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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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Sati H, Alastruey-Izquierdo A, Perfect J, Govender NP, Harrison TS, Chiller T, Sorrell TC, Bongomin F, Oladele R, Chakrabarti A, Wahyuningsih R, Colombo AL, Rodriguez-Tudela JL, Beyrer C, Ford N. HIV and fungal priority pathogens. Lancet HIV 2023; 10:e750-e754. [PMID: 37827187 PMCID: PMC7615271 DOI: 10.1016/s2352-3018(23)00174-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/01/2023] [Accepted: 07/07/2023] [Indexed: 10/14/2023]
Abstract
The burden of invasive fungal infections associated with opportunistic fungal pathogens is a persistent challenge, particularly among people with advanced HIV disease. In October, 2022, WHO published the Fungal Priority Pathogens List (FPPL)-the first global effort to systematically prioritise fungal pathogens. Of the 19 pathogens in the WHO FPPL, four opportunistic pathogens in particular cause invasive diseases in people living with HIV: Cryptococcus neoformans, Histoplasma spp, Pneumocystis jirovecii, and Talaromyces marneffei. These four fungal pathogens are major causes of illness and death in people with advanced HIV and overwhelmingly affect those in low-income and middle-income countries. Access to diagnostics, improved surveillance, targeted support for innovation, and an enhanced public health focus on these diseases are needed in the effort to reduce HIV-associated deaths.
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Affiliation(s)
- Hatim Sati
- Antimicrobial Resistance Division, WHO, Geneva, Switzerland
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Center for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - John Perfect
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Nelesh P Govender
- National Institute for Communicable Diseases, Division of the National Health Laboratory Service, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa; MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Tom S Harrison
- Centre for Global Health, Institute of Infection and Immunity, St George's University of London, London, UK; MRC Centre for Medical Mycology, University of Exeter, Exeter, UK
| | - Tom Chiller
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Tania C Sorrell
- Sydney Infectious Disease Institute, University of Sydney, Sydney, NSW, Australia
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Rita Oladele
- Department of Medical Microbiology and Parasitology, Faculty of Basic Medical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | | | - Retno Wahyuningsih
- Department of Parasitology, Universitas Indonesia and Universitas Kristen Indonesia, Indonesia
| | - Arnaldo Lopes Colombo
- Department of Medicine, Division of Infectious Diseases, Federal University of São Paulo, São Paulo, Brazil
| | | | - Chris Beyrer
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Nathan Ford
- Department of Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland; Centre for Infectious Disease and Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
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Naicker SD, Shuping L, Zulu TG, Mpembe RS, Mhlanga M, Tsotetsi EM, Maphanga TG, Govender NP. Epidemiology and susceptibility of Nakaseomyces (formerly Candida) glabrata bloodstream isolates from hospitalised adults in South Africa. Med Mycol 2023; 61:myad057. [PMID: 37336590 DOI: 10.1093/mmy/myad057] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/07/2023] [Accepted: 06/14/2023] [Indexed: 06/21/2023] Open
Abstract
During 2016-2017, Nakaseomyces glabrata (formerly Candida glabrata) caused 14% of cases of candidaemia in South Africa. We aimed to describe the clinical characteristics of adults with N. glabrata candidaemia at 20 sentinel hospitals (accounting for 20% (172/917) of cases) and the antifungal susceptibility of the corresponding isolates. A higher proportion of patients with N. glabrata candidaemia were older (median age: 55 years [interquartile range (IQR): 41-65 years] vs. 49 years [IQR: 35-63 years]; p = 0.04), female (87/164, 53% vs. 283/671, 42%; p = 0.01), admitted to a public-sector hospital (152/172, 88% vs. 470/745, 63%; p < 0.001), treated with fluconazole only (most with suboptimal doses) (51/95, 54% vs. 139/361, 39%; p < 0.001), and had surgery (47/172, 27% vs. 123/745, 17%; p = 0.001) and a shorter hospital stay (median 7 days [IQR: 2-20 days] vs. 13 days [IQR: 4-27 days]; p < 0.001) compared to patients with other causes of candidaemia. Eight N. glabrata isolates (6%, 8/131) had minimum inhibitory concentrations in the intermediate or resistant range for ≥ 1 echinocandin and a R1377K amino acid substitution encoded by the hotspot 2 region of the FKS2 gene. Only 11 isolates (8%, 11/131) were resistant to fluconazole. Patients with confirmed N. glabrata candidaemia are recommended to be treated with an echinocandin (or polyene), thus further guideline training is required.
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Affiliation(s)
- Serisha D Naicker
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Liliwe Shuping
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Thokozile G Zulu
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Ruth S Mpembe
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Mabatho Mhlanga
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Ernest M Tsotetsi
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Tsidiso G Maphanga
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
| | - Nelesh P Govender
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, a Division of the National Health Laboratory Service, Johannesburg, South Africa
- School of Pathology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Division of Medical Microbiology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Institute of Infection and Immunity, St George's University of London, London and Medical Research Council Centre for Medical Mycology, University of Exeter, Exeter, United Kingdom
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Okoye CA, Nweze E, Ibe C. Invasive candidiasis in Africa, what is the current picture? Pathog Dis 2022; 80:6572357. [PMID: 35451463 DOI: 10.1093/femspd/ftac012] [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: 12/20/2021] [Revised: 03/23/2022] [Accepted: 04/20/2022] [Indexed: 11/14/2022] Open
Abstract
Invasive candidiasis is a serious, progressive, and potentially deadly infection that can affect the brain, heart, bones, eyes, and other parts of the body. It is associated with risk factors such as the use of indwelling medical devices and prolonged hospital stay, and broad-spectrum antibiotics use. It is especially seen in immunocompromised individuals such as patients with prolonged hospital stay, gastrointestinal surgery, haematological malignancies, and respiratory diseases. We have conducted a systematic search of literature using a select group of database and appropriate search words and found that in Africa, there are 18,293 documented/reported cases of invasive candidiasis in the last few decades (1976-2021) and 16,636(91%) were cases of candidaemia. South Africa had the highest number of reported cases - 15,002(82%), which may be due to underreporting of cases in other countries. HIV positive persons with invasive candidiasis in Africa accounted for 1,052(5.8%). C. albicans was the most frequently isolated species 6,328(32.6%), followed by Candida parapsilosis 5,910(30.4%), and Candida auris 1,505(7.8%). Due to the affordability and availability of blood culture, it was used for diagnosis in most of the studies examined, while a few studies combined other techniques and just 3 studies from 2 countries used serological tests. Echinocandins are recommended as first-line therapy but are only available in 12 countries and are highly priced. The use of fluconazole because of its availability and relatively inexpensive nature has led to increased resistance of Candida species to the drug.
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Affiliation(s)
- Chinonyelum A Okoye
- Departments of Microbiology, Faculty of Biological Sciences, Abia State University, Uturu, Nigeria
| | - Emeka Nweze
- Microbiology University of Nigeria Nsukka, Faculty of Biological Sciences, Enugu State, Nigeria
| | - Chibuike Ibe
- Departments of Microbiology, Faculty of Biological Sciences, Abia State University, Uturu, Nigeria
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Radionuclide Imaging of Invasive Fungal Disease in Immunocompromised Hosts. Diagnostics (Basel) 2021; 11:diagnostics11112057. [PMID: 34829403 PMCID: PMC8620393 DOI: 10.3390/diagnostics11112057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 12/19/2022] Open
Abstract
Invasive fungal disease (IFD) leads to increased mortality, morbidity, and costs of treatment in patients with immunosuppressive conditions. The definitive diagnosis of IFD relies on the isolation of the causative fungal agents through microscopy, culture, or nucleic acid testing in tissue samples obtained from the sites of the disease. Biopsy is not always feasible or safe to be undertaken in immunocompromised hosts at risk of IFD. Noninvasive diagnostic techniques are, therefore, needed for the diagnosis and treatment response assessment of IFD. The available techniques that identify fungal-specific antigens in biological samples for diagnosing IFD have variable sensitivity and specificity. They also have limited utility in response assessment. Imaging has, therefore, been applied for the noninvasive detection of IFD. Morphologic imaging with computed tomography (CT) and magnetic resonance imaging (MRI) is the most applied technique. These techniques are neither sufficiently sensitive nor specific for the early diagnosis of IFD. Morphologic changes evaluated by CT and MRI occur later in the disease course and during recovery after successful treatment. These modalities may, therefore, not be ideal for early diagnosis and early response to therapy determination. Radionuclide imaging allows for targeting the host response to pathogenic fungi or specific structures of the pathogen itself. This makes radionuclide imaging techniques suitable for the early diagnosis and treatment response assessment of IFD. In this review, we aimed to discuss the interplay of host immunity, immunosuppression, and the occurrence of IFD. We also discuss the currently available radionuclide probes that have been evaluated in preclinical and clinical studies for their ability to detect IFD.
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Development of Carbazole Derivatives Compounds against Candida albicans: Candidates to Prevent Hyphal Formation via the Ras1-MAPK Pathway. J Fungi (Basel) 2021; 7:jof7090688. [PMID: 34575726 PMCID: PMC8466151 DOI: 10.3390/jof7090688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 12/03/2022] Open
Abstract
Morphogenesis contributes to the virulence of the opportunistic human fungal pathogen Candida albicans. Ras1-MAPK pathways play a critical role in the virulence of C. albicans by regulating cell growth, morphogenesis, and biofilm formation. Ume6 acts as a transcription factor, and Nrg1 is a transcriptional repressor for the expression of hyphal-specific genes in morphogenesis. Azoles or echinocandin drugs have been extensively prescribed for C. albicans infections, which has led to the development of drug-resistant strains. Therefore, it is necessary to develop new molecules to effectively treat fungal infections. Here, we showed that Molecule B and Molecule C, which contained a carbazole structure, attenuated the pathogenicity of C. albicans through inhibition of the Ras1/MAPK pathway. We found that Molecule B and Molecule C inhibit morphogenesis through repressing protein and RNA levels of Ras/MAPK-related genes, including UME6 and NRG1. Furthermore, we determined the antifungal effects of Molecule B and Molecule C in vivo using a candidiasis murine model. We anticipate our findings are that Molecule B and Molecule C, which inhibits the Ras1/MAPK pathway, are promising compounds for the development of new antifungal agents for the treatment of systemic candidiasis and possibly for other fungal diseases.
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