International Journal of Infection Control

Online ISSN: 1996-9783
Publications
Saudi Ministry of Health (MOH) hospitals enrolled in the
Rates of central-line-associated bloodstream infections (CLABSI) and central line utilization ratios by birth weight category for level III neonatal intensive care units (ICUs) enrolled in Saudi Health Electronic Surveillance Network (HESN), 2018-2019
Comparisons of CLABSI rates and central line utilization ratios between neonatal ICUs in Saudi Health Electronic Surveillance Network (HESN) and other recognized benchmarking networks after adjustment for different birth weight categories
Background: Although the Saudi Ministry of Health (MOH) is managing the majority of inpatient bed capacity in Saudi Arabia, surveillance data for central-line-associated bloodstream infections (CLABSI) have never been reported at a national level. Objectives: To estimate unit-specific CLABSI rates along with central line utilization ratios in MOH hospitals. Additionally, to benchmark such rates and ratios with recognized regional and international benchmarks. Methods: A prospective surveillance study was conducted in 106 MOH hospitals between January 2018 and December 2019. The data from 14 different types of intensive care units (ICUs) were entered into the Health Electronic Surveillance Network (HESN) program. The surveillance methodology was similar to the methods of the US National Healthcare Safety Network (NHSN) and the Gulf Cooperation Council (GCC) Center for Infection Control. Results: During the 2 years of surveillance in ICU setting covering 1,475,177 patient-days and 475,913 central line-days, a total of 1,542 CLABSI events were identified. The overall CLABSI rate was 3.24 (95% confidence interval [CI], 3.08–3.40) per 1,000 central line-days, and the overall central line utilization ratio was 0.32 (95% CI, 0.322–0.323). CLABSI-standardized infection ratios in HESN hospitals were very similar (1.01) to GCC hospitals, but 3.2 times higher than NHSN hospitals and 36% lower than International Nosocomial Infection Control Consortium (INICC) hospitals. Central-line-standardized utilization ratio in MOH hospitals was 15–30% lower than the three benchmarks. Conclusions: The overall CLABSI rate was 3.24 per 1,000 central line-days, and the overall central line utilization ratio was 0.32. MOH CLABSI rates were very similar to GCC hospitals, but higher than NHSN hospitals and lower than INICC hospitals. MOH central line utilization is slightly lower than the three benchmarks.
 
Middle East respiratory syndrome (MERS), an emerging disease with fatal outcomes, has limited information on regional variations and their impact on the control measures. The aim of this study was to describe data on distribution of and possible association of risk factors for the disease and poorer outcomes, and recommendations for better control of the disease. Data were collected for 2015-2018 in Al Ahsa, the largest region (population 1.2 million) in the eastern part of Saudi Arabia. In total, 103 cases were reported during the study period with fever and cough as predominant presenting symptoms. The majority were male, >50 years old, and Saudi nationals. One third of patients had comorbid conditions (diabetes and cardiac predominantly). Occupation profiles of the patients varied, with camel owners and security personnel constituting 40% of the study population. In conclusions, older age, nationality, extracorporeal membrane oxygenation (ECMO) treatment, and associated comorbid conditions were found to be probable risk factors for poor outcomes. The mortality rate (59%) was distinctly higher in patients aged >60 years. The study highlights probable risk factors for poor outcomes in MERS patients, and discusses scope for further intervention and better management.
 
COVID-19 outbreak which originated from Wuhan, a city in China has spread to over 180 countries in the world, disrupting several sectors of the human life, and causing deaths. This unprecedented event has affected 55 countries in Africa in different ways. This study aims to outline the current epidemiological data of COVID-19 in Africa. The number of confirmed cases and deaths in Africa was obtained from COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. Mortality rate and daily cumulative index were calculated for each country. The mortality rate in Africa is low compared to other Continents regardless of the high Daily Cumulative Index recorded.
 
Layout of free-standing isolation facility showing modifications. HCW -healthcare worker; GF -ground floor.
(a) Flow chart of donning steps.
Design of COVID ward.
ICU design.
Intubation box.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which is a highly virulent disease associated with high mortality. Its outbreak into a pandemic has challenged the healthcare system of most countries around the world. A large number of infectious diseases hospitals are the need of hour to counteract this worrying infection. However, it is not possible to build such hospitals on a large scale within a short period of time; the only possibility is to convert existing healthcare facilities into COVID-19 facilities. The Centers for Disease Prevention and Control (CDC) has released guidelines for the preparation of COVID-19 hospitals, but execution at the ground level comes with many challenges. Here, we share our experience and the challenges we faced during the preparation of a tertiary healthcare centre into a COVID-19 centre, with the hope that it will help other institutions to prepare.
 
Knowledge and sources of COVID-19 information among participants. (a) Formal training about COVID-19. (b) Adequacy of knowledge (self-assessment) among HCWs and support staff. (c) Sources of information about COVID-19. (d) Percentage of HCWs and support staff with adequate knowledge (score > 80%).
Self-reported infection prevention and control practices for COVID-19. (a) Stacked bar in percentage of HCWs' and support staffs' responses to the practice questions (n = 422). (b) Percentage of HCWs' reported handwashing practices for the WHO's five moments of handwashing (n = 339). (c) The practice of preventive measures by the HCWs and support staff.
Coronavirus disease 2019 (COVID-19) is a pandemic affecting over 106 million and killing over 2.3 million people. Inadequate knowledge of the disease coupled with scarce or improper use of infection prevention and control (IPC) measures by healthcare workers (HCWs) and support staff may be contributing to the rapid spread of infection. This survey aims to assess knowledge, risk perception, and precaution practices of HCWs and support staff toward COVID-19 under resource-constrained circumstances at a major referral hospital in Ethiopia. An institution-based survey was conducted in April 2020 using 422 subjects selected by stratified random sampling. A five-section survey instrument was distributed, and the collected responses were cleaned and entered into Epi data (v3.1) and exported to SPSS (v.26) for further statistical analysis. The survey found that about 58% of the HCWs and support staff in the hospital appear to have adequate awareness and perceive COVID-19 to be a high-risk disease. Seven out of 10 subjects practice some form of IPC measures. However, the knowledge among allied HCWs and support staff appears to be inadequate. Gender, occupation, and years in service correlated with the level of awareness. Of those surveyed, 78% were concerned about the lack of personal protective equipment and perceived public transportation to be a high-risk factor for the transmission of infection. Additional campaigns may be necessary to reinforce existing knowledge of HCWs, but more emphasis should be geared toward educating allied HCWs and support staff.
 
The coronavirus disease 2019 (COVID-19) has caused devastating public health, economic, political, and societal crises. We performed a comparison study of COVID-19 outbreaks in states with Republican governors versus states with Democratic governors in the United States between April 2020 and February 2021. This research study shows that 1) states with Democratic governors had tested more people for COVID-19 and have higher testing rates than those with Republican governors; 2) states with Democratic governors had more confirmed cases for COVID-19 from April 12 until the end of July 2020, as well as from early December 2020 to February 22 2021, and had higher test positivity rates from April 12 until late June 2020, and the states with Republican governors had more confirmed cases from August to early December 2020 and had higher test positivity rates since late June 2020; 3) states with Democratic governors had more deaths for COVID-19 and higher mortality rates than those with Republican governors; 4) more people recovered in states with Democratic governors until early July 2020, while the recovery rate of states with Republican governors is similar to that of states with Democratic governors in May 2020 and higher than that of states with Democratic governors in April 2020 and between June 2020 to February 22 2021. We conclude that our data suggest that states with Republican governors controlled COVID-19 better as they had lower mortality rates and similar or higher recovery rates. States with Democratic governors first had higher test positivity rates until late June 2020 but had lower test positivity rates after July 2020. As of February 2021, the pandemic was still spreading as the daily numbers of confirmed cases and deaths were still high, although the test positivity and mortality rates started to stabilize in spring 2021. This study provides a direct description for the status and performance of handling COVID-19 in the states with Republican governors versus states with Democratic governors, and provides insights for future research, policy making, resource distribution, and administration.
 
Hospital Supportive Services complement the clinical services in any setting. They have a crucial role in mitigation of infection and delivery of safe care to the patients. The spectrum of hospital supportive services encompasses linen & laundry, dietary, Central Sterile Supply Department (CSSD), transport hospital stores, mortuary and engineering services. Each of these services has a significant role to help abort the ‘chain of transmission’ of COVID-19 infection across various patient care areas in the hospital, while providing them supportive services. The overall patient satisfaction greatly depends on the quality of hospital supportive services rendered to him during his stay. These Services usually work at the back end but their contribution in the overall care of a patient is no where less than that of the clinical services.
 
Background: Various recommendations exist concerning the discontinuation of contact and droplet precautions (CDP) for patients hospitalised with coronavirus disease 2019 (COVID-19). Some are based on repeated negative real-time polymerase chain reaction (RT-PCR) results, whereas other are based on clinical criteria. The feasibility and safety of these recommendations are poorly documented. Method: We conducted a retrospective study to assess the feasibility and safety of a symptom-based strategy to discontinue CDP for patients hospitalised with COVID-19. We reviewed the clinical charts of all symptomatic patients hospitalised in our institution with RT-PCR-confirmed COVID-19 to assess the application of a symptom-based strategy for the implementation and discontinuation of CDP. The patients with discontinuation of CDP in accordance with the symptom-based strategy were cross-referenced with patients with potential hospital-acquired COVID-19 in order to assess the safety of this strategy. Results: Among the 147 patients included in our study, our symptom-based strategy was respected in 95 cases (64.6%). Discontinuation of CDP in accordance with the recommendations occurred in 39 patients (26.5%). After the discontinuation of CDP, patients remained hospitalised for a median time of 18 days, with exposure to a median number of three patients, resulting in a total number of 588 days ‘patient-day-exposition’. No hospital-acquired COVID-19 was detected in contact patients. Discussion: The use of a symptom-based strategy to discontinue CDP is applicable and safe. This symptom-based strategy was applicable regardless of patient’s age or COVID-19 severity.
 
With the global concern of the 2019 novel coronavirus (COVID-19), infection prevention and control (IPC) is increasingly perceived as a major contributor to achieve a highly effective response to the outbreak and to prevent or limit transmission in healthcare settings. Improving health results is highly reliant on well-trained nurses especially during unexpected infectious disease outbreaks. The World Health Organization (WHO) promotes hand hygiene, which is the cornerstone of infection prevention, through its annual global campaign on 5 May every year. The 2020 campaign targets nurses and midwives with the overall theme “Nurses and Midwives: CLEAN CARE is in YOUR HANDS”.
 
During the COVID-19 crisis, dengue cases have been increased especially in dengue endemic countries. Currently we are fighting against COVID-19, the situation may be more difficult to manage if dengue outbreak is further added. During COVID-19 crisis, there is a possibility to occur co-infection of corona and dengue virus in these dengue endemic countries as both the viruses are co-existing. Altogether, further outbreak of dengue, viral co-infection and concurrent outbreak may pose new challenges in the dengue endemic countries specially for the health professionals.
 
A novel coronavirus first reported from China has resulted in a formidable outbreak globally threatening millions of human lives with unprecedented challenges. Society needs effective information source to combat this pandemic. Academic institutions would play an important role in disseminating science-based information and planning pandemic crisis. This study aims to examine how academic institutions around the world have been working in combating COVID-19 pandemic. Two hundred and thirty three high ranking universities representing 44 countries from six continents, viz. Africa, Asia, Europe, North America, South America, and Oceania were selected and their websites visited. Any information on COVID-19 updated in the websites were noted and classified. Universities from developed world (North America, Europe) and Oceania were found to be actively disseminating up-to-date information on COVID-19 with compared to those from developing world. All universities in Oceania, 96.66% universities in North America, 96.55% in Europe, 83% in South America, 61.25% in Asia, and 56% in Africa had information regarding COVID-19 in their websites. The high income coutries were facing high casulaties of the disease, and majority of their universities (85.71%) were disseminating up-to-date information through their websites. There exists a gap between the universities of developed and developing world in disseminating COVID-19 pandemic information.
 
During the coronavirus disease 2019 (COVID-19) pandemic, many public response activities were conducted outdoors to reduce the risk of transmission. This was in adherence to existing infection prevention recommendations. We report the development and safe, efficient operation of a mass COVID-19 vaccination clinic during a time when guidelines for indoor clinics were limited.
 
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Coronavirus disease 2019 (COVID-19), a disease caused by a novel coronavirus, is a major global human threat that has turned into a pandemic. Elderly patients and patients with comorbid conditions have a higher risk of complications and morbidity. Patients suffering from kidney disease on hemodialysis have an intrinsic fragility combined with a frequent burden of comorbidities in hemodialysis centers, a setting in which many patients are repeatedly treated in the same area. Moreover, if infected, the intensity of dialysis requiring specialized resources and staff is further complicated by requirements for isolation, control and prevention, putting healthcare systems under additional and exceptional strain. Therefore, all measures to slow if not eradicate the pandemic and to control unmanageably high incidence rates must be taken very seriously. Diaverum is a renal health services company playing a major role in providing end-stage kidney disease (ESKD) patients with optimum dialysis services. The aim of the present review is to shed light on the challenges and steps taken by an outsourcing dialysis program to provide recommendations for the prevention, mitigation, and containment of the emerging COVID-19 pandemic in hemodialysis centers.
 
Professional anxiety existed early in the coronavirus disease 2019 (COVID-19) pandemic with challenging infection prevention and control support. The aims of this study were to compare epidemiological features of healthcare workers (HCWs) within primary and secondary care with their serological evidence of infection. A prospective observational cohort of 1,916 HCWs completed a questionnaire, and their sera were assayed for detectable antibody to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleoprotein in the first wave of the pandemic. Datasets were compared between the two sub-cohorts in primary and secondary care and between the combined seropositive and seronegative cohorts. Curiosity of antibody status was high. Detectable antibody was 7% in the primary care and 5% in the secondary care workers at a time of 1.7% in the general community. Inappropriate personal protective equipment (PPE) was more common in primary care, and detectable antibody was twice as prevalent in HCWs who felt they did not have appropriate PPE. Contact tracing was perceived to be inadequate although it was more commonly performed in the seropositive cohort suggesting appropriate prioritisation. Both temperature and symptom checking alerts and work exclusion were significantly more prevalent in the seropositive cohort. The seroprevalence data support increased risk for HCWs, the importance of appropriate PPE and the usefulness of the daily temperature and symptom checks, particularly in primary care.
 
We describe events leading to and actions taken to address a newly diagnosed COVID-19 case, admitted as dengue on the general ward. A risk Stratification strategy of patients into high, medium and low risk was considered for the isolation and COVID-19 swabbing strategies. Additional measures for cleaning and ward lockdown were also employed. There were a total of 191 exposures; 68 staff, 39 inpatients and the rest were community contacts. There was no transmission of COVID-19 in the 14 days following exposure, suggesting that a universal surgical mask and hand hygiene strategy in place at that time was sufficient in preventing transmission. The built environment of adequate bed-space and natural ventilation were other important considerations.
 
The continuous rise in the number of cases of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), generated an urgent need to transform the facilities of our existing operating rooms (OR) to cater for emergency surgeries for patients with suspected COVID-19. The aim was to minimise the spread of infection and to achieve the lowest risk for patients and staff while caring for COVID-19 suspects undergoing surgery. We devised a protocol in our hospital to prepare OR for patients suspected to be suffering from COVID-19 but in whom the surgical intervention could not be deferred until the result of the COVID-19 test was obtained. The key consideration was that we cater to suspected and confirmed COVID-19 patients who required emergency surgery while adhering to strict infection control measures. The study was undertaken as a pilot exercise in consultation with treating surgeons, hospital infection control committee members, hospital administrators, and engineers, along with a literature review, to transform the design and functioning of existing facilities to prepare for emergency surgeries of COVID-19 suspects at the beginning of the pandemic. While this required significant planning on paper and onsite by members of the OR staff, hospital infection control committee, administration, and engineers, the creation of a safe operating environment was possible within a 48-h period with minimal structural alterations.
 
This scoping review responds to the appeal of the scientific community for collaboration between different entities for pharmacovigilance and active surveillance of coronavirus disease 2019 (COVID-19) vaccines. The objective is to identify, systematically evaluate, and synthesize the best scientific evidence available on the indicators used in pharmacovigilance systems. Our results demonstrate that approximately 50% of the 25 studies used in this review have been carried out in the past 5 years. Of these, only four used the pharmacovigilance indicators proposed by the World Health Organization (WHO). Eighty-seven pharmacovigilance indicators were identified, of which seven (8.0%) related to signal detection. While the WHO advocates signal detection as routine pharmacovigilance, in special situations – such as accelerated clinical studies where adverse events are not yet well known – other indicators related to signal detection appear to be good options for maintaining quality pharmacovigilance and active surveillance in the development of the COVID-19 vaccine. However, the less robust pharmacovigilance systems in low-income countries will necessitate greater involvement of health professionals from public and private sectors, pharmaceutical companies, academic institutions, and the general public, to ensure information security and detection of signals for the COVID-19 vaccine.
 
During the coronavirus disease 2019 (COVID-19) pandemic, many health organizations faced shortages of personal protective equipment for their personnel. In case of extreme urgency, re-using disposable materials might offer a temporary solution. Hydrogen peroxide vaporization (HPV) has been used for disinfection of patient rooms for more than a decade. We investigated HPV as a method for disinfecting disposable gowns. After HPV, gowns proved to be free of bacteria and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA while their functionality and water-repellency remained intact. We conclude that, in case of emergency and lack of available alternatives, HPV is a suitable and relatively inexpensive method for one-time reuse of disposable gowns.
 
Swedish nursing homes are obliged to have a management system for systematic quality work including self-monitoring of which surveillance of infections is one part. The Department of Infection Control in Stockholm County Council has provided a simple system for infection surveillance to the nursing homes in Stockholm County since 2002. A form is filled in by registered nurses in the nursing homes at each episode of infection among the residents. A bacterial infection is defined by antibiotic prescribing and a viral infection by clinical signs and symptoms. Yearly reports of numbers of infections in each nursing home and calculated normalized figures for incidence, i.e. infections per 100 residents per year, as well as proportion of residents with urinary catheter are delivered to the medically responsible nurses in each municipality by the Department of Infection Control. Number of included residents has varied from 4,531 in 2005 to 8,157 in 2014 with a peak of 10,051 in 2009. The yearly incidences during 2005 - 2014 (cases per 100 residents) were: Urinary tract infection (UTI) 7.9-16.0, Pneumonia 3.7-5.3, Infection of chronic ulcer 3.4–6.8, Other infection in skin or soft tissue 1.4–2.9, Clostridium difficile-infection 0.2–0.7, Influenza 0–0.4 and Viral gastroenteritis 1.2–3.7. About 1 % of the residents have a suprapubic urinary catheter, 6–7 % have an indwelling urinary catheter. Knowledge about the incidence of UTI has contributed to the decrease of this infection both in residents with and without urinary catheter.
 
Infection control (IC) in hospitals depends on adequate human resources and organization. The aim of the study was to assess the IC resources and activities in Finnish acute care hospitals. A questionnaire covering information on hospital characteristics, IC staff and surveillance activities in 2008 was mailed to all Finnish acute care hospitals. All 57 (100%) hospitals responded. Of the hospitals, 70% had infectious disease specialists and 37% had clinical microbiologists who participated in the IC. Most of the hospitals (88%) had trained IC nurses. The median number of hospital beds per full-time equivalent ICN was 257 (range, 87-770). The IC staff had limited secretarial and IT-support. Most hospitals (95%) had IC committees as well as a link nurse system (96%), and they all implemented incidence surveillance at least in one specialty. In comparison with the results from our previous study in 2000, the ICN to bed ratio has improved (2000: range 394-953 beds/ICN). Now that the situation with IC staff seems better, the focus could be shifted to additional training and an evaluation of the curriculum of the ICNs.
 
This Supplement contains abstracts for the 20th Congress of the International Federation of Infection Control, Belgrade, Serbia, March 11-14, 2020. Despite the cancellation of the Congress due to the COVID-19 pandemic, the conference organizers and IJIC recognize those presenters whose research was to be presented and are pleased to publish their abstracts
 
While in the past hazardous healthcare waste was generally incinerated, if it was treated at all, in the last decade more comprehensive waste management systems have been set up and alternative treatment systems have emerged. The raising of awareness about healthcare waste issues and the application of advanced systems resulted however in an increase of uncertainties and mistaken ideas. An overview of the 7 most typical myths in modern healthcare waste treatment and the evidence-based truth on these myths are the subject of this paper. The myths to be discussed include the incineration of healthcare waste, the issue of waste “sterilization”, the myth of the need of shredding decontaminated waste, the disposal of blood, the usage of old and new autoclaves for the decontamination of waste and the centralized treatment of hazardous healthcare waste. The existing myths and related practical problems illustrate the great need of detailed, international technical standards and norms for healthcare waste treatment equipment. They also underline the need for standardized systems for the type testing of hazardous waste treatment systems and the need for standardized tests for installed treatment systems, as well as the need for clear protocols for the regular testing of waste treatment equipment.
 
This report is about two cases of acute abdomen-like symptoms that proved to be due to swine flu. Two patients above 60 years of age, with cardiac and respiratory chronic disease, presented with acute abdominal pain. One of them was subjected to abdominal exploration that revealed functional colonic obstruction. The diagnosis of H1N1 was made later upon development of respiratory symptoms. In the other case the diagnosis of H1N1 was made preoperatively, and conservative management was pursued. Once H1N1 was suspected, viral culture was performed and found positive. Acute abdominal symptoms were relieved in both cases by administration of Oseltamivir. Acute abdomen-like presentation of H1N1 Influenza is rare. Suspecting such a diagnosis is crucial to save patients with an H1N1 Acute abdomen-like presentation unnecessary surgery. Cure of the patient and prevention of disease spread depend on accurate diagnosis of H1N1. Surgeons should be aware of the possibility of presentation with acute abdomen-like symptoms, during an H1N1 outbreak.
 
This study aims to determine the incidence of and identify the risk factors responsible for surgical site infection (SSI) following laparotomies in adult patients in a Nigerian tertiary care facility. This is a prospective study carried out between January and December 2012. Wound assessment was done using standardized criteria stipulated by the Centres for Disease Control and Prevention. There were 291 patients during the study period, out of which 223 met the inclusion criteria: 157 (70.4%) males and 66 (29.6%) females. Surgical site infection was diagnosed in 85 patients giving an incidence rate of 38.1%. Identified risk factors for SSI include anaemia, contaminated and dirty wounds, retroviral disease status, physiological status (ASA scores IV and V), prolonged surgery time, cadre of surgeon, emergency surgeries and use of drains. The high incidence of SSI observed in this study was found more in patients that presented with septic abdomen and those that had large bowel procedures. Paying close attention to identified risk factors will reduce the burden of SSI.
 
Infection Control and Antimicrobial Stewardship Programs (ICASPs) are essential to reduce the emergence and spread of antimicrobial resistance. The primary objective of this study was to assess the feasibility of extending a commercial off-the-shelf (COTS) software for ICASPs in LMICs. This project involved three hospitals in Colombia, including Centro Médico Imbanaco, Clínica San Francisco, and DIME Clínica Neurocardiovascular. A COTS platform (ILÚM Health Solutions™; Kenilworth, NJ) was extended to function in a range of technology settings, and translatable to almost any language. ICASP features were added, including clinical practice guidelines, hand hygiene (HH) documentation, and isolation precaution (IP) documentation. The platform was delivered as a smartphone app for both iOS and Android. The app was successfully implemented at all sites, however, full back-end data integration was not feasible at any site. In contrast to the United States, a suite of surveillance tools and physician-focused decision support without patient data proved to be valuable. Language translation processing occurred quickly and incurred minimal costs. HH and IP compliance tracking were the most used features among ICASP staff; treatment guidelines were most often used by physicians. Use of the app streamlined activities and reduced the time spent on ICASP tasks. Users consistently reported positive impressions including simplicity of design, ease of navigation, and improved efficiency. This ICASP app was feasible in limited-resource settings, highly acceptable to users, and represents an innovative approach to antimicrobial resistance prevention.
 
Intravenous access is one of the most commonly performed invasive procedures in the clinical practice, during which the improper practice of the aseptic precautions could lead to fatal healthcare associated infections. A descriptive cross sectional study was conducted to assess the compliance with aseptic precautions during intravenous access and to identify the determinants of the substandard practice and practical difficulties encountered at the National Hospital of Sri Lanka using a self administered questionnaire and an observational check list. The majority (60.2%) of the participants fell in to the ‘substandard’ practice category. Compliance for the accepted method of hand washing was 8.4%. Compliance was significantly better among the nursing students (P=0.001), nursing staff that had less experience (P=0.001) and who had updated their knowledge recently (P=0.043). The work load (95.2%) and the shortage of equipment (65.06%) were the main practical difficulties identified. Hand washing practice should be further encouraged in the hospital setting. Continuing education and provisions of the necessary equipment are equally important.
 
Background: Nosocomial bacteremia caused by Acinetobacter baumannii (AB) is of increasing concern in critically ill patients. There is a world-wide increase in the emergence of multidrug-resistant (MDR) AB to antimicrobials. Therefore we conducted this study to evaluate the resistance pattern of AB in patients with bacteremia. Methods: This is a retrospective study conducted in a tertiary hospital in Saudi Arabia. During the period from April 2008 till April 2010, data for AB isolated from blood were collected. Multidrug resistant AB was defined as resistance to three or more classes of antibiotics. Results: 191 isolates of AB were recovered from blood. The majority of cases were reported in surgical ICU (40.8%). The highest resistance rates to antimicrobials were reported for cefepime (73.8%) and piperacillin / tazobactam (72.3%), followed by ciprofloxacin (68%), and gentamicin (66%). Resistance rates were also high to imipenem (61.3%) and meropenem (60.7%). Low rates of resistance to colistin (0.5%) and to tigecycline (3.9%) were observed. 132 (69%) AB isolates were MDR and 104 (78.8%) of these MDR strains showed sensitivity only to colistin and tigecycline. Conclusion: Bacteremia due to AB was the highest in surgical ICU. The emergence of MDR AB is increasing and the resistance rates to carbapenems are alarming. Urgent measures are needed to slow development of MDR AB. We recommend encouraging clinicians for strict adherence to infection control policies, enhancement of ongoing antimicrobial stewardship program and restrictive use of recommended antibiotics according to susceptibility testing and local guidelines. In-house surveillance is needed for the detection of resistance rates particularly MDR AB.
 
Hospital-acquired infections occur in 5 to 10% of admitted patients in hospital. It is one of the main reasons for death of many hospitalized patients especially in developing countries. Therefore, finding ways to control these infections should be a priority and certainly the first step in achieving this goal. The aim of this study was to determine the frequency of hospital-acquired infections and related factors in Mousavi Hospital in Zanjan, Iran. The demographic data and data about the kind of infection, admission, duration and the ward of admission were reviewed. Statistical analysis was performed by SPSS version 16.0. Among 34102 admitted patients from 21st March 2013 to 21st March 2014 in Mousavi hospital in Zanjan, Iran, 206 (0.6%) patients, 141 (68.4%) male and 65 (31.6%) female, met the criteria of hospital-acquired infections. The highest frequency was in the burn ward with 82 (20.55%) patients. The most common type of infections were surgical site infections, pneumonia, urinary tract infection, sepsis and eye infection respectively. There was a significant correlation between the type of hospital-acquired infections and hospital wards (P=0.0001). The rate of hospital-acquired infections in this study is lower than other studies, which can be due to an effective way of infection control with continuous surveillance and health education for hospital staffs. However, poor diagnostic methods and failure in the reporting system of infections should be considered.
 
Hospital-based infection surveillance and control programs can reduce hospital acquired infection (HAI) prevalence. In resource-limited countries, HAI surveillance is challenging to implement due to inadequate or lacking laboratory infrastructure and trained personnel. A HAI surveillance system was implemented in a teaching hospital in Rwanda. A multi-disciplinary team developed a point-prevalence HAI surveillance tool based on World Health Organization (WHO’s) criteria and conducted surveillance on all inpatient units from September 2013 to March 2014. The baseline HAI rate was 15.1%. Highest HAI rates were found in intensive care unit (ICU) (50.0%), Neonatal ICU (23.1%) and Orthopedics/burn unit (37.3%). Factors significantly associated with increased risk of developing HAIs included surgery within the past month (odds ratio [OR] 2.75, 95%CI: 1.40, 5.40), use of a urinary catheter (OR 2.10, 95%CI: 1.05, 4.25), use of mechanical ventilator (OR 3.14, 95%CI: 1.01, 9.74), and use of chest drain, naso-gastric tube, external fixator (OR=3.93). Longer hospital length of stay was also significantly associated with a risk of HAI (OR 1.02). It is feasible in a low-resource setting to establish HAI surveillance and obtain an accurate HAI rate. The surveillance information can inform prioritization of infection prevention efforts.
 
Background: Hospital-acquired infections, including hospital-acquired gastroenteritis (HAGE), are well documented in Western countries but little is known about these infections in sub-Saharan Africa. Aim: To determine the incidence of and explore modifiable risk factors for HAGE. Methods: A prospective cohort study of children 72 hours after admission or upon admission after recent discharge for a non-GE illness. Children were followed until discharge to ascertain therapies used and adverse outcomes. Enteric pathogens were identified by multiplex PCR. Findings: Virtually all of the 32 children with HAGE were < 2 years (n=30, 94%) and most were male (n=19, 59%). Few had HIV infection (n=6, 19%), severe malnutrition (n=8, 25%), or a history of vitamin A use in the past 6 months (n=2, 6%). The mean monthly incidence of HAGE was 2.3 per 1000 patient days, and associated with the monthly number of community-acquired gastroenteritis (CAGE) admissions (IRR 1.02, 95% CI 1.00, 1.04, p=0.025). A stool pathogen was detected in 15/27 (56%) children, including norovirus (n=7, 26%) and rotavirus (n=5, 18%). Most children received oral rehydration solution (n=26, 81%), or IV fluids (n=9, 28%). Antibiotics were administered to 5 (16%) children. Two (6%) children with HAGE were admitted to the ICU and 4 (12%) died. Conclusions: We found HAGE was relatively common and associated with severe outcomes. The monthly incidence of HAGE was associated with CAGE admissions. Common pathogens included norovirus and rotavirus.
 
The provision of healthcare generates waste which can be detrimental to health and environment. Staff that provide dental healthcare ought to be aware of the proper handling and the system of management of dental waste used by different dental hospitals. A survey was conducted to determine the awareness of dental practitioners on hospital generation and handling of waste. A self-administered questionnaire was used. Lack of awareness, ignorance of policy and procedure on the handling of dental healthcare waste and failure to attend educational activities were major defects found among practitioners in the study. There is a need for a plan to improve the awareness of dental healthcare workers about hospital generated waste and its proper handling.
 
High quality infection control practice is fundamental to the provision of safe healthcare. In countries where healthcare is less developed, this notion is less well recognized. The Plan, Do, Study, Act (PDSA) cycle is an implementation strategy used for changing healthcare practice and forms a framework for testing multiple ideas on a small scale, before implementation of change on a larger scale. Our aim was to improve infection control standards in a rural district hospital in Nepal using the PDSA cycle. Potential areas for improvement within infection control practice were first identified. Patient contacts and hand washing episodes were then recorded on the ward round in a tally chart method on the medical wards, which was deemed to reflect infection control standards. The three week intervention period included healthcare staff education and provision of alcohol gel. Data was re-collected after the intervention. 18 hand cleaning episodes were observed in 134 patient contacts in the initial one week observation period, hence 13.4% of patient contacts fulfilled appropriate hand hygiene practice. In the post intervention period, 69 hand cleaning episodes were observed in 142 patient contacts, giving rise to a 48.6% success rate. The overall percentage of appropriate hand hygiene performed therefore improved 3.6 fold. Our results confirmed an improvement in the hand hygiene practice of hospital staff. We extrapolated these results to a probable reduction in healthcare-associated infection for the hospital and local population. The study demonstrates that the PDSA cycle can be an effective tool irrespective of resources available.
 
The SNIV network is a national surveillance system involving nursing homes on a voluntary base. The aim of the SNIV network is to provide systematic year-round surveillance data on the incidence of infections in nursing homes for local interventions and national policymaking and for the development of infection control guidelines. The network was designed as a sentinel active surveillance network involving nurse practitioners and/or elderly care physicians who report weekly on incident infectious diseases (gastro-enteritis, influenza-like illness, probable pneumonia and the addition of urinary tract infections in 2011) in their nursing home based on clinical definitions. The average weekly incidence per 1000 residents in the years 2009 till 2012 varied by year: gastro-enteritis: 3.8, 4.6, 3.7, 2.5; influenza-like illness: 1.6, 0.4, 0.5, 1.8; probable pneumonia: 3.6, 3.7, 2.9, 3.5; urinary tract infections: 8.0, 9.6 per 1000 resident weeks in 2011 and 2012. Gastro-enteritis most frequently occurred in local outbreaks and incidence peaked in winter. Incidence of influenza-like illness only showed a seasonal pattern in 2009 due to absence of infections with A(H1N1) influenza virus in nursing home residents. The results from our nationwide on-going weekly surveillance into the incidence of infections in nursing homes show that systematic surveillance in nursing homes is feasible. These data provides insight into seasonal patterns and risk factors for infection needed to guide infection control efforts and form the basis for comparisons between institutions and within regions. Furthermore, these data provide a solid baseline when studying the effectiveness of intervention strategies in the nursing home setting.
 
Number of Health Care Workers trained in Universal Precautions by year 
Health care workers (HCWs) are at a high risk of occupational blood-borne infections, which may be increased in low and middle income countries by low adherence to Universal Precautions (UP). A baseline survey of Knowledge, Attitudes and Perceived adherence (KAP) was executed to design evidence-based tailor made interventions. A cross-sectional, descriptive study using self-administered questionnaires was conducted among HCWs in the obstetrics and gynecology department of an Indonesian teaching hospital from September-October 2007. The survey included 524 HCWs with a response rate of 72% (n=377). The results indicated that the level of knowledge regarding hand washing, personal protective equipment, medical waste disposal and post exposure prophylaxis was high, over mean score of 71.8. However, level of knowledge regarding instrument processing and medical sharps disposal was low. Perceived adherence was low as reported by majority of respondents (95%). There was significant association between knowledge and attitude (r=0.235; P< 0.001); knowledge and perceived adherence (r=0.314; P< 0.001); attitude and perceived adherence (r=0.233; P< 0.001). This study suggest tailor made interventions were needed to improve adherence to UP.
 
Adherence to hand hygiene recommendations by health care workers (HCWs) participate to minimize healthcare-associated infections. There are few studies, to our present state of knowledge, which interested in the rate of adherence in Algerian hospitals and no one on the associated factors with the non-adherence by HCWs. The objective was to determine the rate of adherence with WHO's hand hygiene recommendations and to identify factors associated with non-adherence, in a regional university hospital. The method used was the direct observation, based on the recording of hygienic actions in opportunities for HCWs in front of the WHO's five indications. To determine the factors associated with non-adherence, a questionnaire was administrated to HCWs. The relationship between the different factors and the achievement of a hygiene action was evaluated by Pearson's Chi-square test. 503 opportunities for hand hygiene were observed among 206 HCWs, during 19 observation sessions. Simple handwashing was noted in 19% of hand hygiene actions. The overall adherence was 21 %. There was a wide variation in the adherence rates between the different departments and the different types of HCWs. There was a statistically significant association (p
 
This study analyzed hand hygiene adherence based on the direct observation computed through a standardized electronic form (Google forms®) available in an smartphone. The observed monthly adherence rates increased during the period. The frequency rates were 21.3% in September; 33.3% in October; 38.7% in November; and 59.7% in December (p
 
Compared to the Intensive Care Unit setting, relatively little data has been published on the benefits of daily Chlorhexidine gluconate (CHG) baths in infection prevention on general wards. To contribute to our knowledge of this infection prevention strategy we report three years of cumulative data from a 550-bed general hospital in Singapore. Our hospital infection control policy mandates Methicillin-resistant Staphylococcus aureus (MRSA) entry-screening for all cases admitted to hospital. Positive cases are isolated or cohorted with appropriate contact precautions. In addition positive cases receive daily 4% CHG baths throughout their stay. We compare the rates of hospital-acquired MRSA (HA-MRSA) infection in the cohort that screened MRSA-positive (and hence received daily CHG baths) with the cohort in whom MRSA was not detected and hence did not receive CHG baths. Of 4598 screen-positive cases only 4 developed HA-MRSA infection. This compares to 36 cases of HA-MRSA infection among 5391 patients who we estimate were undetected MRSA-carriers, either because they missed screening, or screened false-negative, or acquired MRSA during their hospital stay. MRSA-colonized patients receiving daily CHG baths while in hospital were significantly less likely to develop HA-MRSA infection (OR = 0.129; P = 0.0001; 95% CI 0.046-0.36; NNT = 172)). We conclude that General Ward patients who screen MRSA-positive on admission and who receive daily CHG baths throughout hospitalization have a significantly lower rate of HA-MRSA infection compared to patients who screen MRSA-negative and who do not receive such CHG baths.
 
Types of illness or symptoms of illnesses that necessitated self-medication
Source of advice and way of requesting drugs for self-medication
Reasons of participants for self-medication practice,
Types of drugs used for self-medication
Background: Self-medication is the selection and use of medicines by individuals to treat their self-recognized illnesses or symptoms. Self-medication can decrease costs and enable health professionals to concentrate on more serious health problems. Aim: To assess self-medication practice and associated factors among adults in Wolaita Soddo town, Southern Ethiopia, 2017. Methods: An institution-based cross-sectional study was conducted from September 30 to October 30, 2017. A multi-stage sampling technique of drug retail outlets in Wolaita Soddo town was employed to identify 623 individuals that came to buy drugs in the past three months. Data was collected using a structured questionnaire. Results: About 33.7% of the respondents had practiced self-medication in the past 3 months. Multivariate analysis revealed that female sex (adjusted odds ratio (AOR) = 2.22, 95% confidence interval (CI): 1.47–3.36), low income (AOR = 3.95, 95% CI: 2.32–6.73) and higher educational level (AOR = 5.79, 95% CI: 2.47–13.58) were the independent factors significantly affecting the practice of self-medication with drugs. Headache/fever (32.4%), respiratory tract infections (31.4%) and gastrointestinal diseases (16.2%) were the most frequently reported illnesses or symptoms of illnesses that prompted self-medication of study participants. Conclusion: Health education campaigns, strict legislations on dispensing drugs from private pharmacies, and improving accessibility and affordability of health care are among the important interventions required to change people’s health-seeking behavior and prevent the potential risks of self-medication.
 
Top-cited authors
Emmanuel Nwankwo
  • Michael Okpara University of Agriculture, Umudike
Ifeoma Okafor
  • College of Medicine University of Lagos
Timothy Ekwere
  • University of Uyo
Abrar Ahmad Chughtai
Chandini Raina Macintyre