A quality improvement project: Reducing bloodstream infection by improving adherence to the care bundle of peripheral vascular catheters at the COVID-19 treatment centre.

INTRODUCTION: During the COVID-19 pandemic, bloodstream infection (BSI) rates were substantially rising in Sungai Buloh Hospital (HSB). It is believed that the COVID-19 pandemic has had an adverse impact on BSI incidence caused by contaminated periphery vascular catheters (PVCs). The study's objective is to reduce the BSI rates in HSB by improving adherence to the PVC care bundle via the Plan-Do-Study-Act (PDSA) approach. MATERIALS AND METHODS: A quality improvement (QI) project was employed over four months, from June to September 2021, during the COVID-19 pandemic in HSB. All adults hospitalised for COVID-19 with intravenous lines were subjected to data collection. A baseline audit was conducted to study BSI incidence from April to May 2021. Implementation was carried out by PDSA cycles and data on BSI rates per 100 admissions was described using a monthly run chart. RESULTS: At baseline, the BSI rate per 100 admissions was 5.44 before implementing our QI project. Initial changes via PDSA cycles did not bring significant improvements to BSI rates and a rising trend in BSI rates was observed after two PDSA cycles. Further audits identified the problem of noncompliance with the practice of aseptic non-touch technique (ANTT) and a lack of effective leadership in implementing the PVC care bundle. The third PDSA cycle focused on adopting practical leadership skills among senior clinicians to ensure compliance with the prevention bundle and to encourage the use of ultrasound guidance for difficult line insertion. After the third PDSA cycle, the BSI rate per 100 admissions was reduced from 6.41 to 4.34 (p < 0.05). The BSI rates continued to decline down the line for another five months. CONCLUSION: Through QI initiatives, the risk of BSI can be significantly reduced.

Clinical severity of COVID-19 with omicron variant predominance in relation to vaccination status, age, comorbidities- a single center in Selangor, Malaysia.

INTRODUCTION: Recently, the rapid surge of reported COVID-19 cases attributed to the Omicron variant of severe acute respiratory syndrome coronavirus (SARS-CoV-2) created an immediate concern across nations. Local information pertaining to the new variant of concern (VOC) is lacking. We aimed to determine the clinical characteristics of COVID-19 during a period of Omicron prevalence among patients hospitalised from February 1 to 21, 2022 at Sungai Buloh Hospital and to estimate the risks of disease progression presumably caused by this variant in association with gender, age, comorbidity, and vaccination status. MATERIALS AND METHODS: In this retrospective, singlecentered, retrospective cohort study, all hospitalised adults with laboratory-confirmed COVID-19, aged 18 and above, were recruited from February 1 to 21, 2022. Clinical characteristics, investigations, and outcomes were assessed. RESULTS: A total of 2279 patients aged 18 years and above with laboratory-proven COVID-19 were recruited and analysed, excluding 32 patients owing to incomplete data. Majority of the study population had a mean age of 41.8 ± 17.7, was female-predominant (1329/2279, 58.6%), had completed a primary series of vaccination with a booster (1103/2279, 48.4%), and had no underlying medical conditions (1529/2279, 67.4%). The risk of COVID-19-related disease progression was significantly lower in hospitalised patients under the age of 50 who were female, had no comorbidity, and had completed two doses of the primary series with or without a booster. [respectively, OR 7.94 (95% CI 6.16, 10.23); 1.68 (1.34, 2,12); 2.44 (1.85, 3.22); 2.56 (1.65, 3.97), p< 0.001]. CONCLUSION: During the period of Omicron prevalence, a favourable outcome of COVID-19 was strongly associated with female gender, age below 50, a comorbidity-free condition, and having completed immunization. With this new observation, it could help improve public health planning and clinical management in response to the emergence of the latest VOC.

Attitudes and Practices on COVID-19 amongst Residents of Two States in Northern Peninsular Malaysia

INTRODUCTION: With the global evolution of COVID-19, and Malaysia’s efforts in containing it, the onus of curtailing spread depends on the efforts of Malaysians to comply and adapt to the emerging new social norms. Our aim was to study the attitudes and practices of residents in Penang and Kedah towards COVID-19. MATERIALS AND METHODS: A comparative cross-sectional study was conducted in late October 2020 via an online self-reported structured questionnaire. A five-point Likert scale was used in both 12-item attitudes and 10-item practices questionnaires. Data scored was converted into categorical data based on median value of good and bad attitudes and practices. Spearman’s correlation was used to analyse the relationship between attitudes and practices, while Chi-square test was used to determine the differences of attitudes and practices between the two states. RESULTS: A total of 834 respondents were enrolled, who were mostly aged 20 to 30, of Malay and Chinese ethnicity, and were from the green zone (40.9%). The mean attitudes score was 44.5 for Kedah and 44.3 for Penang. The mean practices score was the same for both states at 10.8. Gender was significantly associated with good attitudes (p=0.007) in Penang. Gender: Penang (p=0.007) and Kedah (p=-0.001), marital status (p=0.003) and employment status (p=0.001) in Kedah were significantly associated with good practices. Overall, 94.8% agreed to strict enforcement of social distancing and masking. A weak but positive correlation (r=0.30;p<0.001) was found between attitudes and practices. Shortfall in practices relating to not wearing mask properly, not disposing of masks properly and poor cough etiquette. CONCLUSION: Level of compliance to the new norms was generally good with little difference between the two states. A small proportion of people still had poor practices. We need to ensure that the social norms are sustained by the community. © 2022. IIUM Medical Journal Malaysia. All Rights Reserved.