Introduction: Consistent practice of hand hygiene (HH) has been shown to reduce the incidence and spread of hospital acquired infections. The objectives of this study were to determine the level of compliance and possible factors affecting compliance with HH practices among HCWs at a teaching hospital in Kingston, Jamaica. Methodology: A prospective observational study was undertaken at the University Hospital of the West Indies (UHWI) over a two weeks period. Trained, validated observers identified opportunities for hand hygiene as defined by the WHO "Five Hand Hygiene Moments" and recorded whether appropriate hand hygiene actions were taken or missed. Observations were covert to prevent the observer's presence influencing the behaviour of the healthcare workers (HCWs) and targeted areas included the intensive care units (ICUs), surgical wards and surgical outpatient departments. A ward infrastructure survey was also done. Data were entered and analysed using SPSS version 16 for Windows. Chi-square analysis using Pearson's formula was used to test associations between 'exposure' factors and the outcome 'compliance'. Results: A total of 270 hand hygiene opportunities were observed and the overall compliance rate was 38.9%. No differences were observed between the various types of HCWs or seniority. HCWs were more likely to perform hand hygiene if the indication was 'after' rather than 'before' patient contact (p = 0.001). Conclusion: This study underscores the need for improvement in HH practices among HCWs in a teaching hospital. Health education with particular attention to the need for HH prior to physical contact with patients is indicated.
AIn Kingston, diabetic patients who are adherent are more likely to have health insurance/health benefit ( = 0.01).
BACKGROUND The Sangre Grande Hospital (SGH) experienced several Multi Drug Resistant Organism (MDRO) outbreaks for 2015. In this regard, a study was conducted to understand factors contributing to MDRO acquisition and control, for policy and implementation of prevention and control measures. METHODOLOGY A Case-Control Study Design was chosen to execute this research project in order to determine risk factors and factors associated with control of the outbreaks. This was done retrospectively from January to March 2015. Cases and controls were unmatched. Cases were defined as patients admitted to wards with a contracted MDRO, discharged or died and had a medical or surgical diagnosis. MDROs included Methicillin resistant Staphylococcus aureus (MRSA) and Multi Drug Resistant Gram-Negative Bacilli (MDRGNB). Controls were any other patients on the wards with similar demographics and diagnosis and disposition, not infected or colonized with a MDRO and had a medical or surgical diagnosis. RESULTS Eight (8) cases and ten (10) Controls were incorporated in the study. Patients recently hospitalized had 14 times the odds of the group not recently hospitalized, of developing a MDRO, 95% CI: 1.1352 – 172.6502, p = 0.05. Length of Stay (LOS) on the ward for a minimum of five days showed a significant association with MDRO acquisition (p < 0.036). The main contributory factors to increased MDRO acquisition: greater than one (1) invasive devices, urinary catheter and/or central venous catheter (p < 0.043 and p < 0.007 respectively). Most MDRO cases had at least one invasive device attached to them during their stay on the ward: Central Venous Catheter (CVC), a Urinary Catheter or both. MDRO cases mean LOS: 29.5 days (19.27 S.D.) as opposed to the controls with 5.2 days (4.29 S.D.). CONCLUSION There is a significant association between recent hospitalization and developing an MDRO. Patients with an MDRO also stayed a mean of 29.5 days compared to 5.2 days for controls.
Background The Centres for Disease Control and Prevention (CDC) and World Health Organization (WHO) list extended spectrum beta-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae as serious threats and priority pathogens. This study identified phenotypic resistance patterns to these pathogens in east Trinidad, West Indies. We also aimed to set up and test a pilot surveillance system aligned to WHO’s Global Antimicrobial Surveillance System (WHO-GLASS). Methods Two key bacterial isolates, Escherichia coli and Klebsiella pneumoniae were used and one specimen, blood, was used to test a pilot surveillance system. Data for resistance patterns, for Sangre Grande Hospital (SGH), for ESBL producing E. coli and K. pneumoniae were downloaded from the Microscan Autoscan© for the period 2013 – 2016. ESBL presence in bacteria resistant to Cefotaxime (CTX), Ceftazidime (CAZ) and Ceftriaxone (CRO) were recorded. Data were stored in a Microsoft Excel© spreadsheet and inputted into IBM© SPSSv22. Data were displayed as resistance percentages for the year. No patient data were collected. Simple descriptive statistics were used. Results The number of organisms recovered from the database for the period 2013 to 2016 were:134E. coli and 59K. pneumoniae. Phenotypic resistance rates for ESBLs for 2013 to 2016 were: Ecoli: 2013: Resistance ranged from 22.2-29.6% with maximum resistance seen for CTX. 2014: Resistance ranged from 12.9- 22.2%, with maximum resistance seen for CRO. 2015: Resistance ranged from 21.4- =26.2%, with maximum resistance seen for CTX. 2016: Resistance ranged from 29.4- 32.4%, with maximum resistance seen for CRO and CTX. K pneumoniae: 2013: Resistance was 40% for all 3rd generation Cephalosporins. 2014: Resistance was 16.7% for all 3rd generation Cephalosporins. 2015: Resistance was 16.7% for all 3rd generation Cephalosporins. 2016: Resistance ranged from 52.6 – 63.2%, with maximum resistance seen for CAZ. Conclusion Phenotypic resistance rates in K. pneumoniae and E. coli were generally high. There was an overall increase in resistance from 2013 to 2016 for both K. pneumoniae and E. coli with greater resistance being seen in K. pneumoniae.
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