Efficacy of Air Cleaning Units for preventing SARS-CoV-2 and other hospital-acquired infections on medicine for older people wards: A quasi-experimental controlled before-and- after study.

BACKGROUND: Nosocomial infections are costly and airborne transmission is increasingly recognised as important for spread. Air Cleaning Units (ACUs) may reduce transmission but little research has focused on their effectiveness on open wards. AIM: Assess whether ACUs reduce nosocomial SARS-CoV-2, or other, infections on older adult inpatient wards. METHODS: Quasi-experimental before-after study on two intervention-control ward pairs in a UK teaching hospital. Infections were identified using routinely collected electronic health records data during one year of ACU implementation and the preceding year ("core study period"). Extended analyses included 6 months additional data from one ward pair following ACU removal. Hazard ratios (HR) were estimated through Cox regression controlling for age, sex, ward and background infection risk. Time the ACUs were switched on was also recorded for intervention ward 2. FINDINGS: ACUs were initially feasible but compliance reduced towards the end of the study (average operation in first vs second half of ACU time on intervention ward 2: 77% vs 53%). 8171 admissions >48hrs (6112 patients, median age 85yrs) were included. Overall, incidence of ward-acquired SARS-CoV-2 was 3.8%. ACU implementation was associated with a non-significant trend of lower hazard for SARS-CoV-2 infection (HR core study period 0.90, 95% CI 0.53, 1.52; extended study period 0.78, 95% CI 0.53, 1.14). Only 1.5% of admissions resulted in other notable ward-acquired infections. CONCLUSION: ACUs may reduce SARS-CoV-2 infection to a clinically-meaningfully degree. Larger studies could reduce uncertainty, perhaps using a cross-over design, and factors influencing acceptability to staff and patients should be further explored.

Corrigendum: Regional disparities in the prevalence and correlated factors of myopia in children and adolescents in Gansu, China.

[This corrects the article DOI: 10.3389/fmed.2024.1375080.].

Development and Implementation of Learning Collaboratives for Infection Prevention and Control Education in Long-Term Care Facilities.

Infections in long-term care facilities (LTCFs) pose a critical challenge, with one to three million serious infections annually and up to 380,000 associated deaths. The vulnerability of aging populations and inadequate infection prevention and control (IPC) programs underscore the need for intervention. This initiative provided tailored continuing education through eight virtual learning collaboratives serving 541 infection preventionists. The project also developed nine IPC toolkits and a manual to further support LTCFs' infection prevention efforts.

Environmental risk factors for gallbladder cancer: field-wide systematic review and meta-analysis.

BACKGROUND AND AIMS: Cholelithiasis is the most well-recognized risk factor for gallbladder cancer (GBC), the predominant biliary-tract malignancy; however, credibility on other modifiable exposures remains uncertain. We performed a field-wide systematic review and meta-analysis on environmental factors associated with GBC. METHODS: We systematically searched Medline/PubMed and Embase up to May 8, 2023, to identify randomized and non-randomized studies examining environmental factors for GBC. We conducted random-effects meta-analyses focusing on longitudinal studies. Evidence from case-control studies was considered complementary. Evidence credibility was graded by prespecified criteria including the random-effects estimate, 95% confidence interval, P-value, statistical heterogeneity, small-study effects, and robustness to unmeasured confounding. RESULTS: We identified 215 eligible primary studies and performed 350 meta-analyses across seven domains: lifestyle; reproductive; metabolic; dietary; infections; interventions; contaminants, and occupational exposures. Based on longitudinal evidence, body-mass index (RR per 5-unit increase 1.27; 95% CI, 1.21‒1.33), hip circumference (RR per 5-cm increase 1.16; 1.11‒1.22), infection of bile ducts (RR 31.7; 24.8-40.6), high parity (RR 1.48, 1.30‒1.68), obesity (RR 1.70; 1.44‒2.01), overweight (RR 1.28; 1.14‒1.43), waist circumference (RR per 5-cm increase 1.14; 1.10‒1.18), and waist-to-height ratio (RR per 0.1 increase 1.49; 1.36‒1.64) were robustly associated with increased GBC risk, while high education (RR 0.63; 0.49‒0.82) was associated with reduced risk (moderate-to-high credibility). Another 39 significant associations showed lower credibility, including different exposure scenarios of tobacco smoking, alcohol consumption and insufficient physical activity. CONCLUSIONS: This study offers a detailed appraisal and mapping of the evidence on modifiable factors for GBC. Further high-quality prospective studies are essential to validate emerging associations and inform preventive strategies in high-incidence areas.

Medicated Foley Catheters Do Not Prevent Catheter-Associated Urinary Tract Infection: A Systematic Review of Randomized Controlled Trials.

Infections of the urinary tract are among some of the most common infections treated in clinical practice. Numerous risk factors play an intrinsic role in the development of such infections, namely: age, sexual intercourse, prolonged use of feminine hygiene products, instrumentation, pregnancy, sexually transmitted infections, obstructive uropathy such as prostatic enlargement or urethral strictures, compromised immunity, and constipation. A major cause of urinary tract infections (UTIs) in hospitalized patients is catheter-associated urinary tract infections (CAUTIs). This systematic review aims to identify the causative agents and risk factors and to determine whether nitrofurazone, silver alloy, or zinc oxide-impregnated or coated/medicated Foley catheters, or non-medicated (standard) Foley catheters, can reduce the incidence of CAUTIs. A systematic review was conducted on the following databases: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), Trip medical database, and Google Scholar. A combination of keywords and Boolean operators was used ((((urinary tract infections) OR (urinary catheterization)) OR (prevention AND control)) ) AND (catheter-associated infections) for data extraction. All the randomized controlled clinical trials (RCTs) completed and available between January 1, 2005, and June 30, 2024, which focused on the prevention of CAUTIs, were screened thoroughly and were included in this systematic review. The Cochrane risk-of-bias tool for randomized trials (RoB 2) tool was used for risk of bias assessment. The Robvis visualization tool (McGuinness, LA, Higgins, JPT. Risk-of-bias VISualization (robvis): An R package and Shiny web app for visualizing risk-of-bias assessments. Res Syn Meth. 2020; 1-7) was used for development of traffic light plots and weighted bar plots for risk of bias. The literature search conducted produced 41,909 articles. Among these 19,076 were noted as duplicates and were excluded in the initial analysis; 22,833 manuscripts were thus screened after deduplication. Abstracts, case studies, reports, editorials, viewpoints, cross-sectional studies, cohort studies, case-control studies, case series, and letters to the editor/correspondence manuscripts (n = 22,745) were additionally excluded. A total of 88 full-text articles were assessed for eligibility. An in-depth evaluation and analysis further excluded 82 articles from the analysis quality assessment based on inclusion and exclusion criteria. Six RCTs were finally assessed regarding the prevention of CAUTIs and were ultimately included in the systematic review. The primary causative agents involved in the CAUTIs were found to be mainly Gram-negative bacteria such as Escherichia coli, Pseudomonas aeruginosa, and Enterococcus faecalis. The risk factors noted for the development of these CAUTIs ranged from urethral trauma, overdistention of the bladder, prolonged catheterization, to improper handling of the urine bag. No significant advantage was noted between the use of medicated and non-medicated standard Foley catheters. The aseptic technique and indications followed for the catheterization play a vital role in the prevention of CAUTIs, and more cognizance thereof will aid in the reduction of the development of CAUTIs.

Specialized nursing intervention on critically ill patient in the prevention of intubation-associated pneumonia: an integrative literature review.

Healthcare-associated infections are adverse events that affect people in critical condition, especially when hospitalized in an intensive care unit. The most prevalent is intubation-associated pneumonia (IAP), a nursing-care-sensitive area. This review aims to identify and analyze nursing interventions for preventing IAP. An integrative literature review was done using the Medline, CINAHL, Scopus and PubMed databases. After checking the eligibility of the studies and using Rayyan software, ten final documents were obtained for extraction and analysis. The results obtained suggest that the nursing interventions identified for the prevention of IAP are elevating the headboard to 30º; washing the teeth, mouth and mucous membranes with a toothbrush and then instilling chlorohexidine 0.12%-0.2% every 8/8 hr; monitoring the cuff pressure of the endotracheal tube (ETT) between 20-30 mm Hg; daily assessment of the need for sedation and ventilatory weaning and the use of ETT with drainage of subglottic secretions. The multimodal nursing interventions identified enable health gains to be made in preventing or reducing IAP. This area is sensitive to nursing care, positively impacting the patient, family, and organizations. Future research is suggested into the effectiveness of chlorohexidine compared to other oral hygiene products, as well as studies into the mortality rate associated with IAP, with and without ETT for subglottic aspiration.

Meeting Social Needs in a Crisis Context: Lessons Learned from Integrating the 'Take Care Initiative' into New York City's Testing and Contact Tracing Program.

The COVID-19 pandemic highlighted the importance of addressing social needs in a crisis context. Some US jurisdictions integrated a social service component into case investigation and contact tracing (CI/CT) programs, including the New York City (NYC) Test & Trace (T2) Program; the Take Care initiative referred NYC residents who tested positive or were exposed to COVID-19 to services to support isolation and quarantine and meet basic needs. More research is needed to determine effective implementation strategies for integrating social needs provision into CI/CT programs. To identify barriers and facilitators to the implementation of the Take Care initiative, we conducted key informant interviews with program staff, community-based organization partners, and cases and contacts as part of a larger evaluation of the T2 program. Interviews were recorded, transcribed, and analyzed using rapid qualitative methods. Key facilitators to implementation included utilizing a case management software system, employing strategies to encourage service uptake, leveraging cross-agency collaborations, and partnering with community-based organizations for resource navigation. Barriers identified included external management of the software system, challenges reaching and engaging the public, administrative complications due to shifting collaborations, and management of CBO partners' structure and hiring. Based on our findings, we provide recommendations to support effective planning and implementation of social needs service provision in a crisis context. Future research should focus on testing promising implementation strategies highlighted in this study and applying them to varied contexts and crisis situations.

ISCCM Position Statement on the Approach to and Management of Critically Ill Patients with Tuberculosis.

Tuberculosis (TB) is an important cause of morbidity and mortality globally. About 3-4% of hospitalized TB patients require admission to the intensive care unit (ICU); the mortality in these patients is around 50-60%. There is limited literature on the evaluation and management of patients with TB who required ICU admission. The Indian Society of Critical Care Medicine (ISCCM) constituted a working group to develop a position paper that provides recommendations on the various aspects of TB in the ICU setting based on available evidence. Seven domains were identified including the categorization of TB in the critically ill, diagnostic workup, drug therapy, TB in the immunocompromised host, organ support, infection control, and post-TB sequelae. Forty-one questions pertaining to these domains were identified and evidence-based position statements were generated, where available, keeping in focus the critical care aspects. Where evidence was not available, the recommendations were based on consensus. This position paper guides the approach to and management of critically ill patients with TB. How to cite this article: Chacko B, Chaudhry D, Peter JV, Khilnani G, Saxena P, Sehgal IS, et al. isccm Position Statement on the Approach to and Management of Critically Ill Patients with Tuberculosis. Indian J Crit Care Med 2024;28(S2):S67-S91.

Molecular epidemiology, microbiological features and infection control strategies for carbapenem-resistant Acinetobacter baumannii in a German burn and plastic surgery center (2020-2022).

BACKGROUND: Carbapenem-resistant Acinetobacter baumannii (CRAB) frequently causes both healthcare-associated infections and nosocomial outbreaks in burn medicine/plastic surgery and beyond. Owing to the high antibiotic resistance, infections are difficult to treat, and patient outcomes are often compromised. The environmental persistence capability of CRAB favors its transmission in hospitals. A comprehensive analysis and understanding of CRAB epidemiology and microbiology are essential for guiding management. METHODS: A three-year retrospective cohort study (2020-2022) was conducted in a German tertiary burn and plastic surgery center. In addition to epidemiological analyses, microbiological and molecular techniques, including whole-genome sequencing, were applied for the comprehensive examination of isolates from CRAB-positive patients. RESULTS: During the study period, eight CRAB cases were found, corresponding to an overall incidence of 0.2 CRAB cases per 100 cases and an incidence density of 0.35 CRAB cases per 1000 patient-days. Six cases (75%) were treated in the burn intensive care unit, and four cases (50%) acquired CRAB in the hospital. Molecular analyses comprising 74 isolates supported the epidemiologic assumption that hospital acquisitions occurred within two separate clusters. In one of these clusters, environmental CRAB contamination of anesthesia equipment may have enabled transmission. Furthermore, molecular diversity of CRAB isolates within patients was observed. CONCLUSIONS: CRAB can pose a challenge in terms of infection prevention and control, especially if cases are clustered in time and space on a ward. Our study demonstrates that high-resolution phylogenetic analysis of several bacterial isolates from single patients can greatly aid in understanding transmission chains and helps to take precision control measures.

Radiography students' knowledge, attitude and practice relating to infection prevention and control in the use of contrast media injectors in computed tomography.

INTRODUCTION: Radiography students complete professional placements in various clinical settings and must adhere to distinct infection prevention and control (IPC) protocols. The aim of this study was to explore radiography students' training, knowledge, attitudes, and practice (KAP) relating to IPC in the use of contrast media injectors in computed tomography (CT). METHODS: An online survey study was undertaken with radiography students enrolled at two Australian universities. Survey questions related to contrast media training and KAP regarding IPC in CT. Data was summarised using descriptive statistics, with comparisons between experience in public and private practice. One free-text response question focused on non-adherence to IPC best practice, analysed using content analysis. RESULTS: In total, 40 students completed the survey (9% response rate). Reports of IPC and contrast media equipment training was high, with disposition for further training. Regarding IPC knowledge, 65% of students responded correctly to all 'knowledge' items (individual scores range: 60-100%). Low consensus was observed regarding whether gloves replace the need for hand hygiene and if CT contrast tubing poses risk to healthcare workers (85% each). Mean scores ranged from 41% to 100% regarding identification of sterile syringe and tubing components. Responses to the open-ended question were categorised into four themes: 'High non-adherence risk working conditions', 'attitudes and practice', 'knowledge', and 'prioritise good IPC practice'. CONCLUSIONS: Radiography students demonstrate varied comprehension of IPC regarding contrast media equipment, and results suggest need for collaborative efforts between academic institutions and clinical training sites to integrate IPC protocols into curricula and on-site training.

Chinese expert consensus on management of antifungal-resistant dermatophytoses (2024 edition).

Antifungal-resistant dermatophytes (ARD) infection is a hotspot issue in clinical microbiology and the dermatology field. Trichophyton indotineae as the dominant species of dermatophyte with terbinafine-resistance or multidrug resistance, is easy to be missed detection clinically, which brings severe challenges to diagnosis and treatment. ARD infection cases have emerged in China, and it predicts a risk of transmission among human. Based on the existing medical evidence and research data, the Mycology Group of Combination of Traditional and Western Medicine Dermatology and Chinese Antifungal⁃Resistant Dermatophytoses Expert Consensus Group organized experts to make consensus on the management of the infection. Here, the consensus formulated diagnosis and treatment recommendations, to raise attention to dermatophytes drug resistance problem, and expect to provide reference information for the clinical diagnosis, treatment, prevention and control.

The evolution and diversity of porcine reproductive and respiratory syndrome virus in China.

The porcine reproductive and respiratory syndrome virus (PRRSV) has emerged as a significant pathogen in the global pork industry since the late 1980s, causing substantial economic losses due to its high contagiousness and genetic variability. China, with its complex epidemiological landscape, has witnessed the emergence of four distinct lineages of PRRSV-2 (Lineages 1, 3, 5, and 8) and occasional occurrences of PRRSV-1. This review summarizes the historical context and epidemiological trends that have led to the diversification of PRRSV in China, discusses the evolutionary dynamics behind the establishment of diverse genetic variants, as well as the impact of recombination and modified live vaccines (MLVs) on the virus's rapid evolution. The implications for disease management, including strategies to reduce the complexity of PRRSV epidemics and improve prevention and control measures, are also suggested. Understanding the evolutionary pattern and factors contributing to PRRSV diversity is crucial for enhancing our knowledge, control capabilities, and prevention strategies, which could be integrated into swine health management practices.

Challenges in traumatic spinal cord injury care in developing countries - a scoping review.

Objective: To evaluate the leading challenges in developing countries' traumatic spinal cord injury (TSCI) care. Methods: We conducted a systematic search in electronic databases of PubMed, SCOPUS, Web of Science, EMBASE, and Cochrane Library on 16 April 2023. Studies that investigated challenges associated with the management of TSCI in developing countries were eligible for review. We extracted related outcomes and categorized them into four distinct parts: injury prevention, pre-hospital care, in-hospital care, and post-hospital care. Results: We identified 82 articles that met the eligibility criteria including 13 studies on injury prevention, 25 on pre-hospital care, 32 on in-hospital care, and 61 on post-hospital care. Challenges related to post-hospital problems including the personal, financial, and social consequences of patients' disabilities and the deficiencies in empowering people with TSCI were foremost studied. Lack of trained human resources, insufficient public education and delays in care delivery were barriers in the acute and chronic management of TSCI. A well-defined pre-hospital network and standard guidelines for the management of acute neurotrauma are needed. Critical challenges in injury prevention include deficiencies in infrastructure and supportive legislation. Conclusion: Studies focusing on injury prevention and pre-hospital care in TSCI management in developing countries warrant further investigation. It is imperative to develop systematic and evidence-based initiatives that are specifically tailored to the unique circumstances of each country to address these challenges effectively. By understanding the primary obstacles, policymakers and healthcare providers can establish goals for improving education, planning, legislation, and resource allocation.

Silicone adhesive multilayer foam dressings to prevent hospital-acquired sacrum pressure ulcers: An economic evaluation based on a publicly funded pragmatic randomized controlled trial linked with real-world data.

OBJECTIVES: To estimate the cost-effectiveness of sacrum multilayer silicone foam dressings as an adjuvant prophylactic therapy compared to standard pressure ulcer prevention in a hospital population at high risk for pressure ulcer development. METHODS: An economic evaluation is performed from a healthcare payer's perspective. This evaluation is based on a Belgian publicly funded pragmatic randomized controlled trial (RCT), linked with real-world data from administrative claims database and a Belgian cost analysis. A cost-consequences analysis with a one-year time horizon is performed. RESULTS: The RCT has shown that the risk of developing a new pressure ulcer on the sacrum was statistically significantly reduced by 41 % in the treatment group (RR = 0.59, 95 % CI 0.35-0.98, p = 0.04). The absolute risk reduction of 2.0 % (95 % CI -0.1-4.1 %) coincides with a number needed to treat of 50.0 to prevent one new pressure ulcer of category II or worse. The evolution of quality of life is on average negative for patients who developed a pressure ulcer before day 3, while it is positive for patients without pressure ulcers. In a scenario with conservative assumptions, i.e. without inclusion of price discounts for the multilayer silicone foam dressings and only including costs during the hospitalization, pressure ulcer prevention with dressings on the sacrum was already cost-neutral. CONCLUSIONS: The preventive use of silicone adhesive multilayer foam dressings on the sacrum for a population similar to the pragmatic trial population can be supported both from a clinical and economic point of view.

Integration of IPC/WASH critical conditions into quality of care and quality improvement tools and processes: Bangladesh case study.

Unsafe patient care in hospitals, especially in low- and middle-income countries, is often caused by poor infection prevention and control (IPC) practices; insufficient support for water, sanitation, and hygiene (WASH); and inadequate waste management. We looked at the intersection of IPC, WASH, and the global initiative of improving health care quality, specifically around maternal and newborn care in Bangladesh health facilities. We identified 8 primary quality improvement and IPC/WASH policy and guideline documents in Bangladesh and analyzed their incorporation of 30 subconditions under 5 critical conditions: water; sanitation; hygiene; waste management/cleaning; and IPC supplies, guidelines, training, surveillance, and monitoring. To determine how Bangladesh health care workers implemented the policies, we interviewed 33 informants from 16 public and private facilities and the national level. Bangladesh's 8 primary guidance documents covered 55% of the 30 subconditions. Interviews showed that Bangladesh health facility staff generally rely on eight tools related to quality improvement (five); IPC (two); and supportive supervision (one) plus a robust supervision mechanism. The stakeholders identified a lack of human resources and environmental hygiene infrastructure and supplies as the main gaps in providing IPC/WASH services. We concluded that the Bangladesh government had produced substantial guidance on using quality improvement methods to improve health services. Our recommendations can help identify strategies to better integrate IPC/WASH in resources including standardizing guidelines and tools within one toolkit. Strategizing with stakeholders working on initiatives such as universal health coverage and patient safety to integrate IPC/WASH into quality improvement documents is a mutually reinforcing approach.

Infection prevention and control status at public hospitals and factors associated with COVID-19 infection among healthcare workers in Myanmar: A cross-sectional study.

BACKGROUND: Hospitals should prepare for emerging diseases and protect healthcare workers (HCWs) from work-related infection. This study aims to assess public hospital preparedness for the coronavirus disease 2019 (COVID-19) a year after the Myanmar government began implementing COVID-19 prevention measures, and to identify factors associated with work-related COVID-19 infection among HCWs in Myanmar. METHODS: In January 2021, data were collected from 101 hospitals and 706 HCWs who had COVID-19 in Myanmar in 2020. Data from the hospitals included basic information, the status of infection prevention and control (IPC), the preparedness for COVID-19 (guidelines, checklists, fever screening, patient pathway, and training), handwashing facilities, and availability of personal protective equipment (PPE). Data of COVID-19 infected HCWs included age, occupation, workplace, severity and source of COVID-19 infection, knowledge and practice of handwashing, and working environment. Chi-square test was performed to compare the preparedness for COVID-19 among three hospital levels (primary, secondary and tertiary levels). Logistic regression analysis was performed to identify the associated factors of work-related infection of HCWs. RESULTS: The total number of beds, HCWs, and COVID-19 patients in 2020 at the 101 hospitals was 12,888, 14,421, and 19,835, respectively. The availability of PPE was high in hospitals at all levels. Approximately 80% of hospitals had functional status of IPC, set up fever screening and patient pathway, and provided training on IPC and COVID-19. However, only 39.6% of hospitals had developed COVID-19 guidelines and 55.4% had developed checklists. The percentage of hospitals that prepared each measurement was lowest at the primary level. The factors associated with work-related COVID-19 among HCWs were being 30-39 years old, working as a doctor, working at isolation wards, having disinfection technique training, and having enough PPE at the workplace. CONCLUSION: The preparedness for COVID-19 at public hospitals in Myanmar in January 2021 was insufficient, especially in the availability of the guidelines and checklists and at primary hospitals. A support system for hospital pandemic preparedness and monitoring of IPC implementation is needed. The government should prepare for emerging diseases and provide appropriate and adequate PPE and additional training to all HCWs, especially HCWs who work for isolation wards.

A survey of US and Caribbean veterinary schools reveals strengths and opportunities in antimicrobial stewardship and infection prevention and control activities.

OBJECTIVE: To understand antimicrobial stewardship (AS) and infection prevention and control (IPC) activities in veterinary schools. METHODS: An online survey was completed by representatives from American Association of Veterinary Medical Colleges-accredited veterinary schools in the US and Caribbean prior to attending the Inaugural Small Animal Antimicrobial Stewardship Workshop for US Veterinary Schools. Responses were examined to identify patterns among AS and IPC activities and adherence to the AVMA core principles. RESULTS: Half (12 of 24) of the surveyed schools had an AS committee and most (79% [19 of 24]) had an IPC committee. Lack of dedicated staff time was a common barrier to AS (88% [21 of 24]) and IPC (75% [18 of 24]) reported by schools both with and without AS and IPC committees. Eleven of 24 schools (46%) reported performing at least 1 activity focused on each of the AVMA's 5 core principles of AS. Although 79% (19 of 24) of schools incorporate AS into preclinical curricula, training of clinical faculty (17% [4 of 24]), veterinary technicians and support staff (21% [5 of 24]), and house officers (42% [10 of 24]) is less common, despite these individuals engaging in teaching clinical-year veterinary students. CONCLUSIONS: Veterinary schools varied in established AS education and AS and IPC practices, though financial and human resources were a common barrier. CLINICAL RELEVANCE: A collaborative and cohesive approach to AS and IPC among schools to create sustainable frameworks for practice improvement will help combat the global threat of antimicrobial resistance. This is a critical action for settings where future veterinarians are trained.

Study on the relationship between adolescent myopia and gut microbiota via 16S rRNA sequencing.

Myopia has become a global public health problem, with a high incidence among adolescents. In recent years, the correlation between gut microbiota and various diseases has become a research hotspot. This paper analyzes the relationship between myopia and gut microbiota in adolescents based on 16S rRNA sequencing, opening up a new avenue for the prevention and control of myopia. 80 adolescents aged 6-15 years were included; fecal samples were collected to compare their diversity and species differences. There was no significant difference in α diversity when considering richness and evenness at the same time (P > 0.05). While the group difference in ß diversity reached a significant level (R2 = 0.022, P < 0.05). The absolute quantification and relative abundance of phylum level Firmicutes and Actinobacteriota are different; among the top 30 genera, myopic group only one genus decreased in absolute quantification, while 13 genera decreased in relative quantification; so LEfSe analysis was performed, and the result showed that microbial community composition changed under Linear discriminant analysis (LDA) score, the top ten changes are shown in the figure; the Wilcoxon Rank sum test also found some significant changes in the absolute abundance of differential microbiota among different groups, at the phylum level, one bacterial phylum decreased and three bacterial phyla increased; at the genus level, 2 bacteria genera decreased and 29 bacteria genera increased. Functional pathways prediction found many myopic-related pathways were functionally enhanced in myopic patients (P < 0.05). Multivariate logistic regression analysis results showed that the area under the curve (AUC) of myopic patients predicted was close to or equal to 1. In conclusion, adolescent myopia is closely related to the gut microbiota, and the characteristic gut microbiota can distinguish myopia from healthy controls to a large extent. Therefore, it can be considered to regulate these characteristic gut microbiota to prevent and control myopia.

The effect of infection prevention and control programme for childcare workers in daycare centres: A systematic review.

PROBLEM: Infectious diseases can easily spread in daycare centres (DCCs), primarily due to inadequate hygiene practices of both childcare workers and children. Therefore, childcare workers who provide direct care in early childhood play a crucial role in preventing and controlling infectious diseases in DCCs. This systematic review aims to identify current evidence and examine the effect of the infection prevention and control (IPC) programme for childcare workers in daycare centres, and to obtain a pooled estimate of the intervention's effect using meta-analysis, if possible ELIGIBILITY CRITERIA: We searched literature through CINAHL, Medline, Cochrane Library, ScienceDirect, and Scopus databases, we also performed manual searches on Google Scholar and citation lists. Inclusion criteria comprised: 1) Experimental or quasi-experimental design studies that were published in the English language from October 1971 to December 2023, 2) Population focused on childcare workers responsible for early childhood in DCCs, 3) The intervention focused on the ICP programme, and 4) Outcomes related to childcare workers SAMPLE: From 3,964 articles, eight studies were included in this review RESULTS: Half of the total studies concentrated on hand hygiene intervention, while the remaining four addressed the prevention of infectious diseases and infection control. These studies reported an increase in knowledge, self-efficacy, and compliance regarding hand hygiene, and knowledge and practices related to infectious diseases. Two studies included nurses as conductors in the programme CONCLUSION: IPC programme effectively enhances some knowledge and performances in childcare workers IMPLICATION: Nurses can conduct IPC programme within daycare centres by utilizing evidence-based educational tools. Further research is needed to require well-reported studies, especially randomized controlled trials. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42023492592.

Knowledge and safe handling practices affecting the occupational exposure of nurses and midwives to hazardous drugs: A mixed methods systematic review.

BACKGROUND: Hazardous drugs are inherently toxic and present a potential occupational exposure risk to nurses and midwives. Hazardous drugs require special handling to minimise the risk of exposure and adverse health effects. Although the use of hazardous drugs in oncology services is well recognised, they are also used in other healthcare areas where nurses and midwives may be unaware there is a risk. OBJECTIVE: To investigate what nurses and midwives know and do about their occupational exposure to hazardous drugs, and what factors affect their knowledge and practice. DESIGN: Mixed methods systematic review. METHODS: A systematic review was conducted, and studies were included if the authors described what nurses or midwives knew about hazardous drugs, or what they did in their clinical practice to reduce their risk of occupational exposure (PROSPERO registration CRD42024437493). The databases were searched for any year until the 26th of January 2024.Two independent reviewers extracted data using Covidence and assessed the risk of bias. The data were extracted into the categories of knowledge of risk and safe handling practices, attitude and factors affecting these, and activities that posed the greatest risk of exposure (preparation, administration, and disposal of hazardous drugs, cleaning hazardous drug spills, and handling excreta from patients who had recently been treated with hazardous drugs). RESULTS: Of the 2702 articles that were identified, 59 quantitative and 3 qualitative studies were included in this review. No studies reported on midwives handling hazardous drugs. Most studies investigated nurses working in oncology services. Nurses reported a lack of education about the risk and safe handling. They were often responsible for preparing hazardous drugs and there was inconsistency in their compliance when using personal protective equipment. Nurses did not always perceive that there was a real risk of exposure, were concerned about the effect of wearing personal protective equipment on their relationship with patients and perceived they lacked the time to don equipment. CONCLUSIONS: The risk of occupational exposure to hazardous drugs outside of oncology services was rarely investigated. There were no studies reporting what midwives knew and did about their risk of occupational exposure to hazardous drugs. When nurses were aware of the risks, this did not necessarily translate into the implementation of safe handling practices or the consistent use of personal protective equipment because of a perceived low risk, lack of personal protective equipment availability, and prioritising personal or patient comfort over safety measures. TWEETABLE ABSTRACT: Nurses and midwives are often unknowingly exposed to the toxic effects of hazardous drugs when they prepare and administer these drugs for patients, although knowledge does not always equal safe handling practices.