Objectives: The use of handwashing sinks for activities other than hand hygiene (HH) is associated with higher rates of β-lactamase–producing Enterobacteriaceae. However, little has been published about the handwashing sink activities in Singapore hospitals. We explored the handwashing sink activities in a tertiary-care hospital in Singapore. Methods: Five trained shadow observers conducted this observational study between December 18 and 21, 2018 (6 hours per day: 07:00–09:00, 09:30–11:30, and 12:30–14:30) in acute-care general wards. We divided the handwashing sink activities by healthcare workers (HCWs) and non-HCWs (ie, visitors, caregivers, and relatives) and by HH- and non–HH-related activities. We used Stata version 15 software for the analysis. The study was approved by the Institutional Review Board of the National Healthcare Group, Singapore (DSRB no. 2020/01257). Results: In total, 657 handwashing sink activities were recorded [HCWs, 475 (72.3%) and non-HCWs, 182 (27.7%)]. Of the 475 HCW handwashing sink activities, 451 (94.9%) were HH-related, 10 (2.1%) were for patient nutrition, 7 (1.5%) were for environmental care, 6 (1.3%) were for medical equipment cleaning, and 1 (0.2%) was patient personal-item cleaning. Of the 182 handwashing sink activities by non-HCWs, 117 (64.3%) were HH related, 30 (16.5%) were for patient nutrition, 21 (11.5%) were for personal hygiene, 14 (7.7%) were patient personal-item cleaning. The distribution of handwashing sink activities differed significantly (P < .01) between HCWs and non-HCWs. The odds of non–HH-related handwashing sink activities among non-HCWs was 10× higher than among HCWs (OR, 10.44; 95% CI, 5.98–18.23; P < .01). Conclusions: Handwashing sinks use for non–HH-related activities is higher among non-HCWs than HCWs. Further studies are needed to understand the impact of non-HH handwashing sink activities on nosocomial infections and ways to reduce them.

Objectives: Ancillary staff members perform operational support functions and play an active role in enhancing the patient care experience. Infection prevention practices among ancillary staff play a critical role in preventing transmission of microorganisms, which ensures the safety of patients. Low hand hygiene compliance was found among porters in a cross-institutional hand hygiene audit in 2021. A quality improvement team was formed to improve hand hygiene compliance, especially during the COVID-19 pandemic. Methods: A focus-group discussion and survey were conducted to understand hand hygiene knowledge and challenges among porters. Using the findings, the team initiated Glo–germ education tools, pocket alcohol hand-rub agents, pocket moisturizer, poster display, and a toolbox messaging system via conversion of group roll call to satellite-area roll call. Respective satellite teams were sent hand hygiene reminders, and prompt corrective action was taken following noncompliance events. Analytic comparisons of pre- and postsurvey data were performed using the χ2 test, and P < .05 was regarded as statistically significant. Results: In total, 572 ancillary staff participated in the survey. Knowledge of hand hygiene practices improved significantly following the interventions, as shown in the comparison of pre- and postintervention results: knowledge of the hand hygiene steps (P < .001), knowledge of the duration of hand rub (P < .001), and knowledge of duration of handwashing (P < .001). Also, 295 staff members (97.68%) stated that implementation measures increased their awareness of the importance of hand hygiene. Moreover, the hand hygiene compliance rate improved from 77.8% to 100%. There were no significant differences related to sex (P = .089), age group (P = .355), years of working (P = .359), education level (P = .268), or difficulty in reading English (P = .906). Conclusions: Evaluating staff hand hygiene knowledge and understanding the challenges faced among porters helped toward the development of appropriate interventions and assurance of success in project.

Objectives: Early in the COVID-19 pandemic, global health authorities identified and emphasized the importance of practicing proper hand hygiene to reduce the transmission of SARS-CoV-2 and to diminish the chances of becoming infected. It is well established in the scientific literature that surfactants and alcohols are capable of inactivating enveloped viruses such as SARS-CoV-2. However, given the novel nature of the virus, Unilever adopted an evidence-based approach to demonstrate virucidal efficacy of marketed bar soaps, liquid handwashes, and alcohol-based hand sanitizers against the original and selected variants of SARS-CoV-2. Methods: High titers of clinically isolated and laboratory-propagated SARS-CoV-2 strains were subjected to a range of selected proprietary formulations from Unilever at end-user–relevant dilutions, temperature, and contact duration, and were tested according to the internationally recognized ASTM E-1052 test protocol. Results: All tested personal-care formulations were effective against the parental SARS-CoV-2 strain as well as the β (beta) and δ (delta) variants of concern. More specifically, bar soaps with a varying concentration of total fatty matter content and liquid handwashes with varying levels of total surfactants reduced the viral titer by >99.9% within 20 seconds. Alcohol-based hand sanitizers demonstrated >99.99% reduction of input viral load within 15 seconds of contact with the viral inoculum. Conclusions: In conclusion, we have provided empirical proof that well-designed personal-care formulations that act through generic physicochemical mechanism against the basic structure of the virus particle have high virucidal efficacy against the original and evolved SARS-CoV-2 variants. Furthermore, we argue that due to the broad-spectrum mode of action of these tested formulations, the continued practice of good hand hygiene practices with everyday products holds significant promise as an easily accessible, economic, and effective nontherapeutic public health intervention toward reducing the transmission of present and future variants of SARS-CoV-2 across communities and populations.

Objectives: Hand hygiene is widely recognized as the most effective practice for preventing healthcare-associated infections. Despite ongoing interventions and strategies implemented by the infection control committee, the compliance with and consistency in the hand hygiene practice remains a challenge. At times, staff are unaware when they are noncompliant with hand hygiene; therefore, a more robust strategic approach is needed. One such strategy is customized audit with real-time feedback. A literature review highlighted the effectiveness of audit coupled with specific feedback. This approach was also supported by several guidelines and regulatory bodies that recognized the importance of audit and feedback in hand hygiene improvement efforts. For example, the World Health Organization (WHO) has emphasized 5 core components of improving hand hygiene. One of these components is evaluation and feedback. We sought to provide feedback to healthcare personnel when they do not show compliance with the Five Moments of Hand Hygiene. We aimed to achieve >95% hand hygiene compliance among healthcare staff. Methods: Information on the use of the hand hygiene feedback card was provided to the auditors. The hand hygiene feedback card procedure began in all the wards in May 2020. This process first started with orientation of the auditors regarding the hand hygiene feedback card, followed by auditing hand hygiene practice. Staff who did not comply with hand hygiene procedures were given real-time feedback via a card that specified the missed hand hygiene movement. Results: Overall hand hygiene compliance among healthcare staff increased by 6% after the hand hygiene feedback card procedure was implemented. Conclusions: Overall, the hand hygiene feedback card was effective in improving hand hygiene. Through this quality improvement project, significant and sustained gains in hand hygiene compliance rates of >95% can be achieved.

Objectives: The past hand hygiene (HH) compliance rate has indicated the low number of opportunities for some healthcare workers (HCWs) because the infection control liaison officer (ICLO) tended to capture opportunities from nurses who were available, despite the proportional allocation of opportunities per HCW type based on the World Health Organization (WHO) HH methodology. Therefore, HH compliance rates may not have accurately represented the specific HCW type, which may have affected the overall HH compliance rate. We sought to determine an accurate baseline of HH compliance rate with consistent number of opportunities across all HCW categories. Methods: HH auditors were ICLOs trained in HH observation by the infection control nurse (ICN) according to the WHO “My Five Moments of Hand Hygiene.” HH observations were conducted bimonthly with assigned areas focusing only on 1 HCW category for each session: nursing, medical, clinical support services, or environmental services. A briefing session was given on the day of observation, with the goal of collecting 20 opportunities per area with HCW focus during their peak activities. Direct feedback and positive reinforcement were given to HCWs after observations were completed. Results: A survey of 96 ICLOs indicated that observations based on HCW focus allowed them to capture more HH opportunities and concentrate on their observations. The new approach showed a significant increase in number of opportunities across all HCW categories that was more representative. We also successfully determined a new baseline for all HCW categories, with further breakdown of HCW type. Conclusions: A new methodology of HH observation with a focus on HCW category has resulted in more HH opportunities across all HCW categories and improved representation of the HH compliance rate.

Objectives: To evaluate the tolerability and acceptability of 3 different alcohol-based hand rub (ABHR) products, and to determine factors influencing hand hygiene (HH) behavior among healthcare workers (HCWs) during the COVID-19 pandemic. Methods: A cross-sectional study was conducted in Sarawak General Hospital, a 1,034-bed tertiary-care state hospital. A self-administered 7-point Likert scale questionnaire was adapted from the WHO ‘Protocol for Evaluation of Tolerability and Acceptability of ABHR.’ The study was conducted between November 12 and 26, 2021, based on 3 types of ABHR products. Participation in answering the questionnaire was voluntary, so consent was implied. The Student t test was used to determine the significant differences among the ABHR product. The χ2 distribution test was performed to evaluate the characteristics of ABHR products. Results: We received a response rate of 35% (1,598 of 4,628); 82% of respondents were female, and the overall cohort had a mean age of 35 years. Also, 972 (61%) of 1,598 respondents were nurses, and 1,490 (93%) of 1,598 respondents used ABHR at least 5 days every week. Of 1,598 respondents, 1,156 (72%) indicated that ABHR products were easily accessible at the point of patient care. Evaluation of ABHR products showed that respondents were receptive to all product colors (P < .0114) and had no color preference (P > .05). Comparison among ABHR products yielded no statistical difference (P > .05) for ‘smell,’ ‘stickiness,’ ‘irritation,’ or ‘drying speed.’ ‘Drying effect’ of all products was statistically significant (P < .0252). The overall satisfaction for all products was good (P < .0022). HCWs did not expect their HH compliance to improve even if they were provided with their preferred choice of ABHR. Of 1,598 respondents, 783 (49%) correctly used a palm-full of ABHR for HH, and 1, 275 (80%) indicated that hospital management should organize more HH-related awareness and continuous medical education on HH. Conclusions: A comparison among different ABHR characteristics mostly showed no statistically significant difference regarding tolerability and acceptability. These findings suggest that different ABHR products will not influence HH behavior during COVID-19 pandemic.

Objectives: We evaluated the role of 12-hydroxystearic acid (12HSA) in upregulating skin antimicrobial peptides (AMPs) in in vitro and ex vivo assays, and 12HSA provides long-lasting germ protection in vivo through a handwash formulation. Methods: In vitro assays were performed by treating skin cells, maintained in cell-culture media, with 12HSA. After treatment, AMP gene-expression was measured in cells by RT-qPCR, and secreted AMPs in spent cell culture media were analyzed by ELISA. Skin explants were treated with 12HSA, and 3D-living skin equivalent (LSE) models were treated with 12HSA-containing handwash formulations. AMP levels were measured by immunohistochemical staining or RT-qPCR after treatment. In clinical studies, volunteer forearms were washed multiple times with 12HSA-containing handwash in an ethics-approved study in which participants provided informed consent. The washed forearms were challenged with E. coli at different time points after washing. The 12HSA deposition from the formulation was measured using tape strips. Results: Skin cells treated with 12HSA showed increased expression of several AMP genes in vitro, and higher psoriasin AMP secretion was measured in cell-culture media. An enhanced level of LL37 AMP was obtained from the skin epidermis of 12HSA-treated explant skin. AMP genes were also upregulated in the 3D-LSE model treated with a 12HSA-containing handwash formulation. A measurable level of 12HSA was deposited from handwash formulation in the in vivo clinical sample. E. coli recovery from challenged skin was significantly lower at 6 and 10 hours after washing compared to unwashed skin. Conclusions: These data demonstrate that 12HSA boosts skin-AMPs and that a handwash containing 12HSA provides long-lasting germ protection under in vivo test conditions by potentially enhancing skin’s natural immunity. With an emerging understanding of skin’s innate immunity and AMPs, designing cleansing products that strengthen these natural defenses will offer novel approaches to extend hygiene benefits beyond immediate in-wash protection.

Objectives: Good hand hygiene knowledge among healthcare workers (HCWs) is important in the fight against COVID-19. The coronavirus disease is primarily spread through droplet and contact routes, so hand hygiene and PPE are key infection control measures to protect patients and HCWs. We sought to determine whether hand hygiene knowledge scores had an impact on the hand hygiene adherence rate during a pandemic. Methods: Hand hygiene audit observations that were conducted covertly on a monthly basis and are presented as percentages of adherent reactions to moments to wash or sanitize hands. These data were examined in relation to HCW knowledge scores on hand hygiene. The knowledge scores on hand hygiene were analyzed based on 15 questions derived from WHO tools. Scores were determined using a quiz administered in a hand hygiene promotion event. Results: In total, 195 HCWs participated and scores on hand hygiene knowledge were ranked into 3 categories: 2% scored ≥90% (high), 60% scored 70%–89% (medium), and 38% scored ≤70% (low). Knowledge scores at the medium level and above were considered satisfactory. Even though 38% of the participants scored ≤70%, there was no direct impact on monthly hand hygiene audit observation rates in the 6 healthcare clinics. Hand hygiene observation rates ranged from 90% to 97%, with an overall mean of 92% for 2021. Conclusions: Contrary to studies that have shown the significant impact of knowledge on the hand hygiene adherence rate, our data suggest that a high hand-hygiene adherence rate is achievable and sustainable among HCWs. Adherence could be driven by attention to the importance of hand hygiene associated with the pandemic and potential exposure to COVID-19. High hand-hygiene compliance attains a place of importance in the minds of HCWs during a pandemic crisis.

Objectives: Infection prevention and control (IPC) in hospitals is key to safe patient care. Currently, no data are available regarding the implementation of IPC in hospitals in Indonesia. We assessed the existing IPC practices in a nationwide survey using the World Health Organization (WHO) IPC assessment framework tool (IPCAF) to identify strengths, weaknesses, and challenges. Methods: A cross-sectional study was conducted from July to November 2021. Of all general hospitals in Indonesia, 475 (20%) were selected using stratified random sampling based on class (ie, A, B, C, and D; A being the larger hospitals with ≥250 beds) and region. IPCAF was translated into Indonesian and was tested in 4 hospitals. Questions were added regarding challenges in the implementation of IPC. Introduction meetings were held online with all selected hospitals, after which the IPCAF was sent as an online questionnaire. Results: In total, 355 hospitals (74.7%) participated in this study. The overall median score of IPCAF was 632.5. The level of implementation of IPC was mostly advanced (56.9%), followed by intermediate (35.8%), basic (7.0%), and inadequate (0.3%). The core component with the highest scores was IPC guidelines; almost all hospitals had guidelines on the most important topics, including hand hygiene. Core components with the lowest scores were surveillance of healthcare-associated infections (HAIs), education and training, and multimodal strategies. Although >90% of hospitals indicated that surveillance of HAIs was performed, 57.2% reported no availability of adequate microbiology laboratory capacity to support HAI surveillance. The most reported challenges in the implementation of IPC were behavior change and lack of availability of antibiograms. Conclusions: The implementation of the IPC core components in most Indonesian hospitals was “advanced.” For surveillance of HAIs, the need for the availability and capability of the microbiology laboratory was revealed.

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.

Objectives: Central-line–associated bloodstream infection (CLABSI) has been the leading cause of healthcare-associated infections (HAIs) in the intensive care unit (ICU) setting. Previous studies have shown that a care bundle is effective in reducing CLABSI rates; however, the data on long-term sustainability and cost savings of bundled care are limited. Methods: From January 2011 to December 2020, a prospective surveillance was performed to monitor CLABSI at a university hospital in northern Taiwan. To reduce the CLABSI rate, a hospital-wide bundled care program for CLABSI prevention was implemented in 2013. We evaluated the long-term effect of the care bundle on CLABSI incidence and length of stay in the ICU. Results: During the study period, the overall CLABSI incidence decreased from 8.22 per 1,000 catheter days before the care bundle was implemented to 6.33 per 1,000 catheter days in 2020 (P for trend <.01). The most common pathogens causing CLABSI were gut organisms (1,420 of 2,363, 60.1%), followed by environmental organisms (734 of 2,363, 31.1%) and skin organisms (177 of 2,363, 7.5%). The decreasing trend was statistically significant in the incidence of CLABSI caused by skin organisms (P for trend < .01), but not in the incidence of CLABSI caused by environmental organisms (P for trend = .86) or gut organisms (P for trend = .06). In the multivariable analysis, implementation of this care bundle was independently associated with a decrease in the CLABSI rate (RR, 0.77; 95% CI, 0.66–0.88). Compared with patients without CLABSI, patients with CLABSI had a longer average ICU length of stay (27 vs 17 days). Conclusions: A sustainable reduction in the incidence of CLABSI caused by common commensals could be achieved through a cost-saving bundled care program.

Objectives: Healthcare-associated infections (HAIs) are one of the greatest challenges and concerns in Vietnam and around the world. Many studies have shown that HAIs may result in an increase in hospital length of stay, antibiotic use, multidrug-resistant organism (MDROs) infections, treatment costs, and mortality. Therefore, in the past 5 years, the Department of Infection Control of Cho Ray Hospital has carried out many infection and prevention control (IPC) activities to reduce the rates of HAI and MDRO infection. We evaluated IPC activities and results achieved in these efforts at Cho Ray Hospital during 2017–2021. Methods: We described the implemented IPC activities and retrospectively collected data from HAIs surveillance reports during 2017–2021 for 3 intensive care units (ICUs): ICU-B, ICU-D, and the NICU. Results: In the past 5 years, we implemented synchronous IPC activities, including promoting hand hygiene training and surveillance, environmental cleaning surveillance, carrying out improvement projects such as a ventilator-associated pneumonia (VAP) prevention bundle, an MDRO prevention bundle, and an environmental cleaning quality improvement project. Many positive results were achieved, although a slight increase in the HAI incidence occurred in 2021 due to the COVID-19 pandemic. Overall, the hand hygiene compliance rate increased from 49.7% to 83.8%. The rate of HAIs per 1,000 patient days decreased steadily from 5.4 to 2.4. The VAP rate fell from 30.5 to 17.2 per 1,000 patient days, and the central-line–associated bloodstream infection (CLABSI) rate decreased gradually from 5.4 to 2.4 per 1,000 patient days. The catheter-associated urinary tract infection (CAUTI) rate decreased from 2.9 to 0.9 per 1,000 patient days, and the MDRO infection rate decreased significantly from 32.7 to 11.3 per 1,000 patient days. Conclusions: The synchronous implementation of HAI prevention bundles promoting hand hygiene and environmental cleaning achieved significant effects in the efforts to decrease HAIs and MDROs in the ICUs of Cho Ray Hospital.

Objectives: Candida auris was first detected in Japan in 2009 and has been reported in >47 countries, typically causing outbreaks in healthcare settings. According to the US Centers for Disease Control and Prevention, this pathogen causes death in more than one-third of infected patients. This study describes characteristics of healthcare-associated infections (HAIs) related to C. auris and infection prevention and control (IPC) measures applied to control transmission in Cho Ray Hospital, a tertiary-care, referral, general hospital in southern Vietnam. Methods: We reviewed medical records of all patients with HAIs caused by C. auris at Cho Ray Hospital between April 2020 and March 2021, as well as the IPC measures applied for these patients. Results: Overall, 5 HAI cases caused by C. auris were identified in 5 patients, including 2 catheter-associated urinary tract infections, 2 ventilator-associated pneumonia cases, and 1 surgical site infection. These cases were sporadically detected in 4 different clinical departments; 2 cases occurred in the respiratory department in April and August 2020. The average age of the patients was 63, and 4 of 5 patients were male. The average hospital stay was 27.2 days; 4 patients died and 1 was discharged. IPC interventions were implemented to immediately respond to C. auris infection cases, including isolating the patients, applying standard and transmission-based precautions, supplying adequate personal protective equipment, cleaning environment surfaces and medical equipment in the patient’s room, and marking isolation areas with signage. No additional cases of C. auris infection were detected in the affected units. Conclusions: C. auris can spread in healthcare settings via contact with contaminated equipment and surfaces or from person to person, causing outbreaks in hospitals and leading to severe illness and high mortality for patients. Prompt application of appropriate IPC measures effectively helped prevent additional cases of C. auris in our hospital.

Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) is a major concern for hospitalized patients in Singapore. Hospital-onset (HO) MRSA bacteremia is monitored at the national level as an indicator of hospital quality. Patients who have colonized with methicillin-resistant Staphylococcus aureus (MRSA) are more likely to develop an MRSA infection in the future. A topical antiseptic solution or cloth called chlorhexidine gluconate (CHG) is effective against several gram-positive and gram-negative bacteria, including MRSA. Methods: The following control measures were present before and throughout the study period: (1) active screening of MRSA upon admission; (2) initiation of contact precaution once MRSA is detected; and (3) emphasis on strict hand hygiene. In January 2021, an intervention was for routine application of CHG bathing as follows: (1) training materials were developed; (2) train-the-trainer sessions were organized; (3) compliance regarding the application of CHG baths was monitored; and (4) the postimplementation process was reviewed. Results: There was no change of hand hygiene rate before and after implementation. In 2020, 17 cases of MRSA bacteremia occurred in the hospital, with an infection incidence of 0.54 per 10,000 patient days. In 2021, there were 10 cases of HO-MRSA bacteremia infection, with an overall rate of was 0.30 per 10,000 patient days. Conclusions: Daily bathing with chlorhexidine reduced the risk of MRSA acquisition and of hospital-acquired bacteremia.

Objectives: Preparation of medical devices from central sterile supply department (CSSD) for use in hospital services requires quality and readiness for use. A guideline for good practice is necessary for safety, assurance, and maximum customer satisfaction, and to accommodate effective healthcare services. We sought to develop and improve medical-device preparation guidelines to satisfy clients. Methods: This action research was based on the concepts of Kaizen and eliminate–combine–rearrange–simplify (ECRS). The research was conducted in 3 phases. In the first phase, we designed the study, conducted problem analysis, and developed a plan for improving the preparation of medical devices. In the second phase, we improved the plan for implementation of medical-device preparation guidelines that the research team adapted and developed. We added inspection categories, trained staff members, conducted a focus group. We improved cleaning processes and the inventory system. In the third phase, we conducted an improvement evaluation for (1) quality improvement of medical device preparation and (2) client satisfaction. The research took place from January to December 2019. Results: The monthly percentages of medical equipment that passed quality criteria before and after the implementation plan were 91.82±1.19% and 95.33±1.25% (P ≤ .005). The average client satisfaction score increased from 76.80% to 83.40% (P = .006). Conclusions: The implementation of Kaizen and ECRS principles for quality improvement successfully increased the quality of equipment preparation and introduced standardized, quality guidelines. The plan–do–check–act (PDCA) process improved client satisfaction, staff performance, and operational efficiency while preventing damage to medical devices and improving readiness of use.

Objectives: Sharp injuries are frequent occurrences in healthcare settings. According to the World Health Organization, >2 million occupational exposures to sharp injuries occur among 35 million healthcare workers (HCWs) annually. We report the 5-year incidence and trends of sharp injuries in an acute-care hospital. We compared the rates of injury, the distribution of injuries, and the type of exposure of HCWs during the prepandemic and pandemic eras. Methods: We conducted a retrospective analysis of a 5-year surveillance on self-reported sharp injuries in Changi General Hospital, a 1,000-bed acute-care hospital. The occupational groups, the type of sharps, and the incident activity involved were reviewed. The bloodborne pathogen statuses of the identified source patients were studied. Results: In total, 441 sharp injuries were reported from 2017 to 2021. Among the occupational groups, doctors reported the highest number of sharp injuries (N = 272, 61.7%), followed by nurses (N = 129, 29.3%) and other allied health professionals (N = 29, 6.4%). An increasing proportion of doctors reported sharp injuries from 2017 to 2019 (prepandemic era) and the proportion declined from 2020 to 2021 (pandemic era); 52 doctors (58.4%) reported sharp injuries in 2017, 61 (61.1%) in 2018, 72 (67.9%) in 2019, 47 (61%) in 2020, and 40 (57.1%) in 2021. Most sharp injuries were caused by solid sharps (212 of 441, 48.1%) and hollow-bore needles (205 of 441, 46.5%). Source patients were identified in 407 sharp injuries. From the known sources, 51 were seropositive: 20 for hepatitis B (HBV), 27 for hepatitis C (HCV), and 4 for human immunodeficiency virus (HIV). No seroconversion occurred. Overall, 198 sharp injuries (44.9%) were sustained during surgical procedures, 83 (18.8%) occurred during blood taking, and 44 (9.9%) occurred during injection administration. Also, 37.5% of sharp injuries among doctors occurred during surgical procedures, and 69.6% of sharp injuries in OT occurred among junior surgical doctors. Conclusions: The overall incidence of sharp injuries has decreased during the pandemic. Fewer elective surgical procedures were performed during the pandemic period. OT suturing training workshops and awareness programs on strategies for preventing sharps injuries in the operating theatre, targeted at surgical residents during the past 2 years, could have contributed to the decrease in the incidence of sharp injuries in our hospital. Sharp injuries pose a significant exposure to blood and body fluids and should be subject to continued epidemiological surveillance.

Objectives: The prevention of nosocomial infection is a challenge for all healthcare institutions. Privacy curtains are often changed infrequently, and they are difficult to clean. Contaminated curtains can be touched by healthcare providers and patients, which may result in indirect transmission of infectious disease. Hence, we evaluated the impact of the antimicrobial properties of disposable curtains and their cost-effectiveness. Methods: This descriptive exploratory study was conducted in an ambulatory cancer center in 2017. Privacy curtains were assigned to 2 cohorts, labelled E1 and E2. They were placed in the clinical areas for 6–12 months. Moist swab samples for MRSA, VRE, and CP-CRE cultures were obtained from the leading edges of the curtains during the evaluation period. Also, 10-cm × 10-cm swatches were cut from the high-touch areas of curtains and were tested for total aerobic count on the first of the month and quarterly thereafter. Results: All bacterial culture swabs obtained from the E1 and E2 cohorts of curtains were negative. The total bacterial plate count results from E1 curtains were negative for up to 1 year. However, the total bacterial plate count results for E2 curtains were positive in the sixth month. Using disposable curtains yielded an annual cost saving of ~50%. Conclusions: The use of appropriate impregnated antimicrobial disposable curtains can improve patient safety in the clinical areas. These curtains may eliminate potential sources of infection and thereby decrease the rate of nosocomial infection. They also save significant institutional costs by reducing frequent laundry and manpower requirements needed for the installation of curtains.

Objectives: Following a cluster of COVID-19 cases in a Singapore public hospital in April 2021, the local health authority mandated the use of N95 respirators in all inpatient wards. This increased the demand for N95 mask fit-testing to ensure that healthcare workers were donning respirators that fit their facial characteristics and hence provided protection through a good facial seal. The demand for fit-testing during the pandemic highlighted the scarcity of manpower and ergonomics concern, such as carpel tunnel syndrome experienced in long hours of qualitative fit-testing sessions. We evaluated the operational efficiency, cost-effectiveness, and difference in passing rate after the introduction of the quantitative method. Methods: Conventional qualitative fit-testing was conducted using manual pumping of a challenge agent, enabling the user to determine the fit of the respirator. The quantitative fit-testing protocol used a condensation particle counter (CPC) to measure the concentration of particles inside the mask and the atmosphere to determine the fit of respirator. The Occupational Safety and Health Administration (OSHA)–approved minimum fit factor of 100 was used as the criterion for a successful N95 respirator fit. Tubes used during quantitative fit-testing were reprocessed using thermal disinfection. Results: Quantitative mask fit-testing provided an objective numerical measure to assess adequate fit of N95 respirator, which provided users with confidence in the respirator fit. It addressed a manpower limitation issue because it did not require qualified trainers to conduct the test, and automation also prevented any potential occupational hazard from repeated actions required in qualitative fit-testing. An increase in the passing rate for N95 fit-testing from 94.5% to 95.5% was observed. However, the high cost of equipment, annual recalibration, and consumables must be considered. Conclusions: Quantitative N95 fit-testing, when adopted with careful consideration of its cost, is an approach to consider for hospital-wide fit-testing.

Objectives: Patients undergoing hemodialysis using a catheter are at significant risk of developing central venous catheter–related bloodstream infections (CRBSIs), especially with methicillin-resistant Staphylococcus aureus (MRSA), resulting in increased morbidity, mortality, and cost. In our 1,000-bed regional hospital, the average CRBSI (any bacteria) rate in patients dialyzing via dialysis catheters was 1.44 per 1,000 catheter days, and the average CRBSI (MRSA) rate was 0.56 per 1,000 catheter days. A quality improvement project was initiated to reduce the overall dialysis CRBSI and CRBSI-MRSA by 50%. Methods: Following the formation of a multidisciplinary team, the catheter-insertion protocols and catheter-care protocols were standardized throughout the hospital. We adopted a well-established scientific quality improvement method, plan–do–study–act (PDSA) cycle model for all interventions that were implemented. The patients and general ward nursing staff were provided education and training in dialysis catheter care. Results: The project was initiated in January 2016, and the initial improvement was seen from July 2017 onward. Analysis of the data since 2016 showed a steady improvement in the overall CRBSI rates, as well as CRBSI-MRSA rates. The average CRBSI rate improved to 0.76 per 1,000 catheter days, and the average CRBSI-MRSA rates improved to 0.15 per 100 catheter days in the calendar year 2021. Conclusions: Because the causes of these infections are multifactorial, emphasis should be placed on improving care processes from the patient preparation phase prior to catheter insertion to regular catheter care in the inpatient wards and dialysis units. We attribute the success of our project to involving all stakeholders and obtaining constant feedback from the staff. We successfully applied PDSA cycles to make relevant incremental changes.

Objectives: In the context of the COVID-19 pandemic over the past 2 years, training regarding infection and prevention control (IPC) has become essential in responding promptly to the pandemic. Many healthcare workers from Cho Ray Hospital and provincial hospitals need IPC training; however, human resources and facilities for continuous education and training are lacking. Therefore, IPC e-learning has become necessary for medical staff, and we designed IPC e-learning courses to meet healthcare workers’ needs for efficient, time and cost-saving training to ensure safety during the COVID-19 pandemic. Methods: All medical staff of Cho Ray Hospital were invited to participate in the infection control e-learning study. The software was developed based on the existing lectures from practical infection control protocols. Healthcare workers were asked to study the software and take a test on the their training. Results: We built the e-learning course of IPC for 5,000 participants as well as management software to manage lessons, member data, and test results. After implementation for 2 months in the hospital, 207 participants had taken the exam 2,234 times. Overall, 70.5% of participants were nurses and 14.9% were doctors. Moreover, 66.4% of participants passed the test the first time they took it, and 33.6% took the test a second time. After the second test, the percentage of members who passed the exam was 100%. Conclusions: Building and applying e-learning software for IPC training has brought about efficiency and quality of training, has reduced the use of human resources for training, and has decreased costs. The software application is being expanded to all hospitals in Vietnam.