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Poylin VY, Tyselskyi V, Pereyra MN, Kebkalo A. You don't need to be a millionaire: pragmatic approach to implementing infection control and bowel recovery pathways in low resource environment. Surg Endosc 2024:10.1007/s00464-024-11031-2. [PMID: 38987481 DOI: 10.1007/s00464-024-11031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/30/2024] [Indexed: 07/12/2024]
Affiliation(s)
- Vitaliy Y Poylin
- Division of Gastrointestinal Surgery, Northwestern University Feinberg School of Medicine, Northwestern Medical Group, Northwestern Medicine, 676 N. St. Clair St., Suite 650, Chicago, IL, 60611, USA.
| | - Volodymyr Tyselskyi
- Department of Endoscopic and Robotic Surgery, Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - Maria Navaez Pereyra
- Department of Surgery, Northwestern Feinberg School of Medicine, 676 N. St. Clair St., Suite 650, Chicago, IL, 60611, USA
| | - Andrey Kebkalo
- Department of Endoscopic and Robotic Surgery, Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
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Ambulkar R, Kunte AR, Sarangi A, Nair S, Negussie T, Lima I, Tara M. Long-Term Sustainability of Peri-Operative Infection Control Practices: Implementation of "Clean Cut," a Checklist-Based Quality Improvement Program in India. Surg Infect (Larchmt) 2024. [PMID: 38957964 DOI: 10.1089/sur.2023.334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Introduction: Surgical site infections (SSIs) are a substantial healthcare burden in low- and middle- income countries. "Clean Cut" is a checklist-based infection prevention and control (IPC) program intended to improve compliance to peri-operative IPC standards. We aim to study the short-term and long-term impact of its implementation in a tertiary care cancer referral center. Methods: This was a single institute, prospective interventional study. Patients undergoing elective head-neck surgical procedures were included. The "Clean Cut" program consisting of surveillance, audits, and IPC training was implemented for 6 months, after which there was no active oversight. Post-intervention (T2) and 1-year follow-up (T3) data regarding compliance to core IPC practices and SSI rates were compared with baseline (T1). Results: One hundred eighty six patients were included with 50 (26.9%), 86 (46.2%), and 50 (26.9%) patients at T1, T2, and T3, respectively. At baseline, teams complied with a mean of 3.56 of the six critical components of infection control processes which rose to 4.66 (p < 0.001) at T2, but decreased to 4.02 at T3 (p = 0.053). The SSI rate at baseline decreased significantly after Clean Cut implementation [16 (32%) vs. 12 (13.95%), p = 0.012], but returned to baseline levels after 1 year [17 (34%), p = 0.006]. Conclusion: Implementation of the "Clean Cut" program increases compliance to infection control processes and reduces SSI rates in the short term. Without continuing oversight, these rates return to baseline values after 1 year.
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Affiliation(s)
- Reshma Ambulkar
- Department of Anaesthesiology, Critical Care and Pain, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | | | - Akanksha Sarangi
- Department of Anaesthesiology, Critical Care and Pain, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | - Sudhir Nair
- Head & Neck Surgery, Department of Surgical Oncology, ACTREC, Tata Memorial Centre, Homi Bhabha National Institute, Navi Mumbai, India
| | | | | | - Mansi Tara
- Royal Free London NHS Foundation trust, London, United Kingdom
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Starr N, Gebeyehu N, Nofal MR, Forrester JA, Tesfaye A, Mammo TN, Weiser TG. Scalability and Sustainability of a Surgical Infection Prevention Program in Low-Income Environments. JAMA Surg 2024; 159:161-169. [PMID: 38019510 PMCID: PMC10687710 DOI: 10.1001/jamasurg.2023.6033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 08/07/2023] [Indexed: 11/30/2023]
Abstract
Importance Surgical infections are a major cause of perioperative morbidity and mortality, particularly in low-resource settings. Clean Cut, a 6-month quality improvement program developed by the global nonprofit organization Lifebox, has demonstrated improvements in postoperative infectious complications. However, the pilot program required intense external programmatic and resource support. Objective To examine the improvement in adherence to infection prevention and control standards and rates of postoperative infections in hospitals in the Clean Cut program after implementation strategies were updated and program execution was refined. Design, Setting, and Participants This cohort study evaluated and refined the Clean Cut implementation strategy to enhance scalability based on a qualitative study of its pilot phase, including formalizing programmatic and educational materials, building an automated data entry and analysis platform, and reorganizing hospital-based team composition. Clean Cut was introduced from January 1, 2019, to February 28, 2022, in 7 Ethiopian hospitals that had not previously participated in the program. Prospective data initiated on arrival in the operating room were collected, and patients were followed up through hospital discharge and with 30-day follow-up telephone calls. Exposure Implementation of the refined Clean Cut program. Main Outcomes and Measures The primary outcome was surgical site infection (SSI); secondary outcomes were adherence to 6 infection prevention standards, mortality, hospital length of stay, and other infectious complications. Results A total of 3364 patients (mean [SD] age, 26.5 [38.0] years; 2196 [65.3%] female) from 7 Ethiopian hospitals were studied (1575 at baseline and 1789 after intervention). After controlling for confounders, the relative risk of SSIs was reduced by 34.0% after program implementation (relative risk, 0.66; 95% CI, 0.54-0.81; P < .001). Appropriate Surgical Safety Checklist use increased from 16.3% to 43.0% (P < .001), surgeon hand and patient skin antisepsis improved from 46.0% to 66.0% (P < .001), and timely antibiotic administration improved from 17.8% to 39.0% (P < .001). Surgical instrument (38.7% vs 10.2%), linen sterility (35.5% vs 12.8%), and gauze counting (89.2% vs 82.5%; P < .001 for all comparisons) also improved significantly. Conclusions and Relevance A modified implementation strategy for the Clean Cut program focusing on reduced external resource and programmatic input from Lifebox, structured education and training materials, and wider hospital engagement resulted in outcomes that matched our pilot study, with improved adherence to recognized infection prevention standards resulting in a reduction in SSIs. The demonstration of scalability reinforces the value of this SSI prevention program.
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Affiliation(s)
- Nichole Starr
- Department of Surgery, University of California, San Francisco
- Lifebox Foundation, New York, New York
| | - Natnael Gebeyehu
- Lifebox Foundation, New York, New York
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Maia R. Nofal
- Lifebox Foundation, New York, New York
- Department of Surgery, Boston Medical Center, Boston, Massachusetts
- Department of Surgery, Stanford University, Palo Alto, California
| | | | - Assefa Tesfaye
- Lifebox Foundation, New York, New York
- Department of Surgery, St Peter’s Specialized Hospital, Addis Ababa, Ethiopia
| | - Tihitena Negussie Mammo
- Lifebox Foundation, New York, New York
- Department of Surgery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Thomas G. Weiser
- Lifebox Foundation, New York, New York
- Department of Surgery, Stanford University, Palo Alto, California
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Gashaw M, Gudina EK, Ali S, Gabriele L, Seeholzer T, Alemu B, Froeschl G, Kroidl A, Wieser A. Molecular characterization of carbapenem-resistance in Gram-negative isolates obtained from clinical samples at Jimma Medical Center, Ethiopia. Front Microbiol 2024; 15:1336387. [PMID: 38328425 PMCID: PMC10848150 DOI: 10.3389/fmicb.2024.1336387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Background In resource-constrained settings, limited antibiotic options make treating carbapenem-resistant bacterial infections difficult for healthcare providers. This study aimed to assess carbapenemase expression in Gram-negative bacteria isolated from clinical samples in Jimma, Ethiopia. Methods A cross-sectional study was conducted to assess carbapenemase expression in Gram-negative bacteria isolated from patients attending Jimma Medical Center. Totally, 846 Gram-negative bacteria were isolated and identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Phenotypic antibiotic resistance patterns were determined using the Kirby-Bauer disk diffusion method and Etest strips. Extended-spectrum β-lactamase phenotype was determined using MAST disks, and carbapenemases were characterized using multiplex polymerase chain reactions (PCR). Results Among the isolates, 19% (157/846) showed phenotypic resistance to carbapenem antibiotics. PCR analysis revealed that at least one carbapenemase gene was detected in 69% (107/155) of these strains. The most frequently detected acquired genes were blaNDM in 35% (37/107), blaVIM in 24% (26/107), and blaKPC42 in 13% (14/107) of the isolates. Coexistence of two or more acquired genes was observed in 31% (33/107) of the isolates. The most common coexisting acquired genes were blaNDM + blaOXA-23, detected in 24% (8/33) of these isolates. No carbapenemase-encoding genes could be detected in 31% (48/155) of carbapenem-resistant isolates, with P. aeruginosa accounting for 85% (41/48) thereof. Conclusion This study revealed high and incremental rates of carbapenem-resistant bacteria in clinical samples with various carbapenemase-encoding genes. This imposes a severe challenge to effective patient care in the context of already limited treatment options against Gram-negative bacterial infections in resource-constrained settings.
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Affiliation(s)
- Mulatu Gashaw
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
- CIHLMU Center for International Health, Ludwig Maximilians Universität München, Munich, Germany
| | | | - Solomon Ali
- Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Liegl Gabriele
- Max von Pettenkofer-Institute (Medical Microbiology), Ludwig Maximilian University of Munich, Munich, Germany
| | - Thomas Seeholzer
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research, Munich, Germany
| | - Bikila Alemu
- School of Medical Laboratory Sciences, Jimma University, Jimma, Ethiopia
| | - Guenter Froeschl
- CIHLMU Center for International Health, Ludwig Maximilians Universität München, Munich, Germany
- Division of Infectious Disease and Tropical Medicine, University Hospital (LMU), Munich, Germany
| | - Arne Kroidl
- CIHLMU Center for International Health, Ludwig Maximilians Universität München, Munich, Germany
- Division of Infectious Disease and Tropical Medicine, University Hospital (LMU), Munich, Germany
- German Center for Infection Research (DZIF), Munich, Germany
| | - Andreas Wieser
- Max von Pettenkofer-Institute (Medical Microbiology), Ludwig Maximilian University of Munich, Munich, Germany
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Immunology, Infection and Pandemic Research, Munich, Germany
- Division of Infectious Disease and Tropical Medicine, University Hospital (LMU), Munich, Germany
- German Center for Infection Research (DZIF), Munich, Germany
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Gebeyehu EM, Debie A, Yazachew L, Fetene SM, Azanaw KA. Implementation fidelity of infection prevention practices at Debre Tabor comprehensive specialized hospital, Northwest Ethiopia. BMC Infect Dis 2023; 23:343. [PMID: 37217843 DOI: 10.1186/s12879-023-08263-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Healthcare-Acquired Infections are a major problem in the world and within the healthcare delivery system. An estimated 5-10% and around 25% of hospitalized patients have healthcare-acquired infections in developed and developing countries, respectively. Infection prevention and control programs have proven to be successful in lowering the incidence and spread of infections. Thus, this evaluation aims to evaluate the implementation fidelity of infection prevention practices at Debre Tabor comprehensive specialized hospital in Northwest Ethiopia. METHODS A facility-based cross-sectional design with a concurrent mixed method was used to evaluate the implementation fidelity of infection prevention practices. A total of 36 indicators were used to measure adherence, participant responsiveness, and facilitation strategy dimensions. A total of 423 clients were administered for an interview, an inventory checklist, a document review, 35 non-participatory observations, and 11 key informant interviews were conducted. A multivariable logistic regression analysis was used to identify factors significantly associated with the satisfaction of clients. The findings were presented using descriptions, tables, and graphs. RESULT The overall implementation fidelity of the infection prevention practices was 61.8%. The dimensions of adherence to infection prevention and control guidelines were 71.4%, participant responsiveness was 60.6%, and facilitation strategy was 48%. In multivariable analysis, ward admission and educational level had a p-value of below 0.05 and were significantly associated with the satisfaction of clients with infection prevention practices at the hospital. The major themes that emerged in qualitative data analysis were healthcare worker-related factors, management-related factors, and patient- and visitor-related factors. CONCLUSION The evaluation result of this study concluded that the overall implementation fidelity of infection prevention practice was judged to be medium and needed improvement. It included dimensions of adherence and participant responsiveness that were rated as medium, as well as a facilitation strategy that was rated as low. Enablers and barriers were thematized into factors related to healthcare providers, management, institutions, and patient and visitor relations.
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Affiliation(s)
| | - Ayal Debie
- Department of Health Systems and Policy, University of Gondar, Gondar, Ethiopia
| | - Lake Yazachew
- Department of Health Systems and Policy, University of Gondar, Gondar, Ethiopia
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Joshi MP, Alombah F, Konduri N, Ndiaye A, Kusu N, Kiggundu R, Lusaya EP, Tuala Tuala R, Embrey M, Hafner T, Traore O, Mbaye M, Akinola B, Namburete D, Acho A, Hema Y, Getahun W, Sayem MA, Nfor E. Moving from assessments to implementation: promising practices for strengthening multisectoral antimicrobial resistance containment capacity. ONE HEALTH OUTLOOK 2023; 5:7. [PMID: 37055845 PMCID: PMC10101730 DOI: 10.1186/s42522-023-00081-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/01/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Antimicrobial resistance (AMR) poses a global threat to human, animal, and environmental health. AMR is a technical area in the Global Health Security Agenda initiative which uses the Joint External Evaluation tool to evaluate national AMR containment capacity. This paper describes four promising practices for strengthening national antimicrobial resistance containment capacity based on the experiences of the US Agency for International Development's Medicines, Technologies, and Pharmaceutical Services Program work with 13 countries to implement their national action plans on AMR in the areas of multisectoral coordination, infection prevention and control, and antimicrobial stewardship. METHODS We use the World Health Organization (WHO) Benchmarks on International Health Regulations Capacities (2019) to guide national, subnational, and facility actions that advance Joint External Evaluation capacity levels from 1 (no capacity) to 5 (sustainable capacity). Our technical approach is based on scoping visits, baseline Joint External Evaluation scores, benchmarks tool guidance, and country resources and priorities. RESULTS We gleaned four promising practices to achieve AMR containment objectives: (1) implement appropriate actions using the WHO benchmarks tool, which prioritizes actions, making it easier for countries to incrementally increase their Joint External Evaluation capacity from level 1 to 5; (2) integrate AMR into national and global agendas. Ongoing agendas and programs at international, regional, and national levels provide opportunities to mainstream and interlink AMR containment efforts; (3) improve governance through multisectoral coordination on AMR. Strengthening multisectoral bodies' and their technical working groups' governance improved functioning, which led to better engagement with animal/agricultural sectors and a more coordinated COVID-19 pandemic response; and (4) mobilize and diversify funding for AMR containment. Long-term funding from diversified funding streams is vital for advancing and sustaining countries' Joint External Evaluation capacities. CONCLUSIONS The Global Health Security Agenda work has provided practical support to countries to frame and conduct AMR containment actions in terms of pandemic preparedness and health security. The WHO benchmarks tool that Global Health Security Agenda uses serves as a standardized organizing framework to prioritize capacity-appropriate AMR containment actions and transfer skills to help operationalize national action plans on AMR.
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Affiliation(s)
- Mohan P. Joshi
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA USA
| | - Fozo Alombah
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA USA
| | - Niranjan Konduri
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA USA
| | - Antoine Ndiaye
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Abidjan, Côte d’Ivoire
| | - Ndinda Kusu
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Nairobi, Kenya
| | - Reuben Kiggundu
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kampala, Uganda
| | - Edgar Peter Lusaya
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Dar Es Salaam, Tanzania
| | - Robert Tuala Tuala
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Kinshasa, Democratic Republic of the Congo
| | | | - Tamara Hafner
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA USA
| | - Ousmane Traore
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Bamako, Mali
| | - Mame Mbaye
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Dakar, Senegal
| | - Babatunde Akinola
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Abuja, Nigeria
| | - Denylson Namburete
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Maputo, Mozambique
| | - Alphonse Acho
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Yaoundé, Cameroon
| | - Yacouba Hema
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Ouagadougou, Burkina Faso
| | - Workineh Getahun
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Addis Ababa, Ethiopia
| | - Md Abu Sayem
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Dhaka, Bangladesh
| | - Emmanuel Nfor
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health, Arlington, VA USA
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An outbreak of Burkholderia cepacia bloodstream infections in a tertiary-care facility in northern India detected by a healthcare-associated infection surveillance network. Infect Control Hosp Epidemiol 2023; 44:467-473. [PMID: 35670040 DOI: 10.1017/ice.2022.111] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The burden of healthcare-associated infections (HAIs) is higher in low- and middle-income countries, but HAIs are often missed because surveillance is not conducted. Here, we describe the identification of and response to a cluster of Burkholderia cepacia complex (BCC) bloodstream infections (BSIs) associated with high mortality in a surgical ICU (SICU) that joined an HAI surveillance network. SETTING A 780-bed, tertiary-level, public teaching hospital in northern India. METHODS After detecting a cluster of BCC in the SICU, cases were identified by reviewing laboratory registers and automated identification and susceptibility testing outputs. Sociodemographic details, clinical records, and potential exposure histories were collected, and a self-appraisal of infection prevention and control (IPC) practices using assessment tools from the World Health Organization and the US Centers for Disease Control and Prevention was conducted. Training and feedback were provided to hospital staff. Environmental samples were collected from high-touch surfaces, intravenous medications, saline, and mouthwash. RESULTS Between October 2017 and October 2018, 183 BCC BSI cases were identified. Case records were available for 121 case patients. Of these 121 cases, 91 (75%) were male, the median age was 35 years, and 57 (47%) died. IPC scores were low in the areas of technical guidelines, human resources, and monitoring and evaluation. Of the 30 environmental samples, 4 grew BCC. A single source of the outbreak was not identified. CONCLUSIONS Implementing standardized HAI surveillance in a low-resource setting detected an ongoing Burkholderia cepacia outbreak. The outbreak investigation and use of a multimodal approach reduced incident cases and informed changes in IPC practices.
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Wang L, Zhang D, Liu J, Tang Y, Zhou Q, Lai X, Zheng F, Wang Q, Zhang X, Cheng J. The mediating role of incentives in association between leadership attention and self-perceived continuous improvement in infection prevention and control among medical staff: A cross-sectional survey. Front Public Health 2023; 11:984847. [PMID: 36844830 PMCID: PMC9947710 DOI: 10.3389/fpubh.2023.984847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/18/2023] [Indexed: 02/11/2023] Open
Abstract
Objectives Promoting improvement in Infection Prevention and Control (IPC) is an important part of improving the quality of care. The influence of leadership attention and incentives on the self-perceived continuous improvement in IPC has drawn a lot of attention, but relevant academic research is still lacking. The objective of this study is to explore the effect of leadership attention on self-perceived continuous improvement in IPC among medical staff and its underlying mechanisms. Method The 3,512 medical staff from 239 health facilities in Hubei, China, were surveyed online during September 2020. Data on leadership attention, incentives, and improvement in Infection Prevention and Control were collected using self-administered questionnaires. Correlation analysis was used to analyze the relationship between leadership attention, incentives, and improvement in Infection Prevention and Control. Amos 24.0 was used to analyze the mediating role. Results The scores of leadership attention, incentives and self-perceived continuous improvement in Infection Prevention and Control were all high. The score of leadership attention was the highest (4.67 ± 0.59), followed by self-perceived continuous improvement (4.62 ± 0.59) and incentives in Infection Prevention and Control (4.12 ± 0.83). Leadership attention positively affected self-perceived continuous improvement in Infection Prevention and Control (β = 0.85, 95% CI = [0.83, 0.87]). Moreover, incentives partially mediated the effect of leadership attention on self-perceived continuous improvement in Infection Prevention and Control among medical staff (β = 0.13, 95% CI = [0.12, 0.15]). Conclusion Leadership attention positively affects self-perceived continuous improvement in Infection Prevention and Control among medical staff, and incentives mediates this relationship. The present study has valuable implications for self-perceived continuous improvement in Infection Prevention and Control from the perspective of leadership attention and incentives.
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Affiliation(s)
- Lu Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dandan Zhang
- The First Affiliated Hospital, Nanjing Medical University, Human Resource Office, Nanjing, China
| | - Junjie Liu
- School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, China
| | - Yuqing Tang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qian Zhou
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoquan Lai
- Department of Nosocomial Infection, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feiyang Zheng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qianning Wang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Xinping Zhang ✉
| | - Jing Cheng
- Department of Emergency, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,Jing Cheng ✉
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Harun MGD, Anwar MMU, Sumon SA, Abdullah-Al-Kafi M, Datta K, Haque MI, Chowdhury ABMA, Sharmin S, Islam MS. Pre-COVID-19 knowledge, attitude and practice among nurses towards infection prevention and control in Bangladesh: A hospital-based cross-sectional survey. PLoS One 2022; 17:e0278413. [PMID: 36454785 PMCID: PMC9714721 DOI: 10.1371/journal.pone.0278413] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Hospital-acquired infections endanger millions of lives around the world, and nurses play a vital role in the prevention of these infections. Knowledge of infection prevention and control (IPC) best practices among nurses is a prerequisite to maintaining standard precautions for the safety of patients. AIM The study aims to assess knowledge, attitudes, and practices (KAP) towards IPC including associated factors among the nurses of a tertiary care hospital in Bangladesh. METHODS We conducted this hospital-based cross-sectional study from October 2017 to June 2018 at Dhaka Medical College Hospital among 300 nurses working in all departments. We calculated three KAP scores for each participant reflecting their current state of knowledge and compliance towards IPC measures. Descriptive, bivariate and multivariable analyses were conducted to determine KAP scores among nurses and their associated factors. RESULTS Average scores for knowledge, attitudes, and practices were 18.6, 5.4, and 15.5 (out of 26, 7, and 24), respectively. The study revealed that the majority (85.2%) of the nurses had a good to moderate level of knowledge, half (51%) of them showed positive attitudes, and only one fifth (17.1%) of the nurses displayed good practices in IPC. The respondents' age, education, monthly income and years of experience were found to have statistical associations with having moderate to adequate level of KAP scores. Aged and experienced nurses were found more likely to have poor knowledge and unfavorable attitude toward IPC practices. CONCLUSION The majority of nurses had good IPC knowledge, but their practices did not reflect that knowledge. In particular, nurses needed to improve the proper IPC practice for better patient care and to protect themselves. Regular IPC training and practice monitoring can enhance the IPC practice among nurses.
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Affiliation(s)
- Md. Golam Dostogir Harun
- Infection Disease Division, icddr,b, Dhaka, Bangladesh
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
- * E-mail:
| | | | - Shariful Amin Sumon
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
| | - Md Abdullah-Al-Kafi
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kusum Datta
- Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - Md. Imdadul Haque
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
| | | | - Sabrina Sharmin
- Department of Public Health, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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Shrestha SK, Trotter A, Shrestha PK. Epidemiology and Risk Factors of Healthcare-Associated Infections in Critically Ill Patients in a Tertiary Care Teaching Hospital in Nepal: A Prospective Cohort Study. INFECTIOUS DISEASES: RESEARCH AND TREATMENT 2022; 15:11786337211071120. [PMID: 35095279 PMCID: PMC8793418 DOI: 10.1177/11786337211071120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/07/2021] [Indexed: 11/15/2022]
Abstract
Background: Healthcare-associated infection (HAI) is an important public health problem, particularly in intensive care units (ICUs). We aimed to examine the epidemiology and risk factors of HAIs in our ICUs and study their microbiological profile. Methods: We evaluated 100 consecutive patients in 3 medical and surgical ICUs of a tertiary care teaching hospital daily starting in January 2016 using the Centers for Disease Control and Prevention definitions and methods. We determined the incidence and sites of HAIs, identified the causative microorganism, and studied their antibiotic sensitivity profiles. We investigated risk factors for the development of an HAI using a multiple logistic regression model. Results: Of 300 patients, 129 patients (43%) developed HAIs (55.96 HAI events per 1000 ICU-days). Pneumonia was the most common type of HAI (57, 41%). Escherichia coli was the most frequently isolated microorganism (20, 29%) and 74% of the pathogens isolated were multi-drug resistant. The presence of an invasive device (Odds Ratio, 4.29; 95% Confidence Interval, 2.52-7.51) and use of sedation (Odds Ratio, 2.24; 95% Confidence Interval, 1.31-3.87) were the statistically significant risk factors for HAIs. Conclusions: We found a high incidence of HAIs in our ICUs and a high burden of multidrug-resistant microorganisms highlighting the importance of infection control and antibiotic stewardship.
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Affiliation(s)
- Sailesh Kumar Shrestha
- Department of Internal Medicine, National Academy of Medical Sciences, Bir Hospital, Kathmandu, Nepal
| | - Andrew Trotter
- Department of Internal Medicine, Division of Infectious Diseases, University of Illinois at Chicago, Chicago, IL, USA
| | - Pradeep Krishna Shrestha
- Department of Internal Medicine, Tribhuvan University Teaching Hospital, Maharajgunj, Kathmandu, Nepal
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11
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Malinga NZZ, Shobo CO, Molechan C, Amoako DG, Zishiri OT, Bester LA. Molecular Surveillance and Dissemination of Klebsiella pneumoniae on Frequently Encountered Surfaces in South African Public Hospitals. Microb Drug Resist 2021; 28:306-316. [PMID: 34170205 DOI: 10.1089/mdr.2020.0546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Bacteria that cause life-threatening illnesses in humans are also capable of contaminating hospital surfaces, thus pose as a potential source of infection. This study aimed to investigate the prevalence, genetic diversity, virulence, and antibiotic resistance profile of Klebsiella pneumoniae in South Africa. In a nonoutbreak setting involving four public hospitals, 777 samples were collected in three different wards from 11 different sites. Phenotypic and genotypic methods were used for isolation and identification. The Kirby-Bauer disk-diffusion method was used to examine antibiotic resistance followed by the combination disk method to characterize extended-spectrum β-lactamases (ESBLs). Antibiotic resistance and virulence genes were screened using PCR and clonality was investigated using enterobacterial repetitive intergenic consensus (ERIC)-PCR. Seventy-five (10%) K. pneumoniae isolates were recovered. These isolates were obtained from all four hospitals and all three wards involved. However, only six frequently touched surfaces were contaminated. Thirty (40%) isolates were characterized as ESBLs showing high resistance to antibiotics and mostly harboring the blaCTX-M group one gene. Virulence genes were highly prevalent among all the isolates. ERIC-PCR showed that the isolates recovered from different sites within the same hospital were genetically similar. The study highlighted that K. pneumoniae can contaminate various surfaces and this persistence allows for the dissemination of bacteria within the hospital environment. The information from this study can assist hospitals to evaluate and improve current infection prevention and control interventions in place.
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Affiliation(s)
- Nongcebo Z Z Malinga
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Christiana O Shobo
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Chantal Molechan
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Daniel G Amoako
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Oliver T Zishiri
- Discipline of Genetics, School of Life Sciences, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
| | - Linda A Bester
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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12
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Patel LN, Kozikott S, Ilboudo R, Kamateeka M, Lamorde M, Subah M, Tsiouris F, Vorndran A, Lee CT. Safer primary healthcare facilities are needed to protect healthcare workers and maintain essential services: lessons learned from a multicountry COVID-19 emergency response initiative. BMJ Glob Health 2021; 6:e005833. [PMID: 34083244 PMCID: PMC8182752 DOI: 10.1136/bmjgh-2021-005833] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/22/2021] [Accepted: 05/03/2021] [Indexed: 12/23/2022] Open
Abstract
Healthcare workers (HCWs) are at increased risk of infection from SARS-CoV-2 and other disease pathogens, which take a disproportionate toll on HCWs, with substantial cost to health systems. Improved infection prevention and control (IPC) programmes can protect HCWs, especially in resource-limited settings where the health workforce is scarcest, and ensure patient safety and continuity of essential health services. In response to the COVID-19 pandemic, we collaborated with ministries of health and development partners to implement an emergency initiative for HCWs at the primary health facility level in 22 African countries. Between April 2020 and January 2021, the initiative trained 42 058 front-line HCWs from 8444 health facilities, supported longitudinal supervision and monitoring visits guided by a standardised monitoring tool, and provided resources including personal protective equipment (PPE). We documented significant short-term improvements in IPC performance, but gaps remain. Suspected HCW infections peaked at 41.5% among HCWs screened at monitored facilities in July 2020 during the first wave of the pandemic in Africa. Disease-specific emergency responses are not the optimal approach. Comprehensive, sustainable IPC programmes are needed. IPC needs to be incorporated into all HCW training programmes and combined with supportive supervision and mentorship. Strengthened data systems on IPC are needed to guide improvements at the health facility level and to inform policy development at the national level, along with investments in infrastructure and sustainable supplies of PPE. Multimodal strategies to improve IPC are critical to make health facilities safer and to protect HCWs and the communities they serve.
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Affiliation(s)
- Leena N Patel
- Prevent Epidemics, Resolve to Save Lives, an Initiative of Vital Strategies, New York, New York, USA
| | - Samantha Kozikott
- Prevent Epidemics, Resolve to Save Lives, an Initiative of Vital Strategies, New York, New York, USA
| | - Rodrigue Ilboudo
- The Alliance for International Medical Action (ALIMA), Yaoundé, Cameroon
| | - Moreen Kamateeka
- Nigeria Country Office, African Field Epidemiology Network (AFENET), Abuja, Nigeria
| | - Mohammed Lamorde
- Infectious Diseases Institute (IDI), McKinnell Knowledge Center, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Marion Subah
- Liberia Country Office, Last Mile Health, Monrovia, Liberia
| | - Fatima Tsiouris
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Anna Vorndran
- Infection Control Africa Network, Cape Town, South Africa
| | - Christopher T Lee
- Prevent Epidemics, Resolve to Save Lives, an Initiative of Vital Strategies, New York, New York, USA
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13
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Tompkins K, Juliano JJ, van Duin D. Antimicrobial Resistance in Enterobacterales and Its Contribution to Sepsis in Sub-saharan Africa. Front Med (Lausanne) 2021; 8:615649. [PMID: 33575265 PMCID: PMC7870712 DOI: 10.3389/fmed.2021.615649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/04/2021] [Indexed: 12/16/2022] Open
Abstract
Antibiotic resistant Enterobacterales (formerly Enterobactereaceae) are a growing threat to Sub-Saharan Africa. Genes causing antibiotic resistance are easily spread between the environment and humans and infections due to drug resistant organisms contribute to sepsis mortality via delayed time to appropriate antimicrobial therapy. Additionally, second or third-line antibiotics are often not available or are prohibitively expensive in resource-constrained settings leading to limited treatment options. Lack of access to water and sanitation facilities, unregulated use of antibiotics, and malnutrition are contributors to high rates of antibiotic resistance in the region. Improvements in the monitoring of drug resistant infections and antibiotic stewardship are needed to preserve the efficacy of antibiotics for the future.
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Affiliation(s)
- Kathleen Tompkins
- Division of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States
| | - Jonathan J Juliano
- Division of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States.,Curriculum in Genetics and Molecular Biology, School of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - David van Duin
- Division of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, United States
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Use of "Social Media"-an Option for Spreading Awareness in Infection Prevention. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2021; 13:14-31. [PMID: 33519303 PMCID: PMC7826144 DOI: 10.1007/s40506-020-00244-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2020] [Indexed: 11/24/2022]
Abstract
Purpose of review There is a need for enhanced adoption of infection prevention and control (IPC) practices in both healthcare settings and the entire community, more so during pandemics. The exponential increase in the use of social media (SM) has made it a powerful tool for creating awareness, education, training and community engagement on IPC. Here, we review how social media can be used effectively to implement strategies to combat public health issues especially vis-à-vis infection prevention and control. Recent findings According to the World Health Organization, 10% of patients get an infection whilst receiving care in healthcare institutions. Effective infection prevention and control measures can reduce healthcare-associated infections by at least 30%. Education and awareness play a vital role in implementation of infection prevention and control (IPC) strategies. Various studies show how social media has been used successfully in education and training activities, for awareness campaigns, community engagement, risk communications during outbreaks, disease surveillance and pharmacovigilance. Summary Infection prevention and control (IPC) is the need of the hour to mitigate transmission of disease in healthcare settings as well as in the community. SM is the fastest and most efficient way of communicating with the general population as well as health professionals. SM can help people take the right decisions and enable change in their behaviour patterns to introduce infection control practices.
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15
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Lubwama M, Kateete DP, Ayazika KT, Nalwanga W, Kagambo DB, Nsubuga MD, Arach AK, Ssetaba LJ, Wamala JN, Rwot LA, Kajumbula H. Microbiological Contamination of Mobile Phones and Mobile Phone Hygiene of Final-Year Medical Students in Uganda: A Need for Educational Intervention. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2021; 12:1247-1257. [PMID: 34737665 PMCID: PMC8560070 DOI: 10.2147/amep.s333223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 10/13/2021] [Indexed: 05/11/2023]
Abstract
INTRODUCTION Contaminated mobile phones act as reservoirs for organisms causing hospital-acquired infections (HAI). Little is known about medical school students' awareness of infection prevention and control (IPC) regarding mobile phone use among medical students. We demonstrated the presence of organisms on mobile phones of final-year medical students at Makerere University College of Health Sciences and evaluated their awareness of IPC regarding mobile phone hygiene and use in a hospital setting. METHODS In this cross-sectional study, organisms from swabs obtained from 79 medical students' mobile phones were identified and antimicrobial susceptibility test carried out using standard biochemical tests and the automated BD Phoenix instrument. Data were collected using a self-administered questionnaire to assess the students' awareness. The analysis was carried out using STATA software version 16. RESULTS Seventy (88.6%) mobile phones were contaminated with at least one organism. One hundred forty-eight bacteria were isolated, of which 123 (83.1%) were Gram-positive, 24 (16.2%) were Gram-negative, and 1 (0.7%) was yeast (Candida spp). Coagulase negative staphylococci were the most frequently isolated among Gram-positive bacteria. Acinetobacter baumannii were the most frequently isolated among Gram-negative bacteria. The average IPC practical score regarding mobile phone hygiene (34%) was significantly lower than the average IPC awareness score (77%) (p ≤ 0.0001). Seventy-four (93.7%) students use their phones while rotating in the various wards. Forty (50.6%) of the students cleaned their phones with alcohol-based sanitizer after rotations in the ward. Thirty-five (44.3%) students were aware of IPC programs in the hospital they rotated in. CONCLUSION There is a high prevalence of bacterial contamination from mobile phones of medical students. The students had lower IPC practical scores compared to IPC awareness scores regarding mobile phone hygiene irrespective of the ward of rotation. Curriculum of final-year medical students should include IPC-related topics, which incorporate practical skills.
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Affiliation(s)
- Margaret Lubwama
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
- Correspondence: Margaret Lubwama Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, P. O. Box 7072, Kampala, UgandaTel +256774440332 Email
| | - David P Kateete
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kirabo Tess Ayazika
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Winnie Nalwanga
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Douglas Bruno Kagambo
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mayanja David Nsubuga
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Arnold Kingston Arach
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Leoson Junior Ssetaba
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joyce N Wamala
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Leah Amaro Rwot
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Kajumbula
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
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16
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Advantages and Limitations of 16S rRNA Next-Generation Sequencing for Pathogen Identification in the Diagnostic Microbiology Laboratory: Perspectives from a Middle-Income Country. Diagnostics (Basel) 2020; 10:diagnostics10100816. [PMID: 33066371 PMCID: PMC7602188 DOI: 10.3390/diagnostics10100816] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/18/2020] [Accepted: 10/11/2020] [Indexed: 12/19/2022] Open
Abstract
Bacterial culture and biochemical testing (CBtest) have been the cornerstone of pathogen identification in the diagnostic microbiology laboratory. With the advent of Sanger sequencing and later, next-generation sequencing, 16S rRNA next-generation sequencing (16SNGS) has been proposed to be a plausible platform for this purpose. Nevertheless, usage of the 16SNGS platform has both advantages and limitations. In addition, transition from the traditional methods of CBtest to 16SNGS requires procurement of costly equipment, timely and sustainable maintenance of these platforms, specific facility infrastructure and technical expertise. All these factors pose a challenge for middle-income countries, more so for countries in the lower middle-income range. In this review, we describe the basis for CBtest and 16SNGS, and discuss the limitations, challenges, advantages and future potential of using 16SNGS for bacterial pathogen identification in diagnostic microbiology laboratories of middle-income countries.
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Gandra S, Alvarez-Uria G, Turner P, Joshi J, Limmathurotsakul D, van Doorn HR. Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries. Clin Microbiol Rev 2020; 33:e00048-19. [PMID: 32522747 PMCID: PMC7289787 DOI: 10.1128/cmr.00048-19] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Antimicrobial resistance (AMR) is a serious global health threat and is predicted to cause significant health and economic impacts, particularly in low- and middle-income countries (LMICs). AMR surveillance is critical in LMICs due to high burden of bacterial infections; however, conducting AMR surveillance in resource-limited settings is constrained by poorly functioning health systems, scarce financial resources, and lack of skilled personnel. In 2015, the United Nations World Health Assembly endorsed the World Health Organization's Global Action Plan to tackle AMR; thus, several countries are striving to improve their AMR surveillance capacity, including making significant investments and establishing and expanding surveillance networks. Initial data generated from AMR surveillance networks in LMICs suggest the high prevalence of resistance, but these data exhibit several shortcomings, such as a lack of representativeness, lack of standardized laboratory practices, and underutilization of microbiology services. Despite significant progress, AMR surveillance networks in LMICs face several challenges in expansion and sustainability due to limited financial resources and technical capacity. This review summarizes the existing health infrastructure affecting the establishment of AMR surveillance programs, the burden of bacterial infections demonstrating the need for AMR surveillance, and current progress and challenges in AMR surveillance efforts in eight South and Southeast Asian countries.
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Affiliation(s)
- Sumanth Gandra
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gerardo Alvarez-Uria
- Department of Infectious Diseases, Rural Development Trust Hospital, Bathalapalli, Anantapur, Andhra Pradesh, India
| | - Paul Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jyoti Joshi
- Center for Disease Dynamics, Economics and Policy, New Delhi, India
| | - Direk Limmathurotsakul
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - H Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Vietnam
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18
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Mehtar S, Wanyoro A, Ogunsola F, Ameh EA, Nthumba P, Kilpatrick C, Revathi G, Antoniadou A, Giamarelou H, Apisarnthanarak A, Ramatowski JW, Rosenthal VD, Storr J, Osman TS, Solomkin JS. Implementation of surgical site infection surveillance in low- and middle-income countries: A position statement for the International Society for Infectious Diseases. Int J Infect Dis 2020; 100:123-131. [PMID: 32712427 PMCID: PMC7378004 DOI: 10.1016/j.ijid.2020.07.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 07/19/2020] [Indexed: 12/26/2022] Open
Abstract
Surgical site infection (SSI) rates in low- and middle-income countries (LMICs) range from 8 to 30% of procedures, making them the most frequent healthcare-acquired infection (HAI) with substantial morbidity, mortality, and economic impacts. Presented here is an approach to surgical site infection prevention based on surveillance and focused on five critical areas identified by international experts. These five areas include 1. Collecting valid, high-quality data; 2. Linking HAIs to economic incapacity, underscoring the need to prioritize infection prevention activities; 3. Implementing SSI surveillance within infection prevention and control (IPC) programs to enact structural changes, develop procedural skills, and alter healthcare worker behaviors; 4. Prioritizing IPC training for healthcare workers in LMICs to conduct broad-based surveillance and to develop and implement locally applicable IPC programs; and 5. Developing a highly accurate and objective international system for defining SSIs, which can be translated globally in a straightforward manner. Finally, we present a clear, unambiguous framework for successful SSI guideline implementation that supports developing sustainable IPC programs in LMICs. This entails 1. Identifying index operations for targeted surveillance; 2. Identifying IPC “champions” and empowering healthcare workers; 3. Using multimodal improvement measures; 4. Positioning hand hygiene programs as the basis for IPC initiatives; 5. Use of telecommunication devices for surveillance and healthcare outcome follow-ups. Additionally, special considerations for pediatric SSIs, antimicrobial resistance development, and antibiotic stewardship programs are addressed.
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Affiliation(s)
- Shaheen Mehtar
- Infection Control Africa Network, Cape Town, South Africa
| | - Anthony Wanyoro
- Department of Obstetrics and Gynecology, Kenyatta University, Nairobi, Kenya
| | - Folasade Ogunsola
- Infection Control African Network, College of Medicine, University of Lagos, Nigeria
| | - Emmanuel A Ameh
- Division of Paediatric Surgery National Hospital, Abuja, Nigeria
| | - Peter Nthumba
- Clinical Epidemiologist and Plastic Surgeon, AIC Kijabe Hospital, and GCB, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland.
| | | | - Gunturu Revathi
- Microbiology Laboratory, Aga Khan University Hospital, Nairobi, Kenya
| | | | | | | | - John W Ramatowski
- International Federation for Infectious Diseases, Boston, United States
| | | | - Julie Storr
- Consultant with S2 Incorporated, Geneva, Switzerland
| | - Tamer Saied Osman
- Global Disease Detection, US Naval Medical Research Unit 3, Cairo, Egypt
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Abubakar U. Point-prevalence survey of hospital acquired infections in three acute care hospitals in Northern Nigeria. Antimicrob Resist Infect Control 2020; 9:63. [PMID: 32393348 PMCID: PMC7216694 DOI: 10.1186/s13756-020-00722-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 04/23/2020] [Indexed: 11/12/2022] Open
Abstract
Background Effective infection prevention and control strategies require reliable data describing the epidemiology of hospital acquired infections (HAIs), and this is currently lacking in Nigeria. The objective of this study was to evaluate the prevalence, types and risk factors associated with HAIs in acute care hospitals in Northern Nigeria. Methods A pilot point-prevalence survey was conducted in three acute care hospitals in Northern Nigeria between April and May 2019 using a protocol developed by the European Centre for Disease Prevention and Control. Patients admitted into the wards at or before 8.00 am on the survey date were included. Patients’ medical records were reviewed by a clinical pharmacist with the support of the attending physician and nurse to identify HAIs. Results Of the 321 patients surveyed, 50 HAIs were identified among 46 patients translating into a point-prevalence of 14.3%. The most common HAIs were bloodstream infection (38.0%), surgical site infections (32.0%) and pneumonia (12.0%). Neonatal (53.0%), pediatric surgical (26.7%) and surgical (10.1%) specialties had the highest prevalence. Device associated infections represented 16% of all HAIs including bloodstream infections and pneumonia. Of all the HAIs, 15 (30.0%) were present at the time of admission while 75.5% originated from the current hospitals. Univariate analysis showed that newborn (less than 1 month old) (OR: 4.687 95% CI: 1.298–16.927), intubation (OR: 3.966, 95% CI: 1.698–9.261), and neonatal (OR: 41.538 95% CI: 4.980–346.5) and pediatric surgical (OR: 13.091 95% CI: 1.532–111.874) specialties were significantly associated with HAI. Conclusion The prevalence of HAI was relatively high compared to other developing countries and was significantly associated with neonatal and pediatric surgical specialties. Hospital infection control strategies should be strengthened to reduce the burden of HAIs.
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Affiliation(s)
- Usman Abubakar
- Pharmacy Department, Ibrahim Badamasi Babangida (IBB) Specialist Hospital, Minna, Niger State, Nigeria.
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20
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Loftus M, Stewardson A, Naidu R, Coghlan B, Jenney A, Kepas J, Lavu E, Munamua A, Peel T, Sahai V, Tekoaua R, Tudravu L, Zinihite J, Cheng A, Rafai E, Peleg A. Antimicrobial resistance in the Pacific Island countries and territories. BMJ Glob Health 2020; 5:e002418. [PMID: 32349993 PMCID: PMC7213808 DOI: 10.1136/bmjgh-2020-002418] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 12/19/2022] Open
Abstract
Antimicrobial resistance (AMR) is a critical global health threat with a disproportionate impact on low-income and middle-income countries (LMICs) due to their higher burden of infections, reduced laboratory surveillance infrastructure and fewer regulations governing antimicrobial use among humans or animals. While there have been increasing descriptions of AMR within many LMICs in WHO's Western Pacific and South East Asian regions, there remains a paucity of data from Pacific Island countries and territories (PICTs). The PICTs represent 22 predominantly middle-income countries and territories with a combined population of 12 million people and 20 official languages, spread over hundreds of separate islands spanning an area corresponding to more than 15% of the earth's surface. Our paper outlines the present state of the evidence regarding AMR in PICTs-discussing the present estimates of AMR and their accompanying limitations, important drivers of AMR, as well as outlining key priorities and potential solutions for tackling AMR in this region. Significant areas for action include developing National Action Plans, strengthening laboratory surveillance systems and educational activities targeted at both healthcare workers and the wider community. Ensuring adequate funding for AMR activities in PICTs is challenging given competing health and environmental priorities, in this context global or regional funding initiatives such as the Fleming Fund can play a key role.
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Affiliation(s)
- Michael Loftus
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Andrew Stewardson
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Ravi Naidu
- Colonial War Memorial Hospital, Suva, Fiji
| | - Ben Coghlan
- Health Security Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Adam Jenney
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
- College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji
| | - Jonila Kepas
- Medical Standards Division, Government of Papua New Guinea National Department of Health, Port Moresby, National Capital District, Papua New Guinea
| | - Evelyn Lavu
- Central Public Health Laboratory, Government of Papua New Guinea National Department of Health, Port Moresby, National Capital District, Papua New Guinea
| | - Alex Munamua
- National Referral Hospital, Honiara, Solomon Islands
| | - Trisha Peel
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | | | - Rosemary Tekoaua
- Laboratory Services, Government of the Republic of Kiribati Ministry of Health and Medical Services, Tarawa, Kiribati
| | | | - Julie Zinihite
- National Pharmacy Division, Solomon Islands Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Allen Cheng
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eric Rafai
- Fiji Ministry of Health and Medical Services, Suva, Fiji
| | - Anton Peleg
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria, Australia
- Infection and Immunity Program, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, Victoria, Australia
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Avortri GS, Nabyonga-Orem J. The Global call for action on infection prevention and control. Int J Health Care Qual Assur 2020; 32:927-940. [PMID: 31282256 DOI: 10.1108/ijhcqa-03-2018-0063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Healthcare-associated infections (HAIs) constitute a major threat to patient safety and affect hundreds of millions of people worldwide. The World Health Organization in 2016 published guidelines on the core components for infection prevention and control (IPC) programme. This was in response to a global call for focused action. The purpose of this paper is to examine and promote understanding of the tenets of the IPC guidelines and highlight their implications for implementation in low-income countries. DESIGN/METHODOLOGY/APPROACH Drawing from personal experiences in leading the implementation of health programmes as well as a review of published and grey literature on IPC, authors discussed and proposed practical approaches to implement IPC priorities in low-income setting. FINDINGS Availability of locally generated evidence is paramount to guide strengthening leadership and institutionalisation of IPC programmes. Preventing infections is everybody's responsibility and should be viewed as such and accorded the required attention. ORIGINALITY/VALUE Drawing from recent experiences from disease outbreaks and given the heavy burden of HAIs especially in low-income settings, this paper highlights practical approaches to guide implementation of the major components of IPC.
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Affiliation(s)
- Gertrude Sika Avortri
- Department of Health Systems and Services, World Health Organization, Harare, Zimbabwe
| | - Juliet Nabyonga-Orem
- Department of Health Systems and Services, World Health Organization, Inter-Country Support Team for Eastern and Southern Africa, Harare, Zimbabwe
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Biswas A, Bhattacharya SD, Singh AK, Saha M. Addressing Hand Hygiene Compliance in a Low-Resource Neonatal Intensive Care Unit: a Quality Improvement Project. J Pediatric Infect Dis Soc 2019; 8:408-413. [PMID: 30189013 DOI: 10.1093/jpids/piy076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 08/01/2018] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Our goal for this study was to quantify healthcare provider compliance with hand hygiene protocols and develop a conceptual framework for increasing hand hygiene compliance in a low-resource neonatal intensive care unit. MATERIALS AND METHODS We developed a 3-phase intervention that involved departmental discussion, audit, and follow-up action. A 4-month unobtrusive audit during night and day shifts was performed. The audit results were presented, and a conceptual framework of barriers to and solutions for increasing hand hygiene compliance was developed collectively. RESULTS A total of 1308 hand hygiene opportunities were observed. Among 1227 planned patient contacts, hand-washing events (707 [58.6%]), hand rub events (442 [36%]), and missed hand hygiene (78 [6.4%]) events were observed. The missed hand hygiene rate was 20% during resuscitation. Missed hand hygiene opportunities occurred 3.2 times (95% confidence interval, 1.9-5.3 times) more often during resuscitation procedures than during planned contact and 6.14 times (95% confidence interval, 2.36-16.01 times) more often when providers moved between patients. Structural and process determinants of hand hygiene noncompliance were identified through a root-cause analysis in which all members of the neonatal intensive care unit team participated. The mean hand-washing duration was 40 seconds. In 83% of cases, drying hands after washing was neglected. Hand recontamination after hand-washing was seen in 77% of the cases. Washing up to elbow level was observed in 27% of hand-wash events. After departmental review of the study results, hand rubs were placed at each bassinet to address these missed opportunities. CONCLUSIONS Hand hygiene was suboptimal during resuscitation procedures and between patient contacts. We developed a conceptual framework for improving hand hygiene through a root-cause analysis.
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Affiliation(s)
- Arunava Biswas
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, India
| | | | | | - Mallika Saha
- Department of Neonatology, IPGMER & SSKM Hospital, Kolkata, India
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Bulabula AN, Holmes A, Lassmann B. International Society for Infectious Diseases — First series of position papers, with a focus on implementing infection prevention and control measures in low- and middle-income settings. Int J Infect Dis 2019; 87:30-31. [DOI: 10.1016/j.ijid.2019.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/08/2019] [Indexed: 11/16/2022] Open
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Opportunities to Overcome Implementation Challenges of Infection Prevention and Control in Low-Middle Income Countries. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2019. [DOI: 10.1007/s40506-019-00200-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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25
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Zocher U, Dan-Nwafor C, Yahya D, Ita OI, Kloth S, Eckmanns T, Laila Oberländer K, Saleh M, Ogunniyi A, Okwor TJ, Obasanya J, Ihekweazu C, Poggensee G. Participatory approach to quality development in infection prevention and control (IPC) in Nigerian health facilities. Infect Prev Pract 2019; 1:100012. [PMID: 34368677 PMCID: PMC8335908 DOI: 10.1016/j.infpip.2019.100012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/17/2019] [Indexed: 11/29/2022] Open
Abstract
The development of an educational concept of a training programme for infection prevention and control (IPC) was seen as a key issue to successfully address the complexity of change processes of professional IPC routines in clinical procedures. Therefore, the Nigeria Centre for Disease Control (NCDC), Nigeria, and the Robert Koch Institute (RKI), Germany established an interdisciplinary project framework, involving knowledge and competences from different disciplines and professions like health professionals, epidemiologists and educators (MAURICE project). A multi-module training programme for health care workers to improve IPC standards was developed and implemented based on the participatory approach and a systemic view for organizational change.
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Affiliation(s)
- Ute Zocher
- Freelanceconsultantfor Gesellschaft für Internationale Zusammenarbeit and Robert Koch Institute, Germany
| | | | - Disu Yahya
- Nigeria Centre for Disease Control, Abuja, Nigeria
| | | | | | | | | | - Mohammad Saleh
- Centres for Disease Control and Prevention, Country Office Nigeria, Abuja, Nigeria
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Desai AN, Ramatowski JW, Lassmann B, Holmes A, Mehtar S, Bearman G. Global infection prevention gaps, needs, and utilization of educational resources: A cross-sectional assessment by the International Society for Infectious Diseases. Int J Infect Dis 2019; 82:54-60. [PMID: 30794941 PMCID: PMC6500476 DOI: 10.1016/j.ijid.2019.02.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/12/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE The Guide to Infection Control in the Hospital (Guide) is an open access resource produced by the International Society for Infectious Diseases (ISID) to assist in the prevention of infection acquisition and transmission worldwide. A survey was distributed to 8055 current Guide users to understand their needs. METHODS The survey consisted of 48-questions regarding infection prevention and control (IPC) availability and needs. Dichotomous questions, Likert scale-type questions, and open-and closed-ended questions were used. RESULTS Respondents (n=1121) from 194 countries and six WHO regions participated in the survey. 43% (488) identified as physicians. Personal protective equipment (PPE) availability, training, and antimicrobial susceptibility testing varied between regions. Only 11% of respondents from low-income countries reported consistent access to respiratory equipment, 12% to isolation gowns, 4% to negative pressure rooms or personnel trained in IPC, and 20% to antimicrobial resistance testing. This differed significantly to high and upper middle-income resource settings (p<0.05). 80% of all respondents used smartphones or tablets at the workplace. CONCLUSIONS This survey demonstrates varied access to IPC equipment and training between high and low-income settings worldwide. Our results demonstrated many respondents across all regions utilize mobile technology, providing opportunities for rapid distribution of resource specific, up-to-date IPC content.
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Affiliation(s)
- Angel N Desai
- International Society for Infectious Diseases, Brookline, MA, United States; Brigham & Women's Hospital, Division of Infectious Diseases, Boston, MA, United States.
| | - John W Ramatowski
- International Society for Infectious Diseases, Brookline, MA, United States
| | - Britta Lassmann
- International Society for Infectious Diseases, Brookline, MA, United States
| | - Alison Holmes
- International Society for Infectious Diseases, Brookline, MA, United States; National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, United Kingdom
| | - Shaheen Mehtar
- International Society for Infectious Diseases, Brookline, MA, United States; Unit for Infection Prevention and Control, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gonzalo Bearman
- International Society for Infectious Diseases, Brookline, MA, United States; Virginia Commonwealth University, Division of Infectious Diseases, Richmond, VA, United States
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Alp E, Rello J. Implementation of infection control bundles in intensive care units: which parameters are applicable in low-to-middle income countries? J Hosp Infect 2019; 101:245-247. [DOI: 10.1016/j.jhin.2018.07.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 07/22/2018] [Indexed: 12/15/2022]
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Compliance of Nurses and Hospitals With Ventilator-Associated Pneumonia Prevention Guidelines: A Middle Eastern Survey. J Nurs Care Qual 2018; 33:E8-E14. [PMID: 28858912 DOI: 10.1097/ncq.0000000000000286] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study was a self-reported cross-sectional survey that investigated nurses' and hospitals' compliance with ventilator-associated pneumonia prevention guidelines and the barriers and factors that affect their level of compliance. A questionnaire was completed by 471 intensive care unit nurses from 16 medical centers in 3 Middle Eastern countries: Jordan, Egypt, and Saudi Arabia. The results show that both nurses and hospitals have insufficient compliance. Previous education, experience, and academic degree were all found to affect nurses' compliance.
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Prentiss T, Weisberg K, Zervos J. Building Capacity in Infection Prevention and Antimicrobial Stewardship in Low- and Middle-Income Countries: the Role of Partnerships Inter-countries. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2018. [DOI: 10.1007/s40506-018-0140-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Barr KL. Vertical transmission of positive-sense single-stranded RNA viruses in plants as a model for arboviral induced teratogenesis. Curr Opin Virol 2017; 27:42-47. [PMID: 29172070 DOI: 10.1016/j.coviro.2017.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 11/06/2017] [Accepted: 11/09/2017] [Indexed: 11/25/2022]
Abstract
Teratogenic viruses have increased public health importance with the emergence of Zika virus and a recent decline in rubella virus vaccination. Of the seven viruses known to cause birth defects in humans, three are mosquito-borne pathogens. Ethical oversight, compliance, rising costs, and the need for specialized training slow the pace of study of these human pathogens compared to study of similar teratogenic viruses in plants. Plant viruses have served as models for human viruses which can be applied to animal systems. This review describes the similar features of plant and animal teratogenic arboviruses and the common systems and barriers that are encountered during vertical transmission in the host.
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Affiliation(s)
- Kelli L Barr
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, United States.
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