Hand Hygiene Knowledge and Perception Survey for Healthcare Workers in Government Hospitals (GHs) in Bahrain

Introduction and aim Healthcare-associated infections (HAIs) are a serious concern in all healthcare facilities as they may lead to many serious consequences, like prolonged hospitalization, increased mortality and morbidity, and extra costs. Effective hand hygiene (HH) is the primary proven measure known to be effective in reducing the risk of HAIs in all healthcare settings. This study aimed to measure the healthcare workers' (HCWs) knowledge and perception of HH at government hospitals (GHs) in Bahrain. Subjects and methods This cross-sectional study was conducted among HCWs working in GHs in the Kingdom of Bahrain. A self-administered questionnaire was distributed among the targeted population using a Google survey (Google LLC, California, USA). The questionnaire includes socio-demographic data (e.g., age, gender, nationality, etc.) and a validated WHO questionnaire measuring perceptions and knowledge toward HH. Results Of the 285 HCWs, 75.4% were females, and 48.1% were aged between 31 and 40 years old. The overall mean perception was 35.9 (SD 6.93) out of 42 points, with nearly 80% of HCWs considered to have good perception levels. The overall mean knowledge score was 11.4 (SD 1.37) out of 14 points. Accordingly, 75.4% were considered to have good knowledge levels. Factors associated with increased perception include increasing age, female gender, non-Bahraini, being a nurse with increasing years of working experience, and receiving formal training in HH. Being a nurse was the sole significant predictor of increased knowledge. Conclusion The knowledge and perception of HH among HCWs were sufficient. Being a nurse was a significant predictor of both knowledge and perception. Further, a significant positive correlation was noted between the knowledge and perception scores. Maintaining the level of knowledge and perception of HH could lead to improved HH compliance among HCWs.

Non-Adherence to WHO Recommendations Regarding Infant Feeding Practices Results in Dilemma of Malnourishment: A Community-Based Prospective Cohort Study Conducted in Karachi, Pakistan

Background The prevalence of chronic malnutrition and its associated morbid outcomes has been a significant cause of health loss globally, affecting millions of children hampering their mental, physical, social, and immune system development. World Health Organization's (WHO) recommendations presenting infant feeding guidelines have largely controlled this burden. However, developing countries including Pakistan have failed to promote these guidelines and still succumb to a huge burden of morbidity and mortality secondary to malnourishment among infants. Methodology Our study is a prospective cohort including 300 infants without predisposing congenital anomaly, followed from 6 months to 18 months of age. The primary outcome involved was classifying patients as malnourished based on anthropometric measurements, assessing the prevalence of co-morbidities and comparison of results in compliance with WHO guidelines. Results A total of 276 infants were included and the rest were lost to follow-up. Stratification on socioeconomic status was done; 53% of infants were diagnosed as malnourished, either due to stunted growth, underweight, or both. The odds of development of malnourishment based on non-adherence to WHO guidelines on breastfeeding were 2.87 (p=0.001). The incidence of morbid complications was higher in the malnourished group, including gastrointestinal and respiratory tract infections. Conclusion The implementation of WHO recommendations on infant feeding techniques can prove to be a pivotal instrument to control the soaring index of morbidities and mortalities associated with malnourishment. A strong focus on parental education and awareness among masses is required for its promulgation and controlling the infant health burden linked to this preventable condition.

Global Trends in CD4 Cell Count at the Start of Antiretroviral Therapy: Collaborative Study of Treatment Programs

Background

Early initiation of combination antiretroviral therapy (cART), at higher CD4 cell counts, prevents disease progression and reduces sexual transmission of human immunodeficiency virus (HIV). We describe the temporal trends in CD4 cell counts at the start of cART in adults from low-income, lower-middle-income, upper-middle-income, and high-income countries (LICs, LMICs, UMICs, and HICs, respectively).

Methods

We included HIV-infected individuals aged ≥16 years who started cART between 2002 and 2015 in a clinic participating in the International epidemiology Databases to Evaluate AIDS (IeDEA) or the Collaboration of Observational HIV Epidemiological Research in Europe (COHERE). Missing CD4 cell counts at the start of cART were estimated through multiple imputation. Weighted mixed-effect models were used to smooth trends in median CD4 cell counts.

Results

A total of 951855 adults from 16 LICs, 11 LMICs, 9 UMICs, and 19 HICs were included. Overall, the modeled median CD4 cell count at the start of cART increased from 2002 to 2015, from 78/µL (95% confidence interval, 58-104/µL) to 287/µL (250-328/µL) in LICs, from 99/µL (71-140/µL) to 234/µL (192-285/µL) in LMICs, from 71/µL (49-104/µL) to 311/µL (255-379/µL) in UMICs, and from 161/µL (143-181/µL) to 327/µL (286-372/µL) in HICs. In LICs, LMICs, and UMICs, the increase was more pronounced in women; in HICs, the opposite was observed.

Conclusions

Median CD4 cell counts at the start of cART increased in all income groups, but generally remained below 350/μL in 2015. Substantial additional efforts and resources are required to achieve earlier diagnosis, linkage to care, and initiation of cART.

Evaluation of the WHO revised criteria for classification of clinical disease severity in acute adult dengue infection

BACKGROUND

The WHO guidelines were revised recently to identify patients with severe dengue (SD) early. We proceeded to determine the usefulness of the warning signs in the new WHO guidelines in predicting SD and we have also attempted to define other simple laboratory parameters that could be useful in predicting SD.

METHODS

Clinical and laboratory parameters were recorded in 184 patients in 2011, with confirmed dengue viral infections, admitted to a medical ward in two tertiary care hospitals in Colombo, Sri Lanka.

RESULTS

We found that the presence of 5 or more dengue warning signs were significantly (p=0.02) associated with the development of SD (odds ratio 5.14, 95% CI=1.312 to 20.16). The AST levels were significantly higher (p=0.0001) in patients with abdominal pain (mean 243.5, SD ± 200.7), when compared to those who did not have abdominal pain (mean 148.5, SD ± 218.6). Lymphocyte counts <1,500 cells/mm(3) were significantly (p=0.005) associated with SD (odds ratio 3.367, 95% CI 1.396 to 8.123). High AST levels were also significantly associated (p<0.0001) with SD (odds ratio 27.26, 95% CI 1.632 to 455.2). Platelet counts <20,000 cells/mm(3), were again significantly associated (p<0.001) with severe disease (odds ratio 1.632 to 455.2, 95% CI 3.089 to 14.71). The PCR was positive in 26/84 of the patients and we found that the infecting serotype was DEN-1 in all 26 patients.

CONCLUSIONS

The presence of 5 or more warning signs appears to be a predictor of SD. Lymphocyte counts <1,500 cells/mm(3), platelet counts <20,000/mm(3) and raised AST levels were associated with SD and could be used to help identify patients who are likely to develop SD.

Etiology of community-acquired pneumonia in hospitalized children based on WHO clinical guidelines

Community-acquired pneumonia (CAP) is a major cause of death in developing countries and of morbidity in developed countries. The objective of the study was to define the causative agents among children hospitalized for CAP defined by WHO guidelines and to correlate etiology with clinical severity and surrogate markers. Investigations included an extensive etiological workup. A potential causative agent was detected in 86% of the 99 enrolled patients, with evidence of bacterial (53%), viral (67%), and mixed (33%) infections. Streptococcus pneumoniae was accounted for in 46% of CAP. Dehydration was the only clinical sign associated with bacterial pneumonia. CRP and PCT were significantly higher in bacterial infections. Increasing the number of diagnostic tests identifies potential causes of CAP in up to 86% of children, indicating a high prevalence of viruses and frequent co-infections. The high proportion of pneumococcal infections re-emphasizes the importance of pneumococcal immunization.