Introduction: Blood culture result provides a crucial information for patient care. Contaminated blood culture samples may result in inappropriate antimicrobial prescription, increase the cost and unnecessary prolonged hospitalization. In our hospital, the blood culture contamination is high in the emergency department. This initiative aims to improve the emergency department’s blood culture contamination rate which will eventually improve the patient care and benefit the hospital financially. Methods: This quality improvement initiative used the Planning, Doing, Checking and Acting (PDCA) models, which provides a simple yet effective approach for problem solving and managing changes. A workgroup consist of Infection control team and emergency department representatives was formed to work on this initiative. Weekly blood culture contamination rate was closely monitored. Root causes were identified, and series of retraining were performed. Blood culture contamination rate before and after the initiative were compared. Results: Focus group discussion and site visit reinforcement showed that the high blood culture contamination rate is contributed by many factors. Among the factors included were the inadequacy of blood culture sets, improper use of skin disinfectant, improper hand hygiene techniques and improper aseptic techniques practice by some of the house officers. Blood culture contamination rates 6 months before and during feedback intervention showed significant decrease (3.52% before intervention and 2.95% after intervention; P < .05. Discussion: Blood culture contamination rate reduced significantly after the joint initiative continued to decrease with the use of a predisinfection process with 2% Chlorhexidine gluconate cloth before blood sample collection process. Practice improvement also was evident with effective feedback mechanism.

Conclusion:

Introduction: During the years 2018-2019, Nan Hospitalhad tuberculosis screening rates of 69.15% and 74.24%, respectively, which were lower than the target (target > 90%). Consequently, tuberculosis patients were referred for further examination in various hospital units and treated in general rooms without proper isolation. Also, one and four healthcare personnel were diagnosed with pulmonary tuberculosis in 2018 and 2019, respectively. Additionally, the treatment success rates for pulmonary tuberculosis patients were 74.63% and 79.92%, respectively (target >85%). Therefore, to achieve these target goals, actions were taken following the national tuberculosis strategy using the FCD Nan model, which comprises of Fast screening (F), Cure (C), and do not spread (D). Objectives: To develop the tuberculosis patient-care system at Nan Hospital and assess the outcomes of the tuberculosis patient-care system in terms of FCD Nan model Methods: We used the PDSA quality improvement process as follows.

1. 1. Plan: Planning to implement the national tuberculosis strategy including fast screening, cure, and prevention of transmission.

2. 2. Do: Implementing the FCD Nan modelas follows.

   1. 1) Fast screening. We used a fast-track system, enhanced screening efficiency in both OPD and IPD units, established a Line group alert pop-up and AI CXR.

   2. 2) Cure. We adhered to treatment protocols,closely monitored cases, consulted specialists, utilized risk scoring for mortality, and nutritional alert.

   3. 3) Do not spread. We administered 3 measures for preventing transmission including administrative, environmental, and PPE measures.

3. 3. Study: Evaluating the FCD Nan model.

4. 4. Action: Identifying household contacts as a high-risk group and implementing screening for all household contacts due tothe discovery of new tuberculosis patients in the household contacts.

Acknowledgments : This study has been partially funded by the Nursing Association for Prevention and Control of Infections (NAPCI)

Background: WHO estimates over 700,000 deaths globally annually due to antimicrobial resistance. One of the main factors of antimicrobial resistance is non-compliance with infection control measures. Contact alert markers must be installed in the patient area to remind officers to carry out infection transmission prevention to prevent the failure of infection control practices. The provision of red markers and information on the infection suffered by patients creates a stigma that is less accepted because of patient privacy. This study aimed to evaluate the modified marker with a batik design as local wisdom without infection information, as a reminder of infection control practices by officers, and to maintain patient privacy. Method: The Committee for Infection Prevention and Control modified the design of markers of patients with antimicrobial resistance. Batik markers were designed with hand hygiene reminders and batik motifs as local wisdom so as not to cause negative stigma. Batik markers were implemented in the patient’s bed area so that it was easy for officers to understand how to implement infection control practices and supervise patients with antimicrobial resistance. Results: Modifying the marker design was more acceptable to the patient’s family than the previous one. Adherence to supervision filling of antimicrobial resistance patients was performed in all patients. Adherence to Hand Hygiene increased by up to 4% in one month. With the Batik Marker, officers could easily recognize the marker so that infection control practices could be carried out according to hospital regulations. Conclusion: Antimicrobial resistance is an increasing health threat. A type A hospital requires an intradisciplinary approach and collaborative efforts to prevent and control it. Implementing Batik Markers at inpatient areas with antimicrobial resistance makes it easier for staff to implement increased contact awareness, supervision recording, and improved hand hygiene without causing rejection from the patient’s family.

Case Presentation: A 68 year old man. Hospitalized with decreased consciousness. Experienced severe shortness of breath 3 days before entering the hospital. The patient also had wounds on his right and left legs since 1 month ago. But then became more widespread. The patient has kidney failure and routinely undergoes hemodialysis. The patient had diabetes since 6 years ago. Laboratory: Hemoglobin 7.5 Leukocytes 17.8 Netrophils 91.70 Lymphocytes 4.20 Albumin 2.2 Creatinine 2.5 Ureum 61 Artery 2.30, urine bacteria+++. Pus culture results: Enterobacter cloacae with the antibiotic meropenem. Sputum culture results Klebsiella pneumoniae ss. Pneumoniae with amikacin. After 1 week pus culture results: Pseudomonas aeruginosa with amikacin. Blood culture results: Staphylococcus epidermidis suggested vancomycin. The patient underwent debriment in the operating room. However, the condition did not improve. Discussion: This patient experienced sepsis with MDRO. Apart from geriatric age, the patient also has diabetes with complications of kidney failure. This worsens the patient’s immune system. So the patient’s diabetic ulcers and decubitus ulcers worsened with the results of cultures with various antibiotic-resistant multiorganisms. And also the respiratory infections increase the risk of mortality. Conclusion : MDRO is a risk factor for inappropriate antibiotic therapy, which is undoubtedly associated with increased mortality.

Figure :

Diabetic ulcers and decubitus ulcers in patient

Objective: Open surgical wound is prone to surgical site infection due to contamination of surrounding environment. Therefore, routine air sampling and culture of two operating rooms (OR) was performed from 2018 to 2023 to monitor and evaluate air quality and provide appropriate infection control measures. Method: 2 OR regularly performing prosthetic insertion were selected for routine air sampling every 6 months due to high risk of surgical infection associated with the procedure. Air sampling was performed by collecting 1000 litre of air over 10 minutes using air sampler (MAS-100 Eco, Merck). Collected air was cultured on blood agar plate and Sabourand dextrose agar for 30 days, and pathogen identification and quantification was performed upon positive culture result. This study employed a cut-off point of 17.6 colony forming unit (CFU) as specified by federal standards on biological particles published by National Aeronautics and Space Administration. Results: 12 air samplings was performed from 2018 to 2023. A single case of positive bacterial air culture was reported (20 CFU, coagulase-negative Staphylococcus). Infection control measures were provided upon reporting of positive bacterial air culture, including inspection of positive pressure ventilation system and high efficiency particulate air filter, disinfection of OR and the equipment, and more strict regulation of temperature and humidity. Air sampling was repeated after imposing the measures to evaluate their effectiveness. Cases of surgical site infection caused by the identified pathogen were monitored for 90 days, after which it was determined that there was no surgical site infection related to positive air culture. Conclusion: The six-year monitoring of OR air sampling confirmed that detection of positive air culture in routine sampling was not associated with surgical site infection. Based on this result, the hospital decided to conduct air sampling and culture only in outbreak of surgical site infection as part of epidemiologic evaluation.

Introduction: In the Intensive Care Unit(ICU), healthcare-associated infections can arise from factors such as compromised patient immunity and the use of diverse medical equipment. Furthermore, inadequate awareness of infection control among ICU staff can further increase the risk of infections. Therefore, it is crucial for ICU staff to recognize and address infection risks proactively. To enhance infection control measures, designated infection control facilitators within the department have spearheaded infection control activities. Case Presentation: Internal assessments within the ICU identified areas requiring improvement in infection control, leading to the formulation of a self-improvement initiative. The evaluation results revealed deficiencies in pre- hub disinfection and the appropriateness of Chlorhexidine gluconate(CHG) bathing. To address this, ICU team members were tasked with monitoring hand hygiene and performing pre-hub disinfection at least 10 times before central venous catheter usage. The monitoring results were shared with department members monthly, encouraging performance improvement by rewarding outstanding employees. Additionally, protocols and educational videos for proper CHG bathing were developed within the ICU and reviewed by the Infection Control Department. Using this material, internal education sessions were conducted within the ICU to support all team members in achieving their goals. Discussion: Through various improvement initiatives, staff awareness of infection control has increased, leading to proper CHG bathing and hub disinfection. The incidence rate of central venous catheter-related bloodstream infections decreased from 4.25 in 2022 to 3.35 in 2023. Additionally, hand hygiene compliance increased from 92% in 2022 to 96% in 2023. For effective infection management, the participation of not only the Infection Control Department but also departmental members is crucial. Through effective collaboration and discussions between ICU staff and the infection control team, we were able to address departmental issues, improve staff awareness and performance in infection management. Sustained interest and participation in these activities require continuous staffing and support.

Introduction: We propose to develop a Unique Device Identification (UDI) barcode tracking system for surgical instruments. This system aims to enhance hospital processes, thereby benefiting both patients and staff members. Methods: The UDI barcode tracking system for surgical instruments was implemented in March 2023: 1. Each surgical instrument underwent laser engraving with a UDI barcode, encompassing relevant data such as instrument name, image, model, specifications, origin, license, Instructions for Use (IFU), and total distribution quantity. 2. Upon scanning the engraved serial number, the system automatically discerns whether the instrument belongs to the designated set. 3. Mechanical, chemical, and biological monitoring indicators are integrated into the tracking system, with automatic adjudication for release into storage if criteria are met; otherwise, notifications are issued for review and retrieval by personnel. Results: 1. Between March 2023 and February 2024, a total of 157,614 instrument sets were equipped with this system, enabling staff to achieve a zero-error rate in rapid and precise instrument identification. 2.During this period, 4,026 cycles of high-temperature sterilization monitoring and 380 cycles of low- temperature H2O2 plasma sterilization monitoring were recorded. 3.Each monitoring cycle was digitally recorded, obviating the necessity for paper-based documentation and saving a total of 4,406 A4 paper sheets. 4. In the same timeframe, a total of 85,899 packages were dispensed, each linked to patient medical record numbers. Conclusions: The adoption of the surgical instrument UDI barcode tracking system by our institution’s central sterilization supply department has garnered participation from 622 individuals. It not only reduces the time spent by staff searching for items and conducting educational training but also automatically identifies whether the instrument belongs to the package, thereby enhancing inventory efficiency and reducing the incidence of errors. Sterilization monitoring indicators are automatically uploaded and intercepted to uphold patient safety.

Introduction: Urinary tract infection (UTI) is a common healthcare-associated problem. UTI has a lower mortality prevalence than other infections, but it is at high risk of leading to sepsis and increased treatment costs. Therefore, the objective of the study is to describe the epidemiology and burden of disease and determine factors associated with healthcare-associated UTI in the intensive care units (ICUs). Methods: A cross-sectional study was conducted on 4.028 patients admitted to the ICU, Neuro Surgical ICU, and ICU - Cardiovascular Surgery Department at a teaching hospital in Ho Chi Minh City from 2017 to 2022. The study collected secondary data through electronic medical records, including age, gender, diagnosis, department, urinary catheter use, urinary catheter retention time, treatment, and urine test results. Results: The prevalence of UTI in ICUs was 4.0%, of which CAUTI accounts for the highest prevalence, with the typical pathogen being E. coli. The Neuro Surgical ICU had the highest incidence and catheter-used prevalence in ICUs. UTIs were concentrated in people over 80 years old, females, and brain diseases. The length of the hospital stay was long, and the cost of the hospital stay was unaffordable, up to hundreds of millions of VND. The study found factors associated with the prevalence of UTI, such as age, gender, department, diseases, and urinary catheters. Patients with urinary catheters have a 10.98 times higher prevalence of UTI (p < 0.001; PR = 10.98, 95% CI 4.87–24.76) compared to patients without urinary catheters. Conclusions: The results of the study demonstrated that UTI remains a burden on the healthcare system, especially in ICUs. Implementing a UTI prevention package for patients with catheters is important. Besides, it is necessary to maintain continuous training for healthcare workers to properly and timely insert, remove, and replace catheters.

Background: Negative-pressure isolation room was considered the standard for Tuberculosis (TB) isolation ward, but it tends to be high in cost and maintenance. Alternatively natural ventilation with the combination of mechanical ventilation (exhaust fan) room were more commonly used in resource-limited settings. However, its efficacy to prevent TB to the medical staffs are unknown. Objective: To compare the prevalence of latent TB among medical staffs that works in negative-pressure isolation ward against natural ventilation isolation ward at Kandou General Hospital Manado. Methods: An cross-sectional study involving 20 medical personnel that have worked for more than 6 months in negative -pressure isolation ward and natural ventilation isolation ward at Kandou General Hospital Manado, North Celebes, Indonesia. Exclusion criteria were history of TB disease or TB latent, immunodeficiency and long term steroid uses. Fischer exact test and regression analysis was used to evaluate the differences between variables. Results : There were 7 medical personnel (35%) from the negative-pressure isolation ward compared to 11 medical personnel (55%) in natural ventilation isolation ward that were positive for Interferon Gamma Release Assay (IGRA). There were no significance differences between the type of isolation room and the prevalence of latent tuberculosis (p= 0.341). There were also no significant correlations between room type (p = 0.633), work duration (p = 0.181), and the prevalence of latent TB (R2 = 0.06). Conclusion : There is no significant difference between latent TB prevalence among medical presonnel in negative- pressure isolation room and natural ventilation isolation room. Natural ventilation room could be used as an alternative to negative-pressure isolation room.

Background: In University Medical Center Ho Chi Minh City (UMC), shelf life of sterilized packed items has been followed by time-related principle. However, duration of sterility has not been based on strong scientific evidence. Objectives: To determine the most appropriate shelf life for sterilized products according to packaging material and sterilization methods. Methods: All the experimental and the control samples (surgical instruments and linen) were prepared by four types of packaging materials (peel pouch, nonwoven, linen, and rigid container) and three types of sterilization methods (steam, Hydrogen Peroxide, Ethylene Oxide). After sterilization, sterilized samples were stored at CSSD’s storage and tested for microbial contamination in 07 periods: after 07 days, 14 days, 01 month, 03 months, 06 months, 12 months, and 18 months. Identification of the storage environment (shelf location, temperature, and relative humidity) were recorded as the same time collected samples. Results: Positive microbial cultures were seen in 0.44% (07 samples) of 1,574 samples. Up to 18 months, no organisms was cultured from any sample of (1) autoclaved surgical instrument packages wrapped in peel pouches, nonwoven, linen, (2) Hydrogen Peroxide sterilized surgical instrument packages wrapped in nonwoven, (3) Ethylene Oxide sterilized surgical instrument packages, and (4) autoclaved linen packages wrapped in nonwoven. Organisms detected were both Gram–Positive and Gram-Negative bacteria. Just only approximately 17% control samples grew bacteria. There was no any statistically significant relationship between positive experimental samples and packaging materials, sterilization methods, or storage conditions. Conclusions: Based on results of this experiment, shelf life of sterilized packed items should be still followed by time-related principle in UMC. However, the currently shelf life can be extended to reduce unnecessary costs and increase the usage rotation.

Introduction: Bloodborne pathogens’ exposures are defined as injuries to contaminated sharps and exposures to patients’ blood or body fluids continue to present risks to healthcare workers (HCWs). This study was conducted to investigate the epidemiological characteristics of sharps injuries and evaluate the effectiveness of prevention strategies in an Academic Medical Centre (AMC) in Singapore. Method: This retrospective study was conducted at a 1,700 bedded AMC. The data was retrieved from the hospital’s electronic incident reporting system over a five-year period between 2019 and 2023 at Singapore General Hospital. Results: There are a total of 719 bloodborne pathogens’ exposures incidents. The highest incidence of bloodborne pathogens’ exposures was reported among doctors (3.5 incidents per 1000 healthcare workers per month), followed by nurses (1.4), allied health (0.4) and ancillary staff (0.3) during the 5- year period. Intraoperative procedures (IOP) 198 (27.5%) see the most frequent incidents followed by minor procedures 112(15.6%), splash incidents 91 (12.7%), blood taking 87(12.1%), IVIM (8.3%). The highest incidents among IOP were associated with use of suture needles. Approximately 2.9%, 2.3% and 0.7% of the source patients were carriers for Hepatitis B, Hepatitis C and HIV respectively. No seroconversion occurred among all injured HCWs. The overall sharps injury incidence has improved from 21.5 to 11.2 per 1000 healthcare workers per year following targeted preventive measures implementation. Conclusion: A comprehensive bloodborne pathogen exposures programme greatly helps to improve and mitigate the risk of exposures where key preventive measures are identified, followed by timely implementation of appropriate post-exposure management.

Introduction: Razors were being used for pre-operative hair removal in our Institute. As per international guidelines recommending the use of surgical clippers, we opted to study the effects of two pre-operative skin preparations in our Neurosurgical centre Objectives: Primary; Pre auditing period -Assess knowledge and skill in usage of Razor/Clipper as preoperative skin preparation methods, Provide training on Clipper method and assess the knowledge /awareness on merits and demerits of both methods, To implement the Clipper method as against Shaving Secondary ; Post auditing period -Investigate the efficacy and safety of clippers versus razors, on variety of biophysical parameters and Surgical Site Infection (SSI) Methods : PICO questions ; Population: Adult patients undergoing any type of surgical procedure, Intervention: Hair removal, Comparator: Different methods of Hair removal, Outcomes: Biophysical parameters and SSI •Target population: Sixty adult patients undergoing neurosurgical procedures. •Subjects: 30 each subjected to shaving and clipper methods •Pre and Post assessment of on 25 parameters /sub-parameters •Analysis by MS-Excel and SPSS. Results:•Preoperative -Prior skin injuries and/or reactions; adequacy of hair removal •Complete hair removal : 30 (100%) in the clipper group versus 3 (10%) by shaving (p = 0.0001). •30 mins after hair removal ; significantly less skin issues in the clipper group •Post operative - Skin injuries in 20 (66.6%) of the razor and none in the clipper group. •SSI - Two (6.6%) in the razor and none in the clipper group. Conclusions: The assessment showed that shaving leads to partial hair removal increasing the scores for skin issues, significant association between preoperative skin injuries and SSI, implying inverse correlation with the clipper method. This study provides insights into significance of among other biophysical parameters underscoring adoption of clipper as the standard practice for preoperative hair removal, in our setting thus enhancing patient safety.

Background: Antimicrobial Stewardship Program (ASP) is a global issue. World Health Organization (WHO) stated, there are 3 categories of antimicrobial: ACCESS, WATCH, and RESERVE. e-RASPRO as a digital ASP may alter antibiotic prescribing pattern by prioritizing ACCESS category as suggested by WHO. Methods: This manuscript was a ward retrospective survey data of 9 months Define Daily Dose (DDD) average before-after implementing the electronic-RASPRO (e-RASPRO) on ACCESS & WATCH antibiotic. Results: Number of inpatients 9 months before-after e-RASPRO implementation were 7,754 and 6,794. Within 9 months after implementing e-RASPRO there was a trend of antibiotic prescription shifting from WATCH category antibiotic to ACCESS category antibiotic. There was a trend of reduced Define Daily Dose (DDD) average of WATCH category antibiotic. 24.82% of 3rd generation Cephalosporin, 33.20% of Quinolones, 14.76% of Carbapenems and 100% of Piperacillin Tazobactam DDD average were reduced. While, in ACCESS Category Antibiotic, there were an elevation of Penicillin and Aminoglycosides DDD average up to 528.66% and 137.66%. Conclusion: T here are trend changing of DDD average from WATCH to ACCESS category antibiotic following the 9 months implementation of e-RASPRO. We need further study to judge the effectiveness of e- RASPRO as a digital ASP tools.

Background: Occupa(onal blood and body fluid exposure is one of the major public health problems in healthcare workers (HCW). This condi(on had the risk of transmission of infec(ous diseases. Educa(on level is oEen considered a key factor influencing the frequency and dura(on of exposure. This study inves(gates the correla(on between medical profession and the (me of occupa(onal exposure among health workers at RSUD dr. Saiful Anwar Malang from 2020 to 2024. Objective : The primary objec(ve of this study is to determine whether there is a significant correla(on between the educa(on level of health workers and their exposure, with the aim of iden(fying poten(al areas for interven(on to reduce occupa(onal hazards. Methods : A cross sec(onal study from health workers from at RSUD dr. Saiful Anwar Malang. Data included gender, medical profession (nurse, resident, doctor, medical student, cleaning service), and (me of exposure (work hour, duty hour), and status immuniza(on. Sta(s(cal analysis was performed using the chi-square test to determine the significance of the rela(onship between employment status and exposure (me. Result: From 93 responden, distribution gender (60.6% female, 39.4% male), medical profession (35.5% nurse, 33.3% resident, 3.2% doctor, 23.7% medical student and 4.3% others), exposure time (53.2% duty hour, 46.8% working hour), source of exposure (61.3% needle, 34.4% blood, 5% others body fluid), 86.2% used PPE and 68,1% already had hepatitis B immunization. The analysis showed significant relationship with exposure time (p = 0.046) among medical profession and time of exposure. Conclussion : This study is important in identifying specific risks related to the group status of medical personnel and the time of exposure to needles, blood and body fluids to identify vulnerable workers. In addition, with this basic study, more effective safety policies and protocols can be developed by adapting to the needs of each work group. Research recommendation is needed to explore the impact of specific education and training programs in reducing the risk of exposure in HCW.

Objectives: The COVID-19 pandemic has become a serious threat to global health. Current research shows that COVID-19 causes an increase in the incidence of multidrug-resistant organisms (MDRO) due to excessive use of antibiotics during COVID-19 [1,2]. Extended-spectrum β lactamase-producing Enterobacterales (ESBL-PE), especially Escherichia coli-producing ESBL (Eco-ESBL) and Klebsiella pneumoniae-producing ESBL (Kp-ESBL) are pathogens of current concern due to their potential for rapid spread in communities and healthcare [3]. Based on antibiogram data from Dr. M. Djamil General Hospital Padang in 2022, the incidence of MDRO in the inpatient, outpatient, and intensive care units was mostly caused by Kp-ESBL (12,7%), followed by Eco-ESBL (11,9%) [4]. This study aims to compare the incidence of MDRO caused by Eco-ESBL and Kp-ESBL before, during, and after COVID- 19. Methods: This research constitutes a retrospective descriptive study conducted at Dr. M. Djamil General Hospital Padang during three distinct periods: before, during, and after the COVID-19 pandemic. The population of this study was the results of all cultures from all specimen examinations that produced ESBL. Two thousand and seventeen samples were taken from the population that met the inclusion and exclusion criteria using the total sampling technique. Results: Comparison of the incidence showed that Eco-ESBL has an increased risk of incidents after the pandemic by 1.41 times compared to before the pandemic, while the risk of incidence during the pandemic does not show a significant relationship (p=0.63, p>0.05). In contrast to Kp-ESBL, there is a decrease in the risk of incidence after the pandemic by 0.62 times compared to before the pandemic (p<0.05), while the risk of incidence during the pandemic also does not show a significant relationship (p=0.63, p>0.05). Conclusion: There is a significant risk of incidence of MDRO caused by Eco-ESBL and Kp-ESBL after the pandemic compared to before the pandemic COVID-19.

Background: SSI cases in patients undergoing SC procedures are still a problem. Routine bundles are being implemented but infections still occur. So, it is necessary to evaluate existing bundles. Research objective: To compare the incidence of post-SC SSIs between the implementation of routine bundles in hospitals with new SSI bundles. Method: Quantitative research using a prospective cohort method on pregnant women of childbearing age (WCA) aged 15-49 years who were treated in the Dr. Hasan Sadikin General Hospital, Bandung. Data collection was carried out in the period October- November 2023 where SC was carried out. The sampling technique that will be used in this research is a non-probability sampling technique with a consecutive sampling method. The instruments used are the SSI indicator profile, hospital standard tool bundles, and new SSI tool bundles. Data analysis used the Fisher Exact test to compare the two groups and the efficacy formula to calculate the effectiveness of implementing the two bundles. Research Results: There were 710 cases of SC, and in 60 research samples in both groups for one month, the results of the intervention group with new bundles of SC showed 100% effectiveness with no cases or 0% during the 0-30 days post-SC operation monitoring period while the control group with hospital procedure bundles had one case or 3.3%. The Fisher Exact test analysis showed no significant difference (P> 0.005) between the intervention group with new SC bundles and the control group with hospital procedure bundles (P=1.000). Conclusion: The implementation of the new SSI bundles in the intervention group was proven to be effective with no cases of SSI when compared to the control group with hospital procedure bundles which contained one case of SSI.

Background: Technological advancements have made ultrasound devices more portable and user-friendly. Even when ultrasound machines and probes are visibly clean, clinically important pathogenic organisms have been grown from them (Shokoohi et al, 2015). Ultrasound machines could therefore serve as a fomite for pathogens known to cause healthcare-associated infections. Thorough cleaning and disinfection of ultrasound equipment greatly reduces the microbial burden and lessens the chance of clinically important infections. However, studies indicate suboptimal cleaning practices and a lack of training among ultrasonographers [Westerway et al 2019]. Aims and Objectives: To assess the standard of ultrasound/probe cleaning within the hospital at POCUS and to benchmark it against hospital policy. Assess the level of probe reprocessing training received by operators. Develop and implement interventions based on targeted need assessment and evaluate their effectiveness. Method and Outcome: A study of ultrasound/probe reprocessing practices identified serious concerns. The cleaning of USG probes was suboptimal for critical, semi-critical, and non-critical probes as per the Spaulding classification. The compliance level for tracking and tracing was unacceptable. Lack of knowledge, inadequate access to cleaning supplies and equipment, and time constraints were primary barriers to guideline-based disinfection. Interventions were guided by the audit results. To better educate Ultrasonographers, an educational tool was created with best practices for USG machine and probe cleaning and disinfection, an instructional video, a summary of cleaning steps, and links to best-practice guidelines. We were able to significantly improve the thoroughness of cleaning ultrasound machines and probes by using targeted interventions. Conclusion: For ultrasound-guided procedures, non-compliance implies greater risks. The results of this study confirm the concern expressed by a global survey of ultrasound users which suggested that ultrasound cleaning procedures are inadequate and that users are unaware of recommended practices.

Introduction: Catheter Related Bloodstream Infection (CRBSI) continues to be a major healthcare associated infection in Intensive Care Units. The necessity of Central Venous Catheters (CVC) for critically ill patients creates a significant challenge in reducing the CRBSI rates. This challenge is further amplified by the extended duration of CVC use required for many of our patients due to complex treatment regimens, hemodynamic monitoring needs, and the presence of high comorbidity factors. The purpose of this study was to review the impact of a 12-month comprehensive CRBSI reduction program and a new Central Line Maintenance Bundle (CLMB) on reducing CRBSI rate in a cardiothoracic surgical ICU. Case Presentation: Observational study carried out and yearly CRBSI rate compared before and after implementation of the program. The program consists of one-month hand hygiene campaign conducted every quarterly throughout 2021, application of disinfectant cap (Curos) for all long staying patients, application of Chlorhexidine tegaderm for newly inserted central line, application of no sting barrier film at CVL sites and Adenosine triphosphate test on random surfaces for cleanliness. Besides, the existing CRBSI Bundle was separated into CRBSI Insertion and Maintenance Bundle. The new CRBSI Maintenance Bundle consists of HH, hub care, site care, tubing care and daily review. Infection control link nurses were appointed every shift to ensure adherence to the infection control protocol. The CRBSI rate before and after the program was compared. Discussion: At the beginning of the study, the CRBSI rate was 4.8 per 1000 catheter days. The CRBSI rate reduced to 3.3 per 1000 catheter days, at the end of the study. The overall reduction of CRBSI rate was 31%. Conclusion Implementing a comprehensive CRBSI reduction program and a new Central Line Maintenance Bundle was able to significantly reduce catheter related blood stream infection in ICU.

Acknowledgments: Department of Nursing, National Heart Institute, Dato Dr.Suneta Sulaiman, Intensive Care Unit Director.

Introduction: HA-MDRAB infections and colonizations are known to pose an urgent threat to patients admitted to ICUs worldwide and are difficult to treat, which leads to significant mortality and morbidity. However, multimodal environmental cleaning strategies are effective for MDRAB prevention and control. Objective: The objective of this study is to evaluate the impact of multimodal environmental cleaning strategies in reducing HA-MDRAB rate in ICU in a tertiary teaching hospital, Universiti Malaya Medical Centre (UMMC). Methods: This is a retrospective analysis of patients admitted to an adult ICU over three periods (P); P1 (January 2018 - December 2019), P2 (January 2020 - June 2022), and P3 (July 2022 – December 2023). The total number of HA-MDRAB infections and colonizers and total patient days in ICU were collected monthly and HA-MDRAB rate per 1000 patient-days was analyzed. The five elements of infection prevention and control (IPC) multimodal strategies involving multidisciplinary teams were integrated with environmental cleaning since 2018, including tailored in-house training for environmental service staff (EVS), cleaning approach, techniques and product used, hospital-wide environmental cleaning policy, use of environmental audit checklist and giving frequent feedback to the EVS, and communication strategies to engage EVS and key stakeholders in order to promote organizational safety culture. Results: HA-MDRAB rates in ICU increased by 23% from 7.20 (P1) to 8.85 (P2) per 1000 patient days and decreased to 4.94/1000 patient days (P3) after the reinforcement of environmental cleaning strategies. During P2, the rates were higher from July - December 2021 (15.8/1000 patient days). Conclusion: Increase in HA-MDRAB rates was likely due to changes in infection control measures during COVID- 19 pandemic such as extensive workload compromising the compliance to environmental cleaning among EVS. With reinforcement of the environmental cleaning multimodal strategies, HA-MDRAB incidence reduced, emphasizing the importance of adherence to IPC practices in environmental cleaning.

In recent years, organizational factors such as infection prevention climate have been recognized as important factors of healthcare workers’ adherence to infection prevention practices. However, there is a lack of instruments with good reliability and validity to measure infection prevention climate within organizations in Chinese context. Therefore, this study aims to translate, culturally adaptation and test for the psychometric properties of the Chinese version of Leading a Culture of Quality for Infection Prevention (CLCQ-IP). The original scale was translated into Chinese through 1) Forward translation; 2) Expert review; 3) Back translation; 4) Applicability evaluation. Then, a multicenter cross-sectional survey was conducted using the CLCQ-IP. Reliability in terms of internal consistency was evaluated. The content validity, exploratory factor analysis, confirmatory factor analysis, were tested for assessing the construct validity of the CLCQ-IP. After linguistic and cultural adaptation, the CLCQ-IP was finally formed with 19 items in 4 dimensions and a total 882 HCWs from 4 provinces finished the survey. The overall Cronbach’s alpha of the CLCQ-IP was 0.865. The items of content validity index, ICVI of the C-SPQ ranged from 0.875 to 1.00, and the scale of content validity index S-CVI/AVE was 0.894. In terms of construct validity, the exploratory factor analysis extracted a total of 4 factors, which were consistent with the original scale. The factor loadings of each item were above 0.70, and the cumulative variance contribution to the scale was 71.88 %. The Confirmatory factor analysis showed the good model indicators: x"/df =1.508, RMSEA=0.41, GFI=0.934, AGFI=0.912, NFI=0.953, TLI=0.981, CFI=0.984. The results of the study show empirical evidence of validity and reliability of CLCQ-IP can be highly recommended to be widely used among Chinses HCWs.