International Journal of Infection Control International Journal of Infection Control International Federation of Infection Control (IFIC) en-US International Journal of Infection Control 1996-9783 <p><span style="color: #4b7d92;">Authors retain copyright of their work, with first publication rights granted to IJIC. Read the full <a href="">Copyright- and Licensing Statement</a>.</span></p> Pharmacovigilance quality system for vaccine monitoring (COVID-19) using quality indicators: a scoping review <p>This scoping review responds to the appeal of the scientific community for collaboration between different entities for pharmacovigilance and active surveillance of coronavirus disease 2019 (COVID-19) vaccines. The objective is to identify, systematically evaluate, and synthesize the best scientific evidence available on the indicators used in pharmacovigilance systems. Our results demonstrate that approximately 50% of the 25 studies used in this review have been carried out in the past 5 years. Of these, only four used the pharmacovigilance indicators proposed by the World Health Organization (WHO). Eighty-seven pharmacovigilance indicators were identified, of which seven (8.0%) related to signal detection. While the WHO advocates signal detection as routine pharmacovigilance, in special situations – such as accelerated clinical studies where adverse events are not yet well known – other indicators related to signal detection appear to be good options for maintaining quality pharmacovigilance and active surveillance in the development of the COVID-19 vaccine. However, the less robust pharmacovigilance systems in low-income countries will necessitate greater involvement of health professionals from public and private sectors, pharmaceutical companies, academic institutions, and the general public, to ensure information security and detection of signals for the COVID-19 vaccine.</p> Mayra M. Moura de Oliveira Gabriela Arantes Wagner Vera L. Gattás Larissa de Souza Arruda Monica Taminato ##submission.copyrightStatement## 2021-11-25 2021-11-25 17 1 10.3396/ijic.v17.21250 Infection, infection control, and disinfectants in a challenging infection era <p>Health care-associated infections inflict a huge clinical and economic burden on public health worldwide. Bacterial resistance to antibiotics continues to escalate, and antimicrobial stewardship initiatives have yet to make a major impact. Additionally, the ability of bacteria to evade environmental threats by living within a self-produced protective biofilm and/or producing resistant spores further challenges effective infection control. The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has also amplified the burden significantly. Amidst a particularly challenging infection era, the demand for meticulous infection control and prevention practices is paramount, a key component of which is the use of appropriate disinfectants that can combat a wide variety of microbial pathogens, including diverse forms of viruses and bacteria, particularly highly tolerant spore-forming and biofilm-forming microorganisms. This review addresses the advantages and disadvantages of commonly used disinfectants such as alcohols, hypochlorite, and quaternary ammonium compounds, together with oxidizing agents such as chlorine dioxide and peracetic acid, which are gaining increasing acceptance in routine infection control practices today. Given the increasing requirements for rapid-acting disinfectants that are effective against the toughest of microorganisms (e.g. spores and biofilm), are environmentally friendly, and remain active under diverse environmental conditions, emerging oxidizing agents warrant further consideration, particularly chlorine dioxide, which offers most requirements for an ideal disinfectant, including retention of activity over a broad pH range. Given the critical importance of infection control and antimicrobial stewardship in public health and health care facilities today, consideration of chlorine dioxide as a safe, selective, highly effective, and environmentally friendly disinfectant is warranted.</p> Philip G. Bowler ##submission.copyrightStatement## 2021-10-11 2021-10-11 17 1 10.3396/ijic.v17.21564 Antimicrobial drug resistance and infection prevention/control: lessons from tuberculosis <p>Antimicrobial drug resistance (AMR) is increasing rapidly worldwide, causing an estimated 700,000 deaths annually over the past decade, en route to becoming the leading global threat to public health by 2050 with an estimated 10 million deaths per year (more than heart disease, cancer, and stroke), while reducing global wealth by US$100 trillion. Yet AMR has not received the attention and action required to change this trajectory. Appropriate infection prevention and control (IPC) measures are needed to prevent transmission of infections to healthcare workers (HCWs), other patients, families, and the general public. In this review, we discuss a notable case study of AMR: highly drug-resistant tuberculosis (TB) has emerged repeatedly over the past 70 years as new drugs have been introduced, leading to new diagnostics, therapeutics, funding, public health strategies, and, in high-income countries, effective IPC measures that curtailed transmission. We review current efforts to control and prevent AMR using the example of drug-resistant tuberculosis to highlight important themes including laboratory systems, surveillance, control and prevention of healthcare-associated infections (especially among HCWs), better coordination across disciplines and diseases, and powerful advocacy/social change initiatives grounded in social and behavioral sciences. These strategies are the foundation of an effective response to the AMR threat to public health.</p> J. Peter Cegielski Carrie Tudor Grigory V. Volchenkov Paul A. Jensen ##submission.copyrightStatement## 2021-07-29 2021-07-29 17 1 10.3396/ijic.v17.20840 Spatial and temporal distribution of faecal indicators and multidrug resistant bacteria in a multiple-use freshwater lake: the case of Lake Hawassa, Ethiopia <p><strong>Background<em>:</em></strong>&nbsp;Aquatic environments close to cities are frequently used as sources for water and at the same time overloaded with a variety of pollutants either through direct or indirect discharges of untreated wastes and sewage. This condition is also worsened by the indiscriminate disposal of untreated wastes and sewage vigorously into used water. Sewage contaminated waters are known to carry microorganisms, some of which are pathogenic to humans.</p> <p><strong>Aim<em>:</em></strong>&nbsp;The aim of this study was to assess the extent of temporal and spatial levels of microbial pollution and sources of pollution in Lake Hawassa.</p> <p><strong>Method<em>:</em></strong>&nbsp;A cross-sectional study was conducted at Lake Hawassa, which was sampled twice during 2017. A total of 26 samples of lake water were collected from 14 stations using a boat. Entry points of incoming streams, waste receiving sites, and areas upstream of anthropogenic impact, recreational and bathing sites were considered. Microbiological characterisation was performed using selective media and basic biochemical tests. Antibiotic sensitivity was tested with different antibiotics using the Kirby-Bauer agar disk diffusion method.</p> <p><strong>Result<em>:</em></strong>&nbsp;All samples were positive for pathogenic bacteria, including Gram-positive and Gram-negative bacteria.&nbsp;<em>Enterobacteriaceae</em>&nbsp;were the most common bacteria identified from the samples, including&nbsp;<em>Escherichia coli</em>,&nbsp;<em>Salmonella</em>&nbsp;spp,&nbsp;<em>Shigella</em>&nbsp;spp,&nbsp;<em>Proteus</em>&nbsp;spp and Gram-positive bacteria, such as&nbsp;<em>Staphylococcus aureus</em>. The predominant bacteria found in the samples include&nbsp;<em>E. coli</em>, which constituted 22/26 (84.6%) of the total samples, followed by&nbsp;<em>Salmonella</em>&nbsp;and&nbsp;<em>Shigella</em>&nbsp;spp. All bacterial isolates were resistant to penicillin and ampicillin. The&nbsp;<em>Salmonella</em>&nbsp;spp were sensitive only to norfloxacin and gentamicin.</p> <p><strong>Conclusion<em>:</em></strong>&nbsp;A spatial variation with the occurrence of bacterial isolates has been observed. High concentrations and many different species were found in areas of human activities and in areas receiving direct pollutants from the city. This study revealed that multidrug resistant (MDR) pathogenic bacteria are found in Lake Hawassa. There is a possibility of outbreak of diseases associated with the isolated antibiotic-resistant pathogens for which the antibiotic resistance genes are transportable within aquatic bacterial communities. We recommend that the city administration take care of the municipal wastewater or effluents from healthcare facilities that enter the lake. It is also recommended that the government take steps to control anthropogenic activities near the water body.</p> Deresse Daka Hunachew Beyene, Dr Simachew Dires ##submission.copyrightStatement## 2021-10-26 2021-10-26 17 1 10.3396/ijic.v17.20428 A comparison study of COVID-19 outbreaks in the United States between states with Republican and Democratic Governors <p>The coronavirus disease 2019 (COVID-19) has caused devastating public health, economic, political, and societal crises. We performed a comparison study of COVID-19 outbreaks in states with Republican governors versus states with Democratic governors in the United States between April 2020 and February 2021. This research study shows that 1) states with Democratic governors had tested more people for COVID-19 and have higher testing rates than those with Republican governors; 2) states with Democratic governors had more confirmed cases for COVID-19 from April 12 until the end of July 2020, as well as from early December 2020 to February 22 2021, and had higher test positivity rates from April 12 until late June 2020, and the states with Republican governors had more confirmed cases from August to early December 2020 and had higher test positivity rates since late June 2020; 3) states with Democratic governors had more deaths for COVID-19 and higher mortality rates than those with Republican governors; 4) more people recovered in states with Democratic governors until early July 2020, while the recovery rate of states with Republican governors is similar to that of states with Democratic governors in May 2020 and higher than that of states with Democratic governors in April 2020 and between June 2020 to February 22 2021. We conclude that our data suggest that states with Republican governors controlled COVID-19 better as they had lower mortality rates and similar or higher recovery rates. States with Democratic governors first had higher test positivity rates until late June 2020 but had lower test positivity rates after July 2020. As of February 2021, the pandemic was still spreading as the daily numbers of confirmed cases and deaths were still high, although the test positivity and mortality rates started to stabilize in spring 2021. This study provides a direct description for the status and performance of handling COVID-19 in the states with Republican governors versus states with Democratic governors, and provides insights for future research, policy making, resource distribution, and administration.</p> Wen Tang Shuqi Wang Liyan Xiong Mengyu Fang Chi-yang Chiu Christopher Loffredo Ruzong Fan ##submission.copyrightStatement## 2021-09-20 2021-09-20 17 1 10.3396/ijic.v17.20940 Challenges and opportunities for scaling up infection prevention and control programmes in rural district hospitals of Tamil Nadu, India <p><strong>Introduction:</strong>&nbsp;The aim of this study was to explore the barriers to implementing an infection prevention and control (IPC) programme in three public district hospitals in Tamil Nadu by interviewing key stakeholders involved in the roll-out of the programme.</p> <p><strong>Materials and methods:</strong>&nbsp;Investigators conducted interviews (<em>n</em>&nbsp;= 17) with chief medical officers (CMOs), physicians, and IPC nurses at three secondary public district hospitals and their affiliated primary health centres (PHCs).</p> <p><strong>Results:</strong>&nbsp;Six major themes emerged from the interviews: (1) prevalent IPC practices before the programme began; (2) barriers to implementation; (3) perceptions of the effectiveness of the IPC programme; (4) suggestions for future expansion of the programme; (5) the role of healthcare sanitation workers, and (6) water, sanitation and hygiene (WaSH) infrastructure. Stakeholders noted improvements in IPC knowledge, infection control related behaviour, and overall healthcare quality in the three hospitals. In regards to the future of this programme, stakeholders noted the need for more institutional support, a staff nurse solely dedicated to IPC, and the continued training of all staff members.</p> <p><strong>Discussion:</strong>&nbsp;The results of this study highlight the importance of having high-functioning WaSH infrastructure and training for hospital sanitary workers in order to have an effective IPC programme. While the scale-up of this IPC programme is warranted, the barriers to implementation outlined in this study should be considered. To achieve a more effective IPC programme, we suggest that the following steps be carried out: (1) dedicate at least one full-time nurse to implementing IPC activities at each district hospital; (2) ensure that state and national policies for IPC are synchronised, and (3) provide sufficient and consistent funding for IPC activities.</p> Maya Guhan Mohan Kumar Zachary Butzin-Dozier Jay Graham ##submission.copyrightStatement## 2021-09-20 2021-09-20 17 1 10.3396/ijic.v17.20628 Improving hand hygiene measures in low-resourced intensive care units: experience at the Kigali University Teaching Hospital in Rwanda <p><strong>Background<em>:</em></strong>&nbsp;Proper hand hygiene (HH) practices have been shown to reduce healthcare-acquired infections. Several potential challenges in low-income countries might limit the feasibility of effective HH, including preexisting knowledge gaps and staffing.</p> <p><strong>Aim<em>:</em></strong>&nbsp;We sought to evaluate the feasibility of the implementation of effective HH practice at a teaching hospital in Rwanda.</p> <p><strong>Methods<em>:</em></strong>&nbsp;We conducted a prospective quality improvement project in the intensive care unit (ICU) at the Kigali University Teaching Hospital. We collected data before and after an intervention focused on HH adherence as defined by the World Health Organization ‘5 Moments for Hand Hygiene’ and assuring availability of HH supplies. Pre-intervention data were collected throughout July 2019, and HH measures were implemented in August 2019. Post-implementation data were collected following a 3-month wash-in.</p> <p><strong>Results<em>:</em></strong>&nbsp;In total, 902 HH observations were performed to assess pre-intervention adherence and 903 observations post-intervention adherence. Overall, HH adherence increased from 25% (222 of 902 moments) before intervention to 75% (677 of 903 moments) after intervention (<em>P</em>&nbsp;&lt; 0.001). Improvement was seen among all health professionals (nurses: 19–74%, residents: 23–74%, consultants: 29–76%).</p> <p><strong>Conclusions<em>:</em></strong>&nbsp;Effective HH measures are feasible in an ICU in a low-income country. Ensuring availability of supplies and training appears key to effective HH practices.</p> Jean Paul Mvukiyehe Eugene Tuyishime Anne Ndindwanimana Jennifer Rickard Olivier Manzi Gregory R. Madden Marcel E. Durieux Paulin R. Banguti ##submission.copyrightStatement## 2021-09-10 2021-09-10 17 1 10.3396/ijic.v17.20585 Characterization of an outbreak due to extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit <p><strong>Background<em>:</em></strong>&nbsp;The epidemiological–microbiological characteristics and effective intervention measures in an outbreak due to extended-spectrum β-lactamase (ESBL)-producing&nbsp;<em>Klebsiella pneumoniae</em>&nbsp;in a neonatal intensive care unit are described.</p> <p><strong>Materials and methods<em>:</em></strong>&nbsp;Cases from June 22, 2018 to February 11, 2019 were analyzed. Microbiological analysis of intestinal carriage of ESBL-producing&nbsp;<em>K. pneumoniae</em>&nbsp;and environmental samples was conducted. Strain relationships were studied by pulsed-field gel electrophoresis (PFGE).</p> <p><strong>Results<em>:</em></strong>&nbsp;A 35-week outbreak affecting 41 patients, with eight infected, 33 colonized, and two deceased patients occurred. Two stages of the outbreak were observed with differences in the frequency of intestinal carriage of ESBL-producing&nbsp;<em>K. pneumoniae</em>. The same genetic subtype was seen in patient strains and was different from strains isolated from the environment. Deficiencies in contact precautions, hand hygiene, and handling of breast milk were observed.</p> <p><strong>Conclusions<em>:</em></strong>&nbsp;A monoclonal outbreak by ESBL-producing&nbsp;<em>K. pneumoniae</em>&nbsp;that occurred in two phases and the different control measures in each of the stages is described. Effective control measures are mainly based on improving compliance with standard precautions and contact precautions, and other complementary measures are described such as proper handling of breast milk, periodic carriage studies, and the generation of three patient cohorts.</p> Paola Pidal Erna Cona Carolina Torrejón Contanza Airola Javier Cifuentes Sergio Ambiado Annette Navarrete Eliana Chacon Iris Valderrama Velimir Mihalic Fabian Aravena David Gomez Ingrid Araya Loredana Arata ##submission.copyrightStatement## 2021-09-03 2021-09-03 17 1 10.3396/ijic.v17.20916 Feasibility and safety of a symptom-based strategy to discontinue infection control precautions for patients hospitalised with COVID-19 – a retrospective study <p><strong>Background:</strong>&nbsp;Various recommendations exist concerning the discontinuation of contact and droplet precautions (CDP) for patients hospitalised with coronavirus disease 2019 (COVID-19). Some are based on repeated negative real-time polymerase chain reaction (RT-PCR) results, whereas other are based on clinical criteria. The feasibility and safety of these recommendations are poorly documented.</p> <p><strong>Method:</strong>&nbsp;We conducted a retrospective study to assess the feasibility and safety of a symptom-based strategy to discontinue CDP for patients hospitalised with COVID-19. We reviewed the clinical charts of all symptomatic patients hospitalised in our institution with RT-PCR-confirmed COVID-19 to assess the application of a symptom-based strategy for the implementation and discontinuation of CDP. The patients with discontinuation of CDP in accordance with the symptom-based strategy were cross-referenced with patients with potential hospital-acquired COVID-19 in order to assess the safety of this strategy.</p> <p><strong>Results:</strong>&nbsp;Among the 147 patients included in our study, our symptom-based strategy was respected in 95 cases (64.6%). Discontinuation of CDP in accordance with the recommendations occurred in 39 patients (26.5%). After the discontinuation of CDP, patients remained hospitalised for a median time of 18 days, with exposure to a median number of three patients, resulting in a total number of 588 days ‘patient-day-exposition’. No hospital-acquired COVID-19 was detected in contact patients.</p> <p><strong>Discussion:</strong>&nbsp;The use of a symptom-based strategy to discontinue CDP is applicable and safe. This symptom-based strategy was applicable regardless of patient’s age or COVID-19 severity.</p> Gaël Grandmaison Marine Baumberger Charlotte Pellaud Véronique Erard Christian Chuard ##submission.copyrightStatement## 2021-08-31 2021-08-31 17 1 10.3396/ijic.v17.20601 Burden of central-line-associated bloodstream infections in 106 Ministry of Health hospitals of Saudi Arabia: a 2-year surveillance study <p><strong>Background:</strong>&nbsp;Although the Saudi Ministry of Health (MOH) is managing the majority of inpatient bed capacity in Saudi Arabia, surveillance data for central-line-associated bloodstream infections (CLABSI) have never been reported at a national level.</p> <p><strong>Objectives:</strong>&nbsp;To estimate unit-specific CLABSI rates along with central line utilization ratios in MOH hospitals. Additionally, to benchmark such rates and ratios with recognized regional and international benchmarks.</p> <p><strong>Methods:</strong>&nbsp;A prospective surveillance study was conducted in 106 MOH hospitals between January 2018 and December 2019. The data from 14 different types of intensive care units (ICUs) were entered into the Health Electronic Surveillance Network (HESN) program. The surveillance methodology was similar to the methods of the US National Healthcare Safety Network (NHSN) and the Gulf Cooperation Council (GCC) Center for Infection Control.</p> <p><strong>Results:</strong>&nbsp;During the 2 years of surveillance in ICU setting covering 1,475,177 patient-days and 475,913 central line-days, a total of 1,542 CLABSI events were identified. The overall CLABSI rate was 3.24 (95% confidence interval [CI], 3.08–3.40) per 1,000 central line-days, and the overall central line utilization ratio was 0.32 (95% CI, 0.322–0.323). CLABSI-standardized infection ratios in HESN hospitals were very similar (1.01) to GCC hospitals, but 3.2 times higher than NHSN hospitals and 36% lower than International Nosocomial Infection Control Consortium (INICC) hospitals. Central-line-standardized utilization ratio in MOH hospitals was 15–30% lower than the three benchmarks.</p> <p><strong>Conclusions:</strong>&nbsp;The overall CLABSI rate was 3.24 per 1,000 central line-days, and the overall central line utilization ratio was 0.32. MOH CLABSI rates were very similar to GCC hospitals, but higher than NHSN hospitals and lower than INICC hospitals. MOH central line utilization is slightly lower than the three benchmarks.</p> Khalid H. Alanazi Mohammed Alqahtani Tabish Humayun Adel Alanazi Yvonne S. Aldecoa Nasser Alshanbari Aiman El-Saed Ghada Bin Saleh ##submission.copyrightStatement## 2021-08-31 2021-08-31 17 1 10.3396/ijic.v17.20978 Antibiotic usage at a private hospital in Central Java: results of implementing the Indonesian Regulation on the Prospective Antimicrobial System (Regulasi Antimikroba Sistem Prospektif Indonesia [RASPRO]) <p><strong><em>Methods</em></strong>: A pre–post-descriptive study was conducted in 2019 for 3 months at a private hospital in Central Java, Indonesia, to evaluate the implementation of the Regulation on Indonesian Antimicrobial Stewardship Program (ASP), namely, the Prospective Antimicrobial System/Regulasi Antimikroba Sistem Prospektif Indonesia (RASPRO). Outcomes were measured before and after the implementation of the RASPRO in the ward including: 1) intravenous antibiotic defined daily dose (DDD) per 100 patient-days, 2) antibiotic expenditure, and 3) antibiotic expenditure per inpatient.</p> <p><strong><em>Result</em></strong>: The total antibiotic consumption was expressed in DDD/100 patient-days. For the levofloxacin category, the number increased intensely from 2.38 to 15.29; carbapenem escalated from 0.51 to 2.31, ceftriaxone from 32.10 to 38.03, and ampicillin sulbactam from 1.14 to 1.18. In contrast, cefuroxime significantly reduced from 17.25 to 1.38, cefotaxime decreased from 10.33 to 6.83, gentamicin decreased from 3.18 to 1.91, and amikacin decreased from 2.27 to 2.13. The overall cephalosporin usage decreased from 19.89 to 15.41. The total antibiotic expenditure had a decline of 20.28%, followed by 14.44% reduction on the percentage of antibiotic expenditure per inpatient.</p> <p><strong><em>Conclusion</em></strong>: Our study describes the 3-month analysis of antimicrobial usage before and after the implementation of the RASPRO by evaluating several parameters. The antibiotic consumption expressed in DDD/100 patient-days for each antibiotic category has demonstrated that there are different impacts that may be debatable and calls for further evaluation. A decrease in the total antibiotic expenditure has also been reported. However, since our study is a preliminary study, it should be continued by further studies that involve longer study duration to observe further impacts of the program.</p> Ronald Irwanto Natadidjaja Tarcisius Henry Hadianti Adlani Aziza Ariyani Rika Bur ##submission.copyrightStatement## 2021-07-29 2021-07-29 17 1 10.3396/ijic.v17.20411 Knowledge, attitude and self-reported practice of healthcare workers on infection control in a health facility in Akure, Nigeria <p><strong>Background</strong>: Infection control is pivotal in reducing healthcare-associated infections (HAIs), one of the leading causes of morbidity with growing prevalence in sub-Saharan Africa.</p> <p><strong>Objectives</strong>: We investigated the knowledge, attitude and self-reported hygiene practices towards hospital infection control among healthcare workers (HCWs) at the State Specialist Hospital, Akure, Nigeria.</p> <p><strong>Methods</strong>: This descriptive cross-sectional study involving self-administered, structured questionnaires administered to 137 randomly selected HCWs (19 doctors, 66 nurses and 52 health assistants) was conducted in 2015. Descriptive and inferential statistics were used for data analysis at 5% level of significance.</p> <p><strong>Results</strong>: Mean age of HCWs was 39.81 ± 8.69 years. Majority (84.7%) was trained on hand hygiene and was knowledgeable about HAIs (86.9%), modes of transmission (57.7%) and effectiveness of hand hygiene (94.9%). However, about half (48.9%) of the HCWs reported did not adhere to hand hygiene often, because of the distance between a water source and the wards. This study also showed that there are relationships between categories of respondents and their knowledge of routes of HAI transmission (<em>P</em>&nbsp;&lt; 0.01) and practice of hand hygiene after contacts with hospital surfaces (<em>P</em>&nbsp;&lt; 0.01).</p> <p><strong>Conclusions</strong>: Hospital and hand hygiene can be improved by ensuring water supply located close to the wards. There is need for the provision of clear guidance on procedures for hospital hygiene and sanitation.</p> Abiola O. Oluwagbemiga Shade J. Akinsete Godson R. Ana Olusola O. Ogunseye ##submission.copyrightStatement## 2021-07-26 2021-07-26 17 1 10.3396/ijic.v17.20818 Unprepared and unprotected: Graduating medical students’ knowledge, attitudes, and practices regarding drug-resistant tuberculosis in Cape Town, South Africa <p>South Africa has a high burden of drug-resistant tuberculosis (DR-TB), which has a particularly high mortality among healthcare workers. Junior clinicians deliver key DR-TB services and require training in DR-TB management and prevention. This study aimed to investigate graduating medical students’ knowledge, attitudes, and practices relating to DR-TB, including management, infection control measures, and occupational health services. This cross-sectional, questionnaire-based study at the University of Cape Town, South Africa, recruited final year medical students and included 87 participants. The mean DR-TB knowledge score was 4.7 points (95% confidence interval [CI]: 4.42–5.06, maximum score 8 points). Students reported challenges in accessing respiratory protection, with half (47.7%) struggling to find an N95 respirator when needed. DR-TB exposure was reportedly common. Three students reported prior TB disease, approximately half (<em>n</em>&nbsp;= 49, 55.9%) reported personal concern of active DR-TB disease during undergraduate studies, and the majority (<em>n</em>&nbsp;= 80, 91.9%) correctly perceived themselves to be at increased risk compared to the general population. Medical students are currently unprepared for their role in managing DR-TB in South Africa and unprotected against occupational illness during their studies. This should be addressed in undergraduate curricula and in establishing comprehensive occupational health policies. Resilient personal protective equipment (PPE) supply chains, infection control training, and comprehensive occupational health support have relevance to both DR-TB and novel pathogens, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).</p> Michael J. Harrison Jonathan Watts Michael-Jon Rosslee Arne von Delft Helene-Mari van der Westhuizen ##submission.copyrightStatement## 2021-06-24 2021-06-24 17 1 10.3396/ijic.v17.21110 Knowledge, perception of risk of disease, and infection prevention and control practices among healthcare workers and support staff toward COVID-19 in an Ethiopian referral hospital: a cross-sectional survey <p>Coronavirus disease 2019 (COVID-19) is a pandemic affecting over 106 million and killing over 2.3 million people. Inadequate knowledge of the disease coupled with scarce or improper use of infection prevention and control (IPC) measures by healthcare workers (HCWs) and support staff may be contributing to the rapid spread of infection. This survey aims to assess knowledge, risk perception, and precaution practices of HCWs and support staff toward COVID-19 under resource-constrained circumstances at a major referral hospital in Ethiopia. An institution-based survey was conducted in April 2020 using 422 subjects selected by stratified random sampling. A five-section survey instrument was distributed, and the collected responses were cleaned and entered into Epi data (v3.1) and exported to SPSS (v.26) for further statistical analysis. The survey found that about 58% of the HCWs and support staff in the hospital appear to have adequate awareness and perceive COVID-19 to be a high-risk disease. Seven out of 10 subjects practice some form of IPC measures. However, the knowledge among allied HCWs and support staff appears to be inadequate. Gender, occupation, and years in service correlated with the level of awareness. Of those surveyed, 78% were concerned about the lack of personal protective equipment and perceived public transportation to be a high-risk factor for the transmission of infection. Additional campaigns may be necessary to reinforce existing knowledge of HCWs, but more emphasis should be geared toward educating allied HCWs and support staff.</p> Esubalew T. Mindaye Bekalu Assaminew Goytom K. Tesfay ##submission.copyrightStatement## 2021-06-03 2021-06-03 17 1 10.3396/ijic.v17.20726 Self-medication practice and associated factors among adults in Wolaita Soddo town, Southern Ethiopia <p><strong><em>Background</em></strong>: Self-medication is the selection and use of medicines by individuals to treat their self-recognized illnesses or symptoms. Self-medication can decrease costs and enable health professionals to concentrate on more serious health problems.</p> <p><strong><em>Aim</em></strong>: To assess self-medication practice and associated factors among adults in Wolaita Soddo town, Southern Ethiopia, 2017.</p> <p><strong><em>Methods</em></strong>: An institution-based cross-sectional study was conducted from September 30 to October 30, 2017. A multi-stage sampling technique of drug retail outlets in Wolaita Soddo town was employed to identify 623 individuals that came to buy drugs in the past three months. Data was collected using a structured questionnaire.</p> <p><strong><em>Results</em></strong>: About 33.7% of the respondents had practiced self-medication in the past 3 months. Multivariate analysis revealed that female sex (adjusted odds ratio (AOR) = 2.22, 95% confidence interval (CI): 1.47–3.36), low income (AOR = 3.95, 95% CI: 2.32–6.73) and higher educational level (AOR = 5.79, 95% CI: 2.47–13.58) were the independent factors significantly affecting the practice of self-medication with drugs. Headache/fever (32.4%), respiratory tract infections (31.4%) and gastrointestinal diseases (16.2%) were the most frequently reported illnesses or symptoms of illnesses that prompted self-medication of study participants.</p> <p><strong><em>Conclusion</em></strong>: Health education campaigns, strict legislations on dispensing drugs from private pharmacies, and improving accessibility and affordability of health care are among the important interventions required to change people’s health-seeking behavior and prevent the potential risks of self-medication.</p> Tamirat Mathewos Kassa Daka Shimelis Bitew Deresse Daka ##submission.copyrightStatement## 2021-05-28 2021-05-28 17 1 10.3396/ijic.v17.20322 Investigation of the effectiveness of antimicrobial photocatalyst-coated hand-contact surfaces in passenger transport vehicles under everyday conditions <p>The coronavirus disease-2019 pandemic affects all aspects of public life. Measures for infection prevention are implemented in various sectors, in businesses, as well as in private life. Public transport is important and indispensable in daily life for both children and adults.</p> <p>Public transport companies have to take necessary actions to protect passengers and drivers from infections. Skin contact is one of the ways of transmitting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).</p> <p>This research study was designed to evaluate the effectiveness of a photocatalytic, antimicrobial active surface coating under everyday – not hospital – conditions. To date, such coatings have been used in hospitals as an additional measure to regular cleaning and disinfection in order to reduce the risk of infection.</p> <p>We collected samples for bacterial cultures in three classes of public transport vehicles: bus, underground, and tram. Seven different hand-contact surfaces in one vehicle of each class were coated, while the other vehicles remained uncoated. All vehicles were in regular use. The number of colony-forming bacterial units per cm<sup>2</sup>&nbsp;(CFUs/cm<sup>2</sup>) was measured. A representative number of isolates were differentiated at the pathogen level. Data collected were entered into GraphPad Prism (GraphPad Software, San Diego, USA) and analyzed.</p> <p>Overall, no statistically significant reduction in the number of colony-forming units (CFUs) was observed for coated versus uncoated surfaces. Samples with a very high colony count (&gt;250 CFU/25 cm<sup>2</sup>) were equally distributed in both groups, coated and uncoated vehicles. Within one vehicle type, there was no significant difference between the coated and the uncoated vehicle. No relevant infection-preventive effect could be proven.</p> Rudolf Eicker Wilhelm Salomon ##submission.copyrightStatement## 2021-05-14 2021-05-14 17 1 10.3396/ijic.v17.20969 Patient risk factor stratification is essential for the hospital antibiogram <p>Empiric antimicrobial therapy in hospitalized patients is guided by an institution’s cumulative antibiogram, which may not be adequate in giving information on decision-making for optimal treatment in different patient populations. Adding patient risk factors can make it more useful for clinicians in guiding empiric therapy and for antimicrobial stewardship. Cumulative data were obtained for blood culture and urine isolates from the laboratory information system of a tertiary care hospital for 6 months (January to June 2019). Further stratification of organism types and resistance rates on the basis of patient risk factors (Patient Types 1, 2, and 3) was performed and analyzed.&nbsp;<em>Salmonella</em>&nbsp;spp. was seen in community-acquired ward patients (Types 1 and 2).&nbsp;<em>Streptococcus pneumoniae</em>&nbsp;was seen in Type 1 patients, and&nbsp;<em>Acinetobacter</em>&nbsp;spp. was seen in Type 3 patients. Extended-spectrum beta-lactamase-producing gram-negative infection rates were higher in community patients than in hospital patients. Carbapenem-resistant&nbsp;<em>Enterobacteriaceae</em>&nbsp;rates were high in Type 3 hospitalized patients. Cumulative blood methicillin-resistant&nbsp;<em>Staphylococcus aureus</em>&nbsp;rates were 43% but stratification showed it only in Type 2 and Type 3 ICU patients with 0% in ward patients. Stratified antibiograms based on patient risk factors are valuable for antimicrobial stewardship and help to optimize empiric therapy and increase the understanding of antimicrobial resistance trends.</p> Karuna Tiwari Samruddhi Patil Aparna Naik Anjali Shetty Kamini Walia Camilla Rodrigues ##submission.copyrightStatement## 2021-04-21 2021-04-21 17 1 10.3396/ijic.v17.20089 Is a stable positive rate of <0.1% an indication of a fresh outbreak of SARS-CoV-2 infection? <p>This letter gives a short analysis of the rate of positive SARS-CoV-2 tests in New Zealand and the restrictions that were implemented in response to these rates changing. Concerned about the growth of the number of positive cases of SARS-CoV-2 infection, the New Zealand government introduced stricter lockdown measures on August 16, 2020, and on August 18, 2020, it postponed elections planned for September. Growth in the number of positive cases was an artifact of the number of tests growing at a higher rate than the number of positive cases. The positive rate on August 16 was 0.05% (13 positive cases from 26,014 tests). On August 2, the positive rate was higher at 0.18% (three positive cases from 1,692 tests), despite the government considering that the virus was eradicated at this time. A better approach to this pandemic would be the development of policies based on the positive rate, not solely on positive case numbers, and to include viral load using reverse transcription polymerase chain reaction (RT-PCR) tests with an appropriate cycle threshold to properly identify infectious cases. It is also advised to protect vulnerable populations and avoid unnecessary limitations to the healthy population. The SARS-CoV-2 pandemic will last longer than several months, and the sooner life gets back to nearly normal, the better.</p> Alberto Boretti ##submission.copyrightStatement## 2021-09-24 2021-09-24 17 1 10.3396/ijic.v17.20927 The successful development and implementation of an off campus triage system during the COVID-19 pandemic in Guangdong, China <p>To deal with the public health crisis caused by the coronavirus disease 2019 (COVID-19) outbreak, we developed an off campus triage system at entry points to the outpatient, emergency, and inpatient departments. To enhance this off campus triage system, we implemented intensive staff training and made detailed triage plans with a timely referral. Of the 85,414 patients/visitors who visited The Seventh Affiliated Hospital of Southern Medical University, one of the government-designated hospitals to triage-suspected COVID-19 patients between January 22 and March 10, 2020, 359 patients were triaged to the COVID-19 fever clinic and 1,218 were triaged to the general fever clinic; 187 were suspected of COVID-19 infection and quarantined; and four cases of COVID-19 were confirmed and referred. During the outbreak, no inhospital infection and no complaint from patients and their family members occurred, and up to September 10, 2020, no new cases of COVID-19 in this hospital or its catchment area were detected. The off campus triage system is an effective approach to improve the detection of COVID-19 infection and reduce inhospital cross infection.</p> Ri-hua Xie Yanfang Chen Ziyu Xiong Jie Wang Lepeng Zhou Ning Li Smita Pakhale D William Cameron Daniel Krewski Shi Wu Wen ##submission.copyrightStatement## 2021-07-30 2021-07-30 17 1 10.3396/ijic.v17.20918 Challenges facing an outsourcing dialysis program amid the COVID-19 pandemic: Diaverum AB experience <p>Coronavirus disease 2019 (COVID-19), a disease caused by a novel coronavirus, is a major global human threat that has turned into a pandemic. Elderly patients and patients with comorbid conditions have a higher risk of complications and morbidity. Patients suffering from kidney disease on hemodialysis have an intrinsic fragility combined with a frequent burden of comorbidities in hemodialysis centers, a setting in which many patients are repeatedly treated in the same area. Moreover, if infected, the intensity of dialysis requiring specialized resources and staff is further complicated by requirements for isolation, control and prevention, putting healthcare systems under additional and exceptional strain. Therefore, all measures to slow if not eradicate the pandemic and to control unmanageably high incidence rates must be taken very seriously. Diaverum is a renal health services company playing a major role in providing end-stage kidney disease (ESKD) patients with optimum dialysis services. The aim of the present review is to shed light on the challenges and steps taken by an outsourcing dialysis program to provide recommendations for the prevention, mitigation, and containment of the emerging COVID-19 pandemic in hemodialysis centers.</p> Ali Alharbi Dujanah Mousa Jennifer Samson Moustafa Ahmad Lidia Romero Gomez Meshal Alkhulayfi Eyad Suleiman Saeed Alghamdi Fayez Alhejaili Abdullah Alhweish Naglaa Maddh Waleed Bediwi Mohammed Al-Homrany ##submission.copyrightStatement## 2021-07-23 2021-07-23 17 1 10.3396/ijic.v17.20619 Reuse of disposable gowns for COVID-19 personal protective equipment purposes in times of scarcity: results of an experimental study with hydrogen peroxide vaporization <p>During the coronavirus disease 2019 (COVID-19) pandemic, many health organizations faced shortages of personal protective equipment for their personnel. In case of extreme urgency, re-using disposable materials might offer a temporary solution. Hydrogen peroxide vaporization (HPV) has been used for disinfection of patient rooms for more than a decade. We investigated HPV as a method for disinfecting disposable gowns. After HPV, gowns proved to be free of bacteria and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA while their functionality and water-repellency remained intact. We conclude that, in case of emergency and lack of available alternatives, HPV is a suitable and relatively inexpensive method for one-time reuse of disposable gowns.</p> Roy J. Pelzer Elke JP Magdeleyns Paul HM Savelkoul Lieke B van Alphen van Alphen Wil C van der Zwet ##submission.copyrightStatement## 2021-03-12 2021-03-12 17 1 10.3396/ijic.v17.21090 ‘Seconds save lives – clean your hands’: the 5 May 2021 World Health Organization’s SAVE LIVES: Clean Your Hands campaign Benedetta Allegranzi Ermira Tartari Didier Pittet ##submission.copyrightStatement## 2021-04-27 2021-04-27 17 1 10.3396/ijic.v17.21418 Hepatitis B infection and its prevention among healthcare workers in Ghana: More action required <p>No abstract available.</p> Vivian E. Senoo-Dogbey ##submission.copyrightStatement## 2021-07-15 2021-07-15 17 1 10.3396/ijic.v17.21542