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Schutte M, Dekker M, Sikkens J, van Mansfeld R. Between heuristic and deliberative thinking: a multi-center qualitative study of physicians' decision-making in infection prevention practice. Antimicrob Resist Infect Control 2025; 14:50. [PMID: 40375114 DOI: 10.1186/s13756-025-01572-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2025] [Accepted: 05/09/2025] [Indexed: 05/18/2025] Open
Abstract
BACKGROUND Application of standard infection prevention and control (IPC) measures is crucial to prevent hospital-acquired infections, but compliance by physicians is suboptimal. Interventions aimed to improve compliance are often generic and lack sustained effects. A better understanding of physicians' trade-offs regarding application of IPC and influences on their behavior is needed to develop effective behavior change interventions. We aimed to understand physicians' decision-making processes around application of IPC and the factors that influence their behavior. METHODS This qualitative study involved semi-structured interviews with 18 physicians and 7 nurses from five different hospitals in the Netherlands. Reflexive thematic analysis involved inductive coding followed by deductive analysis using mechanisms of action, including the Theoretical Domains Framework, that link to behavior change techniques. RESULTS We found heterogeneity in physicians' approaches to decision-making around application of IPC. Some physicians relied on heuristics, while others applied logical reasoning. The latter group made an autonomous assessment of the risks for infection associated with a situation and traded off the costs and benefits of IPC application. The decision was further influenced by personal beliefs about the value of IPC and a supporting physical and social environment. Eighteen out of 26 mechanisms of action underlying the influences on IPC behavior were matched to our results; most important are "memory, attention and decision processes", "behavioral cueing", "beliefs about consequences", "values", "norms", "social influences", "social learning/imitation" and "environmental context and resources". These findings suggest that interventions are most likely to be beneficial if these focus on developing heuristics, changing risk beliefs, using social norms and imitation and generating a supportive environment. CONCLUSION The heterogeneity in physicians' decision-making and autonomous risk assessment which is different from other healthcare professionals calls for tailored interventions targeting heuristic decision making, personal beliefs, social norms and the environmental context.
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Affiliation(s)
- Miriam Schutte
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands.
| | - Mireille Dekker
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, The Netherlands
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jonne Sikkens
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
- Department of Internal Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rosa van Mansfeld
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam, The Netherlands
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2
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De Capitani G, Colaneri M, Conflitti C, Borgonovo F, Galli L, Scaglione G, Genovese C, Fattore R, Schiavini M, Caloni B, Zizzo D, Busatto N, Gidaro A, Taino A, Calloni M, Casella F, Bartoli A, Cogliati C, Palomba E, Antinori S, Gori A, Foschi A. Effectiveness of Vascular Catheter Removal Versus Retention in Non-ICU Patients with CRBSI or CABSI in Retrospective, Single-Center Study. Microorganisms 2025; 13:1085. [PMID: 40431258 PMCID: PMC12114613 DOI: 10.3390/microorganisms13051085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2025] [Revised: 05/03/2025] [Accepted: 05/05/2025] [Indexed: 05/29/2025] Open
Abstract
Catheter-associated bloodstream infections (CABSIs) and catheter-related bloodstream infections (CRBSIs) are significant causes of morbidity and mortality worldwide. The current practice favors the removal of vascular access devices (VADs); however, the evidence on this topic remains inconclusive. This study evaluates the clinical outcomes in terms of in-hospital mortality and catheter retention vs. removal in CABSI and CRBSI cases. A retrospective, observational, single-center study was conducted at Luigi Sacco Hospital, Milan, Italy (May 2021-December 2023), and it analyzed non-ICU adult patients with VADs diagnosed with CRBSIs or CABSIs. Clinical and microbiological data were collected to assess the outcomes based on catheter management. Among 1874 patients with VADs, 147 were included, with 164 VAD infection events (92 CABSIs and 72 CRBSIs). Overall, 35 (23.8%) patients with CABSIs and CRBSIs died. Out of those who retained the catheter 19 (35.8%) patients died, while among removal patients 16 (17%) died (p = 0.018). A Candida spp. isolation was found to be significantly associated with a higher likelihood of catheter removal (p = 0.04). Our findings suggest that, in non-ICU CRBSI and CABSI cases, VAD removal may be associated with improved outcomes when feasible.
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Affiliation(s)
- Giovanni De Capitani
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy (M.C.); (F.B.); (G.S.); (C.G.); (R.F.); (M.S.); (B.C.); (D.Z.); (N.B.); (S.A.); (A.G.); (A.F.)
| | - Marta Colaneri
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy (M.C.); (F.B.); (G.S.); (C.G.); (R.F.); (M.S.); (B.C.); (D.Z.); (N.B.); (S.A.); (A.G.); (A.F.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Claudia Conflitti
- National PhD Programme in One Health Approaches to Infectious Diseases and Life Science Research, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Fabio Borgonovo
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy (M.C.); (F.B.); (G.S.); (C.G.); (R.F.); (M.S.); (B.C.); (D.Z.); (N.B.); (S.A.); (A.G.); (A.F.)
| | - Lucia Galli
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy (M.C.); (F.B.); (G.S.); (C.G.); (R.F.); (M.S.); (B.C.); (D.Z.); (N.B.); (S.A.); (A.G.); (A.F.)
| | - Giovanni Scaglione
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy (M.C.); (F.B.); (G.S.); (C.G.); (R.F.); (M.S.); (B.C.); (D.Z.); (N.B.); (S.A.); (A.G.); (A.F.)
| | - Camilla Genovese
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy (M.C.); (F.B.); (G.S.); (C.G.); (R.F.); (M.S.); (B.C.); (D.Z.); (N.B.); (S.A.); (A.G.); (A.F.)
| | - Rebecca Fattore
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy (M.C.); (F.B.); (G.S.); (C.G.); (R.F.); (M.S.); (B.C.); (D.Z.); (N.B.); (S.A.); (A.G.); (A.F.)
| | - Monica Schiavini
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy (M.C.); (F.B.); (G.S.); (C.G.); (R.F.); (M.S.); (B.C.); (D.Z.); (N.B.); (S.A.); (A.G.); (A.F.)
| | - Beatrice Caloni
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy (M.C.); (F.B.); (G.S.); (C.G.); (R.F.); (M.S.); (B.C.); (D.Z.); (N.B.); (S.A.); (A.G.); (A.F.)
| | - Daniele Zizzo
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy (M.C.); (F.B.); (G.S.); (C.G.); (R.F.); (M.S.); (B.C.); (D.Z.); (N.B.); (S.A.); (A.G.); (A.F.)
| | - Nicola Busatto
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy (M.C.); (F.B.); (G.S.); (C.G.); (R.F.); (M.S.); (B.C.); (D.Z.); (N.B.); (S.A.); (A.G.); (A.F.)
| | - Antonio Gidaro
- Department of Internal Medicine, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.G.); (A.T.); (M.C.); (F.C.); (A.B.)
| | - Alba Taino
- Department of Internal Medicine, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.G.); (A.T.); (M.C.); (F.C.); (A.B.)
| | - Maria Calloni
- Department of Internal Medicine, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.G.); (A.T.); (M.C.); (F.C.); (A.B.)
| | - Francesco Casella
- Department of Internal Medicine, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.G.); (A.T.); (M.C.); (F.C.); (A.B.)
| | - Arianna Bartoli
- Department of Internal Medicine, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.G.); (A.T.); (M.C.); (F.C.); (A.B.)
| | - Chiara Cogliati
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
- Department of Internal Medicine, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy; (A.G.); (A.T.); (M.C.); (F.C.); (A.B.)
| | - Emanuele Palomba
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy (M.C.); (F.B.); (G.S.); (C.G.); (R.F.); (M.S.); (B.C.); (D.Z.); (N.B.); (S.A.); (A.G.); (A.F.)
| | - Spinello Antinori
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy (M.C.); (F.B.); (G.S.); (C.G.); (R.F.); (M.S.); (B.C.); (D.Z.); (N.B.); (S.A.); (A.G.); (A.F.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Andrea Gori
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy (M.C.); (F.B.); (G.S.); (C.G.); (R.F.); (M.S.); (B.C.); (D.Z.); (N.B.); (S.A.); (A.G.); (A.F.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Antonella Foschi
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20157 Milan, Italy (M.C.); (F.B.); (G.S.); (C.G.); (R.F.); (M.S.); (B.C.); (D.Z.); (N.B.); (S.A.); (A.G.); (A.F.)
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Sandu AM, Chifiriuc MC, Vrancianu CO, Cristian RE, Alistar CF, Constantin M, Paun M, Alistar A, Popa LG, Popa MI, Tantu AC, Sidoroff ME, Mihai MM, Marcu A, Popescu G, Tantu MM. Healthcare-Associated Infections: The Role of Microbial and Environmental Factors in Infection Control-A Narrative Review. Infect Dis Ther 2025; 14:933-971. [PMID: 40208412 PMCID: PMC12084486 DOI: 10.1007/s40121-025-01143-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2025] [Accepted: 03/20/2025] [Indexed: 04/11/2025] Open
Abstract
Healthcare-associated infections (HAIs), previously known as nosocomial infections, represent a significant threat to healthcare systems worldwide, prolonging patient hospital stays and the duration of antimicrobial therapy. One of the most serious consequences of HAIs is the increase in the rate of antibiotic resistance (AR) generated by the prolonged, frequent, and sometimes incorrect use of antibiotics, which leads to the selection of resistant bacteria, making treatment difficult and expensive, with direct consequences for the safety of patients and healthcare personnel. Therefore, timely and accurate diagnosis of HAIs is mandatory to develop appropriate infection prevention and control practices (IPC) and new therapeutic strategies. This review aimed to present the prevalence, risk factors, current diagnosis, including artificial intelligence (AI) and machine learning approaches, future perspectives in combating HAIs causative bacteria (phage therapy, microbiome-based interventions, and vaccination), and HAIs surveillance strategies. Also, we discussed the latest findings regarding the relationships of AR with climate change and environmental pollution in the context of the One Health approach. Phage therapy is an emerging option that can offer an alternative to ineffective antibiotic treatments for antibiotic-resistant bacteria causing HAIs. Clinical trials dealing with vaccine development for resistant bacteria have yielded conflicting results. Two promising strategies, fecal microbiota transplantation and probiotic therapy, proved highly effective against recurrent Clostridium difficile infections and have been shown to reduce HAI incidence in hospitalized patients undergoing antibiotic therapy. Artificial intelligence and machine learning systems offer promising predictive capabilities in processing large volumes of clinical, microbiological, and patient data but require robust data integration. Our paper argues that HAIs are still a global challenge, requiring stringent IPC policies, computer vision, and AI-powered tools. Despite promising avenues like integrated One Health approaches, optimized phage therapy, microbiome-based interventions, and targeted vaccine development, several knowledge gaps in clinical efficacy, standardization, and pathogen complexity remain to be answered.
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Grants
- CNFIS-FDI-2024-F-0484 INOVEX University of Bucharest
- Pillar III Ministry of Research, Innovation and Digitalization through the National Recovery and Resilience Plan (PNRR) of Romania
- Component C9/Investment no. 8 (I8) - contract CF 68 Ministry of Research, Innovation and Digitalization through the National Recovery and Resilience Plan (PNRR) of Romania
- Project No. RO1567-IBB05/2023 Institute of Biology Bucharest of the Romanian Academy
- project no. 23020101 The core program within the National Research Development and Innovation Plan, 2022-2027', carried out with the support of the Ministry of Research, Innovation and Digitalization (MCID),
- Contract no. 7N from 3 January 2023 The core program within the National Research Development and Innovation Plan, 2022-2027', carried out with the support of the Ministry of Research, Innovation and Digitalization (MCID),
- Dezvoltarea cercetării genomice în România - ROGEN" (Development of genomic research in Romania -ROGEN). ROGEN
- The core program within the National Research Development and Innovation Plan, 2022–2027’, carried out with the support of the Ministry of Research, Innovation and Digitalization (MCID),
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Affiliation(s)
- Andreea M Sandu
- Doctoral School, Carol Davila University of Medicine and Pharmacy, Eroii Sanitari 8, District 5, 050474, Bucharest, Romania
- The County Emergency Hospital, Aleea Spitalului 36, 110283, Pitești, Romania
| | - Mariana C Chifiriuc
- The Research Institute of the University of Bucharest, ICUB, Șoseaua Panduri 90, District 5, 050663, Bucharest, Romania
- Microbiology-Immunology Department, Faculty of Biology, University of Bucharest, 050095, Bucharest, Romania
- Biological Sciences Division, Romanian Academy, 125 Calea Victoriei, 010071, Bucharest, Romania
| | - Corneliu O Vrancianu
- Doctoral School, Carol Davila University of Medicine and Pharmacy, Eroii Sanitari 8, District 5, 050474, Bucharest, Romania.
- The Research Institute of the University of Bucharest, ICUB, Șoseaua Panduri 90, District 5, 050663, Bucharest, Romania.
- National Institute of Research and Development for Biological Sciences, 296 Splaiul Independentei, District 6, 060031, Bucharest, Romania.
| | - Roxana-E Cristian
- The Research Institute of the University of Bucharest, ICUB, Șoseaua Panduri 90, District 5, 050663, Bucharest, Romania
- National Institute of Research and Development for Biological Sciences, 296 Splaiul Independentei, District 6, 060031, Bucharest, Romania
| | - Cristina F Alistar
- The Research Institute of the University of Bucharest, ICUB, Șoseaua Panduri 90, District 5, 050663, Bucharest, Romania
| | - Marian Constantin
- The Research Institute of the University of Bucharest, ICUB, Șoseaua Panduri 90, District 5, 050663, Bucharest, Romania
- Institute of Biology of Romanian Academy, 296 Splaiul Independentei, District 6, 060031, Bucharest, Romania
| | - Mihaela Paun
- National Institute of Research and Development for Biological Sciences, 296 Splaiul Independentei, District 6, 060031, Bucharest, Romania
- Faculty of Administration and Business, University of Bucharest, Bucharest, Romania
| | - Alexandru Alistar
- The Research Institute of the University of Bucharest, ICUB, Șoseaua Panduri 90, District 5, 050663, Bucharest, Romania
| | - Loredana G Popa
- Faculty of Medicine, Microbiology Discipline II, Carol Davila University of Medicine and Pharmacy, 020021, Bucharest, Romania
| | - Mircea I Popa
- Faculty of Medicine, Microbiology Discipline II, Carol Davila University of Medicine and Pharmacy, 020021, Bucharest, Romania
- Preclinical Testing Unit, Cantacuzino National Military Medical Institute for Research and Development, 050096, Bucharest, Romania
| | - Ana C Tantu
- University of Medicine and Pharmacy of Craiova, Petru Rareș 2, 200349, Craiova, Romania
- Emergency Clinical County Hospital of Craiova, Tabaci 1, 200642, Craiova, Romania
| | - Manuela E Sidoroff
- National Institute of Research and Development for Biological Sciences, 296 Splaiul Independentei, District 6, 060031, Bucharest, Romania
| | - Mara M Mihai
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 020021, Bucharest, Romania
- Department of Oncologic Dermatology, "Elias" University Emergency Hospital, 010024, Bucharest, Romania
| | - Andreea Marcu
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 020021, Bucharest, Romania
| | - George Popescu
- Department of Neurosurgery 4, Bagdasar-Arseni Emergency Clinical Hospital, Şoseaua Berceni 12, 041915, Bucharest, Romania
| | - Monica M Tantu
- Department of Medical Assistance and Physical Therapy, Pitesti University Center, Târgu din Vale 1, 110040, Piteşti, Romania
- Faculty of Science, Physical Education and Informatics, National University of Science and Technology, Politehnica, Splaiul Independenţei 313, District 6, 060042, Bucharest, Romania
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Tronconi LP, Basile G, Mikus E, Prevot LB, Savini C, Lo Russo GV, Sangiorgi D, Bolcato V. Infective endocarditis and litigation for compensation on healthcare-associated infections: An Italian sample analysis. J Forensic Leg Med 2025; 113:102861. [PMID: 40334359 DOI: 10.1016/j.jflm.2025.102861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2025] [Revised: 03/21/2025] [Accepted: 03/30/2025] [Indexed: 05/09/2025]
Abstract
BACKGROUND Litigation related to Healthcare-Associated Infections (HAIs) in Italy represent a growing field of interest in establishing the medico-legal link between infection and the healthcare environment and practices for compensation; it is little explored in the cardiovascular surgery regarding infective endocarditis (IE). METHODS We retrospectively analysed the civil judgements on infective endocarditis in the Italian region Emilia-Romagna from 2016 to July 2024 using Ministry of Justice national official database. The search was conducted on the online database on July 31, 2024, using the free word "endocarditis". Two authors independently analysed the full-text judgements: , those IE without relevance in the reason for the claim were excluded. Main items were the timeline and outcome, with complaint motivation and liability ascertainment. In-court confirmation of healthcare causal link was reported. RESULTS Twenty-five judgments were retrieved. After screening for inclusion, nineteen judgements (11 of first instance and 8 of appeal) were included, for overall 15 cases of infective endocarditis. Of the fifteen cases, median age 60.5 years, 73 % males, median time for claim 6 years, for judgement 10 years and, if appealed, 16.5 years. Annual distribution of the claims was linear over time. Eleven (67 %) infective endocarditis were confirmed as healthcare-associated in trial. The prevalent reason for liability was improper or delayed diagnosis and/or treatment of the IE. Valvular surgery resulted in 40 %, while the more frequent pathogens were Staphylococcus aureus (40 %) and epidermidis (30 %). Of fifteen cases, 73 % was decided in favour of the patient-claimant, with an average cost of €289.872, plus an additional €55.296 in case of appeal. Only in 25 % the appeal's judge changed decision. In all cases, technical advisors were appointed. CONCLUSIONS This sample provides an initial insight into litigation for compensation related to infective endocarditis, highlighting specific characteristics compared to HAIs management in court. Medico-legal reasoning should be integrated into infection prevention and control policies and overall clinical risk management strategies.
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Affiliation(s)
- Livio Pietro Tronconi
- Department of Health and Life Sciences, European University of Rome, 00163, Rome, Italy; Maria Cecilia Hospital, GVM Care & Research, Cotignola, 48033, Ravenna, Italy
| | - Giuseppe Basile
- Department of Biomedical Sciences and Public Health, University "Politecnica delle Marche" of Ancona, 60124, Ancona, Italy.
| | - Elisa Mikus
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, 48033, Ravenna, Italy
| | - Luca Bianco Prevot
- Trauma Unit and Emergency Department, IRCCS Istituto Ortopedico Galeazzi, 20157, Milano, Italy; Residency Program in Orthopaedics and Traumatology, University of Milan, 20122, Milano, Italy
| | - Carlo Savini
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, 48033, Ravenna, Italy; Department of Experimental Diagnostic and Surgical Medicine (DIMEC), University of Bologna, 40126, Bologna, Italy
| | - Gerardo Vito Lo Russo
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, 48033, Ravenna, Italy; Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122, Milano, Italy
| | - Diego Sangiorgi
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, 48033, Ravenna, Italy
| | - Vittorio Bolcato
- Maria Beatrice Hospital, GVM Care & Research, 50121, Firenze, Italy
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Kolbe-Busch S, Djouela Djoulako PD, Stingu CS. Trends in Healthcare-Acquired Infections Due to Multidrug-Resistant Organisms at a German University Medical Center Before and During the COVID-19 Pandemic. Microorganisms 2025; 13:274. [PMID: 40005641 PMCID: PMC11858357 DOI: 10.3390/microorganisms13020274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2025] [Revised: 01/15/2025] [Accepted: 01/22/2025] [Indexed: 02/27/2025] Open
Abstract
BACKGROUND Healthcare-acquired infections due to multidrug-resistant organisms (MDR-HAIs) pose globally significant challenges to healthcare systems, leading to increased morbidity, mortality, and healthcare costs. According to the World Health Organization, the COVID-19 pandemic significantly impacted the burden of MDR-HAIs. The aim of this study was to investigate the dynamics and epidemiology of MDR-HAIs in inpatients at the University of Leipzig Medical Center (ULMC) before and during the COVID-19 pandemic. METHODS We compared data from inpatients with bacterial infections from 2017 to 2019 (pre-COVID-19) and from 2021to 2023 (during COVID-19) in a cross-sectional, monocentric, retrospective survey. This study focused on selected multidrug-resistant organisms (MDROs) and four clinical specimens. We analyzed the risk factors for MDR-HAIs using logistic regression models. RESULTS Out of 342,705 inpatients, 32,206 were diagnosed with a bacterial infection. The prevalence increased significantly from 8.09% (pre-COVID-19) to 10.79% (during COVID-19) (p < 0.001), but the proportion of MDROs decreased from 10.14% to 8.07%. The proportions of MDR-HAIs were 59.86% and 56.67%, respectively. The proportion of carbapenem-resistant Klebsiella pneumoniae and Enterobacter cloacae increased significantly. The risk of MDR-HAIs during COVID-19 decreased by 18% compared to pre-COVID-19 (p = 0.047). Longer hospital stays increased the risk of MDR-HAIs in both periods. This risk significantly decreased for children and the elderly during COVID-19. CONCLUSION These findings show that it is also important to analyze epidemiological data at the facility level in order to evaluate the effectiveness of infection control practices even during unprecedented health crises like the COVID-19 pandemic.
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Affiliation(s)
- Susanne Kolbe-Busch
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, University of Leipzig Medical Center, 04103 Leipzig, Germany; (S.K.-B.); (P.D.D.D.)
| | - Paule Dana Djouela Djoulako
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, University of Leipzig Medical Center, 04103 Leipzig, Germany; (S.K.-B.); (P.D.D.D.)
- Institut Pasteur/Cnam (Conservatoire National des Arts et Métiers), 75015 Paris, France
- Institute for Medical Microbiology and Virology, University of Leipzig Medical Center, 04103 Leipzig, Germany
| | - Catalina-Suzana Stingu
- Institute for Medical Microbiology and Virology, University of Leipzig Medical Center, 04103 Leipzig, Germany
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6
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Gubler S, Zaugg A, Yi R, Sherren E, Milner E, Conyer W, May T, Jack T, Heaton T, Christopherson J, Higbee P, Powers E, Takara M, Linder A, Boyack B, Pauga F, Salmon M, Thomas M, Shiraki M, Deng S, Savage PB. Design, synthesis, antimicrobial activity, stability, and mechanism of action of bioresorbable ceragenins. RSC Med Chem 2025:d4md00990h. [PMID: 39897390 PMCID: PMC11782991 DOI: 10.1039/d4md00990h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Accepted: 12/27/2024] [Indexed: 02/04/2025] Open
Abstract
Device-related infections (DRIs) from bacterial/fungal biofilms that form on surfaces are a major cause of death in first-world countries. DRIs and the increasing prevalence of antibiotic resistant strains require development of new antimicrobials for improved antimicrobial prophylaxis. New antimicrobial prophylaxis practices necessitate novel agents to combat a broad spectrum of both fungi and bacteria, to be less toxic to patients, and to be locally administrable to prevent perturbations to a patient's microbiome. A class of antimicrobials that we have previously developed to fit these criteria is ceragenins. Here we describe the design, synthesis, and characterization of a new series of ceragenins that is composed of and degrades into endogenous compounds: cholic acid, B alanine, and glycerides. From this series we identify an optimized bioresorbable ceragenin that has comparable antimicrobial activities to other ceragenins, degrades rapidly through the action of lipase and at pH 7.2, and has a similar mechanism of action to previously developed ceragenins.
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Affiliation(s)
- Shawn Gubler
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Aaron Zaugg
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Rebekah Yi
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Elliot Sherren
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Elizabeth Milner
- College of Natural and Computational Sciences, Hawaii Pacific University Kaneohe HI 96744 USA
| | - Wesley Conyer
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Tate May
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Tim Jack
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Tanner Heaton
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Joel Christopherson
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Preston Higbee
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Emma Powers
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Meg Takara
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Anna Linder
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Boston Boyack
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Fetutasi Pauga
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Morgann Salmon
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Miriam Thomas
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Mariko Shiraki
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Shenglou Deng
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
| | - Paul B Savage
- Department of Chemistry and Biochemistry, Brigham Young University Provo UT 84604 USA
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7
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Guo L, Huang S, Sui H, Li W. Incidence and influencing factors for surgical site infections after cesarean section in China: A systematic review and meta-analysis. J Obstet Gynaecol Res 2025; 51:e16172. [PMID: 39716476 DOI: 10.1111/jog.16172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2024] [Accepted: 11/18/2024] [Indexed: 12/25/2024]
Abstract
OBJECTIVE This study aims to estimate the overall incidence of surgical site infections (SSIs) after cesarean section (CS) and the influencing factors in the Chinese population. MATERIALS AND METHODS The study searched all relevant literature in English and Chinese search databases (English search bases: PubMed, Embase, Cochrane Library, Web of Science; Chinese search bases: China National Knowledge Infrastructure, Wanfang, and China Science and Technology Journal Database) up to March 19, 2024, according to the search strategy. A random/fixed effects model was decided on the basis of the I2 statistic assessing the magnitude of study heterogeneity, and publication bias was assessed using the Begg's test. RESULTS After the selection, a final selection of 25 articles was involved. The estimate of post-CS SSIs in China was 2.4% (95%CI: 0.019, 0.029). Age ≥30 years (WMD: 3.8), pre-pregnancy body mass index (BMI) ≥25 kg/m2 (WMD: 1.8), obesity (odds ratio [OR]: 3.0), vaginal cleanliness 3-4 (OR: 4.2), anemia (OR: 1.4), premature rupture of membranes (OR: 2.6), diabetes mellitus (OR: 2.7), National Nosocomial Infections Surveillance System 1-3 (OR: 5.6), emergency surgery (OR: 2.3), trial of labor (OR: 2.9), duration of surgery ≥60 min (OR: 2.0), and intraoperative blood loss >500 mL (OR: 3.5) were the risk factors for post-CS SSIs. CONCLUSIONS The rate of post-CS SSIs estimated was 2.4% in China. Both maternal conditions and surgical factors can potentially increase the risk of post-CS SSIs.
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Affiliation(s)
- Li Guo
- Department of Obstetrics, Beichen Traditional Chinese Medicine Hospital Affiliated to Tianjin University of Traditional Chinese Medicine, Tianjin, P.R. China
| | - Shujuan Huang
- Department of Obstetrics, Beichen Traditional Chinese Medicine Hospital Affiliated to Tianjin University of Traditional Chinese Medicine, Tianjin, P.R. China
| | - Hongmei Sui
- Department of Obstetrics, Beichen Traditional Chinese Medicine Hospital Affiliated to Tianjin University of Traditional Chinese Medicine, Tianjin, P.R. China
| | - Weichao Li
- Department of Infectious Diseases, Tianjin, P.R. China
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8
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Limenyande MJM, Isunju JB, Musoke D. Barriers and facilitators of compliance with infection prevention and control measures during the COVID-19 pandemic in health facilities in Kampala city, Uganda. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0004021. [PMID: 39652537 PMCID: PMC11627369 DOI: 10.1371/journal.pgph.0004021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 11/17/2024] [Indexed: 12/12/2024]
Abstract
During the COVID-19 pandemic, Infection Prevention and Control (IPC) was crucial to reduce the spread of the virus in health facilities. This study explored the barriers and facilitators of IPC compliance among healthcare workers (HCWs) during the COVID-19 pandemic in Kampala City, Uganda. Key informant interviews were conducted with 14 participants in 12 health facilities located in Nakawa division, Kampala City. Of these facilities, 3 were government-owned, and 9 were private not-for-profit. Each health facility's participant was either the IPC focal person or a HCW knowledgeable about the IPC measures implemented there. Transcripts were coded using a newly generated codebook in Atlas.ti version 9, and thematic analysis was carried out to analyze the study findings. Participants identified the fear of contracting the virus as one of the primary facilitators for IPC compliance among HCWs during the COVID-19 pandemic. They explained that the sustainability of IPC measures in health facilities was partly due to HCWs' belief that they served as role models in the community for observing and implementing health-related behaviors, especially regarding COVID-19. Among the barriers, participants mentioned that not all HCWs got the opportunity to be trained on COVID-19 IPC. Only HCWs working in high-risk departments for COVID-19 such as triage or Intensive Care Units were prioritized. However, regardless of the department, all HCWs were exposed to potential COVID-19 patients, and the high workload led them to sometimes skip the required IPC measures. This study found that addressing the spread of COVID-19 among HCWs necessitated a comprehensive approach to IPC in health facilities. This approach should encompass capacity building, as well as provision of necessary supplies. In addition, HCWs, the hospital management and government have a role to play to ensure that IPC is fully implemented in the case of future related outbreaks.
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Affiliation(s)
| | | | - David Musoke
- Makerere University School of Public Health, Kampala, Uganda
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Sczesny NF, Wiggers HJ, Bueno CZ, Chevallier P, Copes F, Mantovani D. From Burst to Sustained Release: The Effect of Antibiotic Structure Incorporated into Chitosan-Based Films. Antibiotics (Basel) 2024; 13:1055. [PMID: 39596749 PMCID: PMC11591004 DOI: 10.3390/antibiotics13111055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Revised: 10/29/2024] [Accepted: 11/03/2024] [Indexed: 11/29/2024] Open
Abstract
Background/Objectives: Medical devices are susceptible to bacterial colonization and biofilm formation, which can result in severe infections, leading to prolonged hospital stays and increased burden on society. Antibacterial films have the potential to assist in preventing biofilm formation, thereby reducing administration of antibiotics and the emergence of antibiotic-resistant strains. In a previous study, a chitosan-based matrix crosslinked with tannic acid and loaded with gentamicin was reported. In this study, five different antibiotics (moxifloxacin, ciprofloxacin, trimethoprim, sulfamethoxazole or linezolid) were loaded into these chitosan-based films, and their impact on the release behavior carefully assessed. Methods: The samples were characterized according to their thickness, swelling, and mass loss in phosphate-buffered saline (PBS), as well as by morphology using scanning electron microscopy (SEM) and optical phase contrast microscopy. Antibiotic release over time was quantified in PBS by high-performance liquid chromatography (HPLC). Antibacterial activity was investigated by disk diffusion test and antibiotic release over time. Finally, the cytotoxicity of the samples was assessed with human dermal fibroblasts. Results: The obtained results differed significantly, especially regarding the antibiotic release time and antibacterial activity, which varied from one day to six months, enabling classification of the films from burst/transient to prolonged release. The films also showed antibacterial features against bacteria mostly present in medical devices and displayed to be non-cytotoxic. Conclusions: In conclusion, it was demonstrated that the antibiotics structure significantly alters the release kinetics, and that by carefully selecting the antibiotic, the consequent release can be tuned. This approach yielded films that could be used for potentially-scalable release in antimicrobial coatings specific to medical devices, aiming to reduce biomaterial associated infections (BAIs).
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Affiliation(s)
- Nathália F. Sczesny
- Laboratory for Biomaterials and Bioengineering (LBB-BPK), Associação de Ensino, Pesquisa e Extensão BIOPARK, Max Planck Avenue, 3797, Building Charles Darwin, Toledo 85919-899, PR, Brazil; (N.F.S.); (H.J.W.); (C.Z.B.)
| | - Helton J. Wiggers
- Laboratory for Biomaterials and Bioengineering (LBB-BPK), Associação de Ensino, Pesquisa e Extensão BIOPARK, Max Planck Avenue, 3797, Building Charles Darwin, Toledo 85919-899, PR, Brazil; (N.F.S.); (H.J.W.); (C.Z.B.)
| | - Cecilia Z. Bueno
- Laboratory for Biomaterials and Bioengineering (LBB-BPK), Associação de Ensino, Pesquisa e Extensão BIOPARK, Max Planck Avenue, 3797, Building Charles Darwin, Toledo 85919-899, PR, Brazil; (N.F.S.); (H.J.W.); (C.Z.B.)
| | - Pascale Chevallier
- Laboratory for Biomaterials and Bioengineering (LBB-UL), Canada Research Chair Tier I, Department of Min-Met-Materials Engineering & Division Regenerative Medicine of CHU de Quebec Research Center, Laval University, Quebec City, QC G1V 0A6, Canada;
| | - Francesco Copes
- Laboratory for Biomaterials and Bioengineering (LBB-UL), Canada Research Chair Tier I, Department of Min-Met-Materials Engineering & Division Regenerative Medicine of CHU de Quebec Research Center, Laval University, Quebec City, QC G1V 0A6, Canada;
| | - Diego Mantovani
- Laboratory for Biomaterials and Bioengineering (LBB-BPK), Associação de Ensino, Pesquisa e Extensão BIOPARK, Max Planck Avenue, 3797, Building Charles Darwin, Toledo 85919-899, PR, Brazil; (N.F.S.); (H.J.W.); (C.Z.B.)
- Laboratory for Biomaterials and Bioengineering (LBB-UL), Canada Research Chair Tier I, Department of Min-Met-Materials Engineering & Division Regenerative Medicine of CHU de Quebec Research Center, Laval University, Quebec City, QC G1V 0A6, Canada;
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10
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Cappelli E, Zaghini F, Fiorini J, Sili A. Healthcare-associated infections and nursing leadership: A systematic review. J Infect Prev 2024:17571774241287467. [PMID: 39544633 PMCID: PMC11559430 DOI: 10.1177/17571774241287467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/29/2024] [Accepted: 08/08/2024] [Indexed: 11/17/2024] Open
Abstract
Background Healthcare-associated infections are strictly related to healthcare practices. A head nurse stimulates and motivates nurses, boosts nurses' job performance and satisfaction, and can influence adverse event development. Aim To explore the relationship between healthcare-associated infections and head nurse leadership style. Methods A systematic review was conducted. The search was conducted from 1973 until March 2022 on PubMed, Cochrane Library, Scopus, CINAHL, Web of Science, Embase, and APA PsycInfo databases. The review followed the Joanna Briggs Institute Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A thematic synthesis and critical appraisal of the included studies have been conducted. Results Eight articles were included in this review. Head nurses' leadership, supported by the organization, can positively influence the job performance and job satisfaction of nurses by reducing infection rates associated with vascular access and urinary catheters. Discussion Authentic and transformational nurse leadership styles can foster targeted interventions and improvements tailored to preventing and controlling healthcare-associated infections. Even if there is limited evidence, the results support that the occurrence of infections can be reduced by leadership strategies implemented by head nurses.
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Affiliation(s)
- Eva Cappelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Francesco Zaghini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Jacopo Fiorini
- Nursing Department, Tor Vergata University Hospital, Rome, Italy
| | - Alessandro Sili
- Nursing Department, Tor Vergata University Hospital, Rome, Italy
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Wubneh CA, Mekonnen BD, Alemu TG, Techane MA, Assimamaw NT, Belay GM, Tamir TT, Muhye AB, Kassie DG, Wondim A, Terefe B, Tarekegn BT, Ali MS, Fentie B, Gonete AT, Tekeba B, Kassa SF, Desta BK, Ayele AD, Dessie MT, Atalell KA. Knowledge, attitude and practice of healthcare workers on infection prevention and control in Ethiopia: A systematic review and meta-analysis. PLoS One 2024; 19:e0308348. [PMID: 39236020 PMCID: PMC11376544 DOI: 10.1371/journal.pone.0308348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/22/2024] [Indexed: 09/07/2024] Open
Abstract
INTRODUCTION Infectious diseases remain the leading causes of death in low and middle-income countries including Ethiopia. The existence of emerging, re-emerging, and drug-resistant infectious agents maximizes the importance of infection prevention and control. Healthcare workers are the key actors in the prevention and control of infection. As a result assessing the knowledge, attitude, and practice of healthcare workers toward infection prevention and control is very critical in the prevention and control of infectious diseases. Therefore, this systematic review and meta-analysis aimed to assess the knowledge, attitude, and practice of healthcare providers toward infection prevention in Ethiopia. METHOD PubMed, Scopus, SEMANTIC SCHOLAR, Google Scholar, and Addis Ababa University Digital Library were systematically searched for relevant literature until November 18/2023. The quality of the included studies was assessed using the Joanna Briggs Institute quality appraisal tool. Data were abstracted using a Microsoft Excel spreadsheet and analyzed using STATA version 11. A random-effects model was used to estimate the pooled prevalence. Heterogeneity among reported studies was assessed by Forest plot, Cochran's Q-statistics, and I2 test. Publication bias was checked using funnel plots, and Egger's regression test. In addition, sub-group and sensitivity analyses were conducted. RESULT A total of 7,681 articles were retrieved of which 19 studies with 5,650 healthcare workers were included in this systematic review and meta-analysis. About 74.5% (95% CI, 65.88, 83.12), 66.71% (95% CI 55.15, 78.28), and 55.2% (95% CI 48.22, 62.18) of healthcare workers were knowledgeable, had positive attitudes, and good standard of practice on infection prevention respectively. CONCLUSION Despite acceptable knowledge and attitude, about half of the healthcare workers have unsafe infection prevention and control practices in Ethiopia. Hence, serious attention should be given to healthcare workers' application of infection prevention standards in their working environment.
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Affiliation(s)
- Chalachew Adugna Wubneh
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | | | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Masresha Asmare Techane
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Nega Tezera Assimamaw
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Getaneh Mulualem Belay
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Addis Bilal Muhye
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Destaye Guadie Kassie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Amare Wondim
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Bewuketu Terefe
- Community Health Nursing Unit, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Bethelihem Tigabu Tarekegn
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mohammed Seid Ali
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Beletech Fentie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Berhan Tekeba
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Selam Fisiha Kassa
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Bogale Kassahun Desta
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Amare Demsie Ayele
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Melkamu Tilahun Dessie
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Kendalem Asmare Atalell
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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12
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Sierra-Diaz E, Puron-Cid G, Torres-Sanchez JP, García-Quintero HI, Cisneros-García DL, García-Gutierrez M, Cremades R, Sandoval-Pinto E. Healthcare-Associated Infections: Pre- and Post-pandemic Microbiological Profile and Antibiotic Resistance. Cureus 2024; 16:e70263. [PMID: 39463524 PMCID: PMC11512655 DOI: 10.7759/cureus.70263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2024] [Indexed: 10/29/2024] Open
Abstract
BACKGROUND In recent years, healthcare-associated infections (HAIs) have been a priority topic for global institutions such as the World Health Organization because, during the COVID-19 pandemic, the role of HAIs as co-morbidity in infected patients was evident. HAIs can cause disability and mortality and lead to excessive healthcare costs. This work aims to calculate the prevalence of HAIs from 2019 to 2023 to determine their microbiological profile and antibiotic resistance. METHODS A cross-sectional design was used for this study. To describe the population, univariate analysis, measures of central tendency, frequencies, and proportions were used. RESULTS The present study included 3,936 HAI notifications, which showed a significant decrease in their number during the COVID-19 pandemic, especially in 2020. In 2021 and 2022, the numbers increased rapidly to around 30%. The most prevalent HAI type was ventilator-associated pneumonia, which had the highest prevalence in 2020. Regarding microorganism isolation, percentages increased after 2020 from 46% to 67%, with Acinetobacter baumannnii beingthe most frequent during and after pandemics. The microbiological profile showed multidrug resistance in several microorganisms. CONCLUSIONS HAIs are a global health concern. The number of cases has been increasing since the COVID-19 pandemic with regard to the multidrug-resistant microorganism. HAIs have an important impact on the quality of life, morbidity, mortality, and financial concerns for health services. Global strategies should be adapted for different regions, since the panaroma in developed countries allows for programs to be established for the prevention and control of HAIs in a better way than in low-income countries that lack adequate infrastructure and resources.
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Affiliation(s)
- Erick Sierra-Diaz
- Epidemiology and Public Health, Mexican Social Security Institute, Guadalajara, MEX
| | - Gabriel Puron-Cid
- Public Administration, Center for Economic Research and Teaching, A.C., Aguascalientes, MEX
| | | | | | | | - Mariana García-Gutierrez
- Pediatrics, School of Medicine and Health Sciences, Monterrey Institute of Technology and Higher Education, Guadalajara, MEX
| | - Rosa Cremades
- Microbiology and Pathology, University of Guadalajara, Guadalajara, MEX
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Aloufi M, Aloufi ME, Almalki SR, Hassanien NSM. Determinants of Healthcare-Associated Infections in King Abdulaziz Specialized Hospital in Taif, Saudi Arabia. Cureus 2024; 16:e69423. [PMID: 39411602 PMCID: PMC11479393 DOI: 10.7759/cureus.69423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND Healthcare-associated infections (HAIs) represent a significant challenge in hospital settings, contributing to increased morbidity, mortality, and healthcare costs. This study aimed to estimate the prevalence and socio-demographic and clinical determinants of HAIs at the King Abdulaziz Specialized Hospital (KAASH) in Taif, Saudi Arabia. METHODOLOGY A hospital-based cross-sectional study was conducted from March 2023 to January 2024 targeting inpatients aged 18 and above in all units and wards. Data were collected using the National Healthcare Safety Network (NHSN) criteria for definitions of surveillance. A structured questionnaire gathered socio-demographic and clinical data from patients or next of kin if the patient was not fully oriented. Descriptive statistics were performed, and analytical methods used included Pearson chi-square test, Pearson correlation, independent t-test, and one-way analysis of variance. RESULTS Among 318 participants included in this study, the mean age of participants was 56.44 years, with a slight female predominance (n=164, 51.6%). Hypertension (n=162, 50.9%) and diabetes (n=126, 39.6%) were the most prevalent comorbidities. Pneumonia (n=60, 26.8%) and trauma (n=55, 17.4%) were the leading causes of admission. The two most common HAIs included catheter-associated urinary tract infections (CAUTI) (n=124, 39%) and central line-associated bloodstream infections (CLABSI) (n=74, 23.3%). The primary causative organisms were Klebsiella pneumoniae (n=96, 30.2%) and Acinetobacter baumannii (n=32, 10.1%). The most significant predictors of HAIs were as follows: For CLABSI, risk factors include having three or more comorbidities, fever above 37.8°C, chills or rigors, hypotension, and positive blood culture. For CAUTI, key predictors were urinary tract infection (UTI), positive urine culture, acute pain or swelling of the testes, suprapubic tenderness, visible hematuria, and leukocytosis. Significant predictors of bloodstream infections (BSI) include having a BSI, positive blood culture, chills or rigors, and hypotension. Fever and hypotension increased CLABSI and BSI risk but reduced the CAUTI risk. CONCLUSION The study highlights a significant burden of HAIs at the KAASH, with multiple predictors. The findings underscore the need for robust infection control measures and targeted interventions to reduce HAI incidence and improve patient outcomes.
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14
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Zhang M, Wu S, Ibrahim MI, Noor SSM, Mohammad WMZW. Significance of Ongoing Training and Professional Development in Optimizing Healthcare-associated Infection Prevention and Control. JOURNAL OF MEDICAL SIGNALS & SENSORS 2024; 14:13. [PMID: 39100741 PMCID: PMC11296567 DOI: 10.4103/jmss.jmss_37_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 08/06/2024]
Abstract
The employees who work in infection prevention and control (IPC) are very important in the field of health-care because they are committed to protecting patients, staff, and visitors from the risk of acquiring infections while in the hospital. The complexity of infection control in hospitals is alwaysgrowing in tandem with the rapid developments that are being made in medical technology andpractices. IPC personnel are required to maintain vigilance and continually improve their monitoringof the entire health-care process due to the ongoing development of IPC guidelines and regulations, the fluctuating infection risks, and the emergence of new infectious diseases. As a result, individuals involved in the prevention and control of infections in health-care settings absolutely need to participate in continual training and professional development. This reviewemphasizes the need of relevant professionals to engage in ongoing training and professional development to maintain their skills in the area of healthcare-associated infection control and prevention. Personnel working in IPC may more effectively react to newly discovered health risks andmake certain that hospital infection (HI) management gets the appropriate attention if they have atimely and in-depth awareness of best practices. They are better able to maintain their composure, react correctly, and deliver the most effective infection control and prevention techniques for the health-care system, all while increasing awareness about the significance of effective HI management.
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Affiliation(s)
- Maojie Zhang
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Department of Infection Management, The First Affiliated Hospital of Guizhou Traditional Chinese Medicine University, Guiyang, China
| | - Shengwei Wu
- Department of Infection Management, The First Affiliated Hospital of Guizhou Traditional Chinese Medicine University, Guiyang, China
| | - Mohd Ismail Ibrahim
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Siti Suraiya Md Noor
- Department of Medical Microbiology & Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Wan Mohd Zahiruddin Wan Mohammad
- Department of Community Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Darjees D, Dhandapani S, Priyadarshi K, Cherian A, Sastry AS. Impact of care bundle audit on compliance to device care bundles and device associated infections in the Critical Care Unit of a tertiary care hospital, Southern India - A before-after interventional study. Indian J Med Microbiol 2024; 50:100651. [PMID: 38906328 DOI: 10.1016/j.ijmmb.2024.100651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 06/01/2024] [Accepted: 06/18/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND A care bundle comprises a set of evidence-based practices in patient care that are grouped together with the assumption that these practices when performed together will result in better clinical outcomes than when these practices are performed separately. Care bundles for devices when implemented effectively can bring about a reduction in device associated infection rates. METHODS The study was conducted in three phases, 1 month pre-interventional and interventional phases and 11 months of post-interventional phase in a critical care unit. Compliance to care bundles were recorded by direct observation during daily audit rounds. An educational intervention addressing the healthcare workers regarding bundle care approach was conducted and supplemented with bedside "audit and feedback" during the interventional phase. Audit was conducted in the post-interventional period to study the trend of device associated infections and compliance rates. RESULTS An increasing trend of month-wise compliance rates to the device care bundles were observed. The month-wise Ventilator Associated Events rates showed a decreasing trend. In the post-interventional phase, the average Catheter-associated Urinary Tract Infection, Central Line Associated Bloodstream Infection and Ventilator Associated Events rates showed a reduction from their respective baseline rates for the study setting. CONCLUSIONS An educational intervention targeted at the healthcare workers along with daily audit of care bundle practices in the critical care setting led to an increase in the compliance to device care bundles and a reduction in the incidence of Catheter-associated Urinary Tract Infection, Central Line Associated Bloodstream Infection and Ventilator Associated Events rates in the critical care setting.
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Affiliation(s)
- Dijo Darjees
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Gorimedu, Pondicherry, 605006, India.
| | - Sarumathi Dhandapani
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Gorimedu, Pondicherry, 605006, India.
| | - Ketan Priyadarshi
- Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Patna - Aurangabad Rd, Phulwari Sharif, Patna, Bihar, 801507, India.
| | - Anusha Cherian
- Department of Anesthesiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Gorimedu, Pondicherry, 605006, India.
| | - Apurba Sankar Sastry
- Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Dhanvantri Nagar, Gorimedu, Pondicherry, 605006, India.
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Aryan N, Grigorian A, Jeng J, Kuza C, Kong A, Swentek L, Burruss S, Nahmias J. Incidence, Risk Factors, and Outcomes of Central Line-Associated Bloodstream Infections in Trauma Patients. Surg Infect (Larchmt) 2024; 25:370-375. [PMID: 38752327 DOI: 10.1089/sur.2024.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Abstract
Introduction: Central line-associated blood stream infection (CLABSI) is a hospital-acquired infection (HAI) associated with increased morbidity and mortality among the general patient population. However, few studies have evaluated the incidence, outcomes, and risk factors for CLABSI in trauma patients. This study aimed to identify the rate of positive (+)CLABSI in trauma patients and risk factors associated with (+)CLABSI. Methods: The 2017-2021 Trauma Quality Improvement Program database was queried for trauma patients aged ≥18 years undergoing central-line placement. We compared patients with (+)CLABSI vs. (-)CLABSI patients. Bivariate and multivariable logistic regression analyses were performed. Results: From 175,538 patients undergoing central-line placement, 469 (<0.1%) developed CLABSI. The (+)CLABSI patients had higher rates of cirrhosis (3.9% vs. 2.0%, p = 0.003) and chronic kidney disease (CKD) (4.3% vs. 2.6%, p = 0.02). The (+)CLABSI group had increased injury severity score (median: 25 vs. 13, p < 0.001), length of stay (LOS) (median 33.5 vs. 8 days, p < 0.001), intensive care unit LOS (median 21 vs. 6 days, p < 0.001), and mortality (23.7% vs. 19.6%, p = 0.03). Independent associated risk factors for (+)CLABSI included catheter-associated urinary tract infection (CAUTI) (odds ratio [OR] = 5.52, confidence interval [CI] = 3.81-8.01), ventilator-associated pneumonia (VAP) (OR = 4.43, CI = 3.42-5.75), surgical site infection (SSI) (OR = 3.66, CI = 2.55-5.25), small intestine injury (OR = 1.91, CI = 1.29-2.84), CKD (OR = 2.08, CI = 1.25-3.47), and cirrhosis (OR = 1.81, CI = 1.08-3.02) (all p < 0.05). Conclusion: Although CLABSI occurs in <0.1% of trauma patients with central-lines, it significantly impacts LOS and morbidity/mortality. The strongest associated risk factors for (+)CLABSI included HAIs (CAUTI/VAP/SSI), specific injuries (small intestine), and comorbidities. Providers should be aware of these risk factors with efforts made to prevent CLABSI in these patients.
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Affiliation(s)
- Negaar Aryan
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
| | - Areg Grigorian
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
| | - James Jeng
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
| | - Catherine Kuza
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, California, USA
| | - Allen Kong
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
| | - Lourdes Swentek
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
| | - Sigrid Burruss
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
| | - Jeffry Nahmias
- Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, University of California, Irvine, Orange, California, USA
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Babore GO, Eyesu Y, Mengistu D, Foga S, Heliso AZ, Ashine TM. Adherence to Infection Prevention Practice Standard Protocol and Associated Factors Among Healthcare Workers. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2024; 7:50-58. [PMID: 38725880 PMCID: PMC11077518 DOI: 10.36401/jqsh-23-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/21/2023] [Accepted: 11/02/2023] [Indexed: 05/12/2024]
Abstract
Introduction Healthcare-associated infection affects more than 100 million patients annually. Healthcare workers' poor adherence to standard infection prevention and control procedures can result in many negative consequences, ranging from disability to death. Methods A facility-based, cross-sectional study was conducted in June 2021 among 379 healthcare workers selected using a stratified random sampling technique. All types of healthcare providers except pharmacy professionals were included in the study. Standardization and validation of the study tool were performed ahead of data collection. Multivariable regression was used to assess the variables associated with adherence. Results The study found that 60.2% of healthcare workers (95% CI, 55.1-65.2) had good adherence to infection prevention practices, and 68.7% and good knowledge of infection prevention practices. Training on infection prevention methods (adjusted odds ratio [AOR] = 1.68; 95% CI, 1.04-2.72), availability of water supply at hand washing station (AOR = 2.90; 95% CI, 1.62-5.31), and attitude toward infection prevention (AOR = 2.64; 95% CI, 1.65-4.24) were identified as predictors of adherence to infection prevention and control procedures. Conclusion More than half of the participants had good adherence to infection prevention guideline practices. In-service infection prevention training, a consistent water supply at the hand washing station, and a positive attitude of participants were associated with good adherence to infection prevention practices.
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Affiliation(s)
- Getachew Ossabo Babore
- Department of Comprehensive Nursing, School of Nursing, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Yaregal Eyesu
- Department of Adult, Health Nursing, Addis Ababa Medical and Business College, Addis Ababa, Ethiopia
| | - Daniel Mengistu
- Department of Nursing, Addis Ababa University College of Medicine and Health Science, Addis Ababa, Ethiopia
| | - Sisay Foga
- Department of Pediatric and Child Health Nursing, School of Nursing, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Asnakech Zekiwos Heliso
- Department of Comprehensive Nursing, School of Nursing, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Taye Mezgebu Ashine
- Department of Comprehensive Nursing, School of Nursing, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
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Melariri H, Freercks R, van der Merwe E, Ham-Baloyi WT, Oyedele O, Murphy RA, Claasen C, Etusim PE, Achebe MO, Offiah S, Melariri PE. The burden of hospital-acquired infections (HAI) in sub-Saharan Africa: a systematic review and meta-analysis. EClinicalMedicine 2024; 71:102571. [PMID: 38606166 PMCID: PMC11007440 DOI: 10.1016/j.eclinm.2024.102571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
Background Hospital-acquired infections (HAI) are a leading cause of morbidity and mortality globally. These infections are diverse, but the majority are lower respiratory tract infection (LRTI), surgical site infection (SSI), bloodstream infection (BSI), and urinary tract infection (UTI). For most sub-Saharan African countries, studies revealing the burden and impact of HAI are scarce, and few systematic reviews and meta-analysis have been attempted. We sought to fill this gap by reporting recent trends in HAI in sub-Saharan Africa (SSA) with attention to key patient populations, geographic variation, and associated mortality. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a literature search of six electronic databases (Web of Science, Pubmed, APA PsycInfo, CINAHL, Embase, and the Cochrane Library) to identify studies assessing the prevalence of HAI in SSA countries. Studies published between 01 January 2014 and 31 December 2023 were included. We applied no language or publication restrictions. Record screening and data extractions were independently conducted by teams of two or more reviewers. Using the R software (version 4.3.1) meta and metafor packages, we calculated the pooled prevalence estimates from random-effect meta-analysis, and further explored sources of heterogeneity through subgroup analyses and meta-regression. This study is registered with PROSPERO, CRD42023433271. Findings Forty-one relevant studies were identified for analysis, consisting of 15 from West Africa (n = 2107), 12 from Southern Africa (n = 2963), 11 from East Africa (n = 2142), and 3 from Central Africa (n = 124). A total of 59.4% of the patient population were associated with paediatric admissions. The pooled prevalence of HAI was estimated at 12.9% (95% CI: 8.9-17.4; n = 7336; number of included estimates [k] = 41, p < 0.001). By subregions, the pooled current prevalence of HAI in the West Africa, Southern Africa, East Africa and Central Africa were estimated at 15.5% (95% CI: 8.3-24.4; n = 2107; k = 15), 6.5% (95% CI: 3.3-10.7; n = 2963; k = 12), 19.7% (95% CI: 10.8-30.5; n = 2142; k = 11) and 10.3% (95% CI: 1.1-27.0; n = 124; k = 3) of the patient populations respectively. We estimated mortality resulting from HAI in SSA at 22.2% (95% CI: 14.2-31.4; n = 1118; k = 9). Interpretation Our estimates reveal a high burden of HAI in SSA with significant heterogeneity between regions. Variations in HAI distribution highlight the need for infection prevention and surveillance strategies specifically tailored to enhance prevention and management with special focus on West and East Africa, as part of the broader global control effort. Funding No funding was received for this study.
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Affiliation(s)
- Herbert Melariri
- Department of Otorhinolaryngology, Port Elizabeth Provincial Hospital, South Africa
- School of Medicine, Nelson Mandela University, South Africa
| | - Robert Freercks
- School of Medicine, Nelson Mandela University, South Africa
- Division of Nephrology and Hypertension, Livingstone Tertiary Hospital, South Africa
| | - Elizabeth van der Merwe
- School of Medicine, Nelson Mandela University, South Africa
- Department of Adult Critical Care, Livingstone Tertiary Hospital, South Africa
| | | | - Opeoluwa Oyedele
- Department of Computing, Mathematical and Statistical Sciences, University of Namibia, Namibia
- Department of Environmental Health, Nelson Mandela University, South Africa
| | - Richard A. Murphy
- White River Junction Veterans Affairs Medical Center, White River Junction, VT, United States
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | - Paschal Emeka Etusim
- Unit of Public Health/Environmental Parasitology and Entomology, Abia State University, Uturu, Nigeria
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Kilani MA, Aljohar BA, Alayed YA, Alshahrani NZ, Shiha HR, Bin Saleh G, Alshanbari NH, Alanazi KH. Epidemiological patterns of bacterial and fungal healthcare-associated infection outbreaks in Ministry of Health hospitals in Saudi Arabia, 2020-2021. J Infect Public Health 2024; 17:551-558. [PMID: 38367569 DOI: 10.1016/j.jiph.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 01/15/2024] [Accepted: 01/23/2024] [Indexed: 02/19/2024] Open
Abstract
BACKGROUND Healthcare-Associated Infections (HAI) outbreaks remain a huge challenge to the healthcare sectors worldwide. Their impact on morbidity and mortality, economic and healthcare burden remains a public health problem and a challenge to the HAI surveillance system, infection control, and HAI management strategies. AIM This study aimed to investigate the epidemiological patterns, distribution, causative agents of HAI outbreaks and the influence of age, COVID-19 co-infection, medical invasive procedures, and hospital units on mortality among HAI outbreaks cases. METHODS This chart review study involved HAI outbreak cases recorded in Ministry of Health hospitals during 2020-2021 in Saudi Arabia. HAI outbreak notification and investigation forms were used for data collection. A binary logistic regression model was performed to determine the significant predictors of mortality. Univariate analyses were performed to determine the association between hospital units, organisms, and COVID-19 co-infection to the site of infection. RESULTS A total of 217 HAI outbreaks with 1003 cases were recorded in 2020-2021. Gram-negative bacteria were isolated from 73.8% of the cases. The overall specific case fatality rate was 47.5%. The significant predictors of mortality were age, invasive medical procedures, COVID-19 co-infection, and intensive care units' admission. Moreover, ventilator-associated events were more associated with cases co-infected with COVID-19. CONCLUSION HAI outbreaks were most prevalent in the Western and Central region and in intensive care units. Gram negative bacteria were responsible for most of cases while ventilator-associated events and central line-associated bloodstream infections were the most common infection sites. Implementing targeted and effective prevention and control strategies is recommended.
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Affiliation(s)
| | - Bashaier A Aljohar
- Assistant Agency for Preventive Health, Ministry of Health, Riyadh, Saudi Arabia
| | | | | | - Hala R Shiha
- General Directorate of Infection Prevention and Control, Ministry of Health, Riyadh, Saudi Arabia
| | - Ghada Bin Saleh
- General Directorate of Infection Prevention and Control, Ministry of Health, Riyadh, Saudi Arabia
| | - Nasser H Alshanbari
- General Directorate of Infection Prevention and Control, Ministry of Health, Riyadh, Saudi Arabia
| | - Khalid H Alanazi
- General Directorate of Infection Prevention and Control, Ministry of Health, Riyadh, Saudi Arabia
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Varon B, Palacios-Baena ZR, de Kraker MEA, Rodríguez-Baño J, Leibovici L, Paul M. Universal Risk Factors for Mortality in Bloodstream Infections (UNIFORM): a systematic review and Delphi survey. Clin Microbiol Infect 2024; 30:453-461. [PMID: 38182050 DOI: 10.1016/j.cmi.2023.12.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/27/2023] [Accepted: 12/31/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Significant variations in the variables collected in clinical studies focusing on bacteraemia lead to inconsistency in the evaluation of risk factors for mortality. OBJECTIVE We aimed to define a minimum set of risk factors that should be assessed and reported in all studies assessing survival in bacteraemia. STUDY ELIGIBILITY We conducted a systematic review including observational prospective and retrospective cohort studies that assessed all-cause mortality among patients with bacteraemia. We included only studies computing an adjusted analysis for mortality, with >500 participants. EXPOSURES Independently significant risk factors for all-cause, preferably 30-day, mortality. DATA SOURCES PubMed was used to identify eligible studies published between 2000 and 2020. A Delphi survey among experts was used to evaluate and prioritize the factors identified by the systematic review. RISK OF BIAS SIGN checklist complemented by risk of bias assessment of the adjusted analysis. DATA SYNTHESIS Definite universal risk factors were defined as those assessed in >50% of all included studies and significant in >50% of those. Potential universal risk factors were defined as those significant in >50% of studies evaluating the factor and a subgroup analysis was performed for studies of Staphylococcus aureus bacteraemia. RESULTS We included in the systematic review 62 studies, comprising more than 300,000 patients, from which a list of 17 risk factors was derived, whose association with all-cause mortality was statistically significant in most studies. The factors address baseline patient variables, the setting of infection acquisition, factors associated with the specific infection, the inflammatory response at onset of sepsis and management parameters where relevant. There were 14 risk factors for S. aureus bacteraemia. CONCLUSION We identified a minimum set of universal factors to be collected, reported, and assessed, in all future studies evaluating factors associated with mortality in bacteraemia to improve study quality and harmonization.
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Affiliation(s)
- Ben Varon
- Medicine B and H, Rambam Healthcare Campus, Haifa, Israel
| | - Zaira R Palacios-Baena
- Infectious Diseases Division, Hospital Universitario Virgen Macarena, Seville, Spain; Department of Medicine, University of Seville/Biomedicine Institute of Seville (IBiS)/CSIC, Seville, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Marlieke E A de Kraker
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jesús Rodríguez-Baño
- Infectious Diseases Division, Hospital Universitario Virgen Macarena, Seville, Spain; Department of Medicine, University of Seville/Biomedicine Institute of Seville (IBiS)/CSIC, Seville, Spain; CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Leonard Leibovici
- Research Authority, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel; Faculty of Medicine, Tel-Aviv University, Ramat Aviv, Israel
| | - Mical Paul
- Infectious Diseases Institute, Rambam Healthcare Campus, Haifa, Israel; Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
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21
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Yaqub Y, Tanko ZL, Aminu A, Umar UY, Ejembi J. An intervention study investigating the effectiveness of contextualizing multimodal strategy on improving hand hygiene at a tertiary hospital in Nigeria. Trans R Soc Trop Med Hyg 2024; 118:178-189. [PMID: 37994919 DOI: 10.1093/trstmh/trad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/12/2023] [Accepted: 10/31/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Hand hygiene (HH) is a proven low-cost means to curtail the problem of hospital-acquired infection (HAI). However, a low HH compliance rate of 17.1% was found among surgical health workers at Ahmadu Bello University Teaching Hospital (ABUTH) in Zaria, Nigeria. METHODS This was an intervention study conducted utilizing mixed methods to investigate the effectiveness of the World Health Organization (WHO) multimodal strategy to improve the HH compliance rate of doctors at ABUTH Zaria. The study was conducted between June and August 2022 and included delivering a behavioural change HH workshop to doctors followed by data collection in the surgical wards that had received environmental modification through the provision of an alcohol-based hand rub (ABHR), HH posters and nurses for visual and/or verbal reminders. RESULTS The cumulative HH compliance rate was 69% (n=1774) and was significantly different from the baseline HH compliance rate of 17.1% (confidence interval 45.5 to 57.7, p<0.001). Observed HH was highest in the ward with both visual and verbal reminders (78%) and lowest (59%) where neither visual nor verbal reminders were provided (n=444 per ward). All respondents reported motivation to perform HH with the presence of ABHR. CONCLUSIONS The WHO multimodal strategy is good for enhancing HH among health workers in the context of low- and middle-income countries. More research is needed to understand how much of a reduction in HAI is directly associated with efficient HH by health workers.
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Affiliation(s)
- Yahaya Yaqub
- Medical Microbiology Department, Ahmadu Bello University Zaria, Nigeria
| | | | - Aliyu Aminu
- Medical Microbiology Department, Bayero University Kano, Nigeria
| | - Usman Yahya Umar
- Medical Microbiology Department, Bayero University Kano, Nigeria
| | - Joan Ejembi
- Medical Microbiology Department, Ahmadu Bello University Zaria, Nigeria
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22
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Tiwari RVC, Sharma SK, Sahoo SR, Velthuru SK, Basavarajaiah JM, Kazi M, Dixit H. Comparative Evaluation of Quality Management Practices in the Public and Private Hospitals in Visakhapatnam District: An Original Research. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S592-S597. [PMID: 38595367 PMCID: PMC11000895 DOI: 10.4103/jpbs.jpbs_882_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/22/2023] [Accepted: 10/01/2023] [Indexed: 04/11/2024] Open
Abstract
Background In the Visakhapatnam District, this study compares the quality management procedures used by public and private hospitals. Knowing how these practices are similar and different from one another can help inform policy decisions and improve the quality of health care. Materials and Methods A cross-sectional study design was used, and 100 hospitals from both public (50 hospitals) and private (50 hospitals) were included in the sample size. A standardized questionnaire that evaluated different aspects of quality management practices was used to gather the data. Descriptive statistics and inferential tests were used in the quantitative analysis. Results Significant variations in quality management procedures between public and private hospitals were found. In terms of patient happiness, service responsiveness, and technological use, private hospitals scored better. Regarding accessibility, cost, and equity of healthcare services, public hospitals fared better. Conclusion The report emphasizes the necessity of focused initiatives to improve quality management procedures in both public and commercial institutions. Collaboration between the two sectors can make it easier to deploy evidence-based tactics and share best practices to raise overall healthcare quality in the Visakhapatnam area.
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Affiliation(s)
| | | | - Sujit R. Sahoo
- Department of Dentistry, PRM Medical College and Hospital, Baripada, Odisha, India
| | - Srujan K. Velthuru
- Department of Public Health Dentistry, Mamata Dental College and Hospital, Khammam, Telangana, India
| | | | - Madiha Kazi
- BDS Maitri College of Dentistry and Research Center, Durg, Chhattisgarh, India
| | - Heena Dixit
- RKSK District Consultant, Visakhapatnam, A.P & MBA- HHM, DY Patil Vidyapeeth, Navi Mumbai, Maharashtra, India
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23
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Safari MS, Mohabatkar H, Behbahani M. Novel surface biochemical modifications of urinary catheters to prevent catheter-associated urinary tract infections. J Biomed Mater Res B Appl Biomater 2024; 112:e35372. [PMID: 38359168 DOI: 10.1002/jbm.b.35372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 11/13/2023] [Accepted: 01/02/2024] [Indexed: 02/17/2024]
Abstract
More than 70% of hospital-acquired urinary tract infections are related to urinary catheters, which are commonly used for the treatment of about 20% of hospitalized patients. Urinary catheters are used to drain the bladder if there is an obstruction in the tube that carries urine out of the bladder (urethra). During catheter-associated urinary tract infections, microorganisms rise up in the urinary tract and reach the bladder, and cause infections. Various materials are used to fabricate urinary catheters such as silicone, polyurethane, and latex. These materials allow bacteria and fungi to develop colonies on their inner and outer surfaces, leading to bacteriuria or other infections. Urinary catheters could be modified to exert antibacterial and antifungal effects. Although so many research have been conducted over the past years on the fabrication of antibacterial and antifouling catheters, an ideal catheter needs to be developed for long-term catheterization of more than a month. In this review, we are going to introduce the recent advances in fabricating antibacterial materials to prevent catheter-associated urinary tract infections, such as nanoparticles, antibiotics, chemical compounds, antimicrobial peptides, bacteriophages, and plant extracts.
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Affiliation(s)
- Mohammad Sadegh Safari
- Department of Biotechnology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran
| | - Hassan Mohabatkar
- Department of Biotechnology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran
| | - Mandana Behbahani
- Department of Biotechnology, Faculty of Biological Science and Technology, University of Isfahan, Isfahan, Iran
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24
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Ghaffari S, Amiri N, Felix DF, Abbasidezfouli S, Franco F, Beaupré SL, Branda NR, Lange D. Surface photosterilization of implantable silicone biomaterials: structural and functional characterization. Colloids Surf B Biointerfaces 2024; 233:113637. [PMID: 37979481 DOI: 10.1016/j.colsurfb.2023.113637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/16/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
Hospital-acquired infections (HAIs) remain one of the major challenges faced by the global healthcare system. The increasing rate of pathogenic resistance against antibiotics suggests that alternative treatments are needed to control recurrent infections. Catheter-associated urinary tract infections (CAUTIs) are the third most common type of HAI worldwide, and this is mainly due to indwelling devices being excellent substrates for bacterial adhesion and growth. Subsequent biofilm formation on the implant surface acts as a constant nidus of bacteria and infection, thereby contributing to increased rates of patient morbidity and mortality. Here, we propose a simple and cost-effective method to sterilize silicone-based implant surfaces and prevent initial bacterial colonization, using Polydimethylsiloxane (PDMS) and an embedded ruthenium photosensitizer (PS). Exposure to LED light triggers potent photokilling action, resulting in significant bactericidal activity as evidenced by the number of adherent bacteria being below the level of detection (<10 CFU/mL) after 24 h. Live/dead staining studies using fluorescence microscopy indicated significant reduction in surface-adhered bacterial growth and biofilm formation. This potent antibacterial activity was verified in vivo, with exposure of contaminated PDMS coupons containing PS to LED prior to implantation resulting in over 99.5% reduction in adherent bacteria compared to controls over the 3-day implantation period. Histological analysis of the implantation site of PDMS+PS samples, in the absence of bacteria, revealed no adverse reactions. This was also confirmed using in vitro cytotoxicity studies. Tensile strength, surface roughness, hydrophobicity, and the development of encrustation of surface-treated groups exhibit comparable or improved properties to bare PDMS.
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Affiliation(s)
- Sahand Ghaffari
- The Stone Centre at VGH, Department of Urologic Sciences, University of British Columbia, Jack Bell Research Centre, 550-3, 2660 Oak Street, Vancouver V6H 3Z6, BC, Canada.
| | - Nafise Amiri
- ICORD and Department of Pathology and Laboratory Medicine, University of British Columbia, 818 W10th Ave, Vancouver V5Z 1M9, Canada.
| | - Demian F Felix
- The Stone Centre at VGH, Department of Urologic Sciences, University of British Columbia, Jack Bell Research Centre, 550-3, 2660 Oak Street, Vancouver V6H 3Z6, BC, Canada.
| | - Samin Abbasidezfouli
- The Stone Centre at VGH, Department of Urologic Sciences, University of British Columbia, Jack Bell Research Centre, 550-3, 2660 Oak Street, Vancouver V6H 3Z6, BC, Canada.
| | - Fernanda Franco
- 4D LABS and Department of Chemistry, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Scott L Beaupré
- Department of Physics, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Neil R Branda
- 4D LABS and Department of Chemistry, Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
| | - Dirk Lange
- The Stone Centre at VGH, Department of Urologic Sciences, University of British Columbia, Jack Bell Research Centre, 550-3, 2660 Oak Street, Vancouver V6H 3Z6, BC, Canada.
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25
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Cabrera-Tejada GG, Chico-Sánchez P, Gras-Valentí P, Jaime-Sánchez FA, Galiana-Ivars M, Balboa-Esteve S, Gómez-Sotero IL, Sánchez-Payá J, Ronda-Pérez E. Estimation of Additional Costs in Patients with Ventilator-Associated Pneumonia. Antibiotics (Basel) 2023; 13:2. [PMID: 38275312 PMCID: PMC10812792 DOI: 10.3390/antibiotics13010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/07/2023] [Accepted: 12/16/2023] [Indexed: 01/27/2024] Open
Abstract
Healthcare-associated infections (HAIs) present a global public health challenge, contributing to high morbidity and mortality and substantial economic burdens. Ventilator-associated pneumonia (VAP) ranks as the second most prevalent HAI in intensive care units (ICUs), emphasizing the need for economic analyses in this context. This retrospective cohort study, conducted at the General Hospital of Alicante from 2012 to 2019, aimed to assess additional costs related to VAP by comparing the extended length of stay for infected and non-infected ICU patients undergoing mechanical ventilation (MV) for more than 48 h. Employing propensity score association, 434 VAP patients were compared to an equal number without VAP. The findings indicate a significantly longer mechanical ventilation period for VAP patients (17.40 vs. 8.93 days, p < 0.001), resulting in an extra 13.56 days of stay and an additional cost of EUR 20,965.28 per VAP episode. The study estimated a total cost of EUR 12,348,965.28 for VAP during the study period, underscoring the economic impact of VAP. These findings underscore the urgent need for rigorous infection surveillance, prevention, and control measures to enhance healthcare quality and reduce overall expenditures.
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Affiliation(s)
| | - Pablo Chico-Sánchez
- Epidemiology Unit, Preventive Medicine Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (P.C.-S.); (P.G.-V.); (I.L.G.-S.); (J.S.-P.)
| | - Paula Gras-Valentí
- Epidemiology Unit, Preventive Medicine Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (P.C.-S.); (P.G.-V.); (I.L.G.-S.); (J.S.-P.)
| | - Francisco A. Jaime-Sánchez
- Medical Intensive Care Unit, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (F.A.J.-S.)
| | - Maria Galiana-Ivars
- Anesthesiology Service and Surgical Intensive Care Unit, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain;
| | - Sonia Balboa-Esteve
- Medical Intensive Care Unit, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (F.A.J.-S.)
| | - Isel L. Gómez-Sotero
- Epidemiology Unit, Preventive Medicine Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (P.C.-S.); (P.G.-V.); (I.L.G.-S.); (J.S.-P.)
| | - José Sánchez-Payá
- Epidemiology Unit, Preventive Medicine Service, Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), 03010 Alicante, Spain; (P.C.-S.); (P.G.-V.); (I.L.G.-S.); (J.S.-P.)
| | - Elena Ronda-Pérez
- Public Health Research Group, University of Alicante, San Vicente de Raspeig, 03690 Alicante, Spain
- Biomedical Research Networking Center (CIBERESP), 28029 Madrid, Spain
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AlSaleh E, Naik B, AlSaleh AM. Device-Associated Nosocomial Infections in Intensive Care Units at Al-Ahsa Hospitals, Saudi Arabia. Cureus 2023; 15:e50187. [PMID: 38186514 PMCID: PMC10771822 DOI: 10.7759/cureus.50187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Introduction Patients admitted to intensive care units (ICU), especially those with devices used to support their condition, are at a higher risk of getting healthcare-associated infections (HAIs). The aim of the present study was to analyze the surveillance data and assess the device-associated infection (DAI) rates such as central line-associated blood-stream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated pneumonia (VAP) and ventilator-associated event (VAE) in ICUs of the Ministry of Health (MoH) hospitals in Al-Ahsa region. Methodology The study was conducted retrospectively using the surveillance data of governmental hospitals' intensive care units in the Al-Ahsa region. The surveillance data was collected from 10 ICUs at six MoH hospitals in the Al-Ahsa region during the year 2022. The data from the participating hospitals was entered into the Health Electronic Surveillance Network (HESN) plus program by trained infection prevention control practitioners of the respective hospitals. Results An overall CLABSI rate of 4.29 per 1000 central line days was reported during the study period. The CAUTI rate was 0.55 with a range from 0 to 1.29 cases per 1000 urinary catheter days. VAP rate ranged from 0.33 to 2.21 cases per 1000 ventilator days (average of 1.17). The study reported VAE only for the adult medical-surgical ICU (3.36 per 1000 ventilator days). Conclusion The present study revealed that the most common DAIs in the Al-Ahsa region are CLABSI and CAUTI. DAI rates generated from this study may be used as benchmarks for regional hospitals. An educational program regarding the prevention and control of DAIs targeting all healthcare workers, especially ICU staff, has to be done in the Al-Ahsa region.
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Affiliation(s)
- Essa AlSaleh
- Infection Control Department, Directorate of Health Affairs, Al-Ahsa, SAU
| | - Balajis Naik
- Infection Control, Al-Ahsa Health Cluster, Ministry of Health Holdings, Al-Ahsa, SAU
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Limenyande MJM, Kobusingye JO, Tindyebwa T, Akongo D, Isunju JB, Musoke D. Factors associated with compliance with Infection Prevention and Control measures during the COVID-19 pandemic among healthcare workers in Kampala City, Uganda. PLoS One 2023; 18:e0293732. [PMID: 37910487 PMCID: PMC10619793 DOI: 10.1371/journal.pone.0293732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/18/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND In the context of the COVID-19 pandemic that originated from China in December 2019 and spread around the world, Kampala City witnessed a high number of infections and deaths among healthcare workers (HCWs). This study assessed the level of compliance with Infection Prevention and Control (IPC) measures and its associated factors among HCWs during the COVID-19 pandemic, in Kampala City, Uganda. METHODOLOGY A cross-sectional study was conducted in Nakawa Division, Kampala City, among 240 HCWs and used multistage sampling in government and private not-for-profit (PNFP) healthcare facilities. The outcome variable was self-reported IPC compliance which was composed of the use of masks, gloves, and hand hygiene. These were assessed using a 4-scale tool: always as recommended, most of the time, occasionally, and rarely. Only HCWs who responded "always as recommended" were considered compliant while the rest were considered non-compliant. Data was analyzed in STATA 14.0 using Modified Poisson regression to obtain factors associated with IPC compliance at 95% confidence interval (CI). RESULTS Forty-six (19.2%) respondents were compliant with all the three IPC measures, and this was associated with the presence of a COVID-19 patients' ward in the healthcare facility (Adjusted Prevalence Ratio, APR: 2.51, 95%CI: 1.24-5.07). Factors associated with the use of masks were being of the Muslim religion (APR: 1.31, CI: 1.05-1.65), and working in a healthcare facility that has COVID-19 patients' ward (APR: 1.29, CI: 1.06-1.59). Factors associated with the use of gloves were the age of the HCW, those above 40 years old being less complaint (APR: 0.47, CI: 0.24-0.93), working in the diagnosis department (APR: 2.08, CI: 1.17-3.70), and working in a healthcare facility that has COVID-19 patients' ward (APR: 1.73, CI: 1.13-2.64). Factors associated with hand hygiene were working in a health center (HC) IV (PR: 1.7, CI: 1.26-2.30) or a HC II (PR: 1.68, CI: 1.28-2.21). CONCLUSION Considering the elevated risk of disease transmission in health settings, IPC compliance was low; indicating an increased risk of COVID-19 infection among health care workers in Kampala City.
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Affiliation(s)
| | | | - Tonny Tindyebwa
- Makerere University School of Public Health, Kampala, Uganda
| | - Dorothy Akongo
- Makerere University School of Public Health, Kampala, Uganda
- Busoga Health Forum, Jinja, Uganda
| | | | - David Musoke
- Makerere University School of Public Health, Kampala, Uganda
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Aiesh BM, Qashou R, Shemmessian G, Swaileh MW, Abutaha SA, Sabateen A, Barqawi AK, AbuTaha A, Zyoud SH. Nosocomial infections in the surgical intensive care unit: an observational retrospective study from a large tertiary hospital in Palestine. BMC Infect Dis 2023; 23:686. [PMID: 37833675 PMCID: PMC10576355 DOI: 10.1186/s12879-023-08677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Nosocomial infections or hospital-acquired infections are a growing public health threat that increases patient morbidity and mortality. Patients at the highest risk are those in intensive care units. Therefore, our objective was to provide a pattern analysis of nosocomial infections that occurred in an adult surgical intensive care unit (ICU). METHODS This study was a retrospective observational study conducted in a 6-bed surgical intensive care unit (SICU) at An-Najah National University Hospital (NNUH) to detect the incidence of nosocomial infections from January 2020 until December 2021. The study group included 157 patients who received antibiotics during their stay in the SICU. RESULTS The incidence of nosocomial infections, either suspected or confirmed, in the SICU was 26.9% (95 out of 352 admitted patients). Pneumonia (36.8%) followed by skin and soft tissue infections (35.8%) were the most common causes. The most common causative microorganisms were in the following order: Pseudomonas aeruginosa (26.3%), Acinetobacter baumannii (25.3%), extended-spectrum beta lactamase (ESBL)-Escherichia coli (23.2%) and Klebsiella pneumonia (15.8%). The average hospital stay of patients with nosocomial infections in the SICU was 18.5 days. CONCLUSIONS The incidence of nosocomial infections is progressively increasing despite the current infection control measures, which accounts for an increased mortality rate among critically ill patients. The findings of this study may be beneficial in raising awareness to implement new strategies for the surveillance and prevention of hospital-acquired infections in Palestinian hospitals and health care centers.
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Affiliation(s)
- Banan M Aiesh
- Infection Control Department, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Raghad Qashou
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Genevieve Shemmessian
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Mamoun W Swaileh
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Shatha A Abutaha
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Ali Sabateen
- Infection Control Department, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Abdel-Karim Barqawi
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Department of General Surgery, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Adham AbuTaha
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Pathology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine
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Konno A, Okubo T, Enoeda Y, Uno T, Sato T, Yokota SI, Yano R, Yamaguchi H. Human pathogenic bacteria on high-touch dry surfaces can be controlled by warming to human-skin temperature under moderate humidity. PLoS One 2023; 18:e0291765. [PMID: 37729194 PMCID: PMC10511134 DOI: 10.1371/journal.pone.0291765] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023] Open
Abstract
Healthcare-associated infections have become a major health issue worldwide. One route of transmission of pathogenic bacteria is through contact with "high-touch" dry surfaces, such as handrails. Regular cleaning of surfaces with disinfectant chemicals is insufficient against pathogenic bacteria and alternative control methods are therefore required. We previously showed that warming to human-skin temperature affected the survival of pathogenic bacteria on dry surfaces, but humidity was not considered in that study. Here, we investigated environmental factors that affect the number of live bacteria on dry surfaces in hospitals by principal component analysis of previously-collected data (n = 576, for CFU counts), and experimentally verified the effect of warming to human-skin temperature on the survival of pathogenic bacteria on dry surfaces under humidity control. The results revealed that PCA divided hospital dry surfaces into four groups (Group 1~4) and hospital dry surfaces at low temperature and low humidity (Group 3) had much higher bacterial counts as compared to the others (Group 1 and 4) (p<0.05). Experimentally, warming to human-skin temperature (37°C with 90% humidity) for 18~72h significantly suppressed the survival of pathogenic bacteria on dry surfaces, such as plastic surfaces [p<0.05 vs. 15°C (Escherichia coli DH5α, Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, and blaNDM-5 E. coli)] or handrails [p<0.05 vs. 15~25°C (E. coli DH5α, S. aureus, P. aeruginosa, A. baumannii)], under moderate 55% humidity. Furthermore, intermittent heating to human-skin temperature reduced the survival of spore-forming bacteria (Bacillus subtilis) (p<0.01 vs. continuous heating to human-skin temperature). NhaA, an Na+/H+ antiporter, was found to regulate the survival of bacteria on dry surfaces, and the inhibitor 2-aminoperimidine enhanced the effect of warming at human-skin temperature on the survival of pathogenic bacteria (E. coli DH5α, S. aureus, A. baumannii) on dry surfaces. Thus, warming to human-skin temperature under moderate humidity is a useful method for impairing live pathogenic bacteria on high-touch surfaces, thereby helping to prevent the spread of healthcare-associated infections.
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Affiliation(s)
- Ayano Konno
- Faculty of Health Sciences, Department of Medical Laboratory Science, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Torahiko Okubo
- Faculty of Health Sciences, Department of Medical Laboratory Science, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Yoshiaki Enoeda
- Faculty of Health Sciences, Department of Medical Laboratory Science, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Tomoko Uno
- Department of Nursing, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
- Faculty of Health Sciences, Department of Fundamental Nursing, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Toyotaka Sato
- Department of Microbiology, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
- Faculty of Veterinary Medicine, Laboratory of Veterinary Hygiene, Hokkaido University, Kita-ku, Sapporo, Japan
- Graduate School of Infectious Diseases, Hokkaido University, Kita-ku, Sapporo, Japan
- One Health Research Center, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Shin-ichi Yokota
- Department of Microbiology, Sapporo Medical University School of Medicine, Chuo-ku, Sapporo, Japan
| | - Rika Yano
- Faculty of Health Sciences, Department of Fundamental Nursing, Hokkaido University, Kita-ku, Sapporo, Japan
| | - Hiroyuki Yamaguchi
- Faculty of Health Sciences, Department of Medical Laboratory Science, Hokkaido University, Kita-ku, Sapporo, Japan
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Xiong CL, Wang GG, Hanafi WUR. Financial impact of nosocomial infections on surgical patients in an eastern Chinese hospital: a propensity score matching study. J Hosp Infect 2023; 139:67-73. [PMID: 37301232 DOI: 10.1016/j.jhin.2023.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/18/2023] [Accepted: 05/17/2023] [Indexed: 06/12/2023]
Abstract
This study, conducted at Zhejiang Taizhou Hospital, China, aimed to examine the financial impact of nosocomial infections on surgical patients. A retrospective case-control study using propensity score matching was conducted over a 9-month period from January to September 2022. The study included 729 surgical patients with nosocomial infections and 2187 matched controls without infections. Medical expenses, length of hospitalization and total economic burden were compared between the two groups. The rate of nosocomial infections in surgical cases was 2.66%. The median hospitalization cost for patients with nosocomial infections was US$8220, compared with US$3294 for controls. The overall additional medical expenditure attributable to nosocomial infections amounted to US$4908. Notable median differences were observed between cases with nosocomial infections and controls in terms of total hospitalization cost, nursing services, medication, treatment, materials, test fees and blood transfusion fees. In each age group, medical costs for patients with nosocomial infections were more than twice those of controls. Additionally, hospital stays for surgical patients with nosocomial infections were, on average, 13 days longer compared with controls. These findings highlight the importance of implementing effective infection control measures in hospitals to reduce the financial burden on patients and the healthcare system.
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Affiliation(s)
- C L Xiong
- Department of Nosocomial Infection Control, Zhejiang Taizhou Hospital, Zhejiang, China
| | - G G Wang
- Department of Nosocomial Infection Control, Zhejiang Taizhou Hospital, Zhejiang, China
| | - W U-R Hanafi
- Public Health Division, Calaveras County, San Andreas, CA, USA.
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Garcell HG, Al-Ajmi J, Arias AV, Abraham JC, Garmendia AMF, Hernandez TMF. Ten-year incidence and impact of coronavirus infections on incidence, etiology, and antimicrobial resistance of healthcare-associated infections in a critical care unit in Western Qatar. Qatar Med J 2023; 2023:11. [PMID: 37521091 PMCID: PMC10375912 DOI: 10.5339/qmj.2023.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/30/2022] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND Healthcare-associated infections (HAI) in critical patients affect the quality and safety of patient care as they impact morbidity and mortality. During the COVID-19 pandemic, an increase in the incidence rate was reported worldwide. We aim to describe the incidence of HAI in the intensive care unit (ICU) during a 10-year follow-up period and compare the incidence during the pre-COVID-19 and COVID-19 periods. METHODS A retrospective observational study of HAI in the medical-surgical ICU at The Cuban Hospital was conducted. The data collected include the annual incidence of HAI, its etiology, and antimicrobial resistance, using the Centers for Disease Control and Prevention definitions, except for other respiratory tract infections (RTIs). RESULTS A total of 155 patients had HAI, of which 130 (85.5%) were identified during COVID-19. The frequency of device-associated infections (DAI) and non-DAI was higher during COVID-19, except for Clostridium difficile infections. Etiology was frequently related to species of Enterobacter, Klebsiella, and Pseudomonas in both periods, and a higher frequency of Acinetobacter, Enterococcus, Candida, Escherichia coli, Serratia marcescens, and Stenotrophomonas maltophilia was noted during the COVID-19 period. Device utilization ratio increased by 10.7% for central lines and 12.9% for ventilators, while a reduction of 15% in urinary catheter utilization ratio was observed. DAI incidence was higher during the COVID-19, with a 2.79 higher risk of infection (95% CI: 0.93-11.21; p < 0.0050), 15.31 (2.53-625.48), and 3.25 (0.68-31.08) for CLABSI, VAP, and CAUTI, respectively. CONCLUSION The incidence of DAI increased during the pandemic period as compared to the pre-pandemic period, and limited evidence of the impact on antimicrobial resistance was observed. The infection control program should evaluate strategies to minimize the impact of pandemics on HAI.
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Affiliation(s)
- Humberto Guanche Garcell
- Infection Control Department, The Cuban Hospital. E-mail: ORCID: https://orcid.org/0000-0001-7279-0062
| | - Jameela Al-Ajmi
- Corporate Infection Control Department, Hamad Medical Corporation, Qatar
| | - Ariadna Villanueva Arias
- Infection Control Department, The Cuban Hospital. E-mail: ORCID: https://orcid.org/0000-0001-7279-0062
| | - Joji C Abraham
- Corporate Infection Control Department, Hamad Medical Corporation, Qatar
| | - Angel M Felipe Garmendia
- Infection Control Department, The Cuban Hospital. E-mail: ORCID: https://orcid.org/0000-0001-7279-0062
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Tesfaye AH, Mekonnen TH, Desye B, Yenealem DG. Infection Prevention and Control Practices and Associated Factors Among Healthcare Cleaners in Gondar City: An Analysis of a Cross-Sectional Survey in Ethiopia. Risk Manag Healthc Policy 2023; 16:1317-1330. [PMID: 37492624 PMCID: PMC10363670 DOI: 10.2147/rmhp.s419110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/11/2023] [Indexed: 07/27/2023] Open
Abstract
Background Healthcare-associated infections are a global health problem and are more prevalent in developing countries such as Ethiopia, but there is a paucity of research on the infection prevention practices of cleaning staff. Therefore, this study aimed to assess infection prevention and control practices and associated factors among cleaners working in healthcare facilities in Gondar City, Ethiopia. Methodology A cross-sectional survey was conducted among healthcare cleaning staff from May to June 2022. A total of 428 cleaners took part in the survey. Data were collected using a semi-structured interviewer-administered questionnaire. The data were entered into EpiData version 4.6 and analyzed using Stata version 14 software. A multivariable binary logistic regression analysis was used to ascertain the significance of associations at <0.05 p-value and the adjusted odds ratio (AOR) with a 95% confidence interval (CI). Results Among the 390 study participants included, 294 (75.1%) were female. Of the surveyed participants, 186 (47.7%) had good knowledge of infection prevention and control practices. This study revealed that out of the 390 healthcare cleaners, 204 (52.3%) had good infection prevention and control practices with 52.3% [95% CI (47.2, 56.4)]. Good knowledge of infection prevention and control [AOR: 1.56, 95% CI (1.03, 2.37)] and the availability of infection prevention and control guidelines in the workplace [AOR: 1.54, 95% CI (1.01, 2.33)] were significant factors associated with infection prevention and control practice. Conclusion The present study found that almost half of the healthcare cleaners had poor IPC practices. The finding underlines the importance of good IPC knowledge and the accessibility of IPC guidelines to improve IPC practices among healthcare cleaning staff. The findings of this study also highlight that behavioral change interventions and paying attention, particularly to nonclinical staff such as cleaners in health care settings, are critical to reducing infection in health care settings.
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Affiliation(s)
- Amensisa Hailu Tesfaye
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tesfaye Hambisa Mekonnen
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belay Desye
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Dawit Getachew Yenealem
- Department of Environmental and Occupational Health and Safety, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Marcut L, Manescu Paltanea V, Antoniac A, Paltanea G, Robu A, Mohan AG, Grosu E, Corneschi I, Bodog AD. Antimicrobial Solutions for Endotracheal Tubes in Prevention of Ventilator-Associated Pneumonia. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5034. [PMID: 37512308 PMCID: PMC10386556 DOI: 10.3390/ma16145034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023]
Abstract
Ventilator-associated pneumonia is one of the most frequently encountered hospital infections and is an essential issue in the healthcare field. It is usually linked to a high mortality rate and prolonged hospitalization time. There is a lack of treatment, so alternative solutions must be continuously sought. The endotracheal tube is an indwelling device that is a significant culprit for ventilator-associated pneumonia because its surface can be colonized by different types of pathogens, which generate a multispecies biofilm. In the paper, we discuss the definition of ventilator-associated pneumonia, the economic burdens, and its outcomes. Then, we present the latest technological solutions for endotracheal tube surfaces, such as active antimicrobial coatings, passive coatings, and combinatorial methods, with examples from the literature. We end our analysis by identifying the gaps existing in the present research and investigating future possibilities that can decrease ventilator-associated pneumonia cases and improve patient comfort during treatment.
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Affiliation(s)
- Lavinia Marcut
- Faculty of Medicine and Pharmacy, University of Oradea, 10 P-ta 1 December Street, RO-410073 Oradea, Romania
- Intensive Care Unit, Clinical Emergency Hospital Oradea, 65 Gheorghe Doja Street, RO-410169 Oradea, Romania
| | - Veronica Manescu Paltanea
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, RO-060042 Bucharest, Romania
- Faculty of Electrical Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, RO-060042 Bucharest, Romania
| | - Aurora Antoniac
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, RO-060042 Bucharest, Romania
| | - Gheorghe Paltanea
- Faculty of Electrical Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, RO-060042 Bucharest, Romania
| | - Alina Robu
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, RO-060042 Bucharest, Romania
| | - Aurel George Mohan
- Faculty of Medicine and Pharmacy, University of Oradea, 10 P-ta 1 December Street, RO-410073 Oradea, Romania
- Department of Neurosurgery, Clinical Emergency Hospital Oradea, 65 Gheorghe Doja Street, RO-410169 Oradea, Romania
| | - Elena Grosu
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei, District 6, RO-060042 Bucharest, Romania
| | - Iuliana Corneschi
- Romfire Protect Solutions SRL, 39 Drumul Taberei, RO-061359 Bucharest, Romania
| | - Alin Danut Bodog
- Faculty of Medicine and Pharmacy, University of Oradea, 10 P-ta 1 December Street, RO-410073 Oradea, Romania
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Fan ZY, You SJ, Li LB, Bian J, Tan FL. Multidrug-Resistant Organism Infections of Inpatients in a Hospital in Eastern China from 2015 to 2021. Infect Drug Resist 2023; 16:4387-4395. [PMID: 37431448 PMCID: PMC10329826 DOI: 10.2147/idr.s412491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/23/2023] [Indexed: 07/12/2023] Open
Abstract
Background The prevalence of multidrug-resistant organisms (MDRO) is gradually increasing in the global scope, causing serious burden to patients and society, which is an important public health problem. Objective To analyze the distribution and trend of MDROs and provide a reference for hospital infection control. Methods Collected data on MDROs infections among inpatients in a Grade III Level A hospital in Suzhou from 2015 to 2021, including drug-resistant bacteria strains and specimen sources, etc. Mantel-Haenszel χ2 test was used to evaluate the trend of infection rates over the years and SPSS version 26.0 was used for statistics analysis. Results The hospital infection rate showed an overall downward trend across the seven-year period, ranging from 1.53% to 2.10%. According to the analysis of change of drug-resistant bacteria strains, the highest infection rate was carbapenem-resistant Acinetobacter baumannii (CRABA) (63.74%), followed by methicillin-resistant Staphylococcus aureus (MRSA) (46.37%), carbapenem-resistant Pseudomonas aeruginosa (CRPAE) (24.87%), carbapenem-resistant Enterobacteriaceae (CRE) (13.14%) and vancomycin-resistant Enterococcus (VRE) (0.42%). The results of Mantel-Haenszel χ2 test showed that there was a linear relationship between the detection rate of CRE and CRPAE and the time (P<0.001), but the correlation was not strong (R = 0.136; R = 0.139). The overall detection rate of the five pathogens also increased (P<0.001). The majority of the specimens, mainly from sputum, airway secretions, and midstream urine, had a detection rate of over 70%. Conclusion Our data showed that the detection rate of MDROs generally increased from 2015 to 2021, although the hospital infection rate displayed a declining trend. Among the detection rate MDROs, the highest was CRABA, and the lowest was VRE. It is necessary to enhance the prevention, control, and management of MDROs infections in the clinical practice.
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Affiliation(s)
- Zhao-Ya Fan
- Department of Infection Management, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, People’s Republic of China
| | - Shou-Jiang You
- Department of Infection Management, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, People’s Republic of China
| | - Liu-Bing Li
- Department of Infection Management, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, People’s Republic of China
| | - Jing Bian
- Department of Infection Management, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, People’s Republic of China
| | - Feng-Ling Tan
- Department of Infection Management, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, People’s Republic of China
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Rajaramon S, David H, Sajeevan A, Shanmugam K, Sriramulu H, Dandela R, Solomon AP. Multi-functional approach in the design of smart surfaces to mitigate bacterial infections: a review. Front Cell Infect Microbiol 2023; 13:1139026. [PMID: 37287465 PMCID: PMC10242021 DOI: 10.3389/fcimb.2023.1139026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/03/2023] [Indexed: 06/09/2023] Open
Abstract
Advancements in biomedical devices are ingenious and indispensable in health care to save millions of lives. However, microbial contamination paves the way for biofilm colonisation on medical devices leading to device-associated infections with high morbidity and mortality. The biofilms elude antibiotics facilitating antimicrobial resistance (AMR) and the persistence of infections. This review explores nature-inspired concepts and multi-functional approaches for tuning in next-generation devices with antibacterial surfaces to mitigate resistant bacterial infections. Direct implementation of natural inspirations, like nanostructures on insect wings, shark skin, and lotus leaves, has proved promising in developing antibacterial, antiadhesive, and self-cleaning surfaces, including impressive SLIPS with broad-spectrum antibacterial properties. Effective antimicrobial touch surfaces, photocatalytic coatings on medical devices, and conventional self-polishing coatings are also reviewed to develop multi-functional antibacterial surfaces to mitigate healthcare-associated infections (HAIs).
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Affiliation(s)
- Shobana Rajaramon
- Quorum Sensing Laboratory, Centre for Research in Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed to be University, Thanjavur, India
| | - Helma David
- Quorum Sensing Laboratory, Centre for Research in Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed to be University, Thanjavur, India
| | - Anusree Sajeevan
- Quorum Sensing Laboratory, Centre for Research in Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed to be University, Thanjavur, India
| | - Karthi Shanmugam
- Quorum Sensing Laboratory, Centre for Research in Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed to be University, Thanjavur, India
| | - Hrithiha Sriramulu
- Quorum Sensing Laboratory, Centre for Research in Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed to be University, Thanjavur, India
| | - Rambabu Dandela
- Department of Industrial and Engineering Chemistry, Institute of Chemical Technology, Bhubaneswar, India
| | - Adline Princy Solomon
- Quorum Sensing Laboratory, Centre for Research in Infectious Diseases (CRID), School of Chemical and Biotechnology, SASTRA Deemed to be University, Thanjavur, India
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Kaya HN, Süslü B, Aydin R, Atay S. COMPLIANCE OF PATIENT COMPANIONS AND VISITORS WITH HAND HYGIENE: AN OBSERVATIONAL STUDY. J Hosp Infect 2023; 136:85-89. [PMID: 37088218 DOI: 10.1016/j.jhin.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/13/2023] [Accepted: 04/15/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Hand hygiene is a simple and low-cost practice to prevent the spread of many microorganisms that cause healthcare-associated infections (HCAIs). Compliance with hand hygiene, especially by patient companions and visitors, is very important in order to prevent the transmission of pathogenic microorganisms between the health institutions and the community. AIM This is a descriptive study designed to investigate the compliance of patient companions and visitors with hand hygiene. METHODS The sample of the study included 209 individuals who were the companions and visitors of the patients who were hospitalized in a University Hospital in the west of Turkey. A questionnaire containing Demographics and Hand Hygiene and the Observation Form to assess Hand Hygiene Practice were used to acquire data. In order to conduct the research, permission was obtained from the ethics committee and the institution, and consent was obtained from the patient companions and visitors. To evaluate the data, the numbers, percentage calculations, mean and independent inter-observer agreement coefficient were used. FINDINGS 96.2% of the patient companions and visitors stated that they did not receive training on the importance of hand washing during their stay in the hospital, and 74.6% stated that hand washing was very important in the prevention of diseases. The patient families reported that they most often washed their hands after touching bodily fluids (91.7%), and that they rarely washed their hands before touching a patient (34.0%). The rates were decreased in the observations, and the lowest rate for handwashing was before touching a patient (22.4%) and the highest rate for handwashing was after the risk for contamination with body fluids of patient (68.6%). CONCLUSION The results of this study indicate that patient companions and visitors did not receive any training on the importance of hand hygiene during the hospital stay, and the observed rate of compliance with hand hygiene was lower than stated. Recommendations include delivering planned handwashing training to patient companions and visitors using different teaching methods, and to conduct longer observational studies.
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Affiliation(s)
- Hanife Nur Kaya
- Nursing Department at School of Health, Çanakkale Onsekiz Mart University, Canakkale,Turkey
| | - Başak Süslü
- Nursing Department at School of Health, Çanakkale Onsekiz Mart University, Canakkale,Turkey
| | - Rabia Aydin
- Nursing Department at School of Health, Çanakkale Onsekiz Mart University, Canakkale,Turkey
| | - Selma Atay
- Nursing Department at School of Health, Çanakkale Onsekiz Mart University, Canakkale,Turkey.
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Alotaibi NH, Barri AM, Somily AM. The Attributable Factors That Increase the Likelihood of Central Line Associated Blood Stream Infection Related In-Hospital 30-Day Mortality. Cureus 2023; 15:e35898. [PMID: 37033526 PMCID: PMC10081389 DOI: 10.7759/cureus.35898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2023] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVE The objective is to investigate the attributable factors associated with an increase in hospital 30-day mortality of central line bloodstream infection (CLABSI). METHODS A retrospective cohort study was conducted at King Saud University Medical City (KSUMC). The sample included adult patients who developed CLABSI between March 2016 and February 2018 after having a central line inserted at KSUMC in Riyadh, Saudi Arabia. RESULTS A total of 283 patients were involved in the study. The 30-day mortality rate was 18.8%. Patients were more likely to die if they were in the intensive care unit (ICU) or required ICU admission after infection (p<0.001). This was also observed in patients who required inotropes or intubation before or after culture (p<0.001). There was a statistically significant difference of 6.60±5.62 in the mean score on the Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II between before and after culture (p<0.001). The likelihood of death was significantly higher among patients with higher APACHE II scores before and after culture (p<0.001). The presence of CLABSI-related sequelae was not associated with increased mortality (p<0.595). CONCLUSIONS The clinical characteristics of CLABSI patients are variable and can increase the risk of mortality or complicate the treatment course. Physicians should be aware of the significance of these factors as potential causes of increased mortality.
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Obaid NA, Abuhussain SS, Mulibari KK, Alshnqiti F, Malibari SA, Althobaiti SS, Alansari M, Muneef E, Almatrafi L, Alqarzi A, Alotaibi N, Mostafa AM, Hagag A. Antimicrobial-resistant pathogens related to catheter-associated urinary tract infections in intensive care units: A multi-center retrospective study in the Western region of Saudi Arabia. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2023. [DOI: 10.1016/j.cegh.2023.101291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
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Alves D, Grainha T, Pereira MO, Lopes SP. Antimicrobial materials for endotracheal tubes: A review on the last two decades of technological progress. Acta Biomater 2023; 158:32-55. [PMID: 36632877 DOI: 10.1016/j.actbio.2023.01.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023]
Abstract
Ventilator-associated pneumonia (VAP) is an unresolved problem in nosocomial settings, remaining consistently associated with a lack of treatment, high mortality, and prolonged hospital stay. The endotracheal tube (ETT) is the major culprit for VAP development owing to its early surface microbial colonization and biofilm formation by multiple pathogens, both critical events for VAP pathogenesis and relapses. To combat this matter, gradual research on antimicrobial ETT surface coating/modification approaches has been made. This review provides an overview of the relevance and implications of the ETT bioburden for VAP pathogenesis and how technological research on antimicrobial materials for ETTs has evolved. Firstly, certain main VAP attributes (definition/categorization; outcomes; economic impact) were outlined, highlighting the issues in defining/diagnosing VAP that often difficult VAP early- and late-onset differentiation, and that generate misinterpretations in VAP surveillance and discrepant outcomes. The central role of the ETT microbial colonization and subsequent biofilm formation as fundamental contributors to VAP pathogenesis was then underscored, in parallel with the uncovering of the polymicrobial ecosystem of VAP-related infections. Secondly, the latest technological developments (reported since 2002) on materials able to endow the ETT surface with active antimicrobial and/or passive antifouling properties were annotated, being further subject to critical scrutiny concerning their potentialities and/or constraints in reducing ETT bioburden and the risk of VAP while retaining/improving the safety of use. Taking those gaps/challenges into consideration, we discussed potential avenues that may assist upcoming advances in the field to tackle VAP rampant rates and improve patient care. STATEMENT OF SIGNIFICANCE: The use of the endotracheal tube (ETT) in patients requiring mechanical ventilation is associated with the development of ventilator-associated pneumonia (VAP). Its rapid surface colonization and biofilm formation are critical events for VAP pathogenesis and relapses. This review provides a comprehensive overview on the relevance/implications of the ETT biofilm in VAP, and on how research on antimicrobial ETT surface coating/modification technology has evolved over the last two decades. Despite significant technological advances, the limited number of gathered reports (46), highlights difficulty in overcoming certain hurdles associated with VAP (e.g., persistent colonization/biofilm formation; mechanical ventilation duration; hospital length of stay; VAP occurrence), which makes this an evolving, complex, and challenging matter. Challenges and opportunities in the field are discussed.
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Affiliation(s)
- Diana Alves
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
| | - Tânia Grainha
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
| | - Maria Olívia Pereira
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
| | - Susana Patrícia Lopes
- CEB - Centre of Biological Engineering, University of Minho, 4710-057 Braga, Portugal; LABBELS - Associate Laboratory, Braga/Guimarães, Portugal.
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Saleem M, Syed Khaja AS, Hossain A, Alenazi F, Said KB, Moursi SA, Almalaq HA, Mohamed H, Rakha E, Alharbi MS, Babiker SAA, Usman K. Pathogen Burden Among ICU Patients in a Tertiary Care Hospital in Hail Saudi Arabia with Particular Reference to β-Lactamases Profile. Infect Drug Resist 2023; 16:769-778. [PMID: 36779043 PMCID: PMC9911906 DOI: 10.2147/idr.s394777] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/16/2023] [Indexed: 02/09/2023] Open
Abstract
Purpose Ventilator-associated pneumonia (VAP) is associated with a higher mortality risk for critical patients in the intensive care unit (ICU). Several strategies, including using β-lactam antibiotics, have been employed to prevent VAP in the ICU. However, the lack of a gold-standard method for VAP diagnosis and a rise in antibiotic-resistant microorganisms have posed challenges in managing VAP. The present study is designed to identify, characterize, and perform antimicrobial susceptibility of the microorganisms from different clinical types of infections in ICU patients with emphasis on VAP patients to understand the frequency of the latter, among others. Patients and Methods A 1-year prospective study was carried out on patients in the ICU unit at a tertiary care hospital, Hail, Saudi Arabia. Results A total of 591 clinically suspected hospital-acquired infections (HAI) were investigated, and a total of 163 bacterial isolates were obtained from different clinical specimens with a high proportion of bacteria found associated with VAP (70, 43%), followed by CAUTI (39, 24%), CLABSI (25, 15%), and SSI (14, 8.6%). Klebsiella pneumoniae was the most common isolate 39 (24%), followed by Acinetobacter baumannii 35 (21.5%), Pseudomonas aeruginosa 25 (15.3%), and Proteus spp 23 (14%). Among the highly prevalent bacterial isolates, extended-spectrum beta-lactamase was predominant 42 (42.4%). Conclusion Proper use of antibiotics, continuous monitoring of drug sensitivity patterns, and taking all precautionary measures to prevent beta-lactamase-producing organisms in clinical settings are crucial and significant factors in fending off life-threatening infections for a better outcome.
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Affiliation(s)
- Mohd Saleem
- Department of Pathology, College of Medicine, University of Hail, Hail, Kingdom of Saudi Arabia
| | - Azharuddin Sajid Syed Khaja
- Department of Pathology, College of Medicine, University of Hail, Hail, Kingdom of Saudi Arabia,Correspondence: Azharuddin Sajid Syed Khaja, Department of Pathology, College of Medicine, University of Hail, Hail, Kingdom of Saudi Arabia, Tel +966 59 184 9573, Email
| | - Ashfaque Hossain
- Department of Medical Microbiology and Immunology, RAK Medical and Health Sciences University, Ras Al Khaimah, United Arab Emirates
| | - Fahaad Alenazi
- Department of Pharmacology, College of Medicine, University of Hail, Hail, Kingdom of Saudi Arabia
| | - Kamaleldin B Said
- Department of Pathology, College of Medicine, University of Hail, Hail, Kingdom of Saudi Arabia
| | - Soha Abdallah Moursi
- Department of Pathology, College of Medicine, University of Hail, Hail, Kingdom of Saudi Arabia
| | - Homoud Abdulmohsin Almalaq
- Hail Health Cluster, King Khalid Hospital, College of Pharmacy, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Hamza Mohamed
- Anatomy Department, Faculty of Medicine, Northern Border University, Arar, Kingdom of Saudi Arabia
| | - Ehab Rakha
- Laboratory Department, King Khalid Hospital, Hail, Kingdom of Saudi Arabia,Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed Salem Alharbi
- Department of Internal Medicine, College of Medicine, University of Hail, Hail, Kingdom of Saudi Arabia
| | - Salma Ahmed Ali Babiker
- Department of Family Medicine, Hail University Medical Clinics, University of Hail, Hail, Kingdom of Saudi Arabia
| | - Kauser Usman
- Department of Internal Medicine, King George’s Medical University, Lucknow, India
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Colborn KL, Zhuang Y, Dyas AR, Henderson WG, Madsen HJ, Bronsert MR, Matheny ME, Lambert-Kerzner A, Myers QWO, Meguid RA. Development and validation of models for detection of postoperative infections using structured electronic health records data and machine learning. Surgery 2023; 173:464-471. [PMID: 36470694 PMCID: PMC10204069 DOI: 10.1016/j.surg.2022.10.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Postoperative infections constitute more than half of all postoperative complications. Surveillance of these complications is primarily done through manual chart review, which is time consuming, expensive, and typically only covers 10% to 15% of all operations. Automated surveillance would permit the timely evaluation of and reporting of all operations. METHODS The goal of this study was to develop and validate parsimonious, interpretable models for conducting surveillance of postoperative infections using structured electronic health records data. This was a retrospective study using 30,639 unique operations from 5 major hospitals between 2013 and 2019. Structured electronic health records data were linked to postoperative outcomes data from the American College of Surgeons National Surgical Quality Improvement Program. Predictors from the electronic health records included diagnoses, procedures, and medications. Infectious complications included surgical site infection, urinary tract infection, sepsis, and pneumonia within 30 days of surgery. The knockoff filter, a penalized regression technique that controls type I error, was applied for variable selection. Models were validated in a chronological held-out dataset. RESULTS Seven percent of patients experienced at least one type of postoperative infection. Models selected contained between 4 and 8 variables and achieved >0.91 area under the receiver operating characteristic curve, >81% specificity, >87% sensitivity, >99% negative predictive value, and 10% to 15% positive predictive value in a held-out test dataset. CONCLUSION Surveillance and reporting of postoperative infection rates can be implemented for all operations with high accuracy using electronic health records data and simple linear regression models.
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Affiliation(s)
- Kathryn L Colborn
- Department of Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO.
| | - Yaxu Zhuang
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Adam R Dyas
- Department of Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - William G Henderson
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO; Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Helen J Madsen
- Department of Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Michael E Matheny
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN; Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN; Division of General Internal Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Anne Lambert-Kerzner
- Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Quintin W O Myers
- Department of Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Robert A Meguid
- Department of Surgery, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO; Surgical Outcomes and Applied Research Program, Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, CO; Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus, Aurora, CO
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Keleb A, Lingerew M, Ademas A, Berihun G, Sisay T, Adane M. The magnitude of standard precautions practice and its associated factors among healthcare workers in governmental hospitals of northeastern Ethiopia. FRONTIERS IN HEALTH SERVICES 2023; 3:1071517. [PMID: 37033899 PMCID: PMC10073742 DOI: 10.3389/frhs.2023.1071517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 02/28/2023] [Indexed: 04/12/2023]
Abstract
Background Non-compliance with infection control guidelines of healthcare workers may increase their risk of exposure to infectious diseases but can be prevented through adherence to standard precautionary practices in healthcare settings. Objective This study aimed to assess the magnitude of standard precautions practice and its associated factors among healthcare workers in government hospitals of South Wollo Zone, northeastern Ethiopia. Methods An institutional-based cross-sectional study was conducted among 1,100 healthcare workers. Proportional sample size allocation for each selected government hospital was conducted followed by simple random sampling to select study participants using human resource records from each hospital. Data were collected using structured and self-administered pretested questionnaires. The data were analyzed using descriptive statistics, bivariable binary, and multivariable logistic regression models. Variables with a p-value <0.05 with a 95% CI were considered as having statistical significance. Results The overall magnitude of compliance with standard precautions among healthcare workers was 19.2%. The result indicated that work experience of <5 years (AOR = 2.51; 95% CI: 1.07-5.89), absence of continuous water supply (AOR = 2.24; 95% CI: 1.95-5.29), and negative attitude (AOR = 2.37; 95% CI: 1.17-4.79) were significantly associated with poor compliance of standard precautions practice. Conclusion The overall magnitude of compliance with standard precautions among healthcare workers was low compared to the national magnitude of infection prevention practice. Interventions including consistent and effective training on infection prevention healthcare workers should be given regularly. Providing continuous water supply and building a positive attitude toward infection prevention practices among healthcare workers are also required.
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Epidemiology of Healthcare-Associated Infections and Adherence to the HAI Prevention Strategies. Healthcare (Basel) 2022; 11:healthcare11010063. [PMID: 36611523 PMCID: PMC9818953 DOI: 10.3390/healthcare11010063] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/02/2022] [Accepted: 12/07/2022] [Indexed: 12/29/2022] Open
Abstract
Healthcare-associated infections are widely considered one of the most common unfavorable outcomes of healthcare delivery. Ventilator-associated pneumonia, central line-associated bloodstream infections, and catheter-associated urinary tract infections are examples of healthcare-associated infections. The current study was a retrospective study conducted at a public hospital in Unaizah, Saudi Arabia, to investigate the frequency of healthcare-associated illnesses and adherence to healthcare-associated infection prevention techniques in the year 2021. Surgical site infections occurred at a rate of 0.1%. The average number of catheter-associated urinary tract infections per 1000 catheter days was 0.76. The average number of central line-associated bloodstream infections per 1000 central line days was 2.6. The rate of ventilator-associated pneumonia was 1.1 per 1000 ventilator days on average. The average number of infections caused by multidrug-resistant organisms per 1000 patient days was 2.8. Compliance rates were 94%, 100%, 99%, and 76% for ventilator-associated pneumonia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and hand hygiene bundles, respectively. It is critical to participate in more educational events and workshops, particularly those that emphasize hand cleanliness and personal safety equipment.
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Guanche Garcell H, Al-Ajmi J, Villanueva Arias A, Abraham JC, Felipe Garmendia AM, Fernandez Hernandez TM. Impact of the COVID-19 pandemic on the incidence, etiology, and antimicrobial resistance of healthcare-associated infections in a critical care unit in Western Qatar. Qatar Med J 2022; 2023:2. [PMID: 36578436 PMCID: PMC9792289 DOI: 10.5339/qmj.2023.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/30/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Healthcare-associated infections (HAIs) in critical patients affect the quality and safety of patient care and increase patient morbidity and mortality. During the COVID-19 pandemic, an increase in the incidence of HAIs, particularly device-associated infections (DAIs), was reported worldwide. In this study, we aimed to estimate the incidence of HAIs in an intensive care unit (ICU) during a 10-year period and compare HAI incidence during the preCOVID-19 and COVID-19 periods. METHODS A retrospective, observational study of HAIs in the medical-surgical ICU at The Cuban Hospital was conducted. DAIs included central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia (VAP). Data included the annual incidence of HAIs, etiology, and antimicrobial resistance, using definitions provided by the Centers for Disease Control and Prevention, except for other respiratory tract infections (RTIs). RESULTS 155 patients with HAI infections were reported, from which 130 (85.5%) were identified during the COVID-19 period. The frequencies of DAIs and non-DAIs were higher during the COVID-19 period, except for Clostridium difficile infections. Species under Enterobacter, Klebsiella, and Pseudomonas dominated in both periods, and higher frequencies of Acinetobacter, Enterococcus, Candida, Escherichia coli, Serratia marcescens, and Stenotrophoma maltophila were noted during COVID-19 period. Device utilization ratio increased to 10.7% for central lines and 12.9% for ventilators, while a reduction of 15% in urinary catheter utilization ratio was observed. DAI incidence was higher during the COVID-19 pandemic, with risks for CLABSI, VAP, and CAUTI increased by 2.79 (95% confidence interval, 0.93-11.21; p < 0.0050), 15.31 (2.53-625.48), and 3.25 (0.68-31.08), respectively. CONCLUSION The incidence of DAIs increased during the pandemic period, with limited evidence of antimicrobial resistance observed. The infection control program should evaluate strategies to minimize the impact of the pandemic on HAIs.
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Affiliation(s)
- Humberto Guanche Garcell
- Infection Control Department, The Cuban Hospital. E-mail: ORCID: https://orcid.org/0000-0001-7279-0062,E-mail: ORCID: https://orcid.org/0000-0001-7279-0062
| | - Jameela Al-Ajmi
- Corporate Infection Control Department, Hamad Medical Corporation, Qatar
| | - Ariadna Villanueva Arias
- Infection Control Department, The Cuban Hospital. E-mail: ORCID: https://orcid.org/0000-0001-7279-0062
| | - Joji C Abraham
- Corporate Infection Control Department, Hamad Medical Corporation, Qatar
| | - Angel M Felipe Garmendia
- Infection Control Department, The Cuban Hospital. E-mail: ORCID: https://orcid.org/0000-0001-7279-0062
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Prabhu D, Rajamanikandan S, Amala M, Saritha P, Jeyakanthan J, Ramasamy P. Functional Characterization, Mechanism, and Mode of Action of Putative Streptomycin Adenylyltransferase from Serratia marcescens. Antibiotics (Basel) 2022; 11:antibiotics11121722. [PMID: 36551379 PMCID: PMC9774460 DOI: 10.3390/antibiotics11121722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
Nosocomial infections are serious threats to the entire world in healthcare settings. The major causative agents of nosocomial infections are bacterial pathogens, among which Enterobacteriaceae family member Serratia marcescens plays a crucial role. It is a gram-negative opportunistic pathogen, predominantly affecting patients in intensive-care units. The presence of intrinsic genes in S. marcescens led to the development of resistance to antibiotics for survival. Complete scanning of the proteome, including hypothetical and partially annotated proteins, paves the way for a better understanding of potential drug targets. The targeted protein expressed in E. coli BL21 (DE3) pLysS cells has shown complete resistance to aminoglycoside antibiotic streptomycin (>256 MCG). The recombinant protein was purified using affinity and size-exclusion chromatography and characterized using SDS-PAGE, western blotting, and MALDI-TOF analysis. Free phosphate bound to malachite green was detected at 620 nm, evident of the conversion of adenosine triphosphate to adenosine monophosphate during the adenylation process. Similarly, in the chromatographic assay, adenylated streptomycin absorbed at 260 nm in AKTA (FPLC), confirming the enzyme-catalyzed adenylation of streptomycin. Further, the adenylated product of streptomycin was confirmed through HPLC and mass spectrometry analysis. In conclusion, our characterization studies identified the partially annotated hypothetical protein as streptomycin adenylyltransferase.
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Affiliation(s)
- Dhamodharan Prabhu
- Research and Development Wing, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research (BIHER), Chennai 600 044, Tamil Nadu, India
- Structural Biology and Bio-Computing Laboratory, Department of Bioinformatics, Alagappa University, Karaikudi 630 003, Tamil Nadu, India
- Correspondence: (D.P.); (J.J.); (P.R.)
| | - Sundararaj Rajamanikandan
- Research and Development Wing, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research (BIHER), Chennai 600 044, Tamil Nadu, India
| | - Mathimaran Amala
- Structural Biology and Bio-Computing Laboratory, Department of Bioinformatics, Alagappa University, Karaikudi 630 003, Tamil Nadu, India
| | - Poopandi Saritha
- Structural Biology and Bio-Computing Laboratory, Department of Bioinformatics, Alagappa University, Karaikudi 630 003, Tamil Nadu, India
| | - Jeyaraman Jeyakanthan
- Structural Biology and Bio-Computing Laboratory, Department of Bioinformatics, Alagappa University, Karaikudi 630 003, Tamil Nadu, India
- Correspondence: (D.P.); (J.J.); (P.R.)
| | - Palaniappan Ramasamy
- Research and Development Wing, Sree Balaji Medical College and Hospital, Bharath Institute of Higher Education and Research (BIHER), Chennai 600 044, Tamil Nadu, India
- Correspondence: (D.P.); (J.J.); (P.R.)
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Pari V. Development of a quality indicator set to measure and improve quality of ICU care in low- and middle-income countries. Intensive Care Med 2022; 48:1551-1562. [PMID: 36112158 PMCID: PMC9592651 DOI: 10.1007/s00134-022-06818-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To develop a set of actionable quality indicators for critical care suitable for use in low- or middle-income countries (LMICs). METHODS A list of 84 candidate indicators compiled from a previous literature review and stakeholder recommendations were categorised into three domains (foundation, process, and quality impact). An expert panel (EP) representing stakeholders from critical care and allied specialties in multiple low-, middle-, and high-income countries was convened. In rounds one and two of the Delphi exercise, the EP appraised (Likert scale 1-5) each indicator for validity, feasibility; in round three sensitivity to change, and reliability were additionally appraised. Potential barriers and facilitators to implementation of the quality indicators were also reported in this round. Median score and interquartile range (IQR) were used to determine consensus; indicators with consensus disagreement (median < 4, IQR ≤ 1) were removed, and indicators with consensus agreement (median ≥ 4, IQR ≤ 1) or no consensus were retained. In round four, indicators were prioritised based on their ability to impact cost of care to the provider and recipient, staff well-being, patient safety, and patient-centred outcomes. RESULTS Seventy-one experts from 30 countries (n = 45, 63%, representing critical care) selected 57 indicators to assess quality of care in intensive care unit (ICU) in LMICs: 16 foundation, 27 process, and 14 quality impact indicators after round three. Round 4 resulted in 14 prioritised indicators. Fifty-seven respondents reported barriers and facilitators, of which electronic registry-embedded data collection was the biggest perceived facilitator to implementation (n = 54/57, 95%) Concerns over burden of data collection (n = 53/57, 93%) and variations in definition (n = 45/57, 79%) were perceived as the greatest barrier to implementation. CONCLUSION This consensus exercise provides a common set of indicators to support benchmarking and quality improvement programs for critical care populations in LMICs.
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Affiliation(s)
- Vrindha Pari
- Chennai Critical Care Consultants, Pvt Ltd, Chennai, India.
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Najjar-Debbiny R, Chazan B, Lobl R, Greene MT, Ratz D, Saint S, Carmeli Y, Schwaber MJ, Ben-David D, Shitrit P, Paz A, Brosh-Nissimov T, Mor M, Regev-Yochay G, Ciobotaro P, Yinnon AM, Mar-Chaim D, Rubinovitch B, Hussein K, Benenson S. Healthcare-associated infection prevention and control practices in Israel: results of a national survey. BMC Infect Dis 2022; 22:739. [PMID: 36114529 PMCID: PMC9482296 DOI: 10.1186/s12879-022-07721-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Healthcare-associated infection (HAI) is a common and largely preventable cause of morbidity and mortality. The COVID-19 pandemic has presented unprecedented challenges to health systems. We conducted a national survey to ascertain hospital characteristics and the use of HAI prevention measures in Israel.
Methods We e-mailed surveys to infection prevention and control (IPC) leads of acute care hospitals in Israel. The survey included questions about the use of practices to prevent catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and Clostridioides difficile infection (CDI). The survey also assessed COVID-19 impact and healthcare worker well-being. Results IPC leads from 15 of 24 invited hospitals (63%) completed the survey. Only one-third of respondents reported strong support for IPC from hospital leadership. Although several prevention practices were used by all hospitals (e.g., maximum sterile barrier precautions for CLABSI and real-time assessment of environmental cleaning for CDI), use of other practices was suboptimal—particularly for CAUTI and VAP. COVID-19 had a profound impact on Israeli hospitals, with all hospitals reporting opening of new units to care for COVID patients and most reporting moderate to extreme financial hardship. All hospitals reported highly successful plans to vaccinate all staff and felt confident that the vaccine is safe and effective.
Conclusion We provide a status report of the IPC characteristics and practices Israeli hospitals are currently using to prevent HAIs during the COVID-19 era. While many globally accepted IPC practices are widely implemented, opportunities to increase the use of certain IPC practices in Israeli hospitals exist. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07721-8.
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Scala A, Loperto I, Triassi M, Improta G. Risk Factors Analysis of Surgical Infection Using Artificial Intelligence: A Single Center Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10021. [PMID: 36011656 PMCID: PMC9408161 DOI: 10.3390/ijerph191610021] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/08/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
Background: Surgical site infections (SSIs) have a major role in the evolution of medical care. Despite centuries of medical progress, the management of surgical infection remains a pressing concern. Nowadays, the SSIs continue to be an important factor able to increase the hospitalization duration, cost, and risk of death, in fact, the SSIs are a leading cause of morbidity and mortality in modern health care. Methods: A study based on statistical test and logistic regression for unveiling the association between SSIs and different risk factors was carried out. Successively, a predictive analysis of SSIs on the basis of risk factors was performed. Results: The obtained data demonstrated that the level of surgery contamination impacts significantly on the infection rate. In addition, data also reveals that the length of postoperative hospital stay increases the rate of surgical infections. Finally, the postoperative length of stay, surgery department and the antibiotic prophylaxis with 2 or more antibiotics are a significant predictor for the development of infection. Conclusions: The data report that the type of surgery department and antibiotic prophylaxis there are a statistically significant predictor of SSIs. Moreover, KNN model better handle the imbalanced dataset (48 infected and 3983 healthy), observing highest accuracy value.
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Affiliation(s)
- Arianna Scala
- Department of Public Health, University of Naples “Federico II”, 80100 Naples, Italy
| | - Ilaria Loperto
- Department of Public Health, University of Naples “Federico II”, 80100 Naples, Italy
| | - Maria Triassi
- Department of Public Health, University of Naples “Federico II”, 80100 Naples, Italy
- Interdepartmental Center for Research in Health Care Management and Innovation in Health Care (CIRMIS), University of Naples “Federico II”, 80100 Naples, Italy
| | - Giovanni Improta
- Department of Public Health, University of Naples “Federico II”, 80100 Naples, Italy
- Interdepartmental Center for Research in Health Care Management and Innovation in Health Care (CIRMIS), University of Naples “Federico II”, 80100 Naples, Italy
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Treglia M, Pallocci M, Passalacqua P, Sabatelli G, De Luca L, Zanovello C, Messineo A, Quintavalle G, Cisterna AM, Marsella LT. Medico-Legal Aspects of Hospital-Acquired Infections: 5-Years of Judgements of the Civil Court of Rome. Healthcare (Basel) 2022; 10:healthcare10071336. [PMID: 35885861 PMCID: PMC9322800 DOI: 10.3390/healthcare10071336] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Healthcare-associated infections (HAIs) represent a risk to patients’ health, as well as being an issue of worldwide relevance in terms of public health and increased healthcare costs. The occurrence of a complication causally related to the development of an infection contracted during a hospital stay, or in any event during a healthcare activity, may represent a source of liability for the healthcare facility itself and, therefore, lead to compensation for the injured patient. The aim of this research is to analyze the phenomenon of professional liability related to HAIs, to emphasize its economic and juridical aspects and, at the same time, highlight the clinical-managerial issues deserving attention, in order to guarantee the safety of care for patients. Methods: The retrospective review concerned all the judgments regarding HAIs drawn up by the Judges of the Civil Court of Rome, published between January 2016 and December 2020. Results: In the five-year period considered, 140 verdicts were issued in which the liability for which compensation was sought was related to the occurrence of healthcare-related infections. Convictions were recognized in 62.8%. The most involved branches were those related to the surgical areas: orthopedics, heart surgery, and general surgery. The three most frequently isolated organisms were Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae. The total amount of compensation paid was EUR 21.243.184,43. Conclusions: The study showed how the analysis of the juridical and medico legal aspects of HAIs may represent not only a helpful tool for healthcare performance assessment, but also a data source usable in clinical risk management and in the implementation of patient safety.
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Affiliation(s)
- Michele Treglia
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (P.P.); (L.D.L.); (C.Z.); (A.M.); (L.T.M.)
| | - Margherita Pallocci
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (P.P.); (L.D.L.); (C.Z.); (A.M.); (L.T.M.)
- Correspondence:
| | - Pierluigi Passalacqua
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (P.P.); (L.D.L.); (C.Z.); (A.M.); (L.T.M.)
| | | | - Lucilla De Luca
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (P.P.); (L.D.L.); (C.Z.); (A.M.); (L.T.M.)
| | - Claudia Zanovello
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (P.P.); (L.D.L.); (C.Z.); (A.M.); (L.T.M.)
| | - Agostino Messineo
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (P.P.); (L.D.L.); (C.Z.); (A.M.); (L.T.M.)
| | | | | | - Luigi Tonino Marsella
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (P.P.); (L.D.L.); (C.Z.); (A.M.); (L.T.M.)
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Catheter-Associated Urinary Tract Infection in Intensive Care Unit Patients at a Tertiary Care Hospital, Hail, Kingdom of Saudi Arabia. Diagnostics (Basel) 2022; 12:diagnostics12071695. [PMID: 35885599 PMCID: PMC9322978 DOI: 10.3390/diagnostics12071695] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/03/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Catheter-associated urinary tract infections (CAUTIs) are some of the most common hospital-acquired infections (HAIs). Prolonged hospitalization, invasive devices such as catheters, and irrational use of antimicrobial agents are believed to be the major causes of high rates of HAIs. Infections such as pyelonephritis, urethritis, cystitis, and prostatitis are the main concerns in catheterized ICU patients. In these cases, Gram-negative bacteria are the most common bacteria. The present study was undertaken to determine the frequency, antibiograms, disease pattern, and risk factors involved in providing an advocacy recommendation to prevent CAUTI. A total of 1078 patients were admitted to the hospital ICU, out of which healthcare-associated infection was reported in 316 patients. CAUTI was reported only in 70 patients. Klebsiella pneumoniae (20%) was the predominant isolate, with Serratia (3%) and Providencia (3%) species being the least common isolates in this study. The present study provides CAUTI incidence rates in a tertiary care hospital in Hail, Saudi Arabia. Furthermore, information on the risk factors of common associated CAUTI causative organisms and their antibiogram patterns are also presented. This study provides vital information that can be used to formulate an effective antibiotic stewardship program that can be implemented throughout the kingdom.
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