsequently placed in differential culture medium for the diagnosis of the causative pathogen, while also evaluating with Muller Hinton Agar culture for antibiogram through disc diffusion method, to evaluate the pathogens sensitivity and resistance towards the tested antibiotics.&#x0D; Results: Based on bacterial culture results among a total of 112 obtained urine samples, 100 (89.2%) were negative while 12 (10.8%) were positive, in which the majority were gram-negative (6.25%) and the most frequent pathogen was Escherichia coli (5.3%). All cases of UTI in our population were fully resistant to cephalexin, ampicillin, and amoxicillin. Also, all gram-negative cultures were sensitive to amikacin. There was also no significant association between the antibiogram results with age, gender, and gram results.&#x0D; Conclusion: we report actual data on the resistance patterns of uro-pathogens in a public hospital in Iran. Escherichia coli showed a high prevalence among all UTIs with lower resistance rates to the antibiotics. Resistance to nalidixic acid and trimethoprim-sulfamethoxazole were significantly lower than other oral antibiotics, making both a suitable and cheap alternative for the empirical treatment.

STUDY OF TRENDS IN THE ETIOLOGICAL STRUCTURE OF NOSOCOMIAL INFECTIONS BEFORE AND DURING THE COVID-19 PANDEMIC IN THE RUSE REGION FOR 2017-2021

The most important and very difficult thing is to establish the cause (etiology) for the occurrence of nosocomial infections in medical facilities in the country and the world. Objective: To study the frequency and structure of nosocomial infections before and during the Covid-19 pandemic in the Ruse region for 2017-2021. Materials and methods: A retrospective analysis of the data on the registered nosocomial infections for a period of five years (2017 - 2021), reports, analyses, and laboratory studies of Regional Health Inspectorate Ruse, from national governmental studies, normative documents and literature are applied. Results: The analysis of the data from the etiological diagnosis of nosocomial infections in the Ruse region is from 9 medical facilities included in the national electronic system for the control of nosocomial infections (NIs). The etiological structure of NIs in the Ruse region is represented by 39 microbial species. The relative share of the untested varies from 10.59% in 2017 to 15.75% in 2021. For the etiologically unproven, it is from 2.39% for 2019 to 1.68% for 2021, with a decreasing trend. Conclusions: The analysis of the isolated microbial species by group shows that for the entire period, the proportion of gram-negative flora was 62% of the isolates (2017), followed by 23.02% of gram-positive microorganisms (2017), and the relative proportion of fungi and viruses was ~ 3 %.

Microbiological Assessment of Indoor Air Quality in Selected Patient Wards at a Tertiary Hospital in Nigeria

Aims: Patients are at higher risk of nosocomial infections from pathogenic microbes contaminating the indoor air of hospitals. This study evaluated selected patient wards at University of Calabar Teaching Hospital (UCTH), for bacterial and fungal contaminants. The study also determined the microbial contamination level when compared to recommended sanitary standards.&#x0D; Methodology: To determine microbial load, petri-plate gravitational settling method was used. The set-ups were exposed for one hour (at morning and noon) for passive sampling onto growth media plates, in accordance with the 1/1/1 scheme as stipulated by the index of microbial air contamination standard. Petri-plates were subsequently covered with lids and placed in a cold box. Samples were then transported to the laboratory for further evaluation. Sampling was performed in duplicates within three months, and further analysis were conducted based on standard protocols. Mean counts of bacteria and fungi was recorded and expressed as colony forming units (CFU/m3).&#x0D; Results: Microbial counts in all wards surveyed ranged from ‘intermediate’ to ‘high’ when compared to the sanitary standards of the European Commission for non-industrial premises. However, the counts were within the WHO acceptable sanitary standard (&lt;1000 CFU/m3). Eleven bacterial genera and seven fungal genera were identified. Isolated bacteria were Staphylococcus aureus (18.3%), CoNS (6.7%), Bacillus sp (13.3%), Streptococcus spp (6.7%), Corynebacterium sp (1.7%), and Micrococcus sp (1.7%), Pseudomonas aeruginosa (15%), Escherichia coli (10%), Klebsiella pneumoniae (10%), Acinetobacter baumannii (8.3%), Salmonella sp (5%) and Enterobacter sp (3.3%). Conversely, isolated fungal contaminants were A. niger (25.9%), A. flavus (20.4%), Penicillium sp (16.7%), Candida sp (9.3%), Rhizopus sp (3.7%), Mucor sp (7.4%), Cladosporium sp (14.8%), and Fusarium sp (1.9%).&#x0D; Conclusion: Regular monitoring of indoor air quality in health-care settings is encouraged to effectively guide infection prevention and control strategies and to limit nosocomial infections occurrence.

Analysis of impact of nosocomial infections on cost of patient hospitalisation.

The scale of the economic problem of the occurrence of nosocomial infections and the resulting high additional costs of treatment can only be assessed using economic analyses. The aim of the study was to analyse the impact of a nosocomial infection in a patient in the treatment process and the direct costs of patient hospitalisation. The article contributes to a cost analysis, which is a relevant basis for adopting effective solutions and decisions on the introduction of new programmes and measures to reduce nosocomial infections and associated costs. In the first phase of the micro-economic analysis, we analysed the course of hospitalisation of a non-colonised patient treated in an ordinary hospital room. In the second phase, we analysed the process of hospitalisation of a patient who developed a nosocomial infection and was transferred to an isolation room. The difference in cost of both types of treatment allowed us to carry out an economic analysis to estimate the direct costs of nosocomial infection, which are not related to the initial diagnosis of the patient but only to the patient hospitalisation. To calculate the individual types of direct costs of both alternative treatments, we first used the process flow diagram method, which then enabled us to analyse the impact of the occurrence of nosocomial infection on the efficiency and costs of the hospital. The results showed that the total direct cost of hospitalisation of a non-colonised patient was 1,317.58 euro per day, and the direct cost of hospitalisation of a patient with a nosocomial infection was 2,268.14 euro per day of hospitalisation. We found that reducing nosocomial infections would have a significant impact on the savings or reduction in healthcare costs associated with a different work process for patients in isolation. It would save 950.56 euro per patient for each day of hospitalisation for individual treatment of a patient hospitalised in an isolation room as consequence of a nosocomial infection.

Analysis of Multi-Drug Resistant Organism Surveillance and Antimicrobial Resistance Early Warning in a Hospital in 2022

Objective: To determine the clinical distribution of multi-drug resistant organism (MDRO) in Jiangyan Hospital and the monitoring and warning of drug-resistance bacteria to provide an important basis for guiding the application of broad-spectrum antibiotics in clinical treatment and reducing the occurrence of nosocomial infection. Methods: Retrospective screening and analysis were conducted on the pathogenic strains of hospitalized patients in our hospital in 2022. Results: A total of 2,769 strains of pathogenic bacteria and 390 strains of MDRO were detected and isolated in our hospital in 2022; the detection rate of MDRO was 14.08%. A total of 516 strains (18.64%) Klebsiella pneumoniae (KP) and 62 strains (12.02%) of carbapenem-resistant Klebsiella pneumoniae (CR-KP) were detected; 436 strains (15.75%) of Escherichia coli (ECO) were detected, including 8 strains (1.83%) of CR-ECO; 342 strains (12.35%) of Pseudomonas aeruginosa (PA) and 116 strains (33.92%) of CR-PA were detected; there were 194 strains (7.01%) of Acinetobacter baumannii (AB), among which 125 strains (64.43%) were CR-AB; there were 291 strains (10.51%) of Staphylococcus aureus, among which 79 strains (27.15%) of methicillin-resistant Staphylococcus aureus (MRSA) were detected; 78 strains (2.82%) of Enterococcus faecalis were detected, and vancomycin-resistant enterococcus (VRE) was not detected. The first five MDROs were CR-AB, CR-PA, MRSA, CR-KP, and CR-ECO. The top five departments with the highest MDRO detection rate in 2022 were the ICU (37.44%), the Pulmonology Department (ward 13; 31.03%), the Department of Rehabilitation (ward 5; 6.67%), the Department of Neurosurgery (ward 11; 4.62%), and the Department of General Surgery (ward 10; 3.59 The resistance rate of antibacterial drugs is divided into four levels for early warning: 30% to 40%, 41% to 50%, 51% to 75%, and 75% or more. Conclusion: Our hospital should strengthen the monitoring of antimicrobial resistance warning related to MDRO and the abuse of antimicrobial drugs. Based on the results of drug sensitivity and antimicrobial resistance warning, the use of antibiotics should be standardized in clinical practice to reduce nosocomial infection.

Cohort profile of PLUTO: a perioperative biobank focusing on prediction and early diagnosis of postoperative complications

PurposeAlthough elective surgery is generally safe, some procedures remain associated with an increased risk of complications. Improved preoperative risk stratification and earlier recognition of these complications may ameliorate postoperative recovery...

Persistently Elevated Soluble Triggering Receptor Expressed on Myeloid Cells 1 and Decreased Monocyte Human Leucocyte Antigen DR Expression Are Associated With Nosocomial Infections in Septic Shock Patients.

Observational study. University Hospital in France. One hundred sixteen adult septic shock patients as a post hoc study from the IMMUNOSEPSIS cohort (NCT04067674). None. Plasma sTREM-1 and monocyte HLA-DR were measured at day 1 or 2 (D1/D2), D3/D4, and D6/D8 after admission. Associations with nosocomial infection were evaluated through multivariable analyses. At D6/D8, both markers were combined, and association with increased risk of nosocomial infection was evaluated in the subgroup of patients with most deregulated markers in a multivariable analysis with death as a competing risk. Significantly decreased mHLA-DR at D6/D8 and increased sTREM-1 concentrations were measured at all time points in nonsurvivors compared with survivors. Decreased mHLA-DR at D6/D8 was significantly associated with increased risk of secondary infections after adjustment for clinical parameters with a subdistribution hazard ratio of 3.61 (95% CI, 1.39-9.34; p = 0.008). At D6/D8, patients with persistently high sTREM-1 and decreased mHLA-DR presented with a significantly increased risk of infection (60%) compared with other patients (15.7%). This association remained significant in the multivariable model (subdistribution hazard ratio [95% CI], 4.65 [1.98-10.9]; p < 0.001). In addition to its prognostic interest on mortality, sTREM-1, when combined with mHLA-DR, may help to better identify immunosuppressed patients at risk of nosocomial infections.

First nosocomial infections in children supported by veno-arterial extracorporeal membrane oxygenation (VA-ECMO)

BackgroundVeno-arterial Extracorporeal Membrane Oxygenation (VA-ECMO) is a standard procedure for patient with refractory shock in Pediatric Intensive Care Unit (PICU). There is a paucity of data on the time relationship between VA-ECMO support, nosocomial infection occurrence, and PICU length of stay (LOS). The aim of this study was to determine the characteristics and impact of ECMO-related infections.MethodsThis is a retrospective study from 01/2008 to 12/2014, enrolling children with a VA-ECMO support for > 6 h. We recorded the first PICU infection during the VA-ECMO run, defined as a positive microbiological sample with clinical signs of infection or clinical signs of severe infection without positive sample.ResultsDuring the study period, 41 patients (25/41 male) were included, with a median age of 41.2 months (IQR 12.9–89.9) and a 53% mortality rate. Median time on VA-ECMO was 4.2 d (IQR 2–7.1), median PICU LOS was 14.7 d (IQR 4,7–26,9). Overall, 34% patients developed an infection, with an incidence of 60/1000 VA-ECMO days. Median time to first infection was 4 d (IQR 3–5), with Pseudomonas spp. being the most commonly detected microorganism (42%). Infected sites were ventilator-associated pneumonia (9/14), sternotomy infection (2/14), bloodstream (2/14) and urinary tract infections (1/14). Longer VA-ECMO support (> 5 d) (OR 5.9 (CI 95% 1.4–24.6; p = 0.01) and longer PICU stay (> 14 d) (OR 12 (95% CI 2.2–65.5; p = 0.004) were associated with infection.ConclusionIn this single-center study, we underlined the high proportion and early occurrence of infections in patient on VA-ECMO, mostly in the first week. As infection was an early event, it may prolong the duration of VA-ECMO support and PICU LOS. Further research is needed to better understand the impact of infections on VA-ECMO and develop prevention strategies.

A clinical pharmacological evidence-based analytical research study on the clinical pharmacokinetic dose-dependent correlation of oral haematinics with the obstetric and gynaecological global anaemic patients’ recovery rate

Background: The goal of iron therapy is to repair the haemoglobin deficit and replenish storage iron. Oral haematinics are the treatment of choice, due to their higher effectiveness, higher safety, higher ease of administration, higher patient compliance, better accessibility, no occurrence of nosocomial infections and lower cost. This analytical evidence-based clinical research was conducted for the molecular pharmacokinetic study of the pharmacological response and adherence of the patients to oral haematinics, in global tertiary medical care centres.Methods: 100 anaemic patients, who were treated for moderate iron-deficiency anaemia, were prescribed oral haematinics, such as, ferrous ascorbate, ferrous sulphate, ferrous fumarate and ferric ammonium citrate, containing 60 mg of elemental iron, once to thrice daily, with or after meals, according to the progress of the disease, treatment regimen scheduling, occurrence or non-occurrence of adverse drug reactions and prognosis of the patient. The pharmacokinetic dose-dependent percentage recovery rate of the patients on 1st (30th day), 2nd (60th day) and 3rd (90th day) months and follow-up (105th day) visits, was finally deduced from the patients’ recovery features of symptoms and signs, and the confirmatory laboratory investigations recordings, with the efficacy and safety evaluation findings.Results: During the oral haematinics treatment, the pharmacokinetic dose-dependent percentage recovery rate of the patients was 29% on 30th day, 62% on 60th day, 93% on 90th day and 100% on 105th day of treatment.Conclusions: All the oral haematinics treated global anaemic patients had shown 100% recovery rate in tertiary medical care centres.

Modified nutrient medium for isolation and identification of non-fermenting bacteria

The relevance of this study is due to the need for laboratory monitoring of the circulation of gram-negative non-fermenting bacteria that have a high etiological significance in the occurrence of nosocomial infections, as well as the complexity of differentiating these bacteria on simple nutrient media from representatives of enterobacteria and between individual representatives of gram-negative non-fermenting bacteria.&#x0D; The purpose of this study was to design a differential diagnostic medium containing domestic ingredients.&#x0D; Materials and methods. The growth efficiency of test strains on comparable nutrient media, their cultural and morphological characteristics were determined.&#x0D; Results. The modified culture medium makes it possible to distinguish test strains of gram-negative non-fermenting bacteria from test strains of other bacteria (gram-negative enterobacteria, Staphylococcus), and between these strains by the color of the colonies and growth patterns. This feature gives the opportunity to apply modified medium for the differentiation of non-fermentative bacteria from fermenting ones and, simultaneously, for the primary differentiation of different representatives of non-fermenting bacteria by changing the color of the medium and different color of colonies.

Combination of early Interleukin-6 and -18 levels predicts postoperative nosocomial infection

BackgroundThe inflammatory response plays a critical role in postoperative nosocomial infections, which are the most common postoperative complications causing adverse events and poor postoperative outcomes. This study aimed to explore the ability of early inflammation-related factor levels to predict the occurrence of nosocomial infections after abdominal surgery.MethodsThe study included 146 patients with open abdominal surgery (a nosocomial infection group (NI group, n=42) and a no-nosocomial infection group (NNI group, n=104)). After 1:1 matching, the patients were divided into a matching nosocomial infection group (M-NI group, n=25) and a matching no-nosocomial infection group (M-NNI group, n=25). Serum levels of interleukin (IL)-6, IL-8, IL-10, IL-12, IL-18, macrophage migration inhibitory factor (MIF), and monocyte chemotactic protein (MCP-1) were tested at three time points (pre-operation, 0-hour post-operation (POD1) and 24-hour post-operation (POD2)). The area under the receiver operating characteristic curve (AUC-ROC) was used to test the predictive abilities.ResultsThere were significant differences in the levels of IL-6, IL-12, and IL-18 between the M-NI and M-NNI groups (p < 0.05), but not in the levels of other inflammatory factors. MIF, IL-8, and MCP-1 levels were higher in the M-NI group than in the M-NNI group at POD2 (p < 0.05). In the ROC analysis, the AUC for prediction of nosocomial infection using a combination of IL-6 and IL-18 at POD1 was 0.9616, while the AUCs for IL-6 alone and IL-12 alone were 0.8584 and 0.8256, respectively.ConclusionsThe combination of the levels of inflammatory factors, IL-6 and IL-18, at the 0-hour postoperative time point, significantly improved the predictive ability to the development of postoperative infection during perioperative period. Our study suggests the importance of monitoring postoperative inflammatory markers.

THE BEAST IN THE BEAUTY BOX

THE BEAST IN THE BEAUTY BOX

Development of a nomogram for predicting nosocomial infections among patients after cardiac valve replacement surgery.

To construct a predictive nomogram of the risk of nosocomial infections among patients after cardiac valve replacement surgery. Nosocomial infections are a standout challenge that worsens the prognosis of patients after valve replacement surgery. However, studies on the nomogram of nosocomial infections in these patients have remained scarce. A retrospective cohort study. Patients (n=720) following valve replacement surgery from 2018 to 2019 were selected. LASSO regression and multivariate logistic regression were utilised to ascertain predictors of nosocomial infections. The predictive performance of the nomogram was appraised by calibration and discrimination. Decision and impact curves were used to assess the clinical utility. Internal validation was implemented via 1000 bootstrap samples to mitigate overfitting. TRIPOD guidelines were used in this study. One hundred and fifty one patients (20.97%) experienced nosocomial infections following valve replacement surgery. Heart failure, preoperative anaemia, valve material, American Society of Anesthesiologists score ≥ IV, prolonged duration of surgery, duration of mechanical ventilation ≥ 24 h and indwelling nasogastric tube were predictors of nosocomial infections. Using these variables, we developed a predictive nomogram of the occurrence of nosocomial infections and the internal validation results demonstrated good discrimination and calibration of the nomogram. The clinical decision and impact curve revealed significant clinical utility. The present study constructed a nomogram for predicting the risk of nosocomial infections in patients following cardiac valve replacement surgery. This nomogram may strengthen the effective screening of patients at high risk of nosocomial infections. This risk warning tool can assist clinical staff in making decisions and providing individualised infection control measures for patients, which has a significant reference value for clinical practice. The data for this study were obtained from the hospital database, and the entire process of the study did not involve patient participation.

Determination of In-door Air Quality by Estimating Microbiological Load from the Ambient Air among Basic Health Units in the City of Januaria, Brazil - A Cross Sectional Study

Aims: Poor air quality can compromise the health and recovery of patients and even compromise the quality of life and productivity of health professionals, affecting the speed of recovery of patients and allowing the occurrence of nosocomial infections. The present work evaluated the microbiological quality of ambient air in Basic Health Units (BHU), determining the degree of microbiological safety for the population served.&#x0D; Study Design: This study was conducted with triplicate evaluation of samples of ambient air.&#x0D; Place and Duration of Study: This study was conducted in the city of Januária, state of Minas Gerais, Brazil, between March 2016 and July 2016.&#x0D; Methodology: Environmental air samples were collected in five BHU in the urban area of the city, evaluating the contamination by aerophilic mesophilic microorganisms, enterobacteria, molds and yeasts, using the simple sedimentation technique in a Petri dish.&#x0D; Results: It was verified the presence of mesophilic aerobic bacteria and molds and yeasts in amounts higher than the recommendation used as a parameter for this study, indicating that the hygienic-sanitary conditions in the evaluated BHU are not adequate.&#x0D; Conclusion: The presence of Enterobacteriaceae in some evaluated sites suggests the possibility of the presence of pathogenic microorganisms, which may pose risks to the health of the population.

An Analysis of the Effect of Personal Protective Equipment (PPE) Training Based on the Information-Motivation-Behavior Skills Model in the Practice of COVID-19 PPE Application.

ObjectiveThe aim of this study is to improve the effectiveness of training in putting on and removing personal protective equipment (PPE) during COVID-19.MethodsAn information–motivation–behavioral skills (IMB) model intervention team was established with the adoption of the IMB model to intervene in putting on and removing PPE by medical staff during COVID-19. Specifically, the information intervention was strengthened through the formulation of the hospital manual for PPE application. In the present study’s five-stage motivational interview, the personal motivation and social motivation of medical staff were deeply understood, helping the medical staff to improve their belief in the importance of correct PPE application and to establish the correct attitude toward PPE application. In terms of behavioral skills, there are numerous issues that could interfere with the establishment of proper PPE application, including material supply, double duty, simultaneous supervision of entering and leaving, continuous supervision, video supervision, and nosocomial infection inspection. The scores relating to PPE application knowledge and self-efficacy as well as the PPE usage qualification rate were calculated in the control group and the IMB intervention group and subsequently compared.ResultsFor the control group and the IMB intervention group, the scores for PPE application knowledge were 87.78 ± 10.46 and 95.56 ± 9.06 points, respectively. For self-efficacy, the scores were 25.19 ± 0.97 and 33.79 ± 2.05 points, and the PPE usage qualification rates were 64.8% and 90.0%, respectively. The differences in all the scores were statistically significant between the two groups.ConclusionThe application of the IMB model could improve the relevant knowledge relating to PPE application, strengthen the belief in the importance of and motivation for correct PPE application, improve the qualification rate for PPE application, and provide a theoretical and practical basis for reducing the occurrence of nosocomial infection.