An intervention study investigating the effectiveness of contextualizing multimodal strategy on improving hand hygiene at a tertiary hospital in Nigeria.

BACKGROUND: Hand hygiene (HH) is a proven low-cost means to curtail the problem of hospital-acquired infection (HAI). However, a low HH compliance rate of 17.1% was found among surgical health workers at Ahmadu Bello University Teaching Hospital (ABUTH) in Zaria, Nigeria. METHODS: This was an intervention study conducted utilizing mixed methods to investigate the effectiveness of the World Health Organization (WHO) multimodal strategy to improve the HH compliance rate of doctors at ABUTH Zaria. The study was conducted between June and August 2022 and included delivering a behavioural change HH workshop to doctors followed by data collection in the surgical wards that had received environmental modification through the provision of an alcohol-based hand rub (ABHR), HH posters and nurses for visual and/or verbal reminders. RESULTS: The cumulative HH compliance rate was 69% (n=1774) and was significantly different from the baseline HH compliance rate of 17.1% (confidence interval 45.5 to 57.7, p<0.001). Observed HH was highest in the ward with both visual and verbal reminders (78%) and lowest (59%) where neither visual nor verbal reminders were provided (n=444 per ward). All respondents reported motivation to perform HH with the presence of ABHR. CONCLUSIONS: The WHO multimodal strategy is good for enhancing HH among health workers in the context of low- and middle-income countries. More research is needed to understand how much of a reduction in HAI is directly associated with efficient HH by health workers.

Antimicrobial susceptibility pattern of extended-spectrum beta-lactamase-producing uropathogens in aminu Kano teaching hospital, Northwestern Nigeria.

Background: UTI is the most common nosocomial infection among hospitalized patients. Emerging increasing resistance has been observed among uropathogens of the family enterobacterales. Extended spectrum beta lactamase genes encode for multidrug resistance and unrestricted use of antibiotics in hospitals provides an environment for spread of infections with limited treatment options. This necessitates therapies based on culture and antimicrobial sensitivity to improve patients' outcomes We aimed to determine susceptibility pattern of ESBL uropathogens among hospitalized patients in Aminu Kano Teaching Hospital, Kano. Methodology: Three hundred and eighty-nine urine samples were obtained from in-patients with UTI between April 2020 and April 2021. Five samples were rejected and remaining analyzed. Susceptibility testing was done by modified Kirby Bauer technique. Clinical Laboratory Standards Institute guidelines 2019 (CLSI 2019) and the European Committee on Antimicrobial Susceptibility testing guidelines version 2 (EUCAST version 2) were used for screening and confirmation of ESBL production respectively. Results: Of the 384-urine processed, 105 (27.3%) were gram negatives and 81 were Enterobacterales, Isolation rates were E. coli-55.6%, K. pneumoniae-29.6%, Citrobacter spp.-12.3%, P. mirabilis-1.2% and Morganella spp.-1.2%. Among Enterobacterales, 32 (39.5%) were ESBL producers. Prevalence of ESBL were 62.5% for Escherichia coli, 28.1% for Klebsiella pneumoniae and 9.4% for Citrobacter species. Susceptibility showed that ESBL-producing Isolates were highly susceptible to amikacin (96.9%). Resistance to other antibiotics varied from 3.1% to 100%. Conclusion: We recommend strengthening laboratory capacity, antibiotics stewardship and Infection control to prevent spread of resistant pathogens including ESBLs.

Résumé L'infection urinaire est l'infection nosocomiale la plus fréquente chez les patients hospitalisés. L'émergence d'une résistance croissante a été observée parmi les uropathogènes de la famille des entérobactéries. Les gènes de bêta-lactamase à spectre étendu codent pour la multirésistance et l'utilisation sans restriction d'antibiotiques dans les hôpitaux crée un environnement propice à la propagation des infections avec des options de traitement limitées. Nous avons cherché à déterminer le profil de sensibilité des uropathogènes BLSE chez les patients hospitalisés à l'hôpital universitaire Aminu Kano, à Kano. Méthodologie: Trois cent quatre-vingt-neuf échantillons d'urine ont été obtenus auprès de patients hospitalisés souffrant d'infections urinaires entre avril 2020 et avril 2021. Cinq échantillons ont été rejetés et les autres analysés. Les tests de sensibilité ont été effectués à l'aide de la technique Kirby Bauer modifiée. Les directives 2019 du Clinical Laboratory Standards Institute (CLSI 2019) et les directives de l'European Committee on Antimicrobial Susceptibility testing version 2 (EUCAST version 2) ont été utilisées respectivement pour le dépistage et la confirmation de la production de BLSE. Résultats: Sur les 384 urines traitées, 105 (27,3 %) étaient à Gram négatif et 81 étaient des Enterobacterales, les taux d'isolement étaient de 55,6 % pour E. coli, 29,6 % pour K. pneumoniae, 12,3 % pour Citrobacter spp, 1,2 % pour P. mirabilis et 1,2 % pour Morganella spp. Parmi les entérobactéries, 32 (39,5 %) étaient productrices de BLSE. La prévalence des BLSE était de 62,5 % pour Escherichia coli, de 28,1 % pour Klebsiella pneumoniae et de 9,4 % pour les espèces de Citrobacter. La sensibilité a montré que les isolats producteurs de BLSE étaient très sensibles à l'amikacine (96,9 %). La résistance aux autres antibiotiques variait de 3,1 % à 100 %. Conclusion: Nous recommandons de renforcer les capacités des laboratoires, la gestion des antibiotiques et le contrôle des infections afin de prévenir la propagation de pathogènes résistants, y compris les BLSE. Mots-clés: Hôpital universitaire Aminu Kano, sensibilité aux antimicrobiens, bêta-lactamase à spectre étendu, Kano, uropathogènes.