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Objective We aimed to study the effect of visual observation of bacterial growth from handprints on healthcare workers' (HCWs) compliance with hand hygiene (HH). Settings Medical and postoperative cardiac surgery units. Design Prospective cohort study. Subject The study included 40 HCWs. Intervention Each HCW was interviewed on 3 separate occasions. The 1st interview was held to obtain a handprint culture before and after a session demonstrating the 7 steps of HH using alcohol-based hand rub, allowing comparison of results before and after HH. A 2nd interview was held 6 weeks later to obtain handprint culture after HH. A 3rd interview was held to obtain a handprint culture before HH. One month before implementation of handprint cultures and during the 12-week study period, monitoring of HCWs for compliance with HH was observed by 2 independent observers. Main Results There was a significant improvement in HH compliance following handprint culture interview (p < 0.001). The frequency of positive cultures, obtained from patients with suspected healthcare-associated infections, significantly declined (blood cultures: p = 0.001; wound cultures: p = 0,003; sputum cultures: p = 0.005). Conclusion The visual message of handprint bacterial growth before and after HH seems an effective method to improve HH compliance.

BACKGROUND: High antibiotics use in pediatric intensive care units (PICUs) results in antibiotic resistance, the unfavorable clinical outcome of patients, increase the length of hospital stay, and drug expenditure. AIM: This study aimed at setting clinical guidelines customized according to local diseases epidemiology and local cumulative antimicrobial susceptibility, implementing, and evaluating the Antimicrobial Stewardship Program (ASP) effect in; optimizing antibiotics use, decreasing antibiotics expenditure, decreasing the length of therapy and stay in hospitals, and improving patients’ clinical outcomes. METHODS: A prospective study was conducted at a PICU of the Specialized Pediatric Hospital, Cairo University. Facility-specific guidelines were set, and the ASP was implemented and evaluated through the following indicators; adherence of physicians to the guidelines, ASP recommendations and acceptance of them, the rate of mortality, length of stay, drug costs, antibiotics days of therapy, and length of therapy. RESULTS: The adherence to the ASP guidelines was positively correlated to the patient’s clinical outcome (p = 0.018). In post ASP period, the average length of stay and the length of therapy significantly decreased (p = 0.047, p = 0.001, respectively), the rate of adherence to the ASP guidelines was (91.9%), the days of therapy of ceftazidime, ceftriaxone, and amikacin decreased significantly (p = 0.041, p = 0.026, p = 0.004, respectively). The most common ASP recommendation was drug schedule/frequency change (26.1%) followed by drug discontinuation (17.8%) and the most common antibiotic required intervention was ampicillin-sulbactam (21.6%). CONCLUSION: The antimicrobial stewardship is very effective in optimizing antibiotics use and leads to favorable outcomes in terms of decreased length of therapy, hospital stay, and mortality rate of the patients.

Background: Bacteria are resistant to an antibiotic such as Escherichia coli, Klebsiella pneumonia, and Enterobacter sp. responsible for morbidity in worldwide. ESβLs are a group of plasmids encoded enzymes that have the efficacy to hydrolyze β-lactams antibiotics. The spread of (ESβLs) representing a serious problem and threatening the ability to treat an infection. Aim of the study: This study aimed to investigate ESβLs-producing Enterobacteriaceae sp. isolated from patients and healthy individuals and detect the resistant genes bla TEM , bla SHV, and bla CTX-M . Patients and Methods: Two hundred bacterial isolates were recovered from patients and healthy individuals rectal swab samples. These isolates were screened for producing ESβLs and identified using both standard bacteriological methods and VITEK2 compact system). The antibiotics resistance of Enterobacteriaceae was assessed by the disk diffusion method and detection of bla TEM , bla SHV, and bla CTX-M genes by multiplex PCR. Results: Two hundred Enterobacteriaceae screening for-producing ESβLs showed that 56% (112/200) produce ESβLs. One hundred and twelve ESβLs-Enterobacteriaceae identified as following, Klebsiella pneumonia 51.73% (58/112), Escherichia coli and 46.40% (52/112), and Enterobacter cloacae 1.80% (2/112). The antibiotic resistance patterns of Enterobacteriaceae showed high resistance to ciprofloxacin, levofloxacin, and amikacin with the ratio of (71.76%), (60.72%) and (60.72%), respectively. Furthermore, ESβLs Enterobacteriaceae harbored genes bla CTX-M (78.6%) , bla TEM (73.2%) and bla SHV (68.75%). The bla TEM was found the predominant gene in E. coli isolates 80.8%, while bla CTX-M in Klebsiella pneumonia 81%. Conclusion:The present study showed a significant distribution of multidrug-resistant ESβLs-producing Enterobacteriaceae in patients in the hospital-and community-acquired rectal infection. ESβLs-producing Enterobacteriaceae species harboring co-existence resistant genes.