RESUMO
BACKGROUND: A surgical site infection (SSI) is a postoperative infection that occurs at or near the surgical incision. SSIs significantly increase morbidity, mortality, length of hospital stay, and healthcare costs. The World Health Organization (WHO) has established hospital hygiene precaution guidelines for the prevention of SSIs, which were enhanced during the COVID-19 pandemic. The current study aims to explore the effect of the COVID-19 pandemic on SSI incidence among initially uninfected postoperative patients. We hypothesize that these enhanced precautions would reduce the incidence of SSIs. MATERIALS AND METHODS: A retrospective study comparing surgical outcomes before and during the pandemic. Patients who had abdominal surgery between June and December 2019 (Non-COVID-19) or between February and June 2020 (COVID-19) were included. The two groups were matched in a 1:1 ratio based on age, Sex, acuity (elective or emergent), surgical approach, and comorbidities. Electronic medical records were reviewed to identify SSIs and hospital readmissions within 30 days after surgery. Pearson's chi-square test and Fisher's exact test were used. RESULTS: Data was collected and analyzed from 976 patients who had surgery before the COVID-19 pandemic (non-COVID group) and 377 patients who had surgery during the pandemic (COVID group). After matching, there were 377 patients in each group. In our study, we found 23 surgical site infections (SSIs) in both laparoscopic and open surgeries. The incidence of SSIs was significantly higher in the non-COVID period compared to the COVID period [17 cases (4.5%) vs. 6 cases (1.6%), respectively, p = 0.032], especially in non-COVID open surgeries. The incidence of SSIs in laparoscopic surgeries was also higher during the non-COVID period, but not statistically significant. CONCLUSIONS: Enhanced hygiene precautions during the COVID -19 pandemic may have reduced SSIs rates following abdominal surgery.
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COVID-19 , Infecção da Ferida Cirúrgica , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção da Ferida Cirúrgica/epidemiologia , Masculino , Feminino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Controle de Infecções/métodos , Incidência , Abdome/cirurgia , Pandemias , Adulto , SARS-CoV-2 , HigieneRESUMO
Unsafe patient care in hospitals, especially in low- and middle-income countries, is often caused by poor infection prevention and control (IPC) practices; insufficient support for water, sanitation, and hygiene (WASH); and inadequate waste management. We looked at the intersection of IPC, WASH, and the global initiative of improving health care quality, specifically around maternal and newborn care in Bangladesh health facilities. We identified 8 primary quality improvement and IPC/WASH policy and guideline documents in Bangladesh and analyzed their incorporation of 30 subconditions under 5 critical conditions: water; sanitation; hygiene; waste management/cleaning; and IPC supplies, guidelines, training, surveillance, and monitoring. To determine how Bangladesh health care workers implemented the policies, we interviewed 33 informants from 16 public and private facilities and the national level. Bangladesh's 8 primary guidance documents covered 55% of the 30 subconditions. Interviews showed that Bangladesh health facility staff generally rely on eight tools related to quality improvement (five); IPC (two); and supportive supervision (one) plus a robust supervision mechanism. The stakeholders identified a lack of human resources and environmental hygiene infrastructure and supplies as the main gaps in providing IPC/WASH services. We concluded that the Bangladesh government had produced substantial guidance on using quality improvement methods to improve health services. Our recommendations can help identify strategies to better integrate IPC/WASH in resources including standardizing guidelines and tools within one toolkit. Strategizing with stakeholders working on initiatives such as universal health coverage and patient safety to integrate IPC/WASH into quality improvement documents is a mutually reinforcing approach.
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Controle de Infecções , Melhoria de Qualidade , Bangladesh , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Higiene/normas , Qualidade da Assistência à Saúde , Saneamento/normas , Infecção Hospitalar/prevenção & controle , Instalações de Saúde/normas , Pessoal de Saúde , FemininoRESUMO
BACKGROUND: Hospitals should prepare for emerging diseases and protect healthcare workers (HCWs) from work-related infection. This study aims to assess public hospital preparedness for the coronavirus disease 2019 (COVID-19) a year after the Myanmar government began implementing COVID-19 prevention measures, and to identify factors associated with work-related COVID-19 infection among HCWs in Myanmar. METHODS: In January 2021, data were collected from 101 hospitals and 706 HCWs who had COVID-19 in Myanmar in 2020. Data from the hospitals included basic information, the status of infection prevention and control (IPC), the preparedness for COVID-19 (guidelines, checklists, fever screening, patient pathway, and training), handwashing facilities, and availability of personal protective equipment (PPE). Data of COVID-19 infected HCWs included age, occupation, workplace, severity and source of COVID-19 infection, knowledge and practice of handwashing, and working environment. Chi-square test was performed to compare the preparedness for COVID-19 among three hospital levels (primary, secondary and tertiary levels). Logistic regression analysis was performed to identify the associated factors of work-related infection of HCWs. RESULTS: The total number of beds, HCWs, and COVID-19 patients in 2020 at the 101 hospitals was 12,888, 14,421, and 19,835, respectively. The availability of PPE was high in hospitals at all levels. Approximately 80% of hospitals had functional status of IPC, set up fever screening and patient pathway, and provided training on IPC and COVID-19. However, only 39.6% of hospitals had developed COVID-19 guidelines and 55.4% had developed checklists. The percentage of hospitals that prepared each measurement was lowest at the primary level. The factors associated with work-related COVID-19 among HCWs were being 30-39 years old, working as a doctor, working at isolation wards, having disinfection technique training, and having enough PPE at the workplace. CONCLUSION: The preparedness for COVID-19 at public hospitals in Myanmar in January 2021 was insufficient, especially in the availability of the guidelines and checklists and at primary hospitals. A support system for hospital pandemic preparedness and monitoring of IPC implementation is needed. The government should prepare for emerging diseases and provide appropriate and adequate PPE and additional training to all HCWs, especially HCWs who work for isolation wards.
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COVID-19 , Pessoal de Saúde , Hospitais Públicos , Controle de Infecções , Equipamento de Proteção Individual , SARS-CoV-2 , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Mianmar/epidemiologia , Estudos Transversais , Hospitais Públicos/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Controle de Infecções/métodos , Controle de Infecções/normas , Equipamento de Proteção Individual/estatística & dados numéricos , Equipamento de Proteção Individual/provisão & distribuição , Masculino , Adulto , Feminino , Pessoa de Meia-Idade , Desinfecção das MãosRESUMO
BACKGROUND: African swine fever (ASF) poses a threat to the global pig industry, leading to significant economic losses and widespread disruptions in pig farming and associated sectors. In September 2023, the first case of ASF in Swedish wild boar triggered immediate responses from authorities, including the establishment of restricted zones and culling measures. A new ASF certification programme for pig herds was initiated to improve biosecurity and proactive disease management. This survey aimed to assess the sentiments and actions of Swedish pig farmers six months post-outbreak, particularly regarding biosecurity measures. Such information is important to improve preparedness for future disease threats. A questionnaire was distributed to members of the Swedish pig producers' organisation. RESULTS: A total of 113 farmers responded (response rate 27%), with the majority considering the risk of ASF reappearing in Sweden as high. The estimated cost for connecting the farms to the ASF certification programme varied greatly, with a majority identifying cost as a substantial hurdle. While many farmers sought biosecurity advice from veterinarians, 43% had not implemented suggested measures. Over one third had not received concrete measures that would fit their farms, and 14% had not received any biosecurity advice from veterinarians at all. Discussions among farmers emphasized concerns about ASF outbreaks, transmission mechanisms, and regulatory compliance, highlighting the importance of ongoing communication and knowledge exchange to address the challenges posed by ASF effectively. Additionally, participants also mentioned the role of dense wild boar populations and shortcomings in municipal food waste management as important risk factors. CONCLUSIONS: The responding farmers expressed widespread concern about new ASF outbreaks. A majority identified cost as a substantial hurdle for joining the ASF certification programme. While many farmers consulted veterinarians for advice on biosecurity, a significant number had yet to implement suggested measures and one third had not received specific guidance suitable for their farms. Stakeholder conversations highlighted concerns about ASF outbreaks, transmission, and compliance. They also discussed the role of dense wild boar populations and issues with municipal food waste management as significant risk factors for ASF.
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Febre Suína Africana , Criação de Animais Domésticos , Animais , Suécia , Suínos , Febre Suína Africana/prevenção & controle , Febre Suína Africana/epidemiologia , Criação de Animais Domésticos/métodos , Controle de Infecções/métodos , Inquéritos e Questionários , Biosseguridade , Fazendas , Fazendeiros/psicologia , Sus scrofa , Surtos de Doenças/veterinária , Surtos de Doenças/prevenção & controleRESUMO
BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) frequently causes both healthcare-associated infections and nosocomial outbreaks in burn medicine/plastic surgery and beyond. Owing to the high antibiotic resistance, infections are difficult to treat, and patient outcomes are often compromised. The environmental persistence capability of CRAB favors its transmission in hospitals. A comprehensive analysis and understanding of CRAB epidemiology and microbiology are essential for guiding management. METHODS: A three-year retrospective cohort study (2020-2022) was conducted in a German tertiary burn and plastic surgery center. In addition to epidemiological analyses, microbiological and molecular techniques, including whole-genome sequencing, were applied for the comprehensive examination of isolates from CRAB-positive patients. RESULTS: During the study period, eight CRAB cases were found, corresponding to an overall incidence of 0.2 CRAB cases per 100 cases and an incidence density of 0.35 CRAB cases per 1000 patient-days. Six cases (75%) were treated in the burn intensive care unit, and four cases (50%) acquired CRAB in the hospital. Molecular analyses comprising 74 isolates supported the epidemiologic assumption that hospital acquisitions occurred within two separate clusters. In one of these clusters, environmental CRAB contamination of anesthesia equipment may have enabled transmission. Furthermore, molecular diversity of CRAB isolates within patients was observed. CONCLUSIONS: CRAB can pose a challenge in terms of infection prevention and control, especially if cases are clustered in time and space on a ward. Our study demonstrates that high-resolution phylogenetic analysis of several bacterial isolates from single patients can greatly aid in understanding transmission chains and helps to take precision control measures.
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Infecções por Acinetobacter , Acinetobacter baumannii , Carbapenêmicos , Infecção Hospitalar , Controle de Infecções , Acinetobacter baumannii/genética , Acinetobacter baumannii/efeitos dos fármacos , Acinetobacter baumannii/isolamento & purificação , Humanos , Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/microbiologia , Alemanha/epidemiologia , Carbapenêmicos/farmacologia , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Idoso , Adulto , Controle de Infecções/métodos , Epidemiologia Molecular , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Queimaduras/microbiologia , Queimaduras/complicações , Cirurgia Plástica , Unidades de Queimados , Sequenciamento Completo do Genoma , Incidência , Testes de Sensibilidade MicrobianaRESUMO
This paper explores the potential of artificial intelligence, machine learning, and big data analytics in revolutionizing infection control. It addresses the challenges and innovative approaches in combating infectious diseases and antimicrobial resistance, emphasizing the critical role of interdisciplinary collaboration, ethical data practices, and integration of advanced computational tools in modern healthcare.
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Inteligência Artificial , Controle de Infecções , Aprendizado de Máquina , Humanos , Controle de Infecções/métodos , Big DataRESUMO
The coronavirus disease (COVID-19) SARS-CoV-2 virus epidemic continues to exhibit a sporadic onset trend due to the continuous variation of the novel coronavirus. However, the psychological impact of the pandemic persists. It is crucial to reflect on our experiences to better prepare for future large-scale infectious diseases. During outbreaks of infectious diseases, patients may still require orthopaedic surgery. It is crucial to prioritize the safety of medical staff and establish procedures to ensure their protection. However, with the implementation of a series of standardized operational protection procedures, orthopaedic surgeons can safely perform their duties without the risk of contracting COVID-19. There is no doubt that the orthopaedic occupational exposure protection process and perioperative management plan for global infectious diseases, such as COVID-19, require a standardized summarization process and a narrative review.
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COVID-19 , Exposição Ocupacional , Assistência Perioperatória , SARS-CoV-2 , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , COVID-19/transmissão , Exposição Ocupacional/prevenção & controle , Exposição Ocupacional/efeitos adversos , Assistência Perioperatória/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Procedimentos Ortopédicos/efeitos adversos , Controle de Infecções/métodosRESUMO
Infection prevention and control (IPC) is essential in nursing practice to safeguard patient health and reduce healthcare-associated infections. This article explores IPC strategies, including hand hygiene, the use of personal protective equipment, environmental cleaning, safe injection practices, and antimicrobial stewardship. It discusses the implementation challenges and solutions, such as ensuring compliance through education, monitoring and strong leadership. IPC measures are crucial in preventing infections such as catheter-associated urinary tract infections, central line-associated bloodstream infections, surgical site infections, and ventilator-associated pneumonia. By integrating personalised IPC strategies into nursing practice, healthcare providers can significantly improve infection control outcomes and enhance overall patient safety and quality of care.
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Infecção Hospitalar , Controle de Infecções , Humanos , Controle de Infecções/métodos , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/enfermagem , Higiene das Mãos/normas , Equipamento de Proteção Individual , Gestão de AntimicrobianosRESUMO
Environmental cleaning is essential to patient and health worker safety, yet it is a substantially neglected area in terms of knowledge, practice, and capacity-building, especially in resource-limited settings. Public health advocacy, research and investment are urgently needed to develop and implement cost-effective interventions to improve environmental cleanliness and, thus, overall healthcare quality and safety. We outline here the CLEAN Group Consensus exercise yielding twelve urgent research questions, grouped into four thematic areas: standards, system strengthening, behaviour change, and innovation.
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Consenso , Instalações de Saúde , Humanos , Infecção Hospitalar/prevenção & controle , Pesquisa , Controle de Infecções/métodos , Desinfecção/métodos , Zeladoria Hospitalar/normasRESUMO
Healthcare-associated infections (HAIs) caused by multidrug-resistant organisms (MDROs) represent a global threat to human health and well-being. Because transmission of MDROs to patients often occurs via transiently contaminated hands of healthcare personnel (HCP), hand hygiene is considered the most important measure for preventing HAIs. Environmental surfaces contaminated with MDROs from colonized or infected patients represent an important source of HCP hand contamination and contribute to transmission of pathogens. Accordingly, facilities are encouraged to adopt and implement recommendations included in the World Health Organization hand hygiene guidelines and those from the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America/Association for Professionals in Infection Control and Epidemiology. Alcohol-based hand rubs are efficacious against MDROs with the exception of Clostridiodes difficile, for which soap and water handwashing is indicated. Monitoring hand hygiene adherence and providing HCP with feedback are of paramount importance. Environmental hygiene measures to curtail MDROs include disinfecting high-touch surfaces in rooms of patients with C. difficile infection daily with a sporicidal agent such as sodium hypochlorite. Some experts recommend also using a sporicidal agent in rooms of patients colonized with C. difficile, and for patients with multidrug-resistant Gram-negative bacteria. Sodium hypochlorite, hydrogen peroxide, or peracetic acid solutions are often used for daily and/or terminal disinfection of rooms housing patients with Candida auris or other MDROs. Products containing only a quaternary ammonium agent are not as effective as other agents against C. auris. Portable medical equipment should be cleaned and disinfected between use on different patients. Detergents are not recommended for cleaning high-touch surfaces in MDRO patient rooms, unless their use is followed by using a disinfectant. Facilities should consider using a disinfectant instead of detergents for terminal cleaning of floors in MDRO patient rooms. Education and training of environmental services employees is essential in assuring effective disinfection practices. Monitoring disinfection practices and providing personnel with performance feedback using fluorescent markers, adenosine triphosphate assays, or less commonly cultures of surfaces, can help reduce MDRO transmission. No-touch disinfection methods such as electrostatic spraying, hydrogen peroxide vapor, or ultraviolet light devices should be considered for terminal disinfection of MDRO patient rooms. Bundles with additional measures are usually necessary to reduce MDRO transmission.
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Clostridioides difficile , Infecção Hospitalar , Higiene das Mãos , Staphylococcus aureus Resistente à Meticilina , Humanos , Clostridioides difficile/efeitos dos fármacos , Infecção Hospitalar/prevenção & controle , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Candida/efeitos dos fármacos , Desinfecção das Mãos/métodos , Controle de Infecções/métodos , Farmacorresistência Bacteriana Múltipla , Candidíase/prevenção & controle , Candidíase/microbiologia , Infecções por Clostridium/prevenção & controle , Infecções por Clostridium/transmissão , Infecções por Clostridium/microbiologia , Infecções por Clostridium/epidemiologia , Desinfetantes/farmacologia , Mãos/microbiologia , Pessoal de SaúdeRESUMO
BACKGROUND & OBJECTIVE: Tuberculosis (TB) is endemic in India. TB is transmitted through droplet infection and the transmission occurs when a person inhales droplet nuclei containing of Mycobacterium tuberculosis. Infection control practices play a major role in controlling the TB infection in healthcare settings and further prevents TB infection in the HCWs. The aim of the study is to conduct the cross sectional study for infection control practices in DOTS cum Sputum Microscopy Centre's under NTEP in Ghaziabad (Uttar Pradesh) & Dehradun (Uttarakhand) districts with the objective to assess the compliance of infection control measures by HCWs in DOTS cum Sputum Microscopy Centre's and to suggest the suitable measures and/or model to reduce the transmission of infection to the HCWs and to the community at large. MATERIALS & METHODS: The cross sectional study is conducted for two years in two districts of different state having high burden of TB disease in UP and low burden of disease in UK state. All DOTS cum Sputum Microscopy centres of both selected districts i.e. 100% sample size are covered in the study. RESULTS: Hand washing is the most efficient and cost-effective practice for prevention and control of infection. In Dehradun district 66.66% (12) centers and in Ghaziabad district 57.14% (16) centers have adequate hand washing facility available at DOTS and sputum microscopy lab. Unavailability of adequate PPE will lead to the infection. In Dehradun district, 55.56% (10) centers have adequate PPE available whereas in Ghaziabad District 21.43% (6) centers have adequate PPE available. Training on infection prevention and control for HCWs are provided in 27.78% (5) DOTS/sputum microscopy center in Dehradun whereas none of the DOTS/sputum microscopy center in Ghaziabad district are given training on infection prevention & control for HCWs in last one year. Adequate ventilation plays an important role in transmission of TB/MDR TB or any respiratory infection. HCWs working in DOTS/Sputum microscopy center are at risk to contact the TB/MDR TB infection if there is no proper ventilation in their working places. In 33.33% (6) DOTS/sputum microscopy center in Dehradun & 28.57% (8) in Ghaziabad district have adequate ventilation. Layout of DOTS room and for sputum microscopy center are suggested to reduce the risk of transmission of TB/MDR-TB and other respiratory pathogens amongst HCWs who are working in DOTS cum sputum microscopy center. CONCLUSION: DOTS cum Sputum Microscopy Centers of both districts in different states are having deficient infection control practices. Staff is not adequately trained in infection prevention and control practices.
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Controle de Infecções , Escarro , Humanos , Índia/epidemiologia , Estudos Transversais , Escarro/microbiologia , Controle de Infecções/métodos , Microscopia , Terapia Diretamente Observada , Tuberculose Pulmonar/prevenção & controle , Tuberculose Pulmonar/epidemiologia , Tuberculose Pulmonar/transmissão , Desinfecção das Mãos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controleRESUMO
Introduction: The intensive care unit (ICU) caters to patients with severe illnesses or injuries who require constant medical attention. These patients are susceptible to infections due to their weak immune systems and prolonged hospital stays. This makes the ICU the specialty with the highest hospital-acquired infection (HAI) cases. The core dimension of infection prevention and control for ICUs is infection surveillance, which analyses the risk factors of HAI and implements comprehensive interventions for HAI prevention and control. Hence, this study aimed to investigate the potential risk factors for developing HAI in the ICU using real-time automatic nosocomial infection surveillance systems (RT-NISS) to surveil, and analyze the effectiveness of RT-NISS coupled with comprehensive interventions on HAI prevention and control in the ICU. Methods: A retrospective analysis was conducted using data from an RT-NISS for all inpatients in the ICU from January 2021 to December 2022. Univariate and multivariate logistic regression analyses were performed to analyse potential risk factors for HAI in the ICU. Surveillance of the prevalence proportion of HAI, the prevalence proportion of site-specific HAI, the proportion of ICU patients receiving antibiotics, the proportion of ICU patients receiving key antimicrobial combination, the proportion of HAI patients with pathogen detection, the proportion of patients with pathogen detection before antimicrobial treatment and the proportion of patients before receiving key antimicrobial combination, the utilization rate of devices and the rate of device-associated HAIs were monitored monthly by the RT-NISS. Comprehensive interventions were implemented in 2022, and we compared the results of HAIs between 2021 and 2022 to evaluate the effect of the RT-NISS application combined with comprehensive interventions on HAI prevention and control. Results: The relative risk factors, observed as being a significantly higher risk of developing HAI, were hospitalization over 2 weeks, chronic lung diseases, chronic heart diseases, chronic renal diseases, current malignancy, hypohepatia, stroke, cerebrovascular accident, severe trauma, tracheal intubation and tracheostomy and urinary catheter. By implementing comprehensive interventions depending on infection surveillance by the RT-NISS in 2022, the prevalence proportion of HAI was reduced from 12.67% in 2021 to 9.05% in 2022 (χ2 = 15.465, p < 0.001). The prevalence proportion of hospital-acquired multidrug-resistant organisms was reduced from 5.78% in 2021 to 3.21% in 2022 (χ2 = 19.085, p < 0.001). The prevalence proportion of HAI in four sites, including respiratory tract infection, gastrointestinal tract infection, surgical site infection, and bloodstream infection, was also significantly reduced from 2021 to 2022 (both p < 0.05). The incidence of ventilator-associated pneumonia in 2022 was lower than that in 2021 (15.02% vs. 9.19%, χ2 = 17.627, p < 0.001). Conclusion: The adoption of an RT-NISS can adequately and accurately collect HAI case information to analyse the relative high-risk factors for developing HAIs in the ICU. Furthermore, implementing comprehensive interventions derived from real-time automation surveillance of the RT-NISS will reduce the risk and prevalence proportions of HAIs in the ICU.
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Infecção Hospitalar , Unidades de Terapia Intensiva , Humanos , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/epidemiologia , Unidades de Terapia Intensiva/estatística & dados numéricos , Estudos Retrospectivos , Masculino , Feminino , Fatores de Risco , Pessoa de Meia-Idade , Idoso , Controle de Infecções/métodos , Prevalência , AdultoRESUMO
BACKGROUND: Comprehensive infection prevention and control (IPC) programmes are proven to reduce the spread of healthcare-associated infections (HAIs) and antimicrobial resistance (AMR). However, published assessments of IPC programmes against the World Health Organization (WHO) IPC Core Components in Pacific Island Countries and Territories (PICTs) at the national and acute healthcare facility level are currently unavailable. METHODS: From January 2022 to April 2023, a multi-country, cross-sectional study was conducted in PICTs. The self reporting survey was based on the WHO Infection Prevention Assessment Framework (IPCAF) that supports implementing the minimum requirements of the WHO eight core components of IPC programmes at both the national and facility level. The results were presented as a 'traffic light' (present, in progress, not present) matrix. Each PICT's overall status in achieving IPC core components was summarised using descriptive statistics. RESULTS: Fifteen PICTs participated in this study. Ten (67%) PICTs had national IPC programmes, supported mainly by IPC focal points (87%, n = 13), updated national IPC guidelines (80%, n = 12), IPC monitoring and feedback mechanisms (80%, n = 12), and waste management plans (87%, n = 13). Significant gaps were identified in education and training (20%, n = 3). Despite being a defined component in 67% (n = 10) of national IPC programmes, HAI surveillance and monitoring was the lowest scoring core component (13%, n = 2). National and facility level IPC guidelines had been adapted and implemented in 67% (n = 10) PICTs; however, only 40% (n = 6) of PICTs had a dedicated IPC budget, 40% (n = 6) had multimodal strategies for IPC, and 33% (n = 5) had daily environmental cleaning records. CONCLUSIONS: Identifying IPC strengths, gaps, and challenges across PICTs will inform future IPC programme priorities and contribute to regional efforts in strengthening IPC capacity. This will promote global public health through the prevention of HAIs and AMR.
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Infecção Hospitalar , Controle de Infecções , Organização Mundial da Saúde , Humanos , Estudos Transversais , Ilhas do Pacífico/epidemiologia , Controle de Infecções/métodos , Infecção Hospitalar/prevenção & controleRESUMO
BACKGROUND: Despite the extensive use of antibiotics and the growing challenge of antimicrobial resistance, there has been a lack of substantial initiatives aimed at diminishing the prevalence of infections in nursing homes and enhancing the detection of urinary tract infections (UTIs). OBJECTIVE: This study aims to systematize and enhance efforts to prevent health care-associated infections, mainly UTIs and reduce antibiotic inappropriateness by implementing a multifaceted intervention targeting health care professionals in nursing homes. METHODS: A before-and-after intervention study carried out in a minimum of 10 nursing homes in each of the 8 European participating countries (Denmark, Greece, Hungary, Lithuania, Poland, Slovakia, Slovenia, and Spain). A team of 4 professionals consisting of nurses, doctors, health care assistants, or health care helpers are actively involved in each nursing home. Over the initial 3-month period, professionals in each nursing home are registering information on UTIs as well as infection and prevention control measures by means of the Audit Project Odense method. The audit will be repeated after implementing a multifaceted intervention. The intervention will consist of feedback and discussion of the results from the first registration, training on the implementation of infection and prevention control techniques provided by experts, appropriateness of the diagnostic approach and antibiotic prescribing for UTIs, and provision of information materials on infection control and antimicrobial stewardship targeted to staff, residents, and relatives. We will compare the pre- and postintervention audit results using chi-square test for prescription appropriateness and Student t test for implemented hygiene elements. RESULTS: A total of 109 nursing homes have participated in the pilot study and the first registration audit. The results of the first audit registration are expected to be published in autumn of 2024. The final results will be published by the end of 2025. CONCLUSIONS: This is a European Union-funded project aimed at contributing to the battle against antimicrobial resistance through improvement of the quality of management of common infections based on evidence-based interventions tailored to the nursing home setting and a diverse range of professionals. We expect the intervention to result in a significant increase in the number of hygiene activities implemented by health care providers and residents. Additionally, we anticipate a marked reduction in the number of inappropriately managed UTIs, as well as a substantial decrease in the overall incidence of infections following the intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/60099.
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Antibacterianos , Gestão de Antimicrobianos , Casas de Saúde , Infecções Urinárias , Humanos , Antibacterianos/uso terapêutico , Infecções Urinárias/prevenção & controle , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Europa (Continente)/epidemiologia , Controle de Infecções/métodos , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/epidemiologiaRESUMO
BACKGROUND: Healthcare workers are a high-risk group for COVID-19 and protecting them is crucial for healthcare delivery. Limited studies have explored compliance with infection prevention and control (IPC) practices among Somali healthcare workers. This study aimed to determine compliance with IPC practices among healthcare workers in De Martino Public Hospital, Somalia. METHODS: A cross-sectional study was conducted at the De Martino Public Hospital, Mogadishu, Somalia from August to October 2022, with the participation of 204 healthcare workers (response rate = 97%). Compliance was assessed using responses to 25 questions on a five-point Likert-type scale, and a median score of 20 was used to dichotomize compliance scores. A chi-square test and logistic regression analysis were performed to check the associations between healthcare workers' socio-demographic information, IPC-related factors, work conditions and practices on COVID-19, and IPC compliance during healthcare interventions using SPSS 23 version. RESULTS: In total, 58.3% of the participants had good compliance with IPC. There were significant associations between IPC compliance and the type of healthcare worker (doctors and doctor assistants: 72.3%, nurses and paramedical staff: 67.3%, non-clinical staff: 5.7%, p < 0.01). After adjusting for potential confounding factors, compared to non-clinical staff, doctors and doctor assistants (OR: 12.11, 95% CI: 2.23-65.84) and nurses and paramedical staff (OR: 21.38, 95% CI: 4.23-108.01) had higher compliance with IPC measures. There were no significant associations between compliance and sex, marital status, vaccination status, or smoking (p > 0.05 for all). CONCLUSIONS: Low levels of compliance with COVID-19 IPC measures were observed among hospital workers. Prioritizing awareness campaigns and behavior change interventions, especially among non-clinical staff, is crucial for effective COVID-19 infection prevention and control within hospitals.
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COVID-19 , Fidelidade a Diretrizes , Pessoal de Saúde , Humanos , COVID-19/prevenção & controle , COVID-19/epidemiologia , Estudos Transversais , Masculino , Feminino , Adulto , Pessoal de Saúde/estatística & dados numéricos , Somália , Fidelidade a Diretrizes/estatística & dados numéricos , Pessoa de Meia-Idade , SARS-CoV-2 , Controle de Infecções/métodos , Inquéritos e Questionários , Hospitais Públicos , Adulto JovemRESUMO
During the COVID-19 pandemic, a system was established in China that required testing of all residents for COVID-19. It consisted of sampling stations, laboratories capable of carrying out DNA investigations and vehicles carrying out immediate transfer of all samples from the former to the latter. Using Beilin District, Xi'an City, Shaanxi Province, China as example, we designed a genetic algorithm based on a two-stage location coverage model for the location of the sampling stations with regard to existing residencies as well as the transfer between the sampling stations and the laboratories. The aim was to estimate the minimum transportation costs between these units. In the first stage, the model considered demands for testing in residential areas, with the objective of minimizing the costs related to travel between residencies and sampling stations. In the second stage, this approach was extended to cover the location of the laboratories doing the DNAinvestigation, with the aim of minimizing the transportation costs between them and the sampling stations as well as the estimating the number of laboratories needed. Solutions were based on sampling stations and laboratories existing in 2022, with the results visualized by geographic information systems (GIS). The results show that the genetic algorithm designed in this paper had a better solution speed than the Gurobi algorithm. The convergence was better and the larger the network size, the more efficient the genetic algorithm solution time.
Assuntos
COVID-19 , SARS-CoV-2 , Meios de Transporte , COVID-19/prevenção & controle , Humanos , China , Algoritmos , Controle de Infecções/métodos , Manejo de Espécimes/métodos , Sistemas de Informação Geográfica , Pandemias , Teste de Ácido Nucleico para COVID-19/métodos , Teste para COVID-19/métodosRESUMO
BACKGROUND: The WHO Infection Prevention and Control Assessment Framework (IPCAF) is a standardized tool to assess infection prevention and control (IPC) structures in healthcare facilities. The IPCAF reflects the eight WHO core components (CC) of IPC. Besides facility self-assessment, the IPCAF can be used for national surveys, and repeated usage can aid in describing trends concerning IPC structures. A previous survey in over 700 German hospitals conducted in 2018, yielded an overall high IPC level in participating hospitals, albeit with potentials for improvement. In 2023, the survey was repeated to describe once again the state of IPC implementation in German hospitals and compare findings to data from 2018. METHODS: The German National Reference Center for the Surveillance of Nosocomial Infections (NRC) invited 1,530 German acute care hospitals participating in the national surveillance network "KISS", to complete a translated online version of the IPCAF between October 2023 and January 2024. The questionnaire-like nature of the IPCAF, where each answer corresponds to a number of points, allows for calculating an overall IPC score. Based on the overall score, hospitals were allocated to four different IPC levels: inadequate (0-200), basic (201-400), intermediate (401-600), and advanced (601-800). Aggregated scores were calculated and compared with results from 2018. RESULTS: Complete datasets from 660 hospitals were received and analyzed. The median overall IPCAF score was 692.5 (interquartile range: 642.5-737.5), with 572 hospitals (86.6%) classified as advanced, and 87 hospitals (13.2%) as intermediate. One hospital (0.2%) fell into the basic category. The overall median score was virtually unchanged when compared to 2018 (690; data from 736 hospitals). The median score for the CC on workload, staffing and bed occupancy was markedly higher (85 vs. 75), whereas the median score for the CC on multimodal strategies was slightly lower than in 2018 (75 vs. 80). CONCLUSIONS: Repeated assessments of IPC structures at the national level with the IPCAF are feasible and a means to gain insights into the evolution of IPC structures. When comparing aggregated scores, a stable and high level of IPC key aspects in Germany was observed, with improvements over time in IPC indicators related to workload and staffing.