Background

Hand hygiene(HH) is the most effective safeguard against healthcare-associated infections(HAIs). It is particularly important in the pediatric intensive care unit (PICU), where young age and an immunocompromised status make patients particularly vulnerable to infections. Surveillance data on HH compliance within pediatric European hospitals are poor. Our aim was to measure the degree of compliance with HH practices in PICUs across Europe and identify targets for improvement.

Methods

RANIN-KIDS(Reducing Antimicrobial use and Nosocomial INfections in KIDS) is a European network with the aim of achieving optical clinical outcomes among pediatric patients. This was an observational study carried out in 9 PICUs in 7 European countries in a 6 month-period, using WHO’s “Five moments of Hand Hygiene” definitions. Observations were conducted in every unit by trained observers, using a data collection tool developed based on WHO guidelines. Compliance and appropriateness rates were defined as [(performed actions/opportunities)x100] and [(appropriately performed actions/performed actions)x100] respectively.

Results

1715 HH opportunities were observed. Across all PICUs, the median HH compliance rate was 82.3%(IQR:71.6%-94.5%). Compliance to moment 5 was the lowest across hospitals(Table1). Stratified by type of professional, compliance was comparable among doctors and nurses, but lower for non-unit healthcare personnel(HCP) and non-HCP(Table1). “Alcohol-based handrub” was substantially preferred to soap and water. Cleaning and drying technique was considered appropriate in a median of 93% of observations(IQR:86.4%-96.3%).

Conclusions

The overall level of HH compliance in European PICUs is high but surveillance allowed us to identify targets for improvement. Moment 5 is the most frequently missed opportunity and non-healthcare personnel show lower adherence to WHO guidelines than doctors and nurses. These results will be used to inform tailor-made interventions in participating units with the aim of reducing HAIs and MDR spreading.

Background

In low- and middle-income countries, postpartum maternal and neonatal infections continue to be important causes of morbidity and mortality. These risks are amplified in community healthcare sites, where a large disparity in resources exists compared to tertiary care hospitals. Interventions at the primary care level are crucial in bridging this gap.

Methods

A quasi-experimental study was conducted at five rural health facilities in Southern Province of Zambia from December 2018 to August 2019. Data collection occurred before and after 3 months of interventions, including infection prevention and control (IPC) education, alcohol hand rub provision, and SMS reminders. Infection Control Assessment Tool (ICAT), a survey completed by the in-charge nurse, was used to assess the health facility’s comprehensive IPC measures. Logbook was reviewed for pre- and post-intervention rates of maternal and newborn infections, complications, and hospital outcomes including mortality and transfers.

Results

Wilcoxon paired signed rank test showed the mean ICAT score was 69.4/140 and 77.2/140 at pre- and post-intervention (p=0.23). ICAT scores for the hand hygiene module (p=0.04) and labor and delivery practices (p=0.06) showed improvements. There were no significant changes on modules on facility, general IPC program or practices, or postpartum care. Logbook review of 654 mothers and 655 newborns showed one case of newborn fever. Logistic regression showed no significant change in newborn outcomes, while there was a post-intervention reduction in maternal transfers due to complications (p=0.04).

Conclusions

Low-cost intervention bundle can improve aspects of IPC at rural health facilities in Zambia, although systematic and behavioral improvements may require further interventions. Rates of newborn and maternal infection in community settings were low, but charting practices were inconsistent. Higher quality routine health center data would assist in studying newborn and maternal health.

Clinical Trial Registration

Clinical trial registration: ClinicalTrials.gov NCT03809741

Background

Pharyngeal carriage is the reservoir for Neisseria meningitidis in the population and the first step in disease transmission. Especially in young infants and adolescents, N. meningitidis can cause serious invasive infection with high fatality rates and high rates of long-term sequelae among survivors.

Aim of this study was to determine N. meningitidis colonization rates and serogroup distribution of carried meningococcal isolates in asymptomatic health care professionals at a tertiary university paediatric hospital. Furthermore, we sought to identify risk factors for carriage.

Methods

This cross-sectional meningococcal carriage survey was conducted between April and October 2018 at the Department of Paediatrics and Adolescent Medicine at the Medical University of Vienna. Individuals working as nurses, paediatricians or medical students were enrolled. Oropharyngeal swabs were directly plated onto selective agar plates and conventional culture was used for bacterial identification. Meningococcal isolates were further characterized using whole genome sequencing.

Results

A total of 437 oropharyngeal specimens were collected. The median age of participants was 33 (IQR 17) and 85.6% (374/437) of the study population were female. Overall meningococcal carriage prevalence was 1.14% (5/437), with 0.7% (3/437) for capsular genotype B, and 0.5% (2/437) for capsular genotype W. Mean age of carriers was significantly lower than of non-carriers (24.2 vs. 35.8; p = 0.004). The highest carriage rate of 4.4% (4/91) was found in the age group 18-25. Carriage was negatively associated with age and timespan working in paediatrics.

Conclusions

This is the first study evaluating the prevalence of Neisseria meningitidis carriage in health care professionals working in Paediatrics and Adolescent Medicine. Carriage was in general lower than expected for all age groups, implicating a low risk of horizontal meningococcal transmission via this population.

Clinical Trial Registration

not available

Background

Staphylococcus aureus is one of the major causes of neonatal infections. Methicillin-resistant Staphylococcus aureus (MRSA), a hospital environmental bacterium, has been declining in the neonatal intensive care unit (NICU) due to the spread of infection control. On the other hand, methicillin-sensitive Staphylococcus aureus (MSSA) is still detected in a certain number from blood culture. We evaluated the epidemiological factor of MSSA in NICU for controlling MSSA infection in NICU.

Methods

We collected nasal vestibule swabs and isolated S.aureus from patients, their parents, and healthcare workers in the NICU at our hospital from October 2018 to March 2019. Whole-genome sequencing (WGS) was performed on MSSA isolates from patients and their parents. Healthcare workers’ isolates were identified by PCR-based ORF Typing (POT), along with WGS for some isolates. Multi-locus sequence typing, spa typing, and single-nucleotide polymorphism analysis were performed.

Results

Sixteen of 89 sampled neonates were MSSA positive. There were 52 families that could sample both neonates and parents, and the parental MSSA carriage rate was 24%. Of these, three families had MSSA in both patient and either parent. Only one out of these three groups were identified homology in WGS. Thirty-five of 97 sampled healthcare workers were MSSA carriers. Four neonate isolates showed homology with those from healthcare workers. In addition, three neonate groups had the same strain, one of which was twins.

Conclusions

The MSSA transmission pathway of neonates has the same horizontal transmission as MRSA, but it has been suggested that the colonization of healthcare workers may be one of the important acquisition pathways. Control of S. aureus in the NICU needs to consider not only infection control that suppresses horizontal transmission among patients, but also surveillance and carrier measures for healthcare workers.

Background

Dengue fever is an important vector-transmitted disease worldwide. By controlling mosquitoes’ breeding places, this study aims to analyze the effect of reducing transmission in elementary schools (grades 1–9) on the dynamics of the epidemic at a regional level.

Dengue virus transmission occurs within the community or schools, and there is evidence that transmission in schools plays an important role in the progression of dengue epidemics. In Mexico, elementary schools are left unattended for almost two months during the summer break; many of them become a suitable environment for mosquitoes. After the break, students return to classes (25% of the population in Mexico). Thus, a great deal of the population suddenly increases their exposure to the vector.

Methods

We implemented a massive campaign in a region of México (Colima state, 5,191 km², population 568,000) focused on training janitors to locate and avoid mosquitoes’ breeding places, the objective being to maintain elementary schools free of mosquitoes. Colima is one of the states with a higher dengue incidence in Mexico. We implemented a special statewide campaign before the beginning of classes, in 482 schools with 75,000 students (average school size 120+-131). There were a total of 1,284 attendees at the meetings that included personnel from 91% of schools in the state of Colima, including public and private schools.

Results

We observed a 45% reduction in dengue incidence compared to the previous year. In contrast, the rest of Mexico observed an 81% increase in incidence on average.

Conclusions

We conclude that the described intervention gave empirical evidence to avoid dengue transmission in elementary schools. Costs associated with campaigns focusing on cleaning schools are meager, and results seem to be promising. Nevertheless, more controlled studies are needed worldwide.

Clinical Trial Registration

No Clinical trial registration needed.

Background

Slow bactericidal activity, limited bone penetration, and potential for nephrotoxicity raise concerns about continued use of vancomycin as first-line therapy for acute osteomyelitis with concurrent MRSA bacteremia. This audit explores the effort and resources devoted to the use of vancomycin in this setting and evaluates the utility of AUC/MIC calculation to modify future dosing strategies including loading with 30 mg/kg.

Methods

Children with osteomyelitis and concurrent MRSA bacteremia from 2009-2018, who were treated with a sufficient duration of vancomycin to evaluate serum trough and AUC/MIC were retrospectively studied. Data collected: antibiotic susceptibilities; duration of bacteremia; number of dose/interval changes; vancomycin trough and creatinine levels; rate of achieving therapeutic trough and AUC/MIC > 400; rate of acute kidney injury; length of stay.

Results

85 children with MRSA osteomyelitis had bacteremia for 4.1 days on average. Target trough (15-20 µg/mL) was achieved in 59 (69.4%) children within 4.9 days. There were 231 dose/interval adjustments, 918 serum creatinine levels, and 648 vancomycin troughs obtained. Ten children (11.8%) experienced AKI with LOS 25.8 days compared to 14.9 days in children without AKI. AUC/MIC was > 400 for 62 (72.9%) children while trough was therapeutic in only 12 (14.1%) children. Loading with 30 mg/kg produced higher AUC/MIC (668.0 vs.520.8) and trough (11.1 vs. 9.1 µg/mL) without AKI.

Conclusions

This study illustrates the resources devoted to vancomycin use in children with osteomyelitis and concurrent bacteremia. The challenges and hidden costs raise consideration about alternative antibiotic therapy strategies in this setting. If vancomycin is utilized, a deliberate approach should be taken to mitigate risk of AKI, including AUC/MIC ratio calculation, commitment to 30 mg/kg loading dose, and limiting concurrent use of other nephrotoxic agents, including contrast, loop diuretics, aminoglycosides, and NSAIDs.