Objectives: The recent experience of the COVID-19 pandemic emphasized the critical need for a surveillance system to alert healthcare facilities about the admission of patients with emerging infectious diseases (EID), thereby preventing nosocomial transmissions. Methods: Tan Tock Seng Hospital, an 1800-bed acute tertiary-care hospital in Singapore, transitioned to a new- generation electronic medical record system, Epic, in August 2022. Leveraging the system’s capabilities, we developed an algorithm to generate the line-list of suspected Middle East Respiratory Syndrome (MERS) patients, in alignment with the screening guidelines provided by Singapore’s Ministry of Health. The algorithm first identifies patients who presented within 14 days (maximum incubation period) of their travel to Arabic peninsular countries. This information is documented by the emergency department’s triage nurses. Additionally, patients with suspected MERS indicated in the problem list or diagnosis by attending clinicians, particularly emergency-medicine physicians or infectious-disease physicians, are included. Furthermore, patients who are ordered for a MERS- Coronavirus polymerase chain reaction test, are identified. The algorithm can also be further modified as and when the case definition of the EID changes. Results: The surveillance report constructed with Epic algorithm can be scheduled for daily generation or generated on demand within a few minutes. This newer approach is more time- and resource-efficient compared to the manual surveillance process, which necessitates at least three staff members to engage in a series of prolonged manual processes. The report, by extracting information directly from Epic in near real-time, also minimizes the likelihood of errors that may occur during the manual process. Subsequently, the team of epidemiologists identifies the suspected MERS patients form the generated report and efficiently follow up them until a diagnosis of MERS is excluded. Conclusions: Harnessing Epic’s capabilities, we constructed an algorithm to efficiently and swiftly identify suspected MERS patients, enabling the timely implementation of infection prevention strategies to prevent nosocomial transmission.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAb) and carbapenem-resistant Pseudomonas aeruginosa (CRPa) are critical priority MDROs. They can develop resistance to last-line antibiotics, complicating infection treatment, leading to longer hospital stays, higher costs, and mortality. Objectives: To describe trends in CRAb and CRPa prevalence and antibiotic susceptibility in the access, watch, and reserve groups of positive blood cultures. Methods: This was a descriptive observational study using data from positive blood cultures at Dr Sardjito General Hospital from 2020-2023. Bacterial identification and antibiotic susceptibility testing were performed using the Vitec-2 Compact system. Patient demographics and clinical data were obtained from the microbiology LIS and electronic medical recods. Results: A total of 3603 positive blood cultures were obtained. CRAb rates were 85%, 62%, 68%, 78%, while CRPa were 26%, 21%, 12%, 25% respectively. CRAb antibiotic susceptibility in access group: 2%, 8%, 5%, 3%, in watch group: 27%, 28%, 27%, 22% and in reserve group: 33%, 58%, 37%, 30%. CRPa susceptibility was reduced in all groups: 13%, 30%, 13%, 6% in access, 0%, 4%, 0%, 19% in watch, and 13%, 7%, 13%, 14% in reserve group. CRPa was more susceptible in the access group, while CRAb was more susceptible in the watch and reserve groups suggesting that CRPa infections were more difficult to treat. The highest prevalence was in 2020, possibly due to failure to control antibiotic use during the early Covid-19 pandemic. A decrease in both MDR pathogens in 2021 was associated with intense ASP activities in the second year of the pandemic. Increasing prevalence in the following years may be due to a lack of stewardship following a change in the internal antimicrobial stewardship team structure. Conclusions: These data indicate that consistent ASP had important role in controlling CRAb and CRPa. Changing the structure of antimicrobial stewardship team should be well prepared to ensure a good adaptation.

Background/Aim: The manual compilation of employees’ health information and record-keeping can be an arduous and distressing task. Therefore, it is essential to invest time and effort in finding a solution to collect, store, and retrieve data in real-time when required. Method: To address this challenge, the Infection Control Team collaborated with the IT department and relevant HODs to develop an integrated and digitalized record system known as the “Staff Health System.” This system can be easily accessed by all employees, supervisors, and the infection control team. The Infection Control (IC) team is responsible for updating and maintaining vaccination records, while HR takes charge of documenting the health records of new employees and monitoring staff health/vaccination in compliance with MOH requirements. Result: The implementation of the Staff Health System offers several benefits as: (1) Empowerment of staff: The system grants employees the autonomy to schedule and reschedule vaccination and mask fitting sessions at their convenience; (2) Enhanced accessibility: Staff and other stakeholders can readily access vaccination and mask fitting records, as well as pre-employment lab results through the system; (3)Real-time data: The system can generate up-to-date data that are relevant to stakeholders and management, improving decision-making processes; (4) Resource efficiency: The digitalized system reduces the consumption of resources such as paper, toner, and manpower required for collating, updating, storing, and retrieving data; (5) Data accuracy: With the Staff Health System, data accuracy is ensured, reducing the risk of errors and discrepancies in records. Conclusion: Overall, the implementation of this digitalized solution has elevated Mt Alvernia Hospital’s service standards by enhancing efficiency and compliance in record-keeping and updating processes.

Background: Vietnam has the national guidelines for infection control in hospitals and it also recommends the application of WHO’s IPCAF framework to do self-evaluation of infection prevention and control (IPC) activities and plan to improve them in hospitals. Objective: Our study aimed to implement the multimodal strategy for IPC, in which our expected outcome was the practices of doctors and nurses for pediatric ventilator-associated events (Ped-VAE). Design: We used the implementation research approach with the hybrid design of quasi-experimental pre-post comparison without control group. All 16 doctors and 32 nurses at the Department of PICU were observed 3 times that practicing the IPC packages for PedVAE guided by MOH. The implementation strategies used included Plan, Restructure, Train, and Quality Management. Results: Four over six steps practised by doctors and 5/10 steps practised by nurses for PedVAE were well practised after the intervention with significantly higher proportion of right practices (p<0.001). The practices of doctors had insignificant changes between pre-post intervention, including hand hygiene (85.4% and 83.3% of right practice at pre-post intervention, respectively) and daily assessment of weaning from mechanical ventilation (54.2%-68.7%). Most unchanged practices among nurses were steps of ensuring humidification and heating of inhaled gas for in patients with artificial airway.

All practice scores of the whole steps among doctors and nurses had statistically significant increase after intervention. Our implementation strategies were highly assessed by providers (doctors and nurses) and hospital managers in terms of the its acceptibility, feasibility and sustainability. Conclusion: The implementation of multimodal strategy in IPC for pediatric ventilator-associated events is effective and acceptable and feasible for hospitals at city/province level in Vietnam. In addition with improving practices of healthcare staffs, hospitals should regularly assess and upgrade ventilators machines to ensure the effectiveness of IPC.

Background: Enhancing environmental hygiene resulted in a reduction of multidrug-resistant microorganisms colonization and healthcare-associated infections. There has been less studies to compare the effects of practice observation with other methods. This study aimed to compare correlations between visual inspection, practice observation and aerobic colony count (ACC) and verify the effectiveness. Methods: A prospective study was conducted in a medical intensive care unit from May 2021 to November 2022. High-touch surfaces were assessed by visual inspection (clean or not clean) and practice observation (compliant or not compliant) to compare the correlations by using ACC with the cut-off point of 2.5 CFU/cm2 as a golden standard. Results: Among 569 samples, the pass rate by ACC was 90.5%, the clean rate by visual inspection was 73.3%, and the compliant rate by practice observation was 47.1%. The concordance was 245 surfaces (43.1%) of the three methods. There was no correlation between visual inspection and ACC (p<0.001, φ=0.184). The correlations were weak positive between visual inspection and practice observation and between practice observation and ACC (p<0.001, φ=0.212, 0.233). The median aerobic colony count of “compliant” group (0.00 CFU/cm2) was significantly lower than “not compliant” (0.40 CFU/cm2) (p<0.001). The median aerobic colony count of “clean” groups (0.08 CFU/cm2) was also significantly lower than “not clean” groups (0.20 CFU/cm2) (p<0.001). Conclusion: Practice observation is more reliable than visual inspection. Therefore, visual inspection can be used for low risk area to maintain visibly clean. In high risk area, an integrated program is critical to combine practice observation with other methods to monitor cleanliness.

Objectives: Energy devices (EDs), such as Harmonic, Ligasure, Thunderbeat and Trocar are widely used in Minimally Invasive Surgeries. They are expensive and designed for single use. However, due to the limitation of resources, they have been reused in some cases. Therefore, we aimed to assess the efficacy of EDs reprocessing by Adenosine Triphosphate (ATP) method. Methods: This was a cross-sectional description study. After first clinical using, EDs were taken to cleaning. Every ED was cleaned three times. Efficacy cleaning was assessed after each cleaning procedure by ATP method. ATP <200 RLUs (Relative Light Units) was benchmark as efficient cleaning process. Results: A total of 611 EDs were studied, including 269 of Harmonic, Ligasure, Thunderbeat, 298 of Trocar, and 44 other types. Detachable devices accounted for about 32.7%. Overall, after three consecutive cleanings, the median ATP values were decreased dramatically (957 RLUs, 160 RLUs, and 62 RLUs, respectively). This was a significant reduction in ATP levels between three stages (p < 0.05). There were 63.5%, 84.3%, and 92.8% EDs that had ATP < 200 RLUs after first, second, third cleaning respectively. Approximately 90% of EDs were still functional after three cleaning times. Nondetachable items were to be more difficult to clean than detachable ones (p = 0.0003, OR 1.3 [1.1 – 1.5]). Conclusions: Our data suggest that monitoring efficacy cleaning of surgical instruments in general and single-use energy devices in particular with ATP can identify a number of different influence factors, like the instrument condition, reprocessing procedure, or especially their structure. ATP measurement seems to be a valid technique that allows an immediate repeat of the manual cleaning if the results exceed the established cutoff of 200 RLUs.

Objectives: Chronic wounds are commonly manifested with biofilms that result in delayed healing and recurring infection episodes. Due to increasing antimicrobial resistance, antiseptics have played a significant role in wound infection management. To date, there is no standardised method to assess the ‘true’ antimicrobial efficacy of different antimicrobials, especially in testing condition that stipulate a high protein environment in the wound. As clinicians often rely on the antimicrobial efficacy profiles for product selection, a rigorous testing is warranted. Hypochlorous acid (HOCl)-based solutions have been introduced as a good alternative for wound cleansing but the assessment of its antimicrobial activities in a stipulate wound environment is limited. In this study, we assessed the in vitro bactericidal activities of 7 commercially available wound irrigation products commonly found in South-East Asia. Method: The evaluation was conducted using quantitative suspension method, EN 13727 in either low or high protein conditions. Results: Under low protein conditions, four out of the five HOCl products achieved bactericidal activity (≥ 5 log10 reduction factor; RF) within 2 to 5 minutes, and only one product achieved 5 log RF at 15 seconds. None of the HOCl achieved 5 log RF under high protein, even after 30 minutes of exposure time. In contrast, protein interference on the antimicrobial activities of polyhexamethylene biguanide-based product is less pronounced (low protein: 60 seconds vs. high protein: 2 minutes to attain ≥ 5 log RF). Octenidine dihydrochloride is the only active not affected by protein interference achieving ≥ 5 log10 RF within 15 seconds in both low and high protein conditions. Conclusion: These findings warrant the need to screen antimicrobial wound care products, especially HOCl-based products, in high protein condition to better reflect the antimicrobial activities in wound care.

Objectives: Management of outbreaks of the newly emerging pathogen Candida auris may include use of antimicrobial wash-mitts for decolonization. In the absence of large-scale clinical trials, the immediate assessment of the efficacy claims for these products can be based on in vitro experimental data that follows the standard protocols established by CEN (European committee for Standardization). In this study, the chemical tolerance of C. auris was compared with the surrogate test organism Candida albicans as established in the European standards (EN). Methods: The study was conducted following the protocol for the quantitative suspension test EN 13624 using C. albicans ATCC 10231 in comparison to C. auris DSMZ 21092 and C. auris DSMZ 105986. Two commercially available wash-mitts containing chlorhexidine digluconate (CHG) or octenidine dihydrochloride (OCT) were used. Experiments were conducted using the impregnation liquid squeezed from the wash-mitts at different dilution concentrations between 0.5% to 97% at a contact time of 30 sec in the presence of 0.03% bovine serum. Results: Yeasticidal efficacy according to EN 13624 was found for the OCT wash-mitts at 30 sec at ≥ 10% concentration with C. albicans (≥ 4 log RF). In comparison, for both C. auris strains ≥ 4 log RF was found at a much lower concentration of ≥ 1%. For the CHG wash-mitts efficacy against C. albicans was below 2 log RF at 97% concentration within 30 sec. In contrast efficacy against the two C. auris strains was around 3 log RF. Conclusion: In conclusion, both C. auris strains were found to be significantly more susceptible when compared to C. albicans in this study. Moreover, our data also demonstrates that not all antiseptic-impregnated body wipes is equally effective against C. auris with OCT having a higher efficacy compared to CHG.

Objectives: The recent experience of the COVID-19 pandemic emphasized the critical need for a surveillance system to alert healthcare facilities about the admission of patients with emerging infectious diseases (EID), thereby preventing nosocomial transmissions. Methods: Tan Tock Seng Hospital, an 1800-bed acute tertiary-care hospital in Singapore, transitioned to a new- generation electronic medical record system, Epic, in August 2022. Leveraging the system’s capabilities, we developed an algorithm to generate the line-list of suspected Middle East Respiratory Syndrome (MERS) patients, in alignment with the screening guidelines provided by Singapore’s Ministry of Health. The algorithm first identifies patients who presented within 14 days (maximum incubation period) of their travel to Arabic peninsular countries. This information is documented by the emergency department’s triage nurses. Additionally, patients with suspected MERS indicated in the problem list or diagnosis by attending clinicians, particularly emergency-medicine physicians or infectious-disease physicians, are included. Furthermore, patients who are ordered for a MERS- Coronavirus polymerase chain reaction test, are identified. The algorithm can also be further modified as and when the case definition of the EID changes. Results: The surveillance report constructed with Epic algorithm can be scheduled for daily generation or generated on demand within a few minutes. This newer approach is more time- and resource-efficient compared to the manual surveillance process, which necessitates at least three staff members to engage in a series of prolonged manual processes. The report, by extracting information directly from Epic in near real-time, also minimizes the likelihood of errors that may occur during the manual process. Subsequently, the team of epidemiologists identifies the suspected MERS patients form the generated report and efficiently follow up them until a diagnosis of MERS is excluded. Conclusions: Harnessing Epic’s capabilities, we constructed an algorithm to efficiently and swiftly identify suspected MERS patients, enabling the timely implementation of infection prevention strategies to prevent nosocomial transmission.

Objectives: A multi-center study aimed to determine the outcome of using oral care sets for cleaning the oral cavity of the patients admitted to the Intensive Care Units (ICU). Methods: Oral care sets which are single-use sets consisting of two toothbrushes with toothpaste, six 0.12% chlorhexidine swabs, and an oral moisturizer swab were developed. The ICUs of fourteen tertiary care hospitals participated in the study. All ICU nurses were asked to brush the patient’s teeth twice and clean the patient’s oral cavity with antiseptic six times daily. One thousand four hundred and two patients were recruited. The oral care sets were used with each patient on the first day they received mechanical ventilation until weaning. VAP surveillance was conducted to compare the VAP rate before and after the ICU used the oral care set. Results: Two hundred and sixty-six VAPs developed with an overall 34,731 ventilator days in the participating ICUs in 2022, before ICUs used oral care sets. The VAP rate was 7.66 per 1,000 ventilator days. The cost of antibiotic treatment was 5,134,621.74 Thai Bath. In 2023, after the ICUs used the oral care sets, 182 VAPs were developed. The overall ventilator day was 34,309. The VAP rate was reduced to 5.30 per 1,000 ventilator days. The cost of antibiotic treatment was reduced to 2,101,939.70 Thai Bath. One hundred and eighty-seven ICU nurses evaluated the benefit of the oral care set. Ninety-six-point eight percent of them agreed and strongly agreed that the single-use oral care set could prevent hospital- associated infections. Ninety-two-point five percent agreed and strongly agreed that only one nurse could clean the patient’s oral cavity, the oral care set helped reduce VAP occurrence (92%), the patient’s teeth and oral cavity were clean (92%), and ICU nurses could work conveniently (91.4%). Conclusion: The single-use oral care set can help reduce the VAP occurrence among patients admitted to the ICU.

Introduction: According to the recommendation of the United States Environmental Protection Agency, the bacteria count of airborne microbe must be under 1500 cfu/ m3. And as we know, the environment is the key factor of the airborne microbe. Traditional, we used air-conditioning to let the air circulate, but this method may be useful in other environments but is not suitable in hospitals. So, there were many new technologies to improve the quality of airborne microbe, just as UVC, plasma, and filtration. In this study, we used the UVC LED to examine the quality of airborne microbes in our meeting room of the emergency room. Material and method: We used the impaction method to collect the air for 10 minutes then gathered 1000L air to impact the Tryptone Soy Agar. After collection, we incubated at 37oC for 48 hours the check the bacteria count. So, we used this method to test the quality of airborne microbe before and after adding the UVC-LED (NKFG, Taiwan) to our air conditioner vent in the meeting room of the emergency room. Result: Before adding the UVC-LED, the average bacteria count in difference time was from 361 to 443, and after adding the UVC-LED, the average bacteria count in difference time was from 214 to 300, and the percentage of reducing count was from 24% to 40%. Conclusion: Due to this study, we though the UVC-LED could improve the quality of the airborne microbe. Otherwise, this technology would not use too much space because of the limitations of the environment.

Introduction: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is highly contagious in humans, and in May 2021, an outbreak occurred in the Wanhua district of Taiwan. During the Coronavirus disease 2019 (COVID-19) pandemic, we implemented various rules to prevent the spread of SARS-CoV-2- alpha in the hospital. This included establishing four special wards (dedicated care wards) specifically for patients infected with SARS-CoV-2-alpha. When patients were discharged, we conducted real-time polymerase chain reaction (RT-PCR) testing on the terminal environment to ensure that SARS-CoV-2- alpha was not present. Maintaining a negative test result was crucial for preventing cross-infection and further outbreaks. The goal of this study was to identify effective intervention measures to improve the quality of terminal cleaning and achieving overall infection control in the hospital. Methods: After cleaning and disinfection of the dedicated care wards by the cleaning staff as per the recommendations of the Centers for Disease Control (CDC), we collected three swabs from different areas in one ward. We used Roche and GeneXpert instruments for COVID-19 RT-PCR testing. However, because the test results were not ideal, we introduced ultraviolet-C (UV-C) machines and a disinfectant solution containing hydrogen peroxide (H2O2) into our current cleaning and disinfection procedures. Results: The negative test result ratios for RT-PCR testing were 80.13% when cleaning was done with bleach- only method as a disinfectant (without intervening with other methods); 92.81% when intervening with UV-cC machine disinfection for 5 minutes was done before bleach disinfection; 96.19% when bleach was replaced with a disinfectant solution containing H2O2 and intervening with UV-C disinfection. Conclusion: The quality of terminal cleaning and disinfection was a key factor in reducing nosocomial outbreaks. We could consider using UV-C machine and H2O2 disinfectant to intervene in the current bleach disinfection method to enhance the quality of terminal cleaning and disinfection in the hospital.

Background: Irrational use of antibiotics will trigger anti-microbial resistance which is a threat to health problems now and in the future. The use of meropenem is often the last choice in using antibiotics without undergoing microbiological examination (culture). The rational use of meropenem is expected to reduce resistant microbes as well as reducing hospital costs. Anti-microbial stewardship at Prof Ngoerah General Hospital began to be implemented at the end of 2020, and evaluation of the implementation of antimicrobial stewardship is required. Objective: The aim of this study was to determine the effect of meropenem stewardship on the prevalence of Carbapenem-resistant Acinetobacter Baumannii, Carbapenem-resistant Pseudomonas Aeruginosa and evaluate meropenem cost of purcashing. Retrospective cohort study from medical records, pharmacy records and microbiology data from microbiology from 2020 to 2023 was taken. Data is presented in the form of tables and graphs. Results: Before antimicrobial stewardship was implemented, in 2020 the prevalence of Carbapenem-resistant Acinetobacter Baumannii reached 69.1% and began to decline in 2021 by 52.35%, in 2022 it became 43.8% and 44.3% in 2023, respectively. The prevalence of Carbapenem-resistant Pseudomonas Aeruginosa also decreased, in 2020 was 31.6% to 27.3% in 2021, in 2022 it fell again to 24.8% and in 2023 only 18.4%. The cost of purchasing meropenem at Prof Ngoerah hospital before implementing antimicobial stewardship in 2020 was IDR 229,905,300,- decreasing to IDR 94,156,920,- in 2021, IDR 98,025,255 in 2022 and in 2023 IDR. 97,147,335,-, respectively. Conclusions: Meropenem stewardship at Prof. Ngoerah Hospital reduces the prevalence of Carbapenem-resistant Acinetobacter Baumannii and Carbapenem-resistant Pseudomonas Aeruginosa. Meropenem stewardship also reduces hospital costs in purchasing antibiotics.

Objectives: Hospital networks can significantly improve healthcare-associated infection (HAI) prevention and management through quality improvement and standardization. Since 2017, the Korea Disease Control and Prevention Agency (KDCA) has coordinated a network project involving a central hospital and participating community hospitals nationwide. This paper shares our experience as one of the central hospital operating the program for seven years (2017-2023). Methods: Our network comprised one central tertiary-care hospital and 12 community hospitals. Activities focused on education, consultation, and quality improvement (QI). QI activities analyzed hand hygiene (HH) practices, alcohol-based hand rub consumption, and the World Health Organization’s HH Self- Assessment Framework (HHSAF) results. We provided educational resources for personal protective equipment (PPE) training, particularly during the COVID-19 pandemic. Annual workshops facilitated the sharing of specialized infection control programs from each hospital. Results: The project conducted 19 training sessions on topics like multidrug-resistant organism (MDRO) infection control, with 1,435 participants. We offered consultations for 41 cases (paper, phone, and 8 on-site visits) and shared consultation details through regular meetings. QI activities resulted in most hospitals maintaining a HH practice rate above 90%. All eight hospitals that consistently participated in the program saw improvements in their HHSAF scores compared to baseline. Notably, two hospitals achieved an “Advanced” level, having previously been at an “Intermediate” level. PPE training for 12,762 healthcare workers across 13 hospitals strengthened their response capabilities during COVID- 19 and reduced occupational infection risks. Conclusions: Frequent patient transfers and rising HAI rates highlight the limitations of individual hospitals in preventing and managing HAIs. The community hospital network establishes a government-led infection prevention response system. This model fosters enhanced infection control capabilities across network hospitals by offering technical support to resource-constrained facilities and implementing effective infection prevention initiatives that address ongoing challenges.

Introduction: Purulent pericarditis is defined as an infection in the pericardial space that produces macroscopically or microscopically purulent fluid. It was a rare but life-threatening condition. It may be primary or secondary to another infectious process. The diagnosis can only be confirmed by pericardiocentesis. Treatment must include drainage of the pericardial space combined with systemic antibiotics. This case report focuses on a critical and rare clinical scenario of purulent massive pericardial effusion in an 85- year-old male patient. This condition, characterized by an infectious or inflammatory accumulation of fluid in the pericardial cavity, presents significant diagnostic and therapeutic challenges, particularly in the context of multiple comorbidities. Case Description: The patient’s presentation, complicated by pneumonia, diabetes mellitus (DM), and heart failure, underscores the complexities in diagnosing and managing elderly patients with diverse medical backgrounds. The diagnosis of massive pericardial effusion was confirmed through echocardiography, which revealed the purulent fluid from pericardiocentesis procedure, a finding critical for guiding the diagnostic and management strategy. The source of infection wasn’t clear in patient with immunocompromised condition. Some examination performed to find the source of infection that led to a subdiaphragmatic suppurative focus. Infection management was good, but the patient ended with a constrictive that make his condition worse. The patient passed away on the 10th day of hospitalization. Conclusion: It is importance to recognize and promptly address purulent massive pericardial effusion in elderly patients with complex medical histories. The successful clinical outcome following the pericardiocentesis and the adaptive antimicrobial treatment approach provides valuable insights into the management of this severe condition.

Objectives: Environmental hygiene of patient zones in the wards of TTSH- a 1700 bedded hospital in Singapore is upkept through twice daily HTC. An outbreak in two wards end March 2023 with high levels of Adenosine Triphosphate (ATP) found on surfaces after cleaning corroborated that the cleaning process was ineffective [1]. Though operatives undergo on-job training (OJT), they expressed difficulty in understanding the purpose of such cleaning and remembering the steps. To address these gaps, a new training and competency framework was developed. We thus sought to evaluate its usefulness in improving compliance to HTC. Method: The framework, effected from May 2023, consisted of three domains: standardized education, competency assessment, and feedback mechanisms[2, 4]. Educational materials explaining the importance of HTC and overall infection prevention were developed in three common languages to facilitate understanding for operatives of different races. Under the framework, all existing and new operatives undertake a 2-day classroom teaching and OJT, before a competency check. Upon passing the first competency, they are given a two-week probation. Another assessment is done before certifying them competent. Operatives who fail twice are redeployed to non-clinical areas. The audit team gave direct feedback during monthly audits to evaluate performance and provide ongoing support and reinforcement. Results: The compliance of HTC in the patient zone picked up immediately from 71% in April to 92% in June. However, a decrease to 68% was observed between September to December 2023, but soon picked up to 82% in February 2024 after retraining was conducted. Decrease in ATP levels after cleaning further validated increase efficiency of HTC. Conclusions: These results highlight that structured learning rapidly improves the thoroughness of cleaning [2, 3]. Ongoing assessment and feedback are essential to address subsequent deficiencies and for corrective actions to be taken promptly [2, 4]. This framework may be useful for teams seeking to optimize strategies in environmental hygiene.

Acknowledgments: The authors thank the frontline environmental services teams for conducting and providing results of the HTC audits.

Introduction: Hemodialysis (HD) is the most common renal replacement therapy modality for chronic kidney disease patients. Nearly 80% of patients starting HD use a non-tunneled double lumen (DL) catheter as the first vascular access. However, the use of this access may increase the risk of both exit site and bloodstream infections. This study aims to identify the risk factors for infection related to non-tunneled DL catheters in HD patients at Dr. Kariadi Hospital, Semarang, Indonesia. Methods: A retrospective cross-sectional study design was applied among adult patients who underwent HD using non-tunneled DL catheter in the Hemodialysis Unit at Dr. Kariadi Hospital between January 2022 and March 2024. Data were collected from medical histories and patients’ medical records, then analyzed using SPSS 21. P-values less than 0.05 were considered statistically significant. Results: This study involved 72 adult HD patients, with 58% male subject. Among them, 23 (31.9%) subjects experienced infections related to non-tunneled DL catheter. These infections included exit site infections (21%) and bloodstream infections (95%). The most dominant microorganism in infected patients was Staphylococcus aureus. The location of catheter insertion in the femoral vein (p = 0.03) and a high white blood cell count (p = 0.03) were significant risk factors for infection. However, factors such as age, diabetes mellitus, duration of catheter insertion > 3 months, serum iron levels, hypoalbuminemia, and anemia were not significant risk factors (p > 0.05). Conclusion: In conclusion, catheter insertion in the femoral vein and a high white blood cell count were identified as contributing factors to infections related to non-tunneled DL catheters in HD patients.

Objectives: 2% chlorhexidine gluconate (CHG) with 70% isopropyl alcohol (IPA) has been recommended over povidone-iodine (PVI) for skin preparation. BD ChloraPrep™ is a ready-to-use applicator pre-filled with sterile 2% CHG and 70% IPA solution, which healthcare professionals have reported higher preference over PVI in an applicator or a bulk bottle. This study aims to evaluate the impact of including 2% CHG with 70% IPA applicator in the care bundle for preoperative skin preparation on surgical site infection (SSI) rate. Methods: A systematic literature review was conducted on PubMed in July 2022. Study inclusion criteria were (1) English publications, (2) 2% CHG with 70% IPA applicator included in a preoperative skin preparation bundle and (3) SSI rate reporting. A weighted average of SSI rate change was calculated, using the study sample size as weights. Results: A total of 116 studies were identified and 51 of them were found relevant for further review. Of them, 18 studies met the study inclusion criteria and 13 of these publications (72%) studied BD ChloraPrep™ in their bundle of care. 92% (12/13) of these studies demonstrated a statistically significant reduction in SSIs. 10 studies reported statistically significant SSI reduction rates, one study reported full compliance with the care bundle was associated with lower risk of SSI and one study reported four-fold higher likelihood of achieving zero SSI. Based on the 10 studies which reported statistically significant SSI reduction rates, a sample-size-weighted average of 71% reduction in SSI was observed when BD ChloraPrep™ was included in the bundle for preoperative skin preparation. Conclusions: There remains considerable low compliance and major variation in standardised skin preparation practices among hospitals. Using BD ChloraPrep™ may encourage a standardised and thorough approach in skin preparation. With the implementation of a bundle, together with appropriate training, compliance with skin preparation may be improved, which can potentially reduce SSIs.

Background: As the incidences of preterm births and surgical cases increases, so do cases of neonatal sepsis in CMH. Furthermore, the common etiology of neonatal sepsis are multidrug-resistant bacteria which increase the risk of mortality. Cefepime is a fourth-generation cephalosporin which is increasingly being utilized in NICUs. Theoretically, continuous infusion of beta lactam antibiotics could maximize the time- dependent bactericidal activity and improve the probability of target attainment. This study aims to determine the effectiveness and safety of continuous cefepime administration in managing sepsis. Methods: This is retrospective cohort study on infants who suspected late onset sepsis from 2021 to 2023. The independent variables are continuous infusion and intermittent infusion, with outcomes including mortality rate, reduction in septic markers, use of antibiotic combinations, duration of antibiotic use, and renal function test. Result: There were 106 subjects receiving cefepime (56 continuous and 50 intermittent infusions; p>0.05). No significant differences in demographic data such as gestational age, prematurity condition, birth weight, and surgical conditions were found between the two methods. Out of 66 subjects with proven sepsis, 28% were classified as MDR, 12% as XDR, and 16% as PDR. No difference in sepsis-related mortality outcomes was observed between the two methods (64.3% vs. 70%; p=0.532). Continuous administration reduced C-reactive protein (80.52 vs. 51.69 mg/L; p=0.000) and procalcitonin (11.9 vs. 6.72 ng/mL; p=0.008) more effectively than intermittent. In surgical cases, continuous administration reduced the risk of multidrug therapy (RR 0.5 CI 95% 0.243-0.902; p=0.045). There was no difference renal function impairment between two methods. Conclusion: Cefepime continuous infusion can significantly reduce infection markers compared to intermittent administration. In surgical cases, continuous cefepime administration reduces the risk of multidrug therapy. The use of continuous cefepime can be considered as part of antibiotic stewardship in the NICU.

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: