APSIC guide for prevention of catheter associated urinary tract infections (CAUTIs).

BACKGROUND: The Asia Pacific Society of Infection Control launched the APSIC guide for prevention of catheter associated urinary tract infections in July 2022. It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities in the Asia Pacific region to achieve high standards in infection prevention and control practices during the management and care of patients with a urinary catheter. METHODS: The guidelines were developed by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section. RESULTS: It recommends that healthcare institutions have a catheter associated urinary tract infection prevention program that includes surveillance and the use of the insertion and maintenance bundles. Implementation of the bundles is best done using a quality improvement approach with a multidisciplinary team. CONCLUSIONS: Healthcare facilities should aim for excellence in care of patients with urinary catheters. It is recommended that healthcare facilities have a catheter associated urinary tract infection prevention program as part of their Infection Prevention and Control program.

Process improvement to effectively manage and reduce sharps injuries in a Tertiary Hospital in Northern India.

INTRODUCTION AND OBJECTIVES: Needle stick injuries are associated with a 0.3-30% risk of transmission of Human Immunodeficiency virus, Hepatitis C virus, and Hepatitis B virus. Despite causing psychological trauma they also involve a huge financial burden. A robust process improvement (RPI) toolkit was introduced in order to effectively manage and reduce needle stick injuries, as well as an attempt to report prevalence, post-exposure management, and associated economic burden. MATERIALS AND METHODS: Prospective Observational Study (2015-2018) has been design in a Corporate Tertiary Care Hospital. The participants included were needle stick injuries exposed staff. RPI toolkit was implemented (2015-2018) focusing on root cause analysis, availability of safety engineered devices, immunization and post-exposure management of needle stick injuries exposed staff. The main outcome measure was needle stick injuries incidence. RESULTS: A total of 211 needle stick injuries were reported (mean - 52.72/year, needle stick injury incidence - 13.18/year/100 beds). Yearly trends showed a decrease of 21.3% in injuries from 2015 (61) to 2018 (48). Half (106, 50%) of the total injuries were reported among nurses. Use of hypodermic needles was involved in 116 (55%) injuries, with 114 (54%) occurring due to nonadherence to hospital policies. Overall, 204 staff had protective immunity, and 135 (64%) of these had completed their Hepatitis B immunizations. The source was known in 165 (78%) cases, and 113 of these cases had an injury from a source with negative viral markers. A 6-month follow-up was completed in 90 cases. No seroconversion was reported. Overall costs incurred in post-exposure prophylaxis was approximately €30,000 (mean cost €143.50/needle stick injury). CONCLUSION: Nurses are most at risk of needle stick injury in healthcare settings. Implementation of RPI toolkit led to a 21.3% reduction in sharps injury incidences. These injuries incur huge financial burden on the hospital. Appropriate immunization strategies saved about €1360 expenditure on post-exposure prophylaxis.

Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in 21 adult intensive-care units from 10 cities in India: findings of the International Nosocomial Infection Control Consortium (INICC).

We report on the effect of the International Nosocomial Infection Control Consortium's (INICC) multidimensional approach for the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 21 intensive-care units (ICUs), from 14 hospitals in 10 Indian cities. A quasi-experimental study was conducted, which was divided into baseline and intervention periods. During baseline, prospective surveillance of VAP was performed applying the Centers for Disease Control and Prevention/National Healthcare Safety Network definitions and INICC methods. During intervention, our approach in each ICU included a bundle of interventions, education, outcome and process surveillance, and feedback of VAP rates and performance. Crude stratified rates were calculated, and by using random-effects Poisson regression to allow for clustering by ICU, the incidence rate ratio for each time period compared with the 3-month baseline was determined. The VAP rate was 17.43/1000 mechanical ventilator days during baseline, and 10.81 for intervention, showing a 38% VAP rate reduction (relative risk 0.62, 95% confidence interval 0.5-0.78, P = 0.0001).

Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC).

PURPOSE: We aimed to evaluate the impact of a multidimensional infection control strategy for the reduction of the incidence of catheter-associated urinary tract infection (CAUTI) in patients hospitalized in adult intensive care units (AICUs) of hospitals which are members of the International Nosocomial Infection Control Consortium (INICC), from 40 cities of 15 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, Philippines, and Turkey. METHODS: We conducted a prospective before-after surveillance study of CAUTI rates on 56,429 patients hospitalized in 57 AICUs, during 360,667 bed-days. The study was divided into the baseline period (Phase 1) and the intervention period (Phase 2). In Phase 1, active surveillance was performed. In Phase 2, we implemented a multidimensional infection control approach that included: (1) a bundle of preventive measures, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CAUTI rates, and (6) feedback of performance. The rates of CAUTI obtained in Phase 1 were compared with the rates obtained in Phase 2, after interventions were implemented. RESULTS: We recorded 253,122 urinary catheter (UC)-days: 30,390 in Phase 1 and 222,732 in Phase 2. In Phase 1, before the intervention, the CAUTI rate was 7.86 per 1,000 UC-days, and in Phase 2, after intervention, the rate of CAUTI decreased to 4.95 per 1,000 UC-days [relative risk (RR) 0.63 (95% confidence interval [CI] 0.55-0.72)], showing a 37% rate reduction. CONCLUSIONS: Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries.

Parasitological examination for presence of hookworms (Uncinaria spp.) in northern elephant seals (Mirounga angustirostris) at Año Nuevo State Reserve, California (2012).

Northern elephant seals (Mirounga angustirostris Gill, 1866), inhabiting rookeries on the mainland of Año Nuevo State Reserve in central California, were investigated in 2012 for presence of hookworms (Uncinaria spp.). Material collected and examined for hookworms included: blubber (n = 15), stomach and intestines (n = 21) from dead pups; feces from the rectum of weaned pups (n = 23); sand containing apparent feces in areas of weaned pups (n = 28) and sand without apparent feces in areas of weaned pups (n = 54); milk from females (n =23) at 5 days and about 23 to 26 days postpartum; and placenta from one female. Evidence of hookworm presence was not detected in any of the samples examined. Possible reasons why hookworms were not found in northern elephant seals on the mainland of Año Nuevo State Reserve are discussed.

Genotype distribution of hepatitis C virus infection in Greece: correlation with different risk factors and response to interferon therapy.

The aim of this study was to investigate the prevalence of HCV genotypes among Greek patients with chronic hepatitis C and to assess the influence of genotypes and quasi-species populations on efficacy of interferon therapy. Genotypes were determined in 65 patients (18 patients after kidney transplantation, 16 with thalassemia and 31 with no known risk factor) with elevated ALT for more than 6 months and histologically proven chronic hepatitis, using the Inno-Lipa strip assay. The quasi-species were determined using the fluorescence single-strand conformational polymorphism method. Most patients were infected with genotype 3a, namely 61% of patients with kidney transplants (n = 18), 50% of patients with thalassemia (n = 16) and 48% of patients without known risk factors (n = 31). Other genotypes were found including coinfection with different genotypes. In all patients with mixed infection, genotype 3a was present. Thirty-six patients from the last two groups received interferon (3Mio U 3x week) for 1 year. Biochemical and/or virological and histological responses were found in 11/19 patients with genotype 3a (58%), 3/5 with mixed infection, 2/4 with genotype 1b, 2/5 with genotype 2a, 1/4 with genotype 1a and 1/1 with genotype 4. The virus found in non-responders with genotype 3a was genetically more heterogeneous than in responders. These data indicate that (1) the genotype 3a is prevalent in Greek patients (68% of all patients), (2) there is no significant difference regarding genotypes among patients with different risk factors and (3) although based on a small number of patients, the genotype 3a seems to respond better to interferon therapy. Finally, the number of quasi-species may be a factor predictive of response.

Determinants of symptomatic giardiasis in childhood.

Giardia has been frequently implicated as a causative agent for acute as well as chronic diarrheal diseases in children. The present study was aimed at exploring the determinants of manifestations of Giardiasis in childhood, in relation to various host and parasite related factors. A total of 200 children with acute (100), chronic (50) or without (50) diarrhea in last 15 days were recruited for the study and evaluated with regards to nutritional status, serum immunoglobulins, secretory IgA levels, presence of Giardia in stool/duodenal aspirate/duodenal biopsy specimen and for associated infections. Lysates from acute giardiasis cases were further studied for zymodeme (banding) pattern. After correlation of all investigations, humoral immune defect in the host was found to be the major determinant of whether the Giardial infestation would be symptomatic or not, while associated bacterial infections and zymodeme patterns were not found to be important in determining the pathogenicity or presentation of giardiasis.

Assessment of the immune and nutritional status of the host in childhood diarrhoea due to cryptosporidium.

Cryptosporidium oocysts were detected microscopically in the concentrated faecal smears (stained by modified kinyoun's acid fast stain) in 13 out of 100 (13 per cent) cases of acute diarrhoea (AD < 2 weeks duration), 7 out of 50 (14 per cent) cases of chronic diarrhoea (CD > 2 weeks duration) and none in 50 age matched controls. The grades of malnutrition of the cases and controls were calculated by the weight for age criteria and the immune status assessed by the levels of serum immunoglobulins and SIgA in duodenal fluids. Malnutrition was observed in 6 out of 13 cases (46.1 per cent) in acute and 6 out of 7 cases (85.71 per cent) in chronic cryptosporidial diarrhoeas. There was no significant statistical difference (P > 0.05) in serum immunoglobulins and SIgA levels in chronic cryptosporidiosis. SIgA was significantly reduced (P > 0.05) in cases of acute cryptosporidiosis. Cryptosporidium is an important cause of symptomatic infection in apparently immunocompetent children not having been detected in a single non-diarrhoeal control. Further a low SIgA could contribute to acute symptomatic cryptosporidiosis by favouring colonization with the parasite.

Purification and characterization of a 40 S ribosomal protein S6 kinase from vanadate-stimulated Swiss 3T3 cells.

Recently we have identified a mitogen-activated S6 kinase from Swiss 3T3 cells (Jenö, P., Ballou, L. M., Novak-Hofer, I., and Thomas, G. (1988) Proc. Natl. Acad. Sci. U.S.A. 85, 406-410). Here we describe the detailed purification of this enzyme from high-speed supernatants (400,000 x g) of vanadate-treated cell extracts. The enzyme is purified through six sequential steps including cation- and anion-exchange, sizing, and affinity chromatography. At each step, the enzyme behaves as one entity and, on the final step of purification, is revealed on silver-stained sodium dodecyl sulfate-polyacrylamide gels as a single protein of Mr 70,000. As reported earlier, the overall purification factor is 3,000-fold, and the specific activity of the homogeneously purified enzyme is 0.6 mumol/min/mg of protein. However, recovery of total activity is only 0.2%. This large loss of activity appears to be due to freeze-thawing the enzyme between each step of purification. The purified kinase does not phosphorylate casein, histones 2A and 3S, or phosvitin. It has a Km for ATP of 28 microM and a broad optimum for Mg2+ between 5 and 20 mM. Mn2+ does not affect the basal level of kinase activity, and at concentrations as low as 1 mM, it completely suppresses the effect of 20 mM Mg2+ on kinase activity. The relationship of this enzyme to two other purified S6 kinases is discussed.

Bulk Superconductivity at 122 K in T1(Ba,Ca)2Ca3Cu4O10.5+8 with Four Consecutive Copper Layers.

The observed increase of superconducting transition temperature (T(c)) with the number of copper oxide planes continues in the four-[CuO(2)](-2) layer (single TI layer) oxide superconductor, which has been prepared with > 80% purity and was magnetically aligned for crystallographic identification. A master scaling curve is proposed, which ties together the T(c)'s of virtually all known Bi and Tl oxide superconductors, and shows that the Tl(Bi) layers play an essential role in the superconductivity. publication 350 of the Barnett Institute.