Surgical site infections (SSIs) remain among the most frequent healthcare-associated infections worldwide and are associated with significant morbidity, mortality, and healthcare costs. Despite availability of evidence-based guidelines, adherence to SSI prevention measures varies substantially across countries and institutions. In Ukraine, reliable data describing SSI prevention practices remain limited due to absence of nation-wide monitoring of infection prevention and control practices. We conducted two rounds of a national survey among surgeons and anaesthesiologists in Ukraine in 2021 and 2025. The survey was based on the World Health Organization (WHO) Global Guidelines for the Prevention of Surgical Site Infection (2018 edition) and assessed knowledge, attitudes, and self-reported adherence to recommended and non-recommended SSI prevention practices. Both surveys were distributed online via professional societies' platforms, targeting practicing surgeons and anaesthesiologists across different levels of healthcare facilities. In 2021, a total of 294 responses were received, followed by 145 responses in 2025. Across both survey periods, respondents represented a wide range of clinical specialties and geographic regions, with anaesthesiologists comprising the majority. In the 2025 survey, perioperative antimicrobial prophylaxis was reported as universally practiced (100%). In addition, active intraoperative warming was implemented by 82.6% of respondents and goal-directed fluid therapy by 93.8%. Despite these encouraging figures, several evidence-based measures were only partially adopted. For instance, alcohol-based chlorhexidine for skin preparation was used by 51%, surgical hand preparation with antiseptic soap by 60%, and intensive perioperative blood glucose control by 71.7% of respondents. Conversely, certain non-recommended practices, such as extended antimicrobial prophylaxis after surgery, remained prevalent, with 82.6% of respondents reporting its use. Although self-rated knowledge of WHO guidelines was generally high, notable gaps between awareness and actual practice were observed. This national survey, conducted in two rounds (2021 and 2025), was instrumental in understanding which SSI prevention practices are currently used in Ukraine. The continued use of non-recommended practices remains evident. These results underscore the need for targeted educational interventions, systematic monitoring, and strengthened institutional support to improve adherence to evidence-based guidelines and ultimately reduce the burden of SSIs nationwide.
Enteric infectious diseases claim more than 1 million lives annually and are among the top ten causes of death in children younger than 5 years. Remarkable global investment has been dedicated to enteric infectious disease prevention and control; however, the shifting global health landscape is testing the continuance of progress. To evaluate the current status and guide future interventions, we present the latest epidemiological estimates of enteric infectious diseases from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 and assess progress towards the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) mortality target of fewer than 20 deaths per 100 000 children younger than 5 years by 2025. We quantified the incidence, mortality, and disability-adjusted life-years (DALYs) of enteric infectious diseases by age, sex, and year across 204 countries and territories from 1990 to 2023. In GBD 2023, the following were considered under the category of enteric infectious diseases: diarrhoeal diseases, enteric fever (typhoid and paratyphoid), invasive non-typhoidal Salmonella spp (iNTS) infections, and other intestinal infectious diseases. We also examined 15 aetiologies contributing to diarrhoeal diseases. Incidence and prevalence were estimated with DisMod-MR (version 2.1), a Bayesian meta-regression tool, drawing on data from systematic reviews, population-based surveys, claims data, and hospital sources. Cause-specific mortality was modelled with Cause of Death Ensemble Modelling based on data from sources including vital registration, mortality surveillance, verbal autopsy, and minimally invasive tissue sampling. Years of life lost and years lived with disability were computed and combined to derive DALYs. For aetiology-specific estimation, population-attributable fractions (PAFs) for 15 pathogens were derived with a counterfactual framework. Point estimates and 95% uncertainty intervals (UIs) were generated from 250 draws from the posterior distribution. In 2023, enteric infectious diseases resulted in an estimated 1·27 million (95% UI 0·963-1·68) deaths globally, declining from 3·69 million (3·04-4·56) in 1990. The global age-standardised mortality rate (ASMR) decreased from 74·1 (62·0-92·9) per 100 000 population to 16·4 (12·6-21·3) per 100 000 population during the same period. Diarrhoeal diseases accounted for most deaths in 2023 (1·11 million [0·811-1·54]), followed by enteric fever and iNTS. South Asia and sub-Saharan Africa remained the most affected regions in 2023, with 599 000 (441 000-882 000) and 501 000 (373 000-648 000) deaths due to enteric infectious diseases, respectively, predominantly from diarrhoeal disease. Rotavirus was the leading cause of all-age diarrhoeal disease deaths (PAF 16·3% [12·0-21·5]), followed by norovirus (10·2% [2·4-17·0]) and Shigella spp (9·3% [5·4-15·2]). Among children younger than 5 years, PAFs of deaths due to diarrhoeal diseases were 40·2% (32·5-48·5) for rotavirus, 24·0% (15·1-36·7) for Shigella spp, and 23·4% (13·7-34·3) for adenovirus. Across 204 countries and territories, 141 met the GAPPD mortality target in 2023. The driving aetiologies among countries that did not meet the target in 2023 varied slightly by GBD super-region, but the highest or second-highest number of deaths in children younger than 5 years were consistently attributed to rotavirus. Astrovirus and sapovirus, newly included in GBD 2023, were responsible for 24 600 (6290-49 000) and 18 800 (4650-44 400) deaths, respectively, in 2023, mainly in children younger than 5 years. Our findings show that mortality and ASMRs of enteric infectious diseases declined substantially between 1990 and 2023. This decline is consistent with the expansion of public health measures and broader socioeconomic development. However, the burden in 2023 remains considerably high, with the highest mortality concentrated in sub-Saharan Africa and south Asia. Considering that more than a quarter of all countries had yet to meet the GAPPD mortality target in 2023, sustained efforts are needed to address the persistent burden in affected countries and to adapt to the changing global health landscape. Gates Foundation.
Environmental contamination of handwashing sinks and drains can negatively impact hand hygiene practices and facilitate pathogen transmission. This study determined what contaminations occurred after sink and drain installation, when and for how long, as well as differences in contamination patterns depending on the purpose of sink use in a non-outbreak setting. The study was conducted from November 2022 to October 2023. Two new sinks and drainpipes replaced the existing sinks in a general internal medicine hospital ward staff station for use before and after patient care. A third single sink and drainpipe was installed in the staff break room for non-medical use. Bacterial samples were collected from the water tap, sink basin, drain and drainpipe by swab or sponge on days 1 (installation day) and 3 in week 1, in week 2 and monthly thereafter. The cleaning staff members were responsible for cleaning the sink basins and drains daily with detergent. Within the first week after installation, pathogenic microbial contamination (Pseudomonas aeruginosa, Citrobacter freundii and Stenotrophomonas maltophilia) of drainpipes was observed in both the staff station and the break room. Taps were contaminated 2 weeks after installation at the staff station. The contamination cleared but recurred repeatedly until the 12-month point. Pathogens in drainpipes persisted for longer in the staff station than in the break room. The intermittent microbial contamination patterns of the handwashing sinks changed over time following their installation. Pathogenic microbes persisted, especially in drainpipes and in sinks used for clinical purposes, as opposed to non-clinically used sinks.
Central line-associated bloodstream infections (CLABSIs) pose a significant risk to patients and contribute to increased healthcare costs. They are largely preventable through evidence-based quality improvement (QI) initiatives. In the polytrauma ICU, the CLABSI rate suddenly increased to 14/1000 central line days in the latter half of 2023. This QI initiative aimed to identify the root causes and reduce the CLABSI rates by 30% (targeting 10/1000 central line days) by June 2024. A multidisciplinary team tested several interventions using small Plan-Do-Study-Act cycles. CLABSI prevention bundles were introduced and refined, including: the use of maximum barrier precautions during line insertion, adherence to the Central Line Insertion Practice (CLIP) tool, standardized and real time bundle monitoring via direct observation, regular training and education sessions for staff. Surveillance methods and modified CLABSI definitions from the Healthcare-Associated Infection Surveillance Network were applied. The CLABSI rate dropped from 14 to 8 per 1,000 central line days, with 49 consecutive CLABSI-free days. Regular monitoring improved staff compliance with central line insertion and maintenance bundles including the completion of the central line (CL) insertion checklist (100%), use of full body drape (78.4%), chlorhexidine for site cleaning, aseptic conditions during CL insertion (75%) and "scrub the hub" technique (65%). Staff awareness of healthcare-associated infections (HAIs) improved through regular refresher classes, bedside teaching sessions, and daily rounds by Infection Control Nurses (HCNs) and the Quality Improvement (QI) team. Implementation of an evidence-based CLABSI prevention bundle, combined with direct process monitoring, led to significant and sustained reduction in CLABSI rates in the polytrauma ICU.
Co-infection with avian influenza virus (AIV) is common in poultry populations, primarily due to the diversity of viral subtypes and the practice of mixed-species farming. However, the replication dynamics of different AIV subtypes within distinct avian host-species remain unclear. In this study, we isolated and identified H5N1 and H5N8 AIVs from a naturally co-infected duck and characterized their biological characteristic regarding co-infection under both in vitro and in vivo conditions. Phylogenetic analysis revealed the HA genes of both H5 subtype AIVs belonged to clade 2.3.2.1d, sharing identical segments excluding differences in the M and NA genes. The H5N1 virus exhibited significantly higher infectivity and replication than the H5N8 virus in chicken embryo fibroblasts (CEF) and duck embryo fibroblasts (DEF). Serial passages of co-infection in vitro revealed that H5N1 virus became dominant in the first passage in both CEF and DEF cells. In vivo, both viruses caused high mortality in SPF chickens, while nonlethal in SPF ducks. In co-infected SPF chickens, H5N1 virus exhibited a pronounced replication advantage and higher viral loads. However, compared with single infections, co-infection delayed death time and reduced replication capacity. Conversely, in co-infected SPF ducks, H5N8 virus exhibited a significant replication advantage; however, compared to single infections, the replication capacity of H5N8 virus was reduced while H5N1 virus was maintained. These findings suggest that host-species influence the replication fitness and dominance of AIVs during co-infection, highlighting the importance of enhanced epidemiological surveillance and reducing mixed-species farming to minimize reassortment and evolution of high-risk AIVs.
Rising antimicrobial resistance of Helicobacter pylori is a public health challenge. Genomic-based susceptibility testing allows for the identification of resistance-associated mutations, complementing conventional diagnostics and advancing towards pathogen-based personalised therapies. Our study aimed to identify genes and mutations involved in antimicrobial resistance in H pylori and evaluate the extent to which these markers can be used as predictors of phenotypic resistance against clarithromycin and levofloxacin. In this retrospective phenotypic and genotypic observational study, we included 1011 H pylori whole-genome sequences and strains of known geographical origin from the H pylori Genome Project (HpGP) collection. We performed phenotypic clarithromycin and levofloxacin susceptibility testing on a subset of 419 HpGP strains using Etest at a centralised laboratory. A genomic analysis was conducted to identify 23S rRNA and gyrA variants and build a curated catalogue of mutations associated with resistance to clarithromycin (ie, 23S rRNA 2142A→G, 2142A→C, and 2143A→G) and levofloxacin (ie, gyrA A88V or A88P, N87K or N87I, and D91G, D91N, or D91Y). Genotype-phenotype concordance was assessed to estimate sensitivity and specificity, and the curated catalogue of resistance-associated mutations was applied to the complete HpGP set. Region-specific prevalence of resistance-associated mutations was calculated for a combined dataset including the HpGP genomes and 768 whole-genome sequences retrieved from the US National Center for Biotechnology Information Sequence Read Archive repository. Associations between resistance genotypes, H pylori subpopulations, and minimum inhibitory concentrations (MICs) were tested. Clarithromycin-resistant and levofloxacin-resistant HpGP strains were estimated with a sensitivity and specificity of 100%, with all confidence intervals ranging from 96% to 100%. The combined analysis (n=1779) found the highest prevalence of clarithromycin resistance in the western Pacific region (173 [51·2%] of 338 in southeast Asia and 75 [29·8%] of 252 in eastern Asia), north African region (seven [38·9%] of 18), and western Asian region (12 [31·6%] of 38), whereas the highest prevalence of levofloxacin resistance was found in south Asia (14 [51·85%] of 27), Central America (48 [38·7%] of 124), eastern Europe (four [36·4%] of 11), and southern Africa (three [33·3%] of nine). Similarly, 23S rRNA and gyrA genotypes are variable across H pylori subpopulations. MIC values changed depending on the specific mutation in 23S rRNA (mean clarithromycin MIC 24·61 mg/L [95% CI 12·27-36·96] for 2143A→G and 142·25 mg/L [95% CI 77·88-206·61] for 2142A→G) and gyrA (mean levofloxacin MIC 9·66 mg/L [95% CI 6·75-12·56] for mutations on codon 91, and 27·97 mg/L [95% CI 25·82-30·11] for mutations on codon 87). Mutations in specific genes are reliable indicators to clarithromycin and levofloxacin resistance in H pylori, making them useful markers for the development of diagnostic assays and molecular monitoring. Our results suggest that using clarithromycin and levofloxacin empirically, without previous susceptibility testing, is unsuitable in all geographical regions covered by this study. Intramural Research Program of the US National Cancer Institute, the European Research Council, and the Spanish Ministry of Science and Innovation.
Klebsiella pneumoniae is a major cause of healthcare-associated infections. Although colonisation with Gram-negative bacteria in hospitalised patients is well recognised, the relative contributions of patient-to-patient versus environment-to-patient transmission remain unclear. Most outbreak investigations focus on multi-drug-resistant (MDR) strains. This study investigates a non-MDR K. pneumoniae outbreak in an intensive care unit (ICU) to examine the role of the hospital environment in nosocomial transmission. Clinical isolates of Klebsiella spp. were obtained from six patients between January 2021 and June 2021. Environmental swabs were collected from handwashing sinks in patient and preparation rooms, 3 months apart. Whole-genome sequencing (WGS) assessed singlenucleotide polymorphism (SNP)-based relatedness using literature-informed thresholds. WGS identified five distinct clusters of genetically related K. pneumoniae isolates, linking clinical and environmental sources. The closest relationships (2-5 SNPs) were observed between patient and sink isolates within the same room, consistent with recent transmission or a shared source. Additional clusters (5-23 SNPs) involved isolates from sinks in different rooms, indicating environmental persistence and potential inter-room dissemination. Two Klebsiella varicola subspecies variicola bloodstream isolates from spatially distinct patients differed by only 2 SNPs, forming an additional cluster consistent with a common clonal lineage. Following enhanced daily sink disinfection and staff education, no further clinical acquisitions were identified. WGS demonstrated genetic relatedness between nonMDR Klebsiella spp. strains and ICU environmental isolates, underscoring the role of environmental reservoirs in transmitting antimicrobial-susceptible Gram-negative organisms and the importance of targeted surveillance beyond MDR settings.
Infertility is a prevalent global reproductive health issue. In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), as pivotal assisted reproductive technologies, are widely implemented in clinical practice. However, clinical pregnancy outcomes following IVF/ICSI are influenced by various factors, making accurate prediction essential for optimizing treatment strategies. To develop and validate a predictive model for clinical pregnancy outcomes following IVF/ICSI treatment. A retrospective analysis was conducted on clinical data from 154,307 patients who underwent assisted reproductive treatment due to infertility at the First People's Hospital of Yunnan Province. Based on inclusion and exclusion criteria, 11,449 patients who underwent IVF/ICSI were included. Key predictors were identified using LASSO regression. A Nomogram scoring system was developed for an intuitive visualization of individualized prediction results. Model performance was evaluated using the area under the receiver operating characteristic (ROC) curve, calibration curves, decision curve analysis (DCA), and clinical impact curves. LASSO regression identified eight critical predictors influencing clinical pregnancy outcomes: male age, antral follicle count (AFC), Day 3 follicle-stimulating hormone (FSH) level, endometrial thickness, female age, number of usable embryos, number of high-quality blastocysts, and number of embryos transferred. The predictive model demonstrated excellent performance in both the training and validation cohorts, with AUC values of 0.839 [95% CI (0.825, 0.852)] and 0.827 [95% CI (0.817, 0.835)], respectively, indicating strong discriminatory ability. Calibration curves confirmed a high degree of consistency between predicted probabilities and actual outcomes. Decision curve analysis revealed substantial net clinical benefit across various risk thresholds, while clinical impact curves further validated the model's practical applicability in clinical settings. This study identified key factors influencing clinical pregnancy outcomes following IVF/ICSI treatment, including male age, antral follicle count (AFC), Day 3 follicle-stimulating hormone (FSH) level, endometrial thickness, female age, number of usable embryos, number of high-quality blastocysts, and number of embryos transferred. This model serves as a scientifically sound decision-support tool for clinicians in the management of infertility treatment with IVF/ICSI.
Incisional prophylactic intra-operative wound irrigation (pIOWI) with an aqueous antiseptic solution effectively reduces surgical site infections (SSIs); however, data on the use of aqueous chlorhexidine gluconate remain limited, and no clinical comparisons with aqueous povidone iodine exist. We therefore compare the efficacy of aqueous chlorhexidine gluconate with aqueous povidone iodine for incisional pIOWI in the prevention SSI in elective abdominal surgery. A post hoc analysis of data from the randomised controlled Enhanced PeriOperative Care and Health (EPO2CH) trial was conducted, including 699 patients, to assess the effect of aqueous chlorhexidine gluconate compared with aqueous povidone iodine for incisional pIOWI on the incidence of SSI. Multiple imputation with chained equations was used to impute missing values. The association between the type of irrigation and SSI was assessed using inverse probability of treatment-weighted logistic regression. Weighted regression analysis showed a statistically non-significant difference in the SSI rate (-3.03%, 95% confidence interval [CI]: -7.04 to 0.98) for pIOWI with aqueous chlorhexidine gluconate (4.05%) vs aqueous povidone iodine (7.08%). While the SSI rate for pIOWI with aqueous chlorhexidine gluconate showed a lower estimated SSI incidence than with aqueous povidone iodine, the difference was not statistically significant, with wide CIs, indicating uncertainty. Further research is needed to assess the hypothesis that pIOWI with chlorhexidine gluconate, than in povidone iodine, may reduce SSI.
Blood culture contamination (BCC) poses significant clinical and financial challenges in hospital settings. Guidelines recommend BCC rates remain below 3%; however, in the first quarter (Q1) of 2024, our tertiary hospital emergency department (ED) reported a median rate of 10%. The aim of the present study was to evaluate the impact of the Kurin Lock® device on reducing BCC rates in the ED. The device diverts the initial 0.15 mL of blood, potentially containing skin flora contaminants. An eight-week pilot of the Kurin Lock® device was conducted from May to July 2024. ED clinical staff received training prior to implementation. Blood cultures collected using Kurin Lock® were compared with those obtained via the standard method. Contamination was defined by the clinical microbiology team as isolation of organisms considered clinically insignificant and likely derived from skin flora. Data were extracted from the hospital's surveillance system. A total of 768 blood cultures were collected. Contamination occurred in 2.7% (N = 6/221) of blood cultures obtained using Kurin Lock® compared with 10.4% (N = 57/547) of blood cultures obtained using the standard method (P = 0.0004), representing a 74% relative reduction. Staff adherence to device use averaged 28.5%. Use of the Kurin Lock® was associated with a significant reduction in BCC, achieving rates below the 3% recommended standard. These findings highlight the potential benefits of improving patient outcomes and healthcare costs. Ongoing success will depend on increasing staff engagement and integration into routine practice.
The increasing incidence of carbapenem-resistant Enterobacterales (CRE) infections, driven by carbapenemase-producing Klebsiella pneumoniae (KPC) and New Delhi metallo-β-lactamase (NDM) dissemination, demands reliable predictive tools to optimize empiric therapy. The Giannella risk score (GRS), initially developed in a CRE-KPC-dominant setting, may not perform equally in heterogeneous contexts. This study aimed to evaluate the predictive value of extra-rectal CRE colonization and the GRS for overall CRE infections, specific CRE-KPC and CRE-NDM infections, and bacteraemia in patients rectally colonized with CRE. We conducted a retrospective cohort study of adults with rectal CRE-KPC and/or CRE-NDM colonization admitted to an intensive care unit in Argentina during a Providencia stuartii-NDM outbreak in a setting with endemic CRE-KPC circulation. Patients were followed up for up to 90 days. Associations were analysed using bivariate statistics, and logistic regression and predictive performance were evaluated through receiver operating characteristic (ROC) curves. Among 327 CRE rectal-colonized patients, 49.2% carried CRE-KPC, 30.3% CRE-NDM, and 20.5% were co-colonized. Overall, 10.7% developed CRE infections. Extra-rectal colonization was independently associated with infection (adjusted odds ratio: 3.5 [1.53-7.94], P ≤ 0.01), with high specificity (93.9%) but low sensitivity (20.0%). The GRS showed moderate predictive performance for overall infection (area under the ROC curve, 0.66) with a threshold of ≥3 points. However, when applied specifically to CRE-KPC- or CRE-NDM-colonized patients, neither extra-rectal cultures nor GRS calculations reliably predicted infection or bacteraemia. In this cohort, extra-rectal CRE colonization was the only independent predictor of subsequent infection. These findings highlight the need for carbapenemase-independent dynamic risk models better suited to mixed resistance environments.
The growing incidence of antimicrobial-resistant Candidozyma (Candida) auris (C. auris) poses a major public health threat, especially because of its association with serious healthcare-related infections and high mortality rates. Ultraviolet-C (UV-C) irradiation is being viewed as a disinfection method because it has a rapid germicidal effect against a wide range of pathogens. The objective of this study was to assess the effectiveness of UV-C disinfection in reducing environmental contamination with C. auris on high-touch surfaces and C. auris-related central line-associated bloodstream infections (CLABSIs) among adult intensive care unit (ICU) populations. The design used was a before-and-after study, conducted from January 2023 to December 2024. The study was conducted in the adult ICU in a tertiary-care centre hospital in Saudi Arabia. Terminal cleaning was enhanced with the use of three-tower UV-C devices (Surfacide Helios®). Environmental sampling for C. auris was performed on frequently touched surfaces. In addition, the incidence of Candida-associated CLABSI was evaluated and compared between the periods before and after implementation of UV-C disinfection. Colony-forming unit (cfu) counts exceeded >5 log10cfu per sample after manual cleaning and declined to <2 log10cfu per sample following UV-C disinfection. The mean difference in log-transformed cfu counts before and after UV-C exposure was 7.756 (standard deviation [SD]: 0.399, 95% Wald confidence interval [CI]: 7.696-7.817, t (169) = 253.147, P < 0.001). The incidence of C. auris-associated CLABSI decreased significantly after UV-C implementation (incidence rate ratio: 10.88, 95% CI: 1.40-84.25, P = 0.022). UV-C is effective in further decreasing the burden of C. auris and controlling its spread in hospitals with high incidence rates.
Surveillance for influenza A virus infections in vaccinated poultry flocks remains challenging due to animal welfare, logistical and financial constraints, particularly under current EU regulations governing high pathogenicity avian influenza (HPAI) vaccination. In this field study, we evaluated two environmental sampling (ES) methods - bedding boot swabs and drinker wipes - as alternatives to legally mandated individual bird testing, which involved monthly swabbing of 60 healthy birds (active surveillance, AS) and weekly swabbing of dead or sick birds (passive surveillance, PS). A total of 56 turkey flocks from 23 holdings in Lower Saxony, Germany, were monitored throughout the fattening period following single H9N2 vaccination at hatch. Semiquantitative reverse transcription polymerase chain reaction (RT-qPCR) revealed that, despite vaccination, H9N2 virus incursions occurred at least once in 76.8% (43/56) of flocks during the subsequent fattening period. Influenza A virus detection rate on the basis of individual samples was significantly higher by ES (24.1%) than through AS (10.65%; P<0.0001) or PS (15.6%, P=0.001). Overall, ES demonstrated superior performance in identifying 42/43 infected flocks (99.67%) compared with 30/43 (69.97%) by AS and 38/43 (88.37%) by PS. Heatmap and event-time analyses confirmed that ES reliably identified infection events very early and remained positive longer after initial detection. Non-invasive, animal-friendly ES was easy to implement and well accepted by farmers. Costs for ES surveillance were reduced by 73.5% compared to AS and PS. ES was found to be a sensitive, cost-effective and very practical alternative to conventional surveillance in influenza-vaccinated poultry, with direct relevance for future surveillance strategies in HPAI vaccination programmes.
Hospital water systems are recognized as potential sources of waterborne pathogens, posing serious risks to vulnerable patient populations. Despite federal and local guidelines, implementing effective water management programs in healthcare settings remains a significant challenge. From April 2024 to May 2025, the Maryland Statewide Prevention and Reduction Collaborative (SPARC) implemented a participant-driven learning collaborative, the Water Management Initiative, based on interest from infection preventionists at Maryland hospitals. The Water Management Initiative aimed to be responsive to the learning needs of Maryland acute care hospitals regarding their water management practices, as informed by an initial needs assessment. The initiative was evaluated via surveys after all sessions were completed. Of the 42 eligible Maryland acute care hospitals, 26 (62%) responded to the pre-initiative needs assessment. Based on this assessment, SPARC developed the Water Management Initiative, which included a full-day workshop, 11 webinars, one office hour, and individual coaching sessions with two facilities. Following the initiative, 93% of postsurvey respondents (N = 13/14) reported implementing new or modified water management practices, and 77% (N = 10/13) of those respondents attributed these changes to their participation in the initiative. The proportion of respondents who indicated high confidence in conducting water management activities increased between the needs assessment and postinitiative survey. SPARC's Water Management Initiative demonstrated that a participant-driven approach can increase knowledge regarding water management practices in healthcare settings. This initiative provides a replicable model for other states seeking to enhance healthcare water management through public health-academic partnerships, peer-to-peer learning, and multi-disciplinary team engagement.
Hepatitis B virus (HBV) infection is endemic in Ghana, mostly due to vertical transmission and limited vaccine coverage. We estimated hepatitis B surface antigen (HBsAg) prevalence and assessed HBV infection, testing, vaccination, and associated risk factors among adult inpatients receiving care at an urban polyclinic. A hospital-based cross-sectional study was conducted among 313 adult inpatients at Kaneshie Polyclinic (Accra) from September 2020 to September 2021. We administered structured questionnaires, collected venous blood via standard venipuncture, and detected HBsAg using ACON One Step rapid immunochromatographic test, with 99.9% sensitivity and 99.7% specificity. All reactive tests were repeated for confirmation. Pearson's χ2 tests and binary logistic regression were used to assess factors associated with HBsAg positivity, prior testing, and HBV vaccination. Participants' average age was 43.2 (±12.2 SD) years, and the majority were married (71.9%) and male (54.6%). HBsAg prevalence was 14.4% (95% confidence interval [CI]: 10.7-18.8). Prior HBV testing occurred in 32.6%, and full vaccination (≥3 doses) in 11.8%. None of the fully vaccinated participants were HBsAg-positive. Family history was positively associated with infection (adjusted odds ratio [AOR]: 2.54; 95% CI: 1.05-6.16), while low monthly income was associated with reduced odds of hepatitis B testing (AOR: 0.18, 95% CI: 0.05-0.62) and vaccination (AOR: 0.55, 95% CI: 0.17-1.82). Vaccination was protective in those who received it. This study found a high prevalence of HBsAg positivity, low testing, and inadequate vaccine coverage among inpatients in an urban polyclinic. To reduce transmission risks, population-specific interventions that raise public knowledge of HBV transmission and prevention are required. Findings also support routine HBV screening and subsidized vaccination for adult inpatients, with targeted outreach to low-income groups and household contacts of known cases.
Surgical site infection (SSI) imposes a significant burden on patients with cancer, yet comprehensive studies on the cancer-specific SSI remain limited. A case-control study analysed SSI epidemiology in 20,370 cancer patients who underwent surgery at a specialized hospital in Shandong Province, China, between 2021 and 2023, using propensity score matching (PSM) to adjust for confounders. Multi-variable conditional logistic regression and restricted cubic splines (RCS) were used to identify risk factors and non-linear associations. SSI incidence was 1.23%, predominating in males, class II wounds, organ/space SSI, and colorectal surgery. Microbiological testing recovered 277 pathogens, mainly Gram-negative bacteria (67.1%). Gram-negative isolates showed high resistance to ampicillin and cephalosporins, while carbapenems and amikacin remained effective. Independent risk factors were body mass index (BMI) (adjusted odds ratio [aOR]: 1.090), postoperative antibiotic therapy (aOR: 3.662), and prolonged postoperative antibiotic therapy (aOR: 1.214). Protective factors included extended pre-operative antibiotic therapy on the day of surgery (aOR: 0.958) and elective surgery (aOR: 0.325). A non-linear relationship appeared between SSI risk and pre-operative white blood cell (WBC) counts. SSI risk increased linearly with BMI above 25 kg/m2 and operative time exceeding 161 min. In cancer patients, SSI is mainly caused by Gram-negative bacteria resistant to ampicillin and cephalosporins. Risk factors included higher BMI, prolonged surgery, and postoperative antibiotic use, whereas pre-operative antibiotic therapy on the day of surgery and elective surgery was protective. A non-linear relationship was observed between SSI risk and pre-operative WBC counts. These findings inform prevention strategies but require validation in multi-centre prospective studies.
Standard laboratory tests for surface disinfectants often fail to reflect real-life clinical conditions, potentially overestimating efficacy. Simulated-use testing that incorporates clinical strains, realistic contamination and user application may provide a more accurate reflection of in-use performance in healthcare settings. The aim of this study was to develop and validate a standardized, reproducible Phase 3 Step 1 simulated-use surface disinfection test that incorporates clinically relevant organisms, hospital-representative surfaces, and realistic application methods. Based on EN 16615:2015, the test method was modified to reflect hospital conditions more closely. Clinically isolated outbreak strains of Staphylococcus aureus, Enterococcus faecium and Acinetobacter baumannii were used. Contamination was applied via a touch-transfer method. Surface materials included hospital-relevant substrates, and disinfectant wipes were applied by trained volunteers to simulate routine cleaning practices. The touch-transfer contamination method was reproducible, and no significant differences were observed in drying or water controls across different surfaces. Wiping speed and contact pressure did not correlate with efficacy. However, microbial recovery varied across test runs and participants. The test method presented here allows for efficacy testing of commercial disinfectants. A Phase 3 Step 1 simulated-use test was established, which incorporates micro-organisms isolated from the application area, surfaces representative of the application area, and where the product is applied by trained participants. This internally validated method better represents clinical disinfection practices compared with current standardized tests and may support improved assessment of surface disinfectant efficacy under conditions approximating real-world hospital use.
Healthcare-associated infections (HAIs) acquired in intensive care units (ICUs) represent a major burden of morbidity and mortality worldwide. However, national data in Hungary are limited, and few studies compare local findings with national and international surveillance systems. We conducted a retrospective longitudinal study involving 1002 patients admitted to ICUs between 1st May 2023 and 30th April 2024. We analysed the prevalence, types and distribution of pathogens responsible for HAIs. Data were compared with national reports from the Hungarian National Nosocomial Surveillance System and international reports from the Centers for Disease Control and Prevention and European Centre for Disease Prevention and Control. The overall prevalence of HAIs was 16.9% (169/1002 patients). The most frequent infection types were lower respiratory tract infections (9.2%), ventilator-associated pneumonia (4.3%), urinary tract infections (UTIs, 3.8%) and Clostridioides difficile infections (2.5%). All UTIs identified during the study period were catheter-associated urinary tract infection, attributable to the high device utilisation rate in the ICU, where all patients had an indwelling urinary catheter during their stay. The leading pathogens were Pseudomonas aeruginosa (23.7%), Clostridioides difficile (13.0%), Klebsiella pneumoniae (13.0%), Enterococcus faecalis (11.6%) and Escherichia coli (5.8%). Overall, 30.9% (64/207) of isolates were multi-drug resistant (MDR). Our study highlighted the considerable prevalence of HAIs and the dominance of MDR Gram-negative bacteria. Comparison with international data helps identify areas requiring targeted infection control measures.
Healthcare associated infections are frequently reported to be antimicrobial resistant. This resistance contributes to poorer patient outcomes, increases the spread of infection and an increase the financial burden on healthcare systems. In an effort to assess whether ESKAPEE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species and Escherichia coli) and other bacteria posed an infection risk during the COVID-19 pandemic, 420 surface swabs and handwash samples were collected from a neonatal intensive care unit (NICU) at a public hospital in Gauteng, South Africa, from July to November 2020. Sterile cotton swabs and sterile, sealable sampling bags were used to collect samples, surface swabs and handwash samples. Bacteria isolated (N = 238) from 127 (32.2%) of the total 420 samples via culture-based methods were then identified using the VITEK 2® compact system. Identifications were confirmed by species- or genus-specific polymerase chain reaction. bacterial isolates were also subjected to antimicrobial susceptibility testing using the VITEK 2® compact system and then categorized as multi-drug-resistant (MDR) or extensively drug resistant (XDR). Almost all (35/38, 92.1%) of the Gram-positive cocci analysed were categorized as MDR. Two-thirds (22/33, 66.7%) of the Gram-negative bacilli analysed were categorized as MDR, and one was XDR. ESKAPEE pathogens (N = 28), including Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter species, comprised a subset of isolated bacteria. Over 85% (24/28) of the ESKAPEE pathogens were identified as MDR. The presence of these MDR bacteria in the NICU poses an important infection risk, and as such, existing infection prevention and control measures in this and other South African hospitals should be strengthened and their implementation and staff adherence to these measures should be regularly monitored and/or assessed.
Hand hygiene (HH) among healthcare workers (HCWs) is important to prevent infections in nursing homes. This study investigated the effect of providing HCWs with weekly feedback on individual hand hygiene compliance (HHC). A 6-month quasi-experimental study (September 2021 to May-2022) was conducted in two nursing homes (9 wards) in Denmark. During the intervention period (3 months), a weekly email with individualized HHC data was sent to HCWs who volunteered to receive individual feedback. HHC was monitored with an automatic hand hygiene monitoring system (AHHMS). A total of 198 nurses and nurse assistants were enrolled. Sixty-seven signed up for the weekly email with individual HHC data (cluster: 'Individual feedback'), and 131 HCWs did not sign up for the intervention (cluster: 'No individual feedback'). The AHHMS registered more than 144,000 HH opportunities from residential apartments. We found a mean difference in baseline HHC between the two clusters (44% vs 52%) of +8 percentage points (95% confidence interval: 6, 10). Overall, the study found no improvements in HHC from baseline compared with the intervention in the cluster receiving individual feedback (52% vs 52%, P = 0.8). Data suggest that providing HCWs with individual feedback on HHC data as a single intervention does not impact the HHC rates. The authors speculate that obtaining improvements in HHC demands a more intensive approach to the intervention. There was no effect of individual feedback on HHC in nursing homes.