Purpose. Hand hygiene is the most important strategy for preventing healthcare-associated infections (HCAIs); however, the impact of hand hygiene in middle-income countries has been poorly described. In this work, we describe the impact of the programme ‘Let’s Go for 100’ on hand hygiene adherence, HCAIs rates and multidrug-resistant (MDR) bacteria, including the molecular typing of methicillin-resistant Staphylococcus aureus (MRSA) strains. Methodology. A multimodal, hospital-wide hand hygiene programme was implemented from 2013. ‘Let’s Go for 100’ involved all healthcare workers and encompassed education, awareness, visual reminders, feedback and innovative strategies. Monthly hand hygiene monitoring and active HCAI surveillance were performed in every ward. Molecular typing of MRSA was analysed by pulsed-field gel electrophoresis (PFGE). Results/Key findings. Hand hygiene adherence increased from 34.9 % during the baseline period to 80.6 % in the last 3 months of this study. The HCAI rate decreased from 7.54 to 6.46/1000 patient-days (P=0.004). The central line-associated bloodstream infection (CLABSIs) rate fell from 4.84 to 3.66/1000 central line-days (P=0.05). Negative correlations between hand hygiene and HCAIs rates were identified. The attack rate of MDR-ESKAPE group bloodstream infections decreased from 0.54 to 0.20/100 discharges (P=0.024). MRSA pulsotypes that were prevalent during the baseline period were no longer detected after the 5th quarter, although new strains were identified. Conclusions. A multimodal hand hygiene programme in a paediatric hospital in a middle-income country was effective in improving adherence and reducing HCAIs, CLABSIs and MDR-ESKAPE bloodstream infections. Sustaining hand hygiene adherence at a level of >60 % for one year limited MRSA clonal transmission.
Introduction: Healthcare-associated infections are an important cause of morbidity and mortality, are among the most common adverse events in healthcare, and of them, pneumonia is the most commonly reported. Our objective was to evaluate the incidence and clinical outcome of respiratory viruses in hospital-acquired pneumonia (HAP). Methods: This was a prospective cohort study, include patients aged between 0 and 18 who fulfilled Centers for Diseases Control and Prevention (CDC) criteria for HAP. Demographic and clinical data were obtained, and a nasopharyngeal swab specimen was taken for the detection of respiratory viruses. All included patients were monitored until discharge to collect data on the need for mechanical ventilation, intensive care unit (ICU) admission, and mortality. All-cause 30-day mortality was also ascertained. Results: Four thousand three hundred twenty-seven patients were followed for 42,658 patient-days and 5,150 ventilator-days. Eighty-eight patients (2.03%) met the CDC criteria for HAP, 63 patients were included, and clinical and epidemiological characteristics showed no statistically significant differences between patients with virus associated healthcare-associated pneumonia (VAHAP) and those with non-viral healthcare-associated pneumonia (NVHAP). At least one respiratory virus was detected in 65% [95% CI (53–77)] of episodes of HAP, with a single viral pathogen observed in 53.9% and coinfection with 2 viruses in 11.1% of cases. The outcome in terms of ICU admission, mechanical ventilation and the 30-day mortality did not show a significant difference between groups. Conclusions: In two-thirds of the patients a respiratory virus was identified. There was no difference in mortality or the rest of the clinical outcome variables. About half of the patients required mechanical ventilation and 10% died, which emphasizes the importance of considering these pathogens in nosocomial infections, since their identification can influence the decrease in hospital costs and be taken into account in infection control policies.
Background: Dengue fever, a diseases caused by Dengue virus (DENV) and transmitted to humans by Aedes aegypti and Aedes albopictus mosquitoes, has been hyper-endemic in Singapore for several decades. In the absence of an effective vaccine or specific treatment to mitigate the infections, control of Aedes mosquitoes plays a critical role in controlling the disease. In recent years, Singapore's vector control operations have been overwhelmed by geographical expansion of dengue transmission as well as increasing magnitude of epidemics. At the same time, they have been hampered by the lack of tools to assess the impending risk of dengue fever outbreaks spatially and manpower insufficiency.Methods & Materials: To help operation department allocate limited resources, we developed a predictive risk map for dengue transmission using the Random Forest algorithm, incorporating various risk factors and accounting for temporal and spatial lag effects of the factors. A wide range of factors representing the characteristics of past dengue situation (total number of cases in previous year and number of non-resident cases in previous year), human population (estimated population density), vector population (estimated ratio of Aedes aegypti mosquitoes out of all Aedes moquitoes-breeding percentage) and environment (vegetation index, connectivity index and ratio of residential area) were examined and incorporated in the model.Results: Validation using most recent data showed that the observed and the predicted risk ranks had a Pearson correlation of 0.87 (P < 0.001) and a weighted Kappa agreement of 0.814 (P < 0.001) when categorised to risk groups. In addition, the model was able to estimate the partial effects and relative importance of individual risk factors, which can strengthen our understanding of the risk factors of dengue transmission.Conclusion: Our risk map has strong predictive capability, hence may be an important tool in guiding targeted vector control interventions for dengue. http://dx.Background: Nosocomial infections (NI) are significant cause of mortality and hospital costs.. Annual costs have approximately estimated of US$6·8 billion in the USA. Hand hygiene is the most important measure to prevent NI reducing them a 30% on average and to reduce MRSA attack rate. There is spare information about this in middle income countries. The aim was to explore the impact of the program in hospital costs, nosocomial infections and MRSA attack rate and clonality.Methods & Materials: Program "Vamos por el CIEN-Go for 100" (CIEN Spanish acronif of infection control by integration and innovative strategies"): based on the WHO hand hygiene multimodal strategy but focalizing education and awareness for every hospital sector and adding periodically innovative strategies. Here we analyze 2013-2015. Direct costs of this program were evaluated monthly.Active nosocomial infections surveillance was done. A collection of 43 S. aureus clinical isolates from pediatric patients (one isolate per patient) was collected from January 2012 to...
Introducción: Los gramnegativos continúan siendo los causantes de infecciones asociadas a la atención a la salud (IAAS).
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