Hand Hygiene is the cheapest and simplest way to prevent the spread of infection, however international compliance is below than 40% (WHO, 2009). In the experience of Al Wakra Hospital, the improvement in hand hygiene compliance highlighted not just interventions towards training and education but also behavioral motivation and physical allocations of hand hygiene appliances and equipment.Through motivating the behavioral, emotional, physical and intellectual dimensions of the different healthcare worker professions, hand hygiene compliance has increased from 60.78% in 2011 to 94.14% by the end of December 2015. It took 25 months of continuous and collaborative work with different healthcare workers to reach the 90% hand hygiene target.“Together, we have reached our goals and together we fight against infections! Because we always strive for excellence in everything we do – that is our vision here in Al Wakra Hospital.”
Background:Candida auris is an invasive, multidrug-resistant pathogen that can cause outbreaks in hospitals. The mode of transmission is through contaminated hospital items such as fomites and staff interventions. The outbreak of Candida auris affecting 13 patients at the medical intensive care unit (MICU) and medical inpatient unit, either in the form of infection or colonization, is the first documented C. auris outbreak in the Qatar. Methods: The first case was identified in November 2018 in a patient colonized in the respiratory tract. Candida auris biweekly tests were conducted. The second to fourth cases were confirmed in the MICU admitted in the same room (room 2). The fifth case was identified incidentally and was not part of the screening in another ward (6 North Medical Inpatient Unit), and 4 weeks later, Candida auris was isolated from the urine and throat of a patient on this ward. The realization that case 5 was an index case changed the direction of the outbreak investigation, and expanded screening was started among the medical inpatients. When the IPC team identified cases 6–11 and 13, all had possible epidemiological links with case 5. Results: Our root-cause analysis suggests that the index case came from another general hospital. However, because no screening protocol has been established for Candida auris, interventions have not been in place to effectively prevent and control this organism. A strong collaborative outbreak team worked to end this outbreak using the following evidence-based IPC interventions: (1) patient screening and decolonization; (2) environmental screening; (3) enhanced environmental disinfection using peracetic acid wipes, 1% chlorine, and hydrogen peroxide vapor disinfection; (4) prophylactic contact precautions; (5) enhanced hand hygiene with bare below elbows protocol; and (6) a no white gown policy. Conclusions: The outbreak of Candida auris was declared to have nbeen terminated on August 22, 2019. Despite the long period involved in this outbreak, we succeeded in ending it through the concerted efforts of a multidisciplinary team utilizing the latest scientific evidence.Funding: NoneDisclosures: None
Background: Candida auris, within the last decade, has emerged as a multidrug resistant public health threat that can lead to hospital outbreaks. It is an invasive fungal yeast resistant to multiple antifungal agents. The mode of transmission is through contaminated hospital items (including clothes and furniture) and interventions by staff. Two Candida auris outbreaks occurred in Qatar. The first outbreak was in Al Wakra Hospital (AWH), which is a facility of Hamad Medical Corporation (HMC), the principal public healthcare provider in the State of Qatar. As concluded by Eyre DW, et al. (2018), a series of interventions and environmental screening program may reduce the Candida auris outbreak. A screening toolkit that includes a checklist based on an existing protocol and operationally defined criteria is a key preventive measure for Candida auris identification. We aim to attain 100% compliance with screening suspected patients and preventing further outbreaks. Methods: A screening protocol toolkit was created for eligible patients that allowed early identification and prompt intervention therefore enhancing the provision of high-quality, efficient, cost effective, and safe patient care. Furthermore, implementation of an Outbreak Prevention Bundle had been proven effective in preventing the spread and comprised: (1) prophylactic contact precautions, (2) blanket screening of at risk/exposed patients, (3) environmental sampling, and (4) hydrogen peroxide disinfection. Results/Findings/Recommendations: In 2020, continuous screening was maintained for patients fitting the HMC criteria. The protocol for the management of outbreaks was implemented. The number of COVID-19 positive cases peaked during July - August 2020 when COVID-19 patients were transferred to AWH . Overall, AWH reached 407 cumulative days without Candida auris outbreak . Conclusion: Candida auris outbreak is preventable through early identification via screening and implementation of an Outbreak Prevention Bundle. This method has led to no active outbreak in AWH since August 2019 until October 2020.
Background: According to the CDC NHSN, surgical site infections (SSI) are wound infections that develop within 30 days postoperatively for nonimplanted surgeries such as cesarean sections. SSIs is shown to manifest in a continuum of a purulent discharge from surgical site to severe sepsis. It contributes to rising morbidity, mortality and prolonged length of stay. Objective: To describe risk factors to the development of SSI in cesarean section in descriptive studies. Methods: The Preferred Reporting Items for Systematic Reviews (PRISMA) reporting guidelines is used as method for this systematic review. A PubMed literature search was conducted, limited to published articles in English from 1998 to 2016 using the broad key terms “cesarean section,” “surgical site infection,” and “risk factor.” The following inclusion criteria were applied to all reviews: (1) peer-reviewed journal, (2) computed risk factor for SSI development, and (3) calculated SSI rate. Reviews of references of the include studies were conducted, and 7 studies were appraised, with only 1 accepted. Results: After extracting data from 52 article reviews, 23 were finally accepted based on the inclusion criteria. Most studies were multivariate studies (n = 8) followed by cohort studies (n = 6). Unique numerators and denominators for SSI reviews were mentioned in all 23 studies, of which 22 studies followed the CDC NHSN definitions for SSI. Within the 23 studies, most studies showed that obesity (11.46%) is a common maternal risk factor for the development of postoperative cesarean section SSI. Conclusions: Identifying that obesity is a major contributor of surgical site infection in postoperative cesarean section women is a topic that warrants exploration. The relationship of cesarean section SSI to obesity should be investigated, specifically highlighting the level of obesity based on the WHO international body mass index (BMI) classification and the development of SSI. A correlation between increasing wound infection rates and increasing body mass index should be studied further. Published recommendations for preventing SSIs in this population should be reviewed.Funding: NoneDisclosures: None
Background: So far, there have been no studies on Candida auris in Qatar. We describe the clinical spectrum and outcome of C. auris infection in patients admitted to a general hospital in Qatar. Methods: We conducted this descriptive observational study in a general hospital in Qatar. We have included all patients with C. auris infection and colonization admitted to a general hospital from December 2018 to August 2019. Results: We identified 13 patients with confirmed C. auris infection or colonization, of whom 5 cases represented an actual C. auris infection, while the remaining 8 cases were considered colonization. The mean age of the patients with infection was 76.6 years (SD, ±8.4), while the mean age of the patients with colonization was 66.4 years (SD, ±24.7). Among the individuals clinically infected with C. auris, 2 had urinary tract infections, 1 had candidemia, 1 acquired a soft-tissue infection, and 1 had a lower respiratory tract infection. All strains of C. auris were susceptible to echinocandins, flucytosine, and posaconazole while resistant to fluconazole and amphotericin B. Of the patients with C. auris infection who received systemic antifungal therapy, 3 (60%) died during antifungal therapy. Conclusions: Our study showed that C. auris can cause a wide variety of invasive infections, including bloodstream infection, urinary tract infection, skin infection, and lower respiratory tract infections, especially in critically ill patients. In addition, our isolates showed resistance to the most common antifungal agents such as fluconazole and amphotericin B.Funding: NoDisclosures: None
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