Introduction: Healthcare-associated infections represent a global public health challenge and are associated with significant mortality and morbidity. Infection Prevention and Control (IPC) is a neglected area in healthcare facilities across Pakistan. The objective of our study was to elucidate the current state of infection prevention and control practices in public sector hospitals of Islamabad to underscore potential areas for improvement. Methodology: A cross-sectional survey was conducted between November and December 2019 at five public sector hospitals of Islamabad. The World Health Organization’s Infection Prevention and Control Assessment Framework (IPCAF) was used to assess the strengths and weaknesses of hospitals regarding infection prevention and control. Adapted tools derived from Centers for Disease Control and Prevention and Infection Prevention Society were used for detailed assessment of various departments. Data was analyzed using Microsoft Excel 2016. Results: In all five hospitals, the total IPCAF score was less than 200 denoting that infection prevention and control implementation is deficient and significant improvement is needed. The median IPCAF score was 117.5 with an interquartile range of 53.75. With the exception of central sterile services unit at one hospital, departments at all hospitals failed to meet even 50% of required IPC standards. Conclusions: Significant change is needed to improve the existent situation of infection prevention and control in public sector hospitals of Islamabad. This would involve establishment of functional programs, development and implementation of infection prevention and control guidelines and provision of adequate supplies.
C hikungunya is a vectorborne viral disease that causes large outbreaks, mainly in tropical and subtropical countries (1). The term chikungunya is derived from a word in the Makonde language (spoken in parts of Tanzania and Mozambique, Africa), kungunyala, meaning "that which bends up," referring to the stooped posture and impaired gait patients exhibit because of severe joint pain (2). Chikungunya virus (CHIKV; family Togaviridae, genus Alphavirus) is an enveloped, single-strand, positive-sense RNA virus transmitted through the bite of infected Aedes mosquitoes, predominantly Ae. aegypti and Ae. albopictus (2). West African, East/Central/South African (ECSA), and Asian CHIKV genotypes are distinguished by envelope 1 (E1) glycoprotein phylogeny. In 2005, a major outbreak in countries around the Indian Ocean was caused by the ECSA genotype (3). Virus mutations facilitated its replication in Ae. albopictus mosquitoes and its rapid spread by Ae. albopictus and Ae. aegypti mosquitoes (3), species prevalent in Pakistan during and after monsoon season, May-September. In Pakistan, CHIKV was reported to be circulating in rodents as early as 1983 (4), but few human cases were reported. During a 2011 dengue outbreak in Lahore, some patients also had CHIKV antibodies. CHIKV emerged in Karachi during 2016, and an outbreak eventually was declared when evidence of local transmission was confirmed (5). We reviewed the epidemiologic and evolutionary links of CHIKV detected during December 2016-May 2017 across Pakistan. The Study We tested serum samples from 584 patients with suspected CHIKV infection, according to the World Health Organization case definition (6). Patients were seen in different hospitals and clinics during December 20, 2016-May 31, 2017. Patients had acute onset fever (temperature >38.5°C), rash, and severe arthralgia or arthritis <7 days after a mosquito bite. Clinical signs and symptoms included fever in 90% (523/584) of persons with suspected cases, headache in 65% (382/584), joint pain in 85% (497/584), and rash in 24% (141/584) (Appendix Table 1, https://wwwnc. cdc.gov/EID/article/26/2/17-1636-App1.pdf). We used a predesigned form to collect patient demographic data, clinical information, and travel histories. We identified 495 (84.7%) suspected cases in Sindh, 52 (8.9%) in Baluchistan, 10 (1.7%) in Federal Capital Territory, 10 (1.7%) in Punjab, and 17 (2.9%) in Khyber Pakhtunkhwa (Figure 1). We used the QIAmp Viral RNA Mini Kit (QIAGEN, https://www.qiagen.com) to extract RNA from serum samples, according to the manufacturer's protocol. We conducted one-step real-time reverse transcription-PCR (rRT-PCR) on the ABI7500 platform (Applied Biosystems, https://www.thermofisher.com) following guidelines from the U.S. Centers for Disease Control and Prevention emergency use authorization for Trioplex Real-Time RT-PCR assay (7). We used CHIKV-specific oligonucleotide primers to detect and sequence the envelope 1 (E1) and nonstructural protein 1 (NSP1) genes (8). We conducted phylogenetic analysis of partial E1 (n...
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