Antibiotic Consumption During a 4-year Period in a Community Hospital with an Antimicrobial Stewardship Program

Objectives: We sought to evaluate the trend of antibiotic consumption in patients admitted to a community hospital in Qatar with an antimicrobial stewardship program. Methods: This observational study was carried out in a 75-bed facility in Western Qatar over a 4-year period (2012–2015). The monitoring of antimicrobial consumption from inpatient wards was performed from the pharmacy records and presented as defined daily dose (DDD) divided by the patient days and expressed as 100 bed-days (DBD). Results: The consumption of antimicrobials in 2012 was 171.3 DBD, and increased to 252.7 DBD in 2013, 229.1 DBD in 2014, and 184.7 DBD in 2015. Cephalosporins use reduced from 98.2 DBD in 2013 to 51.5 DBD in 2015 while the consumption of penicillins increased during the beginning of 2014 with a slight decrease in 2015. Carbapenems consumption during 2014–2015 was lower than previous years, and vice-versa for aminoglycosides. Fluoroquinolones had a sustained increase with 37.1% increased consumption in 2015 compared to the two previous years. There was an increase in the use of intravenous (IV) (108.5%) and oral azithromycin (55.1%) and the use of oral (152.8%) and IV moxifloxacin (22.9%). Conclusions: We observed a decrease in antibiotic use in patients admitted to a community hospital with an antimicrobial stewardship program, but the increase in fluoroquinolones consumption is a concern that requires focused strategies

Infección asociada a dispositivos en Unidad de Cuidados Intensivos. Oeste de Qatar

Introduction: Device-associated infection (DAI) in intensive care units have a major impact on morbidity, mortality, and costs.Objective: To describe the incidence and adherence of a DAI and the bundle compliance in an intensive care unit at a community hospital in Western Qatar.Material and Methods: A prospective surveillance was conducted in a 6-beds medical-surgical intensive care unit from Jan 2013 to December 2016. Data about clinical, laboratory, and other diagnostic information were collected to satisfy the criteria for infection. DAI rates, device utilization ratio (UR) and bundle compliance were analyzed, and comparison with 2013 US data was performed.Results: The pooled mean of ventilator-associated pneumonia rates was 2.61 per 1000 ventilator days, and zero for catheter-associated urinary tract and central line bloodstream infections. The ventilator UR was superior (0.32) (p =0.000) than the National Health System Network (NHSN) data (0.24); the use of the central line bundle and the urinary catheter were similar (0.33, 0.54) (p=0.000), respectively. The compliance with bundle elements for ventilator was 99% and 98.2% for 2013 and 2014 respectively, and 100% compliance afterward. The compliance with central line bundle was 100% during the study period, whereas the compliance with urinary catheter bundle had the lowest figure in 2013 (97.9%), 98.3 % in 2015, and 99.6% in 2016, related to bag contact with the floor. Conclusions: The study has shown the low incidence of device-associated infections related to a comprehensive infection control program in the Intensive Care Unit.Keywords: Device-associated infections, bundle, compliance, Intensive Care UnitIntroducción: Las infecciones asociadas a dispositivos en unidades de cuidados intensivos tienen un gran impacto.Objetivo: Describir la incidencia  y adherencia en el cumplimiento de intervenciones preventivas de infecciones asociadas a dispositivos en la Unidad de Cuidados Intensivos  del Hospital Cubano en Qatar.Material y Métodos: Se realizó una vigilancia prospectiva en la UCI de 6 camas entre enero de 2013 y diciembre de 2016. Se recolectaron datos sobre cumplimiento de intervenciones preventivas para inserción y mantenimiento de dispositivos. Se analizaron las tasas de infección, la razón de utilización del dispositivo y el cumplimiento de prácticas.Resultados: La media de Neumonía asociada a la ventilación fue de 2,61 por 1 000 días de ventilación, las tasas de infección, cero para Infección del tracto urinario asociado al catéter y del torrente sanguíneo por dispositivo vascular. La  utilización del ventilador  fue superior (0,32) (p = 0,000) en comparación con los datos de la Red Nacional de Seguridad Sanitaria de los Estados Unidos (0,24), las del catéter venoso central y el catéter urinario fueron similares 0.33, 0.54 (p = 0,000), respectivamente. La adherencia a las intervenciones preventivas para el ventilador fue de 99% y 98,2% durante 2013 y 2014, y  100%  después, las relacionadas con el uso del dispositivos vasculares centrales fue de 100%, mientras con el catéter urinario tuvo la cifra más baja en 2013 (97,9%), 2015 (98,3%) y 2016(99,6%).Conclusiones: Existió baja incidencia de infecciones asociadas a dispositivos relacionadas con la adherencia al programa integral de control de infecciones en la Unidad de Cuidados Intensivos.Palabras claves: Infecciones asociadas al uso de dispositivos, adherencia, intervenciones preventivas,  unidades de cuidados intensivos

Clinical characteristics of post-vaccination COVID-19 infection in health care workers exposed to Delta and Omicron variants in a COVID-19 dedicated facility from Qatar

Background: Evidence suggests that vaccines efficacy lies on the prevention of severe symptomatic disease. We aim to describe the clinical characteristics of COVID-19 infection among healthcare professionals (HCPs) after vaccination, during periods of transmission of SARS CoV-2 variants in a COVID-19 dedicated facility. Methods: A retrospective observational study of HCPs confirmed with COVID-19 during the period March 2021 to Jan 2022 was conducted. Delta period (March-August 2021), and Omicron period (Dec 2021- Jan 2022) were defined. Clinical, laboratory, radiology and vaccination history was collected from electronic medical records. Results: COVID-19 infection was reported in 16 and 138 HCPs during the Delta and Omicron period respectively.By category the nurses predominate, and a significant contribution of the healthcare related transmission against the community-related one. Higher frequency of loss of taste (37.5% vs 4.3%), and loss of smell (43.8% vs 3.6%) was observed during Delta period. Myalgia (12.5% vs 37.7%), and sore throat (6.3% vs 55.8%) predominated in Omicron period. Bilateral ground-glass appearance of the lung was observed in 28.6% and 7.1% in the Delta and Omicron period, respectively. Higher cycle threshold values of the polymerase chain reaction test during Omicron period, in comparison with Delta period, was observed (22.98 vs 25.98). Time from previous vaccine dose to positive laboratory test was longer during the Delta period (131 vs 98.26 days). Conclusion: SARS CoV-2 viral variants infections in HCPs were associated to selected clinical and epidemiological characteristics, with less severe disease for Omicron variant, and potential shorter duration of the immune response to vaccination

Assessment of Trained Hand Hygiene Observers Using Parallel Observations

Objectives: To validate hand hygiene (HH) observers following training and determine the concordance between the observers and the Kappa index. Methods: This study was conducted during June 2017. HH observers from 15 hospital units received eight-hours training including a two-hour workshop conducted by the infection control practitioner and hospital epidemiologist. After its completion, parallel observations were conducted by trained nurses from each respective unit for a maximum of 20 minutes per session at any time or day. Results: A total of 789 parallel observations were performed. In observed HH actions, the percentage of agreement between trained and experienced observers was 75.4%, with a Kappa index of agreement of 0.61 (95% confidence interval (CI): 0.57−0.66). For the observed HH moments, the agreement among observers was 83.8% with a Kappa index of 0.71 (95% CI: 0.66−0.75). Conclusions: HH observers were validated after a dedicated training in correspondence with the recommendation to improve HH monitoring. Additional studies should focus on evaluating the sustainability of the agreement, the requirement of retraining, and other alternatives for observers’ validation

Assessment of Trained Hand Hygiene Observers Using Parallel Observations

Objectives: To validate hand hygiene (HH) observers following training and determine the concordance between the observers and the Kappa index. Methods: This study was conducted during June 2017. HH observers from 15 hospital units received eight-hours training including a two-hour workshop conducted by the infection control practitioner and hospital epidemiologist. After its completion, parallel observations were conducted by trained nurses from each respective unit for a maximum of 20 minutes per session at any time or day. Results: A total of 789 parallel observations were performed. In observed HH actions, the percentage of agreement between trained and experienced observers was 75.4%, with a Kappa index of agreement of 0.61 (95% confidence interval (CI): 0.57−0.66). For the observed HH moments, the agreement among observers was 83.8% with a Kappa index of 0.71 (95% CI: 0.66−0.75). Conclusions: HH observers were validated after a dedicated training in correspondence with the recommendation to improve HH monitoring. Additional studies should focus on evaluating the sustainability of the agreement, the requirement of retraining, and other alternatives for observers’ validation

Incidence and Etiology of Surgical Site Infections in Appendectomies: A 3-Year Prospective Study

Objectives: Surgical site infections (SSIs) constitute a threat, especially in complicated appendicitis, and are commonly due to gram-negative organisms. We sought to describe the incidence of SSIs in appendectomies performed during a three-year period (January 2013 to December 2015) in a community hospital in Qatar, and compare this with external benchmarks. Methods: We conducted a longitudinal study at The Cuban Hospital, Qatar. We used the standardized surveillance criteria to define SSI developed by the Centers for Disease Control. Information about age, sex, smoking habits, diabetes mellitus status, body mass index, and the result of bacteriologic studies were collected. Results: Of a total 603 patients, 22 (3.6%) cases of SSI were reported, with an infection rate of 13.6%, 4.5%, and 1.0% in 2013, 2014, and 2015, respectively. SSIs were observed more frequently in patients with contaminated/dirty wounds (6.6%). About 65% of isolates from the surgical site were multidrug-resistant organisms (Escherichia coli and Klebsiella spp.). Conclusions: This study describes the incidence of SSI in appendectomy, which could be used as a benchmark for the facility improvement program. The high frequency of multidrug-resistant organisms in SSIs requires additional studies focused on evaluating the effectiveness of the current preventive practices with a particular reference to antimicrobial prophylaxis