Risk Of Healthcare-associated Infections Research Articles

Assess The Workload Management Model and Enhanced Quality Control in The Central Sterile Supply Department: A Study Protocol.

Introduction The Central Sterile Supply Department (CSSD) plays a crucial role in ensuring the safety and efficacy of medical instruments and equipment used in healthcare settings. Effective workload management and quality control are essential for maintaining high standards of patient care and minimizing the risk of healthcare-associated infections. This study protocol aims to assess the implementation and impact of a new workload management model and enhanced quality control measures in a CSSD setting. Methods The study will employ a mixed-methods approach, including quantitative analysis of workload data, qualitative interviews with CSSD staff, and observational assessments of workflow and quality control procedures. The workload management model under investigation involves the allocation of resources based on demand patterns and the implementation of scheduling algorithms to optimize staff efficiency. Enhanced quality control measures include the implementation of advanced sterilization technologies, rigorous inspection protocols, and continuous staff training initiatives. Results The study expects to provide insights into the effectiveness of the workload management model in optimizing resource allocation and improving staff productivity. Additionally, it aims to evaluate the impact of enhanced quality control measures on the reliability and safety of instrument sterilization processes. Findings from this study will inform recommendations for further improvements in CSSD operations and contribute to the advancement of best practices in sterile supply management. Conclusion The successful implementation of an effective workload management model and enhanced quality control measures in the CSSD is crucial for maintaining patient safety and ensuring the efficient functioning of healthcare facilities. By systematically evaluating the implementation and impact of these interventions, this study protocol seeks to contribute to the ongoing improvement of CSSD operations and the enhancement of healthcare quality.

Hand hygiene perceptions, preferences, and practices among hospital staff in the Dominican Republic in the context of COVID-19: a qualitative study

Proper hand hygiene (HH), which includes sanitizing with alcohol-based hand rub (ABHR) (or handwashing with soap and water if ABHR is unavailable), is key for preventing healthcare-associated infections (HCAI), including COVID-19. Understanding drivers of HH is key to improving adherence. This study aims to explore drivers and barriers to HH practice at two hospitals in the Dominican Republic in the context of the COVID-19 pandemic to inform development of HH behaviour change interventions. We conducted in-depth interviews with 20 hospital staff during September 2021. We used the COM-B (capability, opportunity, motivation, behaviour) model to explore HH experiences and preferences. Interviews were recorded, transcribed, coded, and analysed using a thematic approach. A total of 11 parent codes and 27 sub-codes were identified, and 1145 coded segments were analysed. Use of handwashing with soap and water and/or sanitizing with ABHR was reported by all participants; handwashing was generally preferred. Participants expressed knowledge of proper HH methods (capability), but inconsistent supplies and lack of time presented HH challenges (opportunity). Interviewees described practicing HH to protect themselves and their families from COVID-19 and other infections (reflective motivation) or out of habit (automatic motivation). By understanding and addressing underlying factors affecting HH, hospitals can decrease the risk of HCAIs. Our findings suggest that interventions implemented to improve HH in these hospitals should target motivation and opportunity. These findings informed a multimodal intervention to increase ABHR access and implement message-tested communications campaigns; end-point assessments will provide insights into the intervention's impact.

Retrospective analysis of pathogens for guided creation of an EMPIRic antibiotic prEscribing pathway (EMPIRE).

The objective of this study was to evaluate the susceptibilities of pathogens isolated from cultures within the first 7 days of admission to the burn center and in the absence of healthcare-associated infection risk factors (HAIRF) to determine if current empiric antibiotics can be narrowed for refinement of an empiric antibiotic prescribing pathway according to suspected source. A 3-year sample of patients and cultures was utilized in hopes of obtaining at least 30 isolates of the most common pathogens and their respective susceptibilities. Two-hundred and sixty-eight clinically-relevant (e.g., deemed infectious, versus colonization) pathogens were included in the final sample with sources including wounds, respiratory, blood, urine, and bone. Of the 268 pathogens included, 45% were Gram-negative and 69% of all pathogens were isolated from wound cultures. The existing empiric pathway, vancomycin plus cefepime, covered 98% and 84% of all Gram-positive and Gram-negative pathogens, respectively. In patients without HAIRF, coverage rose to 98% and 90%, respectively. Initial use of vancomycin and cefepime remains adequate for pathogens isolated within one week of admission in patients without HAIRF. For pneumonias, a narrower spectrum beta-lactam would not sufficiently cover respiratory pathogens isolated within the first week of admission. Regarding early wound infections, difficult-to-treat pathogens remain as a rare isolate of wound cultures within one week of admission.

Nurses Knowledge and Attitude Regarding Infection Control Practices

Background: Infection control practices are crucial in minimizing the risk of healthcare-associated infections (HAIs) in hospital settings. Adequate knowledge and positive attitudes among nurses towards these practices are essential for effective implementation and patient safety. Objective: This study aimed to evaluate the knowledge and attitudes of nurses regarding infection control practices at a tertiary care hospital in Lahore, Pakistan. Methods: A descriptive cross-sectional study was conducted involving 150 registered nurses from various departments including ICU, ER, and pediatric wards. Participants were selected using a convenient sampling technique. Data were collected via a validated questionnaire assessing knowledge and attitudes toward infection control practices. Descriptive statistics, frequency distributions, and reliability analysis (Cronbach’s Alpha) were performed using SPSS version 25. Results: The study revealed that 47.3% (71/150) of nurses had excellent knowledge, 22.0% (33/150) had good knowledge, and 30.7% (46/150) had poor knowledge about infection control. Regarding attitudes, 94.7% (142/150) of nurses exhibited a positive attitude towards infection control measures. The majority of participants were young, with 97.3% (146/150) between the ages of 21-30. Experience levels varied, with 81.3% (122/150) having between 1 to 3 years of experience. Conclusion: The findings indicate that while there is a good level of knowledge and a very positive attitude towards infection control among nurses, continuous education and training are needed to address gaps in knowledge and ensure high standards of practice are maintained.

Patient safety culture in African health facilities, a systematic review and meta-analysis

Abstract Background The risk of a patient being harmed in a hospital is high in low- and middle-income countries (LMICs), with the risk of health care-associated infection being up to 20 times higher than in developed countries. The purpose of this review was to assess the current patient safety culture and provide insight into areas of strength and areas for improvement in terms of patient safety culture. Method Data sources: English language articles were selected by consulting PubMed databases, African journals online, and Google scholar data sources from 2012-2022, . Medcalc software was used for all calculations. The random effects model was used. The presence of heterogeneity and Publication bias were assessed. Result The systematic review and meta-analysis result showed that the overall pooled result of patient safety culture status was 51.6% with 95% CI (43.364 to 59.773). The results of Cochran’s Q test and I2 statistics showed substantial heterogeneity among the included studies (Q=119.1617, df = 16, P < 0.0001 and I2=86.57%), and thus random effects model was used for meta-analysis. Non-punitive response to errors and staffing were the dimensions with the lowest positive response rate. Whereas, Team-work within units and supervisor expectation were the areas with good positive response rate. Conclusion The studies indicated a predominance of hospital organizational cultures that were immature or weak in terms of patient safety. For them to be effective, safety culture evaluation should be linked to hospital-wide safety culture development strategies.

Adaptive Architecture and Infection Prevention in Hospitals

In healthcare facility design, especially in hospitals, infection control is paramount due to the vulnerability of patients to nosocomial or healthcare-associated infections (HAIs). Despite advancements in medical practices and infection control measures, HAIs remain a significant challenge to patient safety and public health, particularly within hospital settings. Integrating adaptive architecture principles into hospital design and infrastructure presents a promising approach to addressing this issue. This paper examines the intersection of adaptive architecture and infection prevention in hospitals, with a focus on designing and constructing healthcare facilities to effectively curb the spread of infections. By incorporating adaptive architecture, hospitals can create environments that are responsive to the dynamic needs of patients, staff, and infection control protocols. Design elements such as flexible room layouts, easily adaptable ventilation systems, and antimicrobial surfaces can help minimize the risk of HAIs by reducing pathogen transmission and promoting cleanliness. Additionally, strategic placement of hand hygiene stations, isolation rooms, and patient flow pathways can optimize infection control practices and enhance patient safety. Strategically locating hand hygiene stations, isolation rooms, and patient flow pathways optimizes infection control practices and improves patient safety. By combining innovative design strategies and advanced technology, hospitals can better combat HAIs, fostering safer environments for patients and healthcare staff. This paper investigates how the collaboration of adaptive architecture and infection prevention can yield more robust and efficient healthcare facilities in the fight against HAIs. Keywords - HAIs, Adaptive Architecture, Infection, adaptable ventilation, flexible layouts, antimicrobial surfaces.

Highly effective decontamination in a hospital environment: An easy-to-operate, low-cost prototype.

Healthcare-associated infections (HAI) are illnesses acquired during healthcare and are often the most important adverse event during healthcare. With the aim of increasing the effectiveness of disinfection/decontamination processes in the health service with safe and not promote microbial resistance, we propose the development of portable equipment associated with type C ultraviolet light (UVC). The efficiency of the irradiance emitted by the equipment (at dosages 3.5, 5.0, and 60 mJ/cm2) was determined by the action exerted after exposure against four different bacterial (Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa, and Staphylococcus aureus) and three different fungi (Candida albicans, C. parapsilosis, and Aspergillus section Fumigati). It was possible to observe that all treatments were capable of inactivating the bacterial species evaluated (p < 0.05), causing the irreversible death of these microorganisms. The most effective elimination of fungal agents was at a dose of 60 mJ/cm2 of UVC radiation, with a decrease in the fungal inoculum varying between 94% and 100% in relation to the control without exposure. Thus, our study showed that the application of the portable prototype with UVC light (254 nm) at a distance of 48 mm, allowed an average irradiance of 3.5 mW/cm2, with doses of 3.5 ≈ 60 mJ/cm2 (from 1 to 60 s of exposure), which can promote the total reduction of the bacteria evaluated and significantly reduce fungal growth. Therefore, this prototype could be used safely and effectively in the hospital environment, considerably reducing contamination and contributing to the reduction of healthcare-associated infection risk.

The effects of a novel, continuous disinfectant technology on methicillin-resistant Staphylococcus aureus (MRSA), fungi, and aerobic bacteria in 2 separate intensive care units in 2 different states: An experimental design with observed impact on health care associated infections (HAIs)

Hospitals are exposed to abundant contamination sources with limited remediation strategies. Without new countermeasures or treatments, the risk of health care-associated infections will remain high. This study explored the impact of advanced photohydrolysis continuous disinfection technology on hospital environmental bioburden. Two acute care intensive care units in different locations (ie, Kentucky, Louisiana) during different time periodswere sampled every 4 weeks for 4 months for colony-forming units (CFUs) of methicillin-resistant Staphylococcus aureus (MRSA) and fungi on surfaces and floors and fungi and aerobic bacteria in theair. At both sites, surface testing showed greater than 98% reduction in mean fungi and MRSA CFUs. Floor results had reductions by more than 96% for fungi and MRSA at both sites. Aerobic bacterial air and fungal CFUs had reductions up to 72% and 89%, respectively. HAIs declined 70% when postactivation data were compared to preactivation data. The continuous nature of advanced photohydrolysis decontamination, its ability to be used in occupied rooms, and its independence of human resourcesprovidean innovative intervention for complex healthcare environments. This study is on the pioneering edge of demonstrating that continuous decontamination can reduce surface, floor, and air contamination and thereby reduce the acquisition of HAIs.

Impact of COVID-19 on healthcare-associated infections and antimicrobial use in Italy, 2022

IntroductionWe aimed to assess the impact of COVID-19 on healthcare associated infection (HAI) transmission and antimicrobial use (AMU) prevalence during the later stages of the pandemic. MethodsA point prevalence survey (PPS) was conducted among 325 acute-care hospitals of 19/21 regions of Italy, during November 2022. Non COVID-19 patients were matched to COVID-19 patients according to age, sex, and severity of underlying conditions. HAI and AMU prevalence were calculated as the percentage of patients with at least one HAI or prescribed at least one antimicrobial over all included patients, respectively. ResultsIn total, 60403 patients were included, 1897 (3.14%) of which were classified as COVID-19 patients. Crude HAI prevalence was significantly higher among COVID-19 patients compared to non COVID-19 patients (9.54% vs. 8.01%, prevalence rate ratio, PRR 1.19, 95% confidence interval, CI 1.04–1.38, p<0.05), and remained higher in the matched sample, however statistical significance was not maintained: odds ratio (OR) 1.25 (95% CI 0.99 – 1.59, p 0.067). AMU prevalence was significantly higher among COVID-19 patients prior to matching (46.39% vs. 41.52%, PRR 1.21, 95% CI 1.11-1.32, p<0.001), and significantly lower after matching: OR 0.77 (95% CI 0.66-0.89, p < 0.001). ConclusionsCOVID-19 patients could be at higher HAI risk due to underlying clinical conditions and to the intensity of healthcare needs. Further efforts should be dedicated to antimicrobial stewardship among COVID-19 patients.

Impact of Whole Genome Sequencing to investigate transmission of Serratia marcescens in Neonatal Intensive Care Unit

Newborns admitted to neonatal intensive care units (NICU) are at increased risk of health care-associated infections. Serratia marcescens represent the third most common pathogen in NICU outbreaks. Here we present an outbreak investigation performed using Whole Genome Sequencing (WGS) analyses and the control measures implemented to limit the spread of S. marcescens in the NICU of an Italian hospital. In February 2023 S. marcescens was isolated from six newborns, when in 2022 this pathogen was isolated only from two samples in the same ward. Measures for infection prevention were adopted. Routinary surveillance screening, performed with rectal swabs collected at admission and weekly thereafter, was implemented to search for S. marcescens presence. Environmental samples were collected. All the isolates, obtained from the conjunctival swab of six newborns, from rectal swab of two newborns who did not develop infections, as well as from the aerators of two faucets, were sequenced. WGS analyses showed no correlation between the isolates from newborns and environmental isolates. The implementation of the measures for infection prevention and control had enabled us to successfully control the outbreak within a short period. WGS analyses proved to be crucial in outbreak investigation to limit the spreading of the pathogens.

Patient-derived pathogenic microbe deposition enhances exposure risk in pediatric clinics

Healthcare-associated infections (HAIs) pose significant risks to pediatric patients in outpatient settings. To prevent HAIs, understanding the sources and transmission routes of pathogenic microorganisms is crucial. This study aimed to identify the sources of opportunistic bacterial pathogens (OBPs) in pediatric outpatient settings and determine their transmission routes. Furthermore, assessing the public health risks associated with the core OBPs is important. We collected 310 samples from various sites in pediatric outpatient areas and quantified the bacteria using qPCR and CFU counting. We also performed 16S rRNA gene and single-bacterial whole-genome sequencing to profile the transmission routes and antibiotic resistance characteristics of OBPs. We observed significant variations in microbial diversity and composition among sampling sites in pediatric outpatient settings, with active communication of the microbiota between linked areas. We found that the primary source of OBPs in multi-person contact areas was the hand surface, particularly in pediatric patients. Five core OBPs, Staphylococcus epidermidis, Acinetobacter baumannii, Pseudomonas aeruginosa, Streptococcus mitis, and Streptococcus oralis, were mainly derived from pediatric patients and spread into the environment. These OBPs accumulated at multi-person contact sites, resulting in high microbial diversity in these areas. Transmission tests confirmed the challenging spread of these pathogens, with S. epidermidis transferring from the patient's hand to the environment, leading to an increased abundance and emergence of related strains. More importantly, S. epidermidis isolated from pediatric patients carried more antibiotic-resistance genes. In addition, two strains of multidrug-resistant A. baumannii were isolated from both a child and a parent, confirming the transmission of the five core OBPs centered around pediatric patients and multi-person contact areas. Our results demonstrate that pediatric patients serve as a significant source of OBPs in pediatric outpatient settings. OBPs carried by pediatric patients pose a high public health risk. To effectively control HAIs, increasing hand hygiene measures in pediatric patients and enhancing the frequency of disinfection in multi-person contact areas remains crucial. By targeting these preventive measures, the spread of OBPs can be reduced, thereby mitigating the risk of HAIs in pediatric outpatient settings.

The risks of healthcare-associated infections in healthcare settings of the Rostov region

Objective: to analyze the incidence of healthcare-associated infections (HAIs) in healthcare settings of the Rostov region and the risks of their occurrence in order to develop proposals for improving the complex of anti-epidemic and preventive measures to prevent HAIs in healthcare settings of the Rostov region at present.Materials and methods: the materials for the work were data from reports "On the state of sanitary and epidemiological welfare of the population in the Rostov region" during 2009–2022, inspection reports and instructions from officials of the Department of Rospotrebnadzor in the Rostov region, expert opinions of specialists from the filial of the Federal Budgetary Healthcare Institution "Center for Hygiene and Epidemiology in the Rostov Region" in Rostov-on-Don on selective inspection of healthcare setting in 2021-2023. The work used an operative and retrospective epidemiological analysis.Results: the results of the analysis of the incidence of HAIs and the risks of their occurrence in healthcare settings of the Rostov region distinctly demonstrated the relevance of the problem of HAIs. To ensure the safety of medical care in the Rostov region, additional professional training programs about prevention of HAIs have been developed for medical workers.Conclusion: the results obtained made it possible to identify the risks of HAIs and propose specific measures to improve the complex of anti-epidemic and preventive measures to prevent HAIs in healthcare settings of the Rostov region.

Harnessing of Artificial Intelligence for the Diagnosis and Prevention of Hospital-Acquired Infections: A Systematic Review.

Healthcare-associated infections (HAIs) are the most common adverse events in healthcare and constitute a major global public health concern. Surveillance represents the foundation for the effective prevention and control of HAIs, yet conventional surveillance is costly and labor intensive. Artificial intelligence (AI) and machine learning (ML) have the potential to support the development of HAI surveillance algorithms for the understanding of HAI risk factors, the improvement of patient risk stratification as well as the prediction and timely detection and prevention of infections. AI-supported systems have so far been explored for clinical laboratory testing and imaging diagnosis, antimicrobial resistance profiling, antibiotic discovery and prediction-based clinical decision support tools in terms of HAIs. This review aims to provide a comprehensive summary of the current literature on AI applications in the field of HAIs and discuss the future potentials of this emerging technology in infection practice. Following the PRISMA guidelines, this study examined the articles in databases including PubMed and Scopus until November 2023, which were screened based on the inclusion and exclusion criteria, resulting in 162 included articles. By elucidating the advancements in the field, we aim to highlight the potential applications of AI in the field, report related issues and shortcomings and discuss the future directions.

Online spaces and the control of communicable diseases: implications for nursing practice.

The digital revolution has significantly altered healthcare, including communicable disease control, with online spaces emerging as vital tools in preventing, identifying and controlling the spread of diseases. However, healthcare professionals, including nurses, need to find a balance between harnessing the benefits of mass communication and mitigating the potentially harmful effects of online misinformation. This article explores the benefits and challenges of using online spaces such as social media platforms in the control of communicable diseases and discusses the potential use of telehealth in reducing the risk of healthcare-associated infection and antimicrobial resistance. The author also describes a framework that nurses can use to explore potential roles and practice in the context of communicable disease control in online spaces.

Hyperglycemia in hospital: an independent marker of infection, acute kidney injury & stroke for hospital inpatients.

Hyperglycemia in hospital inpatients without pre-existing diabetes is associated with increased mortality. However, the independent contribution of hyperglycemia to healthcare-associated infection (HAI), acute kidney injury (AKI), and stroke is unclear. To investigate the relationship between hyperglycemia and adverse clinical outcomes in hospital for patients with and without diabetes. Diabetes IN-hospital: Glucose and Outcomes (DINGO) was a 26-week (October 2019 - March 2020) prospective cohort study. Clinical and glucose data were collected up to the 14th day of admission. Primary stratification was by hyperglycemia, defined as ≥2 random capillary blood glucose (BG) measurements ≥11.1 mmol/L (≥200 mg/dL). Propensity weighting for nine clinical characteristics, was performed to allow interrogation of causality. To maintain the positivity assumption, patients with HbA1c > 12.0% were excluded and pre-hospital treatment not adjusted for. The Royal Melbourne Hospital, a quaternary referral hospital in Melbourne, Australia. Admissions with at least two capillary glucose values and length of stay >24 hours were eligible, with half randomly sampled. HAI, AKI, stroke, and mortality. Of 2,558 included admissions, 1,147 (45%) experienced hyperglycemia in hospital. Following propensity-weighting and adjustment, hyperglycemia in hospital was found to, independently of nine covariables, contribute an increased risk of in-hospital HAI (130 [11.3%] vs.100 [7.1%], adjusted odds ratio [aOR] 1.03, 95% confidence interval [95%CI] 1.01-1.05, p = 0.003), AKI (120 [10.5%] vs. 59 [4.2%], aOR 1.07, 95%CI 1.05-1.09, p < 0.001), and stroke (10 [0.9%] vs. 1 [0.1%], aOR 1.05, 95%CI 1.04-1.06, p < 0.001). In hospital inpatients (HbA1c ≤ 12.0%), irrespective of diabetes status and pre-hospital glycaemia, hyperglycemia increases the risk of in-hospital HAI, AKI, and stroke compared with those not experiencing hyperglycemia.

Effect of COVID-19 on infections associated with medical devices in critical care

ObjectivesThis study explores the hypothesis that COVID-19 patients are at a heightened risk of healthcare-associated infections (HAIs) associated with medical device usage compared to non-COVID-19 patients. Our primary objective was to investigate the correlation between COVID-19 infection in ICU patients and subsequent HAIs following invasive medical device insertion. Additionally, we aim to assess the impact of SARS-CoV-2 infection on onset times concerning specific microorganisms and the type of medical device, providing valuable insights into this intricate relationship in intensive care settings.MethodologyA retrospective cohort study was conducted using ICU patient records at our hospital from 2020 to 2022. This investigation entailed evaluating the timing of HAIs while distinguishing between patients with and without SARS-CoV-2 infection. We identified and analyzed the type of isolation and infection attributed to the medical device while controlling for ICU duration and ventilator days using Cox regression.ResultsOur study included 127 patients without SARS-CoV-2 infection and 140 patients with SARS-CoV-2 infection. The findings indicated a higher incidence of HAI caused by various microorganisms associated with any medical device in patients with SARS-CoV-2 (HR = 6.86; 95% CI-95%: 3.26–14.43; p < 0.01). After adjusting for ICU duration and ventilator days, a heightened frequency of HAIs persisted in SARS-CoV-2-infected individuals. However, a detailed examination of HAIs revealed that only ventilation-associated pneumonia (VAP) displayed a significant association (HR = 6.69; 95% CI: 2.59–17.31; p < 0.01). A statistically significant correlation between SARS-CoV-2 infection and the isolation of S. aureus was also observed (p = 0.034). The prevalence of S. aureus infection was notably higher in patients with SARS-CoV-2 (RR = 8.080; 95% CI: 1.052–62.068; p < 0.01).ConclusionsThe frequency of pathogen isolates in invasive medical devices exhibited an association with SARS-CoV-2 infection. Critically ill patients with SARS-CoV-2 are more prone to developing early-onset VAP than those without SARS-CoV-2 infection.

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

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

A mixed-methods systematic review investigating the use of digital health interventions to provide palliative and end-of-life care for patients in low- and middle-income countries.

The need for palliative care is rising globally with 76% of those who are in need living in low- and middle-income countries (LMICs). Digital health interventions (DHIs) have been identified as a means of making palliative care more widely accessible. This review summarizes the range and characteristics of DHIs used to deliver palliative care in LMICs and sought to identify factors that influence their implementation and utilization. This review aims to summarize the range and characteristics of DHIs used to deliver palliative care in LMICs and identify factors that influence their implementation and utilization. Mixed-method systematic review incorporating both quantitative and qualitative data. All studies focusing on DHIs for patients who need palliative care (adults/children) and their caregivers (patient and caregiver centred) in LMICs and published in English were identified through a systematic search of MEDLINE, EMBASE, PsycINFO and CINAHL databases. Data synthesis and analysis were carried out following the convergent integrated approach based on the Joanna Briggs Institute (JBI) methodology for mixed-methods systematic reviews. Fifteen studies were included (three qualitative, four mixed-methods and eight quantitative studies). Telemedicine/mHealth was the most reported DHI utilized in LMICs in delivering palliative care. Patients and caregivers benefited from using DHIs in many ways including increased access to care with reduced discomfort, travel time and risk of health care-associated infections. Health care providers also reported that using DHI such as telemedicine enables them to provide care in a more effective and efficient way. Four factors were identified as the main barriers to implementation: resource constraints; literacy, training and skills; governance, operational and communication issues and technical issues. DHIs, such as telemedicine, have the potential to enhance accessibility to palliative care in LMICs, particularly in rural areas. Comprehensive strategies for their use are required to address the identified barriers.

Knowledge, Attitude and Practice of Infection Control among Medical Imaging Students in Unisza

Healthcare-associated infections risk in health care settings has caused a great concern to medical imaging students during clinical attachment due to high interaction rate with patients. Students may spread infections through inadequate knowledge and poor practice, which may then degrade the standard of care. Preventive measures and infection control policies have been developed to prevent the spread of infections, lower morbidity and medical care costs. However, recent evidence revealed poor level of health science students’ knowledge regarding infection control. This cross-sectional survey-based study is aimed to determine level of knowledge, attitude and practice towards infection control. This study is also aimed to determine the association between knowledge, attitude, and practice level of infection control and standard precautions among uniSZA medical imaging students. The sampling method used was purposive sampling. An online questionnaire was distributed using social media platforms, Whatsapp from 21th March to 22th April 2023. The questionnaire consists of 12 items on knowledge, 7 items on attitude and 10 items on practice about infection control. A total of 136 medical imaging students participated in this study, 98 Bachelor’s degree students and 38 Diploma students. Overall knowledge, attitude and practice level among students were good. The percentage of respondents had good knowledge, positive attitude and good practice were 100% (n=136), 100% (n=136) and 98.5% (n=134) respectively. Fisher’s exact test shows there was no association between attitude level and practice level of infection control among respondents (p =1.00). Continuous infection control training and education program are still required to enhance awareness of standard precautions and thus reduce infection exposure. Future recommendations are to include all health science students and medical students to participate in the survey. Further studies to assess the extent of public knowledge regarding infection control may also be conducted.

Factors Impacting Compliance with Infection Control Guidelines among healthcare providers in Neonatal Intensive Care Unit, referral hospital, Saudi Arabia

Healthcare-associated infections continue to be a major problem that endangers patient safety, especially for critically ill hospitalized patients. Reducing the risk of this infection can be achieved through improving compliance with infection control guidelines and identifying and controlling the associated factors. This study aim to investigate factors impacting compliance with infection control guidelines and increasing the risk of healthcare-associated infections in neonatal intensive care units. A qualitative approach, a one-to-one interview design, was used, between April 15 and May 15, 2021, to interview ten participants who worked in the neonatal intensive care unit at a Saudi Arabian referral hospital. Through data analysis, two major themes and four sub-themes were found, which include a factor related to the workforce (shortage of staff and lack of knowledge) and factors related to the workplace (shortage of supplies and lack of monitoring). In conclusion, healthcare-associated infections in neonatal intensive care units are a serious issue that could lead to an increase in mortality and morbidity rates among patients. Thus, healthcare settings' commitment to improve compliance with the infection control guidelines is essential to lowering the incidence of healthcare-associated infections. This can be achieved through proper staffing, sufficient supplies, and effective monitoring.