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Background: The primary goal of hand hygiene is to reduce infectious disease rates. We examined if a nursing home's participation in a hand hygiene intervention resulted in residents having fewer healthcare associated infections (HAIs) when compared to nursing homes without the hand hygiene intervention. Methods: This study is a part of a cluster randomized controlled trial (RCT) in 33 nursing homes to improve hand hygiene (HANDSOME). The incidence of five illnesses was followed over 13 months: gastroenteritis, influenza-like illness, pneumonia, urinary tract infections and infections from methicillin-resistant Staphylococcus aureus (MRSA). Incidence rates per study arm were reported for baseline (October–December 2016) and two follow-up periods (January–April 2017, May–October 2017). HAI rates were compared in a Poisson multilevel analysis, correcting for baseline differences (the baseline infection incidence and the size of the nursing home), clustering of observations within nursing homes, and period in the study. Results: There was statistically significantly more gastroenteritis (p < 0.001) and statistically significantly less influenza-like illness (p < 0.01) in the intervention arm when compared to the control arm. There were no statistically significant differences or pneumonia, urinary tract infections, and MRSA infections in the intervention arm when compared to the control arm. In a sensitivity analysis, gastroenteritis was no longer statistically significantly higher in the intervention arm (p = 0.92). Conclusions: As in comparable studies, we could not conclusively demonstrate the effectiveness of an HH intervention in reducing HAIs among residents of nursing homes, despite the use of clearly defined outcome measures, a standardized reporting instrument, and directly observed HH in a multicenter cluster RCT. Trial registration Netherlands Trial Register, trial NL6049 (NTR6188). Registered October 25, 2016, https://www.trialregister.nl/trial/6049. [ABSTRACT FROM AUTHOR]

Across the globe, hand hygiene (HH) is promoted to fight the spread of healthcare associated infections. Despite multiple ongoing HH campaigns and projects, the healthcare associated infection rates remain high especially in low- and middle-income countries. In the narrative overview presented here, we aim to share objectives, framework, successes and challenges of our long-term partnership in Guinea to offer guidance for other projects aiming to sustainably improve HH. [ABSTRACT FROM AUTHOR]

Objective: to offer additional criteria for assessing registration quality of congenital infections and neonates’ pyoseptic infections. Material and methods: a retrospective epidemiological analysis of congenital infections incidence, pyoseptic infections of puerperas and neonates during 2007–2017 was conducted in this study. All subjects of the Russian Federation were divided into some groups according to registered incidence rate and ratio among congenital, pyoseptic infections of puerperas and neonates with using the method of ranging. Comparative correlation analysis was conducted between puerperas’ pyoseptic infections and neonates’ congenital infections in accordance with registered rate. The sample of the date was taken from Statistical Reporting Form No 2 «Report on infectious and parasitic diseases» for the Russian Federation during 2007–2017, Unified interdepartmental information and statistical system. Results: in most regions of the Russian Federation the registration of healthcare associated infections puerperas and neonates is at a low. More than a half of subjects have low incidence rates (less than 1,0) for one or more of the considered infections. Until now, there are several subjects that do not register healthcare associated infections at all. The absence of correlation relation between the morbidity of the puerperas’ pyoseptic infections and neonates’ congenital infections on the whole in the country confirms this fact. At the same time, the correlation analysis of separate regions with the registration close to the real figures has shown a strong positive relationship between puerperas’ pyoseptic infections and congenital infections. Conclusion: thus, it can be concluded that the presence of relation between rates of incidence of puerperas’ healthcare associated infections and neonates’ congenital infections can be used as one of the epidemiological criteria for assessing the completeness of the registration of healthcare associated infections.

High prevalence and great socio-economic impact of nosocomial infections is documented in obstetric hospitals. Objective: to uncover Russia-wide epidemiological features for congenital and nosocomial infections in newborns. Material and Methods: the data covering 2008–2016 period were retrieved from the Federal Statistical Monitoring Form No. 2 “Report on Infectious and Parasitic Diseases”, via the Unified Interdepartmental Information Statistical System. During 2008–2016, incidence of congenital and nosocomial infections in newborns was analyzed in various constituents of the Russian Federation, which were divided into quartile groups including confidence interval. Results: It was found that the increased/decreased/unchanged incidence of congenital infections in newborns was shown in 30, 31 and 13 subjects, respectively. In case of nosocomial infections in newborns, its incidence was increased/decreased/unchanged in 7, 41 and 26 subjects, respectively. Moreover, a congenital/nosocomial infection ratio in newborns was increased/decreased/ unchanged in 40, 15 and 19 subjects, respectively. Based on the morbidity pattern, 9 major groups might be distinguished. In particular, the most abundant (16 subjects) was the group with increased incidence of congenital infections, decreased incidence of nosocomial infections and increased congenital/nosocomial infection ratio in newborns. However, it is worth mentioning that recording of nosocomial infection cases is incomplete in the vast majority of the subjects of the Russian Federation: as few as seven subjects may be highlighted providing a proper registration of nosocomial and congenital infections in newborns such as: Vologda Region, Trans-Baikal Territory, Nizhny Novgorod Region, Omsk Region, Orenburg Region, Penza Region, and Sverdlovsk Region. Conclusion: to fully assess an objective status on nosocomial and congenital infections in newborns, it is necessary that a hospital epidemiologist investigates every single case; ensure applying a standard approach to determine a case of healthcare-associated infection, congenital infections; official recording of all cases; responsibility of all staff members involved in recording healthcare-associated infection cases; regularly reviewed data by using science-based methods. Key words: congenital infections, nosocomial infections, healthcare associated infections, registration, incidence, mortality.

The rise of multidrug-resistant (MDR) pathogens has become a global health threat and an economic burden in providing adequate and effective treatment for many infections. This large-scale concern has emerged mainly due to mishandling of antibiotics (ABs) and has resulted in the rapid expansion of antimicrobial resistance (AMR). Nowadays, there is an urgent need for more potent, non-toxic and effective antimicrobial agents against MDR strains. In this regard, clinicians, pharmacists, microbiologists and the entire scientific community are encouraged to find alternative solutions in treating infectious diseases cause by these strains. In its “10 global issues to track in 2021”, the World Health Organization (WHO) has made fighting drug resistance a priority. It has also issued a list of bacteria that are in urgent need for new ABs. Despite all available resources, researchers are unable to keep the pace of finding novel ABs in the face of emerging MDR strains. Traditional methods are increasingly becoming ineffective, so new approaches need to be considered. In this regard, the general tendency of turning towards natural alternatives has reinforced the interest in essential oils (EOs) as potent antimicrobial agents. Our present article aims to first review the main pathogens classified by WHO as critical in terms of current AMR. The next objective is to summarize the most important and up-to-date aspects of resistance mechanisms to classical antibiotic therapy and to compare them with the latest findings regarding the efficacy of alternative essential oil therapy.

In the article actual problems of effective struggle against healthcare associated infections (HAI) are formulated. One of the key components of the HAI prevention system is the proper training of medical personnel of all ranks. The article gives an overview of the measures aimed at increasing the level of professional competencies of medical workers in the field of non-specific prevention of HAI. The wide spread of hospital strains having a large arsenal of adaptation mechanisms characteristic of opportunistic microorganisms, the expansion of the range of disinfectants used, the lack of a unified strategy for the use of disinfectants in practical public health care requires a change in the methodological approaches to the use of disinfectants, methods and technologies of nonspecific prevention, and therefore, level of competence of the personnel of the higher and middle level. There is evidence and justification for the existing link between the participation of trained health professionals in the field of infection control and the higher results of HAI prevention The issue is discussed of participation of disinfections specialists of the public health centers in the form of sanitary-epidemiologic audit in the production control of HAI in medical organizations . The effectiveness of the fight against HAI is determined by proper training and continuous adherence to the professional culture of using safe methods in the provision of medical care. Proceeding from this, it is necessary to create Infection Prevention and Control Programmes (IPCPs), identifying the core components required for different levels of health care, from the national to the health care facility.

Abstract Background Blood cultures (BCs) are the gold standard for diagnosing sepsis and are prerequisite for a targeted antibiotic treatment and essential for patient outcomes. Aim of the study was to analyze the frequency of BCs, the rate of central line-associated bloodstream infections (CLABSIs) and to study the association between both parameters on intensive care units in Germany over time. Methods Cross-sectional studies at two points in time (2006, 2015) on ICUs participating in the German hospital infection surveillance system. CLABSIs were defined according to the Center for Disease Control and Prevention (CDC). Univariable and multivariable analyses were performed using generalized linear models. Results A total of 639 ICUs participated in 2006 or 2015 and 90 ICUs (“core group”) in both years. Overall, 2,427,921 patient days from 644,575 patients were analyzed. In the ICU core group the frequency of BCs per 1000 patient days doubled from 57.8 (interquartile range [IQR] 29.8–101.2; 2006) to 128.2 (IQR 71.6–183.2; 2015). In the same time, the pooled median CLABSI rate decreased from 0.8 (IQR 0–1.9; 2006) per 1000 central-line catheter days to 0.2 (IQR 0–0.9; 2015). Conclusions From 2006 to 2015 the frequency of BCs increased on ICUs in Germany and is now within the recommended 100 to 200 BCs sets per 1000 patient days.

Summary: Introduction: In the early phase of the coronavirus disease (COVID-19) epidemic in France, knowledge of SARS-COV-2 characteristics was limited, and personal protective equipment (PPE) was lacking. Thus, health care workers (HCWs) were exposed to nosocomial transmission. Methods: A multicenter regional descriptive study of fifty-two heath care facilities covering 30,533 HCWs in western Normandy, France, from March 3 to March 27, 2020, before the incidence threshold of 10/100,000 inhabitants was crossed in the study area. The incidence rate of COVID-19 in HCWs, the attack rates and the serial interval distribution of nosocomial transmission were computed. Demographic characteristics of HCWs, contacts with index cases, and the use of personal protective equipment were collected by a structured questionnaire. Results: The incidence rate of COVID-19 in HCWs was 2.7‰. Among 19 situations (13 clusters >2 cases), 10 were HCW-HCW and 9 patient-HCW transmission, the global attack rate was 13.7% (95% confidence interval, 10.6%–17.3%), and 68 HCWs were involved (10 index cases, with 58 secondary cases). Exposure of secondary cases was only in the presymptomatic phase of the index case in 29% of cases, 48% for HCW-HCW and 10% for patient-HCW transmission (P

Background: Healthcare-associated infections (HAIs) represent a major Public Health issue. Hospital-based prevalence studies are a common tool of HAI surveillance, but data quality problems and non-representativeness can undermine their reliability.Methods: This study proposes three algorithms that, given a convenience sample and variables relevant for the outcome of the study, select a subsample with specific distributional characteristics, boosting either representativeness (Probability and Distance procedures) or risk factors' balance (Uniformity procedure). A "Quality Score" (QS) was also developed to grade sampled units according to data completeness and reliability. The methodologies were evaluated through bootstrapping on a convenience sample of 135 hospitals collected during the 2016 Italian Point Prevalence Survey (PPS) on HAIs.Results: The QS highlighted wide variations in data quality among hospitals (median QS 52.9 points, range 7.98-628, lower meaning better quality), with most problems ascribable to ward and hospital-related data reporting. Both Distance and Probability procedures produced subsamples with lower distributional bias (Log-likelihood score increased from 7.3 to 29 points). The Uniformity procedure increased the homogeneity of the sample characteristics (e.g., - 58.4% in geographical variability). The procedures selected hospitals with higher data quality, especially the Probability procedure (lower QS in 100% of bootstrap simulations). The Distance procedure produced lower HAI prevalence estimates (6.98% compared to 7.44% in the convenience sample), more in line with the European median.Conclusions: The QS and the subsampling procedures proposed in this study could represent effective tools to improve the quality of prevalence studies, decreasing the biases that can arise due to non-probabilistic sample collection. [ABSTRACT FROM AUTHOR]

• The impact of a multimodal infection control strategy originally designed for containment of COVID-19 on the rates of other hospital-acquired-infections (HAIs) was evaluated over a 7-month period across the largest healthcare system in Singapore. • During the COVID-19 pandemic, methicillin-resistant Staphylococcus aureus acquisition rates declined significantly, together with central-line-associated-bloodstream infection rates; likely due to increased compliance with standard precautions. • Enhanced infection control measures resulted in the unintended positive consequences of containing health care-associated respiratory viral infections, with a significant and sustained decline for both enveloped and nonenveloped respiratory viruses. • The ongoing COVID-19 pandemic provided the impetus to demonstrate the potential benefit of heightened infection control measures in controlling HAIs and acquisition of multidrug-resistant-organisms. In the current COVID-19 pandemic, aggressive Infection Prevention and Control (IPC) measures have been adopted to prevent health care-associated transmission of COVID-19. We evaluated the impact of a multimodal IPC strategy originally designed for the containment of COVID-19 on the rates of other hospital-acquired-infections (HAIs). From February-August 2020, a multimodal IPC strategy was implemented across a large health care campus in Singapore, comprising improved segregation of patients with respiratory symptoms, universal masking and heightened adherence to Standard Precautions. The following rates of HAI were compared pre- and postpandemic: health care-associated respiratory-viral-infection (HA-RVI), methicillin-resistant Staphylococcus aureus , and CP-CRE acquisition rates, health care-facility-associated C difficile infections and device-associated HAIs. Enhanced IPC measures introduced to contain COVID-19 had the unintended positive consequence of containing HA-RVI. The cumulative incidence of HA-RVI decreased from 9.69 cases per 10,000 patient-days to 0.83 cases per 10,000 patient-days (incidence-rate-ratio = 0.08; 95% confidence interval [CI] = 0.05-0.13, P <.05). Hospital-wide MRSA acquisition rates declined significantly during the pandemic (incidence-rate-ratio = 0.54, 95% CI = 0.46-0.64, P <.05), together with central-line-associated-bloodstream infection rates (incidence-rate-ratio = 0.24, 95% CI = 0.07-0.57, P <.05); likely due to increased compliance with Standard Precautions. Despite the disruption caused by the pandemic, there was no increase in CP-CRE acquisition, and rates of other HAIs remained stable. Multimodal IPC strategies can be implemented at scale to successfully mitigate health care-associated transmission of RVIs. Good adherence to personal-protective-equipment and hand hygiene kept other HAI rates stable even during an ongoing pandemic where respiratory infections were prioritized for interventions. [ABSTRACT FROM AUTHOR]

Objective: To evaluate efficacy of chlorhexidine gluconate (CHG) to decolonize multidrug-resistant (MDR) gram-negative bacilli (GNB) bacteria, and to reduce healthcare associated infections (HAIs) in general medical inpatients. Materials and Methods: A 1-year, cluster-randomized study was conducted in a university hospital-based general medical unit. Eligible patients were randomized by study ward for routine daily and extra wiping with non-rinsed CHG-cloths (CHG group, n=145) or rinsed, non-medicated soap bath (control group, n=145), consecutively to the end of study. Study nurses received training and audits per CHG protocol. In all participants, axillae, groins, and perianal area were sampled to detect GNB colonization, on day 4 to 7 and day 11 to 14 of admission, by surveillance culture. All were followed for incidence rates of HAIs to day 14 of the study, or study exclusion. Results: MDR GNB colonization were significantly lower in CHG group than those of control group, both day 4 to 7 (15.9% versus 43.4%, respectively, p<0.01), and day 11 to 14 of admission (20.6% versus 65.4%, respectively, p<0.01). The incidence rates of overall HAIs did not differ between groups (5.80 versus 7.10 episodes per 1,000 patient-day, respectively, p=0.84). Three patients developed minor skin irritation in CHG group. Discussion, to the investigators' knowledge, the present study is the first to demonstrate significant CHG reduction of MDR GNB colonization among medical patients in non-critical care unit. Use of non-rinsed CHG bath, personnel training, and audits, may maintain adequate skin concentration of CHG, and lower risk of cross-transmission. To effectively reduce HAIs, combined CHG bath and bundle of care may be required. Conclusion: Non-rinsed chlorhexidine baths are safe, well-tolerated, and effective to reduce MDR gram-negative bacterial colonization among general medical inpatients, and possible to lower risk of subsequent HAIs and cross-transmission, by day 14 of admission. [ABSTRACT FROM AUTHOR]

The spread of resistant bacteria in hospitals is an increasing problem worldwide. Transfers of patients, who may be colonized with resistant bacteria, are considered to be an important driver of promoting resistance. Even though transmission rates within a hospital are often low, readmissions of patients who were colonized during an earlier hospital stay lead to repeated introductions of resistant bacteria into hospitals. We developed a mathematical model that combines a deterministic model for within-hospital spread of pathogens, discharge to the community and readmission, with a hospital–community network simulation of patient transfers between hospitals. Model parameters used to create the hospital–community network are obtained from two health insurance datasets from Germany. For parameter values representing transmission of resistant Enterobacteriaceae, we compute estimates for the single admission reproduction numbers RAand the basic reproduction numbers R0per hospital–community pair. We simulate the spread of colonization through the network of hospitals, and investigate how increasing connectedness of hospitals through the network influences the prevalence in the hospital–community pairs. We find that the prevalence in hospitals is determined by their RAand R0values. Increasing transfer rates between network nodes tend to lower the overall prevalence in the network by diluting the high prevalence of hospitals with high R0to hospitals where persistent spread is not possible. We conclude that hospitals with high reproduction numbers represent a continuous source of risk for importing resistant pathogens for hospitals with otherwise low levels of transmission. Moreover, high risk hospital–community nodes act as reservoirs of pathogens in a densely connected network.

• Nursing team variables beyond nurse:patient ratios may affect team ability to focus on infection prevention in critically ill patients. • Nursing shift staffing records were used to investigate if periods of relative staffing vulnerabilty were associated with periods of risk occuring a few days before a device associated infection. • Changes in team composition may be associated with acquisition of device associated infection in vulnerable patients. The relationship between nursing staffing levels and healthcare-associated infections (HAIs) has been explored previously with conflicting results. This study uses daily shift records from 2 intensive care units (ICUs) to evaluate whether nuanced changes in nursing team composition impacts subsequent risk for device associated HAIs. Staffing deficiencies may be associated with periods of risk prior to central line-associated bloodstream infection in the ICU. [ABSTRACT FROM AUTHOR]

Background Antibiotics designed to decolonize carriers of drug-resistant organisms could offer substantial population health benefits, particularly if they can help avert outbreaks by interrupting person-to-person transmission chains. However, cost effectiveness of an antibiotic is typically evaluated only according to its benefits to recipients, which can be difficult to demonstrate for carriers of an organism that may not pose an immediate health threat to the carrier. Methods We developed a mathematical transmission model to quantify the effects of 2 hypothetical antibiotics targeting carbapenem-resistant Enterobacteriaceae (CRE) among long-term acute care hospital inpatients: one assumed to decrease the death rate of patients with CRE bloodstream infections (BSIs) and the other assumed to decolonize CRE carriers after clinical detection. We quantified the effect of each antibiotic on the number of BSIs and deaths among patients receiving the drug (direct effect) and among all patients (direct and indirect effect) compared to usual care. We applied these results to a cost-effectiveness analysis with effectiveness outcome of life-years gained and assumed costs for antibiotic doses and for CRE BSI. Results The decolonizing antibiotic, once indirect effects were included, produced increased relative effectiveness and decreased relative costs compared to both usual care and the BSI treatment antibiotic. In fact, in most scenarios, the decolonizing drug was the dominant treatment strategy (ie, less costly and more effective). Conclusions Antibiotics that decolonize carriers of drug-resistant organisms can be highly cost-effective when considering indirect benefits within populations vulnerable to outbreaks. Public health could benefit from finding ways to incentivize development of decolonizing antibiotics in the US, where drugs with unclear direct benefits to recipients would pose difficulties in achieving FDA approval and financial benefit to the developer. [ABSTRACT FROM AUTHOR]

Background: Antibiotic resistance is the main problem in infectious disease management. Multidrug-resistant (MDR) bacteria could be carried by admitted patients and become a source of spread in the hospital, causing infections in other patients or the patients themselves. However, the screening of MDR bacteria has not been a standard in developing countries. This study aimed to get the prevalence of MDR bacteria colonization in patients on admission to Dr. Cipto Mangunkusumo Hospital., Methods: Selective liquid media with added antibiotics were used for culturing the MDR bacteria. While admitted to the hospital, subjects were sampled and interviewed to fill out a questionnaire. The screening specimens used for this study were throat, navel, rectal, nasal, and armpit swabs. During hospitalization, hospital-acquired infections (HAIs) were recorded., Results: Of 100 patients included in the study, the prevalence of MDR bacteria colonization on admission was 63% (n=63) with the prevalence of CR-GNB, ESBL-PE, and MRSA were 11%, 54%, and 11%, respectively. Two-thirds of the patients with HAIs (n=8/12) were colonized with MDR bacteria. Factors associated with MDR bacteria colonization were the recent use of invasive medical devices and comorbidity, while a factor associated with CR-GNB colonization was the recent use of antibiotics., Conclusion: The prevalence of MDR bacteria colonization in patients on admission to Dr. Cipto Mangunkusumo Hospital in 2022 was 63% (n=63), of which 12.68% (n=8) experienced HAIs during hospitalization. MDR bacteria colonization was associated with the recent use of invasive medical devices and comorbidity. History of antibiotic use was associated with CR-GNB colonization.

Two bacteriophages (phages) of Klebsiella pneumoniae were isolated from sewage water collected from Dakar, Senegal. Phage vKpIN17 belongs to the Przondovirus genus within the Autographiviridae family, with double-stranded DNA genomes, whereas vKpIN18 belongs to the Webervirus genus of the Drexlerviridae family., Competing Interests: The authors declare no conflict of interest.

Aim: To determine the level of knowledge and explore the difference of hand hygiene between nursing students and nurses., Background: Annually, 3.8 million people in Europe acquire healthcare-associated infections, highlighting the importance of hand hygiene. Despite WHO's emphasis on the fact that greater hand hygiene knowledge correlates with improved hand hygiene compliance, several studies have shown knowledge gaps among nurses and nursing students regarding hand hygiene., Design: Descriptive cross-sectional comparative survey., Methods: A version of the WHO "Hand Hygiene Knowledge Questionnaire", translated into Swedish, was used for data collection among nursing students in the first and last semester, and registered nurses from a university and associated hospital. Data were analyzed by descriptive statistics, and comparison between groups with Fisher's exact test, one-way ANOVA, and post-hoc tests (Pairwise Z-Tests, Tukey HSD)., Results: The survey, conducted between December 2020 and January 2021, received responses from 201 participants, including 71 first semester students, 46 last semester students and 84 registered nurses, showing moderate (55.7% [50-74% correct answers]) to good (43.8% [75-100% correct answers]) knowledge levels. First-semester students scored lower (17.0 ± 2.1) than last-semester students (18.8 ± 1.8) and registered nurses (18.3 ± 2.1) out of 25 questions., Discussion: It is necessary for all groups to receive proper education on hand hygiene knowledge and to have an educational program that does not separate the groups but combines them with continuing education, since the students will someday be influencing future hand hygiene knowledge as a peer, together with the nurse., (© 2024 The Authors.)

Healthcare-associated infections (HAI) are prime health task worldwide and issue of patient safety besides intensifying antimicrobial drug resistance. It is essential to formulate structurally fascinating novel, active and cost-effective anti-microbial drugs possessing a peculiar way of action and capable of overcoming the resistance to effectively combat this disease. The synthesized spiro-heterocyclic hybrids (SHHs) were elucidated through spectroscopic analysis and were assessed for their in vitro antimicrobial activity by agar diffusion method and minimal inhibitory concentration (MIC) value was also determined. In addition, antioxidant potential was also evaluated through DPPH radical scavenging assays. The novel class of SHHs 4a and 4b displayed significant antibacterial activity against selected healthcare associated microbial pathogens (HAMPs). In addition, SHH 4b showed potent antioxidant properties. Antibacterial and antifungal activity of dispirooxindolopyrrolidine fused acenaphthenone heterocyclic hybrids were examined. Interestingly, SHH 4b exhibited potent antimicrobial activity against selected HAMPs. Further, these compounds were also showed potent antioxidant properties. These results revealed that SHH 4b is a promising lead for the development of new antimicrobial drugs. [ABSTRACT FROM AUTHOR]

• Novel UV-C device found to significantly decrease total and pathogenic bacteria on mobile phones. • UV-C phone disinfecting device is renewable, efficient and effective.. • UV-C device implementation in a hospital system would be desired by healthcare providers. • Healthcare providers felt their mobile phones were an important risk factor in infection transmission and that they would use this device daily to weekly. • UV-C technology is shown to kill coronaviruses and implementation of this device could be impactful during pandemic. Mobile phones are known to carry pathogenic bacteria and viruses on their surfaces, posing a risk to healthcare providers (HCPs) and hospital infection prevention efforts. We utilize an Ultraviolet-C (UV-C) device to provide an effective method for mobile phone disinfection and survey HCPs about infection risk. Environmental swabs were used to culture HCPs' personal mobile phone surfaces. Four cultures were obtained per phone: before and after the UV-C device's 30-second disinfecting cycle, at the beginning and end of a 12-hour shift. Surveys were administered to participants pre- and poststudy. Total bacterial colony forming units were reduced by 90.5% (P =.006) after one UV-C disinfection cycle, and by 99.9% (P =.004) after 2 cycles. Total pathogenic bacterial colony forming units were decreased by 98.2% (P =.038) after one and >99.99% (P =.037) after 2 disinfection cycles. All survey respondents were willing to use the UV-C device daily to weekly, finding it convenient and beneficial. This novel UV-C disinfecting device is effective in reducing pathogenic bacteria on mobile phones. HCPs would frequently use a phone disinfecting device to reduce infection risk. In light of the ongoing coronavirus (COVID-19) pandemic, a standardized approach to phone disinfection may be valuable in preventing healthcare-associated infections. [ABSTRACT FROM AUTHOR]

Wafaa S Hamza,1,2 Mona F Salama,1,3 Samar S Morsi,1,4 Naglaa M Abdo,1,5 Mariam A Al-Fadhli1 1Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait; 2Department of Public Health and Community Medicine, Faculty of Medicine, Assiut University, Assiut, Egypt; 3Department of Microbiology and Medical Immunology, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 4Department of Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt; 5Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt Purpose: To measure surgical site infection (SSI) rates among gastrointestinal surgeries and to identify the associated risk factors. Patients and methods: We conducted a multicenter, retrospective, surveillance-based study of adults undergoing gastric, colon, and small bowel (SB) procedures from January to December 2016. Univariate and multivariate analyses were conducted to determine the predictive variables in each surgery. Results: In total, 71 of 2,099 patients developed SSI – 0.8%, 19.8%, and 10.8% following gastric, colon, and SB surgeries, respectively. In gastric surgery, the risk factors identified by univariate analysis were age, duration, wound class, risk index, emergency, and scope use (P

Objectives: Acinetobacter baumannii is a causative pathogen of various healthcare-associated infections (HAIs) and is particularly prevalent in high-risk hospital settings. This study aimed to determine risk factors associated with HAIs caused by carbapenem-resistant A. baumannii (CRAB) in a neonatal intensive care unit (NICU). Methods: This prospective study was performed between January 2013 and June 2014 among NICU patients at the Mansoura University Children’s Hospital, Mansoura, Egypt. Neonates who developed HAIs due to CRAB were assigned to a case group, while those infected with carbapenem-sensitive A. baumannii (CSAB) were assigned to a control group. Results: Among the 124 neonates who developed A. baumannii-caused HAIs during the study period, 91 (73.4%) were caused by CRAB and 33 (26.6%) were caused by CSAB. Prematurity, premature rupture of the membranes (PROM), a previous stay in another hospital, prolonged NICU stay, the presence of invasive devices, previous exposure to carbapenems or aminoglycosides and prolonged antibiotic therapy before infection were significantly associated with CRAB-caused HAIs. A multivariate logistic regression analysis identified prematurity (adjusted odds ratio [aOR] = 25.3; P

The healthcare associated infections (HAI) represent a significant problem for the public heath and it has a big impact on the following plans: epidemiological, clinical and economical. Also, a major importance represents the activity of monitoring and controlling the infections along with a correct reporting of the cases. The authors conducted a retrospective study in order to evaluate the number of cases of healthcare associated infections in Constanţa County over a period of 5 years, observing a significant increase in HAI reporting during the study period. The most common types of infections were digestive tract infections, followed by respiratory infections, sepsis, surgical wound infections, and urinary tract infections. The departments with the best registration and reporting of healthcare-associated infections are those with a surgical profile, pediatrics, newborns, obstetrics-gynecology and intensive care unit. Following the study, the authors find a better reporting of healthcare associated infections over the 5 years studied, which proves that health units have begun to recognize and manage them properly. This will have a major favorable impact in the prevention and identification of risk factors associated with this category of infections. [ABSTRACT FROM AUTHOR]

Healthcare associated infections in pediatric patients are a major public health problem due to the fact that this category has a high infectious risk due to the body's high susceptibility to these infections. This study aims to highlight that good reporting and management of these cases are essential in combating HAI by intensifying prevention measures and regular training of medical staff. There was a significant increase in HAI reporting throughout the study period, especially among digestive and respiratory infections and sepsis. The increase in the number of HAI cases represents is not a worsening of the situation in hospitals, but indicates an increase in the compliance of medical staff in terms of their identification and reporting, without accusatory meaning. [ABSTRACT FROM AUTHOR]

Healthcare-associated infections (HAI) represent infections that happened during after hospitalization, the symptoms starting at least 48 hours after admission, being present during hospitalization or after discharge. A common category of HAI are surgical infections that have a major clinical and financial impact. The aim of this study is the analysis of cases of healthcare-associated infections in the surgery departments in Constanţa County during 2014-2018. The authors note the progressive increase in the number of cases reported annually, thanks to the rigorous application of the provisions of Order of the Ministry of Health 1101/2016, which regulates the activity of monitoring and controling of HAI. The change of the profile of the infections, with the predominance of the digestive ones compared to those of the surgical wound, denotes on the one hand the improvement of the technical conditions of asepsis, but also an administration of excessive antibiotic therapy, which requires the establishment of effective measures of antimicrobial stewardship. [ABSTRACT FROM AUTHOR]

The healthcare associated infections are the infections in the newborn confirmed by bacteriological cultures (blood culture, culture of cerebrospinal fluid, urine); positive anamnestic-clinical data after 72 hours of life, associated with ICU hospitalization and invasive procedures (intubation, mechanical ventilation, umbilical and peripheral vein catheterization, central artery catheterization, administration of solutions from a single vial to several children). The present study highlights the fact that neonatology departments have a high risk of healthcare associated infections due to the vulnerability of young patients to various germs in hospitals, as evidenced by many cases of sepsis and respiratory infections. In this study, we found a significant increase in the healthcare associated infections reporting in the middle of the study period, followed by a decrease in half the number of reported cases, this fact probably due to awareness of the phenomenon by health units management, the correct implementation of guidelines and protocols protocols regarding the healthcare associated infections prevention or, why not, due to an underreporting. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the outbreak size and hospital cost effects of bacterial whole-genome sequencing availability in managing a large-scale hospital outbreak.Methods: We built a hybrid discrete event/agent-based simulation model to replicate a serious bacterial outbreak of resistant Escherichia coli in a large metropolitan public hospital during 2017. We tested the 3 strategies of using whole-genome sequencing early, late (actual outbreak), or not using it and assessed their associated outbreak size and hospital cost. The model included ward dynamics, pathogen transmission, and associated hospital costs during a 5-month outbreak. Model parameters were determined using data from the Queensland Hospital Admitted Patient Data Collection (N = 4809 patient admissions) and local clinical knowledge. Sensitivity analyses were performed to address model and parameter uncertainty.Results: An estimated 197 patients were colonized during the outbreak, with 75 patients detected. The total outbreak cost was A$460 137 (US$317 117), with 6.1% spent on sequencing. Without sequencing, the outbreak was estimated to result in 352 colonized patients, costing A$766 921 (US$528 547). With earlier detection from use of routine sequencing, the estimated outbreak size was 3 patients and cost A$65 374 (US$45 054).Conclusions: Using whole-genome sequencing in hospital outbreak management was associated with smaller outbreaks and cost savings, with sequencing costs as a small fraction of total hospital costs, supporting the further investigation of the use of routine whole-genome sequencing in hospitals. [ABSTRACT FROM AUTHOR]

Background: Ralstonia species are Gram-negative bacilli of low virulence. These organisms are capable of causing healthcare associated infections through contaminated solutions. In this study, we aimed to determine the source of Ralstonia mannitolilytica bacteraemia in affected patients in a haemodialysis unit. Methods: Our laboratory noted an increase in cases of bacteraemia caused by Ralstonia mannitililytica between May and June 2016. All affected patients underwent haemodialysis at the haemodialysis unit of an academic hospital. The reverse osmosis filter of the haemodialysis water system was found to be dysfunctional. We collected water for culture at various points of the dialysis system to determine the source of the organism implicated. ERIC-PCR was used to determine relatedness of patient and environmental isolates. Results: Sixteen patients were found to have Ralstonia mannitolilytica bacteraemia during the outbreak period. We cultured Ralstonia spp. from water collected in the dialysis system. This isolate and patient isolates were found to have the identical molecular banding pattern. Conclusions: All patients were septic and received directed antibiotic therapy. There was 1 mortality. The source of the R. mannitolilytica infection in these patients was most likely the dialysis water as the identical organism was cultured from the dialysis water and the patients. The hospital management intervened and repaired the dialysis water system following which no further cases of R. mannitolilytca infections were detected. A multidisciplinary approach is required to control healthcare associated infections such as these. Routine maintenance of water systems in the hospital is essential to prevent clinical infections with R.mannitolilytica. [ABSTRACT FROM AUTHOR]

Surgical site infections are the second major cause of hospital acquired infections, accounting for a large part of overall annual medical costs. Airborne particulate is known to be a potential carrier of pathogenic bacteria. We assessed a mobile air particle filter unit for improvement of air quality in an operating room (OR). A new mobile air decontamination and recirculation unit, equipped with a crystalline ultraviolet C (Illuvia® 500 UV) reactor and a HEPA filter, was tested in an OR. Airborne particulate was monitored in four consecutive phases: I) device OFF and OR at rest; II) device OFF and OR in operation; III) device ON and OR in operation; IV) device OFF and OR in operation. We used a particle counter to measure airborne particles of different sizes: ≥0.3, ≥0.5, ≥1, ≥3, ≥5, >10 µm. Activation of the device (phases III) produced a significant reduction (p < 0.05) in airborne particulate of all sizes. Switching the device OFF (phase IV) led to a statistically significant increase (p < 0.05) in the number of particles of most sizes: ≥0.3, ≥0.5, ≥1, ≥3 µm. The device significantly reduced airborne particulate in the OR, improving air quality and possibly lowering the probability of surgical site infections. [ABSTRACT FROM AUTHOR]

Background: Awareness and proper practice of sterilization and disinfection protocols can significantly reduce the risk of infection transmission associated with the use of invasive and noninvasive medical and surgical devices. Lack of knowledge and failure to comply with scientifically based guidelines has led to numerous outbreaks of lethal diseases like HIV, Hepatitis B and C as well as transmission of various bacterial infections. Material and Methods: A descriptive cross sectional study conducted among medical students and healthcare workers using a self administered questioner which was designed to assess the awareness of sterilization and disinfection among medical students, paramedical staff and doctors in a public sector hospital in Karachi. Results: Th e sample size and response rate were 356 and 100% respectively. Th e respondents included 66 doctors, 122 paramedics and 168 medical students. About 58.3% medical students and 62.1% doctors knew the difference between sterilization and disinfection but only 37.7% paramedics were aware of the difference. 79.8% medical students, 69.7% doctors and 60.7% paramedics had received the complete regimen of any vaccine. Overall, the awareness proportion of paramedical staff was significantly lower than doctors and medical students. Conclusion: Our results show that awareness of healthcare workers regarding sterilization and disinfection is not up to the mark. Many of them have not received the complete regimen of HBV vaccine. Th ere is therefore substantial need for the education and training programs to equip the healthcare workers with awareness and knowledge regarding sterilization and disinfection protocols. [ABSTRACT FROM AUTHOR]

Aim: The aim of the research was to identify non-critical high touch risk objects and surfaces used in the provision of nursing care in hospital conditions at standard internal and surgical departments. Methods: Qualitative research using the technique of unstructured observation. The realization of research took place in a regional-type hospital and data collection was completed after reaching theoretical saturation. The analysis was performed by the method of open coding using the pen and paper technique. Results: The research identified non-critical high touch objects, namely medical devices, administrative objects, containers for carrying and storing objects and medical materials and other packaging. Furthermore, objects used to administer drugs, ensure patient self-sufficiency, hygienic care, emptying and collection of biological material. Furthermore, non-critical high touch surfaces were identified, namely work trays, trolleys, work surfaces for the preparation of injection and infusion therapy, lids, storage areas and the hospital bed, including accessories. Conclusion: Healthcare associated infections are an actual problem with regard to the possibility of transmission of pathogens through objects and areas used in the provision of health care, including nursing care. For the transmission of healthcare associated infections through objects and surfaces, their identification and following effective decontamination is important. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial stewardship (AMS) programs have shown to reduce the emergence of antimicrobial resistance (AMR) and health-care-associated infections (HAIs), and save health-care costs associated with an inappropriate antimicrobial use. The primary objective of this study was to compare the consumption and cost of antimicrobial agents using defined daily dose (DDD) and direct cost of antibiotics before and after the AMS program implementation. Secondary objective was to determine the rate of HAIs [Clostridium difficile (C. difficile), ventilator-associated pneumonia (VAP), and central line-associated bloodstream infection (CLABSI) before and after the AMS program implementation. Methods: This is a pre-post quasi-experimental study. Adult inpatients were enrolled in a prospective fashion under the active AMS arm and compared with historical inpatients who were admitted to the same units before the AMS implementation. Study was conducted at four tertiary private hospitals located in two cities in Saudi Arabia. Adult inpatients were enrolled under the pre- AMS arm and post- AMS arm if they were on any of the ten selected restricted broad-spectrum antibiotics (imipenem/cilastatin, piperacillin/tazobactam, colistin, tigecycline, cefepime, meropenem, ciprofloxacin, moxifloxacin, teicoplanin and linezolid). Results: A total of 409,403 subjects were recruited, 79,369 in the pre- AMS control and 330,034 in the post- AMS arm. Average DDDs consumption of all targeted broad-spectrum antimicrobials from January 2016 to June 2019 post- AMS launch was lower than the DDDs use of these agents pre- AMS (233 vs 320 DDDs per 1000 patient-days, p = 0.689). Antimicrobial expenditures decreased by 28.45% in the first year of the program and remained relatively stable in subsequent years, with overall cumulative cost savings estimated at S.R. 6,286,929 and negligible expenses of S.R. 505,115 (p = 0.648). Rates of healthcare associated infections involving C. difficile, VAP, and CLABSI all decreased significantly after AMS implementation (incidence of HAIs in 2015 compared to 2019: for C. difficile, 94 vs 13, p = 0.024; for VAP, 24 vs 6, p = 0.001; for CLABSI, 17 vs 1, p = 0.000; respectively). Conclusion: Implementation of AMS program at HMG healthcare facilities resulted in reduced antimicrobials use and cost, and lowered incidence of healthcare associated infections. [ABSTRACT FROM AUTHOR]

Introduction: Infections with multidrug resistant organisms that spread through nosocomial transmission complicate the care of combat casualties. Missions conducted to review infection prevention and control (IPC) practices at deployed medical treatment facilities (MTFs) previously showed gaps in best practices and saw success with targeted interventions. An IPC review has not been conducted since 2012. Recently, an IPC review was requested in response to an outbreak of multidrug resistant organisms at a deployed facility.Materials and Methods: A Joint Service team conducted onsite IPC reviews of MTFs in the U.S. Central Command area of operations. Self-assessments were completed by MTF personnel in anticipation of the onsite assessment, and feedback was given individually and at monthly IPC working group teleconferences. Goals of the onsite review were to assist MTF teams in conducting assessments, review practices for challenges and successes, provide on the spot education or risk mitigation, and identify common trends requiring system-wide action.Results: Nine deployed MTFs participated in the onsite assessments, including four Role 3, three Role 2 capable of surgical support, and two Role 1 facilities. Seventy-eight percent of sites had assigned IPC officers although only 43% underwent required predeployment training. Hand hygiene and healthcare associated infection prevention bundles were monitored at 67% and 29% of MTFs, respectively. Several challenges including variability in practices with turnover of deployed teams were noted. Successes highlighted included individual team improvements in healthcare associated infections and mentorship of untrained personnel.Conclusions: Despite successes, ongoing challenges with optimal deployed IPC were noted. Recommendations for improvement include strengthening IPC culture, accountability, predeployment training, and stateside support for deployed IPC assets. Variability in IPC practices may occur from rotation to rotation, and regular reassessment is required to ensure that successes are sustained through times of turnover. [ABSTRACT FROM AUTHOR]

Background and Aims: To evaluate existing knowledge, attitude and perception and compliance of hand hygiene activity among various healthcare workers in a tertiary care centre in Uttarakhand. Methods: A cross sectional study was done for a period of two months. WHO hand hygiene and compliance form with slight modification were used to study knowledge, attitude, perception and compliance (overt and covert) by direct observational technique. Statistical analysis was done using Microsoft Excel 2010 and IBM SPSS 23.0 version software. Results: A total of 220 participants were given questionnaire out of which 172 participated in study. 159 (92.4%) had already received training in HH in the past 3 years and were using alcohol based hand rub routinely. The overall correct knowledge score of various professional categories of HCW was good i.e. 71.6% Most of the healthcare workers knew the importance of adhering to this simple practice in prevention of healthcare associated infections. Most of them were aware of the conditions before or after when HH activity has to be performed. Poor compliance of hand hygiene was noted among healthcare workers on covert observation. For given hand hygiene opportunities the HH was started in 53.2% and 15.7% of overt and covert observations, respectively. However, HH compliance decreased drastically among HCW, which was 15.7% and 1.6% of overt and covert observations, respectively. Interpretation and Conclusions: The acceptance of the fact by most of the HCW that direct vigilance over this activity helped them performed better, suggested the demand of regular surveillance and several other promotional activities in the centre. [ABSTRACT FROM AUTHOR]

Objectives: Objective: The aim of this study is to describe the epidemiological surveillance of Carbapenem-Resistant Enterobacteriaceae (CRE) effected at the Neurological Hospital Carlo Besta, Milano, Italy. The primary causes in our division of multidrug-resistant (MDRs) infections in 2016 were K. pneumoniae and A. baumannii; the preventive actions have ensured the reduction of their incidence in 2017 and allowed us to discover the microbiological sentinel events (SE) and start appropriate precautionary behavior and isolation. Methods: The setting is inpatient care with MDR infections and the aim of the procedure is to formalize the management mode, reporting and transmission of SE, collected at the end of study period for previous years from January 1st, 2015 to December 31st, 2017. Results: It should be noted that of a total of 5772 hospitalizations detected in 2016 there was an increase in rate of A. baumannii compared to the rate found in 2015 for 5679 hospitalizations and in 2017 for 5682 hospitalizations; the same trend was observed for K. pneumoniae. For as regards P. aeruginosa carbapenemase producing or MDR, the rates were lower in 2016 and in 2017. Conclusions: The main goals that we achieved in the three years considered are the decreased incidence of healthcare-associated infections (HAIs) and the decreased incidence of multidrug-resistant (MDR) microorganisms. These actions were of course associated with the control of antibiotic pressure and a careful stewardship. The strict surveillance of HAIs is fundamental to control the growing reservoir within hospital communities. [ABSTRACT FROM AUTHOR]

When breastmilk is insufficient to meet planned feed volumes, neonatologists need to continue parenteral nutrition (PN) or use formula. This trial conducted at a tertiary care unit in South India between August 2014 and April 2016 compared time to full feeds in preterms fed 'mother's milk alone(MM)' vs. 'hybrid feed-mother's milk supplemented with formula(HF)'. We also compared time to regain birth weights, duration of PN, feed intolerance, Necrotizing Enterocolitis stage 2 or more, all-cause mortality, Extrauterine growth restriction, Healthcare associated infections, exclusive breast milk feeding rates at discharge, Retinopathy of prematurity requiring laser therapy, abnormal neurosonogram and oxygen dependency at 28 days. Neonates between 27 and 32 weeks were randomized into MM/HF when breast milk was insufficient. HF received formula to reach targeted feed volumes. MM received more PN to meet fluid requirements. 54 babies were analyzed in MM and 58 in HF. Time to full feeds were similar-MM (14.1 ± 4 days); HF (13.5 ± 4 days), p = 0.45. Exclusive breast milk feeding rates at discharge were higher in MM when compared to HF (74% vs. 51%). Other secondary outcomes were similar between groups. When mother's milk is unavailable in sufficient quantities, preterm babies may receive hybrid feeds. (Clinical trials registry of India no. REF/2016/02/006622). [ABSTRACT FROM AUTHOR]

Abstract Background Provision of information plays a critical role in supporting patients to be engaged or empowered to be involved with infection prevention measures in hospitals. This explorative study evaluated the suitability, readability and accessibility of information on healthcare associated infections (HCAIs) and infection prevention strategies targeted at patients from the websites of 19 acute care public hospitals in Sydney, Australia. Methods We included hospitals with greater than 200 beds in the sample. We examined online information targeted at patients on HCAIs and infection prevention and compared it using the Suitability Assessment of Material (SAM) and Simple Measure of Gobbledygook (SMOG) readability formulas for suitability, readability and accessibility. Results Thirty-six webpages were identified as being relevant and containing information about HCAIs or infection prevention. Based on the SAM/SMOG scores, only three webpages were found to be ‘superior’. Many of the webpages scored poorly in content, literacy, graphics, learning stimulation and cultural appropriateness. In comparison, most of the webpages scored well in the layout and typography. The majority (97%) of the materials were written at a level higher than the recommended reading grade level. Lastly, the websites scored poorly on the ability to locate the information easily, as messages about HCAIs/infection prevention were usually embedded into other topics. Conclusion While providing information online is only one approach to delivering messages about infection prevention, it is becoming increasingly important in today’s technology society. Hospitals are neglecting to use best practices when designing their online resources and current websites are difficult to navigate. The findings point to the need to review patient information on HCAIs regarding suitability, readability and accessibility.

Background: Enterococci intrinsically resistant to cephalosporins represent a major cause of healthcare-associated infections, and the emergence of MDR makes therapeutic approaches particularly challenging.Objectives: Teichoic acids are cell wall glycopolymers present in Gram-positive bacteria. Teichoic acids can be modified by d-alanylation, which requires four proteins encoded by the dltABCD operon. Our objective was to evaluate the Dlt system as a druggable target to treat enterococcal infections.Methods: The susceptibility of a d-alanylation-deficient strain of Enterococcus faecalis to β-lactam antibiotics individually and/or in combination was analysed. Moreover, a DltA inhibitor was synthesized to test pharmacological inhibition of d-alanylation in vivo and in host using the animal model Galleria mellonella with different clinical isolates of E. faecalis and Enterococcus faecium.Results: Most cephalosporins used as mono treatment had no impact on survival of the parental strain, but were slightly lethal for the dltA mutant of E. faecalis. Addition of a very low concentration of amoxicillin significantly increased killing of the dltA mutant under these conditions. The most spectacular effect was obtained with a combination of cefotaxime (1 mg/L) and amoxicillin (0.03 mg/L). In the presence of the inhibitor, the WT strain was as susceptible to this combination treatment as the dltA mutant. This molecule associated with the antibiotics was also effective in killing other E. faecalis clinical isolates and successfully prevented death of Galleria infected with either E. faecalis or E. faecium.Conclusions: The combined results support the potential usefulness of the Dlt system as a target to potentiate antibiotic combination therapies for the treatment of drug-resistant enterococci. [ABSTRACT FROM AUTHOR]

Infants born before 28 weeks are at risk of contracting healthcare-associated infections (HAIs), which could be caused by pathogens residing on contaminated hospital surfaces. In this longitudinal study, we characterized by NGS the bacterial composition of nasal swabs of preterm newborns, at the time of birth and after admission to the Neonatal Intensive Care Unit (NICU), comparing it with that of the environmental wards at the time of delivery and during the hospitalization. We characterized the resistome on the samples too. The results showed that environmental microorganisms responsible for HAIs, in particular Staphylococcus spp., Streptococcus spp., Escherichia-Shigella spp., and K. pneumoniae, were detected in higher percentages in the noses of the babies after 13 days of hospitalization, in terms of the number of colonized patients, microorganism amount, and relative abundance. The analysis of nasal bacteria resistome evidenced the absence of resistance genes at the time of birth, some of which appeared and increased after the admission in the NICU. These data suggest that hospital surface microbiota might be transported to respiratory mucosae or other profound tissues. Our study highlights the importance of a screening that allows characterizing the microbial profile of the environment to assess the risk of colonization of the newborn.

Abstract Background Healthcare associated infections (HCAI) and antimicrobial resistance are principal threats to the patients of intensive care units and are the major determining factors for patient outcome. They are associated with increased morbidity, mortality, excess hospitalization and financial costs. The present study is an attempt to investigate the spectrum and antimicrobial resistance of bacterial isolates involved in healthcare associated infections (HCAI) in the patients of a critical care unit at a tertiary care university hospital in Kathmandu, Nepal. Methods A laboratory based study was conducted over the period of 15 months (January 2014 to March 2015) among the patients of intensive care unit of Tribhuvan University Teaching Hospital, Kathmandu, Nepal. Clinical specimens from patients with suspected healthcare-associated infection were processed and bacterial isolates were identified with standard microbiological methods. Antimicrobial susceptibilities of the isolated strains were determined according to the CLSI guidelines and β-lactamases (ESBL, AmpC, MBL and KPC) were detected by various phenotypic tests. Results One hundred and forty nine clinical specimens received from 135 patients suspected of HCAI (out of 491 patients) were found with significant bacterial growth. Specimens were from patients suspected of hospital-acquired pneumonia (16%, 79/491), bloodstream infections (5.7%, 28/491), surgical site infections (4.7%, 23/491), and urinary tract infections (3.9%, 19/491). Acinetobacter spp., Klebsiella spp., Escherichia coli and Burkholderia cepacia were the leading bacterial pathogens. Extremely high level of drug resistance (95.8%) along with the production of β-lactamases (ESBL; 43.7%, AmpC; 27.5%), MBL; 50.2% and KPC; 4.2%) was observed among Gram negative bacterial isolates. Conclusion Healthcare associated infections are very common in our ICU. Gram negative bacterial pathogens are major culprits associated with these infections and there is alarming state of drug resistance among these isolates. Continuous surveillance and establishment of preventive and control measures of healthcare associated infections are urgently needed in our setting.

Abstract Background Surgical site infections (SSI) are one of the most common healthcare associated infections in the low-middle income countries. Data on incidence and risk factors for SSI following surgeries in general and Obstetric and Gynecological surgeries in particular are scare. This study set out to identify risk factors for SSI in patients undergoing Obstetric and Gynecological surgeries in an Indian rural hospital. Methods Patients who underwent a surgical procedure between September 2010 to February 2013 in the 60-bedded ward of Obstetric and Gynecology department were included. Surveillance for SSI was based on the Centre for Disease Control (CDC) definition and methodology. Incidence and risk factors for SSI, including those for specific procedure, were calculated from data collected on daily ward rounds. Results A total of 1173 patients underwent a surgical procedure during the study period. The incidence of SSI in the cohort was 7.84% (95% CI 6.30–9.38). Majority of SSI were superficial. Obstetric surgeries had a lower SSI incidence compared to gynecological surgeries (1.2% versus 10.3% respectively). The risk factors for SSI identified in the multivariate logistic regression model were age (OR 1.03), vaginal examination (OR 1.31); presence of vaginal discharge (OR 4.04); medical disease (OR 5.76); American Society of Anesthesia score greater than 3 (OR 12.8); concurrent surgical procedure (OR 3.26); each increase in hour of surgery, after the first hour, doubled the risk of SSI; inappropriate antibiotic prophylaxis increased the risk of SSI by nearly 5 times. Each day increase in stay in the hospital after the surgery increased the risk of contacting an SSI by 5%. Conclusions Incidence and risk factors from prospective SSI surveillance can be reported simultaneously for the Obstetric and Gynecological surgeries and can be part of routine practice in resource-constrained settings. The incidence of SSI was lower for Obstetric surgeries compared to Gynecological surgeries. Multiple risk factors identified in the present study can be helpful for SSI risk stratification in low-middle income countries.

Abstract Background Studies have implicated Staphylococcus aureus as the leading cause of septicemia in the Tamale metropolis of Ghana. The aim of this study was to determine the prevalence and antibiotic susceptibility of S. aureus and Methicillin Resistant S. aureus (MRSA) in the environments of three hospitals in Ghana. Methods A total of 120 swab samples were taken from door handles, stair railings and other points of contact at Tamale Teaching Hospital, Tamale Central Hospital and Tamale West Hospital. The swab samples were directly plated on Mannitol Salt and Baird Parker agar plates and incubated at 37 °C (± 2) for 18–24 h. An antibiotic susceptibility test was performed using the Clinical Laboratory Standard Institute’s guidelines. Isolates resistant to both cefoxitin and oxacillin were considered to be MRSA. Results A total of 47 (39%) positive S. aureus samples were isolated from all three hospitals, of which, eight (17%) were putative MRSA isolates. One MRSA isolate was resistant to all the antibiotics used (cefoxitin, oxacillin, ciprofloxacin, erythromycin, tetracycline, ampicillin, streptomycin and sulfamethoxazole-trimethoprim). Five of the MRSA isolates were multi-drug resistant, whilst the other three were resistant to only two antibiotics. All the multi-drug resistant MRSA isolates were resistant to at least four antibiotics. The percentage of isolates resistant to oxacillin, ampicillin, ciprofloxacin, tetracycline, streptomycin, erythromycin, and sulfamethoxazole/trimethoprim were 17, 13, 9, 28, 89, 13 and 11% respectively. Conclusion The high multi-drug resistance of MRSA in hospital environments in Ghana reinforces the need for the effective and routine cleaning of door handles in hospitals. Further investigation is required to understand whether S. aureus from door handles could be the possible causes of nosocomial diseases in the hospitals.

An editorial is presented on the Importance of Pathogen Whole-Genome Sequencing in Evaluating Interventions to Reduce the Spread of Multidrug-Resistant Organisms in the Healthcare Setting. The article discusses that the Contact precautions are the most frequently used interventions for the prevention of healthcare-acquired infections (HAIs) caused by multidrug-resistant organisms (MDROs); and Researchers have explored a number of approaches to evaluating the effectiveness of interventions.

Introduction: The level of knowledge on hand hygiene (HH) and healthcare associated infections (HAI) directly influences the practice of HH of medical staff and the rate of HAI. Continuous Medical Education (EMC) is an important way of improving knowledge, increasing compliance with HH and reducing HAI rates. The aim of the study was to evaluate the knowledge of nurses regarding HH and HAI in order to identify their educational needs. Materials and methods: In February-June 2018, a study was conducted which included nurses participating in an educational program on HAI management theme. A questionnaire with 25 items from the following 6 specific areas: HAI, HH, disinfection and sterilization, standard precautions and precautions towards the route of transmission, accidental exposure and medical waste management were used to assess the knowledge. Results: A total of 236 nurses were included in the study. The average age of the participants was 45.60+11.92 years, and the average work experience was 14.80+13.34 years. The average grade of the group was 8.38+1.03. This correlated negatively, but weakly and insignificantly, with the age (r=-0.033, p=0.703) and the work experience (r=-0.072, p=0.282) of the participants. 32.2% of the participants had a very good level of knowledge, but 67.8% had an inadequate level (with satisfactory and good qualifications in the assessment of knowledge). There have been identified 3 important specific areas where nurses have encountered difficulties in identifying the right answer: HAI, HH, disinfection and sterilization. Conclusions: 67.8% of nurses have inadequate knowledge of HH and HAI prevention, and 39% of nurses have an insufficient level, which may be a potential barrier to HAI prevention. Identifying specific areas where nurses have knowledge deficits facilitates the development of an EMC strategy centered on the educational needs of nurses.

Dissemination of carbapenem-resistant Acinetobacter baumannii is currently one of the priority themes discussed around the world, including in Brazil, where this pathogen is considered endemic. A total of 107 carbapenem-resistant A. baumannii (CRAB) isolates were collected from patients with bacteraemia attended at a teaching hospital in Brazil from 2008 to 2014. From these samples, 104 (97.2%) carried blaOXA−23−like, all of them associated with ISAba1 The blaOXA−231 (1.9%) and blaOXA−72 (0.9%) genes were also detected in low frequencies. All isolates were susceptible to minocycline, and 38.3% of isolates presented intermediate susceptibility to tigecycline (MIC = 4 μg/ml). Molecular typing assessed by multi-locus sequence typing demonstrated that the strains were mainly associated with clonal complexes CC79 (47.4%), followed by CC1 (16.9%), and CC317 (18.6%), belonging to different pulsotypes and in different prevalences over the years. Changes in the clones' prevalence reinforce the need of identifying and controlling CRAB in hospital settings to preserve the already scarce therapeutic options available.

Hospital cleaning has been shown to impact on rates of healthcare-associated infections (HCAIs) and good environmental hygiene is critical to quality care, yet those tasked with the role of ensuring a safe and clean environment often go unrecognised as members of the healthcare workforce. Sepsis is a leading cause of maternal and newborn death, a significant proportion of these cases are estimated to be due to HCAIs. Deliveries in health institutions have now reached 75% globally, and in low and middle income countries the corresponding increased pressure on facilities has impacted both quality of care provided and quality of the birth environment in terms of infection prevention and control (IPC) and HCAIs. The paper discusses the neglected role of health facility cleaners, providing evidence from the literature and from needs assessments conducted by The Soapbox Collaborative and partners in Bangladesh, India, The Gambia and Zanzibar. While not the primary focus of the assessments, common themes emerged consistently pointing to institutional neglect of cleaning and cleaners. The paper argues that low status within facilities, wider societal marginalisation, lack of training, and poor pay and working conditions contribute to the lack of prioritisation placed on health facility environmental hygiene. With increased international attention focused towards health facility water, sanitation and hygiene and a growing focus on IPC, now is the time to address the neglect of this frontline healthcare workforce. We propose that provision of and improved training can enable the recognition of the valuable role cleaning staff play, as well as equipping these staff with the tools required to perform their job to the highest standard. In addition to training, wider systems changes are necessary to establish improvements in environmental hygiene and the role of cleaning staff, including addressing resource availability, supportive supervision, and an increased emphasis on preventative healthcare.

Background: Carbapenem-resistant Enterobacterales (CRE) are spreading in the United Arab Emirates (UAE) where their dissemination is facilitated by international travel, trade, and tourism. The objective of this study is to describe the longitudinal changes of CRE as reported by the national AMR surveillance system of the UAE., Methods: In this study, we retrospectively describe CRE isolated from 317 surveillance sites, including 87 hospitals and 230 centers/clinics from 2010 to 2021. The associated clinical, demographic, and microbiological characteristics are presented by relying on the UAE national AMR surveillance program. Data was analyzed using WHONET microbiology laboratory database software (http://www.whonet.org)., Results: A total of 14,593 carbapenem resistant Enterobacterales were analyzed, of which 48.1% were carbapenem resistant Klebsiella pneumoniae (CRKp), 25.1% carbapenem resistant Escherichia coli (CREc), and 26.8% represented 72 other carbapenem resistant species. Carbapenem resistant strains were mostly associated with adults and isolated from urine samples (36.9% of CRKp and 66.6% of CREc) followed by respiratory samples (26.95% for CRKp) and soft tissue samples (19.5% for CRKp). Over the studied period carbapenem resistance rates remained high, especially in K. pneumoniae , and in 2021 were equivalent to 67.6% for imipenem, 76.2% for meropenem, and 91.6% for ertapenem. Nevertheless, there was a statistically significant decreasing trend for imipenem and meropenem resistance in Klebsiella species ( p < 0.01) while the decrease in ertapenem resistance was non-significant. Concerning E. coli , there was a statistically significant decreasing trend for meropenem and imipenem resistance over the 12 years, while ertapenem resistance increased significantly with 83.8% of E. coli exhibiting ertapenem resistance in 2021. Resistance rates to ceftazidime and cefotaxime remained higher than 90% (in 2021) for CRKp and cefotaxime rates increased to 90.5% in 2021 for CREc. Starting 2014, resistance to colistin and tigecycline was observed in carbapenem resistant Enterobacterales . CRE were associated with a higher mortality (RR: 6.3), admission to ICU (RR 3.9), and increased length of stay (LOS; 10 excess inpatient days per CRE case)., Conclusion: This study supports the need to monitor CRE in the UAE and draws attention to the significant increase of ertapenem resistance in E. coli . Future surveillance analysis should include a genetic description of carbapenem resistance to provide new strategies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Thomsen, Abdulrazzaq, the UAE AMR Surveillance Consortium, Everett, Menezes, Senok and Ayoub Moubareck.)