Search Results (27)

Background: Clostridioides difficile infection (CDI) is a major cause of healthcare-associated infections globally. Understanding variations in CDI incidence and outcomes across settings, populations, and regions is important for guiding prevention strategies. Aim: The aim of this study was to determine the global epidemiology of CDI to better understand disease burden across settings and geographic regions. Methods: Relevant publications were identified through searches of major databases, including PubMed, Scopus, and Web of Science, published from 1 January 2016 through 24 July 2024. Random effects models were used to pool estimates, and 95% confidence intervals (CIs) were calculated. Results: A total of 59 studies, representing 24 countries across North America, Europe, the Asia–Pacific region, Latin America, and the Middle East, met the inclusion criteria. The incidence of CDI was highest in hospital-onset healthcare facility settings, with 5.31 cases/1000 admissions (95% CI 3.76–7.12) and 5.00 cases/10,000 patient-days (95% CI 3.96–6.15). Long-term care facilities reported 44.24 cases/10,000 patient-days (95% CI 39.57–49.17). Pediatric populations faced a greater risk, with 4.52 cases/1000 admissions (95% CI 0.55–12.17), than adults did at 2.13 (95% CI 1.69–2.61). Recurrence rates were highest for community-acquired CDI at 16.22%. The death rates for the CDI cases tracked for 30 days and of unspecified duration were 8.32% and 16.05%, respectively. Conclusions: This comprehensive review identified healthcare facilities, long-term care, pediatric populations, and North America as disproportionately burdened. This finding provides guidance on priority areas and populations for targeted prevention through antimicrobial stewardship, infection control, and surveillance. Full article

Background/Objectives: The COVID-19 pandemic disrupted healthcare systems globally, altering the management of chronic conditions like multiple sclerosis (MS) and interrupting the regular monitoring and support that people with MS (pwMS) typically need. The aim of this study was to examine changes in the utilization of MS healthcare resources over various periods during the COVID-19 pandemic in 2020 and 2021, and to assess how these changes affected the perceptions of pwMSregarding their care. Methods: A longitudinal survey study was conducted at the MS Center at the University Hospital Dresden, Germany, involving four survey periods from April 2020 to December 2021. The study assessed the use of healthcare resources, including consultations with specialists, the use of rehabilitative therapy facilities, and unmet healthcare needs, across various phases of the pandemic, encompassing both lockdown and less restrictive periods. Results: At the onset of the pandemic in April 2020, during the first lockdown, 750 questionnaires were evaluated. While most pwMS reported consistent medical care compared with pre-pandemic levels, 19.2% had fewer general practitioner visits, and 10.6% fewer neurologist visits. During the follow-up survey periods, the use of medical care generally remained stable, although there were notable reductions reported by a subset of participants. Conclusions: The findings suggest that medical and therapeutic care for pwMS in Germany remained largely accessible during the COVID-19 pandemic in 2020 and 2021. However, the study also reveals certain gaps in care that may be addressed by incorporating digital technologies into medical care and rehabilitation, potentially enhancing the management of healthcare during future pandemics or similar situations. Full article

The World Health Organization recommends Tranexamic acid (TXA) in the treatment of postpartum haemorrhage (PPH) as part of the PPH care bundle. We conducted integrative review of 36 studies from three databases namely PubMed, Google Scholar, and Dimensions. The integrative review followed PRISMA guidelines and evaluated clinical efficacy of TXA, prophylactic use, cost-effectiveness, alternative administration routes, and real-world implementation challenges and facilitators. The review found that early administration of TXA within three hours of PPH onset significantly reduces maternal mortality by 31%. Despite concerns about thrombosis, pooled data from large-scale cohorts demonstrate minimal thromboembolic risk which reinforces the safety profile of TXA. However, the WOMAN-2 trial revealed no significant benefit in women with moderate-to-severe anaemia which highlights the necessity for patient-specific TXA protocols. Economic evaluations reveal that integrating TXA into national guidelines requires a modest budget increase (approximately 2.3%) but promises substantial cost savings through reduced surgeries and hospital stays. While intravenous TXA remains recommended route by WHO, emerging evidence supports intramuscular and topical administration which is crucial in rural or primary-care settings lacking intravenous facilities. Yet, questions about bioavailability and rapid haemostatic efficacy persist, awaiting outcomes from ongoing trials such as I’M WOMAN, which is currently recruiting women aged 18 years from five countries with results anticipated by late 2025. Significant barriers to widespread adoption of TXA include limited healthcare provider training, lack of budgetary allocation by government and cultural misconceptions associating TXA with “dangerous clotting” in some settings. Successful initiatives, like China’s Strategies and Tools to Enhance Parturient Safety (STEPS) programme, illustrate how enhanced perinatal care bundles, interdisciplinary team training, and continuous monitoring using statistical process control (SPC) tools can overcome these obstacles. To accelerate progress towards reducing preventable maternal deaths globally, future research must address variable effectiveness when TXA is used as prophylaxis, clarify subpopulations most likely to benefit, and rigorously assess alternative routes of TXA administration. Full article

Early-onset sepsis (EOS) remains a major cause of neonatal morbidity and mortality worldwide, with significant differences in the incidence and outcome of the disease in Europe. Eastern European countries face particular challenges due to differences in access to healthcare, diagnostic facilities, and prevention strategies. This review summarizes the results of recent research to provide insights into maternal risk factors, regional inequalities in access to healthcare, diagnostic biomarkers, pathogen patterns, and treatment protocols for EOS. This review also examines how healthcare infrastructure and socioeconomic factors influence EOS outcomes in Eastern Europe. Introduction: Early-onset sepsis (EOS) presents a significant health challenge for newborns, characterized by sepsis occurring within the first 72 h of life, primarily caused by the vertical transmission of pathogens from mother to child. Despite advancements in medical care, EOS remains particularly burdensome in resource-poor settings, especially in Eastern Europe, where disparities in healthcare access and maternal health are pronounced. This systematic review aims to provide insights into maternal risk factors, regional inequalities in healthcare access, diagnostic biomarkers, pathogen patterns, and treatment protocols for EOS. Background/Objectives: EOS is increasingly recognized as a public health issue, with outcomes significantly influenced by maternal health, socioeconomic status, and healthcare infrastructure. The review seeks to summarize the existing literature on EOS, particularly focusing on differences between high-income Western and low-resource Eastern European countries. The influence of maternal access to antenatal care, pathogen prevalence, and antibiotic resistance on EOS outcomes across regions will also be examined. Methods: To achieve the review’s objectives, a comprehensive search was conducted across multiple databases including PubMed, Google Scholar, ScienceDirect, and Scopus, adhering to PRISMA guidelines for systematic reviews. The inclusion criteria encompassed studies published within the last 20 years (January 2004–August 2024) that addressed EOS in late preterm or term infants, emphasizing maternal health, risk factors, diagnostic approaches, and treatment protocols pertinent to European populations. Exclusion criteria included non-English publications and studies lacking a focus on maternal and neonatal health. A total of 29 peer-reviewed articles meeting the specified criteria were ultimately included in the analysis. Results: The findings highlight significant regional disparities in EOS management between Western and Eastern Europe. Key issues include maternal risk factors, socioeconomic barriers to healthcare, diagnostic biomarkers, and pathogen resistance trends. Limited access to prenatal screenings and healthcare infrastructure in Eastern European countries, especially in rural regions in Romania, exacerbate the challenges faced by expectant mothers. Financial burdens, such as high out-of-pocket expenses, were shown to further restrict access to necessary maternal care. Conclusions: This systematic review emphasizes the urgent need for targeted investments in maternal healthcare infrastructure in Eastern Europe to mitigate the impacts of EOS. Enhanced screening programs, standardized surveillance systems, and ensuring equitable health policies are essential to improving neonatal outcomes. Additionally, tailored education and awareness campaigns for disadvantaged groups and comprehensive health policy reforms, including universal antenatal care and Group B Streptococcus (GBS), are essential to bridging healthcare gaps. Full article

Background/Objectives: The COVID-19 pandemic affected antimicrobial stewardship in healthcare, including Skilled Nursing Facilities (SNFs). This study aimed to (1) assess the appropriateness of antibiotic prescriptions for urinary tract infections (UTIs) and respiratory tract infections (RTIs) and identify predictors of inappropriate use; (2) analyze changes in prescribing practices relative to the pandemic’s onset. Methods: A retrospective review of electronic medical records from a 300-bed SNF (March 2019–March 2021) identified suspected UTIs and RTIs based on laboratory tests and antibiotic requests. Antibiotic prescription appropriateness was defined by clinical and microbiological alignment with the McGeer criteria, which are standardized infection definitions for long-term care residents, for UTI and RTI. Logistic regression models identified predictors of inappropriate prescribing, and an interrupted time-series analysis (ITS) examined trends relative to the pandemic onset (11 March 2020) in Arizona. Results: Among 370 antibiotic prescriptions, 77% of UTI and 61% of RTI prescriptions were inappropriate per the McGeer criteria. Acute dysuria and increased urgency were associated with lower odds of inappropriate UTI prescribing. For RTIs, a positive COVID-19 test increased the odds of inappropriate prescribing, while fever and acute functional decline lowered them. UTI prescriptions and inappropriateness overall increased during the pandemic, but no significant ITS trends emerged. For RTIs, no significant changes in prescribing or inappropriateness relative to the pandemic were observed. Findings emphasize the need for robust antimicrobial stewardship during and after public health emergencies. Full article

Healthcare settings, especially intensive care units, can provide an ideal environment for the transmission of pathogens and the onset of outbreaks. Many factors can contribute to the onset of an epidemic in a neonatal intensive care unit (NICU), including neonates’ vulnerability to healthcare-associated infections, especially for those born preterm; facility design; frequent invasive procedures; and frequent contact with healthcare personnel. Outbreaks in NICUs are one of the most relevant problems because they are often caused by multidrug-resistant organisms associated with increased mortality and morbidity. The prompt identification of an outbreak, the subsequent investigation to identify the source of infection, the risk factors, the reinforcement of routine infection control measures, and the implementation of additional control measures are essential elements to contain an epidemic. Full article

Delirium, a multifactorial condition with an acute onset and diverse clinical manifestations, poses a significant challenge in the care of hospitalized individuals aged 65 years and older. This study aimed to evaluate the level of knowledge among nursing healthcare personnel regarding the diagnosis, recognition of complications, and treatment of delirium. A paper questionnaire consisting of 18 multiple-choice questions was distributed to nurses in twelve operational units located in four facilities within a local hospital in a specific geographical region under the jurisdiction of the Romagna Local Health Authority in Italy. Out of 194 respondents, the overall acceptance rate was 64.2%. The findings revealed an insufficient understanding of delirium among the nursing staff, with more than 40% of respondents answering incorrectly to five out of nine questions related to delirium knowledge, diagnosis, prevention, and treatment. Notably, gender emerged as a significant determinant, with female participants exhibiting a substantial odds ratio (OR) of 3.50 (p = 0.011 and CI95% = 1.34–9.16) compared to their male counterparts, indicating a higher likelihood of receiving delirium training among females. Furthermore, prolonged tenure within the same work context was associated with a reduced likelihood of receiving delirium training compared to those with less than two years of experience (OR = 0.21, p = 0.034, and CI95% = 0.05–0.89 for 6–10 years of tenure; OR = 0.22, p = 0.038, and CI95% = 0.05–0.92 for over 10 years of tenure). This study underscores the urgent need for enhanced delirium education and improved strategies among nurses to effectively manage patients with delirium. The results advocate regular educational sessions utilizing diverse formats to comprehensively address knowledge gaps among nursing staff. This study was not registered. Full article

Microbial contamination in the hospital environment is a major concern for public health, since it significantly contributes to the onset of healthcare-associated infections (HAIs), which are further complicated by the alarming level of antimicrobial resistance (AMR) of HAI-associated pathogens. Chemical disinfection to control bioburden has a temporary effect and can favor the selection of resistant pathogens, as observed during the COVID-19 pandemic. Instead, probiotic-based sanitation (probiotic cleaning hygiene system, PCHS) was reported to stably abate pathogens, AMR, and HAIs. PCHS action is not rapid nor specific, being based on competitive exclusion, but the addition of lytic bacteriophages that quickly and specifically kill selected bacteria was shown to improve PCHS effectiveness. This study aimed to investigate the effect of such combined probiotic–phage sanitation (PCHSφ) in two Italian hospitals, targeting staphylococcal contamination. The results showed that PCHSφ could provide a significantly higher removal of staphylococci, including resistant strains, compared with disinfectants (−76%, p < 0.05) and PCHS alone (−50%, p < 0.05). Extraordinary sporadic chlorine disinfection appeared compatible with PCHSφ, while frequent routine chlorine usage inactivated the probiotic/phage components, preventing PCHSφ action. The collected data highlight the potential of a biological sanitation for better control of the infectious risk in healthcare facilities, without worsening pollution and AMR concerns. Full article

The onset of the COVID-19 pandemic posed many global challenges, mainly in the healthcare sector; however, the impacts on other vital sectors cannot be overlooked. The waste sector was one of the significantly impacted sectors during the pandemic, as it dramatically changed the dynamics of waste generation. Inadequate waste management practices during COVID-19 shed light on the opportunities for developing systematic, sustainable, and resilient waste infrastructure in the future. This study aimed to exploit the learnings of COVID-19 to identify any potential opportunities in post-pandemic waste infrastructure. A comprehensive review on existing case studies was conducted to understand the waste generation dynamics and the waste management strategies during COVID-19. Infectious medical waste from healthcare facilities had the largest influx of waste compared with non-medical waste from residential and other sectors. This study then identified five key opportunities from a long-term operational perspective: considering healthcare waste sector as a critical area of focus; encouraging the integration and decentralization of waste management facilities; developing systematic and novel approaches and tools for quantifying waste; shifting towards a circular economy approach; and modernizing policies to improve the effectiveness of the post-pandemic waste management infrastructure. Full article

The COVID-19 pandemic has caused widespread disruptions to health, economic and social lives globally. This qualitative study explores frontline healthcare workers’ (HCWs) experiences delivering routine care in Kenya’s informal settlements during the early phases of the pandemic, amidst stringent COVID-19 mitigation measures. Thirteen telephone interviews were conducted with facility and community-based HCWs serving three informal settlements in Nairobi and Mombasa. Data were analyzed using the framework approach. Results indicate there were widespread fears and anxieties surrounding COVID-19 and its management. Secondly, access to facility-based care at the onset of the pandemic was reported to decline, with service availability hampered by the imposed curfew hours and guidance on the maximum allowable number of clients. HCWs experienced heightened risk of COVID-19 infection due to poor working conditions including inadequate personal protective equipment (PPE) and unavailable isolation areas for COVID-19 positive patients. HCWs also experienced stigma associated with contact with persons suspected of having COVID-19 infection, thereby causing a strain on their mental health and wellbeing. The study recommends the need for interventions to support and protect HCWs’ physical and mental health, alongside health system preparedness. Additionally, it is vital to identify ways of taking health services closer to the community to address access barriers in health emergency contexts. Full article

The acute respiratory infectious disease season, or colloquially the “flu season”, is defined as the annually recurring period characterized by the prevalence of an outbreak of acute respiratory infectious diseases. It has been widely agreed that this season spans the winter period globally, but the precise timing or intensity of the season onset in South Africa is not well defined. This limits the efficacy of the public health sector to vaccinate for influenza timeously and for health facilities to synchronize efficiently for an increase in cases. This study explores the statistical intensity thresholds in defining this season to determine the start and finish date of the acute respiratory infectious disease season in South Africa. Two sets of data were utilized: public-sector hospitalization data that included laboratory-tested RSV and influenza cases and private-sector medical insurance claims under ICD 10 codes J111, J118, J110, and J00. Using the intensity threshold methodology proposed by the US CDC in 2017, various thresholds were tested for alignment with the nineteen-week flu season as proposed by the South African NICD. This resulted in varying thresholds for each province. The respiratory disease season commences in May and ends in September. These findings were seen in hospitalization cases and medical insurance claim cases, particularly with influenza-positive cases in Baragwanath hospital for the year 2019. These statistically determined intensity thresholds and timing of the acute respiratory infectious disease season allow for improved surveillance and preparedness among the public and private healthcare. Full article

Background: Nurses face the risk of new onset occupational asthma (OA) due to exposures to cleaning and disinfection (C&D) agents used to prevent infections in healthcare facilities. The objective of this study was to measure nurses’ preferences when presented with simultaneous OA and respiratory viral infection (e.g., COVID-19) risks related to increased/decreased C&D activities. Methods: Nurses working in healthcare for ≥1 year and without physician-diagnosed asthma were recruited for an online anonymous survey, including four risk–risk tradeoff scenarios between OA and respiratory infection with subsequent recovery (Infect and Recovery) or subsequent death (Infect and Death). Nurses were presented with baseline risks at hypothetical “Hospital 1”, and were asked to choose Hospital 2 (increased OA risk to maintain infection risk), Hospital 3 (increased infection risk to maintain OA risk), or indicate that they were equally happy. Results: Over 70% of nurses were willing to increase infection risk to maintain baseline OA risk if they were confident they would recover from the infection. However, even when the risk of infection leading to death was much lower than OA, most nurses were not willing to accept a larger (but still small) risk of death to avoid doubling their OA risk. Age, work experience, and ever having contracted or knowing anyone who has contracted a respiratory viral infection at work influenced choices. Conclusions: We demonstrate the novel application of a risk–risk tradeoff framework to address an occupational health issue. However, more data are needed to test the generalizability of the risk preferences found in this specific risk–risk tradeoff context. Full article

Background: The COVID-19 pandemic has imposed great pressure on healthcare facilities, exposing healthcare professionals to various challenges that may result in the onset of moral distress, a condition of psychological distress caused by the inability to act as it would be most morally appropriate. The purpose of this research was to investigate the experience lived by nurses who worked in an intensive care unit during the COVID-19 pandemic. Methods: This is a phenomenological study using interpretative phenomenological analysis. Sixteen nurses who worked in the COVID-19 Intensive Care Unit of Northern Italian Hospitals from January to April 2022 were selected through purposive sampling. Data on experiences, thoughts, and symptoms were collected through semi-structured interviews with in-person and remote modalities. Results: Five themes and fourteen subthemes emerged from the study. The themes are: (1) pride, isolation, and fear; (2) teamwork and organisation; (3) moral/ethical aspect; (4) true heroes; and (5) dignity. Conclusions: This study highlights the impact of the COVID-19 pandemic on intensive care unit nurses. It has emerged that the risk of moral distress is high among healthcare workers in the front line of the fight against the virus. This condition should be avoided and managed through early psychological interventions, sharing of experiences, and a good organization that supports decision-making and professional well-being. Full article

The early prediction of onset labour is critical for avoiding the risk of death due to pregnancy delay. Low-income countries often struggle to deliver timely service to pregnant women due to a lack of infrastructure and healthcare facilities, resulting in pregnancy complications and, eventually, death. In this regard, several artificial-intelligence-based methods have been proposed based on the detection of contractions using electrohysterogram (EHG) signals. However, the forecasting of pregnancy contractions based on real-time EHG signals is a challenging task. This study proposes a novel model based on neural basis expansion analysis for interpretable time series (N-BEATS) which predicts labour based on EHG forecasting and contraction classification over a given time horizon. The publicly available TPEHG database of Physiobank was exploited in order to train and test the model, where signals from full-term pregnant women and signals recorded after 26 weeks of gestation were collected. For these signals, the 30 most commonly used classification parameters in the literature were calculated, and principal component analysis (PCA) was utilized to select the 15 most representative parameters (all the domains combined). The results show that neural basis expansion analysis for interpretable time series (N-BEATS) forecasting can forecast EHG signals through training after few iterations. Similarly, the forecasting signal’s duration is determined by the length of the recordings. We then deployed XG-Boost, which achieved the classification accuracy of 99 percent, outperforming the state-of-the-art approaches using a number of classification features greater than or equal to 15. Full article

Background: South Asian workers have a greater predisposition to non-communicable diseases (NCDs) that is exacerbated by migration and length of residence in host countries. Aims: To examine the association between length of residence in Qatar with diagnosis of NCDs in male blue-collar workers. Methods: A retrospective investigation of the electronic health records (EHRs) of 119,581 clinical visits by 58,342 patients was conducted. Data included age, nationality and confirmed ICD-10 diagnosis. Based on duration of residence, the population was divided into groups: ≤6 months, 6–12 months, 1–≤2 years, 2–≤5 years, 5–≤6 years, >6 years. It was assumed that the group that had been resident in Qatar for ≤6 months represented diseases that had been acquired in their countries of origin. Results: South Asian (90%) patients presented with NCDs at a younger (mean ± SD age of 34.8 ± 9.0 years) age. Diabetes and hypertension were higher in those who had just arrived (<6 months’ group), compared to the other durations of residence groups. Conversely, acute respiratory infections, as well as dermatitis and eczema, all increased, perhaps a consequence of shared living/working facilities. Only patients with diabetes and hypertension visited the clinic multiple times, and the cost of medication for these NCDs was affordable, relative to earnings. Discussion/Conclusions: Blue-collar workers were predominantly South Asian, from lower socioeconomic classes, with early onset chronic NCDs. Notably, residence in Qatar gave them better access to affordable, significantly subsidized healthcare, leading to effective management of these chronic conditions. Full article