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Tran DM, Larsson M, Olson L, TB Hoang N, Kien Ngai L, TK Khu D, Nguyen HD, Vu TV, Trinh TH, Le TQ, TT Phan P, Nguyen BG, Pham NH, Mai BH, Nguyen TV, Nguyen PTK, Le ND, Huynh TM, Anh Thu Le T, Chi Thanh T, Berglund B, Nilsson LE, Bornefall E, Huu SL, Stig-Inge. Hanberger H. 492. High Prevalence of Colonization with Carbapenem-Resistant Enterobacteriaceae Among Patients Admitted to Vietnamese Hospitals: Risk Factors and Burden of Disease. Open Forum Infect Dis 2019. [PMCID: PMC6811223 DOI: 10.1093/ofid/ofz360.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Carbapenem-resistant Enterobacteriaceae (CRE) is an increasing problem worldwide, but particularly problematic in low- and middle-income countries (LMIC) due to limitations of resources for surveillance of CRE and infection prevention and control (IPC). Methods A point prevalence survey (PPS) with screening for colonization with CRE was conducted on 2233 patients admitted to neonatal, pediatric and adult care at 12 Vietnamese hospitals located in northern, central and southern Vietnam during 2017 and 2018. CRE colonisation was determined by culturing of fecal specimens on selective agar for CRE. Risk factors for CRE colonisation were evaluated. A CRE admission and discharge screening sub-study was conducted among one of the most vulnerable patient groups; infants treated at an 80-bed Neonatal ICU from March throughout June 2017 to assess CRE acquisition, hospital-acquired infection (HAI) and treatment outcome. Results A total of 1165 (52%) patients were colonized with CRE, most commonly Klebsiella pneumoniae (n = 805), Escherichia coli (n = 682) and Enterobacter spp. (n = 61). Duration of hospital stay, HAI, intubation, peripheral venous catheter and treatment with a carbapenem were independent risk factors for CRE colonization. The PPS showed that the prevalence of CRE colonization increased on average 4.2% per day and mean CRE colonisation rates increased from 13% on the day of admission to 89% at day 15 of hospital stay. At the NICU CRE colonisation increased from 32% at admission to 87% at discharge, mortality was significantly associated (OR 5·5, P < 0·01) with CRE colonisation and HAI on admission. Conclusion These data indicate that there is an epidemic spread of CRE in Vietnamese hospitals with rapid transmission to hospitalized patients. CRE colonization places a major burden on the healthcare system due to the increased risk of HAI caused by CRE and associated increased mortality. This study shows that large-scale epidemiological surveillance of CRE using affordable methods is possible in low- and middle-income countries. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Dien M Tran
- Vietnam National Children’s Hospital, Hanoi, Ha Noi, Vietnam
| | | | - Linus Olson
- Karolinska Institutet, Stockholms Lan, Sweden
| | - Ngoc TB Hoang
- Vietnam National Children’s Hospital, Hanoi, Ha Noi, Vietnam
| | - Le Kien Ngai
- Vietnam National Children’s Hospital, Hanoi, Ha Noi, Vietnam
| | - Dung TK Khu
- Vietnam National Children’s Hospital, Hanoi, Ha Noi, Vietnam
| | | | - Tam V Vu
- Uong Bi Hospital, Quang Ninh, Vietnam, Uong Bi, Quang Ninh, Vietnam
| | | | - Thinh Q Le
- Children’s Hospital 1, Ho Chi Minh, Ho Chi Minh, Vietnam
| | | | | | | | - Bang H Mai
- Central Military Hospital 108, Hanoi, Ha Noi, Vietnam
| | - Tuan V Nguyen
- Central Military Hospital 108, Hanoi, Ha Noi, Vietnam
| | | | - Nhan D Le
- Da Nang General Hospital, Da Nang, Vietnam
| | - Tuan M Huynh
- University Medical Clinic, HCMC, Ho Chi Minh, Vietnam
| | | | - Tran Chi Thanh
- Training and Research Academic Collaboration Sweden-Vietnam, Hanoi, Ha Noi, Vietnam
| | - Björn Berglund
- Faculty of Medicine, Linköping University, Linkoping, Ostergotlands Lan, Sweden
| | - Lennart E Nilsson
- Clinical Microbiology, Faculty of Medicine, Linköping University, Linkoping, Ostergotlands Lan, Sweden
| | - Elin Bornefall
- Infectious Diseases, Faculty of Medicine, Linköping University, Linkoping, Ostergotlands Lan, Sweden
| | - Song L Huu
- Central Military Hospital 108, Hanoi, Ha Noi, Vietnam
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Campbell JI, Thanh Thuy P, Trang L, Thi Thu Huong D, Chandonnet C, Thi Hoa T, Duong H, Duc Duat N, Thi Huyen L, Thi Ha T, Thi Kim Oanh N, Thi Minh Than H, Kien Ngai L, Pollack T, Sandora T. 1192. A Visual Family Empowerment Tool Is Associated with Increased Healthcare Worker Hand Hygiene in a Pediatric Intensive Care Unit in Vietnam. Open Forum Infect Dis 2019. [PMCID: PMC6808815 DOI: 10.1093/ofid/ofz360.1055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Hand hygiene (HH) is the most effective way to prevent healthcare-associated infections. The World Health Organization (WHO) recommends empowering patients and families to remind healthcare workers (HCWs) to perform HH. The effectiveness of patient and family empowerment tools in Southeast Asia is unknown. Methods We performed a prospective intervention study in an intensive care unit of a pediatric referral hospital in Vietnam. Using family and HCW input, we created a visual tool for families to use to remind HCWs to perform HH. For 2 weeks pre-intervention, we collected baseline data on HH performance, method (hand rub or soap and water), adequacy, HCW type (e.g., physician, nurse), and WHO 5 moments of HH using direct, unobtrusive observation. During a subsequent 3-week intervention period, consenting families were provided the visual tool and educated on its use to prompt HCW HH. Prospective collection of outcome data continued during the intervention period. The primary outcome was change in HCW HH between baseline and intervention periods. Multivariable logistic regression models were used to identify independent predictors of HH. Results A total of 2,014 pre-intervention and 2,498 intervention period HH opportunities were observed. During the intervention period, 73 families received visual reminder tools and education. Overall HCW HH was 46% pre-intervention, which increased to 73% in the intervention period (P < 0.001). Lowest HH adherence in both periods occurred after HCW contact with patient surroundings (WHO Moment 5; 16% pre-intervention and 24% intervention). In multivariable analyses, the odds of HCW HH during the intervention period were significantly higher than pre-intervention (OR 2.94 [95% CI 2.54 – 3.41], P < 0.001) after adjusting for observation room, HCW type, time of observation (weekday business hours vs. evening/weekend), and HH moment. Among completed HH opportunities, HH adequacy was >90% in both periods. Conclusion Introduction of a visual empowerment tool was associated with significant improvement in HH adherence among HCWs in a Vietnamese pediatric intensive care unit. More research is needed to explore acceptability and barriers to the use of such tools in other low- and middle-income settings. ![]()
Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Pham Thanh Thuy
- Partnership for Health Advancement in Vietnam, Hanoi, Ha Noi, Vietnam
| | - Le Trang
- Partnership for Health Advancement in Vietnam, Hanoi, Ha Noi, Vietnam
| | | | | | - Truong Thi Hoa
- Vietnam National Children’s Hospital, Hanoi, Ha Noi, Vietnam
| | - Hao Duong
- Partnership for Health Advancement in Vietnam, Hanoi, Ha Noi, Vietnam
| | - Nguyen Duc Duat
- Partnership for Health Advancement in Vietnam, Hanoi, Ha Noi, Vietnam
| | - Le Thi Huyen
- Partnership for Health Advancement in Vietnam, Hanoi, Ha Noi, Vietnam
| | - Tran Thi Ha
- Partnership for Health Advancement in Vietnam, Hanoi, Ha Noi, Vietnam
| | | | | | - Le Kien Ngai
- Vietnam National Children’s Hospital, Hanoi, Ha Noi, Vietnam
| | - Todd Pollack
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States; and the Partnership for Health Advancement in Vietnam, Hanoi, Ha Noi, Vietnam
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Hai LT, Bich VTN, Ngai LK, Diep NTN, Phuc PH, Hung VP, Taylor WR, Horby P, Liem NT, Wertheim HFL. Fatal respiratory infections associated with rhinovirus outbreak, Vietnam. Emerg Infect Dis 2013; 18:1886-8. [PMID: 23092635 PMCID: PMC3559162 DOI: 10.3201/eid1811.120607] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During an outbreak of severe acute respiratory infections in 2 orphanages, Vietnam, 7/12 hospitalized children died. All hospitalized children and 26/43 children from outbreak orphanages tested positive for rhinovirus versus 9/40 control children (p = 0.0005). Outbreak rhinoviruses formed a distinct genetic cluster. Human rhinovirus is an underappreciated cause of severe pneumonia in vulnerable groups.
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