Impact of a focused antimicrobial stewardship program in adherence to antibiotic prophylaxis and antimicrobial consumption in appendectomies.

Antibiotic use in appendectomy constitutes a fundamental practice to achieve the clinical outcomes and the prevention of surgical site infection. A prospective interventional study was performed in a community hospital from January 2013 to December 2015 with the aim of determining the effect of a focused antimicrobial stewardship program in the compliance with antibiotic prophylaxis and the antimicrobial consumption in appendectomies. The compliance with the antibiotic prophylaxis was monitored for the timing of administration, the selection and dose and the discontinuation. The monitoring of antimicrobial consumption was performed by a pharmacist using ATC/DDD methodology. The stewardship program includes the education of the staff and the monitoring of the quality of antibiotic prophylaxis and consumption, and feedback. Comparison of the variables over the years was performed using student's t-test or chi-square test as required. In 603 appendectomies performed the compliance with timely administration was achieved in 72.9%, 99.6% and 100% during 2013, 2014 and 2015 respectively and the compliance with the discontinuation had an increase from 86.4% (2013) to 96.7% in 2015. Consumption of antimicrobial was 355.1 DDD/100 procedures (DDD) in flemonous, 447.3 DDD in suppurative, 892.8 DDD in gangrenous and 1162.7 DDD in perforated appendectomies. Reduction in consumption for cefuroxime (26.2%), metronidazole (12.6%) and ceftriaxone (18.1%) was observed. The consumption of antimicrobials in flemonous and suppurated appendectomies achieved the lowest figure in 2015. The focused antimicrobial stewardship program was effective to improve the timely administration and the proper discontinuation of prophylactic antibiotic, with an important reduction of antimicrobial consumption.

Outbreaks of brucellosis related to the consumption of unpasteurized camel milk.

Brucellosis is the most frequent zoonosis reported in Qatar, mainly related to exposure to infected camels. An outbreak of human brucellosis in 14 members of a family living in a rural area in Qatar is reported herein. Clinical, epidemiological and laboratory results from all 14 patients with Brucella and 12 non-confirmed family members were collected from files. All patients reported fever for a maximum of 14 days, associated with arthralgia (6 patients), weakness (4 patients), headache (4 patients), diarrhea (2 patients) and abdominal pain (2 patients). The median age of the patients was 10 years and that of non-cases was 16 years, with a predominance of males (92.9%). Elevated levels of transaminases were observed in patients. A mixed infection caused by Brucella abortus and Brucella melitensis was identified by blood culture and serology. The source of the infection was the milk of an infected camel. The outbreak of brucellosis melitensis/abortus related to the consumption of camel milk constitutes a gap in the prevention and control of the potential sources of brucellosis in animal farms. Proper control and education of the population are required.

Assessment of hand hygiene techniques using the World Health Organization's six steps.

The quality of hand hygiene was evaluated via direct observation for compliance with the six recommended World Health Organization steps. A total of 2497 HH opportunities, of which 1573 (63.0%) were hand rubs, were monitored over a five month period. Compliance was higher in nurses compared with physicians and auxiliaries and in steps 1 and 2 for hand rubs as well as the first three steps of hand washing, with lower rates after these steps. Rubbing of the thumbs and fingertips achieved the lowest rates of compliance in both HH types. A combination of the five recommended moments and six steps and staff education is recommended to improve the quality of hand hygiene.