bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antimicrobial resistance surveillance, intensive care units of a tertiary care hospital, Islamabad
Authors: Noreen N , Dil S , Ullah Khan N , Naveed I 
Published: October 2020

Abstract

Background
Hospital Acquired Infections (HAIs) are the emerging threat in the health care facilities around the globe. Most of Intensive Care Unit(ICU)patients are frequently on broad spectrum antimicrobials, this induces selective antibiotic pressure which leads to development of Antimicrobial Resistance (AMR) among the microorganisms of ICUs. Objective was to study the occurrence of different types of HAIs in patients admitted to various ICUs of and the AMR pattern of the bacterial pathogens isolated from them.

Methods
It was a retrospective descriptive study based on culture reports of the patients admitted to surgical, Medical ICU of tertiary care hospital during period from March 2019 to October 2019.

Results
Most common culture positive clinical specimen received was tracheal aspirate(35.3%) followed by exudate(22.7%).Pseudomonas from blood specimens were the most common organisms isolated; whereas Escherichia coli was the predominant organism found in urine, exudate and sterile fluid specimens. About 25% infections were HAIs, out of which pneumonia(7.24%)was the most common. Analysis of antimicrobial susceptibility pattern revealed that most of Gram-Negative Bacilli(GNB) was Multi Drug Resistant(MDR) resistant to three or more class of antibiotics such as cephalosporins, aminoglycosides, tetracyclines and fluoroquinolones.

Conclusions
Increasing trend of AMR among hospital acquired pathogens such as MDR-GNBs,MRSA and VRE pose a great threat to critically ill patients of ICUs. Study on AMR surveillance is the need of the hour as it helps the centers to generate local antibiogram which further helps in formulating the national data. Hence, such studies will be a stepping stone in establishing antimicrobial stewardship and regulate the antimicrobial resistance in future

Key messages
Study on AMR surveillance is the need of the hour. such studies will be a stepping stone in establishing antimicrobial stewardship and regulate the antimicrobial resistance in future.
Analytical approach for a better control of environmental contamination
Authors: Bosco R , Gambelli S , Urbano V , Cevenini G , Messina G 
Published: October 2020

Abstract

Background
The environment of hospital rooms plays a role on Hospital Acquired Infections. Objects may be repository of germs and have a role on cross contamination, mainly in high-touch surfaces. Proper sanitation and disinfection procedures are needed.

Aims
i) to highlight the different probabilities of microbial contaminations in Hospital, ii) to assess whether the use of a UVC device (UVC-D), after standard disinfection procedures, improves the level of hygiene.

Methods
Between November 2019 and February 2020 a cross sectional study in a real clinical context was conducted. Investigations were carried out in double rehabilitation rooms with patients admitted for at least 48h. 16 preliminary Petri dishes (PD) were used in one rehabilitation room and bathroom, to assess the contamination level after deep disinfection procedures (T0). Matched comparisons were made after the use of UVC-D, 3 points/room and 1 point/bathroom, 3 minutes each(T1). At T0 we estimated the probability of contamination to select the following sampling. Six rooms and bathrooms were investigated using randomized spots. PD were incubated at 36 °C and colony forming unit (CFU) counted at 48h. Descriptive statistic and Wilcoxon test were performed to assess the levels of contamination between (T0) and (T1).

Results
At T0 we have a mean of 5.83 CFU/PD (CI 3.79-7.86) and a median of 1.0 CFU/PD (min 0 - max 118); at T1 mean is 0.28 CFU/PD (CI 0.15-0.40) and median of 0 CFU/PD (min 0-max 5). Significant reduction of contamination was achieved between T0 and T1 (p &lt; 0.001). 83,33% of the contamination sites had 0 CFU/PD after using UVC-D.

Conclusions
The probability approach has driven the selection of the highest contaminations spots. Standard disinfection, followed by using UVC-D, significantly reduces contamination assuring a lower probability of cross contamination and risk of infection.

Key messages
Analytical approach to assess the contamination level of room to address with greater precision the points with higher risk of cross contamination. The UVC technology assures better results when associated with standard sanitation procedure decreasing the risk of hospital acquired infections.
Ventilator-Associated Pneumonia: Incidence and risk factors six intensive care units in Tunisia
Authors: Cheikh A Ben , Bhiri S , ketaka N , Gara A , Khefacha S , Rejeb M Ben , Latiri H Said 
Published: October 2020

Abstract

Background
Ventilator-Associated Pneumonia (VAP) continues to cause significant morbidity, mortality, and hospital costs, especially in the intensive care unit (ICU). This study aimed to determine incidence and factors associated with VAP in six ICUs of the University Hospital-Sahloul (Sousse, Tunisia) in 2018.

Methods
We conducted a prospective observational cohort study over a three months period in six ICUs of the University Hospital-Sahloul (Sousse, Tunisia) in 2018. All patients hospitalized with mechanical ventilation (MV) for more than 48 hours in the ICUs were included. Logistic regression with the stepwise method of Hosmer and Lemeshow was used to identify factors associated with VAP.

Results
Overall, 110 patients were enrolled. The mean age of patients was 44 ± 25 years. Of them, 66.4% were male. The median duration of MV was 5 days [2-16]. The incidence of VAP was 32% and the density incidence was 33/1000 ventilator days. The most common organism were Pseudomonas aeruginosa (n = 14). Of them, 12 were ceftazidime-resistant and thee were resistant to imipenem. Independent risk factors associated with VAP in ICU were history of antibiotic therapy during last 6 months (p = 0.007), tracheotomy (p &lt; 0.001) and reintubation (p &lt; 0.001).

Conclusions
VAP rates in our ICUs were very high. Antimicrobial stewardship programs involving pharmacists and physicians must be elaborated to optimize the antibiotic prescribing. Mechanical ventilation require more-effective interventions control in our hospital.

Key messages
Ventilator-Associated Pneumonia rates were very high. Independent risk factors associated with Ventilator-Associated Pneumonia were history of antibiotic therapy during last 6 months, tracheotomy and reintubation.
SARS-CoV-2: Sanitize a hospital
Authors: De Caro F , Moccia G , Borrelli A , Annecchiarico A , Cioffi G , Campanella A , Motta O , Caputo V , Boccia G , Capunzo M 
Published: October 2020

Abstract

Issue
During the SARS-CoV-2 pandemic, several critical issues emerged. One of these was to identify which was the best terminal disinfection strategy for hospital rooms of a COVID-19. Description of the problem. Our University Hospital adopted ozone disinfection two years ago, recognized internationally as a 'safe gas' and is an excellent disinfectant for its characteristics of attacking and oxidizing each type of organic and inorganic compound and specifically also works against SARS-CoV-2.

Results
23 ozone generators were purchased, 20 ozonizers were assigned to departments with high environmental sanitation needs, 3 ozonizers supplied to the ozonator team. For the correct use of the equipment, 200 operators were trained in a certified way. The rooms are ozonated with pre-established frequency and whenever a COVID-19 patient is cared for. The ozonation team sanitizes rooms in wards that are not equipped but that may have hosted patients with carriers. Indications have been given in all the wards to create the ozonation room, that can be used as an ozone disinfection chamber, where it is possible to place garrisons and furnishings, even large-sized, that cannot be disinfected in other ways (in addition to sanitization with hypochlorite). The team also provides for the ozonation of ambulances with a predetermined periodicity or in the case of transport of patient carrying SARS-CoV-2. All activities are monitored with a special traceability card.

Lessons
Terminal disinfection of environments that have hosted patients with COVID-19. Terminal disinfection of the devices used on patients with COVID-19. Increased safety for operators carrying out environmental sanitation.

Key messages
Fight SARS-COV-2 with ozone. Disinfecting with ozone is safety for everyone.
Risk factors for sharps injuries and the prevalence of blood borne infections among paramedics
Authors: Gańczak M , Topczewska K , Korzen M 
Published: October 2020

Abstract

Background
Although paramedics constitute a group of medical professionals continually at risk for sharps injuries (SI), possibly resulting in occupationally acquired bloodborne infections (BBI), data on blood exposures in this group are rather scant.

Objectives
To assess the incidence and selected risk factors for SI and to estimate the prevalence of BBI among paramedics.

Methods
An anonymous cross-sectional serosurvey, with ELISA system used to detect anti-HBc/anti-HCV/anti-HIV, was conducted among paramedics from 10 randomly selected ambulance stations in West Pomerania, Poland, between December 2018-October 2019. Knowledge about infection-control procedures was assessed with the use of 10 multiple choice questions.

Results
Response rate: 93%. Among 286 participants (76.5% males, Me age 37 years, Me length of practice 14 years) 19.6% sustained ≥ 1 SI in the preceding year (Me = 6.0, range 1-100); 50.8% of incidents were not reported. Regarding the most recent SI - the most often it took place in an ambulance (45.9%), during an emergency procedure (76.3%) and was caused by a hollow-bore needle (60.7%); in 66.1% of cases the device did not have a safety feature. Risk factors for SI were as follows: 52.6% paramedics did not use safety engineered devices at work, 52.2% reported recapping a needle in the preceding year, 5.5% irregularly used gloves; 3.4% had never participated in infection control training. The mean knowledge score was 2.6. The lack of infection control training was associated with higher odds (OR 4.64) of a SI. HBV vaccination coverage was 95.6%. Anti-HBc were found in 7.3% participants, no anti-HCV/anti-HIV positive paramedics were recognized.

Conclusions
Frequent SI, about half of those unreported, are important risk factors which could contribute to occupational HBV infections reported among paramedics. The risk of SI could be reduced by supply with safety engineered devices, safe work practices and an adequate training in infection-control procedures.

Key messages
Most risk factors for sharps injuries among Polish paramedics are modifiable. Continuous exposure to sharps injuries should be taken into account while assessing paramedics’ risk for acquiring an occupational blood-borne infection.
A Mycobacterium chimaera infection after 12 years since cardiac surgery: a case report
Authors: Fabricci M , Vacchi O G B , Scarpis E , Brunelli L , Nalon S , Livi U , Cocconi R 
Published: October 2020

Abstract

Issues
Mycobacterium chimaera bacterium, firstly identified in 2004, is mainly present in drinking water but is generally not harmful for human health. Incubation period ranges from 3 to 72 months, with a median of 17 months. Clinical signs are fever, weakness and weight loss. The infection has a lethality rate of 50%. Invasive infections are associated to the use of Heater-Cooler-Devices (HCD) in cardiovascular surgery.

Description of the Problem
This work reports on an unexpected Mycobacterium chimaera infection case occurred after a time period much longer than what literature reports for both incubation and surgical infection. In January 2007, a 67-year-old man underwent cardiac surgery for an aortic dissection Stanford type A, with implantation of an ascending aorta prosthesis at Udine Academic Hospital (Italy). After a chronic heart failure relapse occurred in September 2018, he developed fever of unknown origins, sepsis, and then he underwent surgery to substitute the vascular prothesis. In January 2019 the clinical condition of the patient got worse and he died in September 2019.

Results
The first level bacterial culture turned out to be positive for Mycobacteria, so the second level molecular biology test was carried out with GenoType NTM-DR. This analysis revealed a specific positivity for Mycobacterium chimaera. The confirmation test on the Heater-Cooler-Device (HCD) could not be carried out as this device was scrapped since years.

Lessons
This case report suggests that Mycobacterium chimaera incubation period can be extremely variable. Therefore, when performing differential diagnosis, it should be considered even for those patients who underwent cardiac surgery more than 5 years prior clinical manifestation. We suggest extending the current ECDC's exposure criteria, assuming that incubation period could cover the entire patient's life.

Key messages
Mycobacterium chimaera can have an incubation period much longer than what is usually described in literature and ECDC guidelines. This report can be considered a starting point to improve the hospital infection control surveillance system in hospitals performing cardiac surgery.
Physical activity in relation to wellbeing among newly arrived refugees in Sweden
Authors: Sjögren Forss K , Mangrio E , Leijon M , Grahn M , Zdravkovic S 
Published: October 2020

Abstract

Background
In the light of the growing number of refugees that the world has faced during the last years it is reasonable to suggest that the number with both physiological and mental health needs will raise and result in increased public health challenges. Physical activity with its well documented positive impact on both mental and physical health might be one way for refugees to promote health. The importance of investigating participation in physical activity in this group and the impact it might have on their health and wellbeing cannot be underestimated. Few studies exists in the field and therefore, this study aimed to investigate physical activity in relation to mental well-being, vitality, stress and sleep quality among newly arrived refugees in Sweden.

Methods
The study was based on the results from a survey, conducted in 2015 - 2016 among newly arrived adult refugees who spoke Arabic, Pashto, Somali or Dari, participated in a mandatory public integration support programme in the Scania region of Sweden and agreed to participate in the survey. Ultimately 681 participants completed the survey (a response rate of 39,5%).

Results
We found a significant association between physical activity and mental well-being, vitality, stress and sleep quality among newly arrived refugees.

Conclusions
Newly arrived refugees need to be informed about the importance of prioritising physical activity for their health and wellbeing, regardless of their external circumstances, and supported in their attempts to do so.

Key messages
There is a significant association between physical activity and mental well-being, vitality, stress and sleep quality among newly arrived refugees. Newly arrived refugees need to be informed about the importance of prioritising physical activity for their health and wellbeing, and supported in their attempts to do so.
When there is no sleep: forced migration and the social determinants of health during post-migration
Authors: Ona F 
Published: October 2020

Abstract
Attending to and addressing the public health needs of forced migrants, especially those who experience torture due to their identities as sexual minorities, is increasingly challenging in socio-political landscapes that may negatively impact access to health resources and health care services. A great deal of public health intervention work has focused on pre-migration and migration contexts but post-migration contexts remain less developed in regards to the social determinants of health. The significance of post-migration challenges to refugee and asylum seekers' health need to integrate social determinants of health frameworks that meaningfully engage with the risk and protective factors in the complex sociocultural conditions in post-migratory experiences that include social, economic and political factors that impinge on housing, legal representation, employment, education food security and health access. This presentation provides findings from an integrated biopsychosocial and spiritual intervention that focused on LGBTQ refugee and asylum-seeking populations seeking health care services at a health clinic in North America. These findings recommend horizontal approaches that engage in transdisciplinary teams that address physical, emotional, social, spiritual and mental health arenas to engage in a social determinants of health framework.

Key messages
Integrated, trauma-responsive biopsychosocial and spiritual interventions may be most effective post-migration. Increased public health activism must support post-migration health interventions.
Experts’ point of view on migrants’ health and Bulgarian health system performance
Authors: Kamburova M , Georgieva S , Tsanova D , Mineva E 
Published: October 2020

Abstract

Introduction
Migrants often face serious inequities concerning their state of health and their access to good quality health services. The aim of the study is to analyze the experts' point of view on migrants' health and Bulgarian health system performance in this field.

Methods
Within the TRAIN4M&H project, founded by European Commission, work seminar was organized in Bulgaria in March 2019th. Focus group and facilitated discussion with experts intended to elicit information about significant migrants' health problems was performed. Quantitative and qualitative data were collected through an unstructured interview. Data processing was performed by SPSS v.24.

Results
All participants in the seminar: 22 frontline health professionals (5), law enforcement officers (13), social workers (2) and other professionals (2) were covered. According 60% of participants the health of migrants threatens the health of the host population. The leading health issues among migrants are: infectious and parasitic disorders as a result of bad hygiene (9), psychiatric problems and drug abuse (5), children and pregnant women health problems (3) etc. Most of the experts (77.3%) determine that there is no difference between health care needs of the migrants and Bulgarian population. None of the respondents said that migrants need hospital care mainly. On the opposite, according to experts' point of view they need emergency care (31.8%), primary health care (36.4%) and specialized care (22.7%). The Bulgarian health system provides adequate health care only in some specific cases, according to two thirds of the respondents. As positive results of the health system performance experts point “asylum seekers are fully health insured”, “the treatment of migrants in the centers is free of charge” etc.

Conclusions
In order to establish migrant friendly health system in Bulgaria and to improve the quality of services provided develop and enhance skills of professionals working at local level is crucial.

Key messages
Professionals working at local level with migrants have to be well qualified to face problems in relation to migrants’ health and their access to health care. According to the experts working at local level with migrants Bulgarian health system is not well prepared and provides adequate health care for migrants only in some specific cases.
Examining emergency department inequities between Māori and non-Māori: do they exist?
Authors: Curtis E , Paine S , Jiang Y , Jones P , Raumati I , Tomash I , Healey O , Reid P 
Published: October 2020

Abstract
Despite Māori (Indigenous population of New Zealand, NZ) having high Emergency Department (ED) use, few studies have explored for ethnic inequities in ED within NZ. ED healthcare can be time-pressured, complex and demanding. Clinical decision-making in this context may facilitate provider prejudice, stereotyping and bias.
The Examining Emergency Department Inequities (EEDI) is a retrospective observational study, designed from a Kaupapa Māori Research position, examining ED admissions in NZ between 2006 and 2012 using the existing Shorter Stays in Emergency Department National Research Project dataset combined with clinical information extracted from NZ’s National Minimum Dataset. The key predictor variable is patient ethnicity with covariates: sex, age-group, area deprivation, mode of presentation, referral method, Australasian Triage Scale and the Multimorbidity Measure (M3 Index) for co-morbidities. Generalised linear regression models investigated the associations between pre-admission variables and the measures of ED care, and mortality.
There were a total of 5,972,102 ED events (1,168,944 Māori, 4,803,158 non-Māori). We found an increasing proportion of ED events/year, a higher proportion of Māori ED events from younger age groups and areas of high deprivation compared to non-Māori. Māori had a higher proportion of self-referral and were triaged to be seen within a longer timeframe compared to non-Māori. After controlling for year of ED event, gender, triage category, age at presentation, NZ Deprivation decile and M3 Comorbidity score: Māori had shorter ED arrival to assessment time; shorter ED Length of Stay and less Access Block (&gt;8 hour ED LOS before ward admission). Despite this, Māori mortality within ED or within 10 days of discharge was higher than non-Māori.
These findings suggest different patterns in ED usage between Māori and non-Māori. Of concern, inequities in mortality exist despite positive indicators of ED care.

Key messages
There is evidence of different patterns in emergency department use between Māori and non-Māori in New Zealand. Māori:non-Māori inequities in mortality exist despite positive indicators of emergency department care.
Outcomes along the HIV continuum of care for Men who have Sex with Men in Haiti
Authors: Dunbar W , Sohler N , Coppieters Y 
Published: October 2020

Abstract

Background
The HIV epidemic in Haiti continues, with an estimated 160,000 people living with HIV at the end of 2018. Although HIV prevalence in the general population is estimated to be 2.0%, certain groups are at a higher risk of HIV infection. The prevalence of HIV among men who have sex with men (MSM) is estimated to be 12.9%. As previous data have found gaps in HIV care for this population, we explored the steps in the continuum of care to determine outcomes at each step.

Methods
We used an observational retrospective cohort study design to follow up MSM diagnosed with HIV in the largest HIV care clinic in Port-au-Prince, Haiti. Estimates were calculated of proportions of participants reached, tested, linked to care, commencing treatment, adherent to treatment, and who achieved virologic suppression. We identified factors associated with loss to follow-up at each step using multivariable analysis.

Results
Data were collected between January 1, 2015, and December 31, 2018. 5009 MSM were reached for prevention services. Of those reached, 2499 (49.8%, 95% CI 48.5-51.3) were tested for HIV, 222 (8.8%, 95% CI 7.8-10.0) had a positive test result for HIV, and 172 (77,47%, 95% CI 71.4-82.8) were linked to HIV care. Among participants who started care, 54 (44.6 95% CI 24.5-38.9) were retained and 98 (78.4%, 95% CI 49.2-64.5) achieve a suppressed viral load. Fifty-nine (44.8%, 95% CI 27.2-41.9) were lost to follow-up. Participants who had been younger, with lower educational and economic level were significantly less likely to achieve retention and viral suppression (p = 0.001).

Conclusions
HIV cascade data among MSM in Haiti show very poor rates of retention in treatment although those retained had good virologic outcome. Characteristics associated with LTFU suggest an urgent need to develop and implement effective interventions to support patients in achieving retention and viral suppression among MSM living with HIV.

Key messages
Poor HIV outcomes for men who have sex with men in Haiti. Effective interventions to improve HIV outcomes for men who have sex with men in Haiti are urgently needed.