Cost-effectiveness analysis of an active 30-day surgical site infection surveillance at a tertiary hospital in Ghana: evidence from HAI-Ghana study

ObjectiveTo assess the cost-effectiveness of an active 30-day surgical site infection (SSI) surveillance mechanism at a referral teaching hospital in Ghana using data from healthcare-associated infection Ghana (HAI-Ghana) study.DesignBefore and during intervention study using economic evaluation model to assess the cost-effectiveness of an active 30-day SSI surveillance at a teaching hospital. The intervention involves daily inspection of surgical wound area for 30-day postsurgery with quarterly feedback provided to surgeons. Discharged patients were followed up by phone call on postoperative days 3, 15 and 30 using a recommended surgical wound healing postdischarge questionnaire.SettingKorle-Bu Teaching Hospital (KBTH), Ghana.ParticipantsAll prospective patients who underwent surgical procedures at the general surgical unit of the KBTH.Main outcome measuresThe primary outcome measures were the avoidable SSI morbidity risk and the associated costs from patient and provider perspectives. We also reported three indicators of SSI severity, that is, length of hospital stay (LOS), number of outpatient visits and laboratory tests. The analysis was performed in STATA V.14 and Microsoft Excel.ResultsBefore-intervention SSI risk was 13.9% (62/446) as opposed to during-intervention 8.4% (49/582), equivalent to a risk difference of 5.5% (95% CI 5.3 to 5.9). SSI mortality risk decreased by 33.3% during the intervention while SSI-attributable LOS decreased by 32.6%. Furthermore, the mean SSI-attributable patient direct and indirect medical cost declined by 12.1% during intervention while the hospital costs reduced by 19.1%. The intervention led to an estimated incremental cost-effectiveness ratio of US$4196 savings per SSI episode avoided. At a national scale, this could be equivalent to a US$60 162 248 cost advantage annually.ConclusionThe intervention is a simple, cost-effective, sustainable and adaptable strategy that may interest policymakers and health institutions interested in reducing SSI.

Hubungan Kepatuhan Cuci Tangan dan Penggunaan APD Perawat dengan Resiko Kejadian Healthcare Associated Infections (HAIS) pada Masa Pandemi Covid-19 di RSUD Mayjend. H.M. Ryacudu Lampung Utara

ABSTRACT: RELATIONSHIP OF HANDWASHING COMPLIANCE AND NURSE PPE USE WITH RISK OF HEALTHCARE ASSOCIATED INFECTIONS (HAIS) DURING THE COVID-19 PANDEMIC AT RSUD MAYJEN H.M. RYACUDU NORTH LAMPUNG Introduction: Infection is the invasion of the body by a pathogen or microorganism, which can cause disease or tissue damage. A hospital infection or hospital-acquired infection (HOIS) or healthcare-associated infection (HAIS) is an infection acquired during a patient's hospital stay, provided that the incubation period of the disease has not occurred at the time of admission. Objective: It is known that there is a relationship between handwashing compliance and the use of PPE for nurses with the risk of healthcare-associated infections (HAIS) during the COVID-19 pandemic at the Mayjend. H.M Ryacudu Hospital, North Lampung in 2021. Methods : The type of research used in this study is related to the descriptive nature with a cross sectional research design. The subjects of this study were all obstetrical, pediatric (perinatal and NICU) nurses, operating rooms and internal medicine at Mayjend.H.M Ryacudu Hospital, North Lampung. The number of samples used as many as 60 respondents.Results: The statistical test of nurses' compliance with the chi-square in handwashing obtained a p-value of 0.033 where the p-value < (0.033 < 0.05) then Ha, and the Odds Ration value was accepted at 0.314. By using the chi-square statistical test for nurses who use PPE, the p-value is 0.241, so the p-value < (0.241 > 0.05) and Ho is rejected, and the Odds ration value is 0.519.Conclusion: There is a relationship between handwashing compliance with the risk of health-related infections (HAIS), and there is no relationship between the use of PPE by nurses and the risk of healthcare-associated infections (HAIS) at the Mayjend H.M Ryacudu Hospital, North Lampung. Keywords: Compliance with handwashing, use of APD, HAIS INTISARI : HUBUNGAN KEPATUHAN CUCI TANGAN DAN PENGGUNAAN APD PERAWAT DENGAN RESIKO KEJADIAN HEALTHCARE ASSOCIATED INFECTIONS (HAIS) PADA MASA PANDEMI COVID-19 DI RSUD MAYJEND. H.M. RYACUDU LAMPUNG UTARA Pendahuluan : Infeksi adalah invasi tubuh oleh patogen atau mikroorganisme, yang dapat menyebabkan penyakit atau kerusakan jaringan. Infeksi rumah sakit atau infeksi yang didapat di rumah sakit (HOIS) atau infeksi terkait perawatan kesehatan (HAIS) adalah infeksi yang diperoleh selama pasien dirawat di rumah sakit, asalkan masa inkubasi penyakit belum berlangsung pada saat masuk. Tujuan : Diketahui hubungan kepatuhan cuci tangan dan penggunaan APD perawat dengan resiko kejadian healthcare associated infections (HAIS) pada masa pandemi covid-19 di RSUD Mayjend.H.M Ryacudu Lampung Utara.Metode : Jenis penelitian yang digunakan dalam penelitian ini berkaitan dengan sifat deskriptif dengan desain penelitian cross sectional. Subyek penelitian ini adalah seluruh perawat obstetri, anak (perinatal dan NICU), kamar operasi dan penyakit dalam di RSUD Mayjend.H.M Ryacudu Lampung Utara. Jumlah sample yang dipakai sebanyak 60 responden.Hasil : Uji statistik kepatuhan perawat terhadap chi-square dalam cuci tangan diperoleh nilai p sebesar 0,033 dimana nilai p < α (0,033 < 0,05) kemudian Ha, dan nilai Oods Ration diterima sebesar 0,314. Dengan menggunakan uji statistik chi-square perawat yang menggunakan APD didapatkan nilai p-value 0,241, sehingga nilai p-value < α (0,241 > 0,05) dan Ho ditolak, serta nilai Oods ration sebesar 0,519.Kesimpulan : Memiliki hubungan antara kepatuhan cuci tangan dengan risiko infeksi terkait kesehatan (HAIS), serta tidak ada hubungan antara penggunaan APD oleh perawat dengan risiko healthcare associated infections (HAIS) pada RSUD mayjend H.M Ryacudu Lampung Utara. Kata Kunci : Kepatuhan cuci tangan, penggunaan APD, HAIS

Invasive Group B Streptococcal Disease in Neonates and Infants, Italy, Years 2015–2019

Invasive infections by group B streptococci (iGBS) are the leading cause of sepsis and meningitis in the first three months of life worldwide. The clinical and microbiological characteristics of neonatal and infant iGBS in Italy during the years 2015–2019 were investigated. Voluntary-based surveillance reported 191 cases (67 early-onset (EOD) and 124 late-onset disease (LOD)) and 89 bacterial isolates were received. The main clinical manifestations were sepsis (59.2%) followed by meningitis (21.5%), bacteremia (12.0%) and septic shock (6.3%). Hospitalized preterm babies accounted for one third of iGBS and constituted the most fragile population in terms of mortality (8.2%) and brain damage (16.4%). GBS serotype III was predominant in EOD (56%) and caused almost all LOD (95%). The rate of resistance to clindamycin reached 28.8%. Most of clindamycin-resistant GBS strains (76%) were serotype III-ST17 and possessed the genetic markers of the emerging multidrug resistant (MDR) CC-17 sub-clone. Our data revealed that iGBS is changing since it is increasingly reported as a healthcare-associated infection (22.6%), mainly caused by MDR-CC17. Continuous monitoring of the clinical and microbiological characteristics of iGBS remains of primary importance and it represents, at present, the most effective tool to support prevention strategies and the research on the developing GBS vaccine.

Factors Associated with Intention to Comply with Infection Control Guidelines in Physicians and Nurses: An Analysis Based on the Theory of Planned Behavior

Purpose: This study aimed to identify factors affecting physicians and nurses’ intention to comply with healthcare-associated infection control guidelines, based on the theory of planned behavior.Methods: This study was a cross-sectional, descriptive survey. Data were collected using self-report questionnaires from 169 doctors and nurses at a tertiary hospital. Pearson correlation analysis and multiple regression analysis were used to analyze the factors influencing intention to comply with healthcare-associated infection control guidelines.Results: The mean score of intention to comply with infection control guidelines was 17.17±2.60 points (possible range 3-21 points). The intention to comply with infection control guidelines was positively associated with subjective norms and perceived behavioral control over compliance with healthcare-associated infection control guidelines. In the multiple regression analysis, perceived behavioral control was the only significant predictor of intention to comply with healthcare-associated infection control guidelines.Conclusion: In order to encourage doctors and nurses to comply with infection control guidelines, it is necessary to provide resources, enhance the work environment, and utilize strategies to increase perceived behavioral control over compliance with infection control guidelines.

COVID-19 Nosocomial Transmission Dynamics, a Retrospective Cohort Study of Two Healthcare Associated Clusters in a District Hospital in England during March and April 2020

Summary Objective: To understand the transmission dynamics of SARS-CoV-2 in a hospital outbreak to inform infection control actions. Design: Retrospective cohort study. Setting: General medical and elderly inpatient wards in a hospital in England. Methods: COVID-19 patients were classified as community or healthcare-associated by time from admission to onset/positivity using European Centre for Disease Prevention and Control definitions. COVID-19 symptoms were classified as asymptomatic, non-respiratory or respiratory. Infectiousness was calculated from 2 days prior to 14 days post symptom onset or positive test. Cases were defined as healthcare-associated COVID-19 patients where infection was acquired from the wards under investigation. COVID-19 exposures were calculated based on symptoms and bed proximity to an infectious patient. Risk ratios and adjusted odds ratios (aOR) were calculated from univariable and multivariable logistic regression. Results: Of 153 patients: 65 were COVID-19 patients (45 healthcare-associated). Exposure to a COVID-19 patient with respiratory symptoms was associated with healthcare-associated infection irrespective of proximity (aOR 3.81; 95%CI 1.6.3-8.87), non-respiratory exposure was only significant within 2.5m (aOR 5.21; 95%CI 1.15-23.48). A small increase in risk ratio was observed for exposure to a respiratory patient for >1 day compared to 1 day from 2.04 (95%CI 0.99-4.22) to 2.36 (95%CI 1.44-3.88) Discussion: Respiratory exposure anywhere within a 4-bedded bay was a risk whereas non-respiratory exposure required bed distance ≤2.5m. Standard Infection control measures required beds to be >2m apart; our study suggests this may be insufficient to stop SARS-CoV-2 spread. We recommend improving cohorting and further studies into bed distance and transmission factors.

Spectrum of all microorganism isolated from surgical site infection and their antimicrobial susceptibility profile

Surgical site infection are the most common nosocomial infection accounting for 14% healthcare associated infection and are estimated to double the post-operative stay and significantly increase the cost of care. Surgical site infection has been considered as the third regularly occurring infection according to national nosocomial infection surveillance system.To determine the bacterial agents causing surgical site infection and antimicrobial susceptibility pattern of isolated microorganisms.: Isolate and identify pathogens of surgical site infection. To determine antimicrobial resistance and sensitivity pattern of isolated wound microbes. To determine the frequency of pathogens of surgical site infection.: Samples were cultured on Blood agar and MacConkey agar then incubated at 37 C for 24 hours. Any growth for further confirmed by Gram stain and appropriate biochemical tests, and then Antibiotic sensitivity test was done.: In this study 106 (61.7) were of male and 66 (38.3) were of female total 172 were examined. In our study total 172 patients included in which 142 pathogenic organism were isolated. The most common pathogenic organism found to be 44 isolates (30.99%) followed by 41 isolates (28.87%) 23 isolates (16.20%), 18 isolates (12.68%), 9 isolates (6.34%), 5 isolates (3.52%), 1 isolate (0.70%) and 1 isolate (0.70%). Antimicrobial resistance always pose challenges for clinician for treating wound infection the present study guide clinician about common pathogens and countered in pus sample furthermore it help the clinician to select and treat patients with proper antibiotics and decreased mortality and morbidity.

Microbial Profile and Antibiogram of Ventilator Associated Pneumonia at Tertiary Care Hospital U.P

Ventilator associated pneumonia (VAP) is a common and serious healthcare associated infection (HAI). VAP is inflammation of lung parenchyma caused by infectious agents that develops in a patient who is on a ventilator occurring 48-72 hrs or more after tracheal intubation and mechanical ventilation (MV). The risk of VAP is highest early in the course of hospital stay, and is estimated to be 3%/day during the first 5 days of ventilation, 2%/day during days 5-10 of ventilation and 1%/day after this. Aim of this study was find out the Microbial profile and antibiogram of ventilator associated pneumonia at tertiary care hospital U.P. This study was conducted in the Department of Microbiology, Rama Medical College, Hospital & Research Centre, Kanpur India from January 2016 to December 2016. A total of 100 Endotracheal aspirated samples were collected in a sterile & labelled clean dry container from the clinically suspected cases of VAP patients. Out of 100 patients 31 patients shown growth of the bacteria & considered as Ventilator Associated Pneumonia patients. And 69 patients have not shown any kind of growth. Acinetobacter baumanni, Pseudomonas aeruginosa, Enterobacter & Klebsiella Pneumoniae were the most common pathogens from both early & late onset VAP. Proper monitoring and strict implementation of infection control practices is very essential to reduce VAP in hospital setting. Also the short term use of invasive devices and judicious use of antibiotics are important in preventing VAP caused by these MDR pathogens.

Pseudomonas aeruginosa Susceptibility in Spain: Antimicrobial Activity and Resistance Suppression Evaluation by PK/PD Analysis

Pseudomonas aeruginosa remains one of the major causes of healthcare-associated infection in Europe; in 2019, 12.5% of invasive isolates of P. aeruginosa in Spain presented combined resistance to ≥3 antimicrobial groups. The Spanish nationwide survey on P. aeruginosa antimicrobial resistance mechanisms and molecular epidemiology was published in 2019. Based on the information from this survey, the objective of this work was to analyze the overall antimicrobial activity of the antipseudomonal antibiotics considering pharmacokinetic/pharmacodynamic (PK/PD) analysis. The role of PK/PD to prevent or minimize resistance emergence was also evaluated. A 10,000-subject Monte Carlo simulation was executed to calculate the probability of target attainment (PTA) and the cumulative fraction of response (CFR) considering the minimum inhibitory concentration (MIC) distribution of bacteria isolated in ICU or medical wards, and distinguishing between sample types (respiratory and non-respiratory). Ceftazidime/avibactam followed by ceftolozane/tazobactam and colistin, categorized as the Reserve by the Access, Watch, Reserve (AWaRe) classification of the World Health Organization, were the most active antimicrobials, with differences depending on the admission service, sample type, and dose regimen. Discrepancies between EUCAST-susceptibility breakpoints for P. aeruginosa and those estimated by PK/PD analysis were detected. Only standard doses of ceftazidime/avibactam and ceftolozane/tazobactam provided drug concentrations associated with resistance suppression.