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SG-APSIC1100: Healthcare-associated infections in COVID-19 patients in Vietnam: Are we able to respond better?
- Thu Truong Anh, Dao Xuan Co, Do Ngoc Son, Pham The Thach, Luong Quoc Chinh, Huynh Xuan Nghiem, Nguyen Dai Vinh, Truong Thai Phuong, Pham Hong Nhung, Le Duc Nhan, Tran Thi Dung, Tran Thi Nga, Nguyen Quang Tuan
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S1 / February 2023
- Published online by Cambridge University Press:
- 16 March 2023, p. s18
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Objectives: Studies have revealed that a relatively high incidence of severe infection and mortality in COVID-19 patients is attributed to healthcare-associated infections (HAIs). We implemented a study in 2 field hospitals dedicated to COVID-19 treatment in Da Nang, Vietnam (July–August 2020), and Ho Chi Minh City, Vietnam (August–October 2021), to identify pathogens, risk factors, and outcomes associated with HAIs. Methods: We applied a prospective study tool to estimate HAI incidence among 1,454 patients. HAIs are diagnosed and ascertained using surveillance criteria established by the US Centers for Disease Control and Prevention. All patients hospitalized for COVID-19 for at least 2 days were enrolled in this assessment of HAI risks, pathogens, and outcomes. Results: Among 1,454 sampled patients, 391 patients had 423 HAIs (27.1%). The highest proportion occurred in ICUs, with 422 HAI patients (34.1%). Pneumonia (n = 331, 78.3%) and bloodstream infections (n = 55, 13.1%) were the most common HAIs. Multidrug-resistant (MDR) bacteria, such as Klebsiella pneumonia (27.9%) and Acinetobacter baumannii (25.3%), were the most commonly isolated organisms. Ventilators and central venous catheters were independently associated with HAIs. Regarding the mortality rates, 55% of deaths occurred in intensive care units. Patients with HAIs (70.3%) were twice as likely to die compared to patients without HAIs (38.8%). HAIs leading to septic shock caused almost triple mortality (n = 58, 90.6%) compared with non-HAI patients (n = 412, 38.8%). HAIs prolonged hospital stay: 24.7 days for patients with HAIs and 19.1 days for patients without HAIs (P < .001). Conclusions: Patients with COVID-19–related critical illnesses are at high risk of HAIs from multidrug-resistant (MDR) bacteria. HAIs prolong hospitalization, whereas HAIs with septic shock almost tripled mortality. Guidelines and procedures to prevent and control HAIs caused by MDR bacteria as well as training and monitoring on aseptic-compliant techniques during invasive clinical procedures are needed.
Strengthening Adherence to a Central-Line–Associated Bloodstream Infection Prevention Bundle in a Surgical ICU in Vietnam
- Thuy Le, Hung Nguyen Thanh, Minh Ngo Ngoc Quang, Chau Nguyen Thi Tran, Ha Nguyen Thi Thanh, Thinh Le Quoc, Tuan Dang Thanh, Le Nguyen Thi Cam, Thuy Duong Thi Kim, Ha Tran Thi Thu, Lan Nguyen Thi Phong, Amber Vasquez
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s392
- Print publication:
- October 2020
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Background: Central-line–associated bloodstream infections (CLABSIs) increase the length of hospital stay, healthcare costs, and patient mortality. Objective: We conducted a quality improvement (QI) approach with plan-do-study-act (PDSA) cycle to strengthen adherence to a central-line (CL) maintenance bundle and to reduce CLABSI rate in a surgical intensive care unit (ICU) of children’s hospital 1 (CH1). Methods: The baseline CLABSI rate per 1,000 CL days and the ratio of CL days to patient days (device utilization ration; DUR) were captured for 12 months preceding the intervention. Baseline process indicators were captured for 2 months preceding implementation, including hand hygiene adherence, sterile technique for dressing change and CL access, CL hub cleaning, dating of CL components and daily chlorhexidine bathing. A multimodal intervention of clinician training, bedside checklist, and poster reminders of best practices was implemented. Process and outcome measures were monitored over 12 months of implementation. Z-test was used to calculate statistical significance before and after intervention. Results: Among 46 clinical ICU staff trained on a CLABSI maintenance bundle, mean pre- and posttest knowledge scores increased from 63% to 86%. Staff adherence to each CL care bundle element improved significantly (P < .001) and sustainably over the intervention period: hand hygiene adherence increased from 54% to 82%; sterile technique for dressing increased from 60% to 94%; sterile technique for CL access increased from 51% to 97%; hub scrubbing increased from 52% to 93%; dating of CL elements increased from 63% to 85%; daily chlorhexidine bathing increased from 52% to 87%. During the first 9 months, the CLABSI rate and the DUR decreased from 5.8 to 3.7 and from 0.43 to 0.41, respectively. In the following 2 months, the CLABSI rate increased to 12.7 while bundle adherence remained high. A root-cause analysis identified inadequate environmental hygiene and use of multidose saline bottles for multiple patients as potential factors. A PDSA cycle to improve these elements (enhanced cleaning; single-patient saline bottles) led to a decrease in the CLABSI rate from 12.7 to 3.0 after these efforts. Conclusions: This is the first time CH1 has used quality improvement methodology to implement an HAI prevention enhancement, which proved effective at creating and sustaining adherence to a multimodal CL maintenance bundle and an overall decrease in CLABSI rates. A 2-month increase in CLABSI rates highlights the unique challenges faced in low-resource settings and demonstrates the need for IPC elements not captured in a typical CLABSI prevention bundle. The quality improvement methodology provided a structured approach to implementing change. This methodology will be used for additional patient safety improvements at CH1 and other Viet Nam hospitals interested in CLABSI prevention.
Funding: None
Disclosures: None
First-Time Use of Clinical Pharmacists to Improve Appropriate Antibiotic Prescribing in a Medical ICU in Viet Nam
- Tuan Mai Van, Nhu Hiep Pham, Thi Lan Huong Hoang, Nhat Tan Dang, Thi Ngoc Anh Pham, Thanh Huy Nguyen, Quoc Tuan Cao, Vu Thuy Hang Pham, Nga Nguyen, Amber Vasquez, Lan Nguyen Thi Phong, Hien Bui, Manh Hung Bui
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s236
- Print publication:
- October 2020
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Background: Antibiotic overuse has led to increasing rates of antibiotic resistant infections and unnecessary antibiotic costs. Clinical pharmacists can play a key role in optimizing appropriate use of antimicrobials and reducing antimicrobial resistance. However, the role of clinical pharmacists in antimicrobial stewardship is new and not well established in Viet Nam. Objective: We evaluated the use of clinical pharmacists for improved antimicrobial prescribing. Methods: We assembled an antibiotic stewardship program (ASP) team consisting of a clinical pharmacist and a specialist in infection prevention and control in a 60-bed medical intensive care unit (MICU) at Hue Central Hospital in central Viet Nam. During January–September 2018, the ASP team collected baseline antibiotic prescribing days of therapy (DOT) for all antibiotics administered in the MICU. Then, from October 2018 through June 2019, the ASP team reviewed daily positive clinical bacterial cultures and susceptibility results for all patients present in the MICU. They reviewed medical charts, including antimicrobial prescriptions, during week days and only if patient was still in the ICU at the time of ASP rounds. The team recommended changes to antibiotic therapy verbally to physicians and left the decision to change antibiotic therapy to their discretion. The ASP team documented whether their recommendations were accepted or rejected. Statistical significance was determined using the Student t test. Results: The ASP team reviewed 160 medical charts and made 169 ASP recommendations: 122 (72%) to continue current treatment; 24 (14%) to monitor drug levels or obtain diagnostic tests; 10 (6%) to discontinue therapy; 6 (4%) to de-escalate therapy; 5 (3%) to adjust doses; and 2 (1%) to broaden therapy. Only 8 of the recommended changes (5%) were declined by the clinicians. The average monthly DOT for all types of antibiotics declined significantly from 2,213 to 1,681 (24% decrease; P = .04). Reductions in DOT for the most common broad-spectrum antibiotics included colistin from 303 to 276 (P = .75); imipenem-cilastatin 434 to 248 (P = .06); doripenem 150 to 144 (P = .85). Piperacillin-tazobactam increased from 122 to 142 (P = 0.75). Conclusions: We demonstrated that daily review of cultures and antibiotic use decreased overall antibiotic prescribing. Given that few recommendations included discontinuation of therapy, ASP rounds likely raised awareness for clinicians to optimize antibiotic use.
Funding: None
Disclosures: None
OP169 Usability Evaluation Of A Portable Dry-Electrode Electrocardiography Device In Vietnam
- Precious Kilimo, Ngoc Phan, Tai Le, Thai Hoang, Dung Han, Linh Dang, Nguyen Vu, Nga Pham, Tuan Nguyen, Hung Cao, Cuong Nguyen
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- Journal:
- International Journal of Technology Assessment in Health Care / Volume 34 / Issue S1 / 2018
- Published online by Cambridge University Press:
- 03 January 2019, p. 61
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Introduction:
According to the Vietnamese Cardiovascular Association, one-fifth of Vietnam's population is suffering from cardiovascular disease (CVD) – now the leading cause of death in the country that accounts for about one-third of total deaths every year. Yet affordable and convenient solutions to monitor and detect CVDs remain limited and not available nation-wide. This study aimed to investigate the usability of a portable dry-electrode electrocardiography (ECG) device, paired with a mobile phone, in supporting ECG service delivery in Vietnam.
Methods:An evaluation study was designed to combine a portable dry-electrode ECG device to measure and a mobile phone to receive and record ECG signals. Healthy young college students were invited to participate in the study. Three rounds of ECG measurement were administered for each of the participants. Usability of the device was assessed through the reliability of the measures and feasibility of use during intervention. Standard error of measurement (SEM) and intra-class correlation coefficient (ICC) estimations were used for reliability, while structured questionnaire administered before and after measures was used for feasibility assessments.
Results:A total of 234 participants enrolled in the study. No major difference was found in SEMs between trials one and two (4.96 percent, 90% CI: 4.61 − 5.37) and two and three (4.14 percent, 90% CI: 3.85 − 4.48). A slight improvement was observed in ICC of trials two and three (0.95, 90% CI 0.94 − 0.96) in comparison to one of trials one and two (0.94, 90% CI: 0.92 − 0.95). The SEM and average ICC of all trials were 3.41 (90% CI: 3.17 − 3.69) and 0.96 (90% CI: 0.95 − 0.96) respectively. Forty-five percent of participants thought the device would be suitable for their parents while 69 percent thought the device would benefit their grandparents the most.
Conclusions:High consistency of measures demonstrated that the device is reliable to provide ECG service delivery. The study also showed great potential of device usage in primary health care of Vietnam.
Effects of imidacloprid and fenobucarb on the dynamics of the psyllid Diaphorina citri Kuwayama and on the incidence of Candidatus Liberibacter asiaticus
- Frédéric Gatineau, François Bonnot, To Thi Hong Yen, Do Hong Tuan, Nguyen Duong Tuyen, Nguyen Thi Ngoc Truc
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Introduction. The effects of imidacloprid and fenobucarb insecticides on the dynamics of the psyllid Diaphorina citri and on the incidence of Candidatus Liberibacter asiaticus (Ca. L. a.), the putative causal agent of Huanglongbing disease (HLB), were studied in a field experiment. Materials and methods. The experimental design consisted of three independent 0.5-ha Citrus orchards planted with disease-free HLB-susceptible orange trees, located in a Citrus producing area seriously affected by HLB. Imidacloprid was applied monthly to the trunks in one orchard at a rate of 0.15 g a.i.·tree–1; fenobucarb was sprayed fortnightly in a second orchard at a rate of 250 g a.i.·ha–1. The 3rd orchard was managed as a control without insecticide applications. The total number of adult D. citri specimens and the percentages of trees harbouring psyllid eggs and 5th instar nymphs were monitored at fortnightly intervals in each orchard. Ca. L. a. incidence was assessed in each orchard by PCR at 5 months, 12 months and 24 months after planting. Results. Compared with the control, both the fenobucarb and imidacloprid treatments reduced adult psyllid populations by over 90% and reduced the frequency of trees harbouring eggs and 5th instar nymphs. Only imidacloprid treatments totally prevented development of a new generation of adults from eggs. Two years after planting, the prevalence of Ca. L. a. was 0.939, 0.745 and 0.239 in the control and in the orchards treated with fenobucarb and imidacloprid, respectively. Discussion and conclusion. The results indicated that, although both the insecticides used effectively reduced D. citri populations by killing adults and nymphs and by affecting or preventing psyllid reproduction in orchards, neither of the two insecticide treatments totally prevented transmission of Ca. L. asiaticus. However, due to its long-lasting effect and systemic activity, the imidacloprid treatment provided the best protection against infections, and delayed and slowed down the spread of the pathogen. Furthermore, it reduced the number of pesticide applications needed and left the way open for biological integrated pest management programmes.
2 - Restructuring of State-Owned Enterprises towards Industrialization and Modernization in Vietnam
- from Section I - Reforms of SOEs in Vietnam
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- By Nguyen Ngoc Tuan, Vice Chairman, Government Price Committee, Hanoi, Ngo Tri Long, Vice Director, Institute for Market and Price, Hanoi, Ho Phuong, Centre for Encyclopaedia, Hanoi
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- Book:
- State-Owned Enterprise Reform in Vietnam
- Published by:
- ISEAS–Yusof Ishak Institute
- Published online:
- 09 November 2017
- Print publication:
- 01 November 1996, pp 19-37
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Summary
Introduction
Both in the immediate future and in the long term, Vietnam's state-owned enterprises (SOEs) will still play an extremely important role — and hold key positions — in various sectors of the national economy. However, the recent shift of the centrally planned economic system, towards a market-oriented economy under state control, has exerted a marked impact on the need to restructure the state sector, and there is an urgent need to improve the efficiency of these SOEs. Therefore, the main topic of this chapter is a study of the present status of SOE restructuring, as part of Vietnam's aim of advancing towards industrialization and modernization, and will address two key issues. First, an analysis of the present state of Vietnam's SOEs: by size, sectoral profile, and management and ownership structures. Based on this analysis, an evaluation of SOE efficiency can be made, from which we can have a sound basis to understand the process of restructuring Vietnam's SOEs. Secondly, the chapter will advance views on the orientations needed to restructure the SOEs, to achieve the aim of industrializing and modernizing Vietnam.
Current State of SOEs in Vietnam
The current system of SOEs in Vietnam was formulated both through a process of industrialization and through the establishment of new SOEs, of which the latter was more important. A series of SOEs, spanning various sectors — run either by national ministries and general departments, or by provincial authorities — was set up in North Vietnam between 1960 and 1970, and this policy was initiated across the entire country after 1975. Since the late 1980s, however, a process of reforming and reducing the cumulative number of SOEs has been under way. By the end of 1989, there were 12,297 SOEs in operation in Vietnam, with a total capital value of 34,216 billion dong. Over the last three years, under the market mechanism, the country's SOEs have been revamped and re-registered under government decree No. 388/CP. And by June 1993, the total number of SOEs had dropped to 7,060, with a total capital value of 44,965 billion dong. Between June 1993 and April 1994, SOEs continued to be reformed, and the cumulative number of SOEs reduced further, to 6,264, with a total capital of 53,150 billion dong (approximately US$5 billion).