bluuebunny/crossref_metadata_2025 huggingface dataset:
SG-APSIC1026: COVID-19 vaccine acceptance and hesitancy among primary healthcare workers in Singapore
Authors: Koh Sky Wei Chee , Yiyang Liow , Keong Victor Loh Weng , Jia Liew Seaw , Yiong-Huak Chan , Young Doris
Published: March 2023

Objectives: Factors affecting COVID-19 vaccine acceptance and hesitancy among primary-care healthcare workers (HCWs) remain poorly understood. We sought to identify factors associated with vaccine acceptance and hesitancy among HCWs. Methods: A multicenter online cross-sectional survey was performed across 6 primary-care clinics from May to June 2021, after completion of the vaccination rollout. The following data were collected: demographics, profession, years working in healthcare, residential status, presence of chronic medical conditions, self-perceived risk of acquiring COVID-19, and previous influenza vaccination. HCWs who accepted the vaccine were asked to rank their 5 best reasons for vaccine acceptance. HCWs who were vaccine hesitant completed the 5C scale on psychological antecedents of vaccination. Results: Of 1,182 eligible HCWs, 557 responded (response rate, 47.1%) and 29 were excluded due to contraindications. Among 557 respondents, the vaccine acceptance rate was 94.9% (n = 501) and 5.1% were hesitant (n = 27). COVID-19 vaccine acceptance was not associated with sex, age, ethnicity, profession, number of years in healthcare, living status, presence of chronic diseases, self-perceived risk, or previous influenza vaccination. The 3 most common reasons for COVID-19 vaccine acceptance as ranked by 501 HCWs were (1) to protect their family and friends, (2) protect themselves from COVID-19, and (3) the high risk of acquiring COVID-19 because of their jobs. The 15-item questionnaire from the 5C psychological antecedents of vaccination was completed by 27 vaccine hesitant HCWs. The mean scores for the components of the 5Cs were ‘confidence’ (3.96), ‘complacency’ (3.23), ‘constraint’ (2.85), ‘calculation’ (5.79) and ‘collective responsibility’ (4.12). Conclusions: COVID-19 vaccine hesitancy is a minute issue among primary-care HCWs in Singapore, where the acceptance rate is 95% with a 5% hesitancy rate. Future studies can focus on other settings with higher hesitancy rates and acceptance of booster vaccinations with the emergence of the SARS-CoV-2 δ (delta) variant. Trial Registration: This study was approved by the National Healthcare Group (NHG) Domain Specific Review Board (DSRB), Singapore on April 26, 2021 (Reg No. 2021/00213).
SG-APSIC1111: Abstract management services for the sterilization of single-use medical supplies
Authors: Nimnaparoj Tussanee
Published: March 2023

Objectives: Single-use medical supplies are usually expensive, resulting in excess costs for hospitals and patients. Reusing single-use medical devices by resterilization or reprocessing has thus been enacted. We compared the cost of resterilizing single-use medical supplies with the cost of new purchases to reduce the unnecessary resterilization of medical supplies. Methods: The central sterile supply department (CSSD) listed single-use medical supplies that were sent for resterilization. Policies and guidelines for reusing or resterilizing single-use medical supplies were established following the standards for disinfection and sterilization. The costs of the resterilizing process for single-use medical supplies were compared with the expenses of new purchases of those medical supplies. Results: In 2019, many medical supplies were resterilized, and the resterilization of single-use devices cost up to 2,352,270 Thai baht (US $68,340). Since this project was implemented in fiscal year 2020 (October 1, 2019–September 30, 2020), the resterilization of medical supplies has decreased, and the cost of resterilization has decreased to 1,356,280 Thai baht (US $40,557), leading to a saving of 995,990 Thai baht (US $29,783, or 42% of the resterilization cost in 2019). The CSSD proposed a resterilization policy in which resterilization for reuse must be done for medical supplies and/or devices that cost ≥1,000 Thai baht (US $30). Conclusions: Although this project did not reach the target outcome of 100% reduction, the outcome was consistent with the aims of the project. The cost of resterilization of single-use medical supplies can be reduced, and a resterilization system can be developed that assures safety and effectiveness to both service providers and patients.
SG-APSIC1112: The quality enhancement in sterilization processes at Naresuan University Hospital
Authors: Wilachai Kanokporn
Published: March 2023

Background: Disinfection and sterilization of medical devices, instruments, and medical supplies are a crucial part of hospital infection control. The significant problems include insufficient cleaning, incorrect registration in the request form, no basic cleaning at the point of use (POS), and incorrect labelling. These problems were analyzed according using the fishbone diagram process. Objectives: We sought to decrease insufficient cleanliness of items after washing, to increase data accuracy in transferring contaminated devices from wards (from end users), to increase the rate of decontamination at the point of use, and to decrease incorrect labelling on instrument packaging. Method: The Community of Practice in Sterilization (CoP Sterile) team revised the disinfection and sterilization system of the Naresuan University Hospital Central Sterile Supply Department (CSSD) using root-cause analysis of subprocess problems and implementing prioritized solutions. A regular monthly meeting was set up to ensure active response, and closed monitoring was performed to ensure the implementation of the revised protocol according to the plan–do–study–act (PDSA) process. Results: From 2019 to 2021, the percentages of annual insufficient cleanliness of items after washing decreased from 4.8% to 3.6% to 3.1% each year. The percentages of incorrect request forms decreased from 14.59% to 2.91% to 1.84% during these same years. The percentages of decontamination ignorance at the point of use decreased from 3.13% to 0.12% to 0.03% from 2019 to 2021. The percentages of incorrect labelling were 0.013%, 0.008%, and 0.013% each year. Conclusions: The CoP Sterile team used quality improvement tools and regular monitoring to achieve reductions in insufficient cleanliness and incorrect request forms and to increase knowledge of decontamination procedures.
SG-APSIC1151: ZeBox: A prophylactic device against airborne infection
Authors: Venkatraman Srividya Janani , Ghatak Arindam , Kundu Debosmita , Datta Santanu
Published: March 2023

Objectives: Public health emergencies caused by airborne infectious agents are a significant concern, re-emphasized by the current COVID-19 pandemic. It is therefore vital to employ a technology that destroys microbes of all phyla and genera. We describe a novel technology called “Zebox” that can extract, trap, and destroy microbes from the air. This technology destroys even microbes that are resistant to known antibiotics. Methods: Airborne microbial load was enumerated using standard microbiological methods in both hospital ICUs and controlled conditions. Significant microbial reductions due to the ZeBox intervention in the ICUs were confirmed by statistical analysis. Results: ZeBox eliminated a broad spectrum of airborne pathogens (ie, viruses, bacteria, and fungi) in laboratory tests and in hospital ICUs, which are characterized by high, stochastic microbial loads. In closed-chamber experiments, ZeBox achieved a >99.999% reduction of airborne microbes. In the hospital ICU, ZeBox achieved a consistent >90% reduction across several months. Some of the airborne pathogens that ZeBox eliminated in the hospital ICU were multidrug resistant. Conclusions: ZeBox is an effective preventive technology against the spread of airborne pathogens and potentially associated infections. ZeBox could be used to reduce healthcare-associated infections in clinics and hospitals, as well as in burns units and immunocompromised patients. Zebox has the potential to be a significant prophylactic device in the global war on antimicrobial resistance.
SG-APSIC1174: High-value instrument management: Rigid endoscopes
Authors: Sirijindadirat Nanthipha
Published: March 2023

Background: After 3 years, we discovered that a high-value instrument, rigid endoscopes, needed to be used and cleaned properly. If those instruments are damaged from inappropriate handling or reprocessing, they can pose infection risks to patients. Furthermore, the hospital incurs additional repair costs. Objectives: We sought to ensure that specialized instruments are handled and used appropriately in accordance with the manufacturers’ recommendations and that all related units handle and use instruments appropriately. Methods: A meeting was convened to establish the purposes and scope of the work, and related data were collected. As a result, we created registration forms for high-risk instruments as well as a survey list for rigid endoscopes. These forms were distributed to appropriate units. We analyzed outcomes, monitored the indicators, and audited work processes. The operating room registered high-value instruments on a form that included instructions for use. A dealer demonstrated how to handle the rigid endoscopes. The CSSD team visited the operating room to emphasize the importance of handling and reprocessing to ensure compliance. The BEM team inspected all endoscopes after use. We created group communication within the software. Using T-DOC, we analyzed and monitored outcomes. We measured the rate of high-risk instrument registration as well as the completeness of registration. We also measured the rate of damage to rigid endoscopes. Results: We collected data related to rigid endoscopes and educated the staff to handle and reprocess the instruments appropriately, including instructions for use. High-risk instrument registration forms and surveys were created to record information in the T-DOC system. The staff was invited to educational workshops. The rates of registration, registration completeness, and readiness were measured using the plan–do–check–act (PDCA) method. The results of every indicator reached the expected rates of 100%. Conclusions: We achieved our goal of 100% compliance with the new program. All high-value instruments should be registered, and all related staff should be trained to use them appropriately.
SG-APSIC1132: BHQ isolation cart management at a Bangkok Hospital
Authors: Chomrak Rome
Published: March 2023

Objectives: We aimed to provide sufficient equipment to effectively and efficiently track all equipment. Advanced management procedures are available for the treatment of any patients with infections or immunodeficiency as well as those who need special treatment or isolation from others. This management plan can be beneficial for the hospital by promoting process improvement and achieving cost effectiveness. Methods: The instruments used were surveyed in all departments of Bangkok Hospital and these data were analyzed. We used a plan–do–check–act (PDCA) strategy to improve the management by moving from a manual system to a collaborative innovation project that used 4 technological systems: (1) storage identification and identification codes for equipment; (2) request, return, and delivery using the Nsmart system; (3) transportation, receiving, and delivery; and (4) an HIS system for tracing and NSterile version 4.0 software for reporting. Results: The BHQ isolation cart management system helped the hospital control inventory and prevent infection and helped standardize patient services to improve quality at the hospital. Conclusions: This report confirms earlier findings that sufficient equipment can be made available to patients with no extra cost to management. Our findings can contribute to efforts to prevent the virus from spreading within the hospital.
SG-APSIC1176: Laboratory-acquired COVID-19 during the SARS-CoV-2 ο (omicron) pandemic wave at a tertiary-care hospital in Korea
Authors: Kim Mi-Na , Yu Joonsang , Hong Hun
Published: March 2023

Objectives: Laboratory-acquired infection (LAI) of SARS-CoV is well known, but MERS-CoV or SARS-CoV-2 LAI has not yet been reported. Beginning last November, COVID-19 cases increased among laboratory staff at our 2,700-bed tertiary-care hospital. A 7-day home-quarantine policy for healthcare workers when household members were confirmed with SARS-COV-2 was lifted February 28. We investigated LAI and its risk factors. Methods: From March 21 to 25, all confirmed cases of COVID-19 among 176 laboratory staff were surveyed with questionnaire to collect the following data: symptom onset and period, SARS-CoV-2 PCR–positive sample date, age, sex, infection in household members, close contact with COVID-19 confirmed staff, work type, work unit, possibility of LAI and LAI risk factors. Results: In total, 54 laboratory staff (30.1%) were confirmed with SARS-CoV-2 infection; first 1 person on November 28 and 1 person on November 30, 2021, then 13 in February 2022 and 39 later in 2022. Overall, 22 cases had previously infected household members, and 9 cases suspected that they had had hospital contact with an infected patients through phlebotomy or bedside tests. In total, 25 cases of possible LAI mainly occurred in clusters of 3, 6, or 7 people through person-to-person transmission of a coworker who had an infected family member. The remaining 9 cases, including 1 sample receptionist, 2 urine analysis technicians, and 6 SARS-CoV-2 PCR test staff, may have been infected through an infected sample. However, person-to-person transmission was still possible because most shared a changing room and lounge in the same work unit. Conclusions: The most important cause of LAI is person-to-person transmission between coworkers; therefore, home quarantine is an effective measure to prevent LAI when a household member is infected wish SARS-CoV-2. Handling of infected specimens may be the second most common cause of LAI.
SG-APSIC1117: Healthcare-associated infections among the obstetrics and gynecology patients with confirmed COVID-19 in Hung Vuong Hospital, Vietnam
Authors: Nhung Ngo , Tran Hang , Ngo Nhung , Dinh Anh , Nguyen Nga , Ngo Tham , Vu Thang , Nguyen Duy , Phan Hang
Published: March 2023

Objectives: During the COVID-19 surge, our hospital was overloaded due to the increasingly high volume of patients and lack of resources, which resulted in difficulties in complying with infection control and prevention (IPC) practices. In this study, we estimated healthcare-associated infection (HAI) incidence and relevant factors among COVID-19 patients in Hung Vuong hospital. Methods: This study included all SARS-CoV-2–positive adult patients hospitalized between September 1 and October 31, 2021. The Centers for Disease Control and Prevention definition of HAI in the acute-care setting was used. Results: Among 773 patients, 21 (2.72%) developed 26 separate HAIs. The cumulative days of hospitalization were 5,607. The incidence of HAI among COVID-19 patients was 4.64 per 1,000 days of hospitalization. The most frequent HAI was clinically defined pneumonia (46.2%), for which the ventilator-associated pneumonia (VAP) rate was 41.9 per 1,000 ventilator days. Among 21 positive cultures, the most frequently isolated microorganisms were
pseudomonas aeruginosa, Klebsiella pneumoniae, and escherichia coli. HAIs were significantly associated with the number of central-line days (OR, 1.74; 95% CI, 1.33–2.78), the number of indwelling urinary catheter days (OR, 1.46; 95% CI, 1.05–2.03), the length of administration days (OR, 1.25; 95% CI, 1.07–1.45), antibiotics use prior to HAIs (OR, 0.01; 95% CI, 0.01–0.21), and the number of nasal cannula days (OR, 0.62; 95% CI, 0.44–0.85). Conclusions: COVID-19 makes patients more vulnerable and may require more invasive procedures, increasing the infection risk by opportunistic pathogens like gram-negative Enterobacteriaceae. Hence, fundamental IPC recommendations should be strongly implemented.
SG-APSIC1201: Knowledge and awareness of healthcare workers in a residential care home regarding the use of personal protective equipment (PPE) during the COVID-19 pandemic: A pilot study
Authors: Chung Cho Yan , Yin Chau Ho , Fung Chu Hoi , Yan Chung Cho , Kit Fong Long , Fung Foo Siu , Yan Ho Tsz , Peggy Or Pui Lai , Patricia Ching Tai Yin
Published: March 2023

Background: According to the World Health Organization (WHO), as of April 9, 2022, there had been 494,587,638 confirmed COVID-19 cases and 6,170,283 deaths reported worldwide. In Hong Kong, in recent outbreak, ~55% of confirmed cases were residential care home (RCH) residents and >800 staff were infected. In 2016, ~15% of people aged ≥80 years were living in residential care homes. Objectives: To assess healthcare worker (HCW) knowledge level and attitudes about PPE use in residential care homes. Methods: This cross-sectional study, included participants who worked in the residential care homes, registered as healthcare workers (HCWs). HCWs who were part-time staff or worked <3 months in the residential care home were excluded. Ethical review approval from the faculty research committee of the university was obtained in January 2022. The Knowledge, Attitude, Practical (KAP) questionnaire was adapted. The questionnaire has 33 items pertaining to knowledge, attitude, and practice regarding PPE. Results: In total, 50 questionnaires were received; 32 respondents (64%) were female and 18 (36%) were male. Nearly half of the participants had completed a high diploma course, and 32% had graduated from secondary school. Using ANOVA, there were no significant differences of education level of participants or participant knowledge level of PPE [F(2,47) = .181; P = .835], attitudes [F(2,47) = 1.995; P = .147] and practice [F(2,47) = .459; P = .635]. The Pearson correlation was used to measure the relationship between knowledge level and PPE practices. Our results indicated a significant difference and moderate correlation between knowledge level and PPE practice among HCWs. Conclusions: Knowledge level does not directly affect HCW practice regarding PPE. PPE practice skills have been influenced by various factors during the pandemic situation, such as availability of PPE, manpower, workload, and communication.
SG-APSIC1027: COVID-19 vaccination strategy in Singapore—Perspectives and lessons from primary care
Authors: Koh Sky Wei Chee , Keong Victor Loh Weng , Yiyang Liow , Kit Leong Choon , Young Doris
Published: March 2023

Objectives: The disruptions wrought by COVID-19 have spurred the development of vaccines at a pace unprecedented in global history. We have witnessed vaccine development from in vivo testing to population-wide implementation in just under 1 year. Singapore’s vaccination rate of 80%, attained at the start of September 2021, marks a milestone. It signals that plans to shift from a “zero transmission” approach to an endemic “living with COVID-19” approach is headed in the right direction, albeit cautiously and with some uncertainty. Although we ask ourselves at what rate our society should be reopened, we acknowledge that such questions are not easily answered because newer variants are proving more transmissible and, possibly, vaccine resistant compared to earlier variants. Methods: COVID-19 vaccination milestones were plotted. A timeline was used to map key events of Singapore’s vaccination strategy in terms of legislation, logistics and operations, vaccination eligibility, vaccination sites, and measures implemented to encourage vaccine uptake. These factors were compared with Singapore’s vaccination rate from December 2020 to early September 2021. Results: The successful vaccination strategy in Singapore has been explored in 4 main areas: good leadership and evidence-based decision making, use of communications, utilizing existing logistics, and an ever-ready primary care. Conclusions: As we transition to our second year of combating COVID-19, emerging variants, spread despite vaccination, and the contesting voices of antivaxxers pose new challenges. Vaccine-generated immunity is only one, albeit an important, element of a comprehensive COVID-19 strategy. The strategy must also entail surveillance, self-testing, contact tracing, quarantine, legislation, financial support, and strengthened social responsibility. As providers of vaccination and translators of upstream evidence and policy decisions in the community, primary care providers should be involved early in decision making regarding interventions in the community because they can foresee challenges on the ground. Let us put our continued trust in primary care providers to contribute to making Singapore a COVID-19–resilient nation.
SG-APSIC1116: Assessing COVID-19 symptoms in infected healthcare workers in Vietnam
Authors: Huong Dinh Thi Thu , Hoa Le Nguyen Minh , Thuy Bui Thi , Van Kinh Nguyen , Thach Pham Ngoc
Published: March 2023

Objectives: In early 2021, when the COVID-19 vaccine was scarce in Vietnam, healthcare workers (HCWs) were prioritized for vaccination due to high risk of occupational exposure. However, there is some COVID-19 vaccine hesitancy within HCW communities. Assessing COVID-19 severity among vaccinated and nonvaccinated HCWs would contribute essential information to assure people of vaccine effectiveness and reduce vaccine hesitancy. Methods: We conducted a descriptive cross-sectional study at the National Hospital for Tropical Diseases in Hanoi, Vietnam, from May to June 2021. Clinical and epidemiological data from HCWs with positive polymerase chain reaction (PCR) results were collected. The severity of symptoms were classified according to Vietnam Ministry of Health guideline (Decision no. 3416 issued  July 14, 2021) into 5 categories: asymptomatic, mild, moderate, severe, and critical conditions Results: Overall, 25 HCWs qualified for this study (14 women and 11 men), with a median age of 31 years. Among them, 3 HCWs were infected due to community exposure, and the rest were infected due to occupational exposure. Also, 3 HCWs received the Astra Zeneca vaccine before being infected with SARS-CoV-2 (one fully vaccinated with 2 doses and the other 2 had had the first dose). Categorized by the severity of infection, 28% were asymptomatic, 44% had mild symptoms, 20% had moderate symptoms, and 8% experienced severe symptoms. All 3 vaccinated HCWs showed only mild symptoms. Cough and sore throat were the main symptoms recorded (60%), followed by fever (56%). Blood test results did not show significant differences between the severe and mild COVID-19 groups. Conclusions: COVID-19 vaccination reduced the severity of COVID-19 in this small sample of HCWs. Full COVID-19 vaccination is strongly recommended for HCWs to reduce the spread of COVID-19 and to limit the number of cases with severe disease.
SG-APSIC1172: Mitigating the problems that arose in a ward with COVID-19 cases: Development of a “hot ward” tool kit for a potential COVID-19 outbreak
Authors: Mahdi Razali , Jyoti Somani , Sridhar Revathi
Published: March 2023

Objectives: COVID-19 cases continue to climb in the community from the SARS-CoV-2 δ (delta) variant wave. To prepare for cases that may be nosocomial or detected late, the infection prevention team constructed a ‘hot ward’ tool kit to guide implementation of infection control measures. Methods: We engaged the NUH Facilities Management ventilation engineers to understand every ward’s mechanical ventilation setup. With this information, we created of “green” and “hot” zones within ward. After conducting assessments on individual wards, we created the “hot ward” tool kit: (1) 38 ward floor plans indicating ventilation setup, “green” zones, and “hot” zones; (2) a risk matrix to guide ward actions based on cycle threshold (Ct) value and duration of exposure; and (3) “hot ward” checklists. The tool kit was presented to infectious disease clinicians on the infection prevention team and senior nursing leaders for input and guidance. To ensure that these plans were practical, we conducted numerous site walks with HOD and ward nurse managers (ie, for the ICUs and psychiatric units). Finally, the tool kit was shared in a meeting with key stakeholders and senior leaders. It was also uploaded to the NUH COVID-19 quick-reference intranet page for easy staff access. Results: The tool kit was used by 2 general wards when cases of confirmed COVID-19 were detected among patients. Overall, the tool kit helped HOD and nurse managers with the immediate actions required and it provides useful guidance for the infection prevention team to assess and guide decisions regarding whether a ward lockdown is necessary. Conclusions: Although the guidance was useful, from the site walk we learned that the mechanical ventilation system of some wards is shared, making it challenging to prevent cross contamination between wards because any shared ventilation between unmasked areas can be pose a risk for both patients and staff. Additional measures were instituted to mitigate this risk.
SG-APSIC1155: Drug susceptibility patterns of fulminant group G Streptococcus (GGS) infection as a re-emerging infectious disease in Japan
Authors: Minami Masaaki , Sakakibara Ryoko , Akahori Shunsuke
Published: March 2023

Objectives: Severe streptococcal infections are invasive, re-emerging infections that rapidly worsen and lead to death. Not only group A Streptococcus (GAS) but also group g Streptococcus (GGS) are the causative agents of this infection. Moreover, GGS produces hemolytic toxins, proteolytic toxins, and other toxins like GAS. Furthermore, drug-resistant Streptococcus spp, like other pathogenic bacteria, are on the rise worldwide. However, drug resistance has not been studied extensively in invasive GGS. Therefore, we investigated the drug susceptibility of GGS clinical isolates that are closely related to fulminant streptococcal infections. Methods: We used GGS strains isolated from sterile sites of invasive infections at a hospital in Nagoya City, Japan, from 2017 to 2021. Bacterial identification and drug-susceptibility testing were performed using a VITEK-2 system. Results: Overall, 53 strains were included in the study. The GGS strains examined in this study were resistant to 3 different antibiotics (erythromycin, clindamycin, and minocycline). Also, 18 strains (34%) were resistant to erythromycin, 9 (17%) were resistant to clindamycin, and 18 (34%) were resistant to minocycline. Moreover, there were 5 strains (9.4%) of 2-drug–resistant bacteria and 8 strains (15.1%) of 3-drug–resistant bacteria. Conclusions: Acquired resistance not only to individual antibiotics but also to multiple antibiotics suggests that GGS tends to become multidrug resistant. Continued surveillance of the drug susceptibility of GGS as a potential cause of fulminant streptococcal infections will be necessary in the future.
SG-APSIC1118: Introduction of carbapenemase-producing Enterobacterales (CPE) in the aqueous environment of the newly built National Centre for Infectious Diseases (NCID) in Singapore
Authors: Ong Chong Hui Clara , Linn Kyaw Zaw , Farhanah Sharifah , Xiaowei Huan , Loo Liang Hui , Tan Danielle Hui Ru , Hamad Nur Hafizah Binte , Lim Allie Yin , Poon Chu Ying , Tang Ying Wei , Hon Pei Yun , Vasoo Shawn , Ng Oon Tek , Marimuthu Kalisvar
Published: March 2023

Objectives: In healthcare facilities, environmental reservoirs of CPE are associated with CPE outbreaks. In the newly built NCID building, we studied the introduction of CPE in the aqueous environment. Methods: We sampled the aqueous environments (ie, sink, sink strainer, and shower drain-trap with Copan E-swabs and sink P-trap water) of 4 NCID wards (ie, 2 multidrug-resistant organism (MDRO) wards and 2 non-MDRO wards). Two sampling cycles (cycle 1, June–July 2019 and cycle 2, September–November 2019) were conducted in all 4 wards. Cycle 3 (November 2020) was conducted in 1 non-MDRO ward to investigate CPE colonization from previous cycles. Enterobacterales were identified using MALDI-TOF MS and underwent phenotypic (mCIM and eCIM) and confirmatory PCR tests for CPE. Results: We collected 448, 636, and 96 samples in cycles 1, 2, and 3, respectively. MDRO and non-MDRO wards were operational for 1 and 7 months during the first sampling cycle. The CPE prevalence rates in MDRO wards were 1.67% (95% CI, 0.46% – 4.21%) in cycle 1 and 1.76% (95% CI, 0.65% – 3.80%) in cycle 2. In the aqueous environments in MDRO wards, multiple species were detected (cycle 1: 2 K. pneumoniae, 1 E. coli, and 1 S. marcescens; cycle 2: 5 K. pneumoniae and 1 R. planticola), and multiple genotypes were detected (cycle 1: 3 blaOXA48; cycle 2: 5 blaOXA48 and 1 blaKPC). The CPE prevalence in non-MDRO wards was 1.92% (95% CI, 0.53%–4.85%) in cycle 1. The prevalence rate increased by 5.51% (95% CI, 1.99%–9.03%) to 7.43% (95% CI, 4.72%–11.04%; P = .006) in cycle 2, and by another 2.98% (95% CI, −3.82% to 9.79%) to 10.42% (95% CI, 5.11% – 18.3%; P = .353) in cycle 3. Only blaOXA48 S. marcescens were detected in all cycles (except 1 blaOXA48 K. pneumoniae in cycle 2) in the non-MDRO ward. Conclusions: CPE established rapidly in the aqueous environment of NCID wards, more so in MDRO wards than non-MDRO wards. Longitudinal studies to understand the further expansion of the CPE colonization and its impact on patients are needed.
SG-APSIC1091: Assessment of compliance to cleaning of computers by healthcare workers (HCWs) using adenosine triphosphate (ATP) measurement
Authors: Linn Kyaw Zaw , Clara Ong Chong Hui , Farhanah Sharifah , Xiaowei Huan , Hui Loo Liang , Danielle Tan Hui Ru , Hamed Nur Hafizah Binte , Lim Allie Yin , Ying Poon Chu , Wei Tang Ying , Marimuthu Kalisvar
Published: March 2023

Objectives: HCWs are recommended to wipe the computers with alcohol wipes before clinical use. Compliance assessment by direct observation is resource intensive. We used ATP measurement as a surrogate to assess the compliance to preutilization cleaning of computers. Methods: We conducted a pilot study to determine the median relative light unit (RLU) value reflective of preutilization cleaning of the computers. We identified values of <250, 250–500, and >500 RLU to reflect cleaned, probably cleaned, and not cleaned computers, respectively. Subsequently, we conducted a cross-sectional study of the computers in the inpatient wards in Tan Tock Seng Hospital and National Centre for Infectious Diseases. Using 3M Clean-Trace ATP swabs, we tested 5 computers in each ward: 2 computers on wheels, 2 from the nursing station, and 1 at the patients’ room entrance. All analyses were conducted using STATA version 15 software. Results: Between October 4 and 10, 2021, we collected 219 samples from 219 computers. Among them, 44 (20.1%) were cleaned, 49 (22.4%) were probably cleaned, and 126 (57.5%) computers were not cleaned. Higher compliance to computer cleaning was observed in COVID-19 wards [85 ATP samples; cleaned, 37 (43.5%); probably cleaned, 26 (30.6%); not cleaned, 22 (25.9%)] compared with non–COVID-19 wards [134 ATP samples; cleaned, 7 (5.2%); probably cleaned, 23 (17.2%); not cleaned, 104 (77.6%)]
(P < .01). No significant difference was observed in compliance with cleaning computers between the ICU [30 ATP samples; cleaned, 7 (23.3%); probably cleaned, 4 (13.3%); not cleaned, 19 (63.3%)] and general wards [189 ATP samples; cleaned, 37 (19.6%); probably cleaned, 45 (23.8%); not cleaned, 107 (56.6%)] (P = .47). Conclusions: ATP swab tests can be used as a surrogate marker to assess compliance to pre-utilization cleaning of computers. Enhanced awareness of environmental hygiene may explain the higher compliance to computer cleaning observed in COVID-19 wards.
SG-APSIC1085: Microbiological analysis concerning antimicrobial effect of atomized ionless hypochlorous acid water in a hospital environment
Authors: Miura Miho , Katayama Hideki , Miyake Atsushi , Sakamoto Toru , Naitou Tetsuya , Sakai Yoshiro , Tanamachi Chiyoko , Goto Kenji , Watanabe Hiroshi
Published: March 2023

Objectives: We evaluated the disinfecting efficacy of atomized ionless hypochlorous acid water (CLFine) against pathogenic microorganisms in an isolation room. Methods: The study was conducted in an isolation room of Kurume University Hospital. CLFine with available chlorine concentrations of 40 ppm and 300 ppm as test substances and purified water as control were atomized with an ultrasonic atomizer (CLmistL). The 40 ppm and 300 ppm of CLFine were atomized at the atmospheric available chlorine concentrations of ~0.03 ppm and 0.1~0.2 ppm, respectively, and purified water was atomized in the same manner as CLFine. Petri dishes with Staphylococcus aureus, Bacillus cereus spores, Bacillus subtilis spores and Aspergillus ruber were allocated in the room, then CLFine or purified water was atomized. Sampling was performed at 3 and 5 hours after the start of atomization, and the bacterial counts were measured. The study was carried out either with air conditioning turned “on” or “off” because atmospherically available chlorine concentration is affected by ventilation. Results: When the air conditioning was turned on, purified water showed a slight reduction of bacterial counts by 0.9 log or less at 5 hours after the atomization. When CLFine was used, 40 ppm greatly reduced the counts of Staphylococcus aureus by 5.1~5.4 logs reduction at 5 hours after the atomization, but no distinctive efficacy was observed against other microorganisms. On the other hand, 300 ppm caused a significant reduction of the bacterial counts for all the microorganisms at 5 hours after the atomization (P < .001 vs purified water). The same results were observed in the environment with the air conditioning turned off. Conclusions: Our data suggest that CLFine effectively disinfects pathogenic microorganisms and can contribute to maintaining the hygienic environment of hospital rooms. This study was funded as contracted research by NIPRO Corporation with the approval of the ethics committee (study no. 21229).
SG-APSIC1087: Transcriptome meta-analysis revealed concordant molecular signatures between acne skin and PM2.5-treated in vitro skin models
Authors: Gu Xuelan , Cui Xiao , Zhang Hong , Mi Grace
Published: March 2023

Objectives: Cohort and epidemiology studies have previously revealed potential associations between air pollution exposure and acne vulgaris. However, the molecular mechanisms that drive these associations are not currently well understood. In this study, we compared the molecular signatures of acne and PM2.5-exposed skin to infer whether common underlying biological mechanisms exist. Methods: Acne microarray data sets were downloaded from GEO. RMAExpress was used for microarray normalization, and TMeV was used to identify differential expressed genes (DEGs). A random-effects model in MetaVolcanoR was used to determine fold changes and P values. DEGs of PM2.5-exposed skin-cell models were obtained from the literature. DEGs were compared using GeneOverlap and a custom R script. Analyses of pathways, upstream regulators, and causal networks were conducted using ingenuity pathway analysis (IPA). Results: The molecular signatures of acne skin and the effect of PM2.5 on skin in vitro were compared at 3 levels: (1) gene expression, (2) pathway activity, and (3) upstream regulators. Significant concordant overlaps of both upregulated (P < 3e-23) and downregulated DEGs (P< .005) were observed in acne skin and PM2.5-exposed keratinocytes. However, for the PM2.5-exposed 3D skin model, significant overlap with acne skin was only observed for upregulated DEGs (P < 8e-14). Fold changes of DEGs in both acne and PM2.5-exposed data sets showed significant correlation (Pearson correlation coefficient > 0.6; P < .001). An IPA analysis identified 13 pathways commonly enriched in acne and PM2.5 data sets, including IL17, IL6, Toll receptor PPAR, LXR–RXR, and acute-phase response pathways. Common upstream regulators were further identified including TNFα, NFκB, CAMP, AhR, and IL17A. Finally, causal network analysis revealed several potential hub regulators shared in acne pathogenesis and PM2.5-exposed skin, including HIF1α, TNF, IL1α, and CCL5. Conclusions: Our analysis revealed significant concordant molecular signatures between acne and PM2.5-exposed skin. Biological insights from this study offer clues that build the causal links between air pollution and acne pathogenesis.
SG-APSIC1094: Impact of environmental pollution on skin antimicrobial peptide genes expression revealed by transcriptome profiling
Authors: Gu Xuelan , Cui Xiao , Zhang Hong , Mi Grace
Published: March 2023

Objectives: Pollution exposure is associated with several dermatological conditions including acne, atopic dermatitis, and psoriasis. Antimicrobial peptides (AMPs) are key effectors of innate defense, and some AMPs are involved in inflammatory skin conditions. In this study, we aimed to characterize expression changes of human AMPs under different in-vitro pollution exposures. Methods: RNA-seq profiling was conducted on normal human primary epidermal keratinocytes (NHEK) treated with either a vehicle control, or benzo[a]pyrene (BaP) and on pigmented living skin equivalent models (pLSE) treated with either a vehicle control, ozone, or vehicle exhaust. Differential expressed genes (DEGs) were identified with R scripts. DEGs of PM2.5 were obtained from the literature and the GEO database. Also, 180 human AMP genes were obtained from a UDAMP database. UpSetPlot was used to plot DEGs overlaps. MetaVolcano was used to identify frequently changed AMPs. Results: We used in-house and published transcriptome profiles to identify AMP genes that displayed altered expression under in-vitro pollution exposure. Of the 180 AMP genes under investigation, 37 showed significant changes in expression in at least 1 of the 5 experiments. Using MetaVolcano, 13 AMP genes were identified to be frequently and consistently changed. Several AMPs associated with inflammation and skin diseases were frequently upregulated, including S100A8, S100A9, LCN2, HBD3, RNASE7, and CXCL1. Only 3 frequently downregulated AMP genes were identified, including CXCL14, which is reported to be a noninflammatory AMP that is highly expressed in healthy skin and is downregulated in skin diseases. Conclusions: The data sets suggest that expression of both proinflammatory and homeostatic AMPs can be perturbed by pollution. These findings provide new clues to explain how pollution affects skin innate defense, host–microbe interactions and contributes to abnormal skin conditions. Normalizing aberrant AMP expression may be a potential approach to treat pollution associated skin disorders in the future.
SG-APSIC1165: Hand hygiene feedback card—Providing real-time feedback to improve hand hygiene compliance
Authors: Maruthasalamoorthy Malathi , Ibrahim Asnah Binte
Published: March 2023

Objectives: Hand hygiene is widely recognized as the most effective practice for preventing healthcare-associated infections. Despite ongoing interventions and strategies implemented by the infection control committee, the compliance with and consistency in the hand hygiene practice remains a challenge. At times, staff are unaware when they are noncompliant with hand hygiene; therefore, a more robust strategic approach is needed. One such strategy is customized audit with real-time feedback. A literature review highlighted the effectiveness of audit coupled with specific feedback. This approach was also supported by several guidelines and regulatory bodies that recognized the importance of audit and feedback in hand hygiene improvement efforts. For example, the World Health Organization (WHO) has emphasized 5 core components of improving hand hygiene. One of these components is evaluation and feedback. We sought to provide feedback to healthcare personnel when they do not show compliance with the Five Moments of Hand Hygiene. We aimed to achieve >95% hand hygiene compliance among healthcare staff. Methods: Information on the use of the hand hygiene feedback card was provided to the auditors. The hand hygiene feedback card procedure began in all the wards in May 2020. This process first started with orientation of the auditors regarding the hand hygiene feedback card, followed by auditing hand hygiene practice. Staff who did not comply with hand hygiene procedures were given real-time feedback via a card that specified the missed hand hygiene movement. Results: Overall hand hygiene compliance among healthcare staff increased by 6% after the hand hygiene feedback card procedure was implemented. Conclusions: Overall, the hand hygiene feedback card was effective in improving hand hygiene. Through this quality improvement project, significant and sustained gains in hand hygiene compliance rates of >95% can be achieved.
SG-APSIC1171: A new approach of hand hygiene observation with focus on healthcare worker (HCW) category
Authors: Tee Wee Ling , Fisher Dale , Teo Cathrine , Mahdi Razali Bin , Lum Yvonne
Published: March 2023

Objectives: The past hand hygiene (HH) compliance rate has indicated the low number of opportunities for some healthcare workers (HCWs) because the infection control liaison officer (ICLO) tended to capture opportunities from nurses who were available, despite the proportional allocation of opportunities per HCW type based on the World Health Organization (WHO) HH methodology. Therefore, HH compliance rates may not have accurately represented the specific HCW type, which may have affected the overall HH compliance rate. We sought to determine an accurate baseline of HH compliance rate with consistent number of opportunities across all HCW categories. Methods: HH auditors were ICLOs trained in HH observation by the infection control nurse (ICN) according to the WHO “My Five Moments of Hand Hygiene.” HH observations were conducted bimonthly with assigned areas focusing only on 1 HCW category for each session: nursing, medical, clinical support services, or environmental services. A briefing session was given on the day of observation, with the goal of collecting 20 opportunities per area with HCW focus during their peak activities. Direct feedback and positive reinforcement were given to HCWs after observations were completed. Results: A survey of 96 ICLOs indicated that observations based on HCW focus allowed them to capture more HH opportunities and concentrate on their observations. The new approach showed a significant increase in number of opportunities across all HCW categories that was more representative. We also successfully determined a new baseline for all HCW categories, with further breakdown of HCW type. Conclusions: A new methodology of HH observation with a focus on HCW category has resulted in more HH opportunities across all HCW categories and improved representation of the HH compliance rate.
SG-APSIC1038: Hospital-wide study to evaluate the tolerability and acceptability of alcohol-based hand rubs according to WHO protocol, and healthcare worker hand hygiene behavior during the COVID-19 pandemic
Authors: Lee Yew Fong , Lai Wei Hong , Lee Peh Yee , Ting Samual Chuo Yew , Nuja Irena Albert , Ngian Hie Ung , Wang Jiancong
Published: March 2023

Objectives: To evaluate the tolerability and acceptability of 3 different alcohol-based hand rub (ABHR) products, and to determine factors influencing hand hygiene (HH) behavior among healthcare workers (HCWs) during the COVID-19 pandemic. Methods: A cross-sectional study was conducted in Sarawak General Hospital, a 1,034-bed tertiary-care state hospital. A self-administered 7-point Likert scale questionnaire was adapted from the WHO ‘Protocol for Evaluation of Tolerability and Acceptability of ABHR.’ The study was conducted between November 12 and 26, 2021, based on 3 types of ABHR products. Participation in answering the questionnaire was voluntary, so consent was implied. The Student t test was used to determine the significant differences among the ABHR product. The χ2 distribution test was performed to evaluate the characteristics of ABHR products. Results: We received a response rate of 35% (1,598 of 4,628); 82% of respondents were female, and the overall cohort had a mean age of 35 years. Also, 972 (61%) of 1,598 respondents were nurses, and 1,490 (93%) of 1,598 respondents used ABHR at least 5 days every week. Of 1,598 respondents, 1,156 (72%) indicated that ABHR products were easily accessible at the point of patient care. Evaluation of ABHR products showed that respondents were receptive to all product colors (P < .0114) and had no color preference (P > .05). Comparison among ABHR products yielded no statistical difference (P > .05) for ‘smell,’ ‘stickiness,’ ‘irritation,’ or ‘drying speed.’ ‘Drying effect’ of all products was statistically significant (P < .0252). The overall satisfaction for all products was good (P < .0022). HCWs did not expect their HH compliance to improve even if they were provided with their preferred choice of ABHR. Of 1,598 respondents, 783 (49%) correctly used a palm-full of ABHR for HH, and 1, 275 (80%) indicated that hospital management should organize more HH-related awareness and continuous medical education on HH. Conclusions: A comparison among different ABHR characteristics mostly showed no statistically significant difference regarding tolerability and acceptability. These findings suggest that different ABHR products will not influence HH behavior during COVID-19 pandemic.
SG-APSIC1137: 12-hydroxystearic acid upregulates skin antimicrobial peptides in skin models and provides long-lasting protection from bacterial challenge from a handwash formulation
Authors: Waskar Morris , Gu Xuelan , Mi Tingyan , Swaminathan Meenakshi , Vincent Carol , Ghosh Rimpa , Doraiswamy Chandraprabha , Majumdar Amitabha
Published: March 2023

Objectives: We evaluated the role of 12-hydroxystearic acid (12HSA) in upregulating skin antimicrobial peptides (AMPs) in in vitro and ex vivo
assays, and 12HSA provides long-lasting germ protection in vivo through a handwash formulation. Methods: In vitro assays were performed by treating skin cells, maintained in cell-culture media, with 12HSA. After treatment, AMP gene-expression was measured in cells by RT-qPCR, and secreted AMPs in spent cell culture media were analyzed by ELISA. Skin explants were treated with 12HSA, and 3D-living skin equivalent (LSE) models were treated with 12HSA-containing handwash formulations. AMP levels were measured by immunohistochemical staining or RT-qPCR after treatment. In clinical studies, volunteer forearms were washed multiple times with 12HSA-containing handwash in an ethics-approved study in which participants provided informed consent. The washed forearms were challenged with E. coli at different time points after washing. The 12HSA deposition from the formulation was measured using tape strips. Results: Skin cells treated with 12HSA showed increased expression of several AMP genes in vitro, and higher psoriasin AMP secretion was measured in cell-culture media. An enhanced level of LL37 AMP was obtained from the skin epidermis of 12HSA-treated explant skin. AMP genes were also upregulated in the 3D-LSE model treated with a 12HSA-containing handwash formulation. A measurable level of 12HSA was deposited from handwash formulation in the in vivo clinical sample. E. coli recovery from challenged skin was significantly lower at 6 and 10 hours after washing compared to unwashed skin. Conclusions: These data demonstrate that 12HSA boosts skin-AMPs and that a handwash containing 12HSA provides long-lasting germ protection under in vivo test conditions by potentially enhancing skin’s natural immunity. With an emerging understanding of skin’s innate immunity and AMPs, designing cleansing products that strengthen these natural defenses will offer novel approaches to extend hygiene benefits beyond immediate in-wash protection.