Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of healthcare associated infections. Colonization with MRSA increases the risk of subsequent nosocomial infection. The primary concern regarding widespread use of mupirocin is the emergence of mupirocin resistance. A prospective cross-sectional study in Singapore in 2013, found mupirocin resistance to be 31.6% in Changi General Hospital (CGH). Annual usage of mupirocin (g) in CGH was 36870 and hospital-onset MRSA bacteremia was 1.1/10,000 patient-days in 2013. Objective: To study the impact of hospital measures to reduce mupirocin resistance among MRSA by detection of mupirocin resistance in screening isolates. Method: Changi General Hospital is a 1000 bedded acute care hospital. Hospital wide measures were instituted in CGH to reduce mupirocin resistance in MRSA included a) universal body wash with Octenidine for all hospitalized patients in the wards with MRSA cubicles b) 2% mupirocin ointment removed from formulary (available for nasal decolonization only) A study was conducted on MRSA screening isolates from the Microbiology Laboratory between May and September 2019. These were obtained by swabbing nasal, axilla and groin on all newly admitted patients as part of an active surveillance program since 2013. The swabs were streaked onto MRSAiselective media plates which were incubated at 35 °C for 20 hours and stored at 4 °C. E-test was performed to determine the susceptibility and minimum inhibitory concentration (MIC) of MRSA isolates to mupirocin, oxacillin and vancomycin, following the CLSI guidelines for S. aureus. MPCR (multiplex polymerase chain reaction) assay was used for the simultaneous identification of ileS-2 (primers MupA and MupB) and mecA (primers MecA1 and MecA2). PCR amplification of ileS- 2 gene for high level mupirocin resistance and Mec A gene was performed on Touch thermal cycler. Results: 200 MRSA isolates were tested. E-test revealed 5 isolates were detected to be High Level mupirocin- resistant (2.5%) and 69 isolates were detected to be oxacillin-resistant (74%). The MPCR assay detected mecA gene in 100% and ileS-2 gene in 3 isolates (1.5%). Conclusion: Our study indicated the low prevalence of high level mupirocin resistance among MRSA screening isolates in 2019 in CGH. This suggested that the hospital wide measures to reduce mupirocin resistance were effective.

Objectives: Japan is becoming a super-aging society, with people aged over 65 years old accounting for 28.9% of the total population. Therefore, nursing care facilities have significant implications in contemporary Japanese society. In those facilities, it is important to clean and disinfect the environment in order to prevent the spread of infection to the residents. Thus, the aim of this study was to verify the disinfection effect of atomizing IONLESSTM hypochlorous acid water (CLFineTM) as a newly efficient disinfection method of environment by evaluating its antimicrobial effect against Staphylococcus aureus in two nursing care facilities and one facility shuttle vehicle. Methods: The bacterial suspension of Staphylococcus aureus was dripped onto petri dishes, and they were used as test carriers after drying. The test carriers were allocated in the area of interest (six sites for Facility A and B, two sites for shuttle vehicle), and then CLFineTM was atomized by ultrasonic humidifier so as to adjust the atmospherically available chlorine concentration to 0.03 ppm. The test carriers were collected 3 and 5 hours after atomization of CLFineTM followed by evaluation of the viable bacterial counts. Results: In Facility A and B, antimicrobial effect of 1.68 to 3.79 LogR and 0.98 to 2.76 LogR were observed 5 hours after atomization, respectively. In shuttle vehicle, antimicrobial effect of 2.70 to 6.32 LogR were observed 5 hours after atomization. Conclusions: The atomization of CLFineTM has also been suggested to be useful as a control measure against aerosol infections. Therefore, it is expected to be applied as a non-touch disinfection method in addition to regular wet cleaning in nursing care facilities.

Objectives: The development of medical technology has led to increasingly intricate surgical instruments, varying in types and structures. This complexity has posed challenges in the instrument reprocessing.The Emergency Care Research Institute in the United States has continuously issued alerts regarding the reprocessing of instruments or endoscopes from 2013~2020, It is evident that failure to perform thorough cleaning in accordance with the standards may result in organic debris on the instruments, posing the risk of infection or even death to patients Methods: We collected data on 39 visibly soiled instruments reported by the OR from 2021 to October 2023. Through personnel interviews, questionnaires, and identification of types of soiled instruments,we identified key issues using fishbone diagram analysis, the findings as follows (1).only 48% of OR personnel had received precleaning education and training, 75% of respondents cited being too busy for not precleaning (2).CSSD staff demonstrated a cleaning cognitive test success rate of 81%, particularly challenging were instruments with intricate designs, requiring specialized cleaning procedures (3). Failure to provide different cleaning methods depending on the level of residues or difficulty to clean.The following strategies are proposed:(1). Enhanced precleaning education and training for OR staff (2).Use of enzymatic precleaning products to saturate instruments prior to cleaning. 3. Development of a classification system for instruments requiring longer cleaning times. Results: Between November 2023 to March 2024, one visibly soiled instrument was reported, marking a significant drop from an incidence rate of 1.15 to 0.20 per month. Cognitive test success rate rose from 81 to 97%. Implementing different methods based on the difficulty of cleaning or the complexity of features, as well as enzymatic precleaning products, were universally adopted in the OR Conclusion: Thorough cleaning is a crucial process for effective sterilization. Collaborative efforts between CSSD and OR significantly reduce the possibility of cross-contamination

Background: The risk of respiratory infection varies on the degree of the fit of N95 masks, so education and training of appropriate wearing methods are required. This study was conducted to investigate whether there are differences in the fit of N95 masks among healthcare workers(HCWs) with education and experience in N95 mask-wearing and to assess the effectiveness of N95 mask-wearing training through fit tests. Methods: From October 2023 to February 2024, training on the wearing of N95 masks was conducted through fit tests for 195 high-risk department HCWs and new HCWs at a tertiary hospital. Fit tests was conducted before and after the training. Previous experiences of N95 mask-wearing education were investigated using questionnaires. The fit test was measured using QNFT (Quantitative Fit Test). Data was analyzed using percentages and a chi-square test. Result: Out of the 195 participants, 44 HCWs had experience by group or rote learning. The fit test pass rate in the group with education experience was 45.5%, which was higher than the 32.9% in the group without education experience; however, there was no statistically significant difference (P=0.293). The fit test pass rate for N95 mask-wearing training increased significantly from 35.8% (70 HCWs) before training to 98.5% (192 HCWs) after training (p=0.000). The three HCWs who failed the first test all passed the fit test after retraining using N95 masks of different shapes and sizes. Discussion: It was confirmed that N95 mask-wearing training through fit tests was effective in increasing fit, whereas group or rote learning was not effective. N95 mask-wearing training through fit tests is an effective method to enhance N95 mask fitting. It is essential to explore diverse approaches to sustain the training impact.

Introduction: Hundreds of millions of patients worldwide are infected with Healthcare-Associated Infections (HAIs) each year causing deaths and significant financial losses to health systems. HAIs incidence in Indonesia (2021) reached 15.74%, far above in developed countries (4.8-15.5%). At Premier Bintaro Hospital (RSPB), the number of High Care Unit (HCU) patients at risk of HAIs reached 51% in the January - June 2023 period. The aim of this research is to reduce the risk of HAIs in HCU patients at RSPB. Methods: The HAIs risk identification was conducted on all HCU patients when first admitted using the SIRS (Systemic Inflammatory Response Syndrome) and REDS (Risk Emergency Department Scoring) criteria. Based on the screening results, interventions were applied through environmental modifications, implementation of HAIs care bundle, and nurse allocation based on colour codes: At risk of infection as RED, and no risk of infection as GREEN. The risk monitoring was conducted using HAIs scoring. Results: The research was conducted in the January - June 2023 period on 206 patients. It was found that 51% of the patients were at risk of HAIs. After interventions, the number reduced to 39%. In addition, there were zero incidents of HAIs during that period. Conclusions: To control the risk of HAIs in HCUs, the implementation of risk screening & scoring and interventions such as environmental modifications, nurse allocation, and HAIs care bundle, have shown to be effective strategies. This is evident from the decrease in the number of patients at risk of HAIs.

Recommendations for hospital is to continue implementing risk control of HAIs by regularly assessing the risk, applying interventions, and consistently monitoring the risk as efforts in continuously reducing the HAIs risks. For future research, it is recommended to expand the sample of patients and extend the period to implement risk control of HAIs even further.

Acknowledgements: We are very grateful to all members of CCU team at Premier Bintaro Hospital for their contribution in implementing the methods and strategies of HAIs risk control in this study.

Objectives: Central Line-Associated Bloodstream Infections (CLABSIs) are associated with prolonged hospitalization, increased healthcare costs. It is important to reduce CLABSI rates through interventions. This study investigated the current status of CLABSI rates among hospitalized patients to gather foundational data for implementing CLABSI intervention measures. Methods: During a month from June 1st to 30th, 2023, a retrospective investigation of CLABSI rates was conducted among patients hospitalized at a tertiary hospital in South Korea. Psychiatric and obstetric, hospice, emergency, neonatal wards, and delivery rooms were excluded from the study. CLABSI was defined according to NHSN and Korean National Healthcare-associated Infections Surveillance System. Results: A total of 48 CLABSIs were identified, with mucosal barrier injury laboratory-comfirmed bloodstream infection (MBI-LCBI) accounting for 29 (60.4%) and non-MBI-LCBI for 19 (39.6%). Among MBI-LCBI, 28 (96.6%) occurred in hematology wards, while among non-MBI-LCBI cases, 9 (47.4%) occurred in general wards, 9 (47.4%) in hematology wards, and 1 (5.3%) in the intensive care units (ICUs). Overall CLABSI rates was 2.75 per 1,000 catheter days, with 1.66 for MBI-LCBI and 1.09 for non-MBI-LCBI. By department, the CLABSI rates per 1,000 catheter days were 6.11 in hematology wards, 1.02 in general wards, and 0.63 in the ICUs. A total of 58 organisms were isolated, with gram- negative bacteria (78.8%) predominating in MBI-LCBI and gram-positive bacteria (56.0%) in non- MBI-LCBI. Among MBI-LCBI, Klebsiella pneumoniae (30.3%), Escherichia coli (27.3%) were the most frequently isolated organisms, whereas among non-MBI-LCBI, coagulase-negative staphylococci (16.0%) and E. coli (16.0%) were the most frequently isolated organisms. Conclusions: The CLABSI rates among hospitalized patients at a tertiary hospital in South Korea was higher for MBI-LCBI than non-MBI-LCBI, with the majority occurring in hematology wards. Since the departments and causative organisms are different depending on MBI-LCBI and non-MBI-LCBI, it is necessary to individualize the CLABSI surveillance policy based on this.

Background: Prevention of Healthcare-Associated Infections (HCAIs) is an essential component of patient’s safety in every healthcare setting and serve as an indicator for a good healthcare practice. Surveillance for HCAIs is important to measure their burden, identify high-risk patients and procedures, and guide efforts to reduce HCAI incidence. The aim of current study is to determine the prevalence of HCAI Hospital Universiti Sains Malaysia (Hospital USM), Kelantan, Malaysia. Methods: A one-day point prevalence survey (PPS) was conducted between 1st October 2023 to 15th October 2023 on all patients admitted to 15 selected wards at Hospital USM. The PPS was performed strictly following the “Manual for point prevalence survey for healthcare associated infection” by Ministry of Health Malaysia. Data were collected by a team of trained infection control practitioners, compiled, and analysed accordingly. Results: The surveyed hospital is a tertiary care teaching hospital contained 829 beds, has 11 certified infection control nurses, has 50 isolation rooms and 4 negative pressure rooms. During the surveyed period, there were 121 patients on continuous bladder catheterization, 63 patients had central venous catheter in situ and 107 patients were on mechanical ventilation.

Of the 588 patients surveyed, 14 (2.4%) had an active HCAI. Identified predisposing factors associated with the occurrence of HCAI were underlying medical illness (40.7%), prolonged hospitalization (25.9%), prematurity (11.1%), history of surgery (11.7%), immunosuppressive therapy (7.4%) and others (3.7%). The most frequent types of HCAI were pneumonia, followed by blood stream infection, clinical sepsis, surgical site infection and urinary tract infection. Conclusions: The survey reports an overall prevalence of 2.4% of HCAI in Hospital USM. A yearly PPS is very useful tool to measure the overall prevalence of HCAI, highlighting the areas with prevalence that require special attention and allowing planning for improvement actions.

Introduction: To avoid Clostridium difficile infection in the healthcare facility is an important work. There were many methods to do in the C. difficile infection (CDI) reduction bundle, including cleaning and disinfection. After cleaning and disinfection, we can do an environmental examination to check whether it contains C.difficile or not. Traditional, we did the culture to check but it have to wait 24-48 hours. This method was so slow, so in this study, we try to use the molecular methodology to detect C.difficile. Methods: We collected the specimen after 16 hours when the cleaning and disinfection. Then we used the POCT real-time PCR((POCKIT central C.difficile, GeneReach Biotechnology Corp, Taiwan)) and culture agar to detect whether C.difficile is present or not. In this study, we collected 48 specimens from CDI patients’ environments when they transferred to another space or left. Results: We found all the POCT real-time PCR results were the same compared to the culture results. That’s to say, the POCT real-time PCR can replace the culture method and improve the term around time on the diagnosis of C.diffiicle. Conclusion: The molecular method could replace the traditional culture due to it was quick and precise. Patients can’t wait for the culture result in clinical, especially in the ICU. Once delayed, the mortality rate would arise. In other words, the POCKIT central C.difficile is useful in clinical. It can be used to detect whether C.difficile survives on the surface or not. However, due to the limitation of the sample count, the statistical significance was not complete. So we will collect the sample to finish this study.

Background: The incidence of Healthcare Associated Infection (HAI) in the ICU is five to seven times higher compared to general. The aim of this study was to determine the incidence and risk factors for HAI in the ICU at Dr. Cipto Mangunkusumo hospital. Methods: This study use retrospective data, adult patients age ≥ 18 years who were treated in ICU and suspected diagnosis of HAI (including Ventilator associated pneumonia, Catheter associated urinary tract infection, Central line associated bloodstream infection and Surgical site infection) in period from October 2022 – January 2023 were included in this study. We analyze the examination results of each specimen with identification, antibiotic susceptibility test and genomic data using whole genome sequencing. Results: There were 160 specimens with 108 positive culture results. The organisms that most commonly cause infections from blood specimens are Klebsiella pneumoniae (3/11), Acinetobacter baumannii (1/11) and Pseudomonas aeruginosa (1/11). For sputum, the causative pathogens obtained included K. pneumoniae (23/57), A. baumannii (11/57), and P. aeruginosa (9/57). Meanwhile, for urine specimen the main bacteria causing infection was K. pneumoniae (4/7). In the antibiotic susceptibility test, the results showed Carbapenem Resistant Organisms (CRO), namely A. baumannii 89.5% (17/19), K. pneumoniae 76.3% (29/38), P. aeruginosa 40% (4/10), and E. coli 20% (1/5) with positive ESBL presentation are 15,8% in K. pneumoniae and 40% in E. coli. Conclusion: We found that the most common risk factor for HAI was the use of medical devices. Most of HAI infections that occurred in all specimens we took were caused by Klebsiella pneumoniae. Antibiotic resistance results show that many organisms that cause HAI are also resistant to Carbapenem antibiotics with variations in resistance genes (gene CTX-M, CTX-M-1, SHV, or TEM).

Objectives: This study was conducted to define the classification of the infection control and prevention (IPC) practices through task analysis method, and to perform importance-performance analysis (IPA) on IPC tasks, consequently providing operational guidelines for the department of IPC. Methods: To define the tasks of the IPC practices, the draft was developed through the legal and literature reviews, and the final IPC tasks were confirmed by content validity test. The IPC tasks were assessed by IPA method. The national surveys were conducted by the institutional and individual level from October to November, 2023. The institutional questionnaire was distributed nationally to the IPC director/manager of the tertiary hospitals, and IPC practitioners assessed the IPA of IPC task. Results: Two thirds (30/45) of the IPC director/manager responded the institutional questionnaire. A total of 135 IPC practitioners (32 physicians and 103 nurses) completed the IPA survey. The average beds of hospitals participated in this study were 1,060±436. The ICP staffing met the legal requirements in all hospitals. The IPC tasks were consisted of 11 categories and 38 items including surveillance and ICP planning. According to IPA, at a 1st quadrant (high in frequency and importance) surveillance, infectious patient management, health management and action planning of healthcare associated infection were placed. At a 2nd quadrant (high in importance but low in frequency), annual IPC planning was positioned. At a third quadrant (low in frequency and importance), ICP training, policy-making, general hygiene, and ICP staffing were placed. There was nothing at a 4th quadrant (high in frequency but low in importance). Conclusion: Most of IPC tasks are consistent in degree of importance and frequency except IPC planning. Based on IPA, priority-based task distribution should be considered to maximize the work efficacy and effectiveness.

Objectives: Pneumonia is the leading cause of morbidity and mortality worldwide, eighth rank in the United States. The use of antibiotic for pneumonia theraphy contribute the highest rate compared to the usage of antibiotic therapy for other diseases. Antibiotic resistance can occur due to the irrational use of antibiotics. World Health Organization (WHO) predicts that by 2050 there will be 10 million people per year who die due to drug resistance. The Gyssens method is a tool to evaluate the quality of antibiotic use that has been widely used in various countries. The purpose of this study was to assess the compatibility of antibiotic use based on Gyssens plot categories in pneumonia patients. Methods: This study used descriptive-observational with a cross-sectional study in pneumonia patients at Dr. Wahidin Sudirohusodo Hospital on periode from July-December 2023. The compatibility of antibiotics was assessed using the Gyssens flow. Results: This study involved 116 subjects, 70 males, 46 females. In this study, found that the use of rational antibiotics is 58% and irrational 42%. From irrational group we obtained category IV (3%), IIIa (31%), IIIb (8%). The most often antibiotic that used are ceftriaxone (26,8%)) and azithromycin (26,3%). Conclusions: The use of antibiotic in pneumonia patients assessed using the gyssens method in the Inpatient Installation of Dr. Wahidin Sudirohusodo Hospital from July to December 2023 found that the usage for antibiotic is rational for 58%, of the total patient and irrational use was 42% of the total patient during the research study.

Objectives: Neonatal intensive care unit (NICU) admits premature babies and neonates with acute illness who are under high infection risk due to immature immune response system. Infections caused by carbapenem- resistant Enterobacterales (CRE) is a serious threat to such patient population. A single case of CRE infection occurred in 36-bed NICU on July 2023. Infection control measures were put in place to prevent further CRE infection within the NICU. Methods: A neonate delivered at gestational age of 23 weeks and 6 days with birth weight of 650g was under mechanical ventilator care. On 35th day of life, CRE (Escherichia coli, New Delhi metallo-beta- lactamase-1 positive) was isolated from this neonate’s endotracheal suction material. After discussion with infection control physician, the bacterial culture was determined to have been resulted from colonization or localized infection, rather than invasive infection. Five measures were taken to prevent additional infection within the NICU. One, contact precaution was issued for CRE-infected baby, and an isolation ward and a designated nurse was assigned for the baby to prevent cross infection. Two, adherence to hand hygiene and personal protective equipment (PPE) application was monitored for medical personnel and visitors entering the NICU. Three, a checklist was designed specifically for disinfection of NICU isolation ward, and the designated cleaner and assistants were educated on the checklist. Four, testing with fluorescent markers was performed to validate cleaning. Five, the infectious disease specialist and the pharmacy analyzed the prescription pattern of broad-spectrum antibiotic among patients in NICU for systematic antibiotic regulation. Results: The following results were obtained after 2 weeks of infection control measures. 57 subjects underwent hand hygiene monitoring, on which 15.8%(9 case) of the subjects unadequately passed. Immediate feedback was provided upon these detections. Cleaning validation detected a single cases of inadequate disinfection (door to isolation ward), for which re-cleaning and education was performed. An increasing trend in consumption of 3rd generation cephalosporin (8.96% in April 2023 to 21.21% in June 2023) was found, and the neonatology department was advised to be more selective in prescription of broad- spectrum antibiotics. Conclusions: There was no CRE infection for 6 months following infection control measures. This case was determined to be an isolated case of CRE infection, and no further surveillance culture was obtained. Proactive infection control measures, including contact isolation, hand hygiene, environment cleaning, and regulation of broad-spectrum antibiotics, are necessary to prevent secondary infections that may follow an index CRE infection in the NICU.

Objectives: The competency of infection control nurses (ICNs) plays a pivotal role in enhancing the quality of healthcare facilities. This descriptive study aimed to assess the competency level of ICNs in South Korea and identify influencing factors. Method: An online self- administered questionnaire survey was conducted through an announcement on the Korean Infection Control Nurses Association website. An online self-administered questionnaire was distributed via the Korean Infection Control Nurses Association website, garnering responses from 199 participants out of 450 approached. Statistical analyses, including descriptive statistics and multiple regression analysis, were conducted using SPSS/WIN 27.0 software. Result: Analysis reveals that participants had an average age of 34.8 (8.4) years and an average of 5.0 (4.7) years of experience in infection control. The competency score for infection control was 3.6 out of 5. Competency levels varied across domains, with the highest scores observed in employee safety and infection control domains, while the lowest scores were in infectious disease identification and communication domains. Significant variables affecting competency, as identified through univariate analysis, included awareness of infection control competency, age, education level, ICN experience, position, and possession of an infection control specialist license. Ultimately, factors influencing ICN competencies were determined to be awareness of infection control competencies, attainment of a master’s degree or higher, over 5 years of ICN experience, and age over 50, collectively explaining 45.6% of the variance. Conclusion: Enhancing the competency of ICNs is crucial for effective infection control in medical settings. Strategies to improve awareness of infection control competencies and provision of continuous education support and career development programs for ICNs are essential to achieve this goal.

Objective: Optimized teaching methods in medical students to improve skills of occupational protection against infectious diseases and reduce the risk of developing infectious occupational exposure in clinical practice. Methods: Establish a database of infectious occupational exposure cases in clinical practice based on monitoring data. Teaching guided by cases and videos-based scenario was carried out in the experimental group and traditional theoretical teaching was carried out in the control group in medical students. And then conducted a questionnaire survey on knowledge and skills of occupational protection against infectious diseases and observed the frequency and the prescriptive disposal measures of infectious occupational exposure in clinical practice in two groups. Results: The infectious occupational exposure database included a total of 95 typical cases in 6 categories, including various sharp weapon injuries and mucosal exposure. There were 116 medical students involved in the study across the course of 12 months. The incidence of infectious occupational exposure in medical students during clinical practice internships was 18.9%. Compared with the control group, the awareness rate of knowledge and skills of occupational protection against infectious diseases significantly increased (91.8% vs 87.0%, P<0.05), the incidence of infectious occupational exposure during clinical internships has decreased (15.6% vs 23.1%, P<0.05), and the implementation rate of prescriptive disposal measures after exposure has increased (91.7% vs 83.3%, P<0.05) in the experimental group in medical students. Conclusion: The case-based scenario teaching in medical students improved skills of occupational protection against infectious diseases and decreased the incidence of infectious occupational exposure during clinical internships. The effect of the optimized teaching methods was significant which is recommended to carry out widely.

Background/Aim: Early removal of indwelling urinary catheters (IDC) is an effective strategy to prevent catheter- associated urinary tract infection (CAUTI). We hypothesized a standardized Trial-Off-Catheter (TOC) protocol would reduce catheter utilisation and CAUTI rates in a community hospital. We aim to reduce catheter utilisation ratio and CAUTI rate per 1000 catheter days by 10% over a period of three months (post-intervention) in three pilot wards with the highest catheter usage. Methods: An IDC review board and a TOC protocol were designed collectively as a team in Yishun Community Hospital based on literature reviews. Roadshows were conducted at the three pilot wards and implemented over 2 months. 2-weekly audit was conducted by Infection Control Nurses on 3 process measures, (1) IDC were reviewed appropriately with IDC review board, (2) Appropriate usage of TOC protocol, (3) Compliance with TOC protocol. Results: Within three months’ post-intervention, IDC utilisation ratio reduced by 18%, CAUTI rate per 1000 catheter days reduced by 45%, percentage of IDC reviewed appropriately increased to 91%, zero CAUTI event related to the use of protocol and 77% successful catheter removal with TOC protocol. Conclusion: CAUTI prevention require continuous effort with multimodal strategies and support from various stakeholders. A standardized TOC protocol can reduce variation in practices among physicians/ nurses with different levels of experience with TOC. A standardized care process ensures efficient utilization of resources to achieve the desired clinical outcomes for patients.

Introduction: Crowded Emergency and Trauma Department (ETD) have been associated with adverse patient outcomes and higher mortality rates. Crowding and lack of alcohol-based hand rubs (ABHRs) have been found to correlate with lower compliance to hand hygiene (HH) protocols among healthcare workers (HWs). This project aimed to improve and sustain HH compliance (HHC) among HWs in the ETD by adapting to the World Health Organization (WHO) HH Multimodal Improvement Strategy. Methodology: This is a cross-sectional study in ETD, Sarawak General Hospital, a university-affiliated, public tertiary-care hospital in Malaysia. It spanned 12 months, from Jan 2023 to Jan 2024. The intervention involved installing wall-mounted automated ABHR dispensers at multiple fixed locations in ETD. Pre-, during, and post-12 weeks intervention HHC audit were conducted according WHO’s gold-standard direct observation method. We conducted a sequential trend analysis and compared proportions across these periods using a linear logistic regression model to assess the improvement and sustainability of HHC. Results & Discussion: Mean HHC improved from 66% (383/579) (95% confidence interval [CI], 62.1%-70.0%) in the pre- intervention period to 81% (321/397) (95% CI, 76.6%-84.6%) in the intervention period, and further sustained at 85% (302/352) (95% CI, 81.7%-89.3%) in the post-intervention period (P value<0.05). The positive coefficient of 1.13 in the model, when moving from the pre- to the post-intervention period indicates a positive trend in HH compliance. The availability of adequate wall-mounted automated ABHR dispensers at multiple fixed locations at ETD created easy accessibility of ABHRs for HWs and acted as visual reminders for good HH behavior at the ETD. Conclusions: Having wall-mounted automated ABHR dispensers in various fixed locations proved effective in promoting good HH among HWs in emergency settings. It’s essential to have fixed ABHR dispenser placement in crowded - areas like the ETD to improve and sustain HHC among HWs.

Introduction: Continuous Ambulatory Peritoneal Dialysis (CAPD) is a treatment method for Chronic Kidney Disease (CKD) that allows patients to undergo dialysis therapy at home. Although CAPD provides benefits in terms of flexibility, efficiency, and comfort, patients undergoing CAPD are at high risk of infections, including exit site infections, tunnel catheter infections, and Peritoneal Dialysis (PD) peritonitis. This study aims to identify risk factors associated with CAPD infections in CKD patients at Dr. Kariadi Hospital, Semarang, Indonesia. Methods: A retrospective cross-sectional study design was applied to adult CKD patients undergoing CAPD at Dr. Kariadi Hospital between January 2022 and March 2024. Data were collected from patients’ medical histories and records, then analyzed using SPSS 21. A p-value less than 0.05 was used to determine statistically significant variables. Results: This study involved 81 adult patients undergoing CAPD with 58% male subjects. There were 23 (31.9%) subjects who experienced CAPD infections. Subjects who had infections experienced exit-site infections (10,5%) and peritonitis (89,5%). The most dominant microorganism in infected patients was Staphylococcus epidermidis. Diabetes mellitus (p = 0.03) contributed as significant risk factors for infection, while hypoalbuminemia and overweight were not significant risk factors (p > 0.05). Conclusion: In conclusion, the incidence of CAPD-related infections was high with a predominance of Staphylococcus epidermidis. Diabetes mellitus is considered a contributing factor to the infection.

Background: The prevalence of surgery in Indonesia is increasing every year and may increase the prevalence of surgical site infection (SSI). SSI is an infection in the surgical site organ or space that occurs after surgery. Complex treatment of SSI has a significant impact on patient outcomes due to increased length of stay. There are a variety of risk factors, both endogenous and exogenous, that can affect the length of stay of SSI patients, especially the concentration of serum albumin before and after surgery. Albumin is an important component of proteins. Albumin plays a role in promoting inflammation, so tissue repair is done more quickly, and without albumin, the body is more difficult to carry out cell regeneration. This study aimed to determine the relationship between pre- and post-operative concentrations of albumin and duration of stay in SSI patients. Method: The study design used a quantitative study using cross-sectional secondary data from the medical records of 40 patients diagnosed with SSI at Gatot Soebroto Army Hospital. All SSI patients met the inclusion criteria. Results: The results showed that patients had moderate hypolbuminemia before surgery (35%) and after surgery (35%), long-term stay (50%), 19-60 years (77,5%), women (52,5%), comorbidities (50%), malnourished nutrition (60%), ASA score 2 (52,5%), clean surgical wound type (60%), abdominal or vaginal hysterectomy (17,5%), and showed that it has the characteristics of a normal operation period. (65%) Bivariate analysis using assay chi-squared shows a relationship between pre-operative serum albumin (p-value =0.005; PR=7.207; 95% CI=1.09-47.55) and post-operative (p-value=0.016; PR=3.857; 95% CI=1.05-14.08) with duration of stay in SSI patients. Concentration. Multivariate results indicate serum albumin preoperative concentration (p-value = 0.049). Conclusion: It can be concluded that serum albumin preoperative concentration is the only variable that greatly affects the length of stay of SSI patients.

Introduction: The use of Personal Protective Equipment (PPE) for healthcare workers must be addressed, especially for procedures that generate aerosols. A standard N95, FFP2 or FFP3 particulate respirator mask is strongly recommended. WHO suggests using a particulate respirator for a maximum of six hours to avoid increasing oxygen debt, fatigue, CO2 levels, and nasal resistance. Methods: This study was observational, using a cross-sectional method conducted from February to April 2022. Participants were healthcare workers (HCWs), including doctors, nurses, and other HCWs who worked in ward of Mawar 1 Isolation Rooms. As screening, the participants underwent a Quantitative Fit Test with PortaCount® Respirator Fit Tester 8038, using particulate masks such as 3M 1870, 3M Vflex 9105, Dreamcan ME01LK, Dreamcan ME0 12.5, and RespoKare that are available in the hospital, while bending over, talking, head side to side, and head up and down. While doing the movement, the Fit Test Score had to reach ≥100. Then, we measured heart rate, oxygen saturation, and respiration rate before they entered and left the isolation rooms. Result: Thirty-one HCWs passed the screening test. One HCW could fit to more than one respirator. Sixteen (41,03%) HCWs fit to 3M Vflex 9105, 10 (25,64%) HCWs fit to Dreamcan ME01LK, 6 (15,38%)

HCWs fit to RespoKare, 4 (10,26%) fit to 3M 1870 and 3 (7,69%) fit to Dreamcan ME0 12.5. HCWs served in the isolation room for 74,0628,18 (35-150) minutes. We found a significant difference in heart and respiration rates before entering and after leaving the isolation room (p<0.05). In contradiction, the study showed no difference in O2 saturation (p=0,06).

Background: The adult intensive care unit comprises a total of 18 beds. On October 18, 2023, a text notification alerted us to a patient whose wound culture tested positive for Enterococcus faecium (VRE). Following protocol, an Anus VRE screening was conducted on the adjacent bed, revealing three additional positive cases, suggesting a cluster outbreak. Investigation and management were initiated. Methods: Through interviews, observations, medical record reviews, and expanded VRE screenings, a total of 8 beds tested positive, resulting in a positivity rate of 44.4% (8/18), all cases being colonization. Root cause analysis identified failures in hand hygiene among healthcare workers (HCWs), failure to wash hands before donning gloves, incorrect sequencing of environmental cleaning and disinfection, and inadequate implementation of contact isolation precautions. Measures included conducting Anus VRE screening for ICU admissions from October 15th to 18th, increasing the frequency of unit cleaning and disinfection, providing education and training, auditing hand hygiene practices and isolation measures, and centralizing VRE patient care. Results: Utilization of multiple measures for controlling drug-resistant bacterial infections, including auditing hand hygiene, environmental cleaning and disinfection, implementing contact isolation precautions, and conducting environmental sampling, yielded negative results. Observation until November 30th showed no new cases, effectively controlling the spread of drug-resistant bacteria and preventing healthcare-associated infections due to VRE. Discussion: Despite HCWs’ often busy clinical care responsibilities leading to neglect of hand hygiene or substituting handwashing with glove usage, and lapses in implementing contact isolation precautions, no healthcare-associated infections occurred, and patients were successfully discharged without disease exacerbation or fatalities. Environmental sampling was conducted post-environmental disinfection. Additionally, all VRE-positive patients were identified as Enterococcus faecium (VRE). Due to limitations, PFGE testing couldn’t be conducted, hence strain and susceptibility determination confirmed the same VRE colonization event within the hospital.