After a 2019 multispecies carbapenemase-producing Enterobacterales (CPE) outbreak, transmission persisted in a 660-bed hospital in South Korea despite enhanced screening and infection prevention and control measures. We evaluated the extent of environmental contamination, contribution of environmental reservoirs to ongoing transmission, and impact of targeted interventions. From January 2021 to April 2022, we conducted three rounds of hospital-wide environmental surveillance. Whole-genome sequencing of 61 environmental and clinical isolates was performed to assess clonal relatedness and plasmid-mediated spread. Interventions included daily sink decontamination, reinforcement of appropriate sink use, and waste-pipe replacement. In the first surveillance round, CPE was detected at 26 of 349 sampled sites (7.5
Caesarean delivery is one of the leading indications for antibiotic use in Lao People’s Democratic Republic (Lao PDR). National guidelines recommend a single pre-incision intravenous dose of ceftriaxone for surgical antibiotic prophylaxis (SAP), yet evidence on adherence and associated costs remains limited. This study assessed compliance with national guidelines, described prescribing patterns, and estimated the economic burden of non-adherence across three hospital levels. A retrospective descriptive study was conducted using medical records of women undergoing caesarean delivery between January and June 2024 in three hospitals representing central, provincial, and district levels. Demographic and antibiotic prescribing data were extracted. Compliance was assessed against the 2020 Lao Adult Antimicrobial Prescribing Guideline. Antibiotics were classified according to the WHO AWaRe framework, and costs were estimated using hospital acquisition prices. A total of 1,105 medical records were included, of which 1,102 women (99.7
Surgical site infections (SSIs) place a significant burden on healthcare systems worldwide. Although surveillance is crucial for obtaining accurate data and developing effective prevention strategies, there are still significant gaps due to the frequent reliance on manual and resource-intensive processes. To gain efficient, in-depth insight, we developed an algorithm for semi-Automated Retrospective Surveillance of Surgical Site Infections (sAReS-SSI), which retrospectively identifies SSIs using existing routine hospital data. sAReS-SSI adopts a patient-centric approach to data analysis, using an ICD-10 and OPS catalogue to detect in-house SSIs through temporal linkage to prior in-house surgeries, refining the NWIF algorithm of the German Institute for Quality and Transparency in Healthcare. sAReS-SSI was evaluated against SSIs that were validated through bedside surveillance in three orthopaedic and trauma surgery wards, as published in the HygArzt study. Its performance was also evaluated in comparison with a reconstructed NWIF algorithm, and contextualised using OP-KISS surveillance reports from the German National Reference Center. sAReS-SSI correctly identified 61 of 65 in-house SSIs published in the HygArzt study. Re-analysis of initially false-positive cases revealed 10 additional true in-house SSIs not captured in HygArzt, yielding a sensitivity of 94.7
Infectious diseases and antimicrobial resistance (AMR) remain one of the major causes of mortality and disability in India. But age- and pathogen-specific evidence on recent changes in AMR burden is limited. We analysed India-specific data from the Global Burden of Disease Antimicrobial Resistance Study to quantify changes in infectious disease and AMR-related deaths and disability-adjusted life years (DALYs) between 2019 and 2021. Deaths and DALYs, both associated with and attributable to AMR, were examined across 11 infectious syndromes, major bacterial pathogens, across age groups, and sex. Between 2019 and 2021, total infectious disease deaths declined by 5.3
Managing infections in older adults is challenging due to their unique characteristics, which often drives empirical antimicrobial use, increasing risks of adverse outcomes and antimicrobial resistance (AMR). Data on antimicrobial adequacy in older patients with suspected infection but negative blood cultures (BC) remain scarce, despite this being a common clinical scenario. In this multicenter prospective cohort study (NO-BACT project) across three Spanish hospitals (2018–2019), we compared antimicrobial therapy adequacy between older adults (≥ 85 years) and younger patients with suspected infections and negative BC. Antimicrobial stewardship (AMS) experts evaluated treatment adequacy at days 2 and 5–7 using standardized guideline-based criteria. We assessed predictors of adequacy using logistic regression and examined clinical outcomes including 30-day mortality and length of hospital stay (LOS). Among 799 enrolled patients, 90 (11.3
Surgical instrument reprocessing is essential for infection prevention and continuity of surgical care. However, evidence on barriers and adaptive strategies for maintaining reprocessing capacity during healthcare disruptions remains fragmented. This systematic review synthesized evidence on reprocessing vulnerabilities, barriers, and adaptive strategies across infectious outbreaks, emergency preparedness contexts, infrastructure disruptions, and resource-constrained settings. PubMed, Scopus, Web of Science, and Google Scholar were searched through February 2026 in accordance with PRISMA 2020 guidelines. Eligible studies evaluated reusable surgical instrument reprocessing during infectious outbreaks, infrastructure disruptions, emergency preparedness contexts, or other healthcare disruption settings. Two reviewers independently performed study screening and quality appraisal, with data extraction conducted by one reviewer and independently checked by a second reviewer, using Joanna Briggs Institute (JBI) appraisal tools appropriate to study design. Given substantial methodological and contextual heterogeneity, findings were synthesized narratively. The review protocol was prospectively registered in PROSPERO (CRD420261324153). Eleven studies from nine countries were included, comprising outbreak investigations, preparedness surveys, cohort and case-control studies, case series, and quasi-experimental or implementation-oriented studies. Most studies focused on infectious outbreaks associated with failures in reprocessing complex reusable devices. Recurrent barriers included incomplete cleaning workflows, inadequate lumen decontamination, equipment malfunction or contamination, contaminated water or rinsing systems, limited emergency preparedness, workforce gaps, and incomplete instrument-tracking systems. Infrastructure disruptions and limited sterilization capacity were associated with delays or interruptions in surgical services. Reported adaptive strategies included standardized multistep cleaning protocols, environmental monitoring, workforce training and simulation, instrument traceability systems, mobile or container-based sterilization capacity, and contingency reprocessing approaches. Current evidence suggests that challenges in surgical instrument reprocessing across healthcare disruption contexts are associated with interacting operational, infrastructural, technological, and organizational factors rather than isolated technical failures alone. Strengthening routine reprocessing reliability, workforce preparedness, environmental monitoring, infrastructure reliability, instrument traceability, and flexible reprocessing capacity may support continuity and safety of surgical services during healthcare disruptions. However, the evidence base remains small and heterogeneous and is weighted toward infectious outbreak investigations and observational studies. Further empirical research is needed to evaluate scalable and context-appropriate approaches to reprocessing preparedness across diverse emergency, disaster-related, and resource-constrained settings.
We conducted microbiological characterization and secondary analysis of longitudinal prospective data to understand the species distribution of vancomycin-resistant Enterococcus faecalis and Enterococcus faecium (VRE) and association with methicillin-resistant Staphylococcus aureus (MRSA) in patient and environmental samples collected in post-acute care, an important but little studied healthcare setting. Multisite longitudinal screening of 197 patients and their immediate environment in three Veterans Affairs Community Living Centers. Species-level identification of sample MRSA and VRE isolates. Measures of association and potential risk factors were evaluated using univariable and multivariable logistic regression at the isolate, visit, and patient level separately for patient and environmental contamination. A total of 689 VRE isolates were identified to the species level from 122 patients and their rooms. The ratio of E. faecium versus E. faecalis colonization and contamination differed significantly across the three facilities (6.0, 11.7 and 0.85, respectively, p < 0.001). In addition to antibiotic use, facility of stay was a significant independent risk factor for E. faecium colonization and contamination. Co-colonization and co-contamination with MRSA were higher-than-expected and significantly different by species (35.5
Ceftazidime/avibactam (CZA) resistance in KPC-producing Klebsiella pneumoniae is a critical public health threat, traditionally associated with in vivo selection. In this three-year study conducted in an Intensive Care Unit (ICU), we aimed to investigate the emergence of CZA-resistant (CZA-R) K. pneumoniae in patients treated with CZA, assessing the possible role of hospital outbreaks in dissemination. We analysed a three-year dataset of antibiotic consumption and K. pneumoniae isolates collected from ICU patients receiving CZA therapy. Whole-genome sequencing (Illumina/Oxford Nanopore) and epidemiological reconstruction were used to investigate resistance mechanisms, KPC variants, and transmission dynamics, including outbreak detection. Among 871 ICU patients, 17.9
Behavioural sciences should be used to design and improve antimicrobial stewardship (AMS) interventions aiming surgical prophylaxis (SP). A mixed-methods study at the University Teaching Hospital of Kigali, Rwanda. The study included an audit on SP practices and the development of SP interventions based on determinants of prescription behaviour yielded by 2 group discussions and by applying the Capability, Opportunity Motivation Behaviour (COM-B) model and the Behaviour Change Wheel (BCW) framework. The audit included 190 patients: SP prescription was inappropriate regarding determinable duration in 37
Clostridioides difficile infection (CDI) remains the leading infectious cause of antibiotic-associated diarrhoea, representing a substantial burden on healthcare systems worldwide. C. difficile spores can persist on environmental surfaces for months and require sporicidal disinfection for effective elimination. The high surface (interfacial) tension of disinfectant formulations may limit their sporicidal efficacy. Evidence suggests that the hydrophobicity of spore surfaces plays a significant role in the transmission and persistence of CDI. The aim of this study was to determine and compare the wetting properties of two disinfectant formulations based on chlorine dioxide on selected test surfaces, including both hydrophobic and hydrophilic materials, and to evaluate the sporicidal activity of these formulations against C. difficile spores in accordance with EN 17846. Two disinfectant formulations based on chlorine dioxide, with identical concentrations of the active substance, were investigated: one containing a surfactant and one without. Wettability measurements were performed on selected solid materials with differing hydrophilic and hydrophobic properties. Seven surfaces were analysed: parafilm (a thin film of specially processed, highly purified paraffin mounted on a roll of waxed paper), glass, ceramic (a commercial glazed ceramic tile), aluminium, PVC flooring (a commercial product), PVC Forex (foamed PVC), and 316 stainless steel. Sporicidal activity was evaluated on PVC carriers using the EN 17846 four-field test under clean conditions with a 15-min contact time. The chlorine dioxide–based disinfectant containing a surfactant demonstrated the most favourable wetting properties. However, wettability varied considerably across the tested surfaces and decreased in the following order: glass > ceramic > PVC > aluminium > stainless steel > > PVC Forex > parafilm. The addition of a surfactant resulted in a greater reduction of C. difficile spores, with a log10 reduction factor of 5.39, compared with 4.22 for the formulation without surfactant. The addition of appropriately selected surfactants reduced surface tension and improved the wettability of the tested materials. Under the EN 17846 test conditions on PVC carriers, the surfactant-containing formulation showed a numerically higher reduction in C. difficile spores than the formulation without surfactants. Further replicated studies on additional healthcare-relevant surfaces are required to confirm whether improved wettability translates into greater sporicidal efficacy across different materials.
Consistent environmental cleaning is essential for preventing healthcare-associated infections, yet achieving uniform standards across multi-campus hospital systems is difficult. Conventional methods, such as manual visual inspection and traditional fluorescent marking, are inherently subjective, qualitative, and prone to observer bias. This study assessed whether a computer vision-assisted mobile application embedded in a technology-empowered Plan-Do-Check-Act (T-PDCA) quality improvement model improves cleaning performance and promotes homogeneity across campuses. We conducted a 17-week prospective interventional study (June–October 2025) in a tertiary hospital system with four geographically dispersed campuses in Southwest China. A smartphone application generated an algorithm-derived fluorescent marker removal rate (FMRR) score by analyzing ultraviolet fluorescence images captured before and after routine cleaning and provided real-time quantitative feedback. The intervention was implemented within a T-PDCA framework, including standardized training, blinded fluorescent marking, algorithm-based performance assessment, and data-driven feedback. Cleaning performance was graded using predefined FMRR thresholds. Temporal trends, between-campus homogeneity, and differences by unit type and surface material were evaluated using nonparametric statistics. A total of 2,457 valid fluorescent marker samples were analyzed during the study period. The overall weekly mean FMRR was 83.91
Proper ultrasound probe disinfection practice is critical in preventing healthcare-associated infections in the radiology department. However, adherence to recommended guidelines varies globally and is influenced by multiple factors, including healthcare professional knowledge, attitude, institutional support, and equipment availability. In Ethiopia, there is limited evidence regarding current disinfection practices and associated factors among radiologists and radiology residents. This study aims to assess the current trend of ultrasound probe disinfection practices among radiologists and radiology residents in Ethiopia and identify factors associated with good practice. A nationwide cross-sectional study was conducted from August to November 2025 among radiologists and radiology residents in Ethiopia. The data were collected using an online-administered questionnaire through KoboToolbox. Data was analyzed using Statistical Package for the Social Sciences (SPSS) version 27. The data were analyzed using descriptive statistics and binary logistic regression models. A p-value less than 0.05 with 95
Monitoring healthcare-associated infections (HAI) and antibiotic use (ABU) in hospitalized patients is essential to control infections and reduce the inappropriate use of antibiotics. This study aimed to describe trends in the prevalence of HAI and ABU between 2017 and 2022 within a group of healthcare facilities in the Paris region. The study focused on data collected during point-prevalence surveys (PPS) conducted in hospitals in 2017 and 2022. Only facilities participating in both surveys and departments enrolling at least 10 patients were included in the analysis. Patient characteristics, HAI, and ABU were compared between 2017 and 2022, excluding COVID-19 infections in 2022, except in cases of co-infection with an HAI. Multivariate regression analysis was performed to measure the prevalence of HAI and ABU. Overall, 79 facilities were included representing 19 211 patients in 2017 and 16 266 in 2022. The overall HAI prevalence remained stable at 6.7
Healthcare workers’ (HCWs) hands are primary vectors for pathogen transmission. While non-sterile examination gloves (NSG) are intended to protect against contamination, they are often perceived as a substitute for hand disinfection (HD). This crossover simulation study in student nurses compared the microbial kinetics of once-disinfected bare hands versus continued NSG use and explored unintended Staphylococcus aureus transmission between participants. Using a crossover design, twenty-five student nurses performed standardised nursing tasks on manikins under both conditions in randomised order: (i) NSG worn continuously for 45 min without change; (ii) HD with an alcohol-based hand rub immediately before tasks (no gloves). Hand-impression cultures were taken at 0, 5, 15, 25, 35 and 45 min, plate-reading after 24 and 48 h. Counts > 100 CFU were capped at 100. Behaviour was video monitored. Group differences were analysed using the Wilcoxon signed-rank test with Bonferroni correction; S. aureus detection (≥ 1 positive timepoint per arm) was compared by McNemar’s exact test. In the HD arm, mean CFU increased from 1.7 ± 3.3 (baseline) to 31.8 ± 30.4 at 5 min and then plateauing around 40–45 CFU for 15–45 min. In the NSG arm, CFU progressively accumulated, reaching 76.7 ± 29.1, 77.1 ± 27.7 and 81.0 ± 27.7 at 25, 35 and 45 min, respectively. From 25 min onwards, NSG counts were significantly higher than HD counts (p = 0.0007, 0.0012 and 0.0003; Bonferroni-corrected α = 0.0083). S. aureus (all methicillin-susceptible) was detected in at least one timepoint in 21/25 (84
Catheter-associated urinary tract infection (CAUTI) is the most common healthcare-associated infection. Chlorhexidine gluconate (CHG) has been widely adopted for reducing central line-associated bloodstream infections. We aimed to evaluate the impact of replacing normal saline with 0.5
Despite the antimicrobial resistance (AMR) policies implemented in Korea, outpatient antibiotic consumption remains high. Evidence on the effects of these policies is limited. We assessed the effects of Korea’s AMR control policies on antibiotic prescription rates by examining short- and long-term impacts across healthcare institution types and policy intervention periods. We conducted an interrupted time series analysis using an ARIMAX (1,0,0) model with nationwide quarterly data from tertiary hospitals, general hospitals, hospitals, and clinics from the first quarter of 2000 to the fourth quarter of 2023. Four policy interventions were modeled as level and slope changes to estimate short-term effects immediately after each intervention and long-term effects eight quarters later. The 2001 policy was associated with short-term reductions in antibiotic prescription rates across all institution types, decreasing by 2.21
Previous studies have reported heterogeneous associations between average hand hygiene (HH) compliance and healthcare-associated infection (HAI) incidence, suggesting that monthly mean compliance alone may not fully characterize clinically relevant patterns of HH performance. We aimed to evaluate whether complementary metrics derived from the same HH dataset could provide additional contextual information on the relationship between HH performance and HAI incidence. We conducted a prospective observational study using HH audit data collected across three intensive care units with differing operational and staffing profiles. Monthly HAI incidence data were obtained from a parallel prospective surveillance program conducted by the same infection prevention team. Monthly HH performance was characterized using predefined metrics representing overall compliance level, day-to-day variability, critical low-compliance episodes, and lower-tail performance. These included weighted monthly HH compliance, coefficient of variation, the proportion of critical HH days defined as observed days with daily compliance below 40
Hand hygiene is a cornerstone of infection prevention, yet compliance among healthcare workers remains low. Despite multiple national initiatives, adherence in Ethiopian hospitals continues to be sub-optimal. This challenge is partly due to knowledge gaps and misconceptions, particularly regarding the WHO “Five Moments” and the appropriate use of gloves. This study aimed to assess the knowledge and misconceptions of healthcare workers concerning hand hygiene practices and glove use in hospitals in Addis Ababa. A mixed-methods cross-sectional study was conducted from December 2024 to January 2025 among 493 healthcare workers from public and private hospitals. Data were collected using the WHO Hand Hygiene Knowledge Questionnaire and in-depth interviews. Knowledge was assessed with a 33-item tool, categorized as good (> 75
Surgical site infections (SSIs), infections at or near surgical incisions, represent 20–30
Abstract Background High antimicrobial exposure and antimicrobial resistance in intensive care units (ICUs) remain major challenges to patient safety. This study evaluated whether a unit-based clinical pharmacist (UBCP) model supported by an individualized daily antimicrobial use density monitoring report (IAUD-RP) could improve antimicrobial stewardship in an ICU. Methods This single-center, retrospective, quasi-experimental study used interrupted time series analysis in a 12-bed ICU of a tertiary teaching hospital in Guangxi, China. Adult patients admitted between April 1, 2023, and October 31, 2025, were included. The intervention, initiated in August 2024, consisted of UBCP-led daily ward-wide screening, real-time risk stratification, and targeted pharmacist interventions using the individualized monitoring report. The primary outcome was antimicrobial use measured as defined daily doses (DDDs) per 100 patient-days. Secondary outcomes included average antimicrobial cost per hospitalization, multidrug-resistant organism healthcare-associated infection incidence density, clinical outcomes, and changes in specific antimicrobial agents or classes. Results A total of 657 patients were included (295 before, 362 after). UBCP recommendations achieved a 91.7% acceptance rate. Interrupted time series analysis showed a significant immediate reduction in antimicrobial use (level change, − 29.0 DDDs/100 patient-days; P = 0.038), following a significant pre-intervention upward trend (+ 2.5 per month; P = 0.005). Interrupted time series analysis showed a significant immediate reduction in average antimicrobial cost per hospitalization (level change, − 8304 CNY; P = 0.035), consistent with the crude reduction (25,568 to 14,926 CNY; P < 0.001). Total antimicrobial consumption decreased by 11.9%. Tigecycline, quinolones, and carbapenems decreased by 52.1%, 39.7%, and 15.8%, respectively, whereas WHO Access-group antibacterial agents increased by 67.8%. After excluding patients with indeterminate (‘Others’) outcomes, clinical failure was lower post-intervention (13.0% vs. 19.2%; adjusted OR 0.62, 95% CI 0.39–0.99; P = 0.045). Conclusion The UBCP-led IAUD-RP model was associated with a significant and sustained reduction in antimicrobial use density, a directionally favorable change in antimicrobial cost and prescribing pattern, and a directionally favorable but non-confirmatory signal for reduced clinical failure.
