Background: Needle stick and sharp injuries (NSSIs) amongst healthcare workers (HCWs) are among the most common occupational accidents in hospitals. Approximately half of the responsible instruments are contaminated with blood, putting users at risk infection from blood-borne pathogens such as HIV. Although post-exposure prophylaxis has been shown to reduce the risk of HIV transmission, adherence to therapy is a well-documented challenge. Aim: To assess healthcare workers adherence to HIV post-exposure prophylaxis following Needle stick and sharp injuries. Method: A retrospective chart review was conducted on HCWs who were started on HIV PEP following a reported occupational exposure due to NSSIs between February 2017 and June 2022 to assess adherence. Result: A total of 136 HCWs had occupational exposure to NSSIs. The majority of the exposures (82.3%) were high risk for HIV transmission. Overall adherence to the 28-day HIV PEP course was 26%. HCWs were more likely to complete HIV PEP when the source's HIV status was positive compared to when it was negative [ 42.4% vs 11.8%; p = 0.001]. The drug regimen (TDF/3TC/DTG) was significantly associated with defaulting treatment (aOR; 5.5 (95% CI 2.16 - 14.02) (p= 0.001), compared with patients using the TDF/3TC/ATVr regimen. Conclusion: 74% of HCWs who started PEP defaulted the recommended 28-day course. Possible strategies for improving adherence and occupational health are required. Contributions: Few studies in Kenya have assessed the completion rate for PEP among HCWs; these findings will contribute to the body of knowledge in this area.
BackgroundAntimicrobial resistance is a pressing global health issue. Data are lacking in detailing the presence and burden of antimicrobial resistance in low and middle-income countries. What is currently available is quarantined to large, urban centers away from the rural facilities. MethodsThis was a retrospective descriptive study performed at Kijabe Hospital, a rural 350-bed teaching hospital, from February 2016 to September 2020. Cultures from blood, urine, and cerebrospinal fluid were included from all pediatric and adult patients. Data was analyzed and an antibiogram was created using WHONET software. ResultsFrom January 2016 to September 2020 a total of 3275 distinct isolates were identified, including 1654 positive blood cultures, 1288 positive urine cultures, and 91 positive cerebrospinal fluid cultures. Aggregate gram negative susceptibility to third generation cephalosporins was approximately 41%, with 67% of isolates susceptible to piperacillin-tazobactam, and 93% of isolates susceptible to meropenem. The most frequently identified organism was coagulase-negative Staphylococcus (1534, 47%), followed by Escherichia coli (721, 22%), Klebsiella species (482, 15%), and Staphylococcus aureus (110, 3.4%). The most common multidrug resistant organism was Escherichia coli (664, 20%), followed by Klebsiella species (461, 14%). Acinetobacter baumannii was found to be only 57% sensitive to meropenem. Staphylococcus aureus was 91% sensitive to cloxacillin.ConclusionThe high rates of antimicrobial resistance found in this rural referral center were similar to the large urban settings in sub-Saharan Africa. This along with the discovery of multidrug resistant gram negative organisms are of great concern. The need for continued surveillance, antimicrobial stewardship, and implementation of quality improvement initiatives is imperative to attempt to curb this burgeoning global problem.
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