Specific Infection Control Measures Research Articles

Prevalence of latent tuberculosis infection (LTBI) in healthcare workers in Latin America and the Caribbean: systematic review and meta-analysis.

Tuberculosis remains a significant global health concern, and healthcare workers (HCWs) face a high risk of acquiring latent tuberculosis infection (LTBI) through occupational exposure. In the Latin American and Caribbean (LAC) region, where the burden of tuberculosis is substantial, understanding the prevalence of LTBI among HCWs is crucial for effective infection control measures. Therefore, we conducted a systematic review and meta-analysis to estimate the prevalence of LTBI among HCWs in LAC countries. Our search included MEDLINE, Scopus, EMBASE, Web of Science, and Google Scholar databases, focusing on relevant English-language records. We looked for observational studies from inception until December 2023. Our analysis included 38 studies representing 15,236 HCWs and 6,728 LTBI cases. These studies spanned the period from 1994 to 2023 and were conducted in Brazil, Peru, Cuba, Colombia, Trinidad and Tobago, Mexico, and Chile. The mean prevalence of LTBI among HCWs was 35.32% (range 17.86-56.00%) for interferon-gamma release assay (IGRA) and 43.67% (range 6.68-70.29%) for tuberculin skin test (TST). The pooled prevalence of LTBI among HCWs was 34.5% (95% CI 25.4-44.1%) for IGRA and 43.0% (95% CI 35.5-50.7%) for TST. When considering both IGRA and TST tests, the overall prevalence of LTBI among HCWs was 40.98% (95% CI 34.77-47.33%). LTBI was associated with longer lengths of employment and exposure to patients, family members, or any person with TB. Additionally, older HCWs faced a higher risk of LTBI. Specific professional roles (such as nurses, nurse technicians, or physicians), smoking, and deficient TB infection control measures increased the likelihood of LTBI. However, information regarding gender and BCG vaccination status showed discordance among studies. Our findings underscore a substantial burden of LTBI among HCWs in LAC countries. Implementing adequate infection control measures is essential to prevent and control transmission within healthcare settings.

The epidemiology of enterococci in a tertiary hospital and primary healthcare facilities in Fiji (2019–2022)

ObjectivesWe analysed 4 y of laboratory data to characterise the species and determine the antimicrobial susceptibility profiles of enterococci as human pathogens in Fiji. The study also investigated the molecular epidemiology amongst the subset of vancomycin-resistant enterococci (VRE). MethodsThis retrospective study reviewed bacteriological data from Colonial War Memorial Hospital (CWMH) and other healthcare facilities in the Central and Eastern divisions of Fiji. Phenotypic, antimicrobial susceptibility and vanA and vanB PCR testing were performed using locally approved protocols. The first clinical isolates per patient with antimicrobial susceptibility testing results in a single year were included in the analysis. Data was analysed using WHONET software and Microsoft Excel. ResultsA total of 1817 enterococcal isolates were reported, 1415 from CWMH and 402 from other healthcare facilities. The majority of isolates, 75% (n = 1362) were reported as undifferentiated Enterococcus spp., 17.8% (n = 324) were specifically identified as Enterococcus faecalis and 6.7% (n = 122) as E. faecium. Overall, 10% of the enterococci isolates were from blood cultures. Among isolates from CWMH, <15% of E. faecium were susceptible to ampicillin, and 17.2% were vancomycin resistant. Overall, 874 enterococcal isolates (including the undifferentiated species) were tested against vancomycin, of which 4.8% (n = 42) were resistance. All of the VRE isolates tested (n = 15) expressed vanA genes. ConclusionsThis study demonstrates the clinical importance of VRE, particularly van A E. faecium in the national referral hospital in Fiji. Enhanced phenotypic and molecular surveillance data are needed to better understand enterococci epidemiology and help guide specific infection prevention and control measures and antibiotic prescribing guidelines.

A predictive score for the result of carbapenem-resistant Enterobacterales and vancomycin-resistant enterococci screening

The duration of extensively drug-resistant bacteria (XDR) carriage depends on several factors for which the information can be difficult to recover. To determine whether past screening and clinical results of patients can predict the results of subsequent screening. In total, 256 patients were retrospectively included from 10 healthcare centres in France from January 2014 to January 2022. We created a predictive clearance score, ranging from -5 to+7, that included the number of XDR species and the type of resistance detected in the sample, as well as the time from the last positive sample, the number of previous consecutive negative samples, and obtaining at least one negative PCR result in the collection. This score could be used for the upcoming rectal screening of a patient carrying an XDR as soon as the last screening sample was negative. The negative predictive value was >99% for score ≤0. The median time to achieve XDR clearance was significantly shorter for a score of 0 (443 days (259-705)) than that based on previously published criteria. This predictive score shows high performance for the assessment of XDR clearance. Relative to previous guidelines, it could help to lift specific infection prevention and control measures earlier. Nevertheless, the decision should be made according to other factors, such as antimicrobial use and adherence to hand hygiene.

Detection and prevalence of extended spectrum β-lactamases production among Enterobacteriaceae isolated from urinary tract infections

Urinary tract infections (UTIs) by extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-E) have become an important public health problem with a substantial economic burden, as they lead to more complicated infections, longer duration of treatment, and increases in patient mortality. A total of 1267 urine samples were collected from patients during the period of 2018 to 2020. The isolates were identified based on colony morphology and biochemical tests. Antimicrobial susceptibility testing was done by modified Kirby Bauer disc diffusion method. Resistant isolates to third generation cephalosporins were tested for ESBL production by double-disk synergy test (DDST), DDST methods on MH agar plates supplemented with cloxacillin and by confirmatory double disk test (DDT). 400 strains causing UTIs were identified and classified as members of Enterobacteriaceae. The results of antimicrobial susceptibility tests showed that 68.5% (274/400) of the Enterobacteriaceae isolates were multi-drug resistant (MDR) strains. The overall prevalence of ESBL-E was 59.5% (238/400). The highest frequencies of ESBL-E were observed in internal medicine devices (68/400) and the highest ESBL production was observed in E. coli (85/238). The ESBL producing isolates were significantly resistant to penicillins and cephalosporins compared to non-ESBL producers. However, those ESBL-E strains were sensitive to imipenem (80.2%) and nitrofurantoin (87.8%). High levels of MDR strains and ESBL-E in our study highlights the need for applying specific infection control measures, and accordingly we urge physicians to opt for specific strategies for regular surveillance of uropathogenic bacteria.

Central-line-associated bloodstream infections, multi-drug-resistant bacteraemias and infection control interventions: a 6-year time-series analysis in a tertiary care hospital in Greece

Central-line-associated bloodstream infections (CLABSIs) are serious healthcare-associated infections with substantial morbidity and hospital costs. To investigate the association between the incidence of CLABSIs, the implementation of specific infection control measures, and the incidence of multi-drug-resistant (MDR) bacteraemias in a tertiary care hospital in Greece from 2013 to 2018. Analysis was applied for the following indices, calculated monthly: CLABSI rate; use of hand hygiene disinfectants; isolation rate of patients with MDR bacteria; and incidence of bacteraemias [total Gram-negative carbapenem-resistant Acinetobacter baumanii, carbapenem-resistant Pseudomonas aeruginosa and carbapenem-resistant Klebsiella pneumoniae; and/or Gram-positive meticillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci]. The total number of bacteraemias from carbapenem-resistant Gram-negative pathogens was significantly correlated with an increased CLABSI rate for all (total) hospital departments [incidence rate ratio (IRR) 1.17, 95% confidence interval (CI) 1.05-1.31, P=0.006] and the adult intensive care unit (ICU) (IRR 1.37, 95% CI 1.07-1.75, P=0.013). In the adult ICU, every increase in the incidence of each resistant Gram-negative pathogen was significantly correlated with a decreased CLABSI rate (carbapenem-resistant A.baumanii: IRR 0.59, 95% CI 0.39-0.90, P=0.015; carbapenem-resistant K.pneumoniae: IRR 0.48, 95% CI 0.25-0.94, P=0.031; carbapenem-resistant P.aeruginosa: IRR 0.54, 95% CI 0.33-0.89, P=0.015). The use of hand disinfectants was correlated with a decreased CLABSI rate 1-3 months before the application of this intervention for all (total) hospital departments (IRR 0.80, 95% CI 0.69-0.93, P=0.005), and for scrub disinfectants in the current month for the adult ICU (IRR 0.34, 95% CI 0.11-1.03, P=0.057). Isolation of patients with MDR pathogens was not associated with the incidence of CLABSIs. Hand hygiene was associated with a significant reduction in the incidence of CLABSIs at the study hospital. Time-series analysis is an important tool to evaluate infection control interventions.

Assessment of Hygiene Indicators When Using Gloves by Transport Workers in Russia during the COVID-19 Pandemic.

The COVID-19 outbreak represents a global public health emergency. National governments have gradually introduced restrictive measures. Using respiratory protective equipment (face masks) and gloves was essential practice without specific infection control measures or guidelines. This study aimed to assess hygiene indicators when using gloves by transport workers in Russia during the COVID-19 pandemic and to develop integral indicators and recommendations for wearing gloves for workers for whom this is a mandatory requirement. For this purpose, 1103 transport workers were surveyed using a questionnaire. We investigated the hygiene aspects of gloves and evaluated the bacterial contamination of the contact side of the gloves based on the wash results. We assessed the socio-demographic characteristics of the respondents, the duration of the work shift, the frequency of use of types of gloves, skin manifestations, the degree of comfort, and bacterial growth. We carried out the ranking according to comfort, the absence of adverse dermatological reactions when wearing gloves, and bacterial contamination of the inner surface of the gloves. It has been identified that it is necessary to use a comprehensive assessment of gloves to create a register of protective equipment, taking into account the frequency with which it was worn, the severity of the skin condition, comfort, and bacterial contamination.

SARS-CoV-2 infection prevalence in people experiencing homelessness.

People experiencing homelessness have peculiar characteristics that make them more vulnerable to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission and to more serious forms of Coronavirus Disease 19 (COVID-19). The aim of this study was to evaluate the prevalence of SARS-CoV-2 infection in the homeless population assisted by the primary care services of the Eleemosynaria Apostolica, Vatican City. Persons experiencing homelessness and the volunteers assisting them were tested for COVID-19 through PCR and antigen rapid test between October 1st, 2020, and June 5th, 2021, in the clinical facilities of the Eleemosynaria Apostolica. A total of 1665 subjects from 96 different countries in five continents were included in the study; age range was 1-90 years. Overall, 2315 COVID-19 tests through nasopharyngeal swab were performed; 1052 Polymerase Chain Reaction (PCR) tests and 1263 antigen rapid tests. Nearly 40% of the subjects underwent both tests (n=650, 39.04%), 402 were tested with PCR test only (24.14%) and 613 with antigen test only (36.8%). PCR tests were negative in 966 cases and positive in 86 (8.17%), while antigen tests were negative in 1205 cases and positive in 58 (4.59%). The number of positive cases varied over time, with a drastic increase during the winter months of 2020 and a progressive decrease over 2021. Among positive cases, 24.41% were symptomatic; symptoms included fever, breathing difficulties, anosmia/hyposmia, cough, headache, and diarrhea. This study reported an overall prevalence of SARS-CoV-2 infection in our sample slightly above 8%. Additional data on viral genome through sequencing of SARS-CoV-2 in positive cases are of utmost importance to help identify variants and implement specific infection control measures.

Cross infection control awareness of dentists of Northern India for Covid-19 pandemic

Pandemic of COVID-19 is globally on the rise. Routes of transmission include human to human contact. Dentists are at highest risk of coronavirus infection contraction and dissemination. Due to recent outbreak of this disease, definitive guidelines on this subject are not sufficient for various procedures. Awareness of protective measures for dental practices may reduce the number of new cases within the country. The aim of this study was to evaluate the awareness of cross infection control measures during stage I of pandemic of COVID-19 within dental practices of Lucknow &amp; Barabanki district Uttar Pradesh, India. A cross sectional study based on evidence provided by Department of Periodontics, Chandra Dental College &amp; Hospital, Safedabad, Barabanki was conducted during the stage I of spread of coronavirus amongst general dental practitioners of Lucknow &amp; Barabanki district Uttar Pradesh, India. A questionnaire comprising of 10 questions pertinent to the cross-infection protocol for COVID-19 in a dental setting was constructed. Sample size was calculated for registered general dental practitioners of Lucknow &amp; Barabanki district Uttar Pradesh, India. The form was communicated to 200 general dental practitioners all over Lucknow &amp; Barabanki district Uttar Pradesh, India. Out of these, 143 (71.5%) responded. Majority participants showed adequate level of awareness (more than 66%), for protection measures against corona virus COVID-19 in a dental practice. However, few aspects need more emphasis. such as during initial patient interview, temperature evaluation, radiographic records, pre-operative rinses, nature of permissible procedures, surface disinfection, irrigation and drainage methods, to control the chain the infection transmission. Earlier awareness of COVID-19 specific protection measures to health professionals may reduce the number of new diseased cases. Strict adherence to social distancing generally and COVID-19 specific cross infection control measures in a dental setting might help in timely control of this potentially deadly disease.

Preparing dental schools to refunction safely during the COVID-19 pandemic: an infection prevention and control perspective.

In late 2019 a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in China and spread throughout the world over a short period of time causing a pandemic of a respiratory disease named coronavirus disease 2019 (COVID-19). SARS-CoV-2 is easily transmitted from person to person through respiratory droplets and direct contact. The scarce available data indicate that dental healthcare personnel are at increased risk for acquisition of infection. Following the lockdown lifting, dental schools should be prepared to refunction safely and provide essential educational and healthcare services while protecting their students, patients, and personnel. The generation of aerosols in dental practice, in association with the high-transmissibility of SARS-CoV-2 through aerosol-generation procedures, the simultaneous provision of dental services to patients in the same areas, and the fact that asymptomatic and pre-symptomatic infected persons may transmit the virus, render the implementation of specific infection prevention and control measures imperative for dental schools. Herein we review the few evidence-based data available to guide infection prevention and control measures for COVID-19 in dental schools.

ANTIBIOTIC SUSCEPTIBILITY PATTERN AND PHENOTYPIC CHARACTERIZATION OF EXTENDED-SPECTRUM-BETALACTAMASE-PRODUCING Enterobacteriaceae ISOLATED FROM VARIOUS CLINICAL SAMPLES

The spread of antibiotic resistant organisms and those producing extended spectrum -lactamases (ESBL) has become a health care problem worldwide in communities and hospitals, as it leads to more complicated infections, longer duration of treatment, and increases in patient mortality. In the present study, we analyzed 226 clinical samples in order to assess the spread of ESBL-producing Enterobacteriaceae. 196 Enterobacteriaceae were identified and classified as members of the genera Pantoea, Klebsiella, Escherichia, Enterobacter, Serratia, Proteus, Citrobacter, and Raoultella. The results of susceptibility testing of isolated strains to 19 antibiotics showed that the most part of the isolates were highly resistant (p.0.01) to the tested -lactams: penicillins and penicillin like antibiotics (amoxicillin, ticarcillin and amoxicillin-clavulanic acid), first-generation cephalosporins (cephalexin), and second generation cephalosporins (cefoxitin). 60.20% of the Enterobacteriaceae isolates were multi-drug resistant (MDR) strains. Resistant isolates to third generation cephalosporins were tested for ESBL by tree methods, concluding its presence in 29.59% of the isolates by double-disk synergy test, 27.55% by the disk approximation method and by 31.63% double-disk test. High levels of MDR strains and ESBL- producing Enterobacteriaceae in our study suggest the need for applying specific infection control measures, and rational antibiotic use to reduce the selection pressure and prevent dissemination of resistant bacteria.

Rapid detection of gene encoding oxa carbapenemases in Acinetobacter using multiplex PCR

Background and Objective: Acinetobacter, has been identified as an important pathogen in nosocomial outbreaks with high levels of emerging drug resistance. So the present study was conducted in Acinetobacter spp to find out the utility of the multiplex PCR assay, which may be used as a useful technique in the early detection & prevention of blaOXA-23 and blaOXA-58 gene harbouring in clinical isolates taken from the patients coming to a tertiary care hospital. Materials and Methods: Strains of Acinetobacter collected from different clinical samples were subjected to antimicrobial susceptibility testing. Strains which were found showing resistance to imipenem by both disk diffusion and minimum inhibitory concentration (MIC), were analysed for the presence blaOXA-23 and blaOXA-58 (CLASS D) by using multiplex PCR. Results: Among 175 strains of Acinetobacter collected from the clinical samples, 45 strains showed imipenem resistance, both by disk diffusion and MIC out of which 19(42.2%) were positive for blaOXA-58 gene and all strains 45(100%) were positive for blaOXA-23 gene. Conclusion: The present study shows that there is dissemination of genes produced carbapenem resistant in the Acinetobacter isolates. This scientific evidence can be used to limit the spread of such strains in hospital settings as well as in the community, and also may help in initiating specific hospital infection control measures. Keywords –OXA carbapenemases, Imipenem, Acinetobacter, PCR

Prävention von postoperativen Wundinfektionen – mit Fokus auf die Gefäßchirurgie

Background Surgical site infections range between the most commonly and second most commonly reported health-care-associated infections worldwide, depending on the analysis. They are associated with increased morbidity and mortality. Not only for the individual patient, the negative consequences of acquiring a surgical site infection affect the patient's relatives, the hospital and health systems in general. In vascular surgery, gram-positive pathogens of the normal flora of the patient's skin and mucosa (nose/throat) represent the almost half of the number of pathogens detected at the infected surgical site. Staphylococcus aureus itself accounts for about one third of these positive samples. Measures of infection prevention and control Several general and more specific infection prevention and control measures exist, which when applied consistently, reliably, and in a timely manner protects patients and health workers, strengthens the health systems, and optimizes financial resources. In 2016 the World Health Organization launched the first Global Guidelines for the Prevention of surgical site infections. This guideline provides a comprehensive range of evidence-based recommendations for interventions related to the prevention of surgical site infections during the pre-, intra-, and postoperative periods. This article points out the value of this guideline and highlights relevant infection prevention and control measures with a special focus on the evidence in vascular surgery. Conclusion Among generally applicable recommendations and measures, in the field of vascular surgery, a special focus should be put on the interventions aiming at the reduction of the patient's flora on the skin and mucosa (nose/throat). This is relevant with regard to the relatively high percentage of pathogens being associated with surgical site infections in this field of surgery, and which are normally residing on these tissues. These measures compromise preoperative bathing or showering with soap, decolonization of Staphylococcus aureus in nasal carriers undergoing surgery with mupirocin ointment with or without CHG body wash or surgical skin preparation with an alcohol-based solution containing an antiseptic compound. Surgeons should closely cooperate with colleagues from other disciplines, the infection prevention and control team as well as with the hospital management in order to implement the infection prevention and control measures into the daily routine. Step-by-step implementation should be based upon the local needs and specifications.

Outbreaks in the adult ICUs.

Infectious disease outbreaks in the critical care setting are common and serious consequence. This article reviews and summarizes recent outbreaks in the adult ICUs. Outbreaks of multidrug-resistant bacteria, fungi, and emerging viruses in ICUs from different countries are common. Outbreak investigation relies on epidemiologic methods, microbiologic studies, and molecular typing methods. Overuse of antibiotics, gaps in implementing infection prevention measures, and contaminated environment are common causes of ICU outbreaks. ICU staff awareness of and preparedness for such outbreaks are crucial for outbreak prevention and control. Specific infection control measures vary according to outbreak transmission mode and cause. Outbreaks remain a significant threat to healthcare systems. Proper implementation of infection prevention practices and judicious use of antibiotics are needed for outbreak prevention in adult ICUs. Surveillance, proper outbreak investigation, adherence to infection prevention and control measures, and thorough disinfection of contaminated areas are required to successfully manage outbreaks.

Test evaluation and strategy proposal to detect and to characterize carbapenemase-producing gram negative bacilli

The detection of carbapenemase-producing gram negative bacilli is complicated, because there are available multiple options of test. The confirmation of the enzyme by molecular characterization is not available in all laboratories in our country. To propose a fast, efficient and simple strategy to detect and confirm CPB. 39 CPB isolates and 8 non-producing were used to evaluate the phenotypic test Carba NP, CarbAcineto NP and Blue-Carba, validating the test Xpert® Carba-R, to be used directly with bacterial colonies with conventional PCR. The sensitivity of Carba NP, CarbAcineto NP and Blue-Carba was 79,5; 87,2 y 84,6%, respectively; and specificity was 79.5; 87.2 and 84.6%, respectively. The limit of detection of Xpert® Carba-R was different for each carbapenemasa: 40.8 ufc/reaction to KPC and NDM and 30.6 ufc/reaction to VIM. On isolates with decreased susceptibility to carbapenems we propose to use as screening the test CarbAcineto NP, follow by Xpert®Carba-R to characterize the carbapenemase and adopt specific infection control measures.

Linezolid-resistant Enterococcus (LRE) faecium from Blood Culture of an Adult Burns Patient: First Report of LRE from Mumbai.

Sir, Linezolid is an oxazolidone antibiotic used for treating infections due to Gram-positive cocci. There have been reports of emerging linezolid resistance in complicated enterococcal infections.[1] The first report of nosocomial transmission of linezolid-resistant Enterococcus (LRE) faecium was from Mayo Clinic, USA.[2] We reported the first documented case of LRE from Mumbai. A 36-year-old male was admitted to a tertiary care hospital in Mumbai with history of electric burns. Extensive debridement of both upper and lower limbs was done. He was started on injection meropenem and metronidazole. After 10 days of admission, the patient developed intermittent spikes of fever, and his blood was sent for culture. The blood culture grew E. faecium, resistant to both vancomycin and linezolid. Minimum inhibitory concentration (MIC) of vancomycin was >32 µg/ml and linezolid MIC >8 µg/ml. It also exhibited high-level aminoglycoside resistance. The first and only reported case of LRE faecium from India was from Kolkata in 2015, with no history of prior linezolid medication.[3] LRE has been reported even without prior exposure, and asymptomatic colonization has also been documented.[4] A nosocomial transmission of LRE may be a possibility in our patient. Resistance to linezolid is a matter of grave concern. Indiscriminate use of linezolid and its availability as an oral preparation may contribute to the development of resistance. Rational use of linezolid and avoiding long-term therapy with linezolid should be the objective of every treating physician. Sincere efforts are also needed for specific infection control measures for LRE. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Molecular Characterization of Multidrug Resistant Strains of Acinetobacter baumannii Isolated from Intensive Care Units in West of Iran

According to the results of various studies using phenotypic methods, the prevalence of Multidrug Resistant (MDR) Acinetobacter baumannii (A. baumannii) isolates has been increasing worldwide. Pulsed-Field Gel Electrophoresis (PFGE) technique is known as the gold standard method to determine clonal characterization of bacterial species, especially A. baumannii. To determine the clonal relatedness and investigate the prevalence of integron classes 1 and 2 and genes encoding OXA-23 and 24 in A.baumanii isolates. A cross-sectional study was conducted from November 2011 to January 2013. A total of 140 A.baumannii isolates collected from three hospitals of Kermanshah were considered out of which 75 ICU isolates were included in this study. Antibiotics susceptibility test was done by disk diffusion method. Polymerase Chain Reaction (PCR) was performed in order to detect class 1 and 2 integrons and blaOXA-23-like, blaOXA-24-like genes. Isolates identified as MDR from a total of 75 Intensive Care Units (ICU) strains were subjected to genotyping for clonal relatedness. A total of 37 isolates among 75 ICU isolates were identified as MDR. The maximum drug resistance was observed against ceftriaxone, mezlocycline, cefotaxime, piperacilin, ciprofloxacin and imipenem. Frequency of Class 1 and Class 2 Integrons, blaOXA-23-like and blaOXA-24-like genes were 33(44%), 27(36%), 60(80%) and 14(18.6%) respectively. Four clusters with high level of similarity were obtained showing homogeneity among MDR isolates. Significant correlation between presence of integrons and resistance to different classes of antibiotic was observed in this study. Monitoring of drug resistance using gene integrase PCR and blaOXA gene by cluster analysis is very important to plan specific infection control measures due to MDR A. baumannii.

Integron-Mediated Antibiotic Resistance in Acinetobacter baumannii Isolated from Intensive Care Unit Patients, Babol, North of Iran.

Background We investigated the integron types and their relation with antibiotic resistance among A. baumannii isolates collected from intensive care unit patients, Babol, north of Iran. Methods In this cross-sectional study, a total of 73 bronchoalveolar lavage samples were obtained from patients in ICU. Susceptibility testing was performed by disk diffusion method. Types of integrons were identified by an integrase gene PCR. Results In total, 47.9% A. baumannii isolates were recovered from the BAL samples. All isolates were resistant to ceftazidime. 91.4% and 58.3% of isolates were MDR and XDR, respectively. The rate of colistin resistance with the E-test was 5.7%. Molecular analysis of class I, II, and III integrons showed that 25.7%, 88.6%, and 28.6% of the isolates carried the intI, intII, and intIII genes, respectively. Discussion Our results show that different classes of integrons are commonly spread among A. baumannii strains and these genomic segments can play an important role in the acquisition of MDR and XDR phenotypes. So monitoring drug resistance in A. baumannii isolates with the use of int gene PCR is very important to plan specific infection control measures to prevent the spread of MDR-AB and XDR-AB in Iran's hospitals.

Hand Hygiene in Haemodialysis Units

Healthcare-associated infections are a major risk to patient safety. Infection is the first cause of hospitalisation and the second most common cause of mortality among haemodialysis (HD) patients. HD patients, as well as the dialysis staff, are vulnerable to contracting healthcare-associated infections due to frequent and prolonged exposures to many possible contaminants in the dialysis environment. The extracorporeal nature of the therapy, the associated common environmental conditions, and the immune compromised status of HD patients are major predisposing factors. HD patients are exposed to different types of infections which include bloodstream infections and localized infections of the vascular access, blood-borne infections with hepatitis B virus, hepatitis C virus, and/or human immunodeficiency virus, and airborne infections. Sources of infections include contaminated water, equipment, environmental surfaces, and infected patients. The evident increased potential for transmission of infections in the HD settings led to the creation and implementation of specific and stricter infection prevention and control measures in addition to the usual standard precautions. Contaminated hands of healthcare workers are among the most common modes of transmission of healthcare-associated infections. Hand hygiene is singled out as the most important infection prevention intervention. Hand hygiene compliance can be improved by continuous education and monitoring, providing a sufficient number of sinks with soap dispensers, paper towels, hand lotions and alcohol-based hand rub placed at each patient station, and regular feedback of surveillance results. Education and training and full awareness of infection control policies and procedures should be provided to all Healthcare workers and to be repeated regularly. The patient and/or caregiver should also be educated on hand hygiene and the care of new vascular access.

Infection control in hemodialysis units: a quick access to essential elements.

Infection is the most common cause of hospitalization and the second most common cause of mortality among hemodialysis (HD) patients, after cardiovascular disease. HD patients as well as the dialysis staff are vulnerable to contracting health-care-associated infections (HAIs) due to frequent and prolonged exposure to many possible contaminants in the dialysis environment. The extracorporeal nature of the therapy, the associated common environmental conditions and the immune compromised status of HD patients are major predisposing factors. The evident increased potential for transmission of infections in the HD settings led to the creation and implementation of specific and stricter infection prevention and control measures in addition to the usual standard precautions. Different international organizations have generated guidelines and recommendations on infection prevention and control for implementation in the HD settings. These include the Centers for Disease Control and Prevention (CDC), the Association of Professionals in Infection Control (APIC), the Kidney Disease Outcomes Quality Initiative (K/DOQI), the European Best Practice Guidelines/European Renal Best Practice (EBPG/ERBP) and the Kidney Disease: Improving Global Outcomes (KDIGO). However, these guidelines are extensive and sometimes vary among different guideline-producing bodies. Our aim in this review is to facilitate the access, increase the awareness and encourage implementation among dialysis providers by reviewing, extracting and comparing the essential elements of guidelines and recommendations on infection prevention and control in HD units.

Epidemiological surveillance of bacterial nosocomial infections in the surgical intensive care unit.

Introduction:Intensive care units (ICUs) are associated with a greater risk of developing nosocomial infections (NIs) than other departments.Aim:The aim of this study was to determine the rate, the site and causative organisms of NIs in the surgical ICU at University Clinical Center Tuzla.Methods:All patients admitted to the surgical ICU were followed prospectively, for the development of NIs (January-December 2010). Determination of NIs was performed using standardized the Centers for Disease Control and Prevention (CDC) criteria.Results:94 out of 834 patients (11.27%) developed NIs. Respiratory tract infections were seen in 56 (60%), urinary tract infections in 15 (16%) and gastrointestinal tract infections in 8 (9%) patients. Other infections identified were surgical site, bloodstream and skin infections. Gram-negative organisms were reported in approximately 75% of cases (78.7% extended-spectrum beta-lactamase (ESBL)-producers). Klebsiella pneumoniae was the commonest (51.0%), followed by Proteus mirabilis (21.3%) and Pseudomonas aeruginosa (10.6%). Methicillin-resistant Staphylococcus aureus (MRSA) (16%), and Clostridium difficile (9.6%) were the commonest among gram-positive bacteria.Conclusion:Respiratory and urinary tract infections made up the great majority of NIs. ICU patients are more susceptible to NIs, emphasizing the importance of continuous surveillance and enforcement of specific infection control measures.