Objective: Carbapenem-resistant Gram-Negative Bacteria (CR-GNB) are a current global concern. CR-GNB in hospitalized patients with bacteremia is a critical health concern due to its high level of resistance to antibiotics and is associated with high mortality rates. This study aims to identify the prevalence of CR- GNB from blood specimens of patients in Adam Malik Hospital. Method: A retrospective cross-sectional study was carried out on blood specimens of patients received at the Clinical Microbiology Laboratory Adam Malik Hospital from January 2023 to December 2023. The bacterial isolates were identified using BD™ Bruker MALDI Biotyper and the susceptibility of the isolates to various antimicrobial agents was tested using the automated antimicrobial susceptibility tests. We performed a descriptive statistical analysis of the Gram-negative bacterial growth from blood specimens and antimicrobial susceptibility against each bacterial isolate. Results: There were 939 bacterial isolates obtained from blood culture, and 57% (534/938) were Gram-negative. The most prevalent Gram-negative bacteria were Klebsiella pneumoniae (22.09%), Escherichia coli (19.84%), Pseudomonas aeruginosa (9.20%), and Acinetobacter baumannii (7.89%). Among all the Gram-negative isolates, 18,1% were carbapenem-resistant. The most prevalent Gram-negative bacteria that are resistant to carbapenems were A. baumannii (56.4%);22/39), K. pneumoniae (25.2%; 27/107), P. aeruginosa (22.7%; 10/44), Proteus mirabilis (20%; 1/5) and Enterobacter cloacae (18.6%);8/43). The highest antimicrobial susceptibility for the most prevalent CR-GNB were amikacin for E. cloacae, P. aeruginosa and A. baumannii (87,5%, 60 %; 40%; respectively), trimethoprim-sulfamethoxazole for K. pneumonia (66,7%), tigecycline for E. cloacae (87,5%). Conclusion: The prevalence of CR-GNB from blood specimens in Adam Malik Hospital was 18,1%. The most common CR-GNB isolates were Acinetobacter baumannii, K. pneumoniae, P. aeruginosa, and Enterobacter cloacae. The infection control program is a critical action to prevent the transmission of CR-GNB, particularly in hospital settings.

Objectives: Meropenem has become one of the most widely used antibiotics and is considered to be the drug of choice for empirical treatment in patients with pneumonia. The aim of this study is to evaluate factors associated with the use of Meropenem as a broad-spectrum antibiotic in a referral hospital in Makassar. Methods: In a retrospective observational study we conducted over one-month period (January- February 2024), adult patients diagnosed with pneumonia who received Meropenem were selected. We included data such as length of stay, admission to the intensive care unit, use of ventilator, basis of prescription (either empirical or culture-based), and laboratory profiles such as white blood cell count, procalcitonin levels, blood culture and resistance towards antibiotics. Results: Over one-month period, thirty patients admitted to our hospital with pneumonia were evaluated. Among these patients, several factors such as admission in intensive care unit, use of ventilator, and procalcitonin levels showed statically significance (p < 0,05) while blood culture and antibiotic resistance showed minimal impact towards utilization of Meropenem in patients with pneumonia. Conclusions: In conclusion, our study indicates that Meropenem usage for pneumonia treatment is significantly influenced by admission to the intensive care unit, use of ventilator, and specific laboratory parameters such as procalcitonin levels. Further research with larger scale is needed to evaluate utilization of Meropenem in clinical practices.

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:

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.

Objectives: In the face of the complicated developments of the COVID-19 epidemic, the increasing number of cases, accompanied by an increase in the number of personal protective equipment has contributed mainly to the increased amount of medical solid waste. Updating knowledge and practicing the correct classifications of solid medical waste according to regulations is an urgent issue to minimize the risk of pandemic spread, health, and the environment, as well as responding to incidents and exposures. To determine the proportion of health workers with correct knowledge and practice in classifying solid medical waste and related factors at District 4 Hospital, Ho Chi Minh City. Methods: A cross-sectional study was conducted on 149 health workers at District 4 hospital in 2022. Self- administrated questionnaires including personal data, 50 knowledge questions and practice checklists for solid medical waste classification were used. Determine the relationship using the Χ2 test, PR, and the 95% confidence interval. Results: Health staff have knowledge account for 87.25%; general practice 53,69%. Knowledge of color coding non-infectious hazardous waste accounts for less than 50%. Waste bin cleaning 9.4%, exposure reporting procedures 30.87%. The age group >30, the subclinical departments, the information sources from radio, and friends have a higher rate of practice correctly than the other group, p < 0.05. Conclusions: Health staff have correct knowledge account for 87.25%; correct practice account for 53.69%. Health facilities need to maintain training on solid waste classification knowledge, focusing on color coding, symbols, handling and responding to incidents of exposure to medical waste and occupational safety. Fully equipped with different means of communication to instruct, supervision classification, collection and transportation of solid waste to take timely remedial measures.

This study considers why public abattoirs of the Republican era failed to function effectively and were unpopular with contemporaneous Chinese people. In the early twentieth century, Chinese officials began to rely on biomedical parameters to define safe food, a critical step in the modernization of social control strategies. Tianjin was among the first Chinese cities to launch government-run slaughterhouses that combined safety inspection with monopolized animal slaughtering. However, how such slaughterhouses operated has received little academic attention. The municipal authorities introduced a series of laws covering slaughterhouses’ construction and operations to ensure meat safety. However, Tianjin’s public slaughterhouses failed to uphold their new duties toward public health and even became menaces to urban sanitation. City officials lacked the ethics of modern public servants, and the slaughterhouses provided them new opportunities for rent-seeking practices. The collection of slaughter tax superseded meat safety inspection as the municipality’s primary concern, which undermined the effectiveness of food hygiene regulation. Therefore, city residents regarded the public slaughterhouses as predatory tax collectors. Taking Tianjin as an example, this article demonstrates the gap between the modernization of governmental agencies modeled on Western countries and the persistence of traditional, exploitive governing practices in Republican China.

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: Data on primary care antibiotic prescription practices for children in Southeast Asia, which are essential for policy, quality improvement and patient safety, are lacking. We aimed to describe this gap and to benchmark prescription practices against international standards. Methods: Antibiotic prescriptions for children (age <18 years) who visited six public primary care clinics in Singapore between 2018 and 2021 were extracted and categorized according to the World Health Organization Access, Watch, Reserve (WHO AWaRe) classification. Quality indicators from the European Surveillance of Antimicrobial Consumption Network (ESAC- Net) and National Institute for Health and Care Excellence (NICE) guidelines were used as a measure of appropriateness of antibiotic prescribing. Descriptive statistics and T-test was used to compare prescription rates pre- and post-COVID-19 pandemic. Results: 19,325 and 20,692 oral and topical antibiotics were prescribed for 831,669 visits, with a prescription rate of 2.3% and 2.5% respectively. Mean antibiotic prescriptions fell significantly post-pandemic (2020–2021), compared to pre-pandemic numbers (1062.8 to 604.5 prescriptions per month) (p <0.001). The majority (95.8%) of prescriptions belonged to the Access group. Watch group antibiotics constituted 6.1% of the total antibiotics prescribed for respiratory conditions (n = 562). While prescriptions were low (4.1%) and well within EASC-Net quality indicator limits of 0-20% for respiratory infections, prescriptions for otitis media were significantly high (56.6%). Approximately 1 in 2 children received antibiotics as recommended by NICE guidelines for both respiratory infections (n=4,622, 51.5%) and otitis media (n=204, 51.8%). Conclusions: Primary care antibiotic prescriptions for children in Singapore decreased post- COVID-19. However, high rates of otitis media prescriptions and only 50% appropriateness for respiratory infections and otitis media emphasize the need for targeted improvements in these areas.

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

Objectives: Octenidine dihydrochloride is a topical antiseptic that has been demonstrated to decrease the microbial burden of bacteria colonizing the skin. Various applications of octenidine have been studied with evidence supporting reductions in Staphylococcus aureus infections. MRSA carriers are at a higher risk of MRSA bacteremia and can be identified early during admission through screening. This study aimed to evaluate the impact of octenidine on the incidence of hospital-onset (HO) MRSA bacteremia amongst MRSA carriers. Methods: A quasi-experimental before-and-after interventional study was conducted in a single 1700 bed academic teaching hospital. From December 2021 onwards, five days of intranasal octenidine and daily octenidine bathing until discharge was introduced only for MRSA carriers. Screening for MRSA colonization status occurs on admission (either by nasal PCR or nasal, axilla and groin culture, and upon inpatient transfer or through clinical cultures. An HO-MRSA bacteremia event is defined as occurring more than 3 days from admission or more than 14 days from the last positive date. Baseline yearly incidence of HO-MRSA bacteremia for 2021, and the proportion occurring in MRSA and non-MRSA carriers was determined. This was then compared to yearly incidence observed post-intervention in 2022 and 2023. Results: Between 2021-2023, the yearly incidence of HO-MRSA bacteremia in carriers decreased steadily from a baseline of 11 to 10 and then to 6 per 1000 patients. In contrast, over the same period the yearly incidence in non-MRSA carriers initially increased from a baseline of 0.26 to to 0.33, before decreasing to 0.22 per 1000 patients. Overall yearly incidence decreased by a greater proportion in those receiving octenidine compared to those who did not – 45.5% vs 15.4%. Conclusion: Intranasal octenidine and daily octenidine bathing when performed on a high risk group such as MRSA carriers, reduces the incidence of HO-MRSA bacteremia.

Objectives: The most common adverse events (AEs) of an arterial line (A-line) insertion included inflammation, infection, bloodstream infection (BSI), disconnection, and occlusion of the device, etc., the purposes of this study were to compare the nursing practice of registered nurses before and after using the nursing care model for the prevention of AEs and to compare the incidence of AEs. Methods: This quasi-experimental study was conducted among registered nurses (n = 14) and critically ill patients who received A-line insertion (n = 40), which were divided into either a control group (n = 20) or an experimental group (n = 20). The tools used included 1) personal data and clinical data recording form, 2) AEs recording form, 3) the nursing care model for prevention AEs in patients who received A-line insertion comprising five methods “ABCD’S of care nursing care model”; 1) assessment of the AEs, 2) blood sampling, 3) cleansing and closed A-line site with the use innovation “Tegaderm with Window for A-line” and circuit care, 4) daily review, and 5) standard of care and 4) a nursing practice behavior assessment form. Data analysis involved descriptive statistics, t-tests, and chi-square tests. Results: The average nursing practice behavior scores increased from 2.57 points (SD = 0.51) to 4.5 points (SD = 0.52), indicating a substantial improvement. Moreover, the incidence of AEs decreased from 45% to 5%, a remarkable reduction. These findings underscore the effectiveness of the nursing care model in preventing AEs in critically ill patients. Conclusion: Based on the “ABCD’S of care”, the nursing care model has proven effective in reducing the incidence of AEs in critically ill patients. This finding enhances our understanding of nursing practices and provides a practical solution for healthcare professionals. It is, therefore, crucial to disseminate and implement these guidelines to ensure sustainable nursing practices.

Background: Urinary tract infection (UTI) is the most dominant case, around 40% of healthcare-associated infections (HAIs). UTI related to catheter placement called as Catheter-Associated Urinary Tract Infection (CAUTI). Catheterization is considered as a port of entry that lead to infection. In sepsis patients, CAUTI can significantly affect clinical outcomes. Prolonged CAUTI can worsen but can be prevented via suitable intervention, particularly in septic patients with urine catheters. To effectively prevent and manage diseases, gathering data focusing on surveillance is essential. Hence, examining multiple risk variables associated with CAUTI is vital, including age, gender, diabetes mellitus, kidney failure, frequency and duration of catheterization, and duration of antibiotic usage before urine culture. Method: A quantitative study using a cross-sectional design by selecting samples using total sampling was conducted at RSPAD Gatot Soebroto (n=42). All sepsis patients using catheters met the inclusion criteria. The data obtained was analysed (univariate, bivariate and multivariate), which will be presented in table and narrative format. Results: It was found that 21 sepsis patients with catheters confirmed CAUTI. Risk factors in septic patients with catheters that have a significant relationship with CAUTI are diabetes mellitus (p=0.013), kidney failure (p=0.005), length of stay (p=0.013), duration of antibiotic usage before urine culture (p=0.031), frequency of catheterization (p=0.028), and duration of catheterization (p=0.013). However, age (p=0.739) and gender (p=0.757) did not have a significant relationship. In the multivariate test was found that the most significant variables were kidney failure (p=0.006; OR=22.219; 95%CI=2.424- 293.744) and duration of catheterization (p=0.009; OR=19.147; 95%CI=2.070-177.149). Conclusion : Our findings indicate that kidney failure and duration of catheterization are the most significant risk factors for septic patient who develop CAUTIs. To enhance the clinical outcomes of sepsis patients prone to CAUTI, it is crucial to identify the risk factors as a part of treatment management and infection prevention control.

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.

Objectives: Antibiotic resistance is a global issue that has significant negative effects on both health and the economy. Klebsiella pneumoniae is grouped with Enterococcus faecium, Staphylococcus aureus, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter spp. (ESKAPE) as multidrug-resistant (MDR) bacteria worldwide. The challenges associated with controlling life-threatening infections caused by MDR organisms have pushed research focus toward alternative treatments, which include bacteriophage therapy. Therefore, this study aimed to isolate the carbapenem-resistant K. pneumoniae (CRKP) specific phages from the hospital sewage water effluent for future application in a clinical setting. Methods: Sewage samples were obtained from different points of hospital effluent. The collected samples were primarily filtrated and centrifuged to recover, purify, and concentrate the bacteriophage. The lytic phages were detected using a spot assay. Subsequently, the specific CRKP phages were isolated using the double agar layer method, where the four CRKP clinical isolates were used as the host system. Results: Altogether, 30 sewage samples were collected from different points of hospital treatment plant at the Hospital Universiti Sains Malaysia (Hospital USM). Each samples were screened with four different clinical CRKP strains, giving rise to a total of 120 screened plates. Lytic phages were isolated in 50 /120 (41.70%) of the screened plates. The diameter of isolated CRKP lytic phages ranged between 0.01-0.7 cm. The phage titer ranged between 6×103−1.6×109 plaque- forming units per milliliter (PFU/ml). Conclusion: The lytic phages were isolated in abundance from the hospital treatment plant and exhibited a wide range of inhibitions against the CRKP, indicating its therapeutic potential in the future. However, further studies are required to comprehend the process of in vivo phage-mediated selection.

The population changes in waterbirds are recognised as a global issue. Many waterbird species, especially migratory ones, are undergoing population changes. Monitoring these changes is crucial for waterbird conservation. However, the lack of data to quantify these populations hinders comprehension of the factors responsible for these changes. Although a few studies have investigated the long-term trends of waterbirds in the Republic of Korea (ROK), most have concentrated on a limited number of species and groups. Understanding these changes enables us to identify which species are vulnerable and develop more effective conservation measures accordingly. This study aimed to investigate the population dynamics of waterbirds in the ROK from 2000 to 2024. Data from the Winter Waterbird Census of Korea were used to analyse trends across various waterbird groups and species. The results showed diverse population trajectories, with some species experiencing notable increases while others underwent severe declines. Among the observed trends, several globally threatened species, such as the White-naped Crane Grus vipio and Oriental Stork Ciconia boyciana, exhibited significant population growth. This is largely a testament to the effectiveness of conservation interventions aimed at these species. However, the study also identified population declines of some species, such as the Tundra Swan Cygnus columbianus and Common Pochard Aythya ferina, indicating pervasive threats due to habitat loss and degradation. Lastly, several recommendations are made regarding the identified population trends that should be used to guide future conservation efforts in the East Asian–Australasian Flyway. This study, with its comprehensive and detailed findings, reiterates the importance of long-term monitoring data for developing effective conservation measures.

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.

This paper investigates the time N until a random walk first exceeds some specified barrier. Letting $X_i, i \geq 1,$ be a sequence of independent, identically distributed random variables with a log-concave density or probability mass function, we derive both lower and upper bounds on the probability $P(N \gt n),$ as well as bounds on the expected value $E[N].$ On barriers of the form $a + b \sqrt{k},$ where a is nonnegative, b is positive, and k is the number of steps, we provide additional bounds on $E[N].$

Objectives: Periprosthetic joint infection (PJI) is one of the most serious and debilitating complications that can occur after total joint arthroplasty. Therefore, early diagnosis and appropriate treatment are important for a good prognosis. Recently, molecular diagnostic methods have been widely used to detect the causative microorganisms of PJI sensitively and rapidly. The Multiplex Loop- Mediated Isothermal Amplification (LAMP) method is faster and easier to perform compared to polymerase chain reaction (PCR)-based assays. Therefore, this study developed a multiplex LAMP assay for diagnosing bacterial PJI using LAMP technology and evaluated its analytical and clinical performance. Methods: We developed a multiplex LAMP assay for the detection of five bacteria: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus agalactiae, Pseudomonas aeruginosa, and Escherichia coli, frequently observed to be the causative agents of PJI. The method limit of detection (LOD) and cross-reactivity were determined by spiking standard strains into the joint synovial fluid. The LOD of the multiplex LAMP assay was compared with that of a quantitative real-time PCR (qPCR) assay. Clinical performance was evaluated using 20 joint synovial fluid samples collected from patients suspected of having bacterial PJI. Results: The LOD of the gram-positive bacterial multiplex LAMP assay and qPCR were 105/104 CFU/mL, 103/103 CFU/mL, and 105/104 CFU/mL against S. agalactiae, S. epidermidis, and S. aureus, respectively. For P. aeruginosa and E. coli, the LOD of the multiplex LAMP and qPCR assays were 105/104 and 106/104 CFU/mL, respectively. The multiplex LAMP assay detects target bacteria without cross-reacting with other bacteria, and exhibited 100% sensitivity and specificity in clinical performance evaluation. Conclusions: This multiplex LAMP assay can rapidly detect five high-prevalence bacterial species causing bacterial PJI, with excellent sensitivity and specificity, in less than 1 h, and it may be useful for the early diagnosis of PJI.

Background: Throughout healthcare, the physical environment presents an important source of pathogens that can cause healthcare associated infections (HAIs) To keep patients safe, hospitals must maintain a clean environment and minimize the presence of pathogens. Objectives: 1. To identify through environmental monitoring the level of cleanliness in area of pediatrics isolation ward. 2.To assessments of environmental cleaning practice of environmental service (EVS) staff, and healthcare worker. Methodology: This retrospective study was done in pediatrics isolation ward, tertiary hospital. Sample sizes were 1 EVS staff, 3 nurses aid, and 102 environmental sites. Data were collected from database of infection control program between February 29, to March 2, 2024 via Infection control assessment and response (ICAR: tool for assessing cleaning practice of EVS staff, personnel by direct performance observations), visual assessment, and monitored the residual bioburden by adenosine tri phosphate (ATP) tests, and swab culture of the surface. Data were analyzed by using descriptive statistics. Results: The results of this study revealed that level of cleanliness in area of ward by ATP test found, contaminated spots were highest (61.76%, 21/34) and clean spots were lowest (38.24%, 13/34), while swab culture method found contaminated spots were higher (55.88%, 19/34), clean spots were lower (44.12%, 15/34), and visual monitoring found contaminated and clean spots were 35.29%, 12/5 and 64.71%, 22/34 respectively. The most of contaminated sites were bed rails, toilet sink, Treatment and IV care car, door handle, mop, Light scope & blade (5.88%, 6/102). As the results proved the most organisms were Acinetobacter spp., Escherichia coli, and Pseudomonas spp., respectively. Conclusion: This study suggests that the environmental cleaning in specialized area must be monitored continuous with standard methods. It is necessary to promote education and training staffs follow update practice guidelines, especially the participation of disciplinary team motivated effective activities in reducing the microbial contamination.