bluuebunny/crossref_metadata_2025 huggingface dataset:
Hydrostatic, strike-slip and normal stress true triaxial hydrofracturing testing of Blanco Mera Granite: breakdown pressure and tensile strength assessment
Authors: Muñoz-Ibáñez Andrea , Herbón-Penabad Miguel , Delgado-Martín Jordi , Alejano-Monge Leandro , Alvarellos-Iglesias José , Canal-Vila Jacobo
Published: March 2023

We have designed and built a versatile testing device to perform hydraulic fracturing experiments under true triaxial conditions. The device, based on a stiff biaxial frame that can be installed in a servocontrolled press, can accommodate cube rock samples of up to 150 mm-edge. Using a low-permeability rock known as Blanco Mera granite, we have performed a series of tests across a range of confining pressures including hydrostatic, normal, and strike-slip regimes. We have verified the applicability of two simple fracture mechanics-based models for the interpretation of experimental results, and we have determined the value of tensile strength of the rock from the injection curves recorded. The orientation of the hydraulically-triggered fractures with respect to the applied stress has also been analyzed. Although the models proposed by Rummel and Abou-Sayed provided reasonably satisfactory results, especially for hydrostatic and strike-slip tests, the presence of heterogeneities and defects in the rock matrix may have a strong influence on the fracture behavior and, therefore, affect the interpretation of hydrofracturing tests.
Direct 3D printing of a two-part silicone resin to fabricate highly stretchable structures
Authors: Gharaie Saleh , Zolfagharian Ali , Moghadam Amir Ali Amiri , Shukur Nurul , Bodaghi Mahdi , Mosadegh Bobak , Kouzani Abbas
Published: March 2023

The direct ink writing (DIW) method of 3D-printing liquid resins has shown promising results in various applications such as flexible electronics, medical devices, and soft robots. A cost-effective extrusion system for a two-part high-viscous resin is developed in this article to fabricate soft and immensely stretchable structures. A static mixer capable of evenly mixing two viscous resins in an extremely low flow regime is designed based on the required mixing performance through a series of biphasic computational fluid dynamics analyses. The printing parameters of the extrusion system are determined empirically, and the mechanical properties of the printed samples are compared to their molded counterparts. Furthermore, some potential applications of the system in soft robotics and medical training are demonstrated. This research provides a clear guide for utilizing DIW to 3D print highly stretchable structures.
Investigative Research Projects for Students in Science: The State of the Field and a Research Agenda
Authors: Reiss Michael J. , Sheldrake Richard , Lodge Wilton
Published: March 2023

One of the ways in which students can be taught science is by doing science, the intention being to help students understand the nature, processes, and methods of science. Investigative research projects may be used in an attempt to reflect some aspects of science more authentically than other teaching and learning approaches, such as confirmatory practical activities and teacher demonstrations. In this article, we are interested in the affordances of investigative research projects where students, either individually or collaboratively, undertake original research. We provide a critical rather than a systematic review of the field. We begin by examining the literature on the aims of science education, and how science is taught in schools, before specifically turning to investigative research projects. We examine how such projects are typically undertaken before reviewing their aims and, in more detail, the consequences for students of undertaking such projects. We conclude that we need social science research studies that make explicit the possible benefits of investigative research projects in science. Such studies should have adequate control groups that look at the long-term consequences of such projects not only by collecting delayed data from participants, but by following them longitudinally to see whether such projects make any difference to participants’ subsequent education and career destinations. We also conclude that there is too often a tendency for investigative research projects for students in science to ignore the reasons why scientists work in particular areas and to assume that once a written report of the research has been authored, the work is done. We therefore, while being positive about the potential for investigative research projects, make specific recommendations as to how greater authenticity might result from students undertaking such projects.
Guidebook to Community Consulting
Authors: Wolfe Susan M. , Price Ann Webb
Published: March 2023

Guidebook to Community Consulting provides advice for people interested in starting or growing a career in community consulting. Drawing on the authors' years of experience as community consultants, it offers a wealth of practical guidance to anyone considering or establishing a successful career serving and empowering communities. It includes guidance about the personal qualities, values, and technical skills needed; how to start a consulting practice; how to collaborate with colleagues, and most importantly, how to collaborate with communities. Practical advice and tips are motivated by core guiding principles and goals including an understanding of consulting as a partnership between consultants and communities; decoloniality; anti-racism, and equity. The text is animated with illustrative anecdotes and lessons gained from real-world experience.
Brief Psychosocial Intervention for Adolescents
Authors: Goodyer Ian , Kelvin Raphael
Published: March 2023

The highest incidence for clinical depressions is during adolescence. Furthermore, mental health illnesses that recur over the life-course begin in young people. 70% of all mental health emerge before thirty years of age. Almost all interventions for young people have been first developed for and targeted at adults. Here for the first time is a talking therapy (BPI), that has been developed for, and with, adolescents. After thirty years of clinical experience with mentally ill adolescents and two major randomised controlled trials of treatment, the authors reveal a brief psychosocial intervention that is as effective as CBT for adolescents with depression with and without comorbid anxiety and conduct disorder. BPI can be taught to mental health practitioners in sixteen hours and they can immediately start delivery of care. After a six-month supervision, new BPI practitioners offer an evidence based and NICE approved treatment in their usual clinical practice.
Propeller control for takeoff of a heavily loaded coaxial compound helicopter
Authors: Zhao Y. , Yuan Y. , Chen R. , Yan X.
Published: March 2023

Although a coaxial compound helicopter can takeoff without propeller in the normal condition, the distance should be as short as possible for obstacle avoidance when the vehicle operates in a confined area with heavy loads. Therefore, a suitable propeller control is required to improve the takeoff performance while the total power consumption is no more than the available power. The path is predicted by applying trajectory optimisation. Several varying takeoff parameters, including attitude, liftoff speed and obstacle height, are considered for optimum global performance. Three path indicators are proposed. Apart from typical distance and pilot workload, path sensitivity is quantified based on deviation from takeoff parameter variation. Results indicated that low propeller thrust at hover and moderate allocation on the propeller through flight is recommended. The aircraft achieves significantly improved takeoff performance compared to flight with pure rotors while maintaining the maximum takeoff weight. The distance is shortened by 12.6%, and the longitudinal pilot workload is alleviated by 9.8% and 7.3% from mean and maximum power frequency aspects. Besides, the path is less sensitive to takeoff parameter variations, such as speed, altitude and height.
SG-APSIC1128: BHQ instrument management at Bangkok Hospital
Authors: Chomrak Rome
Published: March 2023

Objectives: We evaluated the BHQ instrument management strategies at Bangkok Hospital as well as the general instrument and surgical instrument inventories to develop effective management of general and surgical instruments. Methods: A survey of instruments that had been used and were ready for use was conducted in all departments of Bangkok Hospital. Data were collected and analyzed using statistical methods to adapt the “refill and reduce” strategy. We determined usage rates from each department to determine inventory needs based on the principles that patients are safest with sufficient instruments available and that the central sterilization supply department (CSSD) can provide the best inventory management. Results: Our evaluation revealed that BHQ instrument management strategies can assist the hospital in reducing the cost of resterilizing instruments and thus can lower the workload and reduce tracking conflicts related to overdue instruments. Conclusions: This report confirmed earlier findings that Bangkok Hospital can have more instruments ready to use and can reduce costs without buying replacement instruments by using a strategy of “filling missing parts and cutting the excess.”
SG-APSIC1110: Project quality development of zero stock
Authors: Nimnaparoj Tussanee
Published: March 2023

Objectives: Many medical devices and equipment have been reserved in hospital wards and outpatient departments. Among these items, >80% are not often used but are being reserved for emergency situations. We aimed to reduce the number of unnecessarily reserved medical devices and to reduce the cost of unnecessary resterilization of devices and equipment. Methods: The central sterile supply department (CSSD), in coordination with other 13 wards within the Thammasat University Hospital, established a standard action plan for improving the efficiency of medical supply stocking and storage. Medical equipment and/or devices were returned to the CSSD, which acted as the center of management and distribution. The CSSD also tracked and solved problems that occurred and reevaluated practice guidelines. User satisfaction was evaluated and statistic data were collected and analyzed. Results: Wards no longer reserve medical equipment. Thus, no repeated sterilization was needed for unused medical equipment from the participated 13 wards, and sufficient medical equipment was available for various wards when needed. This project helped reduce the cost of purchasing medical equipment, especially for a newly opened ward. The storage of all medical equipment and devices complied with the practice guidelines because the CSSD storage room had a standard temperature and humidity control system. Conclusions: In this project, the CSSD cooperated with the 13 participating wards. As the result of centralizing the supplies, the CSSD has sufficient medical equipment and devices for all other wards, including a newly opened ward. The hospital benefitted from reduced costs of purchasing new medical equipment for a newly opened ward as well as the cost savings of eliminating unnecessary resterilization of unused devices and equipment.
SG-APSIC1127: Digital transformation of the central sterile supply department: Justify by tracking system
Authors: Kongprajak Saharat
Published: March 2023

Background: Avoidable infections in healthcare (healthcare-associated infections or HAIs) occur globally. The causes of HAI are influenced by a complex combination of gaps in policies, infrastructure, organization, knowledge, healthcare worker behavior, and patient-related factors. Through knowledge, best practices, and infrastructure improvement, the infection prevention and control (IPC) team aims to prevent harm to patients and healthcare workers due to HAIs. The most common HAIs are surgical site infections (SSIs) caused by harmful device-reuse practices, inadequate sterilization, and/or inadequate decontamination procedures. Disinfection and sterilization of instruments and medical devices play very important roles in HAI and SSI prevention. World Health Organization (WHO) Collaborating Centre in Quality Improvement Program certification, the first pilot project in Thailand, included the Central Sterilizing Services Association of Thailand and 15 hospital central sterile supply departments (CSSDs). This quality improvement program for sterilization reprocessing aimed to prevent harm to patients and healthcare workers due to HAIs. Objectives: We sought to reduce damage to instruments caused by inadequate reprocessing sterilization to zero incidents. We sought to reduce inadequate packing to ≤3 events per month. We sought to reduce the need to resterilize instruments by >80%. Methods: A root-cause analysis meeting was held by CSSD staff, and an IT vendor was consulted about developing an electronic alert system. The following changes were implemented: Staff packed instruments using a list of pictures for each set. Sticker labels were applied showing the proper number of pieces in the set. Identification O-rings were added to instruments with inventory dates, serial numbers, and instructions for use. Stickers were added to indicate the method of sterilization, such as ethylene oxide gas only or hydrogen peroxide only. Results: Reports of damage due to the sterilization process decreased to zero. No events related to the packing process were reported, and resterilization of instruments decreased by 98.94%. Conclusions: In this project, we implemented a quality improvement process and tracking system, reduced defects, and increased healthcare worker competency to improve patient safety.
SG-APSIC1048: Lean management dressing set of service unit at Pattani Hospital
Authors: Sirijindadirat Nanthipha , Jindarat Chanitsara
Published: March 2023

Background: Pattani Hospital in southern Thailand has 540 beds and a network of 22 family clinical practice and community locations and 13 primary-care hospitals. We care for patients and soldiers who have wounds from guns and bombs of varying wound size. The central sterilization services department (CSSD) prepares dressing sets with 1 size dressing procedures. Objectives: We sought to improve the sizing of dressing sets within Pattani Hospital and network, to reduce preparation time to ≤3 minutes per set, and to reduce the cost of dressing sets by 8,000 Thai baht (US $240) per month. Methods: We convened a problem-solving meeting to address the sizes of dressing sets in the hospital. We decided that 3 sizes were needed (small, medium, and large) following the size of the wound. We performed a pilot project and evaluated its progress every 2 months. Results: Unique dressing sets were used in 68.18% of cases before the intervention and 88.5% after the sizing changes. Time to prepare the dressing sets decreased from 3 minutes to 1 minute per set. The intervention reduced the costs related to dressing sets from 39,952.50 Thai baht (US $1,194) per month to 25,641 baht (US $766) per month. Furthermore, infectious waste was reduced from 31.8 kg per day to 7.99 kg per day. Conclusions: Multiple sizes of dressing sets were prepared for use with wounds of varying size. The CSSD prepared the dressing sets using medical supplies such as gauze, cotton, and top gauze. This project reduced waste and improved cost-effectiveness, and this procedure will be extended to other care facilities in our network.
SG-APSIC1204: Time-based deisolation of generally asymptomatic immunocompetent COVID-19 patients on day 8 of infection to clean wards is safe
Authors: Fauzi Nazira Binte Muhammad , Sridhar Revathi , Ching Chan Hwang , Poh Annie , Low Isaac , Fisher Dale , Somani Jyoti
Published: March 2023

Objectives: The National University Hospital (NUH) is a tertiary-care teaching hospital in Singapore with 60% of patients in 6–8-bed cubicles. NUH recently changed to a time-based deisolation criterion for immunocompetent COVID-19 patients in cohort wards who are afebrile and improved but did not meet the antigen rapid test negative criteria at day 5–6 and who required continued hospital care. The MOH guidelines and studies of viral load trajectory from the SARS-CoV-2 δ (delta) variant suggest that by day 8 of infection, viral loads drop and the risk of transmission is low. We defined a cycle threshold (Ct) value ≥25 as the point at which virus cultures are negative. We assessed whether a time-based deisolation at day 8 correlated with Ct ≥25 during the SARS-CoV-2 ο (omicron) variant pandemic surge. Methods: Data for patients and staff with confirmed positive COVID-19 PCR between January to March 2022 were collected. These data comprised a convenience sample collected retrospectively by the epidemiology team and the obstetrics and gynecology team and were used to deisolate patients. Nasopharyngeal (NP) swabs were sent for PCR for all admissions, to confirm diagnosis, for deisolation and/or transfer, and for staff suspected to have COVID-19 as part of hospital staff policy. Results: Overall, 403 observations were obtained. For 145 NP swabs tested by SARS-CoV-2 PCR on day 1, the median Ct value was 19.55 (IQR, 9.01). The median Ct for 87 observations on day 2 was 15.95 (IQR, 3.45). The median Ct value for 14 observations on day 8 was 24.22 (IQR, 5.19). From day 9 to day 37, with 47 observations, the Ct was generally >25. Conclusions: During the SARS-CoV-2 ο (omicron) surge, NP swabs sent on day 8 had a median Ct value of 24.22. After day 8, the median Ct was >25. The discontinuation of isolation precautions on day 8 balances the use of dedicated COVID-19 beds with risk mitigation of transmission for recovered patients who require ongoing hospitalization. Small sample size and heterogeneous reasons for testing NP swabs after day 5 likely skewed our results and limits the generalizability of our results.
SG-APSIC1162: Challenges in building and running a 4,000-bed COVID-19 intensive care unit in an exhibition center
Authors: Kiernan Martin
Published: March 2023

Objectives: To describe the design process for a hospital in an exhibition center. We discuss challenges during the building process and areas in which risk assessments had to be made and practices modified to mitigate suboptimal conditions. Methods: UK National Health Service designers and military planners worked in conjunction with the infection prevention and control team (IPCT) to work with the existing infrastructure. The clinical area was deemed to be an aerosol-generating procedure (AGP) zone because it was entirely an intensive care unit. The challenges included no oxygen line, a lack of hot water, minimal access to cold water, almost no drainage, and a lack of physical space in which to carry out many necessary procedures. These challenges were overcome either by design or by changes to usual practices through mitigation measures. The IPCT had key roles in ensuring staff and patient safety and personal protective equipment (PPE) inventory management as well as donning and doffing procedures. Results: The Nightingale Hospital became a fully functioning ICU within 10 days of the build commencing, and the first patients were admitted within a few days. The hospital was used only sparingly because the national pandemic lockdown was in effect. In total, 72 patients were admitted, with a survival rate of 63%, comparable to established ICUs. Transmission rates of COVID-19 in staff were very low among those working clinically. The unit closed in June 2020 but reopened in January 2021 for rehabilitation with a smaller number of beds but better facilities as a result of our experience in the first iteration. Conclusions: A temporary hospital was built in an exhibition center to successfully manage a number of patients. Even in a temporary hospital facility that was limited in services, successful outcomes were achieved.
SG-APSIC1042: Cutaneous cryptococcosis in patient with advanced HIV disease: Is it possible to give antifungal monotherapy?
Authors: Irawan Visakha Revana , Nugroho Agung , Lasut Pearla
Published: March 2023

Objectives:Cryptococcus infection is one of the major human immunodeficiency virus (HIV)–related opportunistic infections, and the CD4 count falls below 100 per µL. Primary treatment for HIV-associated cutaneous cryptococcosis is amphotericin B (AmB) plus flucytosine. Methods: We present the case of a man with advanced HIV disease who developed whole-body cutaneous lesions yet improved with high-dose fluconazole alone. Results: A 33-year-old Asian man with a medical history of pulmonary tuberculosis and cryptococcal meningitis with complete treatment, injection drug use, and HIV infection with default of antiretroviral treatments (ART) 3 years earlier, presented to the emergency department with fever, oral thrush, and 30-pound weight loss over 6 weeks. He also had plaques, multiple hard papulonodules with central ulceration, and macular skin lesions all over his body of varying size. Blood cultures were negative for bacteria growth, but fungal microscopy of the blood culture showed unspecific hypha. Histopathology examination of the skin biopsy showed a classic “soap bubble” appearance, which is associated with Cryptococcus infection. Laboratory values revealed anemia (8.6 g/dL), leukopenia (2.9 ×109/L), lymphopenia (58/µL), and thrombocytopenia (145 ×109/L). The CD4 cell count was 18/µL, and the serum viral load was 638.665 copies/mL. Lumbar puncture could not be performed due to patient refusal. Treatment with high-dose fluconazole (1,200 mg) for 3 months was initiated and is planned to continue with consolidation and maintenance dose. ART was administered 4 weeks after starting antifungal therapy. His fever resolved and slow regression of the skin lesions occurred after treatment was given. Conclusions: Cutaneous cryptococcosis was assessed by biopsy of the cutaneous lesion, which is essential to confirming the diagnosis. In the case of cryptococcosis, skin infection may indicate a further progression of advanced HIV disease. In HIV-infected patients with Cryptococcus findings in any part of the body, a lumbar puncture should be considered to rule out central nervous system infection. Although neither AmB nor flucytosine was given due to unavailability in this area, the patient improved. In resource-limited settings, high-dose fluconazole alone may be useful as an alternative treatment, although it is also very challenging.
SG-APSIC1099: Scoping review of cleaning of high-touch surfaces (HTSs) in inpatient wards
Authors: Loo Liang Hui , Ong Clara Chong Hui , Farhanah Sharifah , Linn Kyaw Zaw , Huan Xiaowei , Marimuthu Kalisvar
Published: March 2023

Objectives: High-touch surface (HTS) cleaning is critical to prevent healthcare-associated infections. However, HTS definitions and cleaning frequency vary across guidelines. We conducted a scoping review of published guidelines on HTS definitions and recommended cleaning frequency in inpatient wards. Methods: We searched national and societal guidelines on Google and PubMed using the following search terms: [(environmental cleaning/disinfection/housekeeping/sanitization), (hospital/healthcare/infection control prevention/inpatient/acute care), and (practice/guideline/guidance/methodology/protocol)]. We compared the guidelines’ HTS definitions, recommended cleaning frequency, and supporting evidence. Results: In total, 9 environmental cleaning guidelines were included: Centers for Disease Control and Prevention (CDC 2020); Asia Pacific Society of Infection Control (APSIC 2013); International Society for Infectious Diseases (ISID 2018); Joint Commission Resources (JCR 2018); National Health Service, United Kingdom (NHSUK 2021); Public Health Agency, Northern Ireland (PHANI 2016); Public Health Ontario, Canada (PHOC 2018); National Health and Medical Research Council, Australia (NHMRC 2019); Ministry of Health, Singapore (MOH 2013). These 6 guidelines identified 31 types of HTS: bed rails and frames [mentioned by 6 of 6 guidelines]; call bells, doorknobs and handles (5 of 6 guidelines); bedside tables and handles, light switches, overbed and tray tables, and sinks and faucet handles (4 of 6 guidelines); chairs and chair arms, edges of privacy curtains, IV infusion pumps and poles, keyboards, medical equipment, monitoring equipment, and telephones (3 of 6 guidelines); assist bars, counters, elevator buttons, toilet seats and flushes, transport equipment, and wall areas around the toilet (2 of 6 guidelines); and bedpan cleaners, beds, blankets, commodes/bedpans, dispensers, documents, mattresses, monitors, mouse, pillows, and touch screens (1 of 6 guidelines). The JCR, NHMRC, NHSUK guidelines did not define HTSs. The 6 guidelines recommended at least daily cleaning for HTSs, but ISID, JCR, and NHSUK guidelines did not mention HTS cleaning frequency. The CDC guidelines further specified at least once daily cleaning for inpatient wards and private toilets and twice daily for public or shared toilets. None of the guidelines cited any references for HTS cleaning frequency recommendations. Conclusions: There is no uniformity in HTS definitions among 6 guidelines, and the recommended HTS cleaning frequency in these guidelines was not supported by published evidence. Studies exploring optimal cleaning frequency of HTSs are needed.
SG-APSIC1023: Contamination of the geriatric medicine outpatient rehabilitation gym environment and the effectiveness of our current disinfection methods with patient hand hygiene practices
Authors: Toh Sabrina , Ling Foo Meow , Li Li Dun , Loh Calvin , Lee Toylyn , Seah Angeline
Published: March 2023

Objectives: To quantify the microorganism burden of rehabilitation gym equipment surfaces as well as to assess the effectiveness of patient’s practice of hand hygiene and our current disinfection methods to reduce burden and transmission of microorganisms during rehabilitation sessions. Methods: A prospective study of environmental contamination using microbiology culture in Khoo Teck Puat Hospital Geriatric Medicine Outpatient Rehabilitation Gym. Results: For both the control and intervention group, the total aerobic bacterial count on the gym equipment after patient use is significant and increase up to 360 CFU per swab. In the control and intervention groups, the total aerobic bacterial counts on the gym equipment before patients’ use were negligible (<10 CFU per swab). The total aerobic bacterial count of the equipment remained negligible (<10 CFU per swab) after patient use and immediate disinfection. We detected discrepancies between the results of the total aerobic bacterial count after patient use between the control and intervention groups. Conclusions: Outpatient rehabilitation gyms are potential reservoirs of microorganisms, which may further contribute to the transmission of healthcare-associated pathogens. In this study, an intervention in which cleaning equipment was wiped with alcohol wipes was effective in reducing microorganism transmission in the rehabilitation gym environment and should be considered as part of our infection control strategy. The additional step of involving our patients in using hand rub before the start of their therapy sessions can provide additional benefit in reducing microorganism transmission only if patients adhere to the World Health Organization (WHO) recommended 7 steps of proper hand rub. Good patient education on hand hygiene is equally as important as that for healthcare professionals to control environmental contamination.
SG-APSIC1122: Observational study of handwashing sink activities in the inpatient setting
Authors: Huan Xiaowei , Farhanah Sharifah , Linn Kyaw Zaw , Ong Clara Chong Hui , Loo Liang Hui , Lim Allie Yin , Hamad Nur Hafizah Binte , Poon Chu Ying , Tan Hui Ru , Tang Ying Wei , Ang Brenda Sze Peng , Kalisvar Marimuthu
Published: March 2023

Objectives: The use of handwashing sinks for activities other than hand hygiene (HH) is associated with higher rates of β-lactamase–producing Enterobacteriaceae. However, little has been published about the handwashing sink activities in Singapore hospitals. We explored the handwashing sink activities in a tertiary-care hospital in Singapore. Methods: Five trained shadow observers conducted this observational study between December 18 and 21, 2018 (6 hours per day: 07:00–09:00, 09:30–11:30, and 12:30–14:30) in acute-care general wards. We divided the handwashing sink activities by healthcare workers (HCWs) and non-HCWs (ie, visitors, caregivers, and relatives) and by HH- and non–HH-related activities. We used Stata version 15 software for the analysis. The study was approved by the Institutional Review Board of the National Healthcare Group, Singapore (DSRB no. 2020/01257). Results: In total, 657 handwashing sink activities were recorded [HCWs, 475 (72.3%) and non-HCWs, 182 (27.7%)]. Of the 475 HCW handwashing sink activities, 451 (94.9%) were HH-related, 10 (2.1%) were for patient nutrition, 7 (1.5%) were for environmental care, 6 (1.3%) were for medical equipment cleaning, and 1 (0.2%) was patient personal-item cleaning. Of the 182 handwashing sink activities by non-HCWs, 117 (64.3%) were HH related, 30 (16.5%) were for patient nutrition, 21 (11.5%) were for personal hygiene, 14 (7.7%) were patient personal-item cleaning. The distribution of handwashing sink activities differed significantly (P < .01) between HCWs and non-HCWs. The odds of non–HH-related handwashing sink activities among non-HCWs was 10× higher than among HCWs (OR, 10.44; 95% CI, 5.98–18.23; P < .01). Conclusions: Handwashing sinks use for non–HH-related activities is higher among non-HCWs than HCWs. Further studies are needed to understand the impact of non-HH handwashing sink activities on nosocomial infections and ways to reduce them.
SG-APSIC1093: Engaging inpatients in antibiotic stewardship efforts: The need to enhance knowledge and increase involvement in their antibiotic therapy
Authors: Tay Evonne , Chow Angela
Published: March 2023

Objectives: In tertiary-care settings, up to 50% of patients are prescribed at least 1 antibiotic. However, patients are often not proactively provided with information nor involved in shared decisions regarding their antibiotic therapies. Understanding inpatients’ knowledge and the extent of their involvement in antibiotic therapy help reduce inappropriate or unnecessary antibiotic use. Methods: A cross-sectional survey was conducted from March to December 2021 in a 1,600-bed, adult, acute-care, tertiary-care hospital. Patients prescribed antibiotics for the past 1 week during their hospital stay were surveyed. Ten questions assessing patients’ knowledge of their antibiotic therapy and 3 questions adapted from the NHS Care Quality Commission Inpatient survey (2013) were included in the survey questionnaire. Results: Among the 323 patients surveyed, 88% knew that they had been given antibiotics, and 80% felt that it was important to be informed of the reason, 76% felt that it was important to be informed of side effects, 74% felt that it was important to be informed of duration, and 72% felt that it was important to be informed of dosing frequency. However, only 71% knew the dosing frequency, 54% knew the side effects, 37% knew the duration, and 13% knew the name of the antibiotic agent administered. Of those unaware of the antibiotic name, 59% had indicated their desire to know. Among those aware of their antibiotic therapy, 85% had trust in their doctors but only 42% felt that they always received answers to their questions on antibiotics in an understandable manner from their doctors. Furthermore, 41% felt that they were often or always not given enough time to question their doctors. To raise their awareness on antibiotic use, 73% of respondents felt that having protected time with the doctors to understand more about their antibiotic therapy would be effective. Conclusions: Most inpatients lacked knowledge of details of their antibiotic therapy, and fewer than half were involved in it. Allocation of protected time with doctors to understand their antibiotic therapy can be a potentially effective strategy to increase patient engagement to enhance hospital antibiotic stewardship efforts.
SG-APSIC1120: Hand hygiene knowledge: Its effect on hand hygiene adherence rate during the COVID-19 pandemic in the primary care setting
Authors: Yan Chau Chain , Li Giselle
Published: March 2023

Objectives: Good hand hygiene knowledge among healthcare workers (HCWs) is important in the fight against COVID-19. The coronavirus disease is primarily spread through droplet and contact routes, so hand hygiene and PPE are key infection control measures to protect patients and HCWs. We sought to determine whether hand hygiene knowledge scores had an impact on the hand hygiene adherence rate during a pandemic. Methods: Hand hygiene audit observations that were conducted covertly on a monthly basis and are presented as percentages of adherent reactions to moments to wash or sanitize hands. These data were examined in relation to HCW knowledge scores on hand hygiene. The knowledge scores on hand hygiene were analyzed based on 15 questions derived from WHO tools. Scores were determined using a quiz administered in a hand hygiene promotion event. Results: In total, 195 HCWs participated and scores on hand hygiene knowledge were ranked into 3 categories: 2% scored ≥90% (high), 60% scored 70%–89% (medium), and 38% scored ≤70% (low). Knowledge scores at the medium level and above were considered satisfactory. Even though 38% of the participants scored ≤70%, there was no direct impact on monthly hand hygiene audit observation rates in the 6 healthcare clinics. Hand hygiene observation rates ranged from 90% to 97%, with an overall mean of 92% for 2021. Conclusions: Contrary to studies that have shown the significant impact of knowledge on the hand hygiene adherence rate, our data suggest that a high hand-hygiene adherence rate is achievable and sustainable among HCWs. Adherence could be driven by attention to the importance of hand hygiene associated with the pandemic and potential exposure to COVID-19. High hand-hygiene compliance attains a place of importance in the minds of HCWs during a pandemic crisis.
SG-APSIC1097: The impact of COVID-19 on the incidence of carbapenem-resistant Enterobacterales (CRE) in Singapore: An interrupted time-series analysis
Authors: Ong Chong Hui Clara , Cheng Thoon Koh , Pada Surinder Kaur M S , Narayana Deepak Rama , Ooi Say Tat , Smitasin Nares , Fong Kok Choon Raymond , Koh Tse Hsien , Cherng Pei Zhi Benjamin , Lin Raymond , Pratim De Partha , Yang Hsu Li , Teo Jeanette , Ng Oon Tek , Venkatachalam Indumathi , Marimuthu Kalisvar
Published: March 2023

Objectives: Over the past 2 years, many infection prevention and control (IPC) resources have been diverted to manage the COVID-19 pandemic. Its impact on the incidence of antimicrobial-resistant organisms has not been adequately studied. We investigated the impact of the pandemic on the incidence of carbapenem-resistant Enterobacterales (CRE) in Singapore. Methods: We extracted data on unique CRE isolates (clinical and/or surveillance cultures) and patient days for 6 public hospitals in Singapore from the carbapenemase-producing Enterobacteriaceae (CaPES) study group database, and we calculated the monthly incidence of CRE (per 10,000 patient days). Interrupted time-series (ITS) analysis was conducted with the pre–COVID-19 period defined as before February 2020, and the COVID-19 period defined as after February 2020. Statistical analyses were performed using Stata version 15 software. Results: From January 2017 to March 2021, 6,770 CRE isolates and 9,126,704 patient days were documented. The trend in CRE monthly incidence increased significantly during the pre–COVID-19 period (0.060; 95% CI, 0.033–0.094; P < .001) but decreased during the COVID-19 period (−0.183; 95% CI, −0.390 to 0.023; P = .080) without stepwise change in the incidence (−1.496; 95% CI, −3.477 to 0.485; P = .135). The trend in monthly incidence rate of CRE clinical cultures increased significantly during the pre–COVID-19 period (0.046; 95% CI, 0.028–0.064; P < .001) and decreased significantly during COVID-19 period (−0.148; 95% CI, −0.249 to −0.048; P = .048) with no stepwise change in the incidence (−0.063; 95% CI, −0.803 to 0.677; P = .864). The trend in monthly incidence rate of CRE surveillance cultures decreased during the pre–COVID-19 period (−0.020; 95% CI, −0.062 to 0.022; P = .341) and the COVID-19 period (−0.067; 95% CI, −0.291to 0.158; P = .552) without stepwise change in the incidence (−1.327; 95% CI, −3.535 to 0.881; P = .233). Conclusions: The rate of CRE in clinical cultures decreased during COVID-19 but not the rate in surveillance cultures. Further studies are warranted to study the impact of COVID-19 on CREs.

(DUPLICATE DELETED)
SG-APSIC1157: The attributable mortality and excess length of stay associated with third-generation cephalosporin-resistant Enterobacterales bloodstream infections—A prospective cohort study in Suva, Fiji
Authors: Loftus Michael , Young-Sharma Tracey , Cheng Allen , Jenney Adam , Lee Sue , Naidu Ravi , Peleg Anton , Stewardson Andrew
Published: March 2023

Objectives: Although antimicrobial resistance (AMR) disproportionately affects low- and middle-income countries (LMICs), primary clinical data on AMR burden from LMICs are lacking, particularly from the Pacific Islands. We adapted recent World Health Organization methodology to measure the impact of third-generation cephalosporin (3GC) resistance on mortality and excess length of hospital stay among inpatients with Enterobacterales bloodstream infection (BSI) in Fiji. Methods: We conducted a prospective cohort study of inpatients with Enterobacterales BSIs at Colonial War Memorial Hospital in Suva. We collected demographic, clinical, and microbiological data, and we stored bacterial isolates for confirmatory testing and molecular genomics in Melbourne, Australia. We employed cause-specific Cox proportional hazards models to estimate the effect of 3GC-resistance on hazard of in-hospital mortality and discharge alive (competing outcomes), and we used multistate modelling to estimate the excess length of hospital stay associated with 3GCR. Results: From July 2020 to February 2021, we identified 162 consecutive Enterobacterales BSIs, and 66 (40.7%) were 3GC resistant. The crude mortality rates for patients with 3GC-susecptible and 3GC-resistant BSIs were 16.7% (16 of 96) and 30.3% (20 of 66), respectively. Also, 3GC resistance was not associated with either in-hospital mortality (aHR, 1.67; 95% CI, 0.80–3.49) or discharge alive (aHR, 0.75; 95% CI, 0.50–1.12). However, patient comorbidities and acuity of illness were associated with in-hospital mortality. Furthermore, 3GC-resistance was associated with an increased length of stay of 2.6 days (95% CI, 2.5–2.8). Overall, 3GC-resistance was more common among patients with hospital-associated than community-acquired infection, but genomics did not identify clonal transmission. Conclusions: Among patients with Enterobacterales BSIs, mortality was relatively high, and 3GC resistance was common. Also, 3GC resistance was associated with increased hospital length of stay but not with in-hospital mortality after adjusting for potential confounders. Accurate estimates of the burden of AMR are important, especially from LMICs. Such knowledge can inform policy decisions, guide allocation of limited resources, and assist the evaluation of future interventions to address AMR.
SG-APSIC1069: Implementing infection prevention bundle significantly reduced multidrug-resistant organisms infection and healthcare-associated infections in intensive care unit at a national hospital in Vietnam
Authors: Phung Thang , Hong Thoa Vo Thi , Thi Ven Le , Tien Dung Phan , Quoc Hung Le
Published: March 2023

Objectives: In Vietnam, the burden of healthcare-associated infections (HAIs), especially by multidrug-resistant organisms (MDROs), can be greater at national hospitals where a high number of severe patients from lower-tier hospitals are received for treatment. To reduce MDRO and HAI incidences at the tropical diseases intensive care unit (ICU) of Cho Ray Hospital, the final line of treatment for 20 southern provinces of Vietnam, a comprehensive infection prevention bundle was developed and implemented in 2019. In this retrospective study, we evaluated the effectiveness of this intervention in preventing MDRO infections and HAIs among patients at risk. Methods: The infection prevention bundle included elements to improve administration controls, environmental controls, and personal protective equipment usage. The bundle was implemented via training and active monitoring. Medical data, such as microbiology results, length of hospital stay, treatment cost of all patients admitted to the targeted ICU, and data on adherence to the bundle elements, were collected via routine monitoring from July to December 2019. These data were reviewed and analyzed. An independent 2-sample t test was used to calculate the significance of the differences in MDRO and HAI rates before and after the intervention. Results: The mean number of MDRO infections decreased significantly after implementation of the infection prevention bundle (7.0 vs 3.3; P = .011). HAI and ventilator-associated pneumonia (VAP) rates also decreased significantly (5.9 vs 3.7; P= .013 and 20.4 vs 13.7; P=0.047, respectively). The mean total treatment cost per patient was reduced by 1.8 million VND (US $76.76). Bundle-element adherence was high throughout the intervention period, ranging from 72.7% (putting MDRO sign on beds) to 100% (hand hygiene, cohort patients, environment cleaning). Conclusions: Implementation of an appropriate infection prevention bundle with a high adherence rate by healthcare workers helped to effectively reduce MDRO infection and HAI rates in the tropical diseases ICU.
SG-APSIC1164: Cost-effectiveness of temporary isolation rooms in acute-care settings in Asia
Authors: Graves Nicholas , Cai Yiying , Fisher Dale , Kiernan Martin , Mitchell Brett
Published: March 2023

Objectives: We estimated the change to health-service costs and health benefits resulting from a decision to adopt temporary isolation rooms, which are effective at isolating the patient within a general ward environment. We assessed the cost-effectiveness of the decision to adopt temporary isolation rooms in a Singapore hospital. Methods: Existing data were used to update a model of the impact of adopting temporary isolation rooms on healthcare-associated infections. We predicted the expected change to health service costs and health benefits, measured in life years gained. Uncertainty was addressed using probabilistic sensitivity analysis, and the findings were tested with plausible scenarios to determine the effectiveness of the intervention. Results: We predicted 478 fewer HAIs per 100,000 occupied bed days resulting from a decision to adopt temporary isolation rooms. This decreased would result in cost savings of SGD$329,432 (US $247,302) and 1,754 life years gained. When the effectiveness of the intervention was set at 1% of cases of HAI prevented, the incremental cost per life year saved was SGD$16,519 (US $12,400), indicating that this would be a cost-effective measure in Singapore. Conclusions: We have provided evidence that adoption of a temporary isolation room would be cost-effective for Singapore acute-care hospitals. Using temporary isolation rooms may be a positive decision for other countries in the region with fewer resources for infection prevention and control.
SG-APSIC1053: Detection of SARS-COV-2 in nasopharyngeal swags with MALDI-TOF MS and machine learning
Authors: Kadyrova Irina , Kolesnichenko Svetlana , Korshukov Ilya , Kolesnikova Yevgeniya , Barkhanskaya Valentina , Lavrinenko Alyona , Sultanbekova Aidana , Yegorov Sergey , Babenko Dmitriy
Published: March 2023

Objectives: The widespread distribution of SARS-CoV-2 and its high contagiousness pose a challenge for researchers seeking to develop a rapid and cost-effective screening method to identify carriers of this virus. RT-PCR is considered the gold standard for detecting viral RNA in nasopharyngeal swabs, but it is time-consuming and requires constant changes in the primer composition due to the mutation of SARS-CoV-2 strains. We propose a method for the detection of SARS-CoV-2 in nasopharyngeal swabs using MALDI-TOF MS and machine learning. Methods: Nasopharyngeal swabs from patients with PCR-confirmed COVID-19 and control participants were tested (130 and 80 swabs, respectively) with MALDI-TOF MS MicroFlex LT using the HCCA matrix. MALDI spectra were preprocessed in R version 4.1.2 software with the MALDIquant R package using the workflow: sqrt transformation, wavelet smoothing, SNIP-based base removal, and PQN intensity calibration. Peaks were detected with MAD algorithms with following Peak alignment on the following parameters: minFreq 70% and tolerance 0.005. Machine learning was performed with the rtemis r package on GLM, random forest, and XGBoost models. Results: These models were characterized by specificity, sensitivity, and F1 score. GLM models (specificity 1 and sensitivity 0.5) showed a low F1 score of 0.71. However, the random forest and XGBoost models demonstrated sensitivity, specificity, and F1 score equaling 1. Conclusions: We propose a screening method for SARS-CoV-2 detection (sensitivity 1 and specificity 1). This methodology combines the analysis of nasopharyngeal swab samples using MALDI-TOF-MS with machine learning. It is suitable for screening patients with COVID-19 at the first stages of diagnosis. Random forest and XGBoost models demonstrated sensitivity, specificity, and F1 scores equaling 1.
SG-APSIC1058: Microbiological surveillance of endoscopes in a Singapore tertiary-care academic hospital: A retrospective study from 2018 to 2021
Authors: Zhang Zhimin , Bien Molly How Kue , Chee Lee Lai , Sellamat Nenny Suzanah Binte , Hoon Chua Puay , Mun Lai Kai , Lin Ling Moi
Published: March 2023

Objectives: Improper reprocessing of endoscopes may result in healthcare-associated infections. Regular microbiological surveillance is an important means of evaluating the quality of endoscope reprocessing. We evaluated the effectiveness of reprocessing endoscopes (including the protocols on steps to be taken in the event of any positive microbiological results) in a sterile supply unit (SSU) and an endoscopy unit in a Singapore tertiary-care academic hospital. Methods: Singapore General Hospital (SGH) is a 1,750-bed, tertiary-care, academic medical center in Singapore with 2 main SSUs: 1 inpatient endoscopy unit and 1 outpatient endoscopy unit. We reviewed microbiological surveillance results from endoscopes following reprocessing from January 2018 to December 2021. In total, 160 endoscopes (27 bronchoscopes, 58 gastroscopes, 52 colonoscopes, 6 duodenoscopes, 5 echoscopes, 5 cystoscopes, 5 rhinolaryngoscopes, and 5 enteroscopes) and 15 automated endoscope reprocessors (AERs) were evaluated for the presence of microorganisms. Samples were obtained by swabbing the tip of the scope and the biopsy channel. Fluid was flushed from the biopsy channel after reprocessing, and this water from the AERs was sampled after waterline disinfection. Results: Of the 15,783 samples collected, 15,667 (99.3%) yielded no growth; 36 (0.2%) were positive for gut and environmental flora; and 80 (0.5%) were positive for low-concern organisms such as skin flora. Conclusions: Microbiological surveillance yielded a high percentage of negative results confirming the effectiveness of endoscope reprocessing. This quality-assurance process is necessary and beneficial in achieving patient safety.