Introduction: Catheter Related Bloodstream Infection (CRBSI) continues to be a major healthcare associated infection in Intensive Care Units. The necessity of Central Venous Catheters (CVC) for critically ill patients creates a significant challenge in reducing the CRBSI rates. This challenge is further amplified by the extended duration of CVC use required for many of our patients due to complex treatment regimens, hemodynamic monitoring needs, and the presence of high comorbidity factors. The purpose of this study was to review the impact of a 12-month comprehensive CRBSI reduction program and a new Central Line Maintenance Bundle (CLMB) on reducing CRBSI rate in a cardiothoracic surgical ICU. Case Presentation: Observational study carried out and yearly CRBSI rate compared before and after implementation of the program. The program consists of one-month hand hygiene campaign conducted every quarterly throughout 2021, application of disinfectant cap (Curos) for all long staying patients, application of Chlorhexidine tegaderm for newly inserted central line, application of no sting barrier film at CVL sites and Adenosine triphosphate test on random surfaces for cleanliness. Besides, the existing CRBSI Bundle was separated into CRBSI Insertion and Maintenance Bundle. The new CRBSI Maintenance Bundle consists of HH, hub care, site care, tubing care and daily review. Infection control link nurses were appointed every shift to ensure adherence to the infection control protocol. The CRBSI rate before and after the program was compared. Discussion: At the beginning of the study, the CRBSI rate was 4.8 per 1000 catheter days. The CRBSI rate reduced to 3.3 per 1000 catheter days, at the end of the study. The overall reduction of CRBSI rate was 31%. Conclusion Implementing a comprehensive CRBSI reduction program and a new Central Line Maintenance Bundle was able to significantly reduce catheter related blood stream infection in ICU.

Acknowledgments: Department of Nursing, National Heart Institute, Dato Dr.Suneta Sulaiman, Intensive Care Unit Director.

Objectives: The COVID-19 pandemic has become a serious threat to global health. Current research shows that COVID-19 causes an increase in the incidence of multidrug-resistant organisms (MDRO) due to excessive use of antibiotics during COVID-19 [1,2]. Extended-spectrum β lactamase-producing Enterobacterales (ESBL-PE), especially Escherichia coli-producing ESBL (Eco-ESBL) and Klebsiella pneumoniae-producing ESBL (Kp-ESBL) are pathogens of current concern due to their potential for rapid spread in communities and healthcare [3]. Based on antibiogram data from Dr. M. Djamil General Hospital Padang in 2022, the incidence of MDRO in the inpatient, outpatient, and intensive care units was mostly caused by Kp-ESBL (12,7%), followed by Eco-ESBL (11,9%) [4]. This study aims to compare the incidence of MDRO caused by Eco-ESBL and Kp-ESBL before, during, and after COVID- 19. Methods: This research constitutes a retrospective descriptive study conducted at Dr. M. Djamil General Hospital Padang during three distinct periods: before, during, and after the COVID-19 pandemic. The population of this study was the results of all cultures from all specimen examinations that produced ESBL. Two thousand and seventeen samples were taken from the population that met the inclusion and exclusion criteria using the total sampling technique. Results: Comparison of the incidence showed that Eco-ESBL has an increased risk of incidents after the pandemic by 1.41 times compared to before the pandemic, while the risk of incidence during the pandemic does not show a significant relationship (p=0.63, p>0.05). In contrast to Kp-ESBL, there is a decrease in the risk of incidence after the pandemic by 0.62 times compared to before the pandemic (p<0.05), while the risk of incidence during the pandemic also does not show a significant relationship (p=0.63, p>0.05). Conclusion: There is a significant risk of incidence of MDRO caused by Eco-ESBL and Kp-ESBL after the pandemic compared to before the pandemic COVID-19.

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.

Drawing on ethnographic fieldwork among Make America Great Again (MAGA) activists during the 2020 presidential campaign, we explore the status dynamics behind the appeal of Donald Trump’s right-wing populism. While existing explanations emphasize partisanship, economic anxiety, racial resentment, rural identity, and media polarization, we underscore a less-explored explanation for Trump’s core support: it is a status-based social movement. We find that Trump’s activists are not simply voters responding to policy preferences or culture-war appeals but are also participants in a grassroots social movement organized around a shared perception of lost honor, declining esteem, and institutional disrespect. To make this argument we use the concept of the symbolic politics of status to explain how political conflict extends beyond contests over material distribution or moral values to include battles over whose values and lifestyles are considered worthy. For MAGA activists, reclaiming lost status means seeking public affirmation for identities they feel have been unfairly denigrated. The MAGA movement blends grievance with joy, cultivating pride, belonging, and celebration alongside anger at elites. By centering status in our analysis, we offer an integrative framework that connects material, cultural, and emotional motivations into a broader account of MAGA as a right-wing social movement grounded in grassroots populism.

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.