Antimicrobial Resistance and Infection Control最新文献

{"title":"Antimicrobial prescribing in French nursing homes and interventions for antimicrobial stewardship: a qualitative study.","authors":"Marie Hamard, Claire Durand, Laurène Deconinck, Claire Amaris Hobson, François-Xavier Lescure, Yazdan Yazdanpanah, Nathan Peiffer-Smadja, Agathe Raynaud-Simon","doi":"10.1186/s13756-024-01487-1","DOIUrl":"10.1186/s13756-024-01487-1","url":null,"abstract":"<p><strong>Background: </strong>Overuse of antibiotics is frequent in nursing homes (NHs) leading to adverse events and selection of resistant bacteria. Antimicrobial stewardship interventions showed heterogeneous effects on reducing inappropriate use of antimicrobials in NHs.</p><p><strong>Objectives: </strong>This study aimed (1) to analyze antimicrobial prescribing determinants in NHs; (2) to identify which resources for antimicrobial prescribing are used by NHs' physicians (3) understand which antimicrobial stewardship interventions are required and how they should be implemented in NHs.</p><p><strong>Methods: </strong>We conducted individual semi-directed interviews with NHs' prescribing physicians in Ile-de-France, France. A thematic content analysis was conducted iteratively.</p><p><strong>Results: </strong>Thirteen interviews were conducted. Participants were mostly women, with a median age of 48 years and a median professional experience in NHs of three years. Participants included medical coordinators, general practitioners and salaried physicians. Main determinants of antimicrobial prescribing in NHs were the perceived risk of infectious complications and discomfort in residents, the difficulty in obtaining microbiological samples and the lack of healthcare professionals to monitor patients. Most participants reported using national guidelines and electronic decision support systems to guide their antimicrobial prescribing. Institutional constraints accentuate situations of doubt and prompt physicians to prescribe antimicrobials \"just in case\" despite the will to follow guidelines and the known risks of antimicrobial misuse. Physicians stated that proper antimicrobial use in NHs would require a major effort but was not judged a priority as compared to other medical issues. Producing guidelines tailored to the NH's context, performing good practice audits with feedback on antimicrobial prescribing, and reinforcing multidisciplinary relationships and discussions between city and hospital professionals were cited as potential interventions. The role of the medical coordinator was described as central. According to physicians, collaboration among stakeholders, providing support and training during the process might prove effective strategies to ensure successful implementation.</p><p><strong>Conclusion: </strong>Antimicrobial prescribing is a complex decision-making process involving different factors and actors in NHs. Tailored guidelines, good practice audits, strengthened multidisciplinary collaboration were proposed as key AMS interventions. Physicians emphasized the central role of the medical coordinator supported by stakeholder engagement, collaboration, training and ongoing support for successful implementation.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"13 1","pages":"142"},"PeriodicalIF":4.8,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11600803/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142738139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multidrug-resistant ESBL-producing Klebsiella pneumoniae complex in Czech hospitals, wastewaters and surface waters.","authors":"Lenka Davidova-Gerzova, Jarmila Lausova, Iva Sukkar, Lucie Nechutna, Petra Kubackova, Marcela Krutova, Matej Bezdicek, Monika Dolejska","doi":"10.1186/s13756-024-01496-0","DOIUrl":"10.1186/s13756-024-01496-0","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Multidrug-resistant (MDR) bacteria pose a significant challenge to the treatment of infectious diseases. Of particular concern are members of the Klebsiella pneumoniae species complex (KpSC), which are frequently associated with hospital-acquired infections and have the potential to spread outside hospitals via wastewaters. In this study, we aimed to investigate the occurrence and phylogenetic relatedness of MDR KpSC from patients with urinary tract infections (UTIs), hospital sewage, municipal wastewater treatment plants (mWWTPs) and surface waters and to evaluate the clinical relevance of the KpSC subspecies.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A total of 372 KpSC isolates resistant to third-generation cephalosporins and/or meropenem were collected from patients (n = 130), hospital sewage (n = 95), inflow (n = 54) and outflow from the mWWTPs (n = 63), river upstream (n = 13) and downstream mWWTPs (n = 17) from three cities in the Czech Republic. The isolates were characterized by antimicrobial susceptibility testing and whole-genome sequencing (Illumina). The presence of antibiotic resistance genes, plasmid replicons and virulence-associated factors was determined. A phylogenetic tree and single nucleotide polymorphism matrix were created to reveal the relatedness between isolates.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The presence of MDR KpSC isolates (95%) was identified in all water sources and locations. Most isolates (99.7%) produced extended-spectrum beta-lactamases encoded by bla&lt;sub&gt;CTX-M-15&lt;/sub&gt;. Resistance to carbapenems (5%) was observed mostly in wastewaters, but carbapenemase genes, such as bla&lt;sub&gt;GES-51&lt;/sub&gt; (n = 10), bla&lt;sub&gt;OXA-48&lt;/sub&gt; (n = 4), bla&lt;sub&gt;NDM-1&lt;/sub&gt; (n = 4) and bla&lt;sub&gt;KPC-3&lt;/sub&gt; (n = 1), were found in isolates from all tested locations and different sources except rivers. Among the 73 different sequence types (STs), phylogenetically related isolates were observed only among the ST307 lineage. Phylogenetic analysis revealed the transmission of this lineage from patients to the mWWTP and from the mWWTP to the adjacent river and the presence of the ST307 clone in the mWWTP over eight months. We confirmed the frequent abundance of K. pneumoniae (K. pneumoniae sensu stricto and K. pneumoniae subsp. ozaenae) in patients suffering from UTIs. K. variicola isolates formed only a minor proportion of UTIs, and K. quasipneumoniae was not found among UTIs isolates; however, these subspecies were frequently observed in hospital sewage communities during the first sampling period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study provides evidence of the transmission and persistence of the ST307 lineage from UTIs isolates via mWWTPs to surface waters. Isolates from UTIs consisted mostly of K. pneumoniae. Other isolates of KpSC were observed in hospital wastewaters, which implies the impact of sources other than UTIs. This study highlights the influence of urban wastewaters on the spread of MDR KpSC to rec","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"13 1","pages":"141"},"PeriodicalIF":4.8,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11590221/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142724769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determinants of non-adherence to antibiotic treatment guidelines in hospitalized adults with suspected community-acquired pneumonia: a prospective study.","authors":"Dagfinn Lunde Markussen, Jannicke Slettli Wathne, Christian Ritz, Cornelis H van Werkhoven, Sondre Serigstad, Rune Oskar Bjørneklett, Elling Ulvestad, Siri Tandberg Knoop, Synne Jenum, Harleen M S Grewal","doi":"10.1186/s13756-024-01494-2","DOIUrl":"10.1186/s13756-024-01494-2","url":null,"abstract":"<p><strong>Background: </strong>Antimicrobial resistance (AMR) is a global health threat with millions of deaths annually attributable to bacterial resistance. Effective antimicrobial stewardship programs are crucial for optimizing antibiotic use. This study aims to identify factors contributing to deviations from antibiotic treatment guidelines in hospitalized adults with suspected community-acquired pneumonia (CAP).</p><p><strong>Methods: </strong>We conducted a prospective study at Haukeland University Hospital's Emergency Department in Bergen, Norway, from September 2020 to April 2023. Patients were selected from two cohorts, with data on clinical and microbiologic test results collected. We analysed adherence of antibiotic therapy to guidelines for the choice of empirical treatment and therapy duration using multivariate regression models to identify predictors of non-adherence.</p><p><strong>Results: </strong>Of the 523 patients studied, 479 (91.6%) received empirical antibiotic therapy within 48 h of admission, with 382 (79.7%) adhering to guidelines. However, among the 341 patients included in the analysis of treatment duration adherence, only 69 (20.2%) received therapy durations that were consistent with guideline recommendations. Key predictors of longer-than-recommended therapy duration included a C-reactive protein (CRP) level exceeding 100 mg/L (RR 1.37, 95% CI 1.18-1.59) and a hospital stay longer than two days (RR 1.22, 95% CI 1.04-1.43). The primary factor contributing to extended antibiotic therapy duration was planned post-discharge treatment. No significant temporal trends in adherence to treatment duration guidelines were observed following the publication of the updated guidelines.</p><p><strong>Conclusion: </strong>While adherence to guidelines for the choice of empirical antibiotic therapy was relatively high, adherence to guidelines for therapy duration was significantly lower, largely due to extended post-discharge antibiotic treatment. Our findings suggest that publishing updated guidelines alone is insufficient to change clinical practice. Targeted stewardship interventions, particularly those addressing discharge practices, are essential. Future research should compare adherence rates across institutions to identify factors contributing to higher adherence and develop standardized benchmarks for optimal antibiotic stewardship. Trial registration NCT04660084.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"13 1","pages":"140"},"PeriodicalIF":4.8,"publicationDate":"2024-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11585212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of universal contact precautions and chlorhexidine bathing on the acquisition of carbapenem-resistant enterobacterales in the intensive care unit: a cohort study.","authors":"Jongtak Jung, Hyein Park, Sunmi Oh, Jiseon Choi, Seoyun An, Yeonsu Jeong, Jinhwa Kim, Yae Jee Baek, Eunjung Lee, Tae Hyong Kim","doi":"10.1186/s13756-024-01495-1","DOIUrl":"10.1186/s13756-024-01495-1","url":null,"abstract":"<p><strong>Background: </strong>For the prevention of carbapenem-resistant Enterobacterales (CRE) acquisition in the intensive care unit (ICU), the effectiveness of universal contact precautions (UCP) and chlorhexidine gluconate (CHG) bathing is controversial.</p><p><strong>Methods: </strong>With the aim of evaluating the effectiveness of UCP and CHG on CRE acquisition, this study was conducted in an ICU at a university-affiliated hospital in Seoul. Beginning in April 2017, all patients admitted to the ICU underwent weekly CRE screening and surveillance tests, and beginning in January 2018, UCP and CHG bathing were implemented for all patients. The pre-intervention period spanned from April to December 2017; the post-intervention period spanned from January 2018 to December 2019. The pre- and post-intervention CRE acquisition rates were subsequently compared using Kaplan-Meier analysis and log-rank tests, and independent risk factors for CRE acquisition were analysed using Cox proportional hazard modelling.</p><p><strong>Results: </strong>Of 1,747 patients, 35 acquired CRE during their ICU stay. The CRE acquisition rate was 1.94 and 1.45 per 1,000 patient-days before and after the intervention, respectively, with no significant difference (p = 0.357). The incidence rate of multidrug-resistant organism (MDRO) colonisation decreased from 19.33 to 13.57 per 1,000 patient-days, with Poisson regression analysis showing a relative risk of 0.85 (95% confidence interval [CI] 0.738-0.945, p = 0.004). Additionally, multivariable Cox regression revealed that CRE acquisition was significantly associated with carbapenem exposure (adjusted hazard ratio [aHR] 2.555, 95% CI 1.208-5.405, p = 0.013) and the presence of more than four patients colonised with CRE during their ICU stay (aHR 2.639, 95% CI 1.157-5.243, p = 0.019). However, UCP and CHG bathing were not significantly associated with CRE acquisition (aHR 0.657, 95% CI 0.301-1.433; p = 0.291).</p><p><strong>Conclusions: </strong>UCP and CHG bathing did not affect the CRE acquisition rate in the ICU of a low-prevalence area. A multimodal strategy including antibiotic stewardship is necessary for controlling the nosocomial spread of MDROs.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"13 1","pages":"139"},"PeriodicalIF":4.8,"publicationDate":"2024-11-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11583449/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142692687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of enhanced cleaning on bacterial contamination of the hospital environmental surfaces: a clinical trial in critical care unit in an Egyptian hospital.","authors":"Nermine Mahmoud Hassan Hamed, Osama Ahmed Deif, Aleya Hanafy El-Zoka, Magda Mohamed Abdel-Atty, Mohamed Fakhry Hussein","doi":"10.1186/s13756-024-01489-z","DOIUrl":"10.1186/s13756-024-01489-z","url":null,"abstract":"<p><strong>Background: </strong>Contaminated environmental surfaces play an important role in the transmission of pathogens that cause healthcare acquired infection (HAI). The present study aimed to assess the effect of enhanced cleaning techniques on bacterial contamination in high-touch areas compared to routine cleaning at the intensive care units (ICU) of the neurosurgery department of Alexandria Main University Hospital, Egypt.</p><p><strong>Methods: </strong>The assessment of the knowledge and practices of healthcare cleaning workers and nurses was conducted through a questionnaire and an observational checklist. An educational program about enhanced cleaning was carried out for healthcare cleaning workers and nurses in one room of the ICU unit. Environmental surface swabs were taken from the two rooms of the ICU before and after cleaning (room A and room B). Room A was selected to apply the enhanced cleaning, and room B was selected for routine cleaning.</p><p><strong>Results: </strong>A significant decrease in bacterial counts in the high-touch areas around the patients after the application of enhanced cleaning compared to routine cleaning (p < 0.001) was observed. Gram-negative bacteria isolated from high-touch areas accounted for 45.6% of the samples collected before enhanced cleaning, and they became 16.3% after enhanced cleaning (p < 0.001), while they accounted for 40% after routine cleaning. The enhanced cleaning intervention in Room A resulted in a significant reduction in total infections, decreasing from 18 cases in the six months prior to the intervention to 11 cases in the six months following its implementation. (p < 0.05).</p><p><strong>Conclusion: </strong>The effect of enhanced cleaning was evident in decreasing bacterial counts in the high-touch areas around the patient and consequently in the records of the HAI rate inside the ICU.</p><p><strong>Clinical trial registration number: </strong>PACTR202402531001186, date: 15 February 2024, 'retrospectively registered'.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"13 1","pages":"138"},"PeriodicalIF":4.8,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11575196/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142674949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A multicentric survey and single-centre observational study of usage behaviour of sinks in intensive care: training is needed to minimize risk.","authors":"Giovanni-Battista Fucini, Robert Abe, Elke Lemke, Petra Gastmeier","doi":"10.1186/s13756-024-01493-3","DOIUrl":"10.1186/s13756-024-01493-3","url":null,"abstract":"<p><strong>Introduction: </strong>Sinks have been introduced near patients to improve hand hygiene as part of infection prevention and control measures. However, sinks are a known reservoir for gram-negative bacterial pathogens in particular and their removal to prevent bacterial infections in intensive care patients is currently recommended by several international guidelines.</p><p><strong>Methods: </strong>Healthcare workers (HCWs) in 15 intensive care units (ICUs) in Germany were given the opportunity to complete an anonymous survey on the use of sinks between August 2022 and January 2023. Observations were then made in three participating ICUs to determine the frequency and reason for contact with the sink.</p><p><strong>Results: </strong>258 questionnaires were returned (nurses 87%). 90% found it useful to very useful to have a sink in the patient room, and 56% reported using it daily for hand hygiene. We observed 33 contacts between nurses and sinks over 17 h. In 20/33 (60%) cases, the sink was used for waste disposal. In 3/33 (10%) it was used for hand washing.</p><p><strong>Discussion: </strong>Sinks are still used for daily care in intensive care units. Educational Interventions in existing buildings to minimise risk through \"sink hygiene\" (i.e. separation of sinks for water disposal and uptake) can make an important contribution to infection prevention.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"13 1","pages":"137"},"PeriodicalIF":4.8,"publicationDate":"2024-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11571737/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142646794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of establishing infection control program with core components of World Health Organization on reducing the risk of residents' infections and improving staff infection control competency in a nursing home.","authors":"Min Hye Lee, Yu Mi Yi, Eun-Young Noh, Yeon-Hwan Park","doi":"10.1186/s13756-024-01492-4","DOIUrl":"10.1186/s13756-024-01492-4","url":null,"abstract":"<p><strong>Background: </strong>Nursing homes (NHs) are high-risk facilities with limited infection control resources and residents susceptible to infectious diseases. The evidence regarding World Health Organization (WHO) core components in NHs is lacking. This study evaluates the effectiveness of establishing an infection prevention and control (IPC) program with WHO's core components in an NH.</p><p><strong>Methods: </strong>The IPC program, encompassing evidence-based guidelines, education and training, surveillance, multimodal strategies, monitoring and feedback, workload and staffing considerations, and the built environment, was implemented in a 130-bed NH for one year. The effects were assessed based on the number of infections among residents, the level of knowledge, and the performance of infection control among staff. The risk of infection was analyzed across three phases: pre-implementation phase, implementation phase (6 and 12 months after intervention initiation), and sustainability phase (3, 6, and 12 months after intervention was finished). Staff data were analyzed before and after the intervention.</p><p><strong>Results: </strong>Analysis of 18,124 resident-days revealed that during the sustainability phase, the risk of respiratory tract infection was significantly lower than before intervention implementation (odds ratio [OR] 0.51, 95% CI 0.30-0.86, p = 0.012). Moreover, a significant improvement was observed in staff knowledge (p = 0.002) and performance (p < 0.001) after the intervention compared to before.</p><p><strong>Conclusions: </strong>WHO's core components may have a potential effect on reducing healthcare-associated infections among residents and enhancing the infection control competency of staff in the NH with limited IPC resources.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"13 1","pages":"136"},"PeriodicalIF":4.8,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11562619/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Enhancing clinical microbiology for genomic surveillance of antimicrobial resistance implementation in Africa.","authors":"Henry M Kajumbula, Daniel Gyamfi Amoako, Sofonias K Tessema, Mabel Kamweli Aworh, Francis Chikuse, Iruka N Okeke, Uduak Okomo, Sabelle Jallow, Beverly Egyir, Aquillah M Kanzi, Abdul Karim Sesay, Yewande Habibat Alimi, Kwabena O Duedu, Olga Perovic","doi":"10.1186/s13756-024-01472-8","DOIUrl":"10.1186/s13756-024-01472-8","url":null,"abstract":"<p><p>Surveillance is essential in the fight against antimicrobial resistance (AMR), to monitor the extent of resistance, inform prevention, control measures, and evaluate intervention progress. Traditional surveillance methods based on phenotypic antimicrobial susceptibility data offer important but limited insights into resistance mechanisms, transmission networks, and spread patterns of resistant bacterial strains. Fortunately, genomic technologies are increasingly accessible and can overcome these limitations. Genomics has the potential to advance traditional bacteriology in routine diagnosis and surveillance, it often relies on the initial isolation of bacterial strains from clinical specimens using conventional culture methods. Culture-based phenotypic characteristics are essential for making inferences about newly recognized genomic patterns. The Africa CDC Pathogen Genomics Initiative (Africa PGI) aims to enhance disease surveillance and public health partnerships through integrated, cross-continent laboratory networks equipped with the tools, human resource capacity and data infrastructure to fully leverage critical genomic sequencing technologies. For genomic surveillance of AMR, it is essential to optimize routine clinical microbiology laboratory services that are weak in many African countries. In this review, we outline shortcomings in clinical microbiology laboratories across Africa that compromise pathogen genomic epidemiology. We emphasize the necessity of investing in bacteriology and enhancing leadership capacity to fully capitalize on the advantages offered by genomic antimicrobial resistance (AMR) surveillance.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"13 1","pages":"135"},"PeriodicalIF":4.8,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11559129/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142612308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmental cleaning barriers and mitigation measures identified through two initiatives in four countries, 2018-2023: a commentary.","authors":"Molly Patrick, Claire Kilpatrick, Julie Storr, Giorgia Gon, Tuan Huynh, Phung Manh Thang, Damilola Adeniyi, Folasade Ogunsola, Fatuma Manzi, Ir Por, Bernice Sarpong, Yovitha Sedekia, Ma Sokvy, Vouchnea Tang, Sreytouch Vong, Wendy Graham","doi":"10.1186/s13756-024-01491-5","DOIUrl":"10.1186/s13756-024-01491-5","url":null,"abstract":"<p><p>In recent years, there has been increased attention on the importance of healthcare environmental cleaning, including the need to professionalize and support the workforce responsible for performing cleaning. Global agendas and strategies on infection prevention and control (IPC) and water, sanitation and hygiene highlight the need for improvements to this sector, particularly in resource-limited healthcare facilities in low- and middle-income countries. Correspondingly, several resources have been developed that aim to (1) improve professional training of cleaners and (2) improve implementation of best practices in resource-limited settings. This commentary seeks to provide insight into the barriers and facilitators to implementing these resources, drawing on the practical experience from two initiatives across four countries from 2018 through 2023. Several common barriers were identified across the diverse settings, including (1) low empowerment and status of the workforce, (2) low pay, inadequate staff time for the high workload needed to achieve best practices and high turnover of staff, and (3) a lack of connection and integration of environmental cleaning with IPC and patient safety efforts at the participating hospitals. Despite barriers, local teams identified effective mitigation measures. While considerable time and effort will be needed to truly overcome these barriers, there are opportunities to build upon attention and momentum on this topic and IPC initiatives in resource-limited settings in low- and middle-income countries. We propose several broader actions, all of which require local leadership and context-specific approaches.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"13 1","pages":"134"},"PeriodicalIF":4.8,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11546090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142602778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"WHO/INRUD prescribing indicators with a focus on antibiotics utilization patterns at outpatient department of Adigrat general hospital, Tigrai, Ethiopia: a retrospective cross-sectional study.","authors":"Gebretekle Gebremichael Hailesilase, Brhane Gebrehiwot Welegebrial, Mezgebe Gidey Weres, Senait Abera Gebrewahd","doi":"10.1186/s13756-024-01490-6","DOIUrl":"10.1186/s13756-024-01490-6","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization (WHO) defines rational use of drug as a state in which medications are received by patients appropriately according to their clinical needs and individual requirement, for adequate period and at the right cost. More than 50% of all medicines are prescribed, dispensed, or sold inappropriately worldwide. This study aimed to evaluate the prescribing patterns in Adigrat general hospital, Tigrai, Ethiopia.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was done to evaluate prescription patterns. A systematic random sampling technique was used to select 600 prescriptions and the prescriptions were reviewed using WHO/International Network of Rational Use of Drugs prescribing indicators. Data was collected from prescriptions dispensed from 01 March 2023 to 30 March 2024 at outpatient pharmacy of Adigrat general hospital. Data was analyzed using SPSS version 21 and a p-value < 0.05 was declared statistically significant.</p><p><strong>Results: </strong>A total of 1088 medicines were prescribed in 600 prescription encounters, giving an average number of 1.8 (± 0.83) medicines per encounter. The percentage of medicines prescribed by generic name was 91.5% while 98.7% of the medicines were prescribed from essential medicine list (EML). Besides, the percentages of encounters containing at least one antibiotic and one injection were 44.5% and 7.2%, respectively. A total of 340 antibiotics were prescribed in 267 encounters. Penicillins (34.4%), macrolides (23.8%) and fluoroquinolones (17.1%) were the most prevalent antibiotics classes. The \"Access\" and \"Watch\" groups covered 54.4% and 45.6% of the total antibiotics prescribed, respectively. Being under 18 years old [Adjusted Odds Ratio (AOR): 9.830, CI: 4.062-23.786], being prescribed with three medicines (AOR: 3.247, CI: 1.571-6.708) and certain diagnosis like diseases of the respiratory system (AOR: 3.750, CI: 2.136-6.584) were significantly associated with antibiotic prescribing.</p><p><strong>Conclusion: </strong>This study showed deviations of prescribing patterns from WHO standards. The percentage of prescriptions with antibiotic was far from WHO optimal value. The use of antibiotics from \"Access\" group was below WHO standard. The percentage of medicines prescribed by generic name and the percentage of encounters with injection also deviated from WHO standard. Antibiotics prescribing showed significantly association with age, number of medicines and certain diseases.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"13 1","pages":"133"},"PeriodicalIF":4.8,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11539567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}