Awareness among French healthcare workers of the transmission of multidrug resistant organisms: a large cross-sectional survey

Knowledge, Attitude, and Practices of Mothers Working as Nurses Toward Multidrug-Resistant: Impact of an Educational Program in Neonatal Intensive Care Unit

Objective

This study seeks to assess the influence of an educational program on enhancing the knowledge, attitudes, and practices of NICU nurses regarding MDROs.

Methodology

Quasi-experimental design that investigated the efficacy of an educational intervention in shaping the knowledge, attitudes, and practices of mothers working as nurses in NICU toward MDROs was used. A total of 168 nurses participated, divided into 84 intervention groups and 84 non-educational groups.

Results

The analysis of overall knowledge scores before and after the educational interventions revealed a significant improvement in post-education knowledge scores (Mean = 16.94) compared to pre-education scores (Mean = 12.9929; t(83) = 40.119, p < 0.001). Attitude scores exhibited a notable improvement post-education, with mean scores increasing from 46.64 in the pretest to 58.45 in the posttest. The total attitude shift was statistically significant (t(83) = 104.23, p < 0.001 0). Regarding overall practice, the data suggests a positive impact of education on neonatal nurses' practices related to antibiotic usage (t(3) = 149.31, p < 0.001). A significant positive correlation was found between post-knowledge and post-attitude (r = 0.251, p = 0.021).

Conclusion

Based on the study findings, the MDROs educational program demonstrated its effectiveness in improving nurses' knowledge and attitudes toward MDROs, serving as a valuable educational resource for nurses. Given the increasing demand for nurses with MDROs knowledge, attitude, and practice in NICU, and considering the documented positive impact on protecting neonates from fatal infections, enhancing nurses' knowledge, attitudes, and practices toward MDROs has become imperative.

Targeted Infection Control Practices in Japanese Hospitals for Multidrug-Resistant Organisms: Guidance From the Public Health Center

Introduction The study conducted by the Kawaguchi City Public Health Center (PHC) in 2023 on hospital infection control (IC) programs revealed that hospitals can improve their IC programs if the PHC provides training sessions (TSs) that have numerical effects. In this study, we expected that we could help hospitals develop their IC practices by providing targeted guidance. This study aimed to clarify targeted guidance on IC practices and TS programs to develop hospitals'hospitals' IC programs on multidrug-resistant organisms (MDROs) by examining hospitals'hospitals' IC programs in reference to the study conducted in 2023 and other case reports. Methods In June 2022, the Kawaguchi City PHC conducted TSs for 19 hospitals and eight affiliated (AFs) clinics with beds, providing guidelines and practices on infection control (IC) for MDROs. After the TSs, we sent a questionnaire to these hospitals and affiliated clinics. The questionnaire inquired about current and planned IC policies, hand hygiene compliance programs (HHCPs), the usefulness of the TSs conducted by the PHC, and IC programs that the facilities intended to implement or develop in the future. This study examined the relationship between the perceived usefulness of the information provided and the IC programs planned for development, referencing a study conducted in 2023 and other case reports. Results Seventeen hospitals and six AFs with beds responded to the survey, yielding an 85.2% response rate. IC policies for methicillin-resistant Staphylococcus aureus (MRSA) were prepared by 21 hospitals (91.3%), whereas only five hospitals (21.7%) had prepared IC policies for carbapenem-resistant Enterobacteriaceae. Regarding HHCPs, an increase in the availability of alcohol-based hand sanitizer was identified by 17 hospitals (73.9%), while 13 hospitals (56.5%) reported using posters or symbols, 12 hospitals (52.2%) reported using TS and hand sanitizers, and nine hospitals (39.1%) assessed HH compliance and provided feedback. Furthermore, nine hospitals (39.1%) identified HHCPs and Environmental Cleaning (EC) for carbapenemase-producing Enterobacteriaceae (CPE) as useful information. There was a statistically significant association between TSs on HHCPs and the development of new HHCPs (p = 0.027). Additionally, information on EC for CPE was significantly associated with the development of staff cohorting strategies (p = 0.007). However, TS programs were not significantly connected to EC, nor were TSs to be developed. Conclusion The PHC should advise hospitals to assess if their HHCPs effectively contribute to improving HH compliance. It is essential for the PHC to furnish hospitals with resources and information that aid in the development of EC training. Additionally, the PHC should support the creation of specific and effective TS programs focused on EC or TS development. Conducting surveys to identify barriers to implementing staff cohorting strategies is also recommended. We propose that TS programs should include quantifiable data on HHCPs and EC, such as.

To screen or not to screen medical students for carriage of multidrug-resistant pathogens?

BACKGROUND

The carriage of multidrug-resistant (MDR) pathogens in medical students has not been studied extensively, despite the fact that they are in contact with patients and exposed to a hospital environment.

AIM

To investigate the intestinal and nasal carriage of MDR pathogens among medical students and its association with their lifestyle and demographic data.

METHODS

In 2021, first- and final-year medical students were invited to the study. Two rectal swabs were used for detection of extended-spectrum β-lactamase (ESBL)-producing, colistin-, tigecycline- or carbapenem-resistant Gram-negative bacteria and vancomycin-resistant enterococci. Nasal swab was used for Staphylococcus aureus culture. S. aureus isolates were characterized by spa typing; Gram-negative resistant isolates and meticillin-resistant S. aureus (MRSA) were subjected to whole-genome short and/or long sequencing.

FINDINGS

From 178 students, 80 (44.9%) showed nasal carriage of S. aureus; two isolates were MRSA. In rectal swabs, seven ESBL-producing strains were detected. Sixteen students were colonized by colistin-resistant bacteria, three isolates carried the mcr-1 gene (1.7%). The mcr-9 (10.7%, 19/178) and mcr-10 (2.2%, 4/178) genes were detected by quantitative polymerase chain reaction, but only two colistin-susceptible mcr-10-positive isolates were cultured. The S. aureus nasal carriage was negatively associated with antibiotic and probiotic consumption. S. aureus and colistin-resistant bacteria were detected more frequently among students in contact with livestock.

CONCLUSION

Medical students can be colonized by (multi)drug-resistant bacteria with no difference between first- and final-year students. The participation of students in self-screening increases their awareness of possible colonization by resistant strains and their potential transmission due to poor hand hygiene.

Knowledge, Attitudes, and Practices of NICU Doctors and Nurses Toward Prevention and Control of Nosocomial Infection With Multidrug Resistant Organism

BACKGROUND

Nosocomial infection with multidrug resistant organisms (MDRO) can directly influence the curative effect and the prognosis of neonates, bringing great difficulties to clinical treatment. As direct contacts of neonates, the knowledge, attitudes, and practices (KAP) of doctors and nurses are critical for the prevention and control of MDRO infection in neonatal intensive care units (NICUs).

PURPOSE

This study describes the KAP of doctors and nurses in NICUs toward the prevention and control of nosocomial infection with MDRO and analyzes its influencing factors.

METHODS

This cross-sectional study used convenience sampling to survey 397 doctors and nurses from the NICU of 28 hospitals in 11 cities in Zhejiang Province, China. A univariate analysis and a multiple linear regression were used to analyze the data.

RESULTS

The median scoring rate (interquartile range) of the knowledge, attitude, and practice questionnaire was 0.86 (0.82-0.91), 0.98 (0.91-1.00), and 0.995 (0.97-1.00), respectively. However, the median scoring rate regarding "basic knowledge of MDRO" and "special prevention and control measures" was 0.50 in knowledge. The multiple linear regression showed that the influencing factors of KAP were hospital grade, professional title, gender, regular supervision, and training.

CONCLUSIONS

There was still room for improvement in the KAP of NICU doctors and nurses, especially regarding the knowledge. Men, doctors and nurses in Grade II hospitals, and doctors and nurses with primary professional titles had worse KAP. Training and supervision helped improve the KAP.

RELEVANCE TO CLINICAL PRACTICE

To improve the KAP of doctors and nurses to enhance the prevention and control effect for the MDRO infection in NICUs, hospitals and departments should carry out targeted training and strengthen supervision, while Grade II hospitals, men, and doctors and nurses with primary professional titles need more attention.

Microbiological Contamination of the Office Environment in Dental and Medical Practice

The microbiological contamination of the environment in independent healthcare facilities such as dental and general practitioner offices was poorly studied. The aims of this study were to describe qualitatively and quantitatively the bacterial and fungal contamination in these healthcare facilities and to analyze the antibiotic resistance of bacterial pathogens identified. Microbiological samples were taken from the surfaces of waiting, consulting, and sterilization rooms and from the air of waiting room of ten dental and general practitioner offices. Six surface samples were collected in each sampled room using agar contact plates and swabs. Indoor air samples were collected in waiting rooms using a single-stage impactor. Bacteria and fungi were cultured, then counted and identified. Antibiograms were performed to test the antibiotic susceptibility of bacterial pathogens. On the surfaces, median concentrations of bacteria and fungi were 126 (range: 0–1280) and 26 (range: 0–188) CFU/100 cm², respectively. In indoor air, those concentrations were 403 (range: 118–732) and 327 (range: 32–806) CFU/m³, respectively. The main micro-organisms identified were Gram-positive cocci and filamentous fungi, including six ubiquitous genera: Micrococcus, Staphylococcus, Cladosporium, Penicillium, Aspergillus, and Alternaria. Some antibiotic-resistant bacteria were identified in general practitioner offices (penicillin- and erythromycin-resistant Staphylococcus aureus), but none in dental offices. The dental and general practitioner offices present a poor microbiological contamination with rare pathogenic micro-organisms.

The knowledge, attitudes and practices of doctors, pharmacists and nurses on antimicrobials, antimicrobial resistance and antimicrobial stewardship in South Africa

BACKGROUND

Sustained injudicious and indiscriminate use of antimicrobials has exerted selection pressure for developing antimicrobial resistance (AMR), requiring behaviour change from healthcare professionals (HCPs) based on their knowledge, attitudes and practices (KAP) on antimicrobials, AMR and antimicrobial stewardship (AMS).

METHODS

A cross-sectional online questionnaire-based survey was conducted nationally amongst doctors, pharmacists and nurses from November 2017 to January 2018. The questionnaire comprised demographic information and KAP questions.

RESULTS

Respondents comprised of 1120 doctors, 744 pharmacists and 659 nurses. Antimicrobial resistance was considered a severe problem globally and nationally by majority of HCPs. Self-assessment of knowledge revealed gaps in understanding of antimicrobials, AMR and AMS. Confidence scores in prescribing by doctors, pharmacists and nurses were 57.82%, 32.88% and 45.28%, respectively. Doctors, 441 (45.2%) indicated no confidence in using combination therapy. Prescribing correctly showed a confidence level of 33.99% from 436 doctors, 41.88% from nine pharmacists and 35.23% from 107 nurses. Healthcare professionals (1600 [91.22%]) stated educational campaigns would combat AMR. Only 842 (40.13%) HCPs attended training on these topics and 1712 (81.60%) requesting more education and training.

CONCLUSION

This is the first comparative survey on KAP of practising doctors, pharmacists and nurses in South Africa. Doctors had the highest knowledge score followed by nurses and pharmacists. Practice scores did not corroborate knowledge and the higher attitude scores. Gaps in KAP were evident. Healthcare professionals indicated the need for more education and training, thus requiring a review of pre-service and in-service education and training in addition to continued professional development programmes for practising HCPs.

Multidrug-resistant bacteria in ICU: fact or myth

PURPOSE OF REVIEW

Antimicrobial resistance (AMR) is increasing in ICUs around the world, but the prevalence is variable. We will review recent literature and try to answer the question whether this is a myth or a new reality, as well as discuss challenges and potential solutions.

RECENT FINDINGS

AMR is diverse, and currently Gram-negative multidrug-resistant organisms (MDROs) are the main challenge in ICUs worldwide. Geographical variation in prevalence of MDROs is substantial, and local epidemiology should be considered to assess the current threat of AMR. ICU patients are at a high risk of infection with MDRO because often multiple risk factors are present. Solutions should focus on reducing the risk of cross-transmission in the ICU through strict infection prevention and control practices and reducing exposure to antimicrobials as the major contributor to the development of AMR.

SUMMARY

AMR is a reality in most ICUs around the world, but the extent of the problem is clearly highly variable. Infection prevention and control as well as appropriate antimicrobial use are the cornerstones to turn the tide.