The value of the INFECTIONS scoring system in identifying bacterial infections among patients presenting at the emergency department of a middle-income country: A pilot study.

PURPOSE: To investigate which scoring system is the most accurate tool in predicting mortality among the infected patients who present to the emergency department in a middle-income country, and to validate a new scoring system to predict bacterial infections. METHODS: This was a retrospective, single-center study among patients who were admitted via the emergency department of a public hospital. All patients who were started on antibiotics were included in the study, while patients aged < 18 years were excluded. Data collected includeding patients' demographics, vital signs and basic laboratory parameters like white blood cell count and creatinine. The sensitivity and specificity of different scoring systems were calculated as well as their negative and positive predictive values. Logistic regression was used to derive a novel early warning system for bacterial infections. The area under the receiver operating characteristic (AUROC) was computed for each scoring model. RESULTS: In total, 109 patients were included in this study. The quick sequential organ failure assessment (qSOFA), search out severity and rapid acute physiology score had the highest AUROC (≥ 0.89) for predicting mortality, while qSOFA and universal vital assessment were the simplest scoring systems with an AUROC > 0.85; however, these scoring systems failed to predict whether patients were truly infected. The INFECTIONS (short for impaired mental status, not conscious, fast heart rate, elevated creatinine, high temperature, on inotrope, low oxygen, high neutrophils and high sugar) model reached an AUROC of 0.88 to more accurately predict the infectious state of a patient. CONCLUSIONS: Middle-income countries should use the qSOFA or universal vital assessment score to identify the sickest patients in emergency department. The INFECTIONS score may help recognize patients with bacterial infections, but it should be further validated in multiple countries prior to widely use.

Impact of a Multimodal Improvement Strategy to Promote Hand Hygiene at a Hospital in Mauritius.

Introduction Limited data is available on which interventions are likely to improve compliance to hand hygiene, especially in underdeveloped countries. The objective of this study is to explore whether the introduction of a particular bundle of strategies to improve hand hygiene is effective. Material and methods In this pre-post study, a multimodal strategy comprised of educating healthcare staff, using reminders, providing feedback and increasing the availability of soap and alcohol, was implemented over a period of one year from 2019 to 2020. Trained observers assessed compliance to hand hygiene before and after the intervention. Results A total of 143 hand hygiene opportunities were observed. Hand hygiene compliance rate did not improve despite the introduction of multiple measures. Conclusions Other approaches should be considered to promote hand hygiene. The choice of which strategies to use should be adapted to the local setting. For instance, in some healthcare facilities, emphasis should be placed on leadership support and on the training of hand hygiene champions.

Incidence, Risk Factors, and Mortality From Hospital-Acquired Infections at a Hospital in Mauritius.

Introduction Hospital-acquired infections can be associated with an increase in morbidity, length of stay, and cost. Data on this topic are very limited in Mauritius. This study seeks to identify (a) the most prevalent hospital-acquired infection locally, (b) the risk factors for acquiring nosocomial infections, and (c) the mortality rate linked to such infections. Methods This is an observational study that was conducted at a 600-bed hospital in Mauritius by going through the folders of 109 patients who were admitted in different wards. Cox regression was used to carry out the survival analysis. Results Over the past 25 years, the incidence of hospital-acquired infections has increased by two to three times in Mauritius to reach a value of 18 per 100 admitted patients. The most commonly identified nosocomial infection was ventilator-associated pneumonia. The presence of foreign devices increased the risk of acquiring nosocomial infections. The mortality rate from such infections was almost four times higher compared to the mortality rate from patients who did not suffer from these infections; however, after adjustment for potential confounders, this was not statistically significant. The incidence of ventilator-associated pneumonia and central line-associated bloodstream infections was high at 46 per 1,000 ventilator-days and 25 per 1,000 central line days, respectively. Conclusion Infection prevention and control measures should be implemented to curtail the rise of hospital-acquired infections in Mauritius. Such measures should include the use of bundles of care. In addition, periodic surveillance of nosocomial infections needs to be encouraged.

Assessment of an automated surveillance system for detection of initial ventilator-associated events.

Surveillance for initial ventilator-associated events (VAEs) was automated and compared with nonautomated review of episodes of mechanical ventilation. Sensitivity, specificity, positive predictive value, and negative predictive value of automated surveillance were very high (>93%), and automated surveillance reduced the time spent on detection of VAEs by >90%.