Infection Control Resources Research Articles

Effects of establishing infection control program with core components of World Health Organization on reducing the risk of residents' infections and improving staff infection control competency in a nursing home.

Nursing homes (NHs) are high-risk facilities with limited infection control resources and residents susceptible to infectious diseases. The evidence regarding World Health Organization (WHO) core components in NHs is lacking. This study evaluates the effectiveness of establishing an infection prevention and control (IPC) program with WHO's core components in an NH. The IPC program, encompassing evidence-based guidelines, education and training, surveillance, multimodal strategies, monitoring and feedback, workload and staffing considerations, and the built environment, was implemented in a 130-bed NH for one year. The effects were assessed based on the number of infections among residents, the level of knowledge, and the performance of infection control among staff. The risk of infection was analyzed across three phases: pre-implementation phase, implementation phase (6 and 12 months after intervention initiation), and sustainability phase (3, 6, and 12 months after intervention was finished). Staff data were analyzed before and after the intervention. Analysis of 18,124 resident-days revealed that during the sustainability phase, the risk of respiratory tract infection was significantly lower than before intervention implementation (odds ratio [OR] 0.51, 95% CI 0.30-0.86, p = 0.012). Moreover, a significant improvement was observed in staff knowledge (p = 0.002) and performance (p < 0.001) after the intervention compared to before. WHO's core components may have a potential effect on reducing healthcare-associated infections among residents and enhancing the infection control competency of staff in the NH with limited IPC resources.

Nurse Perceptions of Barriers to Infection Prevention and Control in Labor and Delivery

ObjectiveTo identify nurse perceptions of barriers to performing recommended infection prevention and control practices in labor and delivery to inform future resources tailored to this setting. DesignQualitative focus groups. SettingThe 2023 annual convention of the Association of Women’s Health, Obstetric and Neonatal Nurses, New Orleans, LA. ParticipantsA convenience sample of 16 labor and delivery nurses. MethodsStaff of the Centers for Disease Control and Prevention conducted two focus groups using a standardized script. Coding was performed by three reviewers using Krueger’s systematic analysis process. ResultsAmong the 16 participants, 94% were registered nurses, and 6% were advanced practice registered nurses. From our analysis of the data, five major themes emerged, including the following: Lack of Individual and Organizational Accountability in Implementing Recommended Infection Prevention and Control Practices; Inconsistent Application of Guidance Across State, Hospital, and Specialty; The Unpredictable Nature of the Labor and Delivery Setting; Labor and Delivery Is Not Prioritized in the Hospital for Infection Prevention and Control Resources; and Lack of Coordination Across Stages of Care From Prenatal to Postpartum. Conclusion(s)We identified barriers experienced by nurses to consistently implementing infection prevention and control practices in the labor and delivery setting. These barriers can be addressed through targeted interventions and the development of obstetric-specific infection prevention and control resources.

Molecular characterisation of virulence genes in bacterial pathogens from daycare centres in Ile-Ife, Nigeria: implications for infection control

BackgroundDaycare centres play a critical role in early childhood development but are high-risk environments for infectious disease transmission due to close physical contact, shared toys, inadequate hygiene, and poor ventilation. These risks are especially concerning in low- and middle-income countries (LMICs) like Nigeria, where resources for infection control may be limited. This study aimed to identify and characterise virulence genes in bacterial isolates from daycare centres in Ile-Ife, Nigeria, to assess infection risks.MethodsBetween November 2017 and July 2019, 233 samples were collected from 76 children, 33 daycare workers, and 124 fomites in 17 daycare centres. The bacterial isolates were analysed using conventional PCR and RAPD analysis to detect the presence of virulence genes. The frequency of crucial virulence genes and the prevalence of each bacterial species were recorded.ResultsKey virulence genes were detected, including fimH in Klebsiella species (22.73% of Gram-negative isolates), algD in Pseudomonas aeruginosa (50%), and icaA and cna in Staphylococcus aureus (16.67%). Staphylococcus aureus was the most prevalent species (35%), followed by Klebsiella (28%) and Pseudomonas aeruginosa (20%).ConclusionThis study highlights the presence of virulent bacterial pathogens in daycare environments, posing a severe infection risk to children. To mitigate these risks, it is essential to implement enhanced infection control measures, such as regular microbial screening, improved hand hygiene practices, and disinfection protocols for fomites. Training programs for daycare workers on hygiene practices and routine monitoring could also significantly reduce infection transmission. These interventions are vital for safeguarding the health of daycare children in Nigeria and similar settings globally.

The Impact of COVID-19 on Healthcare-Associated Infections: A Survey of Acute Care Hospitals

Background: The COVID-19 pandemic has placed an enormous strain on the healthcare system, including infection prevention and control. The response to the COVID-19 pandemic required extraordinary resources, which were often diverted from routine infection prevention and control activities and may have contributed to increased rates of HAI in the acute care setting. However, the impact of the COVID-19 pandemic on infection prevention and control departments, including staffing and resources, and on routine infection prevention and control activities is not well-described. The objective of this study was to describe the impact of the COVID-19 pandemic on IPC departments and department response to the pandemic. Methods: Between August and December of 2023, we conducted an electronic survey of all acute care facilities participating in the National Healthcare Safety Network. Survey data were analyzed using descriptive statistics. Results: Over 594 infection control departments participated in the survey, representing 1,400 NHSN facilities (20% response rate based on number of eligible NHSN facilities). Half of the respondents reported that their hospital experienced increases in the following HAI rates during the first two years of the pandemic: central-line associated bloodstream infections (54%), catheter-associated urinary tract infections (46%) and ventilator associated pneumonia (45%). When asked to identify the top three contributors to increased HAI rates in their facility, respondents cited the following factors: staffing shortages (70%), patient acuity (69%), use of travel nurses (48%), increased device utilization (37%), and reduced bedside acuity (31%). Respondents reported that their department utilized the following actions to decrease these HAI rates: increased rounding and monitoring of IPC procedures (81%), reeducation of frontline staff on IPC policies and procedures (77%), environmental care rounds (69%), monitoring of isolation compliance (66%), HAI Task Force/Committee (57%), nurse-driven catheter removal protocols (53%), and insertion prevention protocols (53%). When asked if the department experienced applied pressure or attempts to influence HAI reporting due to the increase in HAI rates in the facility experienced in the wake of the pandemic, 19% of respondents reported increased pressure from management/C-suite and 7% reported increased pressure from providers. Conclusion: The COVID-19 pandemic had a substantial impact on IPC departments in acute care hospitals and had a profound effect on IPC staffing, resources and routine IPC activities. Future work needs to identify best practices and lessons learned from the pandemic to inform future pandemic preparedness.

Development and evaluation of prevention bundle for neonatal healthcare-associated infections: an interventional study

Background Neonatal healthcare-associated infection (HAI) globally is the leading preventable cause of neonatal mortality. Neonatal mortality in India is also very high. Considering that HAIs can be prevented globally, there are disparities in resources; the current study aimed at developing locally feasible and effective prevention bundles for neonatal HAIs. Methods A mixed-method study was conducted at one tertiary care teaching hospital's level IV Neonatal Intensive Care Unit. The study explores the causes of neonatal HAIs, current processes, benchmark practices, gaps in current practices with HAIs, root-cause analysis and system process mapping, and failure mode effect analysis. Observations, interviews, brainstorming activities, and a survey were conducted. Written and audio-video recorded prevention bundle was developed and implemented using a quasi-experimental study design. Results Process standardisation, healthcare worker training, hand hygiene practices, nursing care process and vascular access process were identified as key improvement areas to prevent neonatal HAIs. Out of eighteen identified processes, three processes were standardised. All the healthcare providers were trained at three-time intervals of three months each. After implementing the prevention bundle, there was a significant decline in the rate of HAIs, reducing it from 9.6 to 7.0 per 100 admissions &gt;48 hours. The bacteraemia rate fell from 5.2 per 1000 patient days to 2.6 per 1000 patient days and was statistically significant on a two-tailed student t-test with 95% CI with p-value=0.00073. Conclusions Our developed prevention bundle for neonatal HAIs was significantly effective and reproducible for healthcare workers' training and development. Considering variations in global infection control practices and resources constraint, it is effective to develop a local prevention bundle for neonatal HAIs.

Nurses' experience of end-of-life care for patients with COVID-19: A descriptive phenomenology study.

The mortality rates among critically ill patients with COVID-19 have been high. The national and institutional infection control policies and resource shortages caused by the pandemic led patients to undergo deaths without dignity and inevitably changed intensive care unit (ICU) end-of-life care (EOLC) practices. This study explores ICU nurses' experiences of providing EOLC for patients with COVID-19 who died. Eight nurses participated in a qualitative phenomenological study. Semi-structured interviews were conducted from July to September 2022. Colaizzi's data analysis method was used, and the following four main themes emerged: (i) only companion in the death journey; (ii) helping families prepare for death; (iii) EOLC trapped within a framework; and (iv) EOLC in retrospect. To secure high-quality EOLC in ICU, it is important to promote practical support for nurses and EOLC-related discussions/education. Technical support, such as digital communication technologies, should be reinforced to help patients and their families participate in EOLC.

RSV Pneumonia Mortality: Hematological Malignancies As a Silent Amplifier - Insights from the National Inpatient Sample 2020

Background: RSV is a prevalent cause of acute lower respiratory infections, primarily in young children, but can also lead to severe pneumonia in adults, especially the elderly and immunocompromised. Hematological malignancies, a group of neoplastic disorders affecting blood, bone marrow, and lymph nodes, can render patients more susceptible to infections and complications. The aim of this study is to evaluate the impact of hematological malignancies on inpatient mortality, hospital length of stay, and hospitalization costs and charges in adult patients during RSV-related hospitalizations, using retrospective data from the National Inpatient Sample (NIS) 2020. Methods: In this retrospective cohort study, we used NIS data for 2020. International Classification of Diseases, Tenth Revision, with Clinical Modification (ICD-10-CM) codes were utilized to query the NIS database and identify adults (Age ≥18 years) hospitalized with RSV pneumonia. Our population of interest was subsequently divided into two groups based on the presence or absence of unremitted hematological malignancies. Inpatient mortality served as the primary outcome, with secondary outcomes being hospital length of stay, hospitalization charges, and costs. A multivariate logistic regression analysis was conducted using STATA MP 16.1, incorporating various hospital and patient-level factors. The Charlson comorbidity index was utilized to account for the burden of comorbidities in the analysis. Results: The total population of adult patients admitted in 2020 with RSV pneumonia was 13,900. From this, 980 individuals (7.1%) were diagnosed with a hematological malignancy, of which 43% were female. Conversely, 93% of individuals did not have a hematological malignancy, and, females accounted for 59% of this group. Patients with a hematological malignancy had a mean age of 66, while those without had a mean age of 69. In comparison to those without hematological malignancy, patients with this malignancy demonstrated a higher all-cause inpatient mortality rate for PSV pneumonia (12.24% versus 5.23%). When hospital and patient-level factors were taken into consideration, it was noted that RSV pneumonia patients with hematologic malignancy had a higher odds of all-cause inpatient mortality, with an adjusted odds ratio (aOR) of 1.99 (95% Confidence Interval (CI) 1.21- 3.28). Moreover, these patients had a longer hospital stay (12.2 days) compared to those without hematological malignancy (7.5 days), which reflects an adjusted mean difference of 3.8 days (95% CI 1.7-1.9). Overall, patients with hematological malignancies incurred higher mean hospitalization charges and costs, with an adjusted mean difference of USD 29,044 (95% CI 11,928 - 36,008) and USD 105,210 (95% CI 30,947 - 133,730), respectively. Clinical Implications: This study highlights the increased risk of inpatient mortality and resource utilization in RSV-related hospitalizations for patients with hematological malignancies. These findings emphasize the need for timely detection, prophylaxis, preference for antiviral treatment, and the inclusion of the RSV pneumonia vaccine in the prevention strategy. The results also inform healthcare administrators and policymakers about the importance of effective infection control measures, resource allocation, and public health initiatives to protect this vulnerable population.

Enhancing the hospital at home experience

Background Hospital at Home programs have demonstrated to be safe, feasible and cost effective. However, challenges such as infection control, cleanliness, space constraints and insufficient resources may hamper the adoption and effectiveness of such programs. Aims To understand the challenges of providing and receiving healthcare in the community, design a solution to meet the challenges, and to pilot and evaluate the solution. Methods This is a three-phase mixed method study. Phase 1, nurses, patients and caregivers were surveyed to understand their challenges in providing or receiving healthcare at home. Results of the survey in Phase 1 were used in Phase 2 to design a solution. In phase 3, an integrated structure was designed and piloted for stakeholders’ evaluation. Results Twenty nurses and 50 patient-caregiver dyads responded to Phase 1 survey. Physical home environment was most cited by the nurses as their main challenge, particularly the lack of a dedicated and clean space to conduct nursing procedures. Medication management was the greatest challenge faced by the patient-caregiver dyads. Based on these findings, a prototype of an integrated structure was fabricated in Phase 2. Ten patient-caregiver dyads and nine community nurses tested the prototype in Phase 3. The participants found the structure useful to store and organize their healthcare items, and there was ample clean workspace to carry out nursing procedures. Conclusion An integrated structure that can fulfil the physical, spatial and interpersonal needs at an affordable price could be useful in facilitating the delivery of hospital care in the home setting. Patient Contribution Patient-caregiver dyads were key stakeholders in our study. They provided valuable feedback and suggestions on the prototype and design of the integrated structure.

Impact of cell-free DNA fungal polymerase chain reaction panels on healthcare-associated infection mould investigations.

Launch of in-house sensitive cell-free deoxyribonucleic acid (cfDNA) mould polymerase chain reaction (PCR) assays increased detection of moulds meeting suspected healthcare-associated infection (HAI) criteria. Definition was based on time from admission and mould detection in culture or via molecular methods. We created a modified mould HAI algorithm incorporating clinical context into the case definition, which allowed for better capture of possible mould HAIs, decreased number of investigations, and improved utilization of Infection Prevention and Control (IPC) resources.

The role of online marketing to engage healthcare workers with infection prevention and control information and resources: A pilot study.

The successful adoption and application of infection prevention and control (IPC) principles in all healthcare settings is dependent on the degree to which healthcare workers (HCWs) are aware of the requirements, have access to program resources and information, and engage with the IPC program. This study investigates the impact of redesigning the Infection Control Department (ICD) intranet site based on user feedback followed by a targeted marketing campaign to improve website usability, awareness, and access. In this systematic study, we used a survey plus two focus group interviews to elicit user requirements for the content and look of the ICD intranet page and identify the best communication platforms to use for the marketing campaign to launch the redesigned intranet page. The information was used to redesign the intranet page and develop the marketing campaign. The survey was repeated post-intervention and these results, along with a comparison of website analytics monitoring traffic, were used to determine the success of the intervention. The ICD intranet page redesign increased the information and resources. Post-intervention survey results demonstrated a significant improvement in user satisfaction including ease of navigation and access to IPC information and resources. The marketing campaign resulted in a significant increase in website traffic to the ICD intranet page, demonstrating enhanced engagement with HCWs. This study demonstrated that website redesign based on user feedback, combined with a marketing campaign, can increase the traffic to the website and improve the user experience when accessing and navigating the site making the information and resources more accessible to HCWs.

Knowledge, attitude, implementation and satisfaction levels regarding availability of resources for airborne infection control among the nursing staff of a medical college in central India during the COVID-19 pandemic

Implementing airborne infection control measures as per guidelines are very important in preventing the spread of airborne infections. Therefore the purpose of this study was to evaluate the gaps in knowledge, attitude, implementation and satisfaction levels regarding the availability of resources for airborne infection control among the nursing staff of a medical college in central India during the COVID-19 pandemic. A cross-sectional survey was done in which 109 nurses participated. This self-administrable questionnaire contained five parts (General information, knowledge, attitude, implementation and satisfaction regarding available resources) and was distributed to the participants. The correct responses as per the National airborne infection control guideline, Ministry of Health and family Welfare, Government of India, 2010 (NAIC) were scored and assessed. The mean age of the participants was 28.9 + 3.02 years. The mean scores out of total score of 10 were 5.48 + 1.2 for knowledge, 6.78 +1.0 for attitude, 5.21 + 1.1 for implementation, and 4.28 + 0.9 for satisfaction of available resources. The knowledge was adequate in 46.8%, the attitude was positive in 89.9 %, the guideline implementation was adequate in 45.9% and the resource satisfaction was only in 9.2% of study participants. Although the nurses had a positive attitude to airborne infection control practices, the overall knowledge and implementation of NAIC were barely adequate and the majority of subjects felt gaps in the availability of resources in implementations of these guidelines. Therefore, it is recommended to enforce their training, ensuring better availability of resources and strict monitoring from hospital administrations for better implementation of NAIC.

Traffic-Driven Epidemic Spreading in Networks: Considering the Transition of Infection From Being Mild to Severe.

Realistic epidemic spreading is usually driven by traffic flow in networks, which is not captured in classic diffusion models. Moreover, the progress of a node's infection from mild to severe phase has not been particularly addressed in previous epidemic modeling. To address these issues, we propose a novel traffic-driven epidemic spreading model by introducing a new epidemic state, that is, the severe state, which characterizes the serious infection of a node different from the initial mild infection. We derive the dynamic equations of our model with the tools of individual-based mean-field approximation and continuous-time Markov chain. We find that, besides infection and recovery rates, the epidemic threshold of our model is determined by the largest real eigenvalue of a communication frequency matrix we construct. Finally, we study how the epidemic spreading is influenced by representative distributions of infection control resources. In particular, we observe that the uniform and Weibull distributions of control resources, which have very close performance, are much better than the Pareto distribution in suppressing the epidemic spreading.

Reevaluating the Significance of Infection Preventionists and Infection Prevention and Control Departments in the Post-COVID-19 Era.

Infection preventionists are specialized health care professionals tasked with developing and implementing infection control policies, educating staff and patients on prevention practices, and investigating outbreaks. Infection preventionists role in developing effective measures for infection prevention and control and ensuring public health and safety became even more vital given the emergence of the COVID-19 pandemic. It is important for health care systems and institutions to incorporate lessons learned, enhance infection prevention and control resources, and grow the infection preventionists workforce to prepare for future pandemic events.

Development and evaluation of prevention bundle for neonatal healthcare-associated infections: an interventional study

Background: Neonatal healthcare-associated infection (HAI) globally is the leading preventable cause of neonatal mortality. Neonatal mortality in India is also very high. Considering that HAIs can be prevented globally, there are disparities in resources; the current study aimed at developing locally feasible and effective prevention bundles for neonatal HAIs. Methods: A mixed-method study was conducted at one tertiary care teaching hospital's level IV Neonatal Intensive Care Unit. The study explores the causes of neonatal HAIs, current processes, benchmark practices, gaps in current practices with HAIs, root-cause analysis and system process mapping, and failure mode effect analysis. Observations, interviews, brainstorming activities, and a survey were conducted. Written and audio-video recorded prevention bundle was developed and implemented using a quasi-experimental study design. Results: Process standardisation, healthcare worker training, hand hygiene practices, nursing care process and vascular access process were identified as key improvement areas to prevent neonatal HAIs. Out of eighteen identified processes, three processes were standardised. All the healthcare providers were trained at three-time intervals of three months each. After implementing the prevention bundle, there was a significant decline in the rate of HAIs, reducing it from 9.6 to 7.0 per 100 admissions &gt;48 hours. The bacteraemia rate fell from 5.2 per 1000 patient days to 2.6 per 1000 patient days and was statistically significant on a two-tailed student t-test with 95% CI with p-value=0.00073. Conclusions: Our developed prevention bundle for neonatal HAIs was significantly effective and reproducible for healthcare workers' training and development. Considering variations in global infection control practices and resources constraint, it is effective to develop a local prevention bundle for neonatal HAIs.

SG-APSIC1164: Cost-effectiveness of temporary isolation rooms in acute-care settings in Asia

Objectives: We estimated the change to health-service costs and health benefits resulting from a decision to adopt temporary isolation rooms, which are effective at isolating the patient within a general ward environment. We assessed the cost-effectiveness of the decision to adopt temporary isolation rooms in a Singapore hospital. Methods: Existing data were used to update a model of the impact of adopting temporary isolation rooms on healthcare-associated infections. We predicted the expected change to health service costs and health benefits, measured in life years gained. Uncertainty was addressed using probabilistic sensitivity analysis, and the findings were tested with plausible scenarios to determine the effectiveness of the intervention. Results: We predicted 478 fewer HAIs per 100,000 occupied bed days resulting from a decision to adopt temporary isolation rooms. This decreased would result in cost savings of SGD$329,432 (US $247,302) and 1,754 life years gained. When the effectiveness of the intervention was set at 1% of cases of HAI prevented, the incremental cost per life year saved was SGD$16,519 (US $12,400), indicating that this would be a cost-effective measure in Singapore. Conclusions: We have provided evidence that adoption of a temporary isolation room would be cost-effective for Singapore acute-care hospitals. Using temporary isolation rooms may be a positive decision for other countries in the region with fewer resources for infection prevention and control.

SG-APSIC1097: The impact of COVID-19 on the incidence of carbapenem-resistant Enterobacterales (CRE) in Singapore: An interrupted time-series analysis

Objectives: Over the past 2 years, many infection prevention and control (IPC) resources have been diverted to manage the COVID-19 pandemic. Its impact on the incidence of antimicrobial-resistant organisms has not been adequately studied. We investigated the impact of the pandemic on the incidence of carbapenem-resistant Enterobacterales (CRE) in Singapore. Methods: We extracted data on unique CRE isolates (clinical and/or surveillance cultures) and patient days for 6 public hospitals in Singapore from the carbapenemase-producing Enterobacteriaceae (CaPES) study group database, and we calculated the monthly incidence of CRE (per 10,000 patient days). Interrupted time-series (ITS) analysis was conducted with the pre–COVID-19 period defined as before February 2020, and the COVID-19 period defined as after February 2020. Statistical analyses were performed using Stata version 15 software. Results: From January 2017 to March 2021, 6,770 CRE isolates and 9,126,704 patient days were documented. The trend in CRE monthly incidence increased significantly during the pre–COVID-19 period (0.060; 95% CI, 0.033–0.094; P &lt; .001) but decreased during the COVID-19 period (−0.183; 95% CI, −0.390 to 0.023; P = .080) without stepwise change in the incidence (−1.496; 95% CI, −3.477 to 0.485; P = .135). The trend in monthly incidence rate of CRE clinical cultures increased significantly during the pre–COVID-19 period (0.046; 95% CI, 0.028–0.064; P &lt; .001) and decreased significantly during COVID-19 period (−0.148; 95% CI, −0.249 to −0.048; P = .048) with no stepwise change in the incidence (−0.063; 95% CI, −0.803 to 0.677; P = .864). The trend in monthly incidence rate of CRE surveillance cultures decreased during the pre–COVID-19 period (−0.020; 95% CI, −0.062 to 0.022; P = .341) and the COVID-19 period (−0.067; 95% CI, −0.291to 0.158; P = .552) without stepwise change in the incidence (−1.327; 95% CI, −3.535 to 0.881; P = .233). Conclusions: The rate of CRE in clinical cultures decreased during COVID-19 but not the rate in surveillance cultures. Further studies are warranted to study the impact of COVID-19 on CREs.(DUPLICATE DELETED)

Reimagining Infection Control in U.S. Nursing Homes in the Era of COVID-19.

Residents of nursing homes (NHs) are susceptible to infection, and these facilities, particularly those that provide post-acute care services, are high-risk settings for the rapid spread of communicable respiratory and gastrointestinal illnesses, as well as antibiotic-resistant bacteria. The complexity of medical care delivered in most NHs has increased dramatically over the past 2decades; however, the structure and resources supporting the practice of infection prevention and control in these facilities has failed to keep pace. Rising numbers of infections caused by Clostridioides difficile and multidrug-resistant organisms, as well as the catastrophic effects of COVID-19 have pushed NH infection control resources to a breaking point. Recent changes to federal regulations require NHs to devote greater resources to the facility infection control program. However, additional changes are needed if sustained improvements in the prevention and control of infections and antibiotic resistance in NHs are to be achieved.

Preparedness of Primary Care Centers for COVID-19 epidemic in Aseer region, KSA.

The objective of this study is to assesses the preparedness of primary care centers (PHCs) in Aseer region, KSA, for the coronavirus disease 2019 (COVID-19) pandemic. This survey was conducted during April 2020 in PHCs. The questionnaire was developed by the investigators and sent via e-mail to health care providers of primary health care centers (PHCCs). The questionnaire consisted of five parts to assesses readiness of PHCs, knowledge, attitude, and practice of health care providers (HCPs) concerning the COVID-19 pandemic. Data entry and analysis were managed by SPSS version 20. Three hundred and seventy-one HCPs participated in this study. Most of them were males (58%), doctors or nurses (81%). Almost all PHCCs have adequate infection control resources, with some shortage in sterilization rooms. Most of participants received on-job training (85%) and had good knowledge about COVID-19. Attitudes of participants showed variation toward COVID-19; 74% were afraid to be infected, 54% were afraid to care for infected patients, 58% were ready for vaccination, and 80% thought that COVID-19 has a huge negative impact on the health care system. Compliance with preventive measures ranged from 66% for keeping social distance to 90% for using personal protective equipment. Most of the participants had positive contributions regarding health education of individuals and communities using different methods including the new social media (80%). This study revealed that PHCCs in Aseer region were well equipped and HCPs were well prepared to deal with the COVID-19 pandemic. There are some shortage in a few items of infection control at PHCCs and gaps in knowledge and practice among HCPs which need continuous assessment and monitoring to overcome such barriers.

POS-067 THE IMPACT OF INFECTION ON KIDNEY ALLOGRAFT FAILURE IN AN UNDER-RESOURCED COUNTRY: THE IRAQI KURDISTAN EXPERIENCE DURING THE COVID-19 PANDEMIC

Because of the cost and complexity of dialysis, kidney transplantation is the World's most widely used replacement therapy for end-stage kidney disease. This kidney transplantation is practiced where resources for infection identification and control do not usually meet the standards of developed countries. This is a cross-sectional study of all kidney transplants performed in Sulaimania Governate of Iraq from 2015 through 2019 and followed-up through 2021. There were 656 patients. The average age was 39.2 ± 14.0 years, 68.6% were male, 416 received hemodialysis (HD) for a median of 2 months (IQR 0-5 months), 96% were first-time transplants, all donors were living, and 13.1% of recipients had pre-transplant DSA. Outcomes consisted of return to HD (RHD), death with a functional graft (DWFG), and all graft loss (RHD+DWFG). Infections consisted of pyelonephritis, PCR+ BK viremia (BKV), PCR+ COVID-19, and non-kidney-deep infections (NK-deep infections). NK-deep infections were defined as non-COVID pneumonia, septicemia, gastrointestinal infections, and hepatitis. Breslow proportional hazard functions analyzed outcomes, and logistic regression tested the relationships between infections and outcomes. Results include 95% confidence intervals. Graft failure occurred in 113 patients, 53 with RHD and 50 with DWFG. The 12 and 60 month graft survivals were 97.0% (95.3-98.1%) and 90.0% (86.7-92.5%) for RHD, 97.5% (95.9-98.5%) and 90.3% (87.0-92.8%) for DWFG, and 94.6% (92.5-96.1%) and 81.3% (77.5-84.7%) for all graft loss, with differences between RHD and DWFG being not significant, p=0.46. Seventy-nine patients had pyelonephritis, 37 had BKV, and 211 had COVID, with 9 COVID cases contracted after RHD. There were 11 COVID deaths, 9 causing DWFG and 2 occurring after RHD. Thirty patients had NK-deep infections that involved 13 RHD and 17 DWFG patients. NK-deep infections were the most significant variable associated with all graft loss (OR=222.5, 29.0-1707.9, p>0.001]. BKV adversely affected all graft loss (OR=2.6, 1.1-6.2, p=0.03), but nearly all pyelonephritis resolved with treatment, and its effect on graft survival was not significant (OR=0.53, 0.22-1.26, p=0.15) The one and five-year survivals of this cohort of kidney transplant patients were surprisingly good. Nevertheless, an infection commonly with pneumonia or septicemia contributed to 34.0% of DWFG and 24.5% of RHD. Recovery occurred in 94.8% of COVID-infected patients, but a fatality rate of 5.2% resulted in 18.0% of DWFG. As COVID wanes, a modest improvement in graft survival is expected, but NK-deep infections will remain critical factors influencing 5-year graft loss.

Cost effectiveness of temporary isolation rooms in acute care settings in Singapore.

To estimate the change to health service costs and health benefits from a decision to adopt temporary isolation rooms that are effective at isolating the patient within a general ward environment. We assess the cost-effectiveness of a decision to adopt an existing temporary isolation room in a Singapore setting. We performed a model-based cost-effectiveness analysis to evaluate the impact of a decision to adopt temporary isolation rooms for infection prevention. We estimated changes to the costs from implementation, the number of cases of healthcare associated infection, acute care bed days used, they money value of bed days, the number of deaths, and the expected change to life years. We report the probability that adoption was cost-effective by the cost by life year gained, against a relevant threshold. Uncertainty is addressed with probabilistic sensitivity analysis and the findings are tested with plausible scenarios for the effectiveness of the intervention. We predict 478 fewer cases of HAI per 100,000 occupied bed days from a decision to adopt temporary isolation rooms. This will result in cost savings of $SGD329,432 and there are 1,754 life years gained. When the effectiveness of the intervention is set at 1% of cases of HAI prevented the incremental cost per life year saved is $16,519; below the threshold chosen for cost-effectiveness in Singapore. We provide some evidence that adoption of a temporary isolation room is cost-effective for Singapore acute care hospitals. It is plausible that adoption is a positive decision for other countries in the region who may demonstrate fewer resources for infection prevention and control.