The emerging, often multidrug-resistant Candida auris is increasingly being associated with outbreaks in healthcare facilities. Here we describe the molecular epidemiology of a C. auris outbreak during 18 months, which started in 2018 in the high dependency unit (HDU) of a secondary-care hospital in Kuwait. Demographic and clinical data for candidemia and colonized patients were prospectively recorded. Clinical and environmental isolates were subjected to phenotypic and molecular identification; antifungal susceptibility testing by broth microdilution method; PCR-sequencing of ERG11 and FKS1 for resistance mechanisms to triazoles and echinocandins, respectively; and molecular fingerprinting by short tandem repeat (STR) analyses. Seventy-one (17 candidemic and 54 colonized) patients including 26 with candiduria and seven environmental samples yielded C. auris. All isolates were identified as C. auris by Vitek2, MALDI-TOF MS, PCR amplification and/or PCR-sequencing of rDNA. Twelve candidemia and 26 colonized patients were admitted or exposed to HDU. Following outbreak recognition, an intensive screening program was instituted for new patients. Despite treatment of all candidemia and 36 colonized patients, 9 of 17 candidemia and 27 of 54 colonized patients died with an overall crude mortality rate of ~50%. Nearly all isolates were resistant to fluconazole and contained the Y132F mutation in ERG11 except one patient’s isolates, which were also distinct by STR typing. Only urine isolates from two patients developed echinocandin resistance with concomitant FKS1 mutations. The transmission of C. auris in this outbreak was linked to infected/colonized patients and the hospital environment. However, despite continuous surveillance and enforcement of infection control measures, sporadic new cases continued to occur, challenging the containment efforts.

Surgical site infections (SSI) are a significant cause of post-surgical morbidity and mortality. The objectives of this study were to determine the prevalence of SSI and identify risk factors for infections following cesarean section (CS). A prospective study of SSI after CS was carried out from January 2014 to December 2016 using the methodology of the American National Nosocomial Infection Surveillance System. Suspected SSIs were confirmed clinically by the surgeon, and or, by culture. Seven thousand two hundred thirty five CS were performed with an overall SSI prevalence of 2.1%, increasing from 1.7% in 2014 to 2.95% in 2016 (P = 0.010). Of 152 cases of SSI, the prevalence of infection was 46.7% in women ⩽30 years and 53.3% in women >30 years (P = 0.119). Of 148 culture samples from as many women, 112 (75.7%) yielded growth of microorganisms with 42 (37.5%) of isolates being multi-drug resistant (MDR). Women who did not receive prophylactic antibiotics (35.5%) developed SSI more often than those who did (P < 0.0001). These findings suggest that emergency CS and inappropriate antibiotic prophylaxis are risk factors for developing SSI. In the light of the emergence of MDR bacteria there is a need to implement revised prophylactic antibiotic policy as part of antimicrobial stewardship to decrease SSI rates.

PurposeTo measure surgical site infection (SSI) rates among gastrointestinal surgeries and to identify the associated risk factors.Patients and methodsWe conducted a multicenter, retrospective, surveillance-based study of adults undergoing gastric, colon, and small bowel (SB) procedures from January to December 2016. Univariate and multivariate analyses were conducted to determine the predictive variables in each surgery.ResultsIn total, 71 of 2,099 patients developed SSI – 0.8%, 19.8%, and 10.8% following gastric, colon, and SB surgeries, respectively. In gastric surgery, the risk factors identified by univariate analysis were age, duration, wound class, risk index, emergency, and scope use (P<0.05). Logistic regression analysis revealed that the laparoscopic approach was the only significant predictor, with an inverse relationship of SSI rate vs open gastric surgery (P<0.05). Prolonged duration was a significant risk factor for developing SSI in colon surgery, and emergency was a significant risk for development of SSI in SB surgery. Gram-negative bacilli were the main causative pathogens, with a high percentage of multidrug-resistant organisms.ConclusionVariances in SSI rates and risk factors among gastric, colon, and SB surgery were detected. The use of an endoscope in gastric surgeries exhibited a protective effect against the development of SSI. The reduction of the SSI rate can be achieved by targeted preventive interventions for the identified risk factors.

Objective: The study aimed at determining the prevalence of incident occupational exposure to blood and other potentially infectious materials (OPIM) among healthcare personnel (HCP) during 2010 and at evaluating the factors associated with these incidents. Subjects and Methods: An epidemiological, retrospective, record-based study was conducted. All self-reported incidents of occupational exposure to blood and OPIM among HCP from all healthcare settings of the Kuwait Ministry of Health during 2010 were included. Results: The total number of the exposed HCP was 249. The prevalence of incident exposure was 0.7% of the HCP at risk. Their mean age was 32.31 ± 6.98 years. The majority were nurses: 166 (66.7%), followed by doctors: 35 (14.1%), technicians: 26 (10.4%) and housekeeping personnel: 22 (8.8%). Needle stick injury was the most common type of exposure, in 189 (75.9%), followed by sharp-object injury, mucous-membrane exposure and contact with nonintact skin. The majority of needle stick exposures, i.e. 177 (93.7%), were caused by hollow-bore needles. Exposure to blood represented 96.8%, mostly during drawing blood and the insertion or removal of needles from patients [88 (35.4%)] and when performing surgical interventions [56 (22.6%)]. Easily preventable exposures such as injuries related to 2-handed recapping of needles [24 (9.6%)] and garbage collection [21 (8.4%)] were reported. Exposures mainly occurred in the inpatient wards [75 (30.1%)] and operating theaters [56 (22.6%)]. Among the exposed HCP, 130 (52.2%) had been fully vaccinated against hepatitis B virus (HBV). Conclusion: Needle stick injuries are the most common exposure among HCP in Kuwait, and nurses are the most frequently involved HCP category. A good proportion of exposures could be easily prevented. HBV vaccination coverage is incomplete.

BackgroundParent’s level of knowledge, state of their attitude, and their self-efficacy are the most incriminated reasons for the faulty application of the first aid measures, particularly in children's home injuries.ObjectivesTo assess the effect of a health education intervention on improving knowledge, attitude and self- efficacy of mothers having preschool children about home injuries and the basic first aid measures.MethodsA pre-posttest evaluation of the effect of a health education intervention on changing knowledge, attitude, and self-efficacy about home injuries and the basic first aid measures of 244 rural Egyptian mothers having preschool children.ResultsAbout 35% of the male children had home injuries 8 weeks earlier to the study. Mean score of total knowledge increased from 10.21±3.1 in pretest to 18.90 ± 2.6 in posttest, total attitude from 6.19±1.8 to 10.26±2.3 and self-efficacy from 20.75±6.1 to 34.43 ± 10.1 with (p < 0.001) for all changes. Age, education level and previous home injuries were the significant predicting factors for total knowledge, attitude and self- efficacy of the mothers.ConclusionHealth education improves knowledge, attitude, and self-efficacy of the mothers which were obvious regarding home injuries than first aid measures. There is a need for including knowledge about home injuries in the educational curriculum of high schools and universities and to perform training courses to mothers about first aid measures.

Background: Patients admitted to the Intensive Care Unit (ICU) are prone to develop nosocomial infections due to Multidrug-Resistant (MDR) organisms. Inappropriate and overuse of antibiotics play an important role in the emergence of MDR organisms, which cause life-threatening infections resulting in significant morbidity and mortality. Methods:Retrospective surveillance-based study on healthcare-associated infections. The study conducted over two consecutive years 2018 and 2019, looking at ICU related infections of a regional secondary care general hospital and the data were recorded using the methods and definitions of the Kuwait National Healthcare-associated infections Surveillance System (KNHSS).Results: A total of 1408 patients, admitted to ICU for 7922 days during the 2 years period. Eighty-nine patients were included in this study, where 48 developed one Hospital-acquired Infections (HAI) in the ICU while 25 and two patients presented with two and three HAIs, respectively. The HAIs included Bloodstream Infections (BSI) -42.3%, pneumonia -28.8%, Urinary Tract Infections (UTI) -15.3%, skin and soft tissue infections -9.6% and Clostridium difficile infection -3.4%. The overall infection rate was 13.14 per 1000 patient-days. The rates for Device-associated (DA)-HAIs were 6.27 for Central Line-associated BSI (CLABSI) per 1000 Central Line (CL)-days, 4.21 for Ventilator-associated Pneumonia (VAP) per 1000 Mechanical Ventilator (MV)-days, and 1.91 Catheter-associated UTI (CAUTI) per 1000 Urinary Catheter (UC)-days. Data showed that device use ratios for CL, MV, and UC were 0.81, 0.74, and 0.98, respectively. Acinetobacter baumannii and Klebsiella pneumoniae were the most common organisms isolated from the ICU infections with highest rates of antibiotic resistance. Conclusion:Among DA-HAIs CLABSI was found to be most common in our ICU, followed by VAP and CAUTI. Gram-negative organisms with A. baumannii and K. pneumoniae being the leading causative agents with high antimicrobial resistance profiles.

Purpose The purpose of this paper is to assess the effectiveness of Kuwait Infection Control Directorate educational program in improving knowledge, attitude and practices (KAP) of environmental service workers (ESWs) regarding the management of infectious and sharps waste. Design/methodology/approach An interventional educational pre-test/post-test study was conducted over seven months, on a sample of 102 ESWs in Farwaniya General Government Hospital, Kuwait. Educational sessions and practical training using the KAP approach were applied during the intervention phase. The KAP of the participants were assessed using a questionnaire and observation checklist in the pre- and post-intervention phases. Findings Improvement in all aspects of the KAP regarding infectious and sharps waste management was observed among the participants after implementation of the intervention, with a statistically significant difference between pre- and post-test results (p<0.01). Originality/value The applied multi-component educational program in the current study can be successfully implemented for ESWs in all government hospitals in Kuwait and other countries with similar settings.

Background: Hand hygiene (HH) is one of the most important measures to prevent healthcare-associated infections. The objective of the study was to assess the effectiveness of the augmented multi-interventional approaches on HH compliance rate among intensive care unit (ICU) healthcare workers (HCWs) of Farwaniya Hospital, Kuwait.Methods: An interventional study was conducted in four phases throughout eight months among adult ICU HCWs. First; HCWs, HH compliance rates and alcohol-based hand rub consumption rate (ABHR) were assessed secondly; an augmented multi-interventional approach was implemented, which included administrative support, observation and reporting, education & training, recruiting champions, and maintenance of HH supplies & reminders. Then a washout phase. Finally, re-assessment of HH compliance rates and ABHR.Results: Following the interventions, the overall HCWs’ HH compliance rate increased significantly from 58.81% to 73.17% (p=0.000), for doctors (39.82% vs. 64.93%) and nurses (68.24% vs. 80.18%), p>0.001. Significant improvement of HH compliance rates for most of HH moments, after moments were higher than before moments, p=0.000. ABHR increased significantly from 77.45 ml to 133.33 ml per patient day (95% CI=54.37-57.39, p<0.0001).Conclusions: The applied augmented multi-interventional approach was effective in improving HH compliance rates among ICU HCWs. Sustainability is warranted by continues implementation of this approach.