bluuebunny/crossref_metadata_2025 huggingface dataset:
The value of myocardial work in patients with left ventricular hypertrophy
Authors: Fan Jiali , Ma Changsheng , Wang Heng , Zhou Bingyuan
Published: March 2023

Myocardial work derived from pressure-strain analysis resembles a novel non-invasive method for myocardial function evaluation. Left ventricular hypertrophy (LVH) is commonly detected in Fabry disease (FD), cardiac amyloidosis (CA) and hypertension (HTN). The study aimed to demonstrate the characteristics of myocardial work in patients with LVH suffering from FD, CA, and HTN. Echocardiography were performed in patients with LVH suffering from FD (n = 13), light chain associated cardiac amyloidosis (AL-CA) (n = 29) and HTN (n = 72), 25 healthy controls were also included in the current study. Conventional and myocardial work parameters were assessed and compared among FD, AL-CA, HTN and controls. Patients with FD and AL-CA were included in the group of infiltrative cardiomyopathy. Logistic regression analysis was used to identify independent predictors for discriminating infiltrative cardiomyopathy from hypertension. Compared with controls, HTN patients had preserved global work index (GWI) and global constructive work (GCW) and reduced global longitudinal strain (GLS) and global work efficiency (GWE) (p < 0.05), but patients with FD and AL-CA had reduced GLS, GWI, GCW and GWE and increased global wasted work (GWW) (p < 0.05). GWI and GCW could discriminate infiltrative cardiomyopathy from HTN independently with high accuracy (GWI cut-off value 1626 mmHg%, sensitivity 0.87, specificity 0.82, area under the curve 0.90; GCW cut-off value 2021 mmHg%, sensitivity 0.84, specificity 0.88, area under the curve 0.91). GWI and GCW were reduced in FD and AL-CA patients, but not in patients with HTN. Myocardial work had an addictive value in differentiating infiltrative cardiomyopathy from hypertension.
Teaching Approaches for STEM Integration in Pre- and Primary School: a Systematic Qualitative Literature Review
Authors: Larkin Kevin , Lowrie Thomas
Published: March 2023

In the last 5 years, there have been several literature reviews or meta-analyses investigating various aspects of STEM education; however, they have investigated a specific aspect of STEM, e.g. robotics, or digital games, or Early childhood, or Teacher perspectives. In addition, a broad-reaching review on STEM integration has not been conducted in the past 10 years. This article reports findings from a Systematic Qualitative Literature Review concerning STEM education for children aged 4–12 in formal education contexts. To provide context, the article initially presents descriptive findings (date and country of research, age of participants, research setting, and research methodologies used) in the 60 research articles that are included for analysis. The article then answers three research questions regarding the: (1) level of integration evident in the studies; (2) role of engineering in any such integration; and (3) teaching approaches used in the studies. Findings from this research suggest that there is still much work to be done to move from scenarios where STEM integration is claimed but is not evident in practice. To do so we encourage educators and researchers to (a) focus on authentic interdisciplinary approaches rather than the siloed approaches evident in the existing research; and (b) use a teaching approach such as problem-based or project-based learning that provide opportunities for authentic integration.
A Longitudinal Exploration of How Connections to Staff Facilitate Efficacy and Service Use in Drop-in Centers Serving Youth Experiencing Homelessness
Authors: Rice Eric R. , DiGuiseppi Graham , Onasch-Vera Laura , Casey Erin , Cooper Toni , DiBattiste Mischa
Published: March 2023

Introduction: Youth experiencing homelessness (YEH) benefit from a variety of services to meet their immediate and long-term needs. Drop-in centers are a popular service venue used by YEH. However, the mechanisms responsible for engaging youth in drop-in services are not clear. The current study uses longitudinal data to explore the role of positive staff relationships in increasing youths’ knowledge and efficacy to access and subsequently use drop-in center services. Methods: 731 youth (Mage = 21.8, SD = 2.2, 25.1% female) accessing services at three drop-in centers in Los Angeles, California participated in the study. Surveys were completed at baseline, 1-month, and 3-months later. Path models examined the direct effect of positive relationships with adult staff on service use at the 3-month follow-up, and the indirect effect of service knowledge (assessed at the 1-month follow-up). Results: The direct effect model showed that positive staff relationships at baseline were significantly associated with number of services used at the 3-month follow-up (aIRR = 1.24, 95% CI: 1.00, 1.54). Positive staff relationships were also associated with greater service knowledge at 1-month (b = 0.93, p < 0.001), which in turn was associated with greater service use at 3-months (IRR = 1.15, 95% CI: 1.04, 1.28). The indirect effect of service knowledge was significant (b = 0.13, p = 0.02), suggesting that the association between positive staff relationships and service use was completely mediated by service knowledge. Conclusions: The current study adds to the literature by demonstrating that positive relationships with staff lead to increased service use by increasing youths’ knowledge and efficacy to access services. Efforts should be made to develop positive relationships with YEH in order to engage them in essential services needed to exit homelessness.
Robot-assisted thoracic surgery for stages IIB–IVA non-small cell lung cancer: retrospective study of feasibility and outcome
Authors: Shahin Ghada M. M. , Vos Peter-Paul W. K. , Hutteman Merlijn , Stigt Jos A. , Braun Jerry
Published: March 2023

Robot-assisted thoracic surgery (RATS) for higher stages non-small cell lung carcinoma (NSCLC) remains controversial. This study reports the feasibility of RATS in patients with stages IIB–IVA NSCLC. A single-institute, retrospective study was conducted with patients undergoing RATS for stages IIB–IVA NSCLC, from January 2015 until January 2020. Unforeseen N2 disease was excluded. Data were collected from the Dutch Lung Cancer Audit database. Conversion rate, radical (R0) resection rate, local recurrence rate and complications were analyzed, as were risk factors for conversion. RATS was performed in 95 patients with NSCLC clinical or pathological stages IIB (N = 51), IIIA (N = 39), IIIB (N = 2) and IVA (N = 3). 10.5% had received neoadjuvant chemoradiotherapy. Pathological staging was T3 in 33.7% and T4 in 34.7%. RATS was completed in 77.9% with a radical resection rate of 94.8%. Lobectomy was performed in 67.4% of the total resections. Conversion was for strategic (18.9%) and emergency (3.2%) reasons. Pneumonectomy (p = 0.001), squamous cell carcinoma (p < 0.001), additional resection of adjacent structures (p = 0.025) and neoadjuvant chemoradiation (p = 0.017) were independent risk factors for conversion. Major post-operative complications occurred in ten patients (10.5%) including an in-hospital mortality of 2.1% (n = 2). Median recurrence-free survival was estimated at 39.4 months (CI 16.4–62.5). Two- and 5-year recurrence-free survival rates were 53.8% and 36.7%, respectively. This study concludes that RATS is safe and feasible in higher staged NSCLC tumors after exclusion of unforeseen N2 disease. It brings new perspective on the potential of RATS in higher stages, dealing with larger and more invasive tumors.
Selective Pb2+ removal and electrochemical regeneration of fresh and recycled FeOOH
Authors: Wang Lei , Deligniere Lexane , Husmann Samantha , Leiner Regina , Bahr Carsten , Zhang Shengjie , Dun Chaochao , Montemore Matthew M. , Gallei Markus , Urban Jeffrey J. , Kim Choonsoo , Presser Volker
Published: March 2023

Heavy metal pollution is a key environmental problem. Selectively extracting heavy metals could accomplish water purification and resource recycling simultaneously. Adsorption is a promising approach with a facile process, adaptability for the broad concentration of feed water, and high selectivity. However, the adsorption method faces challenges in synthesizing high-performance sorbents and regenerating adsorbents effectively. FeOOH is an environmentally friendly sorbent with low-cost production on a large scale. Nevertheless, the selectivity behavior and regeneration of FeOOH are seldom studied. Therefore, we investigated the selectivity of FeOOH in a mixed solution of Co2+, Ni2+, and Pb2+ and proposed to enhance the capacity of FeOOH and regenerate it by using external charges. Without charge, the FeOOH electrode shows a Pb2+ uptake capacity of 20 mg/g. After applying a voltage of −0.2/+0.8 V, the uptake capacity increases to a maximum of 42 mg/g and the desorption ratio is 70%–80%. In 35 cycles, FeOOH shows a superior selectivity towards Pb2+ compared with Co2+ and Ni2+, with a purity of 97% ± 3% in the extracts. The high selectivity is attributed to the lower activation energy for Pb2+ sorption. The capacity retentions at the 5th and the 35th cycles are ca. 80% and ca. 50%, respectively, comparable to the chemical regeneration method. With industrially exhausted granular ferric hydroxide as the electrode material, the system exhibits a Pb2+ uptake capacity of 37.4 mg/g with high selectivity. Our work demonstrates the feasibility of regenerating FeOOH by charge and provides a new approach for recycling and upcycling FeOOH sorbent.
The role of movement in young children’s spatial experiences: a review of early childhood mathematics education research
Authors: McCluskey Catherine , Kilderry Anna , Mulligan Joanne , Kinnear Virginia
Published: March 2023

Young children’s spatial reasoning is critical to mathematics learning from an early age. Recent reviews have drawn attention to the importance of mathematical experiences in the early years; however, an explicit focus on research in spatial reasoning can contribute to a more coherent account of the field. This paper reports a scoping review of qualitative studies (n = 37) during the years 2009–2021. The studies analysed in this review provide insight into children’s embodied spatial concepts and non-verbal expressions such as gesture and the relationship between spatial reasoning and mathematics learning in early childhood (birth to 8 years). Four main themes were found: (i) children’s manipulation and transformation of objects, (ii) children’s bodily engagement with and within spaces, (iii) children’s representation and interpretation of spatial experiences, and (iv) contexts for spatial learning. While the review illuminates a deeper awareness and a more holistic and embodied view of children’s spatial competencies, there remains few studies focussed on children under three years of age. Future directions for ongoing research are identified.
Parental Survey on Spanish-English Bilingualism in Neurotypical Development and Neurodevelopmental Disabilities in the United States
Authors: del Hoyo Soriano Laura , Villarreal Jennifer , Abbeduto Leonard
Published: March 2023

Objectives

The cognitive and social benefits of bilingualism for children, including those with neurodevelopmental disabilities (NDDs), have been documented. The present study was designed to characterize and compare English and Spanish use in Hispanic families with and without NDDs residing in the U.S. as well as to understand parental perceptions of their child’s bilingualism and of community and professional support.

Methods

We conducted an online survey of 84 Spanish-speaking parents of 4- to 24-year-olds with (n = 44) and without NDDs (n = 40) who were born in and living in the U.S.

Results

We found that bilingualism was a desired goal for 95% of our families. We also found, however, that 17.1% of parents of children with NDDs have raised them as monolinguals English-speakers, as they thought there were reasons for that, while all families from the NT group raised their children in both languages. In addition, nearly 40% of the NDD children only speak English, compared to a 5% in the NT group. Finally, parents of children with NDDs cite a lack of support for bilingualism in the community (47.6% do not feel supported, compared to a 7.9% in the NT group) and recommendation from professionals as major factors for not raising their children as bilingual.

Conclusions

The results suggest a need to educate professionals from many disciplines about the benefits of bilingualism for children with NDDs and for implementation of inclusion policies that provide access to dual-language programs.
Are public—private partnerships still an answer for social infrastructure? A systematic literature review
Authors: Ma Liang , Hu Yangyang , Zhu Liuying , Ke Yongjian
Published: March 2023

Social infrastructure has become an important element for measuring national economic development and social benefits that are usually financed in the form of government grants, private investment, and public—private partnerships (PPPs). However, social infrastructure PPPs have attracted considerable public debate due to their low profitability and complex operational demands. This study aims to answer the question, “are PPPs still an answer for social infrastructure?”, from the perspectives of the body of knowledge, application status, and prospects. Initially, an iterative search and review procedure and a scientometric analysis were performed to systematically screen the literature and to structure the body of knowledge of the social infrastructure PPPs literature. Furthermore, the application status and trends were analyzed to further explore the studied countries/regions, application sectors, and research topics. Results show that PPPs still have valuable application potential for delivering social infrastructure despite their mixed results across different topics. Six main research themes and the corresponding research trends were also identified, namely, financing and economics viability, risk management, performance management, contract and relationship management, governance and regulation, and facilitating and hindering factors. These findings offer practitioners and researchers a comprehensive overview and constructive guidance on social infrastructure PPPs.
Resiliency in Space Autonomy: a Review
Authors: Banerjee Avijit , Mukherjee Moumita , Satpute Sumeet , Nikolakopoulos George
Published: March 2023

Purpose of Review:

The article provides an extensive overview on the resilient autonomy advances made across various missions, orbital or deep-space, that captures the current research approaches while investigating the possible future direction of resiliency in space autonomy.

Recent Findings:

In recent years, the need for several automated operations in space applications has been rising, that ranges from the following: spacecraft proximity operations, navigation and some station keeping applications, entry, decent and landing, planetary surface exploration, etc. Also, with the rise of miniaturization concepts in spacecraft, advanced missions with multiple spacecraft platforms introduce more complex behaviours and interactions within the agents, which drives the need for higher levels of autonomy and accommodating collaborative behaviour coupled with robustness to counter unforeseen uncertainties. This collective behaviour is now referred to as resiliency in autonomy. As space missions are getting more and more complex, for example applications where a platform physically interacts with non-cooperative space objects (debris) or planetary bodies coupled with hostile, unpredictable, and extreme environments, there is a rising need for resilient autonomy solutions.

Resilience with its key attributes of robustness, redundancy and resourcefulness will lead toward new and enhanced mission paradigms of space missions.
SG-APSIC1182: Sequential time workforce management
Authors: Sirijindadirat Nanthipha
Published: March 2023

Objectives: Since 2018, the workload in the central sterilization services department (CSSD) has intensified as surgeries have increased. The extended operative time among complicated surgical cases has also led to shortages of resterilized surgical instruments. One factor influencing these shortages was inadequate CSSD staff during high workload periods. We developed a strategy to improve the availability of resterilized instruments. We sought to reduce wasted time and improve effectiveness of surgical instrument preparation by adopting a shift-work arrangement. We additionally sought to minimize unorganized instrumentation and surgical equipment loss. Methods: Team members investigated workload disproportion shift by shift. We devised a practical arrangement of staff for each work shift by dividing manpower in ratios based on workload. Results: The period from 10:00 a.m. to 7:00 p.m. was the period of most intense workload in the CSSD. However, 3 staff worked the morning shift and 2 staff worked the evening shift (4:00 p.m.– 2.00 a.m.). We reassigned 1 person to work from 8.00 a.m. to 4.00 p.m. and 2 persons for an extra shift from 10:30 a.m. to 6:30 p.m. After the manpower readjustment, surgical equipment damage and loss decreased from 57 to 26 losses per year from 2018 to 2021. In addition, work productivity increased from 85% to 115%. Worker satisfaction improved >70%. Conclusions: Internal inconsistency concerning instrumental preparation and improper instrument arrangement can affect surgery time. By addressing workload and shift distribution of labor, productivity notably improved, with higher satisfaction and a dramatic decrease in surgical equipment loss.
SG-APSIC1024: The importance of the washing evaluation of flusher disinfector in the medical site: Visual evaluation with the ISO standardized test soil and adenosine triphosphate level
Authors: Shima Mari , Yoshida Rika , Okubo Takashi
Published: March 2023

Objectives: We examined the washing evaluation method of the flusher disinfector installed in the medical site by visual evaluation using an ISO test soil and adenosine triphosphate (ATP) measurement. Methods: The test soil shown in ISO15883-5 was applied to the bedpan using 2 methods (N = 10) and was then visually evaluated using a 4-step scale. The ATP value on the surface of the bedpan corresponding to each scale was measured, and the correlation with the visual scale was confirmed. In addition, a visual evaluation was performed using a different flusher disinfector and bedpan (N = 3). Results: In the visual evaluation, when the test soil was applied to the entire surface of the bedpan, it remained in the parts where the water flow was hard to hit. When the test soil was applied to the surface of the bedpan except the lid, no soil remained. The 4-step visual evaluation scale and the logarithm of ATP value showed a positive correlation. In visual evaluations with different flusher disinfector and bedpan combinations, the residual soil patterns tended to be different. Some bedpans showed washing failure related to improper design. Conclusions: Poor cleaning of flusher disinfectors may occur when the amount of water used is insufficient or when the bedpan is significantly contaminated. It is important to carry out flusher disinfector washing evaluation at medical sites to evaluate the function of flusher disinfectors. An appropriate program must be utilized for staff education and appropriate management. Because flusher disinfectors and bedpans differ, flusher disinfector cleaning evaluations should be carried out at all facilities.
SG-APSIC1047: Patient instrument tracking system
Authors: Sirijindadirat Nanthipha , Noilek Pattaraporn , Somboonsap Dujdarin
Published: March 2023

Background: In the post–COVID-19 era, competency of healthcare workers is very important, and new technology is imperative. The central sterile supply department (CSSD) staff must also improve their response when a patient infection is reported. The sterilization process is more important than ever. Objectives: We sought to simplify surveillance to act faster, to reduce the time to obtain patient data, and to eliminate nonvalue stream mapping in the workflow process in order to prevent patient harm and strengthen our infection prevention and control efforts. Methods: The CSSD staff met with an IT developer to determine requirements for an electronic surveillance program. Before this intervention, we scanned hard copies of patient records and stored them in a folder on a computer on a daily basis. These data were difficult to search, monitor, and display, and this method wasted time in locating patient data. The IT developer designed a program to track patients and instruments. The program collected data regarding the patient’s surgery, instruments used, and monitoring information. With the help of the IT developer, the CSSD staff tested and tweaked the new platform until accuracy and usability were achieved. Staff were trained on the use of the new system before it was implemented. Results: This project yielded simplified surveillance that improved the infection prevention process, reduced potential patient harm, and strengthened the ability of the IPC team to analyze and act on data. Conclusions: A simple surveillance system for tracking patients and instruments used assists both CSSD and IPC teams. This system assures the performance of sterilization procedures. When adverse events occur, patients who used these devices are tracked, and an analysis is performed to identify and implement improvements.
SG-APSIC1181: Design of a temperature and humidity alert system
Authors: Sirijindadirat Nanthipha
Published: March 2023

Objectives: The central sterile supply department (CSSD) is responsible for sterilization processes, and instruments are then stored in a clean room until use. Environmental controls, such as temperature, and relative humidity, are important in preventing the spread of infection during the sterilization process and during storage of medical devices. Data regarding temperature and relative humidity readings in the operating room, and whether instruments remain covered for the duration of the operation, are difficult to obtain. For easy access to relative temperature and humidity data covering all operational intervals, a rapid and convenient notification system was designed using a software application to send temperature and humidity information to the ThingSpeak website. We identified abnormal values for temperature and relative humidity and submitted revisions for all operating periods to facilitate monitoring of the refrigeration system. Methods: We implemented 3 programs: (1) DHT11 humidity and temperature sensor; (2) NodeMCU ESP8266; and (3) Program Arduino IDE. Results: The ESP8266 board connected using WIFI SUTH Mobile, and the DHT11 displayed temperature and humidity. The temperature and humidity data were sent to the website every 10 minutes. When an alarm occurred, it triggered immediate notification via the software application. Conclusions: We designed a temperature and humidity alert system using DHT11. Environmental control was possible using ESP8266, and alerts were triggered in the software application when an anomaly occurred. Data were uploaded to ThingSpeak every 10 minutes. The triple system actually sends alerts through the application and records data every 10 minutes. This system can measure environmental conditions in real time.
SG-APSIC1043: Creating an urgent operating room alert using Kaizen automation
Authors: Sirijindadirat Nanthipha
Published: March 2023

Objectives: We sought to reduce waiting time for instruments in the operating room, to develop technology for communication between zones, to record data in real time for planning instrument management, and to increase trust and satisfaction of customers. Methods: The central sterile supply department (CSSD) provides sterilization of instruments and medical devices, mostly to the following departments: operating room, dental unit, outpatient otolaryngology, and obstetrics and gynecology. The CSSD processes 557,588 units per month, among which 30.05% are for the operating room. In the normal process when the operating room send instruments for decontamination, the operating room staff places stickers on the item or uses a form to document the request. The normal turnaround time was 3 hours and 9 minutes and urgent turnaround time was 2 hours and 14 minutes. For color control, we used white color for normal requests and pink for urgent requests. We redesigned our record keeping using Google forms and sent data on dashboards with real-time alerts in the CSSD application to notify staff of an urgent request. Results: Staff in the dirty zone placed an urgent tag on the instrument baskets of the auto-washer. After the door was opened in the clean zone, staff noted the urgent tag and marked a validation sheet, then placed a red unilock on the rigid constrainer. Peel pouches were marked “urgent,” advising sterile storage zone staff to separate the basket from normal baskets and to apply the “urgent” paper form and labelling. Conclusions: Turnaround time improved by 15 minutes for urgent instruments. Lead time to export data for analysis increased from 80% to 95.49%. Because of facility design, it was difficult to ensure communication between separate dirty, clean, and sterile storage zones. We redesigned our process using new technology to improve turnaround times, reduce waste, improve communication, and increase productivity.
SG-APSIC1054: Sputnik-V postvaccination immunologic responses in nasal mucosa: A prospective cohort study in Kazakhstan
Authors: Kadyrova Irina , Kolesnichenko Svetlana , Korshukov Ilya , Kolesnikova Yevgeniya , Negmetzhanov Baurzhan , Baiken Yeldar , Sultanbekova Aidana , Yegorov Sergey , Babenko Dmitriy , Matkarimov Bakhyt , Hortelano Gonzalo , Miller Matthew S.
Published: March 2023

Objectives: Sputnik-V (Gam-COVID-Vac) is a recombinant adenoviral (rAdv) vector-based, COVID-19 vaccine now used in >70 countries. Mucosal immunity is thought to be important for protection against COVID-19. We did a prospective cohort study to assess Sputnik-V–elicited mucosal SARS-CoV-2 antibody responses. Methods: We divided 82 COVID-19–free participants into prior COVID-19 and no prior COVID-19 groups and followed them at day 21 after Sputnik-V dose 1′ (rAd5) and dose 2′ (rAd26). Nasopharyngeal swabs and blood were collected to perform SARS-CoV-2 diagnostic and immunologic assays. SARS-CoV-2 spike-specific IgG and IgA ELISAs were performed on both nasal swabs and blood. SARS-CoV-2 real-time RT-PCR testing was performed to exclude infectious influencing. Results: Nasal S-IgG levels increased 25-fold after dose 1′ (P < .001) and remained high after dose 2 in all participants. Prior COVID-19 exposure was associated with both elevated baseline mucosal IgG and IgA and higher postvaccination IgG, but not IgA, boost. Nasal IgA levels increased 16.5-fold after dose 1′ (P < .001) and remained high after dose 2’ in all participants. Compared to dose 1′, Sputnik-V dose 2′ did not further increase either mucosal IgG levels (P = .626) or IgA levels (P = .609). Conclusions: A single dose of Sputnik-V boosted mucosal SARS-CoV-2 immunity. The effects of Sputnik-V dose 2′ on mucosal immunity were minimal. These findings indicate (1) that intramuscularly administered adenoviral vaccines enhance SARS-CoV-2 immunity via both systemic and mucosal routes and (2) that cost-effectiveness and the efficacy of Sputnik-V vaccination could be improved by adjusting the current prime-booster regimen and extending the 21-day interval between the doses. Trial registration: Registered on ClinicalTrials.gov (no. NCT04871841).
SG-APSIC1089: Environmental screening of SARS CoV-2 to support an outbreak investigation in Sardjito Hospital, Yogyakarta, Indonesia
Authors: Bariyah Khairul , Dahesihdewi Andaru , Dewi Yunika Puspa , Nursanti Raeni
Published: March 2023

Objectives: Many healthcare workers and patients in intensive care units of Sardjito Hospital, a referral and academic hospital in Yogyakarta, Indonesia, were infected with SARS-CoV-2 in June–August 2021, during the second wave of the COVID-19 pandemic. Much evidence has shown that SARS-CoV-2 persists on hospital environmental surfaces and medical equipment. We investigated the potential sources of virus in our cases, particularly environmental contamination. Methods: Environmental screening for SARS-CoV-2 was conducted using RT-PCR of swabs collected from case-related medical equipment and hospital surfaces. We examined the environmental cleaning method in these areas as well. Results: We swabbed medical equipment in close contact with patient droplets such as the ventilator, the high-flow nasal cannula, the nebulizer, and suction equipment, as well as some environmental surfaces near the patient, such as the bed rail, air conditioning unit, and portable HEPA-filter outlet. Among 19 samples, genetic material of SARS-CoV-2 was detected only on a sample from a nebulizer. The point of contamination was on the outer body of that nebulizer, which indicated that the contact transmission source might be from patient droplets and/or inadequate cleaning. No more positive results emerged from our screening, indicating that the environmental cleaning was adequate. The IPC team recommended that we no longer use nebulizers for COVID-19 patients and that the cleaning procedure be improved, particularly after the device is used. Conclusions: Environmental screening for SARS-CoV-2 can be used to support investigations of inpatient COVID-19 outbreaks in hospitals. Adequate cleaning and care procedures for medical equipment are very important in preventing the transmission of SARS-CoV-2 in the hospital setting.
SG-APSIC1178: Factors influencing COVID-19 prevention practices among healthcare personnel in Rajavithi Hospital
Authors: Kamnon Kampong
Published: March 2023

Objectives: To determine the factors influencing COVID-19 prevention practices among healthcare personnel. Methods: The sample consisted of healthcare personnel working in the emergency department, inpatient wards, and the outpatient department in 250 Rajavithi hospitals selected using a purposive sampling method. Data were collected using questionnaires that were validated by 5 experts and had a content validity index of 0.83. The reliability of the questionnaires was 0.91. Data were analyzed using descriptive statistics and multiple regression. Results: Study participants had good attitudes toward behaviors, subjective norms, perceived behavioral control, and intention to prevent COVID-19. In addition, perceived behavioral control was the only factor that statistically predicted intention to perform COVID-19 infection prevention and may explain 25.6% of the variability of intention (P < .001). Conclusions: Based on the results of this study, relevant authorities, including wards and infection control units, should support perceived behavioral control among registered nurses to encourage COVID-19 prevention practices.
SG-APSIC1200: Infection prevention control along the fast track: Supporting the construction, operation, and closure of a COVID-19 community treatment facility in an F1 Pit
Authors: Tee Wee Ling , Jyoti Somani , Mahdi Razali Bin , Teo Cathrine
Published: March 2023

Objectives: The infection prevention team (IPT) was tasked with providing technical guidance for the construction and setup of a community treatment facility in 3 weeks at a Formula 1 (F1) racing pit to house elderly SARS-CoV-2–positive cases. Methods: The facility was setup with 737 beds including an isolation unit and a resuscitation bay. The multidisciplinary team decided on zone segregation (ie, green and hot zones) and discussed the clean–dirty workflow. IPC measures were revisited, especially regarding the layout of the donning and doffing station, as the facility expanded to accommodate patients with more comorbidities and those who needed dialysis. IPC training for nominated infection control liaison officers (ICLOs) was conducted using a “train the trainer” approach for mask fitting, hand hygiene, donning and doffing of personal protective equipment (PPE). Enhanced IPC measures, including weekly audit and staff surveillance, were mandatory, and monitoring was performed according to MOH guidelines. Linen and waste management and the cleaning and disinfection process were established at the beginning of the project. Results: Construction was completed within 3 weeks. The setup was completed in November 2021 for 737 beds. There were 758 admissions during the 4-month operation. In total, 12 trained ICLOs oversaw the training of 200 healthcare workers. They conducted 12 IPC audits and provided feedback to all staff. Compliance with PPE practices was inconsistent, and findings were shared during daily after-action reviews for improvement. The greatest challenges were converting the F1 facility to a healthcare facility, training staff with no IPC knowledge, and monitoring IPC on the ground. The trained ICLOs were successful in implementing, practicing, and monitoring IPC measures with minimal assistance from the infection prevention team. Conclusions: Operation began on November 5, 2021, and ceased on March 9, 2022. The community treatment facility construction, setup, and operations were completed within a short timeframe due to the efforts of various stakeholders. We faced many challenges, but we managed to implement and uphold IPC standards from beginning to end.
SG-APSIC1011: Factors associated with improved knowledge of COVID-19 prevention and control following a training of healthcare workers in Vietnam
Authors: Nguyen Hoang , Dien Tran Minh , Thu Le Thi Anh , Ngai Le Kien , Thuy Pham Thanh , Loan Do Minh , Tuan Ta Anh , Hai Do Thien , Phuc Phan Huu , Luyen Tran Huu , Tuan Huynh Minh , Thuy Le Thi Thanh , Ha Nguyen Thi Thanh , Thinh Bui Nghia , Huy Do Quoc , Pollack Todd M
Published: March 2023

Objectives: SARS-CoV-2 is a novel and highly infectious virus. An effective response requires rapid training of healthcare workers (HCWs). We measured the change in knowledge related to COVID-19 and associated factors before and after training of HCWs in Vietnam. Methods: A quasi-experimental design was used to evaluate HCW knowledge related to prevention and control of SARS-CoV-2 before and after attending a 2-day training-of-trainers course. Between June and September 2020, 963 HCWs from 194 hospitals in 21 provinces received the training. HCW knowledge was assessed using a 20-item questionnaire consisting of multiple-choice questions at the beginning and closing of the training course. A participant received 1 point for each correct answer. He or she was considered to have improved knowledge the posttest score was higher than the pretest score with a score ≥15 on the posttest. We applied the McNemar test and logistic regression model to test the level of association between demographic factors and change in knowledge of COVID-19. Results: Overall, 100% of HCWs completed both the pretest and posttest. At baseline, only 14.7% scored ≥15. Following the training, 78.4% scored ≥15 and 64.3% had improved knowledge according to the predetermined definition. Questions related to the order of PPE donning and doffing and respiratory specimen collection procedures were identified as having the greatest improvement (44.6% and 60.7%, respectively). Being female (OR, 1.5; 95% CI, 1.1–2.0), having a postgraduate degree (OR, 2.5; 95% CI, 1.4–4.4), working in a nonmanager position (OR, 1.5; 95% CI, 1.1–2.1), previous contact with a COVID-19 patient (OR, 1.5; 95% CI, 1.1–2.0), and working in northern Vietnam (OR, 2.0; 95% CI, 1.4–2.6), were associated with greater knowledge improvement. Conclusions: Most HCWs demonstrated improved knowledge of COVID-19 prevention and control after attending the training. Particular groups may benefit from additional training: those who are male, leaders and managers, those who hold an undergraduate degree, and those who work in the southern provinces.
SG-APSIC1129: Long-term effect of a bundled care program in reducing central-line–associated bloodstream infections
Authors: Liu Yingchieh , Liu Ying-Chieh , Lin Kuan-Yin , Fang Chi-Tai , Chang Yu-Jing , Pan Sung-Ching , Wang Jen-Tay , Sheng Wang-Huei , Chen Yee-Chun , Kao Jia-Horng , Chang Shan-Chwen
Published: March 2023

Objectives: Central-line–associated bloodstream infection (CLABSI) has been the leading cause of healthcare-associated infections (HAIs) in the intensive care unit (ICU) setting. Previous studies have shown that a care bundle is effective in reducing CLABSI rates; however, the data on long-term sustainability and cost savings of bundled care are limited. Methods: From January 2011 to December 2020, a prospective surveillance was performed to monitor CLABSI at a university hospital in northern Taiwan. To reduce the CLABSI rate, a hospital-wide bundled care program for CLABSI prevention was implemented in 2013. We evaluated the long-term effect of the care bundle on CLABSI incidence and length of stay in the ICU. Results: During the study period, the overall CLABSI incidence decreased from 8.22 per 1,000 catheter days before the care bundle was implemented to 6.33 per 1,000 catheter days in 2020 (P for trend <.01). The most common pathogens causing CLABSI were gut organisms (1,420 of 2,363, 60.1%), followed by environmental organisms (734 of 2,363, 31.1%) and skin organisms (177 of 2,363, 7.5%). The decreasing trend was statistically significant in the incidence of CLABSI caused by skin organisms (P for trend < .01), but not in the incidence of CLABSI caused by environmental organisms (P for trend = .86) or gut organisms (P for trend = .06). In the multivariable analysis, implementation of this care bundle was independently associated with a decrease in the CLABSI rate (RR, 0.77; 95% CI, 0.66–0.88). Compared with patients without CLABSI, patients with CLABSI had a longer average ICU length of stay (27 vs 17 days). Conclusions: A sustainable reduction in the incidence of CLABSI caused by common commensals could be achieved through a cost-saving bundled care program.
SG-APSIC1170: Reduction of hospital-onset MRSA bacteremia with chlorhexidine baths among MRSA-colonized patients
Authors: Cabahug Maria Theresa , Cabahug Theresa , Jie Li , Yun Foo Shi , Di Wu Tuo , Hairu Chai , Kaur Harminder , Nasir Suhailah Binte
Published: March 2023

Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) is a major concern for hospitalized patients in Singapore. Hospital-onset (HO) MRSA bacteremia is monitored at the national level as an indicator of hospital quality. Patients who have colonized with methicillin-resistant Staphylococcus aureus (MRSA) are more likely to develop an MRSA infection in the future. A topical antiseptic solution or cloth called chlorhexidine gluconate (CHG) is effective against several gram-positive and gram-negative bacteria, including MRSA. Methods: The following control measures were present before and throughout the study period: (1) active screening of MRSA upon admission; (2) initiation of contact precaution once MRSA is detected; and (3) emphasis on strict hand hygiene. In January 2021, an intervention was for routine application of CHG bathing as follows: (1) training materials were developed; (2) train-the-trainer sessions were organized; (3) compliance regarding the application of CHG baths was monitored; and (4) the postimplementation process was reviewed. Results: There was no change of hand hygiene rate before and after implementation. In 2020, 17 cases of MRSA bacteremia occurred in the hospital, with an infection incidence of 0.54 per 10,000 patient days. In 2021, there were 10 cases of HO-MRSA bacteremia infection, with an overall rate of was 0.30 per 10,000 patient days. Conclusions: Daily bathing with chlorhexidine reduced the risk of MRSA acquisition and of hospital-acquired bacteremia.
SG-APSIC1056: Finding the right fit: Our experience in quantitative N95 respirator fit-testing
Authors: Ong Jin Min Sheena , Ismail Bushra Binte Shaik , Min Sheena Ong Jin , Xin Gillian Lee Li , Chee Lee Lai , Bien Molly How Kue , Lin Ling Moi
Published: March 2023

Objectives: Following a cluster of COVID-19 cases in a Singapore public hospital in April 2021, the local health authority mandated the use of N95 respirators in all inpatient wards. This increased the demand for N95 mask fit-testing to ensure that healthcare workers were donning respirators that fit their facial characteristics and hence provided protection through a good facial seal. The demand for fit-testing during the pandemic highlighted the scarcity of manpower and ergonomics concern, such as carpel tunnel syndrome experienced in long hours of qualitative fit-testing sessions. We evaluated the operational efficiency, cost-effectiveness, and difference in passing rate after the introduction of the quantitative method. Methods: Conventional qualitative fit-testing was conducted using manual pumping of a challenge agent, enabling the user to determine the fit of the respirator. The quantitative fit-testing protocol used a condensation particle counter (CPC) to measure the concentration of particles inside the mask and the atmosphere to determine the fit of respirator. The Occupational Safety and Health Administration (OSHA)–approved minimum fit factor of 100 was used as the criterion for a successful N95 respirator fit. Tubes used during quantitative fit-testing were reprocessed using thermal disinfection. Results: Quantitative mask fit-testing provided an objective numerical measure to assess adequate fit of N95 respirator, which provided users with confidence in the respirator fit. It addressed a manpower limitation issue because it did not require qualified trainers to conduct the test, and automation also prevented any potential occupational hazard from repeated actions required in qualitative fit-testing. An increase in the passing rate for N95 fit-testing from 94.5% to 95.5% was observed. However, the high cost of equipment, annual recalibration, and consumables must be considered. Conclusions: Quantitative N95 fit-testing, when adopted with careful consideration of its cost, is an approach to consider for hospital-wide fit-testing.
SG-APSIC1180: Successful reduction in the number of hospital-acquired dialysis-
catheter–related bloodstream infections: Quality improvement initiative
Authors: Koduri Sreekanth , Yen Tan Seow , Thirukonda Prasanna , Theresa Maria , Jie Alvin Chew Zhen , May Wang Hwee , Van Der Straaten Jane Caroline
Published: March 2023

Objectives: Patients undergoing hemodialysis using a catheter are at significant risk of developing central venous catheter–related bloodstream infections (CRBSIs), especially with methicillin-resistant Staphylococcus aureus (MRSA), resulting in increased morbidity, mortality, and cost. In our 1,000-bed regional hospital, the average CRBSI (any bacteria) rate in patients dialyzing via dialysis catheters was 1.44 per 1,000 catheter days, and the average CRBSI (MRSA) rate was 0.56 per 1,000 catheter days. A quality improvement project was initiated to reduce the overall dialysis CRBSI and CRBSI-MRSA by 50%. Methods: Following the formation of a multidisciplinary team, the catheter-insertion protocols and catheter-care protocols were standardized throughout the hospital. We adopted a well-established scientific quality improvement method, plan–do–study–act (PDSA) cycle model for all interventions that were implemented. The patients and general ward nursing staff were provided education and training in dialysis catheter care. Results: The project was initiated in January 2016, and the initial improvement was seen from July 2017 onward. Analysis of the data since 2016 showed a steady improvement in the overall CRBSI rates, as well as CRBSI-MRSA rates. The average CRBSI rate improved to 0.76 per 1,000 catheter days, and the average CRBSI-MRSA rates improved to 0.15 per 100 catheter days in the calendar year 2021. Conclusions: Because the causes of these infections are multifactorial, emphasis should be placed on improving care processes from the patient preparation phase prior to catheter insertion to regular catheter care in the inpatient wards and dialysis units. We attribute the success of our project to involving all stakeholders and obtaining constant feedback from the staff. We successfully applied PDSA cycles to make relevant incremental changes.
SG-APSIC1102: Antimicrobial resistance and related factors in an intensive care unit—A study at Hue Central Hospital
Authors: Dang Tan , Thihoa Mi Ho , Quyen Vo Dai , Thanh Tran Chi , Van Tuan Mai , Nhan Nguyen Thithanh , Phuoc Le Diem , Thithuan Ha , Nhi Hoang Thiquynh , Thuy Tran Thanh , Toan Nguyen Van Thanh , Huong Hoang Thilan
Published: March 2023

Objectives: Antimicrobial resistance (AMR) has emerged as a major concern in Vietnam, mainly due to the inappropriate use of antibiotics. Appropriate antibiotic management enables us to minimize the likelihood of antibiotic resistance and the spread of resistant bacteria. We evaluated vancomycin and colistin resistance and related factors in the intensive care unit (ICU) of Hue Central Hospital, a national hospital in central Vietnam. Methods: Using a cross-sectional descriptive study, we enrolled 362 patients who were prescribed antibiotics and were admitted to the ICU in 2019. Pathogens isolated from 473 routine clinical samples were subjected to antimicrobial susceptibility testing following the recommendations in the Clinical & Laboratory Standards Institute M100, 28thEdition. Colistin testing was performed using the broth microdilution method. Statistical significance was determined using the Fisher exact test. Results: The most commonly identified microorganisms were Acinetobacter baumannii (31.5%), Klebsiella pneumoniae (31.2%), Pseudomonas aeruginosa (12%), and Staphylococcus aureus (8.9%). All isolates of A. baumannii, K. pneumoniae, and P. aeruginosa tested with colistin were nonresistant. Moreover, >65% of A. baumannii isolates were resistant to all antibiotics except colistin. S. aureus had the highest resistance rate to erythromycin (80.6%), but no vancomycin-resistant isolates were identified. Factors associated with resistance to at least 1 antibiotic tested included length of stay (OR, 5.32; 95% CI, 1.47–19.17; P = .017), duration of antibiotics therapy (OR, 5.25; 95% CI, 1.46–18.95; P = .017), and the use of tracheal intubation and ventilator (OR, 3.08; 95% CI, 1.09–8.72; P = .038). Conclusions: These data indicated that although the vancomycin and colistin resistance rate is low, patients with longer length of stay, longer time on antibiotics, and invasive ventilation were at higher risk of AMR infection. Decreasing device use and strong antibiotic stewardship program at the hospital would help to reduce AMR infections.