Implementation of infection prevention and control in acute care hospitals in Mainland China - a systematic review

The Emergence of Linezolid-Resistant Staphylococcus Epidermidis in the COVID-19 Hospitalized Intubated Patients in North Khorasan, Iran

The present study aimed to investigate secondary bacterial infections among patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Coagulase-negative Staphylococci can infect immunocompromised patients. Linezolid resistance among Staphylococcus epidermidis is one of the most critical issues. In 2019, 185 SARS-CoV-2-positive patients who were admitted to North Khorasan Province Hospital (Bojnurd, Iran), were investigated. Patients having positive SARS-CoV-2 reverse transcriptase real-time polymerase chain reaction (RT-PCR) test results, who had a history of intubation, mechanical ventilation, and were hospitalized for more than 48 hours were included. After microbiological evaluation of pulmonary samples, taken from intubated patients with clinical manifestation of pneumonia, co-infections were found in 11/185 patients (5.94%) with S. epidermidis, Staphylococcus aureus, and Acinetobacter baumani, respectively. Remarkably, seven out of nine S. epidermidis isolates were linezolid resistant. Selected isolates were characterized using antimicrobial resistance patterns and molecular methods, such as Staphylococcal cassette chromosome mec (SCCmec) typing, and gene detection for ica, methicillin resistance (mecA), vancomycin resistance (vanA), and chloramphenicol-florfenicol resistance (cfr) genes. All of the isolates were resistant to methicillin, and seven isolates were resistant to linezolid. Nine out of 11 isolated belonged to the SCCmec I, while two belonged to the SCCmec IV. It should be noted that all patients had the underlying disease, and six patients had already passed away. The increasing linezolid resistance in bacterial strains becomes a real threat to patients, and monitoring such infections, in conjunction with surveillance and infection prevention programs, is very critical for reducing the number of linezolid-resistant Staphylococcal strains. A preprint of this study was published at https://europepmc.org/article/ppr/ppr417742.

Measuring the effectiveness of an integrated intervention package to improve the level of infection prevention and control: a multi-centre study in Bangladesh

BACKGROUND

Infection prevention and control (IPC) is a critical component of delivering safe, effective and high-quality healthcare services, and eliminating avoidable healthcare-associated infections (HAIs) in health facilities, predominantly in population-dense settings such as Bangladesh.

AIM

Our study aimed to assess the effect of an integrated intervention package in improving the IPC level of the health facilities in Bangladesh.

METHODS

We conducted a pre-post intervention study in six district hospitals (DHs) and 13 Upazila Health Complexes (UHCs) in the six districts of Bangladesh. Baseline and endline assessments were conducted between March and December 2021 using the adapted World Health Organization Infection Prevention and Control Assessment Framework (WHO-IPCAF) tool. The IPCAF score, ranging from 0-800, was calculated by adding the scores of eight components, and the IPC promotion and practice level was categorized as Inadequate (0-200), Basic (201-400), Intermediate (401-600) and Advanced (601-800). The integrated intervention package including IPC committee formation, healthcare provider training, logistics provision, necessary guidelines distribution, triage/flu corners establishment, and infrastructure development was implemented in all facilities.

RESULTS

The average IPCAF score across all the facilities showed a significant increase from 16% (95% CI: 11.5-20.65%) to 54% (95% CI: 51.4-57.1%). Overall, the IPCAF score increased by 34 percentage points (P<0.001) in DHs and 40 percentage points (P<0.001) in UHCs. Following the intervention, 12 (three DHs, nine UHCs) of 19 facilities progressed from inadequate to intermediate, and another three DHs upgraded from basic to intermediate in terms of IPC level.

CONCLUSION

The integrated intervention package improved IPCAF score in all facilities.

Identification of essential contents and a standard framework for the development of an Infection Prevention and Control manual for healthcare facilities: A scoping review

BACKGROUND

Several international organizations have outlined the components of infection prevention and control (IPC) programs. To successfully implement an IPC program, hospital staff may adopt a manual that provides support for implementing the IPC measures, even requiring significant efforts. This study aims to identify essential aspects and develop a standardized structure for an IPC manual. The IPC manual framework can be customized and utilized by any health care facility, thereby facilitating adherence to international and national legislation.

METHODS

The study was conducted using the Joanna Briggs Institute methodology for scoping reviews. Reporting followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews standard. The search for evidence was performed on PubMed and Web of Science. Methodological quality was evaluated blindly by 2 reviewers using the Critical Appraisal Skills Program checklist.

RESULTS

Nineteen papers were included in the review. Data extraction considered the most recent guidelines and the categorization into the 8 Core Components established by the World Health Organization. Through the literature review, the essential elements and challenges of an IPC hospital manual were identified, and a framework was proposed.

CONCLUSIONS

By incorporating these essential elements into their IPC manual, health care facilities can establish a robust IPC framework. A potential future development stemming from this work could involve the creation of a standardized national IPC manual tailored for hospital settings.

Autonomous swab robot for naso- and oropharyngeal COVID-19 screening

The COVID-19 outbreak has triggered a global health and economic crisis, necessitating widespread testing to control viral spread amidst rising cases and fatalities. The recommended testing method, a combined naso- and oropharyngeal swab, poses risks and demands limited protective gear. In response to the COVID-19 pandemic, we developed and tested the first autonomous swab robot station for Naso- and Oropharyngeal Coronavirus Screening (SR-NOCS). A force-sensitive robot running under a Cartesian impedance controller is employed to drive the swab to the sampling area. This groundbreaking device underwent two clinical studies-one conducted during the initial pandemic lockdown in Europe (early 2021) and the other, more recently, in a public place after the pandemic had subsided earlier in the year 2023. In total, 52 patients suspected of COVID-19 infection were included in these clinical studies. The results revealed a complete positive correlation between autonomous and manual sampling. The test subjects exhibited a high acceptance rate, all expressing a willingness to undergo future tests with SR-NOCS. Based on our findings, such systems could enhance testing capabilities, potentially conducting up to 300 tests per robot per day with consistent precision. The tests can be carried out with minimal supervision, reducing infection risks and effectively safeguarding patients and healthcare workers.

Navigating a Pandemic: Leadership Dynamics and Challenges within Infection Prevention and Control Units in Israel

This study investigates the impact of the coronavirus disease 2019 (COVID-19) pandemic on leadership within infection prevention and control (IPC) units across public hospitals in Israel. Through qualitative interviews with ten IPC managers from nine hospitals, equivalent to 30% of the country's acute care facilities, the research uncovers significant changes in managerial approaches due to the health crisis. The results reveal four main themes: (1) Enhanced managerial autonomy and leadership skills, with a noted rise in self-efficacy against the pandemic's backdrop; (2) Shifted perceptions of IPC units by upper management, recognizing their strategic value while identifying the need for a more profound understanding of IPC operations; (3) The increased emphasis on adaptability and rapid decision-making for effective crisis management; (4) The dual effect on job satisfaction and well-being, where greater commitment coincides with risks of burnout. The study underscores the essential nature of effective IPC leadership during emergencies, highlighting the need for clear communication, prompt action, and empathetic leadership. The conclusions point to the necessity for continuous research into IPC leadership, promoting strategic advancements in management to bolster IPC units against future health threats.

Factors associated with compliance with Infection Prevention and Control measures during the COVID-19 pandemic among healthcare workers in Kampala City, Uganda

BACKGROUND

In the context of the COVID-19 pandemic that originated from China in December 2019 and spread around the world, Kampala City witnessed a high number of infections and deaths among healthcare workers (HCWs). This study assessed the level of compliance with Infection Prevention and Control (IPC) measures and its associated factors among HCWs during the COVID-19 pandemic, in Kampala City, Uganda.

METHODOLOGY

A cross-sectional study was conducted in Nakawa Division, Kampala City, among 240 HCWs and used multistage sampling in government and private not-for-profit (PNFP) healthcare facilities. The outcome variable was self-reported IPC compliance which was composed of the use of masks, gloves, and hand hygiene. These were assessed using a 4-scale tool: always as recommended, most of the time, occasionally, and rarely. Only HCWs who responded "always as recommended" were considered compliant while the rest were considered non-compliant. Data was analyzed in STATA 14.0 using Modified Poisson regression to obtain factors associated with IPC compliance at 95% confidence interval (CI).

RESULTS

Forty-six (19.2%) respondents were compliant with all the three IPC measures, and this was associated with the presence of a COVID-19 patients' ward in the healthcare facility (Adjusted Prevalence Ratio, APR: 2.51, 95%CI: 1.24-5.07). Factors associated with the use of masks were being of the Muslim religion (APR: 1.31, CI: 1.05-1.65), and working in a healthcare facility that has COVID-19 patients' ward (APR: 1.29, CI: 1.06-1.59). Factors associated with the use of gloves were the age of the HCW, those above 40 years old being less complaint (APR: 0.47, CI: 0.24-0.93), working in the diagnosis department (APR: 2.08, CI: 1.17-3.70), and working in a healthcare facility that has COVID-19 patients' ward (APR: 1.73, CI: 1.13-2.64). Factors associated with hand hygiene were working in a health center (HC) IV (PR: 1.7, CI: 1.26-2.30) or a HC II (PR: 1.68, CI: 1.28-2.21).

CONCLUSION

Considering the elevated risk of disease transmission in health settings, IPC compliance was low; indicating an increased risk of COVID-19 infection among health care workers in Kampala City.

Do Knowledge, Attitudes, and Barrier Perception Affect the Prevention and Control of Healthcare-Associated Infections? A Structural Equation Modelling Approach

Purpose

Healthcare-associated infections (HCAIs) have become a global public health problem, resulting in high mortality, serious morbidity, and heavy healthcare costs. Infection prevention and control (IPC) is a significant priority for healthcare workers (HCWs) to eliminate HCAIs. However, barriers exist in the IPC implementation in daily clinical work. This study aimed to explore the relationship between HCWs' knowledge, attitudes, barrier perception, as well as their effects on IPC practice.

Patients and Methods

A structured questionnaire survey was conducted among HCWs who were responsible for IPC in a large tertiary hospital in China. Cronbach's alpha, average variance extracted (AVE), composite reliability (CR), as well as confirmatory factor analyses (CFA) were performed for reliability and validity. Structural equation modelling (SEM) was applied to establish the relationship between knowledge, attitudes, barrier perception and IPC practice. A Multiple Indicators Multiple Causes (MIMIC) model was conducted to detect the effects of covariates on factor structure.

Results

In total, 232 valid questionnaires were eventually collected. The average score of knowledge, attitudes, barrier perception and IPC practice were 2.95±0.75, 4.06±0.70, 3.14±0.86, and 4.38±0.45, respectively. The instrument demonstrated good reliability and validity. The SEM results showed that knowledge was positively associated with attitudes (β=0.151, p=0.039), and attitudes had positive effects on IPC practice (β=0.204, p=0.001), whereas barrier perception was negatively associated with attitudes and IPC practice (β=-0.234, p<0.001; β=-0.288, p<0.001, respectively). Additionally, time proportion spent on IPC was significantly associated with attitudes and practice (β=0.180, p=0.015; β=0.287, p<0.001, respectively), and training on HCAIs was a predicator for barrier perception and practice (β=0.192, p=0.039; β=-0.169, p=0.038, respectively).

Conclusion

IPC practice was indirectly affected by knowledge through the mediation of attitudes, whereas barrier perception had a negative impact. Designing deficiency-based training programs, developing sustained IPC habits, and strengthening management support are recommended to optimize IPC practice.

Qualidade das práticas de profissionais dos programas de controle de infecção no Brasil: estudo transversal

RESUMO Objetivo Analisar a qualidade das práticas de profissionais dos programas de controle de infecção em relação aos componentes de estrutura, processo e resultado. Método Trata-se de um estudo de abordagem quantitativa, do tipo descritivo e transversal realizado em 114 serviços de controle de infecção hospitalar das cinco regiões oficiais do Brasil. Coletaram-se os dados por meio de um instrumento estruturado, cujas propriedades psicométricas foram validadas previamente. O tratamento dos dados foi realizado pela análise de componentes principais e o teste não paramétrico Kruskal-Wallis. Resultados O melhor índice de qualidade dos programas de controle de infecção foi atribuído à região Sul, aos hospitais que continham 300 leitos ou mais, aos que utilizavam o critério National Healthcare Safety Network para vigilância das infecções e aos locais que realizavam busca ativa prospectiva como método de vigilância. Conclusão e implicações para a prática O índice de qualidade dos programas de controle de infecção está relacionado à localização, ao tamanho do hospital e ao método adotado para vigilância de infecções. A criação de um índice de qualidade, até então inédito em estudos nacionais, chama atenção para o desempenho precário dos serviços de saúde.

The quality of professional practices in infection control programs in Brazil: a cross-sectional study

ABSTRACT Objective To analyze the quality of professional practices in infection control programs regarding structure, process, and outcome. Method This is a quantitative, descriptive, and cross-sectional study carried out in 114 hospital infection control services in the five official regions of Brazil. The data were collected using a structured instrument whose psychometric properties were previously validated. Data treatment was performed by principal component analysis and non-parametric Kruskal-Wallis test. Results The best quality index of infection control programs was attributed to the South region, to hospitals that had 300 beds or more, to those that used the National Healthcare Safety Network criterion for infection surveillance and to places that carried out an active prospective search as their surveillance method. Conclusion and implications for practice: The quality of infection control programs is related to hospital location, size, and infection surveillance method. The creation of a quality index, hitherto unheard of in Brazilian studies, draws attention to the precarious performance of health services.

The status of infection prevention and control structures in Eastern China based on the IPCAF tool of the World Health Organization

Background

The burden of healthcare-associated infections (HAIs) and the spread of antimicrobial resistance can be potentially preventable through comprehensive infection prevention and control (IPC) programs. However, information on the current state of IPC implementation is rare in China.

Methods

A cross-sectional study was conducted in Zhejiang province, China, from April to June 2021. The Zhejiang nosocomial infection control and quality improvement center (NICQI) cooperated with 11 municipal NICQI centers to introduce the purpose of this study and invite all licensed secondary and tertiary hospitals in Zhejiang province through WeChat group. The questionnaire had three sections, including information about participating hospitals, demographic information about IPs, and the Chinese version of the Infection Prevention and Control Assessment Framework that covered eight core components (CC).

Results

Of the 382 hospitals invited, 222 (58.1% response rate) accepted and completed the online questionnaire. The overall median score of the participating hospitals was 682 (630–723), which corresponded to an advanced level of IPC. There was a significant difference in scores between hospitals types (P < 0.001). Profound differences were revealed regarding the scores of the individual components, with CC2 (IPC guidelines) and CC6 (Monitoring/audit of IPC practices and feedback) having the highest (100) and lowest (65) median scores, respectively. Only 23 (10.4%) hospitals reported assessing facility safety culture.

Conclusions

IPC structures are at a relatively high level in acute care hospitals in Eastern China. The identified potential areas for improvement were similar to those identified in developed countries, particularly regarding multimodal strategies for implementation and safety culture construction. Meanwhile, the Chinese government should pay more attention to IPC resources and practices among secondary care hospitals.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13756-022-01087-x.

Factors associated with the diagnosis of COVID-19 among Brazilian health professionals COVID-19 and health professionals

Introduction

Health professionals are on the front lines against the Coronavirus 2019 (COVID-19) pandemic and are at high risk for acquiring the infection. Failures in precautionary measures, inadequacy/scarcity of Personal Protective Equipment (PPE), and lack of social and family distancing may be associated with increased exposure and contamination by the new coronavirus. This study investigated the prevalence of COVID-19 among Brazilian health professionals and associated factors according to demographic and occupational characteristics.

Methods

A cross-sectional, analytical study was conducted using an online survey with 12,086 health professionals from all regions of Brazil. Data were collected using an adaptation of the respondent-driven sampling method for the virtual environment. The outcome variable was the diagnosis of COVID-19. Bivariate and multiple logistic regression analyzes were used to identify an association between the diagnosis of COVID-19 and demographic and occupational variables. Variables were considered statistically significant based on p<0.05.

Results

Most participants were female, from the northeast region, and nursing professionals. A prevalence of 31.95% (95%CI: 31.0%, 32.9%) of COVID-19 was estimated. Following multiple regression analysis, the variables associated with the diagnosis of COVID-19 among health professionals were: male gender, married individuals, professionals who provide care to patients with COVID-19, who work in a field hospital, and those who work in institutions that did not offer enough quality PPE.

Conclusions

The study found a high prevalence of COVID-19 infection, with male professionals being those with greater chances. Inadequate supply or poor quality of PPE offered by health institutions compromises the health of professionals with an increase in positive diagnosis for COVID-19.

Effect of infection control training course on knowledge and practices of medical interns in a large academic hospital in Egypt: an intervention study

Health care-associated infections are reported among the top causes of hospital deaths worldwide. Their prevention is a first priority for patient safety in acute care hospitals. Education and training is recommended as a core component for effective infection prevention and control programs. This study aimed to assess the effect of an infection control training course on the knowledge and practices of medical interns in a large academic hospital in Egypt. The study included 268 medical interns who were getting their practical training at Tanta University Hospitals, Egypt during the study period. Knowledge and practices regarding infection control measures were assessed using a predesigned questionnaire sheet and an observational checklist before and after intervention by infection control training course based on Egyptian national guide for infection control. The data have been analyzed through the application of descriptive frequency, percentages, mean of scores, and the inferential analysis that includes paired t test and Monte Carlo test. The level of statistical significance was adopted at p≤0.05. There was a statistically significant (p < 0.0001) increase in total knowledge score (65.4±13.9 versus 80.2 ±13.2) and total practices score (65±11.3 versus 108±7.9) of infection control measures among studied participants before intervention compared with after intervention. A significant strong positive correlation was detected (r= 0.8, p= 0.0001) between total knowledge and practice scores after intervention by training course. There is a strong positive correlation between knowledge and practices so intervention by infection control training course using teaching multimedia and role play significantly improves the knowledge and practice levels of the studied medical interns.

Conhecimento e adesão às práticas de biossegurança por profissionais que atuam em audiologia

RESUMO Objetivo: identificar as práticas de biossegurança adotadas por audiologistas, bem como sua percepção a respeito dos riscos aos quais estão expostos. Métodos: participaram deste estudo 63 fonoaudiólogos audiologistas clínicos e ocupacionais atuantes no Estado do Rio Grande do Sul - RS. A pesquisa foi realizada de forma on-line, no período de abril a maio de 2022, por meio de um questionário eletrônico do Google Forms® e utilizou-se para a coleta de dados o Questionário de Biossegurança em Audiologia proposto por Rocha et al. (2015). Resultados: a maioria dos profissionais relatou adotar as seguintes práticas: higienização das mãos antes dos atendimentos (86%), higienização das mãos entre os atendimentos (81%), realização de antissepsia com álcool (87,5%), jaleco com barreira de proteção (87%) e abotoado (79%), unhas limpas e cortadas (97%), desinfecção e separação dos artigos utilizados (94%) e organização do ambiente (97%). Entretanto 41% dos entrevistados referiram deixar o local de trabalho com equipamentos de proteção individual (EPI), apenas 22% e 14%, respectivamente, relataram utilizar luvas na realização de meatoscopia e nos exames auditivos. Conclusão: os resultados desta pesquisa indicaram que a maioria dos fonoaudiólogos entrevistados, atuantes na área de audiologia, conhecem e praticam as medidas de biossegurança indicadas nas normativas vigentes.

Audiologists’ knowledge of and adherence to biosafety measures

ABSTRACT Purpose: to identify biosafety measures taken by audiologists and their perception of the risks to which they are exposed. Methods: the sample comprised 63 speech-language-hearing therapists who work with clinical and occupational audiology in the state of Rio Grande do Sul, Brazil. The research was conducted online between April and May 2022 via Google Forms®, collecting data with the Audiology Biosafety Questionnaire proposed by Rocha et al. (2015). Results: most professionals reported taking the following measures: washing hands before patient visits (86%), washing hands in-between patient visits (81%), using hand sanitizers (87.5%), wearing white coats that covered their clothes (87%) and keeping them buttoned up (79%), keeping nails clean and trimmed (97%), disinfecting and separating used equipment (94%), and organizing the environment (97%). However, 41% of interviewees left the workplace wearing personal protective equipment, and only 22% and 14%, respectively, wore gloves when performing otoscopy and auditory examinations. Conclusion: research results show that most of the interviewed speech-language-hearing therapists who work in audiology know and practice the biosafety measures indicated in the existing norms.

EVALUATION OF INFECTION PREVENTION AND CONTROL TRAINING WORKSHOPS USING KIRKPATRICK'S MODEL

OBJECTIVES

To evaluate infection prevention and control (IPC) training workshops using Kirkpatrick model level 1 and 2 regarding satisfaction of trainees and improvement of their knowledge and skills.

METHODS

A cross-sectional study was conducted on 353 healthcare workers from January 2020 to March 2020, at four hospitals in Islamabad, Pakistan. Training feedback questionnaires and pre and post tests were employed for data collection. The authors analyzed data using SPSS version 25.

RESULTS

The majority (52%) of participants rated the trainings as "Excellent", 44% rated "Good" while 2% graded "Average". Pre and post-tests mean scores demonstrated statistically significant improvement in knowledge and skills (p< 0.001).

CONCLUSION

The training workshops significantly improved healthcare workers' knowledge and skills regarding Infection Prevention and Control and earned high satisfaction scores from the trainees.

Beyond the control of the care home: A meta-ethnography of qualitative studies of Infection Prevention and Control in residential and nursing homes for older people

Objective

This study aimed to develop interpretive insights concerning Infection Prevention and Control (IPC) in care homes for older people.

Design

This study had a meta‐ethnography design.

Data Sources

Six bibliographic databases were searched from inception to May 2020 to identify the relevant literature.

Review Methods

A meta‐ethnography was performed.

Results

Searches yielded 652 records; 15 were included. Findings were categorized into groups: The difficulties of enacting IPC measures in the care home environment; workload as an impediment to IPC practice; the tension between IPC and quality of life for care home residents; and problems dealing with medical services located outside the facility including diagnostics, general practice and pharmacy. Infection was revealed as something seen to lie ‘outside’ the control of the care home, whether according to origins or control measures. This could help explain the reported variability in IPC practice. Facilitators to IPC uptake involved repetitive training and professional development, although such opportunities can be constrained by the ways in which services are organized and delivered.

Conclusions

Significant challenges were revealed in implementing IPC in care homes including staffing skills, education, workloads and work routines. These challenges cannot be properly addressed without resolving the tension between the objectives of maintaining resident quality of life while enacting IPC practice. Repetitive staff training and professional development with parallel organisational improvements have prospects to enhance IPC uptake in residential and nursing homes.

Patient or Public Contribution

A carer of an older person joined study team meetings and was involved in writing a lay summary of the study findings.

Infection prevention and control (IPC) implementation in low-resource settings: a qualitative analysis

BACKGROUND

The coronavirus disease-2019 (COVID-19) pandemic has again demonstrated the critical role of effective infection prevention and control (IPC) implementation to combat infectious disease threats. Standards such as the World Health Organization (WHO) IPC minimum requirements offer a basis, but robust evidence on effective IPC implementation strategies in low-resource settings remains limited. We aimed to qualitatively assess IPC implementation themes in these settings.

METHODS

Semi-structured interviews were conducted with IPC experts from low-resource settings, guided by a standardised questionnaire. Applying a qualitative inductive thematic analysis, IPC implementation examples from interview transcripts were coded, collated into sub-themes, grouped again into broad themes, and finally reviewed to ensure validity. Sub-themes appearing ≥ 3 times in data were highlighted as frequent IPC implementation themes and all findings were summarised descriptively.

RESULTS

Interviews were conducted with IPC experts from 29 countries in six WHO regions. Frequent IPC implementation themes including the related critical actions to achieve the WHO IPC core components included: (1) To develop IPC programmes: continuous advocacy with leadership, initial external technical assistance, stepwise approach to build resources, use of catalysts, linkages with other programmes, role of national IPC associations and normative legal actions; (2) To develop guidelines: early planning for their operationalization, initial external technical assistance and local guideline adaption; (3) To establish training: attention to methods, fostering local leadership, and sustainable health system linkages such as developing an IPC career path; (4) To establish health care-associated (HAI) surveillance: feasible but high-impact pilots, multidisciplinary collaboration, mentorship, careful consideration of definitions and data quality, and "data for action"; (5) To implement multimodal strategies: clear communication to explain multimodal strategies, attention to certain elements, and feasible but high-impact pilots; (6) To develop monitoring, audit and feedback: feasible but high-impact pilots, attention to methods such as positive (not punitive) incentives and "data for action"; (7) To improve staffing and bed occupancy: participation of national actors to set standards and attention to methods such as use of data; and (8) To promote built environment: involvement of IPC professionals in facility construction, attention to multimodal strategy elements, and long-term advocacy.

CONCLUSIONS

These IPC implementation themes offer important qualitative evidence for IPC professionals to consider.

Risk assessment of coronavirus disease 2019 among healthcare workers in Neyshabur, 2020

Background:

Since the onset of coronavirus disease 2019 (COVID-19) in the world, healthcare workers have been exposed to this virus due to their important roles and responsibilities in the care and treatment of patients with COVID-19. In this regard, doing risk assessments in healthcare centres helps significantly to control and reduce COVID-19. Therefore, this study aimed to assess COVID-19 risk and its association with clinical symptoms among healthcare workers in Neyshabur.

Methods:

This cross-sectional study was conducted among 483 healthcare workers of Neyshabur medical centres in 2020. In order to collect the data, a checklist consisting of three sections of demographic variables, risk assessment and clinical symptoms was used. Statistical analyses were performed by using the STATA software version 14. The significance level was set at P<0.05.

Results:

The mean ± standard deviation age of the study population was 34.2 ± 8.4 years. Out of 483 participants, 55 (11.4%) were identified as high-risk exposure category, 52 (10.8%) as medium-risk category and 77 (15.9%) as low-risk category. According to multiple logistic regression models, it was observed that cough (odds ratio (OR)=2.2; P=0.001), running nose (OR=3.3; P<0.001), suffocation (OR=3.2; P<0.001), shivering (OR=3.4; P=0.001), nausea (OR=3.3; P=0.001), vomiting (OR=7.2; P=0.025), diarrhoea (OR=3.0; P=0.001), muscular pain (OR=2.1; P=0.005), joint pain (OR=2.2; P=0.005) and fatigue (OR=2.1; P=0.003) were significantly associated with risk assessment.

Conclusions:

The findings showed that more than one-fifth of studied healthcare workers were at high or medium-risk exposure of COVID-19. Cough and fatigue had the most frequencies in healthcare workers with high or medium-risk exposure, and also, vomiting and shivering had a stronger association with risk assessment status.

Factors associated with knowledge, attitude, and practice of COVID-19 among health care professional's working in South Wollo Zone Hospitals, Northeast Ethiopia

OBJECTIVES

This study is aimed to assess factors associated with knowledge, attitude, and practice of COVID-19 among health care professional's working in South Wollo Zone Hospitals, Northeast Ethiopia.

METHODS

Institution-based cross-sectional study was conducted among 422 health care professionals from 10 July to 10 August 2020, at the South Wollo Zone. A pre-tested self-administered structured questionnaire was used to collect the data. Both bi- and multi-variable logistic regressions were fitted to identify variables significantly associated with the outcome variables. Adjusted odds ratios with 95% confidence interval and p-value < 0.05 were used to determine significant factors.

RESULTS

About 92.4%, 64%, and 55% of the respondents had good knowledge, favorable attitude, and good practices toward corona virus disease, respectively. Being female (adjusted odds ratio = 0.23, confidence interval: 0.10, 0.56), age ⩾ 35 years (adjusted odds ratio = 0.14, confidence interval: 0.22, 0.84), being unmarried (adjusted odds ratio = 0.20, confidence interval: 0.70, 0.59), getting information from radio and television (adjusted odds ratio = 6.02, confidence interval: 2.09, 17.36), having average monthly income 93.55-163.67 USD (adjusted odds ratio = 8.00, confidence interval: 0.94, 33.10), and average monthly income > 163.70 USD (adjusted odds ratio = 11.41, confidence interval: 1.41, 15.23) were significantly associated with good knowledge about COVID-19. In addition, being unmarried (adjusted odds ratio = 0.70, confidence interval: 0.49, 0.97), having bachelor of science degree and above (adjusted odds ratio = 1.87, confidence interval: 2.24, 2.83), and getting information from seminars and workshops (adjusted odds ratio = 0.59, confidence interval: 0.35, 0.98) had association with good practice toward COVID-19 prevention and control method.

CONCLUSION

More than 90% of the health care workers have good knowledge; nearly half of the respondents had unfavorable attitudes and poor practice toward COVID-19. The findings imply that the government and other stakeholders should implement further strategies for enhancing to change health care professional's attitude and encourage to practice prevention and control methods.

Infection Prevention and Control at Lira University Hospital, Uganda: More Needs to Be Done

Globally, 5–15% of hospitalized patients acquire infections (often caused by antimicrobial-resistant microbes) due to inadequate infection prevention and control (IPC) measures. We used the World Health Organization’s (WHO) ‘Infection Prevention and Control Assessment Framework’ (IPCAF) tool to assess the IPC compliance at Lira University hospital (LUH), a teaching hospital in Uganda. We also characterized challenges in completing the tool. This was a hospital-based, cross-sectional study conducted in November 2020. The IPC focal person at LUH completed the WHO IPCAF tool. Responses were validated, scored, and interpreted per WHO guidelines. The overall IPC compliance score at LUH was 225/800 (28.5%), implying a basic IPC compliance level. There was no IPC committee, no IPC team, and no budgets. Training was rarely or never conducted. There was no surveillance system and no monitoring/audit of IPC activities. Bed capacity, water, electricity, and disposal of hospital waste were adequate. Disposables and personal protective equipment were not available in appropriate quantities. Major challenges in completing the IPCAF tool were related to the detailed questions requiring repeated consultation with other hospital stakeholders and the long time it took to complete the tool. IPC compliance at LUH was not optimal. The gaps identified need to be addressed urgently.

A Survey of Self-perceived Physical Discomforts and Health Behaviors Related to Personal Protective Equipment of Indian Dental Professionals during COVID-19 Pandemic

Aim

In the current situation of COVID-19 pandemic, personal protective equipment has to be mandatorily worn by dental professionals all times in the dental clinical settings. The aim of this study was to assess the physical discomforts and related health issues faced by dental professionals while wearing personal protective equipment in dental clinical settings during the pandemic.

Methods

This was an online cross-sectional survey conducted in November to December 2020 among dental professionals of various regions of country. A prevalidated questionnaire was sent through email/WhatsApp groups to 650 dental professionals. Informed consent was taken from all the participants. Information was collected about the demographics, type of dental set-up, average daily working hours, types of PPE worn, physical discomforts related to the various procedures in dentistry. Association was analyzed between demographics and the discomforts using Chi-square test.

Results

A total of 309 dental professionals (163 females, 146 males) from all parts of the country responded to the online questionnaire. Maximum respondents were postgraduates or pursuing MDS (79%), majority (42.1%) were pediatric dentists followed by general dentists. Sweating, difficulty in vision, difficulty in breathing, and headache were the common discomforts reported by majority of the respondents. Headache and difficult breathing were more significantly associated with female dental professionals (p < 0.05). N95 wear was associated with breathing difficulty (56%) while use of faceshield led to the discomforts in visual acuity in 46% respondents.

Conclusion

The survey has depicted several challenges and various physical discomforts being experienced by the dental professionals during this pandemic. Although wearing PPE is associated with difficulties to dentists but it is extremely essential to wear PPEs for self-protection during the ongoing pandemic.

How to cite this article

Bansal K, Saji S, Mathur VP, et al. A Survey of Self-perceived Physical Discomforts and Health Behaviors Related to Personal Protective Equipment of Indian Dental Professionals during COVID-19 Pandemic. Int J Clin Pediatr Dent 2021;14(6):784–789.

Infection Prevention and Control Preparedness Level and Associated Determinants in 56 Acute Healthcare Facilities in Ghana

Background

Infection prevention and control (IPC) is a globally relevant aspect of all health systems impacting the health and safety of both patients and healthcare workers. However, best practices remain a challenge in healthcare delivery especially in resource limited situations. The primary objective of this study was to assess the infection prevention and control (IPC) preparedness levels of acute healthcare facilities in Ghana and to determine the factors associated with the overall IPC preparedness levels in acute healthcare facilities.

Methods

A cross-sectional study adapting the IPC assessment framework (IPCAF) developed by the World Health Organization (WHO) was conducted. Five of the core components of the WHO IPCAF were used to assess the IPC level of 56 acute healthcare facilities in Ghana.

Results

Of the 56 facilities surveyed, only 19 had an IPC program with clearly defined objectives. Overall, 8 (14.3%) facilities scored an IPC preparedness level of “Advance”, 18 (32.1%) facilities received an “Intermediate” IPC preparedness score, 23 (41.1%) facilities received an IPC preparedness level of “basic” and 7 (12.5%) facilities scored an IPC preparedness level of “inadequate”. IPC materials like detergents, running water and PPEs were not significantly supplied. Government owned facilities performed better in terms of IPC preparedness as compared to privately owned facilities. A PLUM-ordinal regression analysis revealed that an IPC program with clearly defined objectives (OR= 76; 95% CI; 7.23, 808.19), dedicated IPC budget (OR= 13; 95% CI; 3.8–44.3) and regular mandatory training (OR= 50.9; 95% CI; 6.1–425) were associated with increased IPC preparedness.

Conclusion

Generally, the IPC preparedness levels in a majority of the facilities were low and required significant improvements in several areas. Facilities must make periodic reviews and adjust their objectives based on facility priorities.

Predictors of nursing interns' standard precautions compliance during internship training in four teaching hospitals in Saudi Arabia

AIM

The aim of this study was to assess compliance with standard precautions by Saudi nursing interns who were undergoing their internship training in four governmental tertiary teaching hospitals in Riyadh, Kingdom of Saudi Arabia, and to determine factors predictive of this.

BACKGROUND

Cross-transmission and infection prevention when delivering care must be strictly followed by nursing interns by complying with standard precautions during internship training.

DESIGN

The study employed a descriptive-correlational and cross-sectional design.

METHODS

A total of 224 nursing interns participated in the study by completing the Compliance with Standard Precautions Scale Arabic version between March 2017 and June 2017.

RESULTS/FINDINGS

A high overall compliance rate (84.8%) was observed. Nursing interns reported the highest compliance score in changing gloves between each patient contact and the lowest score in disposing of sharps boxes only when full. Nursing interns in hospital D showed the highest compliance rate over those in other hospitals. Age, sex, marital status, months in internship training and attendance of nursing interns in infection control seminars/trainings influenced their standard precautions compliance.

CONCLUSION

The study revealed good compliance by nursing interns with standard precautions. However, regular educational and clinical interventions are still needed to improve some areas and to ensure the continuity of high levels of compliance in other areas of standard precautions among nursing interns.

Investigation of adverse reactions in healthcare personnel working in Level 3 barrier protection PPE to treat COVID-19

PURPOSE OF THE STUDY

The aim of our study was to investigate potential adverse reactions in healthcare professionals working in Level 3 barrier protection personal protective equipment (L3PPE) to treat patients with COVID-19.

STUDY DESIGN

By using a convenience sampling approach, 129 out of 205 randomly selected healthcare professionals from the First Affiliated Hospital of Zhejiang University School of Medicine were invited to take part in a WeChat messaging app survey, Questionnaire Star, via a survey link. Healthcare personnel details were collected, including profession, years of professional experience and adverse reactions while wearing L3PPE. Survey results were divided by profession and years of professional experience; differences in adverse reactions were compared.

RESULTS

Among the 129 healthcare professionals surveyed, 21 (16.28%) were doctors and 108 (83.72%) were nurses. A total of 122 (94.57%) healthcare professionals experienced discomfort while wearing L3PPE to treat patients with COVID-19. The main reasons for adverse reactions and discomfort include varying degrees of adverse skin reactions, respiratory difficulties, heat stress, dizziness and nausea. Doctors had a lower incidence of rashes (χ²=4.519, p=0.034) and dizziness (χ²=4.123, p=0.042) when compared with nurses. Junior (8.5 years of experience or fewer) healthcare personnel also experienced a higher rate of heat stress when compared with senior personnel (more than 8.5 years greater) (χ²=5.228, p=0.022).

CONCLUSION

More attention should be offered to healthcare personnel wearing L3PPE to treat patients with COVID-19 because they are susceptible to developing adverse reactions.

Antimicrobial resistance in southern China: results of prospective surveillance in Dongguan city, 2017

BACKGROUND

Few studies have estimated the burden of infections due to antimicrobial-resistant (AMR) pathogens in China.

AIM

To summarize antimicrobial resistance and assess the frequency of community-associated infections (CAIs) and healthcare-associated infections (HCAIs) due to AMR pathogens in Dongguan city, China.

METHODS

Seven acute care hospitals provided antimicrobial susceptibility data for 2017, from which 'bug-drug' combinations were analysed. To calculate incidence proportions of CAI and incidence densities of HCAI, data from three tertiary care hospitals were merged with patient data, obtained from the Dongguan Nosocomial Infection Surveillance System.

FINDINGS

A total of 16,548 pathogens were analysed. Non-susceptibility to third-generation cephalosporins (3GCs) in Escherichia coli and Klebsiella pneumoniae was 43.9% and 30.2%, respectively. Non-susceptibility to carbapenems in Pseudomonas aeruginosa and Acinetobacter baumannii was 29.5% and 50.9%, respectively. A quarter of Staphylococcus aureus (26.3%) were non-susceptible to oxacillin. The incidence density of HCAI due to E. coli non-susceptible to 3GCs and fluoroquinolones combined was 0.09 (95% confidence interval: 0.07-0.11) per 1000 patient-days. Both E. coli and K. pneumoniae were the predominant pathogens isolated from blood. Compared with the 2017 European Antimicrobial Resistance Surveillance Network report, the incidence proportion of bloodstream infections due to multidrug-resistant E. coli was significantly higher (14.9% and 4.6%, respectively).

CONCLUSION

The incidence of non-susceptible bug-drug combinations in Dongguan city was lower compared with China as a whole. Non-susceptible bug-drug combinations were significantly more frequent in HCAI compared with CAI. The incidence proportion of bloodstream infections due to multidrug-resistant pathogens in Dongguan City was higher compared with Europe.