Background: Hospital-acquired infections are a significant cause of morbidity and mortality in healthcare settings among patients and healthcare workers, including clinical students. The frequent exposure of students during their clinical postings to various sources of infections emphasizes the need for adherence to standard precautions (SP). This study aimed to assess the knowledge and practice of SP among the clinical students of the College of Medicine, University of Ibadan, Nigeria. Methods: A descriptive cross-sectional study was conducted. Data on sociodemographic, domains of SP knowledge and practice, and source of students’ knowledge were collected via a self-administered online questionnaire. Categorical variables were compared using Chi-square and Z tests, while numerical data were analyzed with Mann–Whitney and Kruskal–Wallis tests. Logistic regression identified predictors of the assessed SP knowledge and practice domains. SPSS v20 was used for data analysis, and P < 0.05 was used as the statistical significance level. Results: Among 371 clinical students, 55.8% were MBBS students, 78.7% were Christians, and 80.6% were aged 21–25 years. Participants’ overall knowledge score was average, and 131 (36.1%) students scored ≥ 29 (out of 36 points) which was considered an acceptable level of knowledge. The overall practice score was average with a mean practice score of 11.76 (± 2.50) out of 17. Participants’ main sources of knowledge were self-learning and the school curriculum. Logistic regression revealed that participants’ knowledge correlated with gender, year of study, and prior knowledge, while practice correlated with age and department. Conclusion: The students’ average knowledge and practice and significant reliance on self-learning of SP is alarming. We recommend that universities and medical colleges integrate early and continuous SP education and training into medical curriculum.
Background and objective: Healthcare-associated infections (HAIs) are a serious threat to patient safety. They cause substantial morbidity and mortality across various healthcare settings, including neonatal intensive care units (NICUs). This study was undertaken to determine the incidence of HA bloodstream infection (HA-BSI) in the NICU of a tertiary care hospital. Methodology: Data were collected in a systematic manner based on the Centers for Disease Control and Prevention (CDC) guidelines for the surveillance of HAI for a period of 1 year (Jan–Dec, 2022). The HAI rate was calculated using the following formula: No. of cases/No. of patient days × 1,000. Result: Among the 1,085 admitted neonates, the incidence of HA-BSI was 15.80/1,000 patient days. HAI was seen in neonates having mean birth weight 1,722.5 ± 113.906 g, mean gestational age 29.6 ± 1.38, and mean duration of hospital stay 13.8 ± 4.081 days. Among the 80 cases of HA-BSI, recognized pathogens were 22 (27.5%) Klebsiella pneumoniae, 16 (20%) non-albicans Candida, 13 (16.25%) methicillin-sensitive Staphylococcus aureus, 10 (12.5%) Candida albicans, 10 (12.5%) Acinetobacter baumannii, 4 coagulase-negative staphylococci, 3 (3.75%) methicillin-resistant Staphylococcus aureus, 1 (1.25%) Escherichia coli, and 1 (1.25%) Enterococcus. The mortality rate was 56.78%. Conclusion: The predominance of K. pneumoniae and A. baumannii as causative pathogens suggests the need of stringent infection control measures and targeted antimicrobial strategies to reduce the burden of HAI and improve patient outcomes.
Background: Aspergillus species are common environmental fungi known to cause Aspergillosis, often presenting as an invasive infection in individuals with a compromised immune system. It is transmitted by the inhalation of Aspergillus spores and contributes to healthcare associated infections in hospitalised patients. Since these patients spend most of the day in their hospital beds, the presence of Aspergillus spores in such settings puts the patient at risk of inhaling aerosolised spores leading to infections. Objective: To determine the prevalence, distribution, and factors associated with Aspergillus contamination of hospital bed rails. Design: This laboratory-based cross-sectional study was carried out at the University College Hospital, Ibadan, Southwest Nigeria, between May and June 2023. In all, 100 beds which were occupied by patients in 13 wards were included in this study. The left and right rails of beds were swabbed and processed for the detection of Aspergillus species using fungal culture and microscopy. A checklist was used to assess selected infection prevention and control measures in the wards. Results: The total number of bedrails with Aspergillus isolated across all the wards where samples were taken was 56 (28.0%). Aspergillus niger was the most prevalent specie (64.2%) followed by Aspergillus flavus (30.4%), then Aspergillus fumigatus (5.4%). The prevalence of Aspergillus contamination was related to the level of sanitation and proximity to construction activity. Conclusion: To reduce the risk of Aspergillus infections in hospitalised patients, adequate infection prevention and control measures including thorough cleaning and disinfection should be strictly adhered to.
Background: Healthcare-associated infections (HAIs) pose a major threat to critically ill intensive care unit (ICU) patients. Limited data on HAIs in Indian ICUs necessitated this study at a tertiary care hospital in North India. Objective: To determine the incidence, distribution, and causative agents of HAIs, assess their antibiotic susceptibility profile, and evaluate the impact of infection prevention and control (IPC) measures. Design: This prospective study was conducted in the ICU settings of a tertiary care centre. Bloodstream infections (BSIs), central line-associated bloodstream infections (CLABSIs), urinary tract infections (UTIs), and catheter-associated urinary tract infections (CAUTIs) were defined according to standard definitions. The incidence and device utilisation ratio (DUR) were calculated. Identification and susceptibility were determined via BacT Alert and VITEK-2 Compact System. IPC compliance, including hand hygiene and central line insertion practices (CLIP), was monitored as per checklist. Results: Overall BSI rates of 12.85 per 1,000 patient-days, CLABSI at 22.11 per 1,000 central line-days, and CAUTI at 1.77 per 1,000 urinary catheter-days were recorded. The DUR was calculated to be 0.44 and 0.6 for CLABSI and CAUTI respectively. Burkholderia cepacia (52.8%) was the predominant CLABSI pathogen, while Acinetobacter spp. (22.2%) was the most common CAUTI pathogen. Hand hygiene compliance improved from 40% in 2019 to 70% in 2023, CLIP adherence increased from 30 to 75%, CLABSI and CAUTI rate reduced from 19.66 to 8.59 and 8.66 to 0.75, respectively. Conclusion: The study highlights the need for stringent IPC measures, robust antibiotic stewardship, and continuous surveillance to mitigate HAIs.
Background: Low- and middle-income countries (LMICs) face more challenges in overcoming healthcare-associated infections (HAIs) due to limited data surveillance, especially during the COVID-19 pandemic. We investigated the epidemiology and relationships between HAIs and COVID-19 status in a referral hospital in Indonesia. Methods: A retrospective study was conducted at Universitas Indonesia Hospital from 2021 to 2022. HAI types were categorized into ventilator-associated event (VAE), central line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infections (CAUTIs). Data were collected from the inpatient ward, emergency department, and intensive care unit. The association among HAIs, COVID-19, and isolated bacteria was analyzed descriptively, and multivariate logistic regression for potential risk factors. Results: We evaluated 255 patients who experienced HAIs, including 159 patients with COVID-19. The incidence of CLABSI was significantly associated with COVID-19 patients (P < 0.001), whereas the occurrence of VAE was significantly lower (P = 0.001). There was no significant association with CAUTI (P = 0.870). Acinetobacter baumannii was isolated as a common cause of HAIs (19%). Carbapenem resistance rates were high among A. baumannii (89.8%) and Pseudomonas aeruginosa (86.9%). Risk factors of CLABSI included COVID-19 status and chronic renal disease, while that of VAE included sex-male (aOR = 1.97). Conclusions: CLABSI was significantly associated with the occurrence of HAIs in patients with COVID-19, while VAE was low, and CAUTI was not significantly impacted. In addition, the isolation rate of carbapenem-resistant bacteria was high. It highlights the urgent need to strengthen the infection prevention and control and antimicrobial stewardship (AMS) approaches through continuous education, monitoring, and enhanced surveillance efforts at the facility level.
Hospital environments pose infection risks. During a meticillin resistant Staphylococcus aureus (MRSA) outbreak in an adult Intensive Care Unit (ICU), a visibly contaminated bladeless Dyson® fan at the bedside of a previous outbreak patient prompted a microbiological investigation. Four sections of the bladeless Dyson® fan were swabbed to identify potentially pathogenic organisms, with confirmed isolates undergoing whole genome sequencing. Results identified MRSA, vancomycin resistant Enterococcus (VRE) and Aspergillus niger. The MRSA strain identified on the bladeless fan matched the outbreak strain. Existing research acknowledges the infection risks associated with inadequate ventilation and the use of fans in healthcare settings. The pandemic highlighted the importance of ventilation; however, comprehensive guidance on the use of portable fans in healthcare settings is yet to be provided. The contaminated fan was removed and disposed of, and trust wide communication was given recommending all portable fans to be removed from the trust. This case study confirmed the presence of potential pathogens on a bladeless Dyson® fan in an ICU. This further highlights the need for cleanable fan designs and research into the safe use of these devices to mitigate infection risks whilst addressing ventilation and cooling needs in healthcare settings.
Background: While sharps injuries are a hazard to healthcare workers globally, research has concentrated on high-income regions. West Africa, including Liberia and Ghana, has high rates of human immunodeficiency virus and hepatitis B virus infections, which can be transmitted via sharps injury. Use of safety-engineered devices is highly limited in this region. Objective: To explore factors contributing to frequent sharps injuries and underreporting among health care workers in Liberia and Ghana, and to recommend potential interventions. Design: Semi-structured interviews were conducted via an Internet-enabled platform among nurses, midwives, physicians and physician assistants in Liberia and Ghana. Questions focused on injury history, sharps injury prevention, and work environment. Interview transcripts were analyzed deductively. Recruitment ended when data saturation was reached. Results: Sixteen interviews were conducted among seven Liberian and nine Ghanaian healthcare workers. Unexpected patient movement and colleagues contributed to seven of 16 injuries. Prelicensure sharps injury prevention training was limited, though more accessible post licensure. Many participants desired more training. Most (n = 12) did not report their injuries. While many viewed their work environment as adequate, others noted specific issues, including inadequate sharps disposal containers and limited supplies. Discussion: Training deficiencies and systemic gaps were key contributors to injury and underreporting. Respondents showed interest in enhanced training and clearer procedures. Conclusion: The results of this study suggest ways to reduce sharps injuries in Ghana and Liberia, including additional training for workers and more accessible sharps disposal containers. Materials developed to train these workers have the potential to be useful to workers anywhere resources are constrained.
Objective: The aim of this study was to assess the prevalence of Shigella infection, its antimicrobial resistance patterns, and associated risk factors among diarrheal patients in Ethiopia. Method: A cross-sectional study was conducted from October 2021 to November 2022 among 2,331 diarrheal patients from Addis Ababa, Gondar, and Harar. Data on socio-demographics and clinical characteristics were collected using a structured questionnaire and REDCap software. Stool samples were processed using standard microbiological methods, and Shigella isolates were confirmed by polymerase chain reaction. Antibiotic susceptibility testing was performed using the Phoenix M50 machine. Data analysis was conducted in R software, employing univariable and multivariable logistic regression to identify associated factors. Result: This study indicated that the prevalence of Shigella spp. was 2.79%, highest in Harar (5.05%) and lowest in Addis Ababa (0.88%). Being resistance to ciprofloxacin (43.08%) and azithromycin (32.31%), key antibiotics recommended for shigellosis treatment are alarmingly high across study sites. The resistance to at least one antibiotic was shown by 98.46% of the isolates, with 33.85 and 73.85% being extended-spectrum beta-lactamase (ESBL) producers and multidrug-resistant (MDR), respectively, and showed significant variation among study sites. Harar had the highest odds of Shigella infection compared to Addis Ababa [AOR: 1.39, 95% CI: 1.02, 1.57] and Gondar [AOR: 1.12, 95% CI: 1.01, 1.24], while Gondar had higher odds than Addis Ababa [AOR: 1.15, 95% CI: 1.09, 1.35]. Households with unimproved water sources and unimproved sanitation showed higher odds of Shigella infection [AOR: 1.99, 95% CI: 1.17, 3.01, P = 0.03] and [AOR: 1.39, 95% CI: 1.27, 1.74, P = 0.03], respectively. Conclusion: In conclusion, Shigella infections in Ethiopia exhibit high ESBL and MDR rates, emphasizing the need for improved sanitation, water safety, and antibiotic stewardship.
Background: The World Health Organization (WHO) published the Global Report on Infection Prevention and Control (IPC) in 2022, highlighting both achievements and areas for improvement in IPC practices globally. The Infection Prevention and Control Assessment Framework (IPCAF) is a tool used to evaluate IPC programs across different healthcare settings. Aim: This scoping review aims to identify published reports of IPCAF use, collate available data, and compare findings to those of the WHO’s Global Report on IPC. Methods: A scoping review methodology was employed, involving searches in PubMed, MEDLINE via Ebsco, CINAHL via Ebsco, Embase via Ovid, and Scopus from November 2016 to March 2024. Studies included were surveys, cross-sectional studies, before-after studies, observational studies, or cohort studies published in peer-reviewed journals. Data extraction focused on study characteristics, IPC Core Component results, and overall IPCAF scores. Results: Twenty-seven articles met the inclusion criteria, representing 18 countries across four WHO regions. High-income countries (HICs) like Germany, Austria, and Japan reported predominantly Advanced IPCAF scores. In contrast, low-income countries (LICs) such as Sierra Leone, Uganda, and Ethiopia often reported Basic or Inadequate scores. Lower-middle-income countries (LMICs) like India, Indonesia, and Pakistan showed mixed results, while upper-middle-income countries (UMICs) like Türkiye and China generally reported higher scores. The review highlighted significant variability in IPC scores within and between countries. Conclusion: The findings corroborate the WHO’s Global Report, emphasizing the need for tailored interventions to enhance IPC practices, particularly in resource-limited settings. Addressing gaps in data collection and increasing participation from underrepresented regions are crucial for developing a robust global IPC framework.
Background: Infection prevention and control (IPC) programs are critical for safe, high-quality, and people-centered care. While the effect of IPC in averting Healthcare-associated infections (HAIs) is not in contention, the intervention models to promote IPC performance are little understood in developing countries such as Kenya. This study tested the feasibility of integrating continuous quality improvement (CQI) approaches in IPC measures and the resultant performance of IPC uptake in selected PEPFAR-supported health facilities in Nairobi, Kenya. Methods: We conducted a baseline assessment (October 2020–December 2020) followed by quarterly assessments over 9 months (January 2021–September 2021) to assess the uptake of IPC practices upon implementation of IPC interventions through a CQI approach. The assessment was done in 49 health facilities in Nairobi, Kenya. The IPC interventions included the following: triage and screening; policies and training; supplies; Tuberculosis (TB) clinic measures; laboratory measures; injection safety; environmental cleaning; and device processing. Each of these interventions had specific activities that were tracked during the assessment. Specific CQI programs at each facility were developed to address gaps observed during baseline assessments, such as hand hygiene, healthcare worker screening, waste management, and triaging. Results: All 49 facilities implemented interventions to improve IPC under a CQI program but only 40 had data available regarding CQI activities. During the assessment period, mean scores for all IPC domains increased across all 49 facilities. There were significant improvements across all domains with the highest improvements recorded in the domains of policies, coordination, and training (from 15 to 100%; p < 0.001), patient screening, and triage (45 to 100%; p < 0.001), TB clinic measures (38 to 86%; p < 0.001), and healthcare worker screening and triage (35 to 72%; p < 0.001). Conclusion: IPC interventions, using a CQI approach, improved IPC mean scores substantially during the assessment period. Evidently, integrating CQI has an additive and significant effect on IPC uptake.
Background: The National Referral Hospital (NRH) in Honiara, Solomon Islands has faced a large-scale rodent infestation for decades posing significant risks to patient safety, infrastructure, and healthcare delivery through issues such as patients receiving bites and medical stores being contaminated. Aim: This study aimed to implement and evaluate a comprehensive rodent management programme to reduce rodent populations and associated infection risks at the NRH. Methods: A two-phase approach was adopted: Meeting pre-conditions identified through consultation with hospital staff and an external pest control company. Implementation of rodent extermination using brodifacoum bait stations throughout the NRH. The programme’s effectiveness was assessed through monitoring bait consumption rates and counting collected deceased rodents. Findings: Following implementation, a significant decrease in rodent populations was observed: A total of 110 deceased rodents were recorded in the initial 1-month period. Bait consumption decreased from an average of 29 blocks per day 3 weeks post-implementation to 3.57 blocks per day after 6 months. No further rodent bites to patients or damage to medical equipment were reported after March 2024. Conclusion: The rodent management programme demonstrated substantial success in reducing rodent populations at the NRH, improving patient safety and healthcare delivery. However, long-term commitment and resource allocation are necessary to maintain these improvements.
Background: Surgical site infections (SSIs) are common complications post-surgery, associated with increased morbidity, healthcare costs, and prolonged recovery. High body mass index (BMI) patients face an elevated risk due to impaired wound healing and systemic inflammation. Wound irrigation with Polyvinylpyrrolidone Iodine (PVP-I) or normal saline (NS) is commonly used, but their comparative effectiveness in high-BMI patients remains unclear. Objective: The study aims to evaluate whether PVP-I is more effective than NS in reducing SSIs in high-BMI surgical patients. Design: Systematic review and meta-analysis. Methods: PubMed, Embase, and Cochrane databases were searched up to December 2024 for randomized controlled trials (RCTs) and observational studies comparing PVP-I and NS for SSI prevention in high-BMI patients. Risk of bias was assessed using ROB 2 for RCTs and ROBINS-I for non-randomized studies. Odds ratios (OR) with 95% confidence intervals (CI) were pooled using a random-effects model in R Studio 4.4.2. Results: Four studies with 604 high-BMI patients were included. The pooled analysis showed a decreased SSI rate in the PVP-I group, though not statistically significant (OR 0.58; 95% CI 0.29–1.13; P = 0.11; I² = 39.4%). Sensitivity analyses confirmed the robustness of findings. Discussion: The effectiveness of PVP-I may depend on factors like surgery type and the patient’s clinical status. Although irrigation may have a protective effect, effective preventive strategies should consider the antiseptic agent and perioperative patient optimization. Conclusion: This meta-analysis suggests that PVP-I irrigation may reduce SSIs in high-BMI patients, though statistical significance was not reached. Further research is needed to confirm its potential benefits.
Background: Healthcare-Associated Infections (HAIs), also known as nosocomial infections are a major cause of morbidity and mortality. Also, the nurses play a vital role to prevent and control the spread of HAIs. Aim: This study aimed to assess the knowledge and practices of nurses regarding HAIs control measures in King Salman bin Abdul-Aziz Medical City (KSAMC) at Madinah City. Methods: A descriptive cross-sectional study, the total population of registered nurses is 1955 in KSAMC, although the target sample size is 322. Self-report questionnaires that consisted of 45 items were distributed by Google Forms among registered nurses working at KSAMC. The data collected was analyzed by Statistical Packages for Social Sciences (SPSS). Results: The study found that most participants were female (79.5%), married (60.2%), had bachelor’s degrees (62.1%), and had work experience between 1 and 5 years (28%). Most nurses worked in maternity and children’s hospitals (51.2%), while emergency units (18%) were the most specialty departments. In addition, (58.4%) of nurses had a fair understanding of HAIs control measures. Among the nurses, 9 out of 10 (94.1%) had good knowledge of HH. In addition, the nurse’s practices regarding HAIs control measures (63.7%) were fair. There was a positive significant correlation observed between the knowledge and practices scores (r = 0.336). Conclusion and recommendations: This study’s findings revealed that nurse’s knowledge and practices of HAIs infection control measures had fair knowledge and fair practices. A nurse needs constant reminders of infection control measures by attending regular and continuous health education and seminars related to preventing and controlling HAIs.
Background: The COVID-19 pandemic highlighted the need for innovative solutions to enhance infection prevention and control measures in healthcare settings, particularly for infectious and isolated patients. Objective: To describe the implementation of a novel cost-conserving electronic procedural consent technique in infectious and isolated patients during the COVID-19 pandemic. Design: During the COVID-19 pandemic, we implemented an electronic consent technique using pre-existing hardware in the form of Toughbook tablets with styluses, and biohazard-grade ziplock bags. We trialled this method on patients with confirmed or suspected COVID-19 requiring surgery. Results: This e-consent system was used in 83 patients undergoing surgery. Benefits included effective sanitization of the Toughbooks and the low cost. Challenges included suboptimal signature accuracy and the need for a back-up method when the Toughbook malfunctioned, or where e-signatures could not be obtained. The system was discontinued as the pandemic and isolation measures eased. Discussion: The e-consent system provided a practical solution during the pandemic, reducing physical contact and supporting infection control. While effective, challenges related to technology and patient adaptability remained. The system demonstrated potential for broader applications, including in telemedicine and isolation care, but requires further evaluation in high-volume settings. Conclusions: E-consent effectively minimized the risk of infection transmission and improved consent workflows. Beyond the pandemic, e-consent offers long-term benefits in infection prevention, consent management, and remote access, supporting safer, more flexible patient care across clinical settings. However, further studies are needed to evaluate its impact on reducing infection transmission and personal protective equipment (PPE) waste.
Background: The spread of severe acute respiratory syndrome (SARS-CoV-2) prompted renewed attention to infection prevention and control (IPC) programs in healthcare settings. Objective: This study aimed to investigate associations between factors derived from a hospital safety climate scale for respiratory diseases and Canadian healthcare providers’ (HCPs) hand hygiene and eye protection practices during the COVID-19 pandemic. Design: Cross-sectional analysis of the COVID-19 Cohort Study (2020–2023) of acute care HCPs providing direct patient care. Results: 100% compliance with Canadian guidelines for the use of eye protection was reported by 73.7%, hand hygiene before entering rooms by 65.3%, and after exiting patient rooms by 81.8% of the 1,361 participants. The adjusted incidence rate ratio (aIRR) for hand hygiene after exiting a patient room was significantly higher for participants who rated organizational support for health and safety higher. The aIRR for the use of eye protection was significantly higher for people who rated their hospital as having fewer job hindrances related to completing their job while using protective equipment and reported higher ratings of their organization’s availability of protective supplies. Discussion: Our data support the association between HCPs’ perception of hospital safety-related organizational factors and the use of eye protection and practice of hand hygiene. These findings also suggest that ease of access impacts the use of eye protection. Conclusions: Although training and making equipment available are necessary, the perception of organizational factors, namely support for health and safety and absence of job hindrances, are important for improving the use of eye protection and hand hygiene.
Despite 5 years of SARS-CoV-2 research, as well as decades of research on tuberculosis (TB), large gaps remain in understanding the transmission of airborne pathogens. Our aim was to delineate these gaps. Understanding them would enable evidence-based, practical efforts to reduce transmission. Building upon the 2017 Roadmap for TB Transmission Science, we interviewed experts in the field and identified six salient topics harboring holes in knowledge that impede prevention and control efforts. These include 1) fundamental elements of aerobiology, 2) detecting and measuring infectious respiratory particles directly in the air, 3) the infectiousness of asymptomatic TB (by extension, other lung infections) and 4) of calm tidal breathing – including their contributions to global epidemiology, 5) the role of ‘superspreading’ in disease incidence, and 6) the duration of infectiousness of highly drug-resistant TB treated with the newest, all-oral short-course regimens. Based on an extensive literature review, we update advances in science since 2017 and then summarize knowledge gaps and research priorities. Several recent systematic reviews all noted the relatively low quality of published research, so there is an overriding need for high-quality studies to provide evidence for national and international entities upon which to base recommendations, guidelines, and standards.
Background: Understanding the risk factors for healthcare workers (HCWs) involved in COVID-19 care is essential for developing effective infection prevention strategies. Methodology: A case-control study, aligned with the World Health Organization UNITY protocol and using the WHO Go.Data template, was conducted in Rajasthan across three public hospitals to identify factors associated with COVID-19 infection among HCWs. Data were analyzed using SPSS v.23. Descriptive analysis included COVID-19 positivity rates, exposure frequency and duration, and Infection Prevention and Control (IPC) practice scores. Chi-square and Fisher’s exact tests (P < 0.05) were used to assess associations. Results: A total of 196 participants (50 cases and 146 controls) were enrolled. Among the cases, 54% were doctors and 42% were specifically assigned to COVID-19 care, with an average exposure duration of 8.8 ± 4.9 days over the prior 2 weeks. Notably, 36% experienced long-term face-to-face exposure. Of all variables, only hand hygiene before and after patient material contact showed a significant association with infection (P = 0.036). Conclusion: These findings underscore the need for strengthened IPC adherence, particularly hand hygiene, among HCWs in high-exposure settings.
Fungal spores are present in the environment. Diabetic and immunosuppressed persons are more vulnerable to such infections. Thus, it is a major concern in a hospital setup as appropriate temperature and humidity can lead to fungal growth. The fairly humid and slightly warm climate of Mumbai is ideal for fungal growth. Here is a brief description of how fungal spores were controlled within a tertiary hospital in Mumbai, India with simple but effective methods. The total fungal count in Mumbai was found to be 16.2 CFUs/m³ (1). During the study period, there were two instances where fungal growth was observed, which is as follows: 1) bone marrow transplant (BMT) (Oct-2017 to Jan-2018): Growth of different Aspergillus spp. (12–36 CFU/m³) was observed 2) ICU (Oct-2019 to Nov-2019) : Growth of A. niger (6–24 CFU/m³) was observed. Corrective actions such as cleaning of the AC ducts, repair of the leakages and filter cleaning were done. Due to the prompt correctional actions, we were able to prevent nosocomial fungal infections from these areas. Even though the hospital is situated by the sea and the outside air has high humidity and high microbial load, effective engineering measures and close monitoring of the areas helped in controlling the spread of fungus within the hospital. Routine periodic checks (weekly in BMT unit and monthly in ICUs) of the air for fungal spores can also help prevent nosocomial infections.
Implementing Infection Prevention and Control (IPC) guidance is crucial for reducing healthcare-associated infection (HAI) rates. However, achieving behavioural and organisational change is necessary for successful implementation. To understand these changes, it is important to identify the barriers and facilitators to IPC implementation, supported by theoretical analysis. This paper presents the second stage of a study conducted in Uganda, aiming to analyse barriers and enablers to IPC guideline implementation and provide preliminary recommendations for intervention design. Interviews with frontline healthcare workers were conducted, and qualitative content analysis helped identify specific barriers and enablers. The Theoretical Domains Framework (TDF) was used to categorise and map these factors to the BCW/COM-B model, enabling the identification of intervention functions supporting IPC implementation. The findings highlighted various important factors influencing IPC implementation, including social influences, environmental context and resources, knowledge, skills, professional role and identity, behavioural regulation, memory, attention and decision processes, goals, beliefs about capabilities, beliefs about consequences, intentions, emotion, and reinforcement. All components of the COM-B model (Capability, Opportunity, Motivation) were deemed significant in IPC implementation. Key intervention functions such as enablement, environmental restructuring, training and education, persuasion, and incentivization were identified as potentially useful for designing interventions to improve IPC implementation. In conclusion, the analysis emphasized the interconnectedness and importance of capability, opportunity, and motivation in adopting IPC guidance in such contexts. The study offers recommendations for future interventions, including education and training programs, leveraging memory and attention, addressing beliefs about consequences, and improving social influences and support systems. These insights can guide the development of effective strategies to enhance IPC implementation.
The most common nosocomial infection seen in patients under mechanical ventilation is ventilator-associated pneumonia (VAP). This study is conducted to study rate of VAP, bacterial agents, and their antibiogram. This was a hospital based, observational cross–sectional study of all the patients who were mechanically ventilated in the intensive care unit at Nepal Medical College Teaching Hospital, Kathmandu during a period of one year. Endotracheal aspirates were processed for bacterial isolation and identification and their antibiotic susceptibility test. Significant bacterial growth was considered on the basis of significant gram stain and semi-quantitative culture obtained by endotracheal sampling. Significant bacterial growth was found in 48(57.8%) endotracheal aspirates (n = 83) of which 4(8.3%) were from cases of VAP and 44(91.7%) from Ventilator associated condition (VAC).VAP rate among patients was 4.8%. Among four VAP cases, two endotracheal aspirates grew Klebsiella pneumoniae, one grew Acinetobacter calcoaceticus baumannii complex, and one grew both Pseudomonas aeruginosa and K. pneumoniae. All isolates of K. pneumoniae were MDR and ESBL producers where two of them were AmpC β-lactamase and MBL producers. The P. aeruginosa isolated was MDR and produced AmpC beta lactamase, MBL and ESBL. The isolated Acinetobacter calcoaceticus baumannii complex was also MDR. VAP is a commonly encountered complication in mechanically ventilated patients. The MDR pathogens associated with VAP and VAC call for special attention to care for the ventilated and need for strict adherence to infection control practices including VAP bundle care.
