The burden of healthcare-associated infection in Moroccan hospitals: systematic review and meta-analysis

Healthcare-associated infections (HAI), also referred to as nosocomial infections, is defined as an infection acquired in a hospital setting. This infection is considered a HAI if it was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility. HAI are a major patient safety measure to be considered in hospitals.

Psychological correlates of COVID safety protocol adherence among university students

Background: The COVID-19 pandemic continues to be a global concern. Reports of insidious asymptomatic variants of the virus raise concerns about the safety of huge numbers of students on university campuses. Objective: The study aimed to delineate psychological correlates for students' adherence to safety protocols for appropriate context-specific coping intervention designs. Setting & Design: 751 students from the various colleges of the KNUST were conveniently sampled for this crosssectional survey. Measures: Psychological instruments with good psychometric properties (DASS-21; Rosenberg Self-Esteem Scale and Perceived Control Scales) were used in addition to demographics and questions on COVID safety protocol adherence. Results: Self-esteem positively correlated with perceived control (r = 0.40, p<0.001) and COVID adherence (r = 0.16, p<0.001); but negatively correlated with psychological distress (r = -0.44 p<0.001). Greater perceived control was associated with lower psychological distress (r = -0.20 p<0.001) and greater adherence to safety protocols (r = 0.24 p<0.001). Protocol adherence was regressed on psychological distress, self-esteem, and perceived control to determine any significant prediction. All the variables accounted for 7% of the variance in COVID protocol adherence (R2 = 0.07, F (3, 661) =17.29, p<0.001) with perceived control significantly predicting adherence to COVID safety protocol (B = 0.11, ß=0.23, t=5.54 p<0.001). Conclusion: Results indicated that perceived control over important life events and healthy self-esteem would likely facilitate adherence to COVID safety protocols and attenuate psychological distress. Implications for further research and design of appropriate COVID coping response interventions are discussed

Mobile phones of hospital workers: a potential reservoir for the transmission of pathogenic bacteria

Background: Mobile phones are increasingly associated with the transmission of pathogenic microbial agents. In the clinical setting where there is usually high exposure to pathogens, these devices may serve as vehicles for the transmission/spread of pathogens. This study determined the prevalence of bacterial contamination of mobile phones of health workers and the predisposing factors, in order to ascertain the risk of transmission of pathogenic bacteria through mobile phones. Methodology: This study was carried out in a private medical center at Mbouda, Cameroon, involving 78 health workers including health professionals (nurses, physicians, laboratory scientists) and hospital support workers (cleaners, cashiers and security guards), recruited by convenient sampling. Sterile swab sticks moistened with physiological saline were used to swab about three quarter of the surface of each phone. The swabs were cultured on MacConkey and Mannitol Salt agar plates which were incubated aerobically at 37oC for 24 hours, while Chocolate agar plate was incubated in a candle extinction jar for microaerophilic condition. The isolates were identified using standard biochemical tests including catalase, coagulase, and the analytical profile index (API) system. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 20.0. Results: Mobile phones of 75 of the 78 (96.2%) health workers were contaminated, with highest contamination rates for the phones of laboratory scientists (100%, 12/12), followed by support staff (98.9%, 13/14), nurses (97.7%, 43/44) and physicians (87.3%, 7/8), but the difference in contamination rates was not statistically significant (p=0.349). A total of 112 bacteria belonging to 12 genera were isolated, with predominance of Staphylococcus aureus (31.3%, n=35), Micrococcus spp (30.4%, n=34), coagulase negative staphylococci (10.7%, n=12) and Pseudomonas spp (5.4%, n=6). The laboratory (18.8%, 21/112) and medical wards (16.1%, 18/112) had the highest bacterial contamination of mobile phones (p=0.041), and more bacterial species were isolated from smartphones (68.8%, n=77/112) than keypad phones (31.2%, n=35/112) (p=0.032). There was no significant difference between phone contamination rates and the practice of hand hygiene or decontamination of work surfaces (p>0.05). Conclusion: The presence of potentially pathogenic bacteria on cell phones of health-care workers emphasizes the role of fomites in the transmission of infectious diseases. Consequently, good hand hygiene and decontamination practices are encouraged among health workers in order to limit the spread of hospital-acquired infections.

Emergence of nosocomial-acquired extensively drug-resistant and pandrug-resistant Enterobacterales in a teaching hospital in Kuwait

Contexte: L'émergence et la montée en puissance des infections causées par des isolats d'entérobactéries ultrarésistantes (XDR) et pandrug-résistantes (PDR) constituent un sérieux défi clinique et de santé publique. L'isolement de bactéries Gram-négatives PDR (GNB) en milieu clinique est très rare et plus rare est l'infection causée par XDR GNB. En dehors des options thérapeutiques restreintes, ces infections sont associées à une augmentation de la mortalité et de la morbidité. Des études urgentes pour réévaluer les options thérapeutiques existantes et la recherche de nouvelles molécules antibiotiques sont désespérément nécessaires. Les objectifs de cette étude étaient de signaler l'émergence d'infections à CRE multirésistantes (MDR), difficiles à menacer, rarement rencontrées dans notre hôpital et d'enquêter sur leur épidémiologie moléculaire. Méthodologie: Il s'agissait d'une analyse observationnelle rétrospective de six patients atteints d'infections graves causées par des isolats d'entérobactéries XDR et PDR à l'hôpital universitaire Mubarak AL Kabeer, Jabriya, Koweït, sur une période d'un an et demi. Les mécanismes de résistance de ces isolats ont ensuite été étudiés de manière prospective par caractérisation moléculaire et études génomiques. Résultats: La majorité des infections ont été causées par Klebsiella pneumoniae (83,3%, 5/6) et une (16,6%) a été causée par Escherichia coli. Trois patients avaient une infection du sang (BSI), un avait à la fois une BSI et une infection des voies urinaires (UTI), un avait une infection des voies respiratoires et le dernier avait une UTI. Deux patients ont été infectés par des producteurs d'OXA-48, un patient a été infecté par un producteur de NDM-1, un patient a été infecté par un producteur de NDM-5, un patient a été infecté par un producteur de NDM-1 et d'OXA-48 et le dernier patient a été infecté avec le producteur NDM-5 et OXA-181. Pour un traitement définitif, tous les patients ont reçu une thérapie combinée. Le taux de mortalité était élevé (50.0%). Conclusion: Le taux de mortalité élevé associé aux infections XDR et PDR Enterobacterales et les options antimicrobiennes limitées pour le traitement soulignent la nécessité d'améliorer la détection de ces infections, l'identification de mesures préventives efficaces et le développement de nouveaux agents avec une efficacité clinique fiable contre elles.

Preparing healthcare facilities to operate safely and effectively during the COVID-19 pandemic: The missing piece in the puzzle

The stated objective of the COVID-19 lockdown was to allow time to prepare healthcare facilities. Preparation must include administrative and environmental measures, which when combined with personal protective equipment, minimise the risk of the spread of infection to patients and healthcare workers (HCWs) in facilities, allowing HCWs to safely provide essential services during the pandemic and limit the indirect effects of COVID-19 caused by healthcare disruption. We present our model for facility preparation based on colour-coded zones, social distancing, hand hygiene, rapid triage and separate management of symptomatic patients, and attention to infection transmission prevention between HCWs in communal staff areas. This model specifically addresses the challenges in preparing a facility for COVID-19 in a low-resource setting and in rural areas. In addition, we include links to resources to allow workers in low-resource settings to prepare their facilities adequately

High burden of nosocomial infections caused by multi-drug resistant pathogens in pediatric patients at hawassa university comprehensive specialized hospital

Background: Pediatric patients are at increased risk of nosocomial infections with multi-drug resistant pathogens which are more prevalent in the hospital environment. The aim of this study was to determine the prevalence of nosocomial infections, antibiotic resistance pattern of bacterial isolates and associated factors in pediatric patients. Methods: This was a cross-sectional study conducted from March to August, 2016. Data included sociodemographic and clinical variables in patients clinically suspected of having nosocomial infections and collected using a structured questionnaire. Bacterial identification and antimicrobial susceptibility test was done with standard microbiological methods. Data were analyzed with SPSS version 20 and p value < 0.05 was considered to be statistically significant. Results: Out of 939 children admitted to the hospital, 384 patients (40.9%) were clinically suspected and had 462 nosocomial infections. Blood stream infection was the most common site of nosocomial infections. Culture confirmed nosocomial infections were reported in 82 patients (21.4%; 95% CI, 17.2-25.8%) with 88 isolates. Among the most frequently isolated bacteria, 21 (23.9%) were Klebsiella spp, and 16 (18.2%) were S. aureus, 62.5% of which were methicillin resistant. Among all bacterial pathogens, 88.9% were multi-drug resistant. Extremely high (97.9%) multi-drug resistance was associated with Gram negative bacteria. Among these, all isolates, except E. coli, were 100% multi-drug resistant. Long hospital stay and malnutrition were significantly associated with nosocomial infections. Conclusion: The high prevalence of nosocomial infections with multi-drug resistant bacteria suggests the need for proper implementation of the nosocomial infections prevention and control measures

La désinfection des empreintes dentaires au laboratoire de prothèse : évaluation de la pratique des prothésistes dentaires ivoiriens

Le prothésiste dentaire est exposé à un risque élevé de transmission infectieuse par la manipulation des empreintes dentaires souillées par la salive et le sang. En effet, lors d'une prise d'empreinte au cabinet dentaire, le matériau entre en contact direct avec les mucosités et sérosités de la cavité buccale, abritant de nombreux germes. Ainsi la décontamination des empreintes, pour prévenir la contamination croisée. Cette étude a eu pour objectif d'évaluer les attitudes et pratiques des prothésistes dentaires dans la ville d'Abidjan, en matière de décontamination des empreintes. Il s'agit d'une étude transversale descriptive qui s'est déroulée sur une période de trois (03) mois. Elle a concerné 35 prothésistes dentaires exerçant tant dans les secteurs privés et publics. Plus de 97% des prothésistes dentaires interrogés, sont conscients de l'existence du risque infectieux liés aux empreintes dentaires. Aucune des empreintes reçues par les prothésistes, n'était accompagnée de fiche mentionnant son état de décontamination. 85,71% des prothésistes, affirment rincer systématiquement toutes les empreintes dès leur réception et près de 32% ne les décontaminent pas

Antimicrobial resistance activity and molecular characterization of methicillin-resistant staphylococci isolates in Tripoli Central Hospital, Libya

Background: Nosocomial infections caused by methicillin-resistant Staphylococci could lead to increased morbidity and mortality, but little is known about the prevalence of infections with these organisms in healthcare facilities and in the community in Tripoli. This study investigated the in vitro susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase negative staphylococci (MRCNS) to antimicrobial agents, and determined the molecular characteristics of MRSA.Methods: This is a retrospective observational study aiming at determining the prevalence and antibiotic resistance pattern of (MRSA) and (MRCNS) isolated from non-duplicated clinical specimens in Tripoli Central Hospital (TCH) between June 2013 and June 2014. Isolates were identified using standard laboratory procedures. Antimicrobial susceptibility tests were carried out by disk diffusion method and automated systems. DNA of the MRSA isolates was used for PCR to determine the molecular analysis.Results: 218 isolates of Staphylococci were obtained, 71.6% were coagulase positive staphylococci (CPS) and 28.4% were coagulase negative staphylococci (CNS). 39.7% of CPS were MRSA, while 75.8% of CNS were MRCNS. The rates of hospital-acquired MRSA (HA-MRSA) and community-acquired MRSA (CA-MRSA) among MRSA isolates were 61.3% and 38.7% respectively. A similar trend was detected among MRCNS isolates, where 74.5% were HA-MRCNS and 25.5% were CA-MRCNS. All the MRSA and MRCNS isolates were susceptible (100%) to vancomycin, tigecycline, linezolid, quinupristin/dalfopristin, daptomycin and moxifloxacin. Generally, hospital-acquired strains showed higher resistance rates than community-acquired ones to the most commonly tested non-beta-lactam antibiotics. 35.5% of all staphylococcal isolates exhibited mecA+ gene and 12.9% expressed mecC+. Meanwhile, 38.7% of MRSA isolates harbored both mecA and mecC. However, 12.9% of MSSA isolates were negative for both mecA and mecC. The mecA gene was detectable in 59.1% and 40.9 % of HA-MRSA and CA-MRSA isolates respectively.Conclusion: Hospital-acquired MRSA and MRCNS isolates had higher resistance rates to non-beta lactam antimicrobial drugs than the respective community-acquired isolates. This was shown by early detection of mecC gene among MRSA isolates

High prevalence of multi-drug resistant klebsiella pneumoniae in a tertiary teaching hospital in western Kenya

Introduction: Klebsiella pneumoniae is a gram negative enterobacteriaciae commonly associated with nosocomial infections. Multidrug resistant strains are increasingly being reported with corresponding increase in morbidity and mortality. The study outlines the epidemiology and antibiotic resistance pattern of K. pneumonia over a 10 year period in Moi Teaching and Referral Hospital; Eldoret; Kenya. Methodology and Study Design: This is a retrospective analysis of all the blood culture results for K. pneumoniae isolates in the hospital for the period 2002-2013. Results: K. pneumoniae accounted for 23% of the hospital isolates (231/1356) during the study period; of these; 82.6% were from the New Born Unit. Most of the isolates were multi drug resistant with highest resistance of over 80% to Penicillins; Cephalosporins; Macrolides; Tetracyclines; Sulphonamides; Lincosamides and Chloramphenicol. Aminoglycoside and Quinolone resistance was also high at 49.2% and 41.3% respectively. The lowest resistance rates were documented for Carbapenems (23.2%). For specific antibiotics; there was high resistance to commonly used antibiotics (over 80% for Ceftriaxone; Cefipime; Gentamycin and Ceftazidime). The antibiotics with least resistance were Amikacin and Meropenem (21% and 7 % respectively). Conclusion: There was a high prevalence of multidrug resistant K. pneumoniae isolates in the hospital; the majority originated from the New Born Unit. Resistance to third generation Cephalosporins and Gentamycin was high while Meropenem and Amikacin had the least resistance

Comparison of the Efficacy of Colistin Monotherapy and Colistin Combination Therapies in the Treatment of Nosocomial Pneumonia and Ventilator-Associated Pneumonia Caused by Acinetobacter baumannii

Objective. To investigate whether there was a difference in mortality; clinical response and bacterial eradication between colistin monotherapy and colistin combination therapies for the treatment of nosocomial pneumonia/ventilator-associated pneumonia (VAP) caused by Acinetobacter baumannii in a medical intensive care unit (ICU).Methods. This retrospective; observational and single-centre study included all patients who were in the medical ICU of Gazi University Medical Faculty Hospital and diagnosed with nosocomial pneumonia/VAP caused by A. baumannii between January 2009 and September 2014. Results. The median age of the 134 patients was 68 years and 53.3% were male. The most common causes of admission were respiratory insufficiency (66.7%) and sepsis/septic shock (54.8%). In patients with nosocomial pneumonia/VAP caused by A. baumannii; on median day 5 of admission; colistin monotherapy was used in 23 (21.6%) patients; a carbapenem combination was used in 80 (59.7%) patients; sulbactam-ampicillin combination was used in 42 (31.4%) patients; tigecycline combination was used in 26 (19.4%) patients; and sulbactam-cefoperazone combination was used in 17 (12.7%) patients. Median ICU stay of the patients was 15.5 days; and 112 (83.6%) patients died. Colistin monotherapy and combination therapies had no superiority over each other in clinical response for the treatment of A. baumannii-associated nosocomial pneumonia/VAP. Mortality was found to be higher in patients receiving the colistin-carbapenem combination (64.3% v. 36.4%; p=0.016). Discharge/day-of-death Sequential Organ Failure Assessment score (odds ratio (OR) 2.017; 95% confidence interval (CI) 1.330 - 3.061) and vasopressor use (OR 9.014; 95% CI 1.360 - 59.464) were independent risk factors for ICU mortality. Conclusion. Colistin monotherapy and combination therapies have no superiority over each other for clinical response in the treatment of nosocomial pneumonia/VAP caused by multidrug-resistant A. baumannii. Colistin-SAM was associated with improved microbiological eradication and colistin-carbapenem combination was associated with increased mortality

Caracterisation phénotypique des souches de pseudomonas aeruginosa isolées dans la ville de Yaoundé (Cameroun)

Introduction. L'objectif etait de determiner la proportion de souches de Pseudomonas aeruginosa (P. aeruginosa) exprimant des mecanismes de resistance dans la ville de Yaounde. Methode. Il s'agissait d'une etude prospective et descriptive realisee du 02 janvier au 30 juin 2012. Des souches de P. aeruginosa provenant de divers produits pathologiques de patients ont ete identifiees a l'aide de la galerie API 20NE (Biomerieux). Pour les prelevements urinaires; une cytologie etait faite pour verifier l'absence de cancer. La lecture interpretative de l'antibiogramme a ete faite par diffusion sur gelose Mueller-Hinton selon CA-SFM 2011. Resultats. Au total 34 souches de P. aeruginosa ont ete isolees dont 85;3?% chez patients hospitalises. Parmi ces souches; 41;2?% etaient isolees des urines; 23;5?% des hemocultures et 17;6?% des suppurations. Les urines montraient a l'examen cytologique des modifications inflammatoires aigues et l'absence de cancer. Le profil de resistance aux antibiotiques a montre une resistance elevee preferentielle des Beta-lactamines notamment a la ticarcilline (35;29?%). Concernant les Beta-lactamines; les phenotypes les plus observes ont ete pour les 2/3 sauvages et 26;5?% pour les penicillinases ; quant aux aminosides 94;1?% etaient de phenotype sauvage; tandis que 2/3 etaient de type sauvage pour les fluoroquinolones. Conclusion. Une association Beta-lactamines/aminosides ou Beta-lactamines/fluoroquinolones pourrait etre preconisee afin de lutter contre toute infection a P. aeruginosa

Prevalence and determinants of occupational exposures to blood and body fluids among health workers in two tertiary hospitals in Nigeria

Background: Healthcare associated infections among health workers commonly follow occupational exposures to pathogens infecting blood or body fluids of patients. We evaluated the prevalence and determinants of occupational exposures to blood/body fluids among health workers in two tertiary hospitals in Nigeria. Methods: In a cross section study undertaken in two tertiary hospitals in North-central and South-south Nigeria in 2011; a structured self-administered questionnaire was used to obtain demographic data and occupational exposures to blood/body fluids in the previous year from doctors; nurses and laboratory scientists. Independent predictors of occupational exposures were determined in an unconditional logistic regression model. Results: Out of 290 health workers studied; 75.8; 44.7; 32.9; 33.9 and 84.4 had skin contact with patient's blood; needle stick injuries; cut by sharps; blood/body fluid splashes to mucous membranes and one or more type of exposures respectively. Ninety one percent; 86; 71.1; 87.6; 81.3; and 84.4 of house officers; resident doctors; consultant doctors; staff nurses; principal/chief nursing officers and laboratory scientists; respectively had one or more type of exposures in the previous year (P0.05). Professional group was found to be the only independent predictor of cut by sharps. House officers and nurses had higher and more frequent occupational exposures than other professional groups. Conclusion: Our results suggest high rates of occupational exposures to blood/body fluid among health workers in Nigeria; especially among newly qualified medical doctors and nurses. Health facilities in Nigeria ought to strengthen infection prevention and control practices while targeting high risk health workers such as house officers and nurses

Re-Evaluating the Role of Piperacillin-Tazobactam in the Treatment of Hospital-Acquired Infections

The objectives were to determine the minimum inhibitory concentrations (MICs) of piperacillin-tazobactam against blood culture isolates over a two-year period; and to compare the MICs with isolates from the same site upon the South African launch of piperacillin-tazobactam. The intention was to use the MIC data to evaluate and contextualise contemporary dosing strategies of piperacillin-tazobactam in South Africa. MICs were determined using broth microdilution antimicrobial susceptibility testing. A comparison of susceptibility between the two time periods was carried out using Fisher's exact test. The MIC data were then used to evaluate current dosing strategies based on current evidence-based pharmacodynamic parameters for piperacillin-tazobactam. A significant decrease in susceptibility was observed for Eschericha coli (p-value = 0.0009); Klebsiella spp. (p-value = 0.0001); Citrobacter spp. (p-value = 0.0001) and Acinetobacter baumannii (p-value = 0.0388) with MIC90 ? 128. Enterobacter spp.; Serratia marcescens; Morganella morganii and Proteus spp./Providencia spp. demonstrating reduced susceptibility (combined intermediate and resistant) of 44; 11; 20 and 0; respectively. No significant difference in susceptibility between current extended spectrum beta-lactamase (ESBL)- and non-ESBL-producing isolates was seen with a lower MIC90 for ESBL-producing Klebsiella spp. and Enterobacter spp.; compared to their non-ESBL-producing counterparts. The MIC data suggest that more targeted dosing strategies that aim to optimise pharmacodynamic parameters are needed. Piperacillin-tazobactam remains a valuable antimicrobial agent whose continued longevity will depend on appropriate optimisation of pharmacodynamic parameters. This requires the application of MIC-based susceptibility data to clinical use; with local assessment of the applicability of various dosing strategies that is based on cumulative antimicrobial susceptibility data

Prevalence of Carbapenem Resistance Genes in Acinetobacter Baumannii Isolated From Clinical Specimens Obtained From an Academic Hospital in South Africa

Acinetobacter baumannii is an important cause of hospital-acquired infections. The occurrence of carbapenem resistance that is caused by the carbapenem-hydrolysing class D ?-lactamases and the metallo-?-lactamases (MBLs) limits the range of therapeutic alternatives in treating A. baumannii infections. In this study; two multiplex polymerase chain reactions were performed to screen for both carbapenem-hydrolysing class D ?-lactamases and MBL genes in 97 clinical isolates of A. baumannii. Oxacillinase (OXA)-51 had a prevalence of 83 (81/97); and OXA-23 had a prevalence of 59 (57/97). One isolate was positive for an MBL [Verona integron-encoded metallo ?-lactamases (VIM)]. Therefore; continuous surveillance and monitoring of A. baumannii is crucial because of the high prevalence of antibiotic resistance genes

Healthcare-Associated Infection in Burkina Faso: an Assessment in a District Hospital

In developing countries; few data are available on healthcare-associated infections. In Burkina Faso; there has been a failure to take into account risk management and patient safety in the quality assurance program. The main objective of our study was to carry out an assessment of healthcare-associated infection in a first level hospital. We conducted a crosssectional study in June 2011 in the care units of Ziniare District Hospital (Ziniare; Burkina Faso). The hospital has been divided in three components: i) hospital population (care providers; in-patients and patients' guardians); ii) healthcare and services organization; iii) hospital environment. We included: care providers of the clinical services; hospital inpatients and patients' guardians; hospitalization infrastructure and nursing units; and all the documents relating to standards and protocols. Data collection has been done by direct observation; interviews and biological samples taken at different settings. In hospital population; care providers and patients' guardians represented a high source of infection: adherence to hygiene practice on the part of care providers was low (12/19); and no patients' guardian experienced good conditions of staying in the hospital. In healthcare and services organization; healthcare waste management represented a high-risk source of infection. In hospital environment; hygiene level of the infrastructure in the hospital rooms was low (6.67). Prevalence of isolated bacteria was 71.8. Urinary-tract catheters infections were the most significant in our sample; followed by surgical-site infections. In total; 56.26(9/19) of germs were -Lactamase producers (ESBL). They were represented by Escherichia coli and Klebsiella pneumoniae. Our analysis identified clearly healthcare-associated infection as a problem in Ziniare district hospital. Hence; a national program of quality assurance in the hospitals should now integrate the risk infectious management of healthcare-associated infections

A Comparative study of awareness and attitude to nosocomial infections among levels of health care workers in Southwestern Nigeria

Introduction: Hospital acquired infections (HAIs) continue to be a threat to hospital admissions and workers thus contributing to mortalities and morbidities. Complexity and type of services rendered by health facilities may determine health worker's attitude towards combating these infections. The objective of this study is to compare knowledge; attitude and practice of HAIs among health workers at the three levels of health care in Southwestern Nigeria. Methods: - This descriptive; comparative cross sectional study was carried out among 273 health workers in Osogbo in Southwestern Nigeria; using multistage sampling method. Pre-coded semi structured self administered and pre-tested questionnaires were administered on sampled health workers. Data was analyzed using the SPSS software 13.0 Results: - All health care workers at the three levels have good awareness that patients could be a source of HAIs. Awareness of common HAIs; awareness of hospital staffs and equipments and the environment as sources of transmission of HAIs were good for health care workers in both tertiary and secondary level care; but poor among primary health care workers. There was poor awareness of presence of hospital policy on HAI and presence of hospital committee on infection control among health care workers at the three levels of health care; but this is worst among primary health care providers. More health care workers in tertiary care has reported themselves to staff clinics when sick; more always washed their hands before and after touching clients and equipments while more has also ever notified HAIs before; when compared to secondary and primary. Attitude towards willingness to report HAIs was better in both secondary and tertiary health care workers. There is a good attitude towards readiness to wear protective devices; towards washing of hand s before and after touching patients and self reporting to staff clinic when sick among health care workers at the three levels of care Conclusion: Good knowledge and attitude; but poor practice characterizes nosocomial infections among tertiary and secondary level health care workers in Osogbo. These indices are worst and ranges from fair to poor among health workers at the primary health care level. Routine seminars on factors associated with occurrence of nosocomial infections could help to improve awareness and reduce its prevalence in our hospital settings

Epidemiological studies on proteeae isolates from clinical specimens in the Laquintinie Hospital in Douala, Cameroon

The tribe Proteeae is a group of bacteria within the family Enterobacteriaceae and is responsible for most cases of nosocomial infections in hospital settings. The objective of this study was to determine the prevalence of members of Proteeae from clinical specimens in Laquintinie hospital in Douala. Specimens were collected from patients and screened for Proteeae using standard microbiological and biochemical methods (API 20 Enterobacteriaceae gallery). Of the 3414 clinical specimens made of 2712 urine; 264 blood; 243 CSF and 195 wounds and burns; 1136 (33.3) yielded a positive bacterial growth; of which 230 (20.2) were Gram positive and 906 (79.7) were Gram negative. 164 (14.4) isolates were identified as members of Proteeae of which 110 (67.1) were from urine; 37( 22.6) from wounds and burns; 10(6.1) from blood and 7( 4.3) from CSF. Speciation of the Proteeae isolates showed that 111 (67.7) were Proteus mirabilis; 21(12.8) Proteus vulgaris; 11 (6.7) Providencia alcalifaciens; 6 (3.6) Providencia stuartii; 4 (2.4) Morganella morganii and 5 (3.0) Proteus penneri and Providencia rettgeri. There was a significant difference between the type of clinical specimens and the age of patients (X2 = 52.623 p0.05). Most Proteeae isolates where susceptible to imipemen; ceftazidine; chloramphenicol; gentamicin; nalidixic acid; ofloxacin and amikacin. These findings have significant clinical and epidemiological implications

Amphotericin B in the Management of Fungal Infections in a Neonatal Intensive Care Unit (NICU): Experiences in a Teaching Hospital

Background:Hospital-acquired pathogens cause considerable morbidity and mortality in preterm infants. Neonatal candidaemia plagued the neonatal ICU at Dr. George Mukhari Hospital. The standard treatment of candidaemia at the time of the study was fluconazole 10 mg/kg/day. The use of amphotericin B was introduced after identifying a problem with fluconazole resistance.Method:The application of the amphotericin B treatment protocol was monitored in the first 20 patients. A test dose of 0.25 mg/kg was administered with 0.25 mg/kg/dose increments until a maintenance dose of 1 mg/kg/dose was reached. Patients were kept on amphotericin B for one week after the first culture came back negative and were discharged as soon as the second blood culture also came back negative and they were clinically doing well. The patients' responses to amphotericin B were evaluated according to the laboratory data and clinical response.Results:Seventeen patients remained and were treated with amphotericin B for an average of 18.5 days (median=11 days) until the first negative Candida culture could be obtained; with a cumulative dose of 20.8 mg (median=19.2 mg) on average. The period to response in this study was relatively short.Conclusion:The specific strain cultured in this NICU could be eradicated with continuous use of amphotericin B. Further clinical investigation and improved infection control practices will be needed to decrease the incidence of invasive Candida infections; the duration of hospital stay associated with these infections and the side-effects associated with amphotericin B

Multidrug-Resistant Nosocomial Infections among Private Hospital Patients in the North West Province

"This article reports on severe clinical cases of nosocomial infections that were caused by multidrug-resistant (MDR) isolates of Acinetobacter baumannii and Pseudomonas aeruginosa in an intensive care unit (ICU). Globally; patients in ICUs have encountered an increasing emergence and spread of MDR pathogens. A retrospective case study was conducted to investigate the possible causes and occurrence of nosocomial infections linked to reported cases thereof in a private hospital in the North West province between December 2009 and August 2010. This followed an enquiry from a concerned community member about two patient deaths and a patient who was in the hospital's ICU between July and August 2010 with an infection by an unknown ""superbug"". Of the 24 adult patients who were admitted to the ICU in the study period; 22 presented with isolates of A. baumannii; one with P. aeruginosa; and one with presumed A. baumannii for which there was no laboratory test confirmation. Of those who were infected with A. baumannii; nine of the 22 died (a case fatality rate of 41). The patient with no laboratory test confirmation also died within seven days; while the patient who was infected with P. aeruginosa was still in hospital at the end of the study period (August 2010). The average length of stay in the hospital was 21.3 days. Six of the 24 patients (25) stayed longer than 30 days. A patient who was infected with P. aeruginosa stayed even longer. The most common cause of death among the ICU patients; notwithstanding other underlying conditions; was A. baumannii strain; which may have directly or indirectly contributed to the prolonged length of stay in hospital. It is possible that P. aeruginosa is a recent introduction to this ICU."

Prevalence of hospital-acquired enterococci infections in two primary-care Hospitals in Osogbo, Southwestern Nigeria

Enterococci are opportunistic bacteria that become pathogenic when they colonize niches where they are not normally found. Of recent; they have become major cause of nosocomial infections; especially of the bloodstream; urinary tract and surgical sites. The aim of this study is to determine the point-prevalence rate of human enterococci infections among hospitalized patients in Osogbo; Nigeria. The study was conducted between January and June 2009 in two primary-care hospitals in Osogbo and involved a total of 118 patients who developed clinical evidence of infection at least 48 hours after hospital admission. Appropriate clinical samples were collected from the patients after an informed consent and cultured for isolation/biochemical identification of Enterococcus species at the Bacteriology Laboratory of Ladoke Akintola University of Technology; Osogbo using standard microbiological methods. There were 525 hospital admissions within the time frame of the study of which 118 (22.5) developed hospital acquired infection (HAI); 58 (49.2) of which cultured positive for bacterial pathogens. Enterococci were isolated from infective focus in 7 patients; giving a prevalence rate of hospital-acquired enterococci infection of 5.9. Two species of Enterococcus were identified; Enterococcus faecalis from urinary tract infection (UTI) and surgical site infection (SSI) of 6 (85.7) patients and Enterococcus faecium from UTI in 1 (14.3) patient. Other bacteria recovered from other infective foci were Klebsiella spp 31.0; Pseudomonas spp 20.7; Staphylococcus aureus 17.2; Escherichia coli 12.1; Staphylococcus epidermidis 3.4; Streptococcus pneumoniae 1.7and Serratia spp 1.7. All the enterococci isolates were multiply antibiotic resistant; and 42.9were vancomycin-resistant enterococci (VRE) with the VRE strains showing resistance to wider range of antibiotics than the vancomycin-sensitive strains. Other Gram-positive and Gram negative bacterial isolates also demonstrated multiple resistance to all commonly available antibiotics in this community except E. coli and Pseudomonas spp which were relatively sensitive to ciprofloxacin and ceftazidime. This limited study demonstrated a high prevalence rate of multiple antibiotic resistant enterococci infections among hospitalized patients in this environment. There is need for systematic surveillance of hospitals for enterococci infections; prudent use and rational prescription of antibiotics and stringent measures to reduce the prevalence rate by health education on infection control measures such as isolation; cleaning; disinfection and sterilization