Journal of Patient Safety and Infection Control最新文献

{"title":"Culture of cultures: Antimicrobial prescription practices in hospitalised patients at level 1 trauma centre","authors":"Vijeta Bajpai, D. Gupta, A. Bindra, R. Malhotra, P. Mathur","doi":"10.4103/JPSIC.JPSIC_6_18","DOIUrl":"https://doi.org/10.4103/JPSIC.JPSIC_6_18","url":null,"abstract":"Introduction: Antibiotic stewardship practices require that antimicrobial treatment should be tailored according to microbiological culture. Therefore, the aim of this study was to describe the antibiotic prescription pattern and to assess how frequently the surgeons request for a specimen culture during the patient's stay. Materials and Methods: This was an observational study; conducted in level-1 trauma center for 10 months and all consecutive neurosurgery patients, admitted in the hospital were included in the study. Detail of microbiology culture and anti-microbial-sensitivity results were recorded. Antibiotic prescriptions were recorded in each patient during their hospital stay. Results: A total of 1216 consecutive patients admitted to the neurosurgery unit were included in the study. The mean age (± standard deviation) of patients was 33.29 (±16.27) years, predominantly male patients; 1038 (85.4%). Overall, culture-confirmed infections were present in 216 (19.4%) patients. Prevalence of Gram-negative bacteria; 195 (90.2%) was more than Gram-positive bacteria; 21 (4.7%) (P < 0.001). The most frequently used antibiotic was cephalosporin; 1030 (84.7%), followed by aminoglycoside; 952 (78.3%), fluoroquinolone; 422 (34.7%), penicillin; 311 (25.6%) and metronidazole 277 (22.8%). A total of 400 (13.15%) antibiotics were prescribed appropriately in patients with culture-confirmed infection while 2640 (86.8%), antibiotics were given inappropriately in rest of the patient in whom there was no matching culture-confirmed infection (P < 0.001). Conclusion: A very small number of antimicrobial prescriptions were based on culture reports. Hospitals in developing countries including India need to institute surgical antibiotic policies soon since most hospitals are facing a severe problem of antimicrobial resistance.","PeriodicalId":310565,"journal":{"name":"Journal of Patient Safety and Infection Control","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116991692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An epidemiological study of ventilator-associated pneumonia in Intensive Care Unit and antibiotics sensitivity pattern of organism causing ventilator-associated pneumonia (2012—2016) at Al Qassim Region of Saudi Arabia","authors":"S. Gupta, Fahd Khaleefah Al Khaleefah, Ibrahim Al Harbi, M. Torre, S. Jabar, S. Mathias, Omar Al Romaih","doi":"10.4103/jpsic.jpsic_27_17","DOIUrl":"https://doi.org/10.4103/jpsic.jpsic_27_17","url":null,"abstract":"Background: Ventilator-associated pneumonia (VAP) is defined as pneumonia that occurs after 48—72 h following endotracheal intubation, characterised by the presence of a new or progressive infiltrate showing in X-ray, signs and symptom of systemic infection such as fever, change in white blood cell count, changes in sputum characteristics and the detection of a causative agent in the sample. Aim: This study aims to find out the epidemiological pattern of the VAP in Intensive Care Unit and their sensitivity pattern. Materials and Methods: This was retrospective observational study. Results: In the past 5 years, 69 (20.24%) cases of VAP were reported out of total healthcare-associated infections (n = 331). The male cases 54 (78%) were nearly four times higher than that of female cases 15 (22%), and difference is statistically significant (χ2 = 15.2, P = 0.01). Most of the cases observed were above 60 years of age (n = 24) whereas, least cases observed in cases below 15 years of age (n = 4). In the present study, VAP was observed in increasing trend (2012—2015) 16% to 27%. Mean hospital-wide infection rate was higher in 2015 (4.34; standard deviation [SD] =3.33) than 2016 (2.14; SD = 2.25). The most common organism isolated from VAP was Acinetobacter baumannii followed by Pseudomonas aeruginosa. Conclusion: The VAP cases reported four times higher among males than females and common above 60 years of age, most common causative organism isolated from VAP patients was A. baumannii. Majority of the isolates of A. baumannii and P. aeruginosa were resistant to commonly used antibiotics.","PeriodicalId":310565,"journal":{"name":"Journal of Patient Safety and Infection Control","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129266982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of isopropyl alcohol and ultraviolet-based sanitiser on decontamination of mobile phones used by dental personnel","authors":"S. Sriram, P. Madan Kumar, Ramanathan Swaminathan, Rajendran Venkatesh, V. Menaka","doi":"10.4103/JPSIC.JPSIC_4_18","DOIUrl":"https://doi.org/10.4103/JPSIC.JPSIC_4_18","url":null,"abstract":"Introduction: Mobile phones have become an inevitable mode of communication. Dental office and the dental operators along with their mobile phones are exposed to numerous pathogens as a part of their profession, leading to nosocomial infection. This study aimed at assessing the effectiveness of isopropyl alcohol and a customised ultraviolet-based (UV) sanitiser in decontamination of mobile phones. Methods: A cross-sectional study was carried out on 30 touch screen mobile phones belonging to dental professionals in a college setting. Swabs were collected along the screen, camera lens and on/off buttons of mobile phones. Swabs were streaked onto nutrient agar and incubated at 37°C for 24 h for the assessment of microbial load before and after the disinfection procedures. The disinfection process was performed using 70% isopropyl alcohol and an UV-based sanitiser. Mann—Whitney U-test was used to compare the values between the two groups. Wilcoxon signed-ranks test was used to compare values within each group Results: There was a statistically significant reduction in the mean number of colonies (P = 0.001) after decontamination by the two groups (isopropyl alcohol and UV-based sanitiser) indicating that both agents were effective in disinfection. Conclusion: The study concluded that the percentage reduction in microbial load of the mobile phones was better with isopropyl alcohol compared to UV-based sanitiser. It is recommended that mobile phones in the dental setup be regularly decontaminated and dentists must adhere to strict infection control protocols specifically in relation to hand hygiene.","PeriodicalId":310565,"journal":{"name":"Journal of Patient Safety and Infection Control","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123789378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A review of prevention of surgical site infections in Indian hospitals based on global guidelines for the prevention of surgical site infection, 2016","authors":"A. Arora, P. Bharadwaj, H. Chaturvedi, P. Chowbey, S. Gupta, D. Leaper, G. Mani, S. S Marya, R. Premnath, K. Quadros, A. Srivastava, A. Tendolkar","doi":"10.4103/JPSIC.JPSIC_29_17","DOIUrl":"https://doi.org/10.4103/JPSIC.JPSIC_29_17","url":null,"abstract":"While the global estimates of surgical site infection (SSI) have varied from 0.5% to 15%, studies in India have consistently shown higher rates ranging from 23% to 38%. The incidence of SSI may be influenced by factors such as pre-operative care, the theatre environment, post-operative care and the type of surgery. Many other factors influence surgical wound healing and determine the potential for, and the incidence of, infection. Therefore, the prevention of these infections is complex and requires the integration of a range of preventive measures before, during and after surgery. No standardised guidelines backed by evidence are currently established in India for the prevention of SSI. Hence, there is a need for an adaptable, executable National Guideline for low- and middle-income countries which includes India. An effort to draw out most doable and must doable action points to prevent SSI was undertaken by the panelists involved in this paper on the basis of recent global guidelines for the prevention of SSI.","PeriodicalId":310565,"journal":{"name":"Journal of Patient Safety and Infection Control","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114608770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular characterisation of beta-lactamases-producing Enterobacteriaceae members from critical care patients","authors":"Richa Gupta, A. Malik, M. Rizvi, S. Ahmed","doi":"10.4103/jpsic.jpsic_20_17","DOIUrl":"https://doi.org/10.4103/jpsic.jpsic_20_17","url":null,"abstract":"Background: This study was done to assess the prevalence of beta-lactamases and biofilm production in general and blaCTX-M, blaTEM, blaSHV and blaAmpC in particular amongst Enterobacteriaceae members in Intensive Care Unit (ICU) patients. Materials and Methods: Samples were collected aseptically from 210 ICU patients from February 2012 to December 2015. Culture, identification, antimicrobial susceptibility, extended-spectrum beta-lactamases (ESBLs), AmpC, metallo-beta-lactamase (MBL) and biofilm detection were done according to the standard protocol. Polymerase chain reaction analysis for beta-lactamase genes of the family CTX-M, TEM, SHV and AmpC was carried out. Results: Amongst 200 pathogens, most commonly isolated Enterobacteriaceae member was Escherichia coli (2 [26%]), Klebsiella pneumonia (37 [18.5%]), Klebsiella oxytoca (12 [6%]), followed by Citrobacter species (33 [16.5%]) and Serratia species (15 [8%]). E. coli (29 [55.7%]) was most commonly associated with urinary tract infection; however, the frequency of K. pneumoniae (18 [48.6%]), K. oxytoca (5 [41.6%]) and Citrobacter koseri (20 [33%]) was higher in lower respiratory tract, bloodstream and surgical site infections, respectively. Phenotypically, prevalence of ESBL, AmpC and MBL amongst Enterobacteriaceae members was 50.2%, 36.6% and 12.3%, respectively. However, blaCTX-M and blaAmpC genes were detected in 48% and 32.4% of members, respectively. BlaTEM and blaSHV were not detected in any of the isolates. The average hospital stay of ICU patients was 21 days and was associated with 48.5% mortality. Conclusion: There is a great need for informed antibiotic treatment guided by not only routine antimicrobial susceptibility but also by knowledge of ESBL, AmpC and MBL status of the isolate.","PeriodicalId":310565,"journal":{"name":"Journal of Patient Safety and Infection Control","volume":"2 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130503202","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Central line-associated bloodstream infection: A study on creating awareness about specimen collection","authors":"Kavita Raja, G. Bridget","doi":"10.4103/JPSIC.JPSIC_26_17","DOIUrl":"https://doi.org/10.4103/JPSIC.JPSIC_26_17","url":null,"abstract":"Background: Central line associated Blood stream infection(CLA-BSI) is a hospital acquired infection that is often missed. In a patient on a central line, culture of peripheral blood along with a sample of blood taken through the CL or CL tips is imperative, for a better laboratory diagnosis of CLA-BSI. Aim: (1) To compare the number of CLA- BSI detected in 2010 with the number in 2012 after the awareness campaign was conducted in 2011. (2) To compare specimen collection in different units and formulate strategies for improvement. Methods: Using the laboratory information network, the number of cannula tips and blood cultures sent for culture in 2010 was taken. An intensive campaign to detect CLA-BSI, was initiated in 2011 by the Infection Control Team. The total number of CLA-BSI detected in 2010 was then compared with the number in 2012 after this campaign. Results: A total of 158 cannula tips were sent for culture during the year 2010, while in 2012, 276 cannula tips were sampled. In 2010, while incomplete sampling occurred in 39%, this was reduced to 33% in 2012. Number of correctly diagnosed CLA-BSI increased from 13 to 27 cases in 2012. Conclusion: The campaign has led to detection of more correctly defined CLA-BSI and hence, continuing the training in sending samples is essential to collect the correct data of CLA-BSI. The case studies included show the benefits of correctly identifying such infections.","PeriodicalId":310565,"journal":{"name":"Journal of Patient Safety and Infection Control","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127600812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of automated blood cultures in the diagnosis of childhood brucellosis","authors":"Nivedhana Subburaju, S. Natarajan, R. Ganesh, S. Putlibai","doi":"10.4103/jpsic.jpsic_15_17","DOIUrl":"https://doi.org/10.4103/jpsic.jpsic_15_17","url":null,"abstract":"Brucellosis, a zoonoses, is an important yet underdiagnosed and underreported cause of fever of unknown origin (FUO) in India. This may be both due to lack of awareness and lack of simple diagnostic tests for confirmation. The serological and molecular diagnostic tests may pose trouble in interpretation due to lack of standardisation. Culture is the gold standard and needs 6 weeks, which can be minimised with automated blood culture system. We describe four cases of culture-proven childhood brucellosis in the past 1 year. In our case series, fever and lymphadenopathy were seen in 100%, arthralgia in 50% and hepatomegaly in 75%. Use of automated blood culture system and good clinician–microbiologist communication aided in early diagnosis (<5 days) and appropriate treatment. On follow-up, all the cases are doing well.","PeriodicalId":310565,"journal":{"name":"Journal of Patient Safety and Infection Control","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129193770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Blood culture contamination rates in two district general hospitals in the Southeast of England","authors":"N. Raja, B. O'Neill","doi":"10.4103/JPSIC.JPSIC_17_17","DOIUrl":"https://doi.org/10.4103/JPSIC.JPSIC_17_17","url":null,"abstract":"Introduction: Blood culture is considered an important diagnostic tool to identify the causative agent of bloodstream infection (BSI) as well as to direct the definitive therapy. High contamination rate in any healthcare institution is directly linked with increased cost, use of unnecessary antibiotics and additional testing in the diagnostic laboratories. The audit team determined the blood culture contamination rate and the distribution of microorganisms causing BSIs in patients for the East Sussex Healthcare Trust, United Kingdom. Materials and Methods: This is a retrospective study which analyses the blood culture results over 2 years period (January 2014 to December 2015). Positive blood cultures were grouped into significant, contaminant or unknown significance by reviewing patient clinical data collected at the time of positive blood culture and the microbiology records. Results: A total of 11036 blood cultures were processed in the microbiology laboratory during the study (January 2014 to December 2015). A total of 1641 (14.9%) blood cultures were positive. Of 1641, 1298 (11.8%) and 286 (2.6%) were grouped as significant and contaminant, respectively. Fifty-six positive blood culture sets remained indeterminate due to the lack of the clinical information. The overall contamination rates in both hospitals in 2014 and 2015 were 0.9% and 1.7%, respectively. The average yearly contamination rate is 1.3%. Higher contamination rates were recorded from the paediatric, emergency, orthopaedics and surgical departments. A total of 1753 microorganisms were isolated. The most common isolated organisms include Escherichia coli 482, (27.5%), Coagulase-negative Staphylococcus, 274 (15.6%), Streptococcus species, 183 (10.4%), Staphylococcus aureus, 162 (9.2%), Klebsiella species, 135 (7.7%), Enterococcus species, 109 (6.2%) and Streptococcus pneumonia, 48 (2.7%). Thirty-three Candida species were isolated. The prevalence of methicillin-resistant S. aureus and the extended-spectrum b-lactamase producing Enterobacteriaceae were low. Conclusion: The present data showed lower contamination rate in the Trust than the acceptable rates. It also supports the need for regular training and education of healthcare professional that collect blood culture where the contamination rates are high.","PeriodicalId":310565,"journal":{"name":"Journal of Patient Safety and Infection Control","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130800614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bacterial spectrum and antimicrobial-resistance pattern of bloodstream infections in neutropenic and non-neutropenic adult cancer patients","authors":"N. Raja, Sunil Gupta, B. O'Neill","doi":"10.4103/jpsic.jpsic_19_17","DOIUrl":"https://doi.org/10.4103/jpsic.jpsic_19_17","url":null,"abstract":"Background: Bloodstream infections (BSI) in cancer patients remain associated with significant morbidity and mortality. The choice of an empirical antibiotic regimen is usually based on the local epidemiology of the microorganisms and their antimicrobial susceptibility profile. We present the spectrum and the antimicrobial susceptibility of the causative agents of BSI in adult cancer patients in East Sussex Healthcare Trust (ESHT), UK. Materials and Methods: This retrospective study was conducted at ESHT from January 2006 to December 2015. Demographic and laboratory data were collected from the pathology information system. Results: A total of 640 episodes of BSI occurred in 297 patients (159 male). Of the 297 patients, 239 (80%) had haematology malignancies, whereas 54 (18%) had solid organ tumours. Four patients had both. Majority of BSI (383, 60% episode) occurred in neutropenic patients. A total of 802 organisms (477 [59%] and 325 [41%] organisms from neutropenic and non-neutropenic patients, respectively) were isolated. Of 802, 406 (51%) Gram-positive and 386 (49%) Gram-negative organisms were isolated. Seven Mycobacterium species and three Candida species were isolated. Most common organisms in neutropenic patients were coagulase-negative Staphylococcus (CoNS) (22%), Klebsiella species (14%), Escherichia coli (13%), Streptococcus species (10%) and Pseudomonas species (10%). In non-neutropenic patients, CoNS (29%), E. coli (11%), Pseudomonas species (8%), Streptococcus species (7%) and Klebsiella species (5%) were isolated. Twelve glycopeptide-resistant Enterococci (26% of total 47 Enterococcus species) were isolated. Four methicillin-resistant Staphylococcus aureus (14% of total 28 S. aureus) were isolated. Furthermore, 15 extended-spectrum β-lactamase producing Gram-negative bacilli were isolated. Among Gram-negative organisms, more than 91% isolates were sensitive to piperacillin/tazobactam, ceftazidime and ciprofloxacin and higher sensitivity rates (>95%) were recorded in gentamicin, polymyxin B and meropenem. Conclusion: This study highlights an ongoing trend towards Gram-positive organisms causing BSI in cancer patients. The antimicrobial regimens used in our institution are highly effective against commonly isolated organisms. The identification and the antimicrobial susceptibility of the microorganisms causing BSI in cancer patients remain important to develop antimicrobial treatment strategies including antimicrobial guidelines as well as infection control and to prevent the spread of antimicrobial resistance.","PeriodicalId":310565,"journal":{"name":"Journal of Patient Safety and Infection Control","volume":"49 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132186101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"To know the hindrance or obstacles in hand hygiene practice among healthcare workers of Qassim province of Saudi Arabia","authors":"S. Gupta, S. Mathias, Ibrahim Al Harbi","doi":"10.4103/JPSIC.JPSIC_16_17","DOIUrl":"https://doi.org/10.4103/JPSIC.JPSIC_16_17","url":null,"abstract":"Introduction: Hand hygiene (HH) is now considered as one of the most important measure of infection control activities. In the time of the growing burden of health care associated infections (HCAIs), the increasing severity of illness and complexity of management, threatened by multi-drug resistant (MDR) pathogen infections, health care workers (HCWs) are reversing back to the basics of infection preventions by simple measures like hand hygiene. Objectives: To find out the hindrance or obstacles in hand hygiene practice among health care workers. Methodology: Hospital based cross sectional study. Observation's: In the present study we asked about their opinion about hand hygiene (HH) around 21(28%) responded were fully correct, we also access their correct knowledge about WHO five moments/ indication of hand hygiene (HH) 70 (94%) had correct knowledge regarding indication of hand hygiene. We also access according to their day to day difficulties/obstacles in hand hygiene practice majority of them responded often too busy or insufficient time 18 (25%) followed by hands don't look dirty and skin irritation 17 (23%) & 17 (23%) respectively, some peoples also influenced by others behavior because they don't practice so we 13 (17.56%) also responded no difficulties in practicing hand hygiene (HH) in day to day work. We also asked their suggestions for improvement in hand hygiene compliance among health care workers majority of them suggested encourage the staff to do hand hygiene practice every now and then. Conclusion: Most of the respondents in present study were young females, most common obstacle in hand hygiene practice was often too busy and hand don't look dirty. Common suggestion for improvement was head of unit should ask to staffs daily in morning meeting about hand hygiene compliance and those who not follow after all these efforts to be punished.","PeriodicalId":310565,"journal":{"name":"Journal of Patient Safety and Infection Control","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130015858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}