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Yu XL, Zhou LY, Huang X, Li XY, Pan QQ, Wang MK, Yang JS. Urgent call for attention to diabetes-associated hospital infections. World J Diabetes 2024; 15:1683-1691. [PMID: 39192868 PMCID: PMC11346093 DOI: 10.4239/wjd.v15.i8.1683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/14/2024] [Accepted: 06/07/2024] [Indexed: 07/25/2024] Open
Abstract
In this editorial, we discuss the recent article by Zhao et al published in the World Journal of Diabetes, which highlights the importance of recognizing the risk indicators associated with diabetes mellitus (DM). Given the severe implications of healthcare-associated infections (HAIs) in hospitalized individuals- such as heightened mortality rates, prolonged hospitalizations, and increased costs- we focus on elucidating the connection between DM and nosocomial infections. Diabetic patients are susceptible to pathogenic bacterial invasion and subsequent infection, with some already harboring co-infections upon admission. Notably, DM is an important risk factor for nosocomial urinary tract infections and surgical site infections, which may indirectly affect the occurrence of nosocomial bloodstream infections, especially in patients with DM with poor glycemic control. Although evidence regarding the impact of DM on healthcare-associated pneumonias remains inconclusive, attention to this potential association is warranted. Hospitalized patients with DM should prioritize meticulous blood glucose management, adherence to standard operating procedures, hand hygiene pra-ctices, environmental disinfection, and rational use of drugs during hospitalization. Further studies are imperative to explore the main risk factors of HAIs in patients with DM, enabling the development of preventative measures and mitigating the occurrence of HAIs in these patients.
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Affiliation(s)
- Xue-Lu Yu
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Li-Yun Zhou
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Xiao Huang
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Xin-Yue Li
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Qing-Qing Pan
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ming-Ke Wang
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ji-Shun Yang
- Medical Care Center, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
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Hutton G, Chase C, Kennedy-Walker R, Hamilton H. Financial and economic costs of healthcare-associated infections in Africa. J Hosp Infect 2024; 150:1-8. [PMID: 38723903 DOI: 10.1016/j.jhin.2024.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) remain a global health challenge, and have elevated rates in Sub-Saharan Africa. HAIs impact patients and their families by causing illness, prolonged hospital stay, potential disability, excess costs and, sometimes, death. The costs of HAIs are increasing due to spreading antimicrobial resistance. A major risk factor for HAIs is lack of water, sanitation and hygiene (WASH); environmental cleaning and healthcare waste management. In Sub-Saharan Africa, these services are lacking in at least 50% of healthcare facilities. AIM To estimate the costs associated with HAIs at national level in 14 countries in Sub-Saharan Africa. METHODS Economic methodologies were employed to estimate the medical costs, productivity losses and value of premature death from HAIs, drawing on national statistics and published studies to populate the economic model. RESULTS In 2022, the number of HAIs was estimated at 4.8 million, resulting in 500,000 deaths. Health-related economic losses amounted to US$13 billion per year, equivalent to 1.14% of combined gross domestic product and US$15.7 per capita. Healthcare costs were US$500 per HAI, and represented 5.6% of total health expenditure. The costs of providing basic WASH were US$0.91 per capita, which, if they reduced HAIs by 50%, would result in benefit-cost ratios of 1.6 (financial healthcare savings alone) and 8.6 (all economic benefits). CONCLUSION HAIs have a major health and economic burden on African societies, and a significant proportion can be prevented. It is critical that health policy makers and practitioners dedicate policy space, resources and training to address HAIs.
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Affiliation(s)
| | - C Chase
- Water Global Practice, World Bank, Washington, DC, USA
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Lyazidi S, Ouhadous M, Arai M, Zerouali K, Barrou H, Hassoune S. Prevalence of Healthcare-Associated Infections in a Tertiary Hospital in Casablanca, Morocco, 2021. Cureus 2024; 16:e67171. [PMID: 39295717 PMCID: PMC11409155 DOI: 10.7759/cureus.67171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2024] [Indexed: 09/21/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, healthcare professionals experienced an increased workload, which may have affected infection prevention and control (IPC) programs and consequently healthcare-associated infection (HAI) rates. The objective of this study was to estimate the prevalence of HAI in Ibn Rochd University Hospital Center (IRUHC) and identify associated factors. METHODS A survey was conducted on November 30, 2021 at IRUHC, including all patients hospitalized for at least 48 hours. Data was collected using a questionnaire, and analyzed using SPSS IBM software version 16. The significance level was set at 0.05. RESULTS Among 887 patients, the prevalence of HAI was 9.7% (7.7%; 11.6%). The highest prevalence was observed in intensive care units (ICUs) (44.2%). Nosocomial pneumonia was the most common site (26.8%). The main isolated microorganisms were Acinetobacter baumannii (18.0%) and Escherichia coli (16.0%). All Acinetobacter baumannii isolated strains were imipenem-resistant. The presence of HAI was significantly associated with the presence of an invasive medical device (p<0.001), a higher physical status score of American Society of Anesthesiologists (ASA) (p<0.001), and a longer hospital stay (p<0.001). Conclusion : The emergence of imipenem-resistant Acinetobacter baumannii (IRAB) represents a serious therapeutic and epidemiological problem requiring the establishment of a system for monitoring the microbial environment and the application of strict hygiene measures.
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Affiliation(s)
- Soukaina Lyazidi
- Laboratory of Epidemiology, Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, MAR
| | - Mohamed Ouhadous
- Hospital Hygiene Department, Ibn Rochd University Hospital, Casablanca, MAR
- Nosocomial Infections Control Committee, Ibn Rochd University Hospital, Casablanca, MAR
| | - Mounir Arai
- Hospital Hygiene Department, Ibn Rochd University Hospital, Casablanca, MAR
- Nosocomial Infections Control Committee, Ibn Rochd University Hospital, Casablanca, MAR
| | - Khalid Zerouali
- Microbiology Laboratory, Ibn Rochd University Hospital, Casablanca, MAR
- Nosocomial Infections Control Committee, Ibn Rochd University Hospital, Casablanca, MAR
| | - Houcine Barrou
- Surgical Intensive Care Unit, Ibn Rochd University Hospital, Casablanca, MAR
- Nosocomial Infections Control Committee, Ibn Rochd University Hospital, Casablanca, MAR
| | - Samira Hassoune
- Laboratory of Epidemiology, Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, MAR
- Laboratory of Cellular and Molecular Pathology/Epidemiology and Histology of Cancerous Diseases Research, Faculty of Medicine and Pharmacy, University Hassan II, Casablanca, MAR
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Boltena MT, Wolde M, Hailu B, El-Khatib Z, Steck V, Woldegerima S, Siraneh Y, Morankar S. Point prevalence of evidence-based antimicrobial use among hospitalized patients in sub-Saharan Africa: a systematic review and meta-analysis. Sci Rep 2024; 14:12652. [PMID: 38825623 PMCID: PMC11144712 DOI: 10.1038/s41598-024-62651-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 05/20/2024] [Indexed: 06/04/2024] Open
Abstract
Excessive and improper use of antibiotics causes antimicrobial resistance which is a major threat to global health security. Hospitals in sub-Saharan Africa (SSA) has the highest prevalence of antibiotic use. This systematic review and meta-analysis aimed to determine the pooled point prevalence (PPP) of evidence-based antimicrobial use among hospitalized patients in SSA. Literature was retrieved from CINAHL, EMBASE, Google Scholar, PubMed, Scopus, and Web of Science databases. Meta-analysis was conducted using STATA version 17. Forest plots using the random-effect model were used to present the findings. The heterogeneity and publication bias were assessed using the I2 statistics and Egger's test. The protocol was registered in PROSPERO with code CRD42023404075. The review was conducted according to PRISMA guidelines. A total of 26, 272 study participants reported by twenty-eight studies published from 10 countries in SSA were included. The pooled point prevalence of antimicrobial use in SSA were 64%. The pooled estimate of hospital wards with the highest antibiotic use were intensive care unit (89%). The pooled prevalence of the most common clinical indication for antibiotic use were community acquired infection (41%). The pooled point prevalence of antimicrobial use among hospitalized patients were higher in SSA. Higher use of antibiotics was recorded in intensive care units. Community acquired infection were most common clinical case among hospitalized patients. Health systems in SSA must design innovative digital health interventions to optimize clinicians adhere to evidence-based prescribing guidelines and improve antimicrobial stewardship.
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Affiliation(s)
- Minyahil Tadesse Boltena
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute's Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia.
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia.
| | - Mirkuzie Wolde
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute's Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
- University of Technology Sydney, Sydney, Australia
| | - Belachew Hailu
- Armauer Hansen Research Institute, Ministry of Health, Addis Ababa, Ethiopia
| | - Ziad El-Khatib
- Global Public Health Department, Karolinska Institute, Solna, Sweden
| | - Veronika Steck
- Department of Pharmacology and Therapeutics, Faculty of Life Sciences, McGill University, Montreal, Canada
| | - Selam Woldegerima
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yibeltal Siraneh
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute's Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Sudhakar Morankar
- Ethiopian Evidence Based Health Care Centre: A Joanna Briggs Institute's Center of Excellence, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia
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Abubakar U, Salman M. Antibiotic Use Among Hospitalized Patients in Africa: A Systematic Review of Point Prevalence Studies. J Racial Ethn Health Disparities 2024; 11:1308-1329. [PMID: 37157014 PMCID: PMC10166031 DOI: 10.1007/s40615-023-01610-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/15/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND There is paucity of data describing the rate and quality indices of antibiotics used among hospitalized patients at continental level in Africa. This systematic review evaluated the pooled prevalence, indications, and types of antibiotics used in hospitals across Africa. METHODS Three electronic databases, PubMed, Scopus, and African Journals Online (AJOL), were searched using search terms. Point prevalence studies of antibiotic use in inpatient settings published in English language from January 2010 to November 2022 were considered for selection. Additional articles were identified by checking the reference list of selected articles. RESULTS Of the 7254 articles identified from the databases, 28 eligible articles involving 28 studies were selected. Most of the studies were from Nigeria (n = 9), Ghana (n = 6), and Kenya (n = 4). Overall, the prevalence of antibiotic use among hospitalized patients ranged from 27.6 to 83.5% with higher prevalence in West Africa (51.4-83.5%) and North Africa (79.1%) compared to East Africa (27.6-73.7%) and South Africa (33.6-49.7%). The ICU (64.4-100%; n = 9 studies) and the pediatric medical ward (10.6-94.6%; n = 13 studies) had the highest prevalence of antibiotic use. Community-acquired infections (27.7-61.0%; n = 19 studies) and surgical antibiotic prophylaxis (SAP) (14.6-45.3%; n = 17 studies) were the most common indications for antibiotic use. The duration of SAP was more than 1 day in 66.7 to 100% of the cases. The most commonly prescribed antibiotics included ceftriaxone (7.4-51.7%; n = 14 studies), metronidazole (14.6-44.8%; n = 12 studies), gentamicin (n = 8 studies; range: 6.6-22.3%), and ampicillin (n = 6 studies; range: 6.0-29.2%). The access, watch, and reserved group of antibiotics accounted for 46.3-97.9%, 1.8-53.5%, and 0.0-5.0% of antibiotic prescriptions, respectively. The documentation of the reason for antibiotic prescription and date for stop/review ranged from 37.3 to 100% and 19.6 to 100%, respectively. CONCLUSION The point prevalence of antibiotic use among hospitalized patients in Africa is relatively high and varied between the regions in the continent. The prevalence was higher in the ICU and pediatric medical ward compared to the other wards. Antibiotics were most commonly prescribed for community-acquired infections and for SAP with ceftriaxone, metronidazole, and gentamicin being the most common antibiotics prescribed. Antibiotic stewardship is recommended to address excessive use of SAP and to reduce high rate of antibiotic prescribing in the ICU and pediatric ward.
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Affiliation(s)
- Usman Abubakar
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
| | - Muhammad Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
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Osman AH, Darkwah S, Kotey FCN, Odoom A, Hotor P, Dayie NTKD, Donkor ES. Reservoirs of Nosocomial Pathogens in Intensive Care Units: A Systematic Review. ENVIRONMENTAL HEALTH INSIGHTS 2024; 18:11786302241243239. [PMID: 38828046 PMCID: PMC11141231 DOI: 10.1177/11786302241243239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/14/2024] [Indexed: 06/05/2024]
Abstract
Background Nosocomial pathogens are known to exacerbate morbidity and mortality in contemporary critical healthcare. Hospital fomites, which include inanimate surfaces, have been identified as "breeding grounds" for pathogens that cause nosocomial infections. This systematic review aimed to deliver incisive insights on nosocomial pathogens in intensive care units (ICUs) and the role of fomites as potential reservoirs for their transmission. Method An extensive exploration of electronic databases, including PubMed and Scopus, from 1990 to 2023, was carried out between 25th and 29th May 2023, per standard PRISMA guidelines. Information were extracted from articles that reported on fomites in the ICU. Studies that did not quantitatively report the fomite contamination, and those that exclusively took samples from patients in the ICU were excluded from the analysis. Results About 40% of the total samples collected on fomites from all the studies yielded microbial growth, with species of Staphylococcus being the most predominant. Other prevalent microbes were Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Candida spp., Enterococcus sp., and Enterobacter sp. The neonatal intensive care unit (NICU) had the highest proportion of contaminated fomites. Among known fomites, the sphygmomanometer exhibited a 100% detection rate of nosocomial pathogens. This included E. aerogenes, Staphylococcus aureus, coagulase-negative Staphylococci (CoNS), E. coli, and K. pneumoniae. Multidrug-resistant (MDR) bacteria, such as methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococci (VRE), extended-spectrum beta-lactamase (ESBL)-producing E. coli, and MDR Pseudomonas aeruginosa were commonly isolated on fomites in the ICUs. Conclusion Many fomites that are readily used in patient care in the ICU harbour nosocomial pathogens. The most common fomite appeared to be mobile phones, sphygmomanometers, and stethoscopes, with Staphylococcus being the most common contaminant. Consequently, the need for rigorous disinfection and sterilization protocols on fomites in the ICU cannot be overemphasized. Additionally, heightened awareness on the subject among health professionals is crucial to mitigating the risk and burden of nosocomial infections caused by drug-resistant bacteria.
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Affiliation(s)
- Abdul-Halim Osman
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Samuel Darkwah
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Fleischer C N Kotey
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Alex Odoom
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Prince Hotor
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Nicholas T K D Dayie
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Eric S Donkor
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
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Mwishingo A, Endres K, Bisimwa L, Sanvura P, Banywesize BM, Bisimwa JC, Williams C, Perin J, Boroto R, Nsimire G, Rugusha F, Endeleya F, Kitumaini P, Lunyelunye C, Timsifu J, Munyerenkana B, Bengehya J, Maheshe G, Cikomola C, George CM. Effect of a Water, Sanitation, and Hygiene Program on Handwashing with a Cleansing Agent among Diarrhea Patients and Attendants in Healthcare Facilities in the Democratic Republic of the Congo: A Randomized Pilot of the PICHA7 Program. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:659. [PMID: 38928906 PMCID: PMC11204100 DOI: 10.3390/ijerph21060659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 06/28/2024]
Abstract
Healthcare-acquired infections are a major problem in healthcare facility settings around the world. The Democratic Republic of the Congo (DRC) has over 2 million diarrhea patients hospitalized each year. These healthcare settings become high-risk environments for spreading diarrheal illnesses such as cholera. The objective of the Preventative Intervention for Cholera for 7 Days (PICHA7) program is to develop evidence-based water, sanitation, and hygiene (WASH) interventions to reduce cholera and other severe diarrheal diseases in the DRC. The study objective was to evaluate the effectiveness of PICHA7 program delivery in increasing handwashing with a cleansing agent at stool/vomit- and food-related events in a healthcare facility setting among diarrhea patients and patient attendants. A pilot of the PICHA7 program was conducted among 284 participants in 27 healthcare facilities from March 2020 to November 2021 in urban Bukavu in the South Kivu Province of the DRC. The standard arm received the standard message provided in the DRC to diarrhea patients on the use of oral rehydration solution and a basic WASH message at healthcare facility discharge. The PICHA7 arm received the PICHA7 WASH pictorial module delivered by a health promoter focused on handwashing with a cleansing agent at the bedside of the diarrhea patient in the healthcare facility and provision of a soapy water bottle (water and detergent powder). Within 24 h of intervention delivery, a three-hour structured observation of handwashing practices at stool/vomit- and food-related events (key events) was conducted in healthcare facilities of diarrhea patients and their attendants. Compared to the standard arm, there was significantly more handwashing with a cleansing agent at key events in the PICHA7 arm (40% vs. 15%) (odds ratio: 5.04; (95% confidence interval (CI): 2.01, 12.7)). These findings demonstrate that delivery of the PICHA7 WASH pictorial module and provision of a soapy water bottle to diarrhea patients and their attendants presents a promising approach to increase handwashing with a cleansing agent among this high-risk population in healthcare facilities in the eastern DRC.
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Affiliation(s)
- Alain Mwishingo
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Kelly Endres
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA (C.W.); (J.P.)
| | - Lucien Bisimwa
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Presence Sanvura
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Blessing Muderhwa Banywesize
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Jean-Claude Bisimwa
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Camille Williams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA (C.W.); (J.P.)
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA (C.W.); (J.P.)
| | - Raissa Boroto
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Gisèle Nsimire
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Feza Rugusha
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Freddy Endeleya
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Pacifique Kitumaini
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Claude Lunyelunye
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Jessy Timsifu
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Brigitte Munyerenkana
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
| | - Justin Bengehya
- Bureau de l’Information Sanitaire, Surveillance Epidémiologique et Recherche Scientifique, Division Provinciale de la Santé Sud Kivu, Ministère de la Santé, Bukavu B.P 265, Democratic Republic of the Congo;
| | - Ghislain Maheshe
- Faculty of Medicine, Catholic University of Bukavu, Bukavu B.P 265, Democratic Republic of the Congo;
| | - Cirhuza Cikomola
- Center for Tropical Diseases & Global Health, Université Catholique de Bukavu, Bukavu B.P 265, Democratic Republic of the Congo; (A.M.); (B.M.B.); (R.B.); (G.N.); (P.K.); (C.L.); (J.T.); (B.M.); (C.C.)
- Faculty of Medicine, Catholic University of Bukavu, Bukavu B.P 265, Democratic Republic of the Congo;
| | - Christine Marie George
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA (C.W.); (J.P.)
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Lompo P, Heroes AS, Ouédraogo K, Okitale P, Wakpo A, Kalema J, Lunguya O, Tinto H, Affolabi D, Sangaré L, Jacobs J. Knowledge, awareness, and risk practices related to bacterial contamination of antiseptics, disinfectants, and hand hygiene products among healthcare workers in sub-saharan Africa: a cross-sectional survey in three tertiary care hospitals (Benin, Burkina Faso, and DR Congo). Antimicrob Resist Infect Control 2024; 13:44. [PMID: 38627805 PMCID: PMC11020199 DOI: 10.1186/s13756-024-01396-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 04/01/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Antiseptics, disinfectants, and hand hygiene products can be contaminated with bacteria and cause healthcare-associated infections, which are underreported from low- and middle-income countries. To better understand the user-related risk factors, we conducted a knowledge, awareness, and practice survey among hospital staff in sub-Saharan Africa. METHODS Self-administered questionnaire distributed among healthcare workers in three tertiary care hospitals (Burkina Faso, Benin, Democratic Republic of the Congo). RESULTS 617 healthcare workers (85.3% (para)medical and 14.7% auxiliary staff) participated. Less than half (45.5%) had been trained in Infection Prevention & Control (IPC), and only 15.7% were trained < 1 year ago. Near two-thirds (64.2%) preferred liquid soap for hand hygiene, versus 33.1% for alcohol-based hand rub (ABHR). Most (58.3%) expressed confidence in the locally available products. Knowledge of product categories, storage conditions and shelf-life was inadequate: eosin was considered as an antiseptic (47.5% of (para)medical staff), the shelf life and storage conditions (non-transparent container) of freshly prepared chlorine 0.5% were known by only 42.6% and 34.8% of participants, respectively. Approximately one-third of participants approved using tap water for preparation of chlorine 0.5% and liquid soap. Most participants (> 80%) disapproved recycling soft-drink bottles as liquid soap containers. Nearly two-thirds (65.0%) declared that bacteria may be resistant to and survive in ABHR, versus 51.0% and 37.4% for povidone iodine and chlorine 0.5%, respectively. Depicted risk practices (n = 4) were ignored by 30 to 40% of participants: they included touching the rim or content of stock containers with compresses or small containers, storing of cotton balls soaked in an antiseptic, and hand-touching the spout of pump dispenser. Filling containers by topping-up was considered good practice by 18.3% of participants. Half (52.1%) of participants acknowledged indefinite reuse of containers. Besides small differences, the findings were similar across the study sites and professional groups. Among IPC-trained staff, proportions recognizing all 4 risk practices were higher compared to non-trained staff (35.9% versus 23.8%, p < 0.0001). CONCLUSIONS The present findings can guide tailored training and IPC implementation at the healthcare facility and national levels, and sensitize stakeholders' and funders' interest.
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Affiliation(s)
- Palpouguini Lompo
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Ouagadougou, 11 BP 218, Burkina Faso.
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, 2000, Belgium.
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Naamsestraat 22, Box 5401, Leuven, 3000, Belgium.
| | - Anne-Sophie Heroes
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, 2000, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Naamsestraat 22, Box 5401, Leuven, 3000, Belgium
| | - Kadija Ouédraogo
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Ouagadougou, 11 BP 218, Burkina Faso
| | - Patient Okitale
- Département de Microbiologie, Cliniques Universitaires de Kinshasa, BP 127, Kinshasa, Congo
| | - Abel Wakpo
- Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou, 01 BP 386, Benin
| | - Jocelyne Kalema
- Département de Microbiologie, Cliniques Universitaires de Kinshasa, BP 127, Kinshasa, Congo
- Département de Microbiologie, National Institute of Biomedical Research, Av. De la Démocratie N°5345, Kinshasa, Congo
| | - Octavie Lunguya
- Département de Microbiologie, Cliniques Universitaires de Kinshasa, BP 127, Kinshasa, Congo
- Département de Microbiologie, National Institute of Biomedical Research, Av. De la Démocratie N°5345, Kinshasa, Congo
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Science de la Santé, Ouagadougou, 11 BP 218, Burkina Faso
| | - Dissou Affolabi
- Centre National Hospitalier Universitaire Hubert Koutoukou Maga, Cotonou, 01 BP 386, Benin
| | - Lassana Sangaré
- Centre Hospitalier Universitaire Yalgado Ouédraogo, Ouagadougou, 03 BP 7022, Burkina Faso
| | - Jan Jacobs
- Department of Clinical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, 2000, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Naamsestraat 22, Box 5401, Leuven, 3000, Belgium
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9
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Chuwa AH. Healthcare-Associated Infections in a Tertiary Care Hospital: Significance of Patient Referral Practices. East Afr Health Res J 2024; 8:111-115. [PMID: 39234348 PMCID: PMC11371007 DOI: 10.24248/eahrj.v8i1.756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 03/13/2024] [Indexed: 09/06/2024] Open
Abstract
Introduction Nosocomial infections, also known as healthcare-associated infections (HCAIs), are infections that a patient acquires while receiving healthcare services within 48 hours of admission to hospital. In high income countries, an average of 7% of hospitalised patients acquire a nosocomial infection. In low and middle income countries, however, prevalence rates can be as high as 30%. This is due to limited resources and supplies for infection control, inadequate training and lack of compliance with infection prevention and control regulations. Methods A cross-sectional, hospital based study was conducted among patients admitted to a tertiary care facility in Tanzania. A semi-structured questionnaire was used to collect information from 134 patients in different wards. Correlation and multivariate regression analyses were performed to determine the association between the independent variables, i.e. chronic illness, invasive procedures, use of antibiotics and referral status, and the dependent variable, i.e. new symptom, and their level of significance. The significance level was set at P≤ .05. Results A total of 134 patients participated in the study. Of the total number, 61% (n=82) of the patients were male and 43% (n=57) were referrals from other institutions. Fifteen percent (n=21) of the surveyed patients reported a new symptom. There was a positive correlation between referral status and invasive procedure with the occurrence of a new symptom. Multivariate analysis identified 'referral status' as an independent significant factor positively associated with healthcare-associated infetions (P=.041). Conclusions The results indicate a prevalence of 15.7% of healthcare-associated infections, which is unacceptably high for a tertiary care facility. Referral status was independently and significantly associated with HCAI. Improving patient referral patterns and hospital infection control can significantly reduce the risk of healthcare-associated infections.
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Affiliation(s)
- Agapiti H. Chuwa
- University of Dar Es Salaam, Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
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10
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Bunduki GK, Masoamphambe E, Fox T, Musaya J, Musicha P, Feasey N. Prevalence, risk factors, and antimicrobial resistance of endemic healthcare-associated infections in Africa: a systematic review and meta-analysis. BMC Infect Dis 2024; 24:158. [PMID: 38302895 PMCID: PMC10836007 DOI: 10.1186/s12879-024-09038-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/20/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Healthcare-associated infections (HCAI) place a significant burden on healthcare systems globally. This systematic review and meta-analysis aimed to investigate the prevalence, risk factors, and aetiologic agents of endemic HCAI in Africa. METHODS MEDLINE/PubMed, CINAHL, and Global Health databases (EBSCOhost interface) were searched for studies published in English and French describing HCAI in Africa from 2010 to 2022. We extracted data on prevalence of HCAI, risk factors, aetiologic agents, and associated antimicrobial resistance patterns. We used random-effects models to estimate parameter values with 95% confidence intervals for risk factors associated with HCAI. This study was registered in PROSPERO (CRD42022374559) and followed PRISMA 2020 guidelines. RESULTS Of 2541 records screened, 92 were included, comprising data from 81,968 patients. Prevalence of HCAI varied between 1.6 and 90.2% with a median of 15% across studies. Heterogeneity (I2) varied from 93 to 99%. Contaminated wound (OR: 1.75, 95% CI: 1.31-2.19), long hospital stay (OR: 1.39, 95% CI: 0.92-1.80), urinary catheter (OR: 1.57, 95% CI: 0.35-2.78), intubation and ventilation (OR: 1.53, 95% CI: 0.85-2.22), vascular catheters (OR: 1.49, 95% CI: 0.52-2.45) were among risk factors associated with HCAI. Bacteria reported from included studies comprised 6463 isolates, with E. coli (18.3%, n = 1182), S. aureus (17.3%, n = 1118), Klebsiella spp. (17.2%, n = 1115), Pseudomonas spp. (10.3%, n = 671), and Acinetobacter spp. (6.8%, n = 438) being most common. Resistance to multiple antibiotics was common; 70.3% (IQR: 50-100) of Enterobacterales were 3rd -generation cephalosporin resistant, 70.5% (IQR: 58.8-80.3) of S. aureus were methicillin resistant and 55% (IQR: 27.3-81.3) Pseudomonas spp. were resistant to all agents tested. CONCLUSIONS HCAI is a greater problem in Africa than other regions, however, there remains a paucity of data to guide local action. There is a clear need to develop and validate sustainable HCAI definitions in Africa to support the implementation of routine HCAI surveillance and inform implementation of context appropriate infection prevention and control strategies.
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Affiliation(s)
- Gabriel Kambale Bunduki
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi.
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
- Centre d'Excellence en Maladies Infectieuses et Soins Critiques du Graben (CEMISoCG), Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo.
| | - Effita Masoamphambe
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tilly Fox
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Janelisa Musaya
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Patrick Musicha
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Nicholas Feasey
- Malawi-Liverpool-Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- School of Medicine, University of St Andrews, St Andrews, UK
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11
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Tshitangano TG. Case Study Protocol to Evaluate the Impact of Training Intervention on Cleaners' Knowledge Level, Perceptions and Practices regarding Correct Cleaning Techniques at Selected Care Facilities in Limpopo Province, South Africa. NURSING REPORTS 2024; 14:328-339. [PMID: 38391070 PMCID: PMC10885113 DOI: 10.3390/nursrep14010025] [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: 11/29/2023] [Revised: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 02/24/2024] Open
Abstract
Despite being preventable, healthcare-associated infections are known primary causes of patient mortality and morbidity, threatening global public health. Though it is believed that one competent and dedicated cleaning staff member given the right tools and enough time can prevent more health-care-associated infectious diseases than a room full of doctors and nurses can cure, it was discovered in Letaba Hospital of the Limpopo Province, South Africa, that knowledge and practices of infection control among cleaning staff were not optimal. The proposed study aims to evaluate the impact of training interventions on cleaners' knowledge levels and practices. In Phase 1, cleaners' pre-training knowledge level, practices, and perceptions regarding correct cleaning techniques will be assessed through qualitative, individual, in-depth interviews. The initial question will read, "Describe the steps you follow when cleaning at this health facility and why?" In Phase 2a, a cleaning training program will be developed based on the South African Qualification Authority ID 118730 Healthcare Cleaner: Occupational Certificate Curriculum and the Center for Diseases Control and ICAN's Best Practices for Environmental Cleaning in Healthcare Facilities in Resource-Limited Settings. In Phase 2b, a cleaning training intervention will be implemented. In Phase 3, cleaners' post-training knowledge level, practices, and perceptions will be reassessed and compared to pre-training findings. The Standard Protocol Items: Recommendations for an Interventional Trial, commonly known as SPIRIT, guided the development of this protocol. This protocol received ethical clearance number FHS/22/PH/04/3005 in August 2023 from the University of Venda Human and Clinical Trials Research Ethics Committee. The protocol approval was granted by the Limpopo Provincial Department of Health (LP_2022-05-028) in October 2023. This protocol is registered with the South African National Clinical Trial Registry. The findings of this study may provide baseline data upon which healthcare facilities' cleaner training qualification curriculum may be developed. In addition, this protocol contributes to the application of qualitative methodology in an intervention trial.
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Affiliation(s)
- Takalani Grace Tshitangano
- Department of Public Health, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
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12
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Abubakar U, Awaisu A, Khan AH, Alam K. Impact of COVID-19 Pandemic on Healthcare-Associated Infections: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2023; 12:1600. [PMID: 37998802 PMCID: PMC10668951 DOI: 10.3390/antibiotics12111600] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 11/25/2023] Open
Abstract
This study investigated how the Coronavirus Disease 2019 (COVID-19) pandemic has affected the rate of healthcare-associated infections (HAIs). PubMed, Scopus and Google Scholar were searched to identify potentially eligible studies published from December 2019 to September 2022. A random effect model was used to determine the changes in the rate of HAIs during the pandemic. Thirty-seven studies, mostly from the United States (n = 13), were included. Fifteen studies described how the pandemic affected the rate of CLABSIs and CAUTIs, and eight of them showed a significant increase in CLABSIs. The risk of CLABSIs and CDIs was 27% (pooled odds ratio [OR]: 0.73; confidence interval [CI]: 0.61-0.89; p < 0.001) and 20% (pooled OR: 1.20; CI: 1.10-1.31; p < 0.001) higher during the pandemic compared to before the COVID-19 pandemic period, respectively. However, the overall risk of HAIs was unaffected by the pandemic (pooled OR: 1.00; 95 CI: 0.80-1.24; p = 0.990). Furthermore, there were no significant changes in the risk of CAUTIs (pooled OR: 1.01; 95 CI: 0.88-1.16; p = 0.890), and SSIs (pooled OR: 1.27; CI: 0.91-1.76; p = 0.16) between the two periods. The COVID-19 pandemic had no effect on the overall risk of HAIs among hospitalized patients, but an increased risk of CLABSIs and CDI were observed during the pandemic. Therefore, more stringent infection control and prevention measures and prudent interventions to promote the rational use of antibiotics are warranted across all healthcare facilities to reduce the burden of HAIs.
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Affiliation(s)
- Usman Abubakar
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha P.O. Box 2713, Qatar
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town 11800, Malaysia
| | - Khurshid Alam
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, George Town 11800, Malaysia
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13
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Mustafa ZU, Khan AH, Salman M, Harun SN, Meyer JC, Godman B, Seaton RA. Healthcare-associated infections among neonates and children in Pakistan: findings and the implications from a point prevalence survey. J Hosp Infect 2023; 141:142-151. [PMID: 37774930 DOI: 10.1016/j.jhin.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/17/2023] [Accepted: 09/18/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) increase morbidity, mortality and costs. The overall prevalence of HAIs is greater in low- and middle-income countries due to poor resources and infrastructure, with the incidence of HAIs greater among neonates and children. There is a need to understand the current situation in Pakistan including key drivers to improve future care. METHODS Point prevalence survey (PPS) of HAIs in the children's wards of 19 public sector secondary- and tertiary-care hospitals of Pakistan and associated key drivers. RESULTS A total of 1147 children were included in the PPS. 35.7% were neonates with 32.8% aged >1-5 years. 35.2% were admitted to the intensive care units (ICUs). Peripheral, central venous and urinary catheters were present in 48%, 2.9% and 5.6% of the patients, respectively. A total of 161 HAIs from various pathogens were observed in 153 cases, giving a prevalence of 13.3%. The majority of HAIs were caused by Staphylococcus aureus (31.7%) followed by Klebsiella pneumoniae (22.9%) and Escherichia coli (17.4%). Bloodstream infections were identified in 42 cases followed by lower-respiratory-tract infections in 35. Increased length of hospital stays and being admitted to the ICU, 'rapidly fatal' patients under the McCabe and Jackson criteria, central and peripheral catheterization, and invasive mechanical ventilation were, associated with higher HAIs (P<0.001). 99.7% of HAI patients fully recovered and were discharged from the hospital. CONCLUSION There is a high prevalence of HAIs among neonates and children admitted to health facilities in Pakistan. Infection prevention and control measures should be implemented to help prevent future HAIs.
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Affiliation(s)
- Z U Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, Pakistan.
| | - A H Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - M Salman
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore, Pakistan
| | - S N Harun
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - J C Meyer
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa
| | - B Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa; Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow, UK
| | - R A Seaton
- Queen Elizabeth University Hospital, Glasgow, UK; Scottish Antimicrobial Prescribing Group, Healthcare Improvement Scotland, Glasgow, UK
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14
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Azaiez S, Haenni M, Cheikh AB, Chalbi MS, Messaoudi A, Tilouch L, Bahri S, Drapeau A, Saras E, Mtibâa M, Zouaoui R, Said H, Madec JY, Lupo A, Mansour W. Healthcare Equipment and Personnel Reservoirs of Carbapenem-Resistant Acinetobacter baumannii Epidemic Clones in Intensive Care Units in a Tunisian Hospital. Microorganisms 2023; 11:2637. [PMID: 38004649 PMCID: PMC10672855 DOI: 10.3390/microorganisms11112637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/26/2023] Open
Abstract
Carbapenem-resistant Acinetobacter baumannii (CRAB) strains can cause severe and difficult-to-treat infections in patients with compromised general health. CRAB strains disseminate rapidly in nosocomial settings by patient-to-patient contact, through medical devices and inanimate reservoirs. The occurrence of CRAB in patients residing in the intensive care units (ICUs) of the Sahloul University hospital in Sousse, Tunisia is high. The objective of the current study was to determine whether the surfaces of items present in five ICU wards and the medical personnel there operating could serve as reservoirs for CRAB strains. Furthermore, CRAB isolates from patients residing in the ICUs during the sampling campaign were analyzed for genome comparison with isolates from the ICUs environment. Overall, 206 items were screened for CRAB presence and 27 (14%) were contaminated with a CRAB isolate. The items were located in several areas of three ICUs. Eight of the 54 (15%) screened people working in the wards were colonized by CRAB on the hands. Patients residing in the ICUs were infected with CRAB strains sharing extensive genomic similarity with strains recovered in the nosocomial environment. The strains belonged to three sub-clades of the internationally disseminated clone (ST2). A clone emerging in the Mediterranean basin (ST85) was detected as well. The strains were OXA-23 or NDM-1 producers and were also pan-aminoglycoside resistant due to the presence of the armA gene. Hygiene measures are urgent to be implemented in the Sahloul hospital to avoid further spread of difficult-to-treat CRAB strains and preserve health of patients and personnel operating in the ICU wards.
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Affiliation(s)
- Sana Azaiez
- Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée, LR12ES02, Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia; (S.A.); (A.M.); (S.B.); (M.M.); (R.Z.)
| | - Marisa Haenni
- Unité Antibiorésistance et Virulence Bactériennes, ANSES—Université de Lyon, 69007 Lyon, France; (M.H.); (A.D.); (E.S.); (J.-Y.M.)
| | - Asma Ben Cheikh
- Departement of Prevention and Security of Care, Sahloul University Hospital of Sousse, Sousse 4054, Tunisia; (A.B.C.); (M.S.C.); (H.S.)
- Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia
| | - Mohamed Sahbi Chalbi
- Departement of Prevention and Security of Care, Sahloul University Hospital of Sousse, Sousse 4054, Tunisia; (A.B.C.); (M.S.C.); (H.S.)
- Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia
| | - Aziza Messaoudi
- Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée, LR12ES02, Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia; (S.A.); (A.M.); (S.B.); (M.M.); (R.Z.)
| | - Lamia Tilouch
- Laboratoire de Microbiologie Sahloul, University Hospital of Sousse, Sousse 4054, Tunisia;
- Faculté de Pharmacie, Université de Monastir, Monastir 5019, Tunisia
| | - Sana Bahri
- Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée, LR12ES02, Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia; (S.A.); (A.M.); (S.B.); (M.M.); (R.Z.)
| | - Antoine Drapeau
- Unité Antibiorésistance et Virulence Bactériennes, ANSES—Université de Lyon, 69007 Lyon, France; (M.H.); (A.D.); (E.S.); (J.-Y.M.)
| | - Estelle Saras
- Unité Antibiorésistance et Virulence Bactériennes, ANSES—Université de Lyon, 69007 Lyon, France; (M.H.); (A.D.); (E.S.); (J.-Y.M.)
| | - Mariem Mtibâa
- Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée, LR12ES02, Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia; (S.A.); (A.M.); (S.B.); (M.M.); (R.Z.)
| | - Rania Zouaoui
- Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée, LR12ES02, Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia; (S.A.); (A.M.); (S.B.); (M.M.); (R.Z.)
| | - Houyem Said
- Departement of Prevention and Security of Care, Sahloul University Hospital of Sousse, Sousse 4054, Tunisia; (A.B.C.); (M.S.C.); (H.S.)
- Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia
| | - Jean-Yves Madec
- Unité Antibiorésistance et Virulence Bactériennes, ANSES—Université de Lyon, 69007 Lyon, France; (M.H.); (A.D.); (E.S.); (J.-Y.M.)
| | - Agnese Lupo
- Unité Antibiorésistance et Virulence Bactériennes, ANSES—Université de Lyon, 69007 Lyon, France; (M.H.); (A.D.); (E.S.); (J.-Y.M.)
| | - Wejdene Mansour
- Laboratoire de Recherche Biophysique Métabolique et Pharmacologie Appliquée, LR12ES02, Faculté de Médecine Ibn Al Jazzar Sousse, Université de Sousse, Sousse 4002, Tunisia; (S.A.); (A.M.); (S.B.); (M.M.); (R.Z.)
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15
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Martínez JL, Baquero F. What are the missing pieces needed to stop antibiotic resistance? Microb Biotechnol 2023; 16:1900-1923. [PMID: 37417823 PMCID: PMC10527211 DOI: 10.1111/1751-7915.14310] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 07/08/2023] Open
Abstract
As recognized by several international agencies, antibiotic resistance is nowadays one of the most relevant problems for human health. While this problem was alleviated with the introduction of new antibiotics into the market in the golden age of antimicrobial discovery, nowadays few antibiotics are in the pipeline. Under these circumstances, a deep understanding on the mechanisms of emergence, evolution and transmission of antibiotic resistance, as well as on the consequences for the bacterial physiology of acquiring resistance is needed to implement novel strategies, beyond the development of new antibiotics or the restriction in the use of current ones, to more efficiently treat infections. There are still several aspects in the field of antibiotic resistance that are not fully understood. In the current article, we make a non-exhaustive critical review of some of them that we consider of special relevance, in the aim of presenting a snapshot of the studies that still need to be done to tackle antibiotic resistance.
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Affiliation(s)
| | - Fernando Baquero
- Ramón y Cajal Institute for Health Research (IRYCIS), Department of MicrobiologyRamón y Cajal University Hospital, CIBER en Epidemiología y Salud Pública (CIBERESP)MadridSpain
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16
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Mudenda S, Chizimu J, Chabalenge B, Kasanga M, Matafwali SK, Daka V, Yamba K, Mulomba M, Mufwambi W, Katowa-Mukwato P, Godman B. Knowledge, attitude, and practices toward infection prevention and control among undergraduate pharmacy students in Zambia: findings and implications. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e154. [PMID: 37771733 PMCID: PMC10523556 DOI: 10.1017/ash.2023.428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/19/2023] [Accepted: 07/25/2023] [Indexed: 09/30/2023]
Abstract
Background Infection prevention and control (IPC) measures are critical in preventing the risk of acquiring and transmitting nosocomial infections. In Zambia, there is little information concerning IPC practices among pharmacy students who are exposed to potentially infectious areas both in public and private healthcare settings. Therefore, this study assessed the knowledge, attitude, and practices of undergraduate pharmacy students toward infection prevention and control at the University of Zambia. Materials and methods This cross-sectional study was conducted among 290 undergraduate pharmacy students at the University of Zambia using a structured questionnaire from August 2022 to October 2022. Data analysis was performed using SPSS version 25.0, and statistical significance was set at a 95% confidence level. Results Of the 290 participants, 166(57.2%) were female and the majority were aged between 18 and 23 years. Overall, 252(86.9%) had good knowledge, 167(57.6%) had positive attitudes, and 248(85.5%) had good practices toward IPC measures. These results indicate lower attitude scores compared to knowledge and practices. Having good knowledge of IPC was associated with being a Christian by religion compared to other religions (OR = 5.314, 95% CI: 1.141-24.745). There was no association between sociodemographics and attitude and practice concerning IPC. Conclusion This study found that pharmacy students had good knowledge, positive attitudes, and good practices toward IPC measures. Consequently, more emphasis is needed to improve the student's knowledge, attitudes, and practices toward IPC, especially in areas where gaps were identified. Additionally, there is a need to improve curricula on IPC measures in the training of pharmacy programs.
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Affiliation(s)
- Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Antimicrobial Resistance Coordinating Committee (AMRCC), Zambia National Public Health Institute, Lusaka, Zambia
| | - Joseph Chizimu
- Antimicrobial Resistance Coordinating Committee (AMRCC), Zambia National Public Health Institute, Lusaka, Zambia
| | - Billy Chabalenge
- Department of Medicines Control, Zambia Medicines Regulatory Authority, Lusaka, Zambia
| | - Maisa Kasanga
- Zhengzhou University, College of Public Health, Zhengzhou, Henan, China
| | - Scott Kaba Matafwali
- Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
| | - Victor Daka
- Department of Public Health, Michael Chilufya Sata School of Medicine, Copperbelt University, Ndola, Zambia
| | - Kaunda Yamba
- Antimicrobial Resistance Coordinating Committee (AMRCC), Zambia National Public Health Institute, Lusaka, Zambia
| | - Margret Mulomba
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Webrod Mufwambi
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Patricia Katowa-Mukwato
- Department of Basic and Clinical Nursing, School of Nursing Sciences, University of Zambia, Lusaka, Zambia
| | - Brian Godman
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- Centre of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Science (SIPBS), University of Strathclyde, Glasgow, UK
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Jarelnape AA. The Assessment of Nursing Staff Knowledge and Barriers Regarding Aseptic Techniques in Khartoum Teaching Hospital, Sudan. Cureus 2023; 15:e45265. [PMID: 37846261 PMCID: PMC10576657 DOI: 10.7759/cureus.45265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
Background Aseptic techniques are crucial in preventing healthcare-associated infections, which are an integral part of standard precautions, and encompass a range of practices designed to safeguard patients from healthcare-associated infections. Objective The objective of this study was to evaluate the level of knowledge and identify the barriers faced by nursing staff in implementing aseptic techniques. Methodology This study employed a stratified random sampling technique to ensure the representation of the research sample. A cross-sectional, descriptive research design was used to assess the knowledge and barriers of nursing staff in maintaining aseptic techniques in their medical practice at Khartoum Teaching Hospital, Sudan. The nursing staff members were divided into different units, and a proportionate number of participants were randomly selected from each stratum. A total of 83 nursing staff members were recruited for this study. Data collection was conducted using a structured questionnaire specifically designed for this study. The questionnaire consisted of items that assessed the nursing staff's knowledge and barriers to aseptic technique implementation. Results The study findings revealed that the mean knowledge score of nursing staff was 14.12, with a median score of 15. The knowledge score had a standard deviation of 3.22. Approximately two-thirds of the nurses (66.3%) had an average level of knowledge, while 33.7% had a below-average level of knowledge. The chi-square analysis indicated a significant association between educational level, years of experience, and knowledge scores (P value=0.010) at a significance level of 0.05. Additionally, 65% of the participants reported facing multiple challenges in maintaining aseptic techniques, including insufficient training, limited resources, and inadequate support. Conclusion In conclusion, the evaluation revealed that a significant proportion of participants felt that their unit lacked adequate training and resources for aseptic techniques. Many had observed colleagues not adhering to aseptic practices, and the participants faced multiple challenges in maintaining aseptic techniques, including insufficient training, limited resources, time constraints, and inadequate support.
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Affiliation(s)
- Ahmed A Jarelnape
- Department of Nursing, Faculty of Applied Medical Sciences, Al Baha University, Al Baha, SAU
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Jung L, Kiwanuka J, Mbabazi L, Nakate V, Musaazi J, Nabajja H, Kajumbula H, Lübbert C, Mwaka E, Nsibirwa S, von Braun A. A case for routine microbial diagnostics: Results from antimicrobial susceptibility testing in post-traumatic wound infections at a Ugandan tertiary care hospital. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001880. [PMID: 37582103 PMCID: PMC10427013 DOI: 10.1371/journal.pgph.0001880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 07/25/2023] [Indexed: 08/17/2023]
Abstract
The global spread of antimicrobial resistance (AMR) poses an increasing challenge for clinicians in Uganda, where microbiological diagnostics are not routinely available or accessible. The aim of this study was to determine pathogen prevalence and antibiotic resistance patterns in patients with wound infections following trauma at a national referral hospital in Kampala, Uganda. In addition, the suitability of currently used empirical treatment options in this setting was evaluated. This prospective, observational study analysed antimicrobial prescriptions, culture results and antimicrobial sensitivity testing (AST) of wound swabs and blood samples from patients with clinical signs of wound infections on the trauma ward. A total of 124 patients (n = 99, 79.8% male) with a median age of 30 years (IQR 23-39) were enrolled between October 2021 and January 2022. Wound infections were classified as nosocomial in 69% of the cases. Pathogens were isolated from 122 wound swabs, yielding 238 bacterial isolates. The most prevalent pathogens were gram-negative bacteria including Escherichia coli (n = 48, 20.2%) and Acinetobacter spp. (n = 43, 18.1%). Empiric treatment consisted of ceftriaxone and gentamicin which was administered to 67.2% (n = 78) and 62.1% (n = 72) of patients, respectively. High rates of antimicrobial resistance could be demonstrated across gram-negative and gram-positive species towards the most common empiric antibiotics. Following the AST results, over 95% (n = 111) of patients required a change of treatment. Our findings demonstrate that current empiric treatment for wound infections is missing its target in hospitalized patients in Kampala. To address the growing problem of AMR in Uganda, there is a pressing need to enhance diagnostic capacity and implement structured antimicrobial stewardship programs.
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Affiliation(s)
- Laura Jung
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Leipzig University Medical Center, Leipzig, Germany
| | - James Kiwanuka
- Department of Orthopedics/Trauma, Mulago National Referral Hospital, Kampala, Uganda
| | - Leah Mbabazi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Vivian Nakate
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph Musaazi
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Hawah Nabajja
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Henry Kajumbula
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | - Christoph Lübbert
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Leipzig University Medical Center, Leipzig, Germany
| | - Erisa Mwaka
- Department of Orthopedics/Trauma, Mulago National Referral Hospital, Kampala, Uganda
| | - Sara Nsibirwa
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Amrei von Braun
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Leipzig University Medical Center, Leipzig, Germany
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19
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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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Al-Shami HA, Abubakar U, Hussein MSE, Hussin HFA, Al-Shami SA. Awareness, practices and perceptions of community pharmacists towards antimicrobial resistance and antimicrobial stewardship in Libya: a cross-sectional study. J Pharm Policy Pract 2023; 16:46. [PMID: 36945072 PMCID: PMC10028782 DOI: 10.1186/s40545-023-00555-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Community pharmacists play a vital role in promoting appropriate use of antibiotics in the community. This study evaluated the practices and perceptions of community pharmacists towards antibiotic use, antibiotic resistance, and antimicrobial stewardship in Libya. METHODS A cross-sectional study was conducted among community pharmacists in Libya using a 47-item validated, pre-tested online questionnaire. Data was collected from December 2021 to February 2022 and was analysed using descriptive and inferential analyses. RESULTS Of the 114 questionnaires included in the analysis, 54.4% were females, 78.1% had < 10 year working experience (78.1%), and 81.6% had a Bachelor of Pharmacy. Most (78.1%) strongly agreed/agreed that community pharmacists have an important role to play to reduce antibiotic resistance. Overall, the participants had a moderate perception towards antimicrobial resistance (median score: 21.5; IQR [16-28] out of 35.0). More than 40% supply antibiotics when patients requested them specifically, because if they do not supply them, patients will just go to another pharmacy. About 47% strongly agreed/agreed that if a patient cannot afford a full course of antibiotics all in one go, they will give them a smaller amount that they are able to afford at that time, even when a longer duration of treatment is required. Most (66.7%) had no previous involvement in antibiotics awareness campaign due to 'I have never heard about the campaign' (48.7%) and 'I do not have enough time to participate' (22.4%). Overall, the perception towards antimicrobial stewardship was good (20 [13-25] out of 25.0). Raising awareness of rational antibiotic use, including antimicrobial resistance, among pharmacy students (83.4%) and patient education by pharmacists in community pharmacies at the time medicines are supplied to patients (81.6%) were the most common strategies to improve rational use of antibiotics in community pharmacy. CONCLUSIONS Community pharmacists in Libya recognise their role in reducing antimicrobial resistance. They had a moderate perception towards antimicrobial resistance and a good perception towards antimicrobial stewardship. However, inappropriate antibiotic practices were common. The most common strategies to improve rational use of antibiotics in community pharmacy were raising awareness about the rational antibiotic use among pharmacy students and patient education by community pharmacists at the time antibiotics are dispensed to patients. Regulations are needed to restrict dispensing antibiotics without prescription among community pharmacists.
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Affiliation(s)
- Hiba A Al-Shami
- Anaesthesia and Emergency Medicine Department, College of Medical Technology, Benghazi, 141, Benghazi, Libya
| | - Usman Abubakar
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, Doha, Qatar.
| | - Maryam S E Hussein
- Anaesthesia and Emergency Medicine Department, College of Medical Technology, Benghazi, 141, Benghazi, Libya
| | - Hanin F A Hussin
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, University of Benghazi, 141, Benghazi, Libya
| | - Sondos A Al-Shami
- Faculty of Pharmacy, Libyan International Medical University, 141, Benghazi, Libya
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Gidey K, Gidey MT, Hailu BY, Gebreamlak ZB, Niriayo YL. Clinical and economic burden of healthcare-associated infections: A prospective cohort study. PLoS One 2023; 18:e0282141. [PMID: 36821590 PMCID: PMC9949640 DOI: 10.1371/journal.pone.0282141] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 02/09/2023] [Indexed: 02/24/2023] Open
Abstract
INTRODUCTION Healthcare-associated infections (HAIs) have become a serious public health problem. Despite the fact that implementing evidence-based infection control strategies could prevent HAIs and save billions of dollars, Ethiopia lacks national surveillance studies on the rate, economic, and clinical burden of HAIs. OBJECTIVE To assess the clinical and economic burden of HAIs in hospitalized patients at Ayder comprehensive specialized hospital. MATERIALS AND METHODS A prospective cohort study design was conducted in patients with and without HAIs. A review of medical records, interviews, and patient bills was used to extract necessary information. The patients in the two arms were matched based on age, sex, Charlson comorbidity index, and ward type. Measurable factors were compared between infected and uninfected patients using the paired ttest or McNemar's test, as appropriate. Logistic regression was used to identify predictors of in-hospital mortality. Stata 14.1 was used to conduct all analyses. RESULTS A total of 408 patients, 204 with HAIs and 204 without HAIs were included in the study. In-hospital mortality was higher in patients with HAI (14.7% vs 7.8%, P = 0.028). Patients with HAI stayed an average of 8.3 days longer than controls (18.85 vs 10.59, P<0.001). The average direct medical costs for patients with HAI were 3033 Ethiopian birrs (ETB) higher than controls (4826 vs 1793, P<0.001). The presence of HAIs (AOR: 2.22, 95% CI: 1.13-4.39) and admission to intensive care units (AOR: 3.39, 95% CI: 1.55-7.40) were significant predictors of in-hospital mortality. CONCLUSION HAIs have a significant impact on in-hospital mortality, the length of extra hospital stays, and extra costs for medical care. Patients admitted to intensive care units and those with HAIs were found to be significant predictors of in-hospital mortality. Interventions must be implemented to prevent HAIs, especially in patients admitted to intensive care units.
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Affiliation(s)
- Kidu Gidey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
- * E-mail:
| | - Meles Tekie Gidey
- Pharmacoepidemiology and Social Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Berhane Yohannes Hailu
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | | | - Yirga Legesse Niriayo
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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