Knowledge, Attitude, and Practice among Palestinian Healthcare Workers in the Gaza Strip towards Hepatitis B: A cross-sectional survey

Objectives: Healthcare workers are at a high potential risk of Hepatitis B virus infection (HBV). This survey aims to identify gaps and strengths in the knowledge, cultural perceptions, and practices of healthcare workers towards HBV in order to drive appropriate health interventions. Methods: This cross-sectional study was conducted between March and April 2022. We surveyed a convenience sample of three at-risk healthcare providers from the major health facilities in Gaza. A 40-item, self-administered questionnaire was used. Statistical data analysis was conducted using SPSS version 25 to obtain descriptive and inferential statistics via various nonparametric, correlation, and regression tests (with p<0.05). Results: 447 healthcare workers participated in the study. Overall, 105 (23.5%) demonstrated poor knowledge (under 14\20 points), 284 (63.5%) had moderate knowledge (14-17 points), and 58 (13%) showed good knowledge about HBV. The majority (367, 82.1%) expressed an excellent attitude. Finally, 287 (64.2%) demonstrated a good level of practice toward HBV infection. A history of needle stick injury was reported by 233 (52.1%) participants, of whom 170 (73.3%) reported taking appropriate preventive actions after exposure. Conclusion: The majority of participants demonstrated overall good knowledge regarding HBV infection. Nonetheless, significant gaps remain in the different aspects of the KAP construct, which require appropriate awareness campaigns to further limit the spread of this preventable viral infection. Keywords: Health Knowledge, Attitudes, Practice; Attitude of Health Personnel; Hepatitis B; Epidemiology; prevention and control; Health Personnel; Cross-Sectional Studies

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes