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Madran B, Keske Ş, Tanju S, Cesur EE, Pala S, Dilege Ş, Ergönül Ö. The Practice of Antimicrobial Stewardship in Thoracic Surgery and its Effectiveness. Infect Dis Clin Microbiol 2024; 6:60-65. [PMID: 38633440 PMCID: PMC11019725 DOI: 10.36519/idcm.2024.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/27/2024] [Indexed: 04/19/2024]
Abstract
This study examines the effects of the bundle of antimicrobial stewardship measures for prophylactic antibiotics among thoracic surgery patients. A local protocol, based on current guidelines starting from December 2014, was developed by the Infection Control and Thoracic Surgery Teams. The effects of this protocol were assessed by monitoring a total of 1380 patients before and after its implementation from January 1, 2011, to December 31, 2022.
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Affiliation(s)
- Bahar Madran
- Department of Public Health, Koç University School of Medicine, İstanbul, Türkiye
- Koç University İşbank Research Center for Infectious Diseases (KUISCID), İstanbul, Türkiye
| | - Şiran Keske
- Koç University İşbank Research Center for Infectious Diseases (KUISCID), İstanbul, Türkiye
- Infection Control Department, American Hospital, İstanbul, Türkiye
- Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, İstanbul, Türkiye
| | - Serhan Tanju
- The Thoracic Surgery Department, Koç University School of Medicine, İstanbul, Türkiye
| | - Ekin Ezgi Cesur
- The Thoracic Surgery Department, VKV American Hospital, İstanbul, Türkiye
| | - Selin Pala
- The Thoracic Surgery Department, VKV American Hospital, İstanbul, Türkiye
| | - Şükrü Dilege
- The Thoracic Surgery Department, Koç University School of Medicine, İstanbul, Türkiye
- The Thoracic Surgery Department, VKV American Hospital, İstanbul, Türkiye
| | - Önder Ergönül
- Koç University İşbank Research Center for Infectious Diseases (KUISCID), İstanbul, Türkiye
- Infection Control Department, American Hospital, İstanbul, Türkiye
- Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, İstanbul, Türkiye
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Madran B, Kayı İ, Beşer A, Ergönül Ö. Uptake of COVID-19 vaccines among healthcare workers and the effect of nudging interventions: A mixed methods study. Vaccine 2023:S0264-410X(23)00688-6. [PMID: 37336661 PMCID: PMC10250152 DOI: 10.1016/j.vaccine.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 05/29/2023] [Accepted: 06/06/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND During the coronavirus disease (COVID-19) pandemic, vaccination of healthcare workers (HCWs) has a critical role because of their high-risk exposure and being a role model. Therefore, we aimed to investigate vaccine hesitancy and the role of mandatory polymerase chain reaction (PCR) testing and education for vaccine uptake. METHODS We conducted an explanatory sequential designed observational mixed-methods study, including quantitative and qualitative sections consecutively in two different pandemic hospitals between 15 September 2021 and 1 April 2022. The characteristics of vaccinated and unvaccinated HCWs were compared. The vaccine hesitancy scales were applied, and the effect of nudging, such as mandatory PCR and education, were evaluated. In-depth interviews were performed to investigate the COVID-19 vaccine hesitancy among HCWs according to Health Belief Model. RESULTS In total, 3940 HCWs were included. Vaccine hesitancy was more common among males than females, the ancillary workers than other health professions, and nonmedical departments than other departments. After the mandatory weekly PCR request nudge, 83.33 % (130/156) vaccine-hesitant HCWs were vaccinated, and 8.3 % (13/156) after the small group seminars and mandatory PCR every two days. The rate of COVID-19 vaccination was raised from 95.5 % to 99.67 % (3927/3940). At the end of in-depth interviews (n = 13), the vaccine hesitancy determinants were distrust, fear of uncertainty, immune confidence and spirituality, the media effect, social pressure, and obstinacy. CONCLUSIONS The nudging interventions such as mandatory PCR testing and small group seminars helped raise the rate of COVID-19 vaccination; the most effective one is mandatory PCR.
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Affiliation(s)
- Bahar Madran
- Koç University, School of Nursing, Public Health Nursing, Istanbul, Turkey.
| | - İlker Kayı
- Koç University, School of Medicine, Department of Public Health, Istanbul, Turkey; Koç University İşbank Center for Infectious Diseases (KUISCID), Istanbul, Turkey.
| | - Ayşe Beşer
- Koç University, School of Nursing, Public Health Nursing, Istanbul, Turkey.
| | - Önder Ergönül
- Koç University İşbank Center for Infectious Diseases (KUISCID), Istanbul, Turkey; Koç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
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Madran B, Akbulut Z, Akbaba G, Taş E, Güçlüoğlu T, Şencanlı Ö, Bozkurt İ, Keske Ş, Ergönül Ö. COVID-19 Severity among Healthcare Workers: Overweight Male Physicians at Risk. Infect Dis Rep 2022; 14:310-314. [PMID: 35645215 PMCID: PMC9149914 DOI: 10.3390/idr14030036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/18/2022] [Accepted: 04/23/2022] [Indexed: 12/10/2022] Open
Abstract
We performed a prospective longitudinal cohort study in two healthcare settings. In total, 909 HCWs out of 3982 (23.35%) were diagnosed with COVID-19 before the vaccination era. Eighty-five per cent of COVID-19 positive HCWs (n = 774) were asymptomatic or mild, and 15% were moderate or severe. The mean age of the infected HCWs in the moderate or severe group was higher than the mild or asymptomatic group (35.4 vs. 31.3 years, p < 0.001). Thirty-two per cent of HCWs were male and the rate of male gender was more frequent in the moderate/severe group (p = 0.009). The rate of those who have cardiovascular diseases (p = 0.003) and diabetes mellitus (p = 0.044) were significantly higher among the HCWs with moderate or severe COVID-19. In multivariate analysis, male gender (OR:1.65, CI:1.11−2.46, p = 0.013), BMI > 30 (OR: 1.9, CI: 1.09−3.51, p = 0.024), and being physician (OR: 2.56, CI:1.45−4.52, p = 0.001) were found to be associated with moderate or severe COVID-19.
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Affiliation(s)
- Bahar Madran
- Infection Control Unit, VKV American Hospital, Istanbul 34365, Turkey;
- Correspondence:
| | - Zeliha Akbulut
- Infection Control Unit, Koç University Hospital, Istanbul 34010, Turkey; (Z.A.); (E.T.); (T.G.)
| | - Gözde Akbaba
- Infection Control Unit, VKV American Hospital, Istanbul 34365, Turkey;
| | - Emre Taş
- Infection Control Unit, Koç University Hospital, Istanbul 34010, Turkey; (Z.A.); (E.T.); (T.G.)
| | - Tuğba Güçlüoğlu
- Infection Control Unit, Koç University Hospital, Istanbul 34010, Turkey; (Z.A.); (E.T.); (T.G.)
| | - Özgür Şencanlı
- Occupational Safety Unit, VKV American Hospital, Istanbul 34365, Turkey;
| | - İsmail Bozkurt
- Hospital Management Department, VKV American Hospital, Istanbul 34365, Turkey;
| | - Şiran Keske
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul 34010, Turkey; (Ş.K.); (Ö.E.)
- İşbank Center for Infectious Diseases, Koç University, Istanbul 34010, Turkey
| | - Önder Ergönül
- Infectious Diseases and Clinical Microbiology, School of Medicine, Koç University, Istanbul 34010, Turkey; (Ş.K.); (Ö.E.)
- İşbank Center for Infectious Diseases, Koç University, Istanbul 34010, Turkey
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Madran B, Kesken Ş, Bakır VO, Ergönül Ö. The Effectiveness of Bundle Applications in the Prevention of Central Line-associated Bloodstream Infections: Nine Years of Observation. Infect Dis Clin Microbiol 2022; 4:40-46. [PMID: 38633548 PMCID: PMC11022820 DOI: 10.36519/idcm.2022.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/23/2022] [Indexed: 04/19/2024]
Abstract
Objective This study aimed to assess the effectiveness of chlorhexidine-impregnated dressing in a bundle of interventions to reduce the rate of central line-associated bloodstream infections (CLABSIs). Materials and Methods We performed a bundle of interventions to reduce the CLABSIs from 2012. As one bundle component, we started using the chlorhexidine impregnated catheter dressing. We used a document describing applying central venous catheters for the practicing physicians and nurses, and we organized several educational meetings. An interrupted time-series analysis was performed. Results Seventy-six CLABSI events were detected in total between January 1, 2011, and December 31, 2019. Twenty-six cases were detected in the pre-intervention period (January 1, 2011, to December 31, 2011), and 50 patients were seen in the post-intervention term (January 1, 2012, to December 31, 2019). The annual CLABSI rate was 2.60/1000 catheter days in the pre-intervention period and 0.46/1000 catheter days (p=0.0328) in the post-intervention period. The CLABSI rate among hematology-oncology inpatients decreased from 3.39 to 0.71 (p=0.0101) in the same term. Conclusion By using bundle form including chlorhexidine impregnated dressing, the rate of CLABSIs decreased significantly. This effect has been observed consistently for nine years, and the clinical pathway use has become the standard care protocol.
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Affiliation(s)
- Bahar Madran
- Infection Control Department, American Hospital, İstanbul,
Turkey
| | - Şiran Kesken
- Koç University İş Bank Research Center for Infectious Diseases,
Istanbul, Turkey
- Department of Infectious Diseases and Clinical Microbiology, Koç
University, School of Medicine, İstanbul, Turkey
| | - Veli Oğuzalp Bakır
- Department of Industrial Engineering and Operations Management,
Koç University, School of Sciences and Engineering, İstanbul, Turkey
| | - Önder Ergönül
- Koç University İş Bank Research Center for Infectious Diseases,
Istanbul, Turkey
- Department of Infectious Diseases and Clinical Microbiology, Koç
University, School of Medicine, İstanbul, Turkey
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Ergonul O, Tokca G, Keske Ş, Donmez E, Madran B, Kömür A, Gönen M, Can F. Elimination of healthcare-associated Acinetobacter baumannii infection in a highly endemic region. Int J Infect Dis 2021; 114:11-14. [PMID: 34653659 DOI: 10.1016/j.ijid.2021.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022] Open
Abstract
This paper describes the elimination of healthcare-associated Acinetobacter baumannii infections in a highly endemic region. A prospective, observational study was performed between October 2012 and October 2017. Acinetobacter baumannii were isolated from 59 patients, and >95% similarity was demonstrated among isolates of seven patients (DiversiLab™, BioMérieux). Carbapenemase activity was detected in 15 of 17 (88%) isolates, and all were OXA-23 type. The control of Acinetobacter baumannii outbreaks can be achieved by close follow-up supported by molecular techniques, strict application of infection control measures, and isolation of transferred patients.
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Affiliation(s)
- Onder Ergonul
- Department of Infectious Diseases, School of Medicine, Koç University, Istanbul, Turkey.
| | | | - Şiran Keske
- Department of Infectious Diseases, School of Medicine, Koç University, Istanbul, Turkey
| | | | | | | | - Mehmet Gönen
- College of Engineering and School of Medicine, Koç University, Istanbul, Turkey
| | - Fusun Can
- Department of Infectious Diseases, School of Medicine, Koç University, Istanbul, Turkey
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Kayı İ, Madran B, Keske Ş, Karanfil Ö, Arribas JR, Psheniсhnaya N, Petrosillo N, Gönen M, Ergönül Ö. The seroprevalence of SARS-CoV-2 antibodies among health care workers before the era of vaccination: a systematic review and meta-analysis. Clin Microbiol Infect 2021; 27:1242-1249. [PMID: 34116205 PMCID: PMC8186944 DOI: 10.1016/j.cmi.2021.05.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/16/2021] [Accepted: 05/22/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prevalence of SARS-CoV-2 infection among health care workers (HCWs) provides information about the spread of COVID-19 within health care facilities, and the risk groups. OBJECTIVES We aimed to describe the rate of SARS-CoV-2 seroprevalence and its determinants among HCWs. DATA SOURCES We used Web of Science, PubMed, Scopus, MEDLINE, EBSCOhost and Cochrane Library. STUDY ELIGIBILITY CRITERIA We included the reports of SARS-CoV-2 seroprevalence with a sample size of minimum 1000 HCWs. METHODS The study was registered at the International Prospective Register of Systematic Reviews (PROSPERO, no. CRD42021230456). We used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The keywords were "COVID-19", "SARS-CoV-2", "Coronavirus", "seroprevalence", "health care workers" and "risk factors". RESULTS In total 4329 reports were retrieved, duplications were removed; after filtering according to the title and abstract, 25 studies were selected. Risk of bias was assessed in 25 studies; it was low in 13 studies, medium in four studies, and high in eight studies. In meta-analysis using the random effect model, the weighted average of seroprevalence was calculated as 8% (95% CI 6-10%). The pooled seroprevalence rates of the selected variables that have a rate above the average were male HCWs with 9% (95% CI 7-11%); HCWs from ethnic minorities with 13% (95% CI 9-17%); high exposure 9% (95% CI 6-13%); exposure to the virus outside the health care setting 22% (95% CI 14-32%). CONCLUSIONS Our analysis indicates a SARS-CoV-2 seroprevalence rate of 8% among studies that included >1000 HCWs for the year 2020, before vaccinations started. The most common risk factors associated with higher seroprevalence rate were ethnicity, male gender and having a higher number of household contacts. Working as a frontline HCW was inconsistent in its association with higher seroprevalence.
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Affiliation(s)
- İlker Kayı
- Koç University, School of Medicine, Department of Public Health, Istanbul, Turkey
| | - Bahar Madran
- Koç University, School of Nursing, Department of Public Health, Istanbul, Turkey
| | - Şiran Keske
- Koç University İş Bank Research Center for Infectious Diseases (KUISCID), Istanbul, Turkey; Koç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Özge Karanfil
- Koç University, College of Administrative Sciences and Economics, Department of Operations Management, Istanbul, Turkey
| | - Jose Ramon Arribas
- La Paz Hospital, Department of Internal Medicine, Infectious Diseases Unit, Madrid, Spain
| | - Natalia Psheniсhnaya
- Central Research Institute of Epidemiology, Clinical Department of Infectious Pathology, Moscow, Russia
| | - Nicola Petrosillo
- National Institute for Infectious Diseases 'L. Spallanzani', IRCCS, Rome, Italy
| | - Mehmet Gönen
- Koç University İş Bank Research Center for Infectious Diseases (KUISCID), Istanbul, Turkey; Koç University, College of Engineering, Department of Industrial Engineering, Istanbul, Turkey
| | - Önder Ergönül
- Koç University İş Bank Research Center for Infectious Diseases (KUISCID), Istanbul, Turkey; Koç University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey.
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Madran B, Keske Ş, Tokça G, Dönmez E, Ferhanoğlu B, Çetiner M, Mandel NM, Ergönül Ö. Implementation of an antimicrobial stewardship program for patients with febrile neutropenia. Am J Infect Control 2018; 46:420-424. [PMID: 29174192 DOI: 10.1016/j.ajic.2017.09.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/23/2017] [Accepted: 09/25/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND We aimed to describe the effectiveness of our standardized protocol for febrile neutropenia (FN), which was targeted to minimize unintended outcomes and reduce antimicrobial consumption. METHODS The study was performed in a private hospital with 300 beds. We included all adult hematologic and oncologic cancer inpatients admitted between January 1, 2015-December 31, 2015, and January 1, 2016-May 31, 2017. The outcomes of the study were fatality, infections, and adherence to the antimicrobial stewardship program (ASP). RESULTS We included 152 FN attacks of 95 adult inpatients from hematology and oncology wards; of these, 43% were women, and the median age was 57 years. The case fatality rate was 30% in the pre-ASP period and decreased to 11% in the post-ASP period (P = .024). The appropriate adding or changing (P = .006) and appropriate continuation or de-escalation or discontinuation of antimicrobials improved (P < .001). In the post-ASP period, Staphylococcus spp infections (from 22% to 8%, P = .02) and gram-negative infections decreased (from 43% to 20%, P = .003). In the multivariate analysis, appropriate continuation or de-escalation or discontinuation was increased in the post-ASP period (odds ratio [OR], 4.3; 95% confidence interval [CI], 1.82-10.41; P = .001), and gram-positive infections were decreased (OR, 0.32; 95% CI, 0.11-0.95, P = .041). Vancomycin and fluoroquinolone use decreased significantly. CONCLUSIONS After implementation of the ASP, the case fatality rate among the patients with FN decreased. Appropriate antimicrobial use increased and overall antimicrobial consumption was reduced. Bacterial infections and Candida infections decreased.
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Affiliation(s)
- Bahar Madran
- Infectious Diseases Department, American Hospital, Istanbul, Turkey
| | - Şiran Keske
- Infectious Diseases Department, American Hospital, Istanbul, Turkey
| | - Gizem Tokça
- Infectious Diseases Department, American Hospital, Istanbul, Turkey
| | - Ebru Dönmez
- Infectious Diseases Department, American Hospital, Istanbul, Turkey
| | | | - Mustafa Çetiner
- Internal Medicine and Hematology Department, School of Medicine, Koç University, Istanbul, Turkey
| | | | - Önder Ergönül
- Infectious Diseases and Clinical Microbiology Department, School of Medicine, Koç University, Istanbul, Turkey.
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