Infection, disease & health最新文献

Objective: This systematic review aims to underscore the adoption and implementation of infection prevention and control (IPC) practices based on the World Health Organization's Infection Prevention and Control Assessment Framework (IPCAF) in low- and middle-income countries (LMICs).

Methods and design: Systematic review.

Guiding methodology: Cochrane Handbook for systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Data sources: PubMed, Google Scholar, Web of Science, Scopus, Cochrane, grey literature and reference lists of studies published between January 2018 and September 2024.

Eligibility criteria to recruit studies: Peer reviewed full length, cross-sectional, mixed method and quasi-experimental studies written in English, conducted in LMICs and used IPCAF as assessment tool.

Data extraction and synthesis: Data were extracted on a data extraction form and quality of studies was evaluated by using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields. Evidence was generated as a group of themes.

Findings: In total, 24 studies were selected based on eligibility criteria. IPC program was implemented to a varying degree in healthcare facilities (HCFs) of LMICs. Key barriers reported were; no allocation of budget for IPC, insufficient staffing of full-time IPC professionals, absence of clear IPC goals, challenges in staff training, lack of resources, no periodic monitoring and inconsistent availability of IPC supplies.

Conclusions: There was an evidence on implementation of IPC program in the HCFs of LMICs, however, LMICs faced substantial challenges in achieving consistent and effective IPC.

Background: The overcrowding of prison cells, combined with precarious and unsanitary conditions, is a critical factor for the health of inmates. This study carried out phenotypic and molecular characterization of the pathogen responsible for an outbreak of furunculosis in a penitentiary in southern Brazil.

Methods: Samples were collected using sterile swabs from the furuncles, then subjected to biochemical identification, disk diffusion, and RAPD-PCR.

Results: Biochemical tests identified Staphylococcus aureus as the etiological agent of this skin infection, while the RAPD-PCR technique revealed a common genetic profile among the affected individuals. All strains analyzed showed susceptibility to most of the antimicrobials evaluated, except penicillin.

Conclusions: These findings highlight the need for investment in prison facilities, efficient disinfection protocols, continuous monitoring, and equitable health treatment for growing inmates in Brazil's prison complex.

Background: Protecting the health workforce is essential to health systems resilience for emerging infectious disease (EID) outbreaks. We explored healthcare workers (HCWs) perceptions of infection prevention and control (IPC) guidelines and training needs for managing the Coronavirus Disease 2019 (COVID-19) pandemic in Sri Lanka as part of a larger study, which aimed to create role specific IPC guidelines for HCWs in low-and-middle-income countries (LMICs).

Methods: Using a qualitative descriptive approach, sixteen semi-structured interviews were conducted among hospital and public health HCWs including, physicians, nurses, public health midwives and support staff, such as cleaning staff, in Kalutara District of Sri Lanka.

Results: Interview findings are described under three themes: HCW workload during an EID outbreak; evolving EID management guidance and education during a public health emergency; and desired EID guidance and IPC education during a public health emergency. The COVID-19 pandemic increased staff workload across the spectrum; HCWs were provided with some form of IPC training but there were lapses in adherence; and staff were interested in having easy to use desk guides, training videos, formal training and access to all training material.

Conclusion: A tailored approach to IPC education based on identified overall and key specific needs (such as training support staff) provides crucial information to improve HCW knowledge of IPC practices in Sri Lanka. In addition, IPC education must be extended to all HCWs to sustain best practices before, during, and after health emergencies.

Introduction: Infection control is crucial in healthcare, particularly in intensive care units (ICUs), where patients are at high risk of infection due to mechanical ventilation. Ventilator-associated pneumonia (VAP) is one of the most common hospital-acquired infections in ICUs, leading to increased morbidity, prolonged hospital stays, and elevated healthcare costs. Nurses are essential in implementing infection control measures to prevent these infections. Evaluating their knowledge and practices is key to identifying areas for improvement.

Aim: This study assesses ICU nurses' knowledge and practices regarding infection control, particularly in preventing VAP in mechanically ventilated patients.

Methods: A descriptive observational study was conducted at King Fahad Specialist Hospital in Saudi Arabia. Participants were selected using purposive sampling based on their experience and direct care responsibilities. Data were collected using a self-report questionnaire and an observational checklist. The questionnaire assessed knowledge across domains such as infection control principles and VAP prevention, while the checklist evaluated practices like hand hygiene and adherence to VAP bundles.

Results: The study found that 61.2 % of nurses demonstrated satisfactory infection control practices, with hand hygiene showing the highest compliance (81.8 %). However, VAP bundle adherence was low (42.4 %). Knowledge gaps were also identified, especially in VAP prevention and oral care.

Conclusion: The findings suggest a need for targeted educational programs to improve infection control practices among ICU nurses. Enhanced training could address observed gaps in knowledge and practice, particularly in VAP prevention and oral care, ultimately improving patient outcomes.

Background: Healthcare-acquired infections are frequently linked to contaminated medical devices such as inadequately sterilized surgical devices, especially surgical implants. To prevent inadequate medical equipment sterilization, various health organizations (eg, World Health Organization) have provided guidance on best practices related to the sterilization monitoring practices of implant-containing loads.

Methods: A survey of sterilization practices, including practices related to monitoring implant-containing loads, at facilities from seven countries in the Western Pacific Region (WPR) and three countries in the Southeast Asia Region (SEAR) was conducted to assess alignment with health organization guidelines and to elucidate factors impacting sterilization practices.

Results: Workload distribution was selected by 47 % of respondents when asked what had changed over the past year. Overall, 21 % of respondents were not monitoring each implant-containing load with a PCD (Process Challenge Device) containing a BI (Biological Indicator) with a Type-5 Chemical Indicator (CI), and 27 % of respondents had seen an implant load released prior to receiving BI results. Twenty-nine percent (29 %) of respondents had no placement guide for CIs when used in multi-level trays. Lastly, 43 % of respondents routinely performed immediate use system sterilization (IUSS), which commonly involved loaner instruments.

Conclusions: The results of this survey study indicate that inappropriate PCD usage in implant loads and frequent IUSS are challenges for some facilities in SEAR and WPR countries. Regional collaboration to produce consensus documents and educational programs may help develop strategies to standardize practice of implant load monitoring and loaner instruments. Thus, a consortium to initiate education programs for SEAR and WPR countries would be worthwhile.

Background: Recently, the cosmetic market has been attracting growing attention. However, studies on the bacterial safety of these products are still very rare. In this preliminary study, we aimed to detect the presence of antibiotic-resistant staphylococci isolates from makeup testers beauty retailers in the city of Batna, Algeria.

Methods: In May 2019, a total of 325 samples were collected by swabbing the surface of different types of makeup testers including mascara, lipstick, eye shadow, face powder and blusher in different beauty retailers. The samples were immediately subjected to non-selective culture, followed by selective isolation. Representative colonies were identified using matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF-MS). Antimicrobial susceptibility testing was carried out by agar disk diffusion method.

Results: Nineteen isolates were obtained from the different types of makeup testers and were identified as: Bacillus mojavensis (n = 1), Staphylococcus haemolyticus (n = 4), Bacillus subtilis (n = 3), Bacillus cereus (n = 3), Bacillus pumilus (n = 1), Bacillus sp. (n = 1), Bacillus amyloliquefaciens (n = 1), Staphylococcus warneri (n = 1) and four unidentified species (n = 4). Antimicrobial susceptibility test results revealed that Staphylococcus haemolyticus presented the highest antibiotic resistance level.

Conclusions: These results showed that makeup testers may act as reservoir and pathway of antibiotic-resistant Gram-positive bacteria transmission. Hence, to reduce health risks and enhance public safety awareness, it is crucial to implement effective control measures and preventive strategies.

Background: Clear specification of desired behaviour within evidence-based guidelines and policies might make them more actionable, i.e. increase the likelihood that those behaviours will take place in practice. It was our expectation that the level of specificity in such documents would be higher, i.e. more detailed, at the organisational level compared with the national level, given that local documents are developed for a specific setting and workforce. This study aimed to compare infection prevention and control (IPC) behaviours and their specificity in a national guideline with local residential aged care policies and procedures.

Methods: The document analysis was informed by the Action, Actor, Context, Target and Time (AACTT) framework. The Australian Guidelines for the Prevention and Control of Infection in Healthcare and the local policies and procedures of eight residential aged care providers were investigated.

Results: There was some overlap between behaviours in the national guideline and local policies and procedures. However, of the 63 behavioural statements in the guideline relating to hand hygiene and appropriate use of gloves and masks, only eight statements were mentioned by all residential aged care providers. Twelve statements were mentioned in the local policies and procedures but not mentioned in the guideline and two statements mentioned locally seemed to conflict with the guideline. IPC statements were generally not well specified in either the national guideline or local documents.

Conclusion: Local policies and procedures should be more aligned with national guidelines to reflect the evidence base. Once this alignment is in place, attention should be given to increasing the specificity and actionability of these documents.

Background: Healthcare-associated infections pose a significant global health challenge. While evidence-based infection prevention and control (IPC) interventions are widely implemented, their implementation may be influenced by religious factors. This scoping review aimed to examine the religious factors that influence IPC practices among healthcare providers.

Method: A systematic search was conducted in CINAHL, Emcare, Scopus, and Web of Science databases. Given the anticipated paucity of literature, there were no date limiters. Articles demonstrating a direct relationship between religion and IPC practices in healthcare settings were included. Data extraction and quality appraisal were performed independently by multiple researchers.

Results: Thirteen articles met the inclusion criteria. Three main themes emerged: 1) religious rituals and influence, 2) use of alcohol, and 3) "bare below the elbows" principle. Religious practices were found to act as both enablers and barriers to IPC compliance. The use of alcohol-based hand rubs presented challenges for some religious groups, while religious dress codes conflicted with the "bare below the elbows" principle.

Conclusion: This review highlights the complex interplay between religion and IPC practices. Findings suggest the need for culturally sensitive IPC strategies that respect religious beliefs while maintaining effective IPC measures. Further research is needed to develop inclusive policies and educational programs that address these religious factors in healthcare settings.

Background: Escherichia coli (E. coli) is a common pathogen responsible for various infections, particularly in healthcare settings. Its antibiotic resistance and susceptibility patterns are crucial for effective treatment. This study aims to assess the prevalence of E. coli in clinical samples and evaluate its antibiotic resistance patterns at SRM Medical Hospital and Research Center from 2022 to 2023.

Methods: A retrospective study was conducted using microbiological records from 30,838 clinical samples collected over two years. Positive E. coli isolates were identified and subjected to antimicrobial susceptibility testing. Demographic data, including age and sex, were analysed. Resistance patterns were assessed using the Vitek 2 system and disc diffusion methods as per CLSI guidelines.

Results: Out of 30,838 samples, 8694 yielded positive cultures, with 2597 E. coli isolates. Most isolates (69.6 %) were from urine, followed by exudate (20.4 %) and blood (6.8 %). E. coli infection was more prevalent in females (60.92 %) and individuals aged 41-70 years (48.97 %) (p < 0.001). High resistance was observed for amoxicillin-clavulanate (32 %) and ciprofloxacin (17.98 %), with high susceptibility to colistin (90.98 %) and piperacillin-tazobactam (90 %).

Conclusion: This study highlights the prevalence of E. coli, especially in urine samples and among females and older adults. High resistance to commonly used antibiotics emphasizes the need for regular susceptibility testing and antimicrobial stewardship.

Clinical implication: This study emphasizes the need for ongoing antibiotic resistance monitoring and customized treatment strategies to combat E. coli infections. Future efforts should focus on enhancing antimicrobial stewardship programs to reduce the spread of resistant strains.

Background: Antimicrobial resistance is a public health problem. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the microorganisms most responsible for illness and death. The aim was to characterize the infections caused by S. aureus and to determine the factors associated with in-hospital mortality in patients treated in a highly complex clinic in Colombia.

Methods: This was a longitudinal retrospective observational study of patients with culture-confirmed S. aureus infections who received hospital care between 2018 and 2023. Follow-up was carried out until the patients died or were discharged from the clinic. Descriptive, bivariate and multivariate analysis was performed.

Results: A total of 361 patients were included; 62.6 % were men, and the mean age was 49.2 years. Most patients were diagnosed with skin and soft tissue infections (51.0 %) and bacteremia (25.5 %). The most used antibiotics were clindamycin (53.5 %) and vancomycin (42.7 %). A total of 46.3 % had MRSA infections and 25.8 % were resistant to clindamycin, 37.7 % of the patients received care in the intensive care unit, 33.2 % had sepsis, 19.1 % required invasive mechanical ventilation, and 13.9 % died. Higher Charlson comorbidity index (aOR:1.45; 95%CI:1.04-2.02), higher Pitt Bacteremia Score (aOR:1,72; 95%CI:1.21-2.46) and bacteremia (aOR:5.30; 95%CI:1.44-19.41) increased the probability of death. Those who were empirically managed with antibiotics that had coverage for MRSA (aOR:0.03; 95%CI:0.00-0.24) and higher levels of hemoglobin (aOR:0.75; 95%CI:0.65-0.87) had a lower risk of death.

Conclusion: MRSA infections are frequent, with significant resistance to clindamycin. The identification of variables associated with a higher risk of dying may be useful for establishing protocols in hospitals that reduce this outcome.