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Healthcare-associated infections (HAIs) represent a major threat in Europe. Infection prevention and control (IPC) measures are crucial to lower their occurrence, as well as antimicrobial stewardship to ensure appropriate use of antibiotics. Starting from Italian national data, this study aimed at: (i) describing IPC indicators, prevalence of HAIs, antimicrobial use and appropriateness of antibiotic use in Italy; (ii) estimating effects of IPC variables on HAI prevalence and on the proportion of antibiotics without specific reason. Based on data collected for Italy during the ECDC PPS-2 Point Prevalence Survey, descriptive statistics were computed at national and macro-regional level. Causal assumption-informed regression models were then built to estimate the impact of structural determinants, staffing parameters and IPC-related variables on HAI prevalence and percentage of antibiotic prescriptions with no reason detailed on medical records, after adjusting for relevant confounders. The Italian frame showed substantial heterogeneity for both outcomes between macro-regions. The percentage of single-bed rooms was the only structural determinant with significant, positive impact on HAI prevalence (OR = 0.91 for every + 5%, p  < 0.001), while the prevalence of antimicrobial agents without specified reason was lower in the presence of one more IPC nurse (OR = 0.78, p  < 0.001) or one more antibiotic stewardship consultant (OR = 0.67, p  < 0.001) per 100 beds. Both outcomes were reduced in the presence of routinely filed IPC plans and reports ( p  < 0.001), HAI prevention measures ( p  < 0.001) and post-prescription review ( p  < 0.01). Our model confirmed the pivotal role of IPC measures and antimicrobial stewardship in contrasting HAIs and inappropriate antibiotic prescriptions. Post-prescription review appeared to be a valuable indicator of antimicrobial stewardship policies.

Background This cross-sectional study investigates infection prevention and control (IPC) competencies among healthcare professionals in northwest China, examining the influence of demographic factors, job titles, education, work experience, and hospital levels. Methods Data from 874 respondents across 47 hospitals were collected through surveys assessing 16 major IPC domains. Statistical analyses, including Mann-Whitney tests, were employed to compare competencies across variables. Results Significant differences were identified based on gender, job titles, education, work experience, and hospital levels. Females demonstrated higher IPC competencies, while senior positions exhibited superior performance. Higher educational attainment and prolonged work experience positively correlated with enhanced competencies. Variances across hospital levels underscored context-specific competencies. Conclusion Demographic factors and professional variables significantly shape IPC competencies. Tailored training, considering gender differences and job roles, is crucial. Higher education and prolonged work experience positively impact proficiency. Context-specific interventions are essential for diverse hospital settings, informing strategies to enhance IPC skills and mitigate healthcare-associated infections effectively.

Antimicrobial resistance (AMR) in intensive care units (ICUs) is a critical issue, which has been exacerbated by the coronavirus disease 2019 (COVID-19) pandemic. This study investigated AMR prevalence and its associated factors among ICU patients in two Vietnamese hospitals from January 2020 to June 2022. Electronic medical records of 1,296 patients with 2,432 non-duplicate bacterial isolates were collected in Phu Tho Hospital (Northern, rural, non-COVID-19 treatment) and 175 Hospital (Southern, urban, COVID-19 treatment centre). Antibiotic susceptibility testing was conducted using VITEK2, BD Phoenix 100, and disk diffusion methods. Logistic regression with 1,000 bootstrap resampling and cross-validation was used to examine factors linked to AMR. Results revealed Acinetobacter spp. (27.5%) as leading strains in Phu Tho Hospital, while Klebsiella spp. (28.0%) predominated in 175 Hospital, except during 2021when Acinetobacter spp. reached the peak. Alarmingly, Acinetobacter spp., Klebsiella spp., and Pseudomonas aeruginosa demonstrated the highest AMR rates and multidrug resistance rates (83.8%–95.8%) in both hospitals. Resistance to cephalosporins, carbapenems, and fluoroquinolones ranged from 75% to 100%. Significant associated factors included age, sex, location, initial admission diagnosis, and bacterial isolation month. This study highlights the urgent need for controlling AMR in ICUs during the pandemic.

This review provides an update on the factors fuelling antimicrobial resistance and shows the impact of these factors in low-resource settings. We detail the challenges and barriers to integrating clinical bacteriology in hospitals in low-resource settings, as well as the opportunities provided by the recent capacity building efforts of national laboratory networks focused on vertical single-disease programmes. The programmes for HIV, tuberculosis and malaria have considerably improved laboratory medicine in Sub-Saharan Africa, paving the way for clinical bacteriology. Furthermore, special attention is paid to topics that are less familiar to the general medical community, such as the crucial role of regulatory frameworks for diagnostics and the educational profile required for a productive laboratory workforce in low-resource settings. Traditionally, clinical bacteriology laboratories have been a part of higher levels of care, and, as a result, they were poorly linked to clinical practices and thus underused. By establishing and consolidating clinical bacteriology laboratories at the hospital referral level in low-resource settings, routine patient care data can be collected for surveillance, antibiotic stewardship and infection prevention and control. Together, these activities form a synergistic tripartite effort at the frontline of the emergence and spread of multi-drug resistant bacteria. If challenges related to staff, funding, scale, and the specific nature of clinical bacteriology are prioritized, a major leap forward in the containment of antimicrobial resistance can be achieved. The mobilization of resources coordinated by national laboratory plans and interventions tailored by a good understanding of the hospital microcosm will be crucial to success, and further contributions will be made by market interventions and business models for diagnostic laboratories. The future clinical bacteriology laboratory in a low-resource setting will not be an \"entry-level version\" of its counterparts in high-resource settings, but a purpose-built, well-conceived, cost-effective and efficient diagnostic facility at the forefront of antimicrobial resistance containment.

Background Surgical Site Infection (SSI) surveillance efforts in sub-Saharan Africa have largely been documented in research settings. Such programs need to be institutionalized within routine healthcare settings for sustainability. We evaluate the feasibility of setting up an SSI surveillance and prevention program within public settings in Kenya. Methods Facility infection prevention and control (IPC) committees were established, trained, and resourced on SSI surveillance and prevention in two large hospitals in Kenya. A surgical checklist and monitoring form assessing surgical care bundle implementation and wound status before discharge was included in the medical charts of women who had cesarean section (CS) deliveries. Post-discharge wound assessment interviews were targeted for completion 14–30 days after surgery. Data were analyzed using descriptive statistics and chi-square tests (χ 2 ) for differences. Results The program enrolled 1,039 women undergoing CS. Only 65% (675/1039) were reached for any post-discharge wound assessment, with 28% (186/675) reached within the targeted 30 days. Of these, 7% (12/186) had an SSI. Six of these women (6/37 = 16%) were identified within 14 days post-operatively while the remaining six (6/149 = 4%) were identified 15–30 days post-operatively. Surgical care bundle implementation differed by site, with pre-operative antibiotic use at 100% in Thika vs. 66% in Kitale, with variation in the antibiotics used. Blood glucose monitoring at 23 vs. 32% respectively. Hair removal was low overall at 2%. Conclusion While setting up an SSI surveillance and prevention program is feasible, efforts and resources targeting post-discharge follow-up and case finding should be prioritized. National guidelines standardizing surgical antibiotic prophylaxis are needed as part of antimicrobial stewardship programs.

The COVID-19 pandemic had challenged healthcare systems worldwide, significantly affecting healthcare workers (HWs), particularly in low- and middle-income countries (LMICs). To address the urgent need for infection prevention and control (IPC) training among diverse healthcare roles, the Massive Open Online Course (MOOC) titled \"Infection, Prevention, and Control of Acute Respiratory Infections for Healthcare Workers in Low- and Middle-Income Countries (IPC MOOC)\" was developed and implemented in Ecuador. This study aimed to evaluate reach and perceived knowledge gains from the IPC MOOC, focusing on whether successful course completion was influenced by sociodemographic factors or occupational roles (manual vs. intellectual work) and whether satisfaction and perceived learning outcomes differed between these groups. The IPC MOOC was developed through an interdisciplinary collaboration involving experts from the Center for International Health at the LMU Munich University Hospital (CIH LMU ) and their partners in Latin America. It utilized problem-based learning and interactive scenarios to teach IPC principles in the context of COVID-19. The course was offered to all Ecuadorian healthcare workers between August and December 2021, with a total of 3498 participants enrolling. Data were collected through registration and post-MOOC surveys and analysed using Chi-squared and Mann-Whitney U tests to assess the influence of sociodemographic and occupational factors on course completion and satisfaction, and to compare perceived learning outcomes between manual and intellectual workers. Of the enrolled participants, 75% completed the IPC MOOC successfully, with no significant differences in completion rates based on gender, region, or occupation. Among the 809 participants who completed the post-course survey, 80% reported high satisfaction (on a scale from 0 to 100%) with the course, and 95% would recommend it to colleagues. There was a small but statistically significant difference in perceived knowledge before the course between manual and intellectual workers (3.41 vs. 3.57 on a 5-point Likert scale; p =0.02), but post-course perceived knowledge was similar for both groups (4.08 vs. 4.14 on the same Likert scale; p =0.41). The IPC MOOC demonstrated to be an effective and accessible training tool, bridging knowledge gaps across diverse healthcare roles and promoting equitable access to IPC education. The high completion and satisfaction rates indicate its potential as a scalable educational intervention in health crisis.

Background Antimicrobial resistance (AMR) in neonatal intensive care units (NICUs) complicates treatment of healthcare-associated infections, causing high morbidity and mortality, especially among low-birth-weight and critically ill infants. This study evaluates AMR prevalence, risk factors, outcomes and infection control measures at Felege Hiwot Hospital, aiming to guide clinical practices, antimicrobial stewardship, and improved neonatal health outcomes. Methods This mixed-methods study (Oct 2022–Jun 2023) assessed AMR in NICU neonates by analyzing 420 blood samples, environmental swabs, and staff insights. Bivariable and multivariable regressions identified significant variables, and content analysis was used for qualitative data. Results Out of 420 samples, 35% tested positive for AMR pathogens, with Coagulase-Negative Staphylococci (16.7%), Klebsiella pneumoniae (12.9%), and Acinetobacter spp. (5.6%) being the most prevalent. Resistance rates for Gentamicin, Cotrimoxazole, and Ciprofloxacin were alarmingly high (98–100%), while Amikacin demonstrated low resistance (3.0-5.56%), indicating potential efficacy. Among the neonates admitted, 91.8% survived, and 8.2% succumbed. Risk factor analysis revealed that improper PPE usage (AOR 3.90, p  < 0.001), non-functional handwashing sinks (AOR 3.20, p  < 0.001), and inadequate disinfection practices (AOR 2.70, p  < 0.001) were strongly associated with microbial contamination. Environmental factors, including cockroach presence (AOR 1.80, p  = 0.040) and high traffic flow (AOR 2.10, p  = 0.005), were also significant contributors. The qualitative data analysis confirmed that improper PPE use, inadequate disinfection practices, pest control challenges, and non-functional handwashing sinks significantly contributed to microbial contamination risks in the NICU, aligning with the quantitative findings. Conclusions This study underscores key factors driving AMR in NICUs, such as inadequate IPC practices and environmental contamination, alongside high resistance to Cotrimoxazole and Ciprofloxacin. Amikacin shows promise as an effective treatment for CONS. Urgent actions, including strengthened IPC measures, staff training, and environmental management, are crucial to combat AMR, ensuring improved neonatal care and outcomes.

Background The prevalence of certain multidrug-resistant organisms (MDROs), especially Gram-negative bacteria, is dramatically increasing in patient care settings, including pediatric and neonatal units. However, most of the new drugs available for the treatment of MDROs have not yet been studied in children and newborns. Case report We report the clinical case of a preterm neonate, born at 31 weeks gestation + 1 day of age by emergency Cesarean Section (CS), with a bloodstream infection (BSI) due to a Verona integron-borne metallo-β-lactamase (VIM)-producing Klebsiella pneumoniae . We successfully treated the infection with cefiderocol in an off-label regimen at the following dose: loading dose 60 mg/kg and then 40 mg/kg every 8 h in extended infusion for 9 days. The baby showed a quick clinical and biochemical improvement and tolerated well the treatment. Follow-up blood cultures at 48 h after the start of cefiderocol were negative. Conclusions Antimicrobial-resistant pathogens are of increasing concern in neonatal settings. More studies in this unique population are necessary to better describe the pharmacokinetic and pharmacodynamic profile of the new drugs against MDROs, such as cefiderocol, and to define a proper effective dose.

Background In response to the COVID-19 pandemic, WHO launched a strategic preparedness and response plan, outlining public health measures to support countries worldwide. Healthcare workers have an increased risk of becoming infected and their behaviour regarding infection prevention and control (IPC) influences infection dynamics. IPC strategies are important across the globe, but even more in low-resource settings where capacities for testing and treatment are limited. Our study aimed to assess and implement COVID-19 pandemic preparedness and response measures in Faranah, Guinea, primarily focusing on healthcare workers’ IPC knowledge, attitude and practice (KAP). Methods The study was conducted between April 2020 and April 2021 assessing IPC pandemic preparedness and response measures such as healthcare workers’ KAP, alcohol-based handrub (ABHR) consumption and COVID-19 triaging in the Faranah Regional Hospital and two associated healthcare centres. The assessment was accompanied by IPC training and visual workplace reminders and done in pre- and post- phases to evaluate possible impact of these IPC activities. Results The overall knowledge score in the Faranah Regional Hospital was 32.0 out of 44 at baseline, and did not change in the first, but increased significantly by 3.0 points in the second follow-up. The healthcare workers felt closer proximity to SARS-CoV-2 overtime in addition to higher stress levels in all study sites. There was significant improvement across the observed triaging practices. Hand hygiene compliance showed a significant increase across study sites leading to 80% in Faranah Regional Hospital and 63% in healthcare centers. The average consumption of ABHR per consultation was 3.29 mL with a peak in February 2020 of 23 mL. Conclusion Despite increased stress levels among HCWs, the ongoing IPC partnership well prepared the FRH in terms of triaging processes with a stronger impact on IPC practice than on theoretical knowledge. Throughout the pandemic, global shortages and surges in consumption did not affect the continuous ABHR provision of the FRH. This highlights local ABHR production as a key pandemic preparedness strategy.

As rates of novel coronavirus disease 2019 (COVID-19) continue rising in Africa, usage of infection prevention and control (IPC) strategies by healthcare workers (HCW) is critical. We highlight a Cochrane review of qualitative evidence that explored barriers and facilitators to HCW compliance with IPC recommendations for COVID-19 and other respiratory infectious diseases. The review found various individual- and organizational- level barriers and facilitators. The findings suggest that healthcare system constraints that make it difficult for healthcare workers to implement IPC guidelines require urgent prioritisation. This will help lay the foundation for addressing the more individual-level barriers potentially discouraging HCW from implementing IPC guidelines. We draw attention to pan-African initiatives for enhancing healthcare workers' capacity to undertake IPC measures at such a critical time.