Antimicrobial Resistance & Infection Control

BackgroundPeripheral intravenous catheters (PIVCs) are the most widely used invasive devices worldwide. Up to 42% of PIVCs are prematurely removed during intravenous therapy due to failure. To date, there have been few systematic attempts in European hospitals to measure adherence to recommendations to mitigate PIVC failures. AimTo analyse the clinical outcomes from clinical practice guideline recommendations for PIVC care on different hospital types and environments. MethodsWe conducted an observational study in three hospitals in Spain from December 2017 to April 2018. The adherence to recommendations was monitored via visual inspection in situ evaluations of all PIVCs inserted in adults admitted. Context and clinical characteristics were collected by an evaluation tool, analysing data descriptively. Results646 PIVCs inserted in 624 patients were monitored, which only 52.7% knew about their PIVC. Regarding PIVC insertion, 3.4% (22/646) patients had at least 2 PIVCs simultaneously. The majority of PIVCs were 20G (319/646; 49.4%) and were secured with transparent polyurethane dressing (605/646; 93.7%). Most PIVCs (357/646; 55.3%) had a free insertion site during the visual inspection at first sight. We identified 342/646 (53%) transparent dressings in optimal conditions (clean, dry, and intact dressing). PIVC dressings in medical wards were much more likely to be in intact conditions than those in surgical wards (234/399, 58.7% vs. 108/247, 43.7%). We identified 55/646 (8.5%) PIVCs without infusion in the last 24 hours and 58/646 (9.0%) PIVCs without infusion for more than 24 hours. Regarding PIVC failure, 74 (11.5%) adverse events were identified, all of them reflecting clinical manifestation of phlebitis. ConclusionsOur findings indicate that the clinical outcome indicators from CPG for PIVC care were moderate, highlighting differences between hospital environments and types. Also, we observed that nearly 50% of patients did not know what a PIVC is.

IntroductionHealthcare-associated infections (HAIs) and antimicrobial resistance (AMR) are critical global challenges. Antimicrobial Stewardship Programs (ASPs) aim to optimize antibiotic use and reduce resistance. This study evaluates carbapenem stewardship compliance in open-heart surgery patients at Shaheed Rajaie Cardiovascular Medical and Research Center, Tehran, emphasizing improved infection control and antibiotic management. MethodologyThis descriptive, cross-sectional study assessed carbapenem antibiotic use compliance with national guidelines in open-heart surgery patients at Shaheed Rajaie Cardiovascular Medical Center, Tehran. Seventy patients were selected, and data on demographics, clinical factors, microbiology, and antibiotic use were analyzed using SPSS 26 to evaluate compliance rates and prescribing factors. ResultsThis study analyzed data from 70 patients undergoing open-heart surgery at a cardiovascular hospital in Tehran. The cohort had an equal gender distribution and a mean age of 59.15 years (SD: 12.0). Of the procedures, 51.43% were elective, while 48.57% were emergencies. The most common surgeries included CABG (45.71%) and valvular procedures (30%). Meropenem was the most prescribed antibiotic (92.9%), with prophylactic use noted in 78.57% intraoperatively. Positive cultures identified Candida albicans (32.7%), Klebsiella pneumoniae (29.8%), and Staphylococcus aureus (22.6%) as predominant pathogens. Serum creatinine levels exceeded the normal range in 55.7% of patients, necessitating dosage adjustments. Antibiotic side effects led to treatment discontinuation in 15.7% of cases. ConclusionThis study highlights a high level of rational carbapenem use in a specialized cardiac surgery ICU, with prescribing guided by infectious disease consultations and adherence to guidelines. Implementing antibiotic stewardship programs can further optimize carbapenem use, reduce antibiotic resistance, and improve treatment outcomes, emphasizing the importance of individualized infection management and monitoring in cardiac surgery patients.

BackgroundUrinary tract infections are among the adverse outcomes of urinary catheter placement. After the installation of a catheter, urinary tract infections happen more often than twice a day. Examining prevention strategies for UTIs in critical care units is the aim of this writing audit. MethodUse ProQuest, Scopus, and ScienceDirect to look up review literature. Urinary tract infections, prevention and management, and intensive care unit were the search terms used to find publications. Search parameters for full-text, open-access, English-language papers published between 2019 and 2023. ResultsThe studys findings indicate that adherence to patient information recording, installation and maintenance procedures, guidelines for the detection and prevention of CAUTI, staff education and good nursing practices, and the application of CAUTI prevention can all help lower the incidence of urinary tract infections. ConclusionHealthcare facilities need to have a program in place to avoid urinary tract infections brought on by catheter installation, as well as the best care possible for patients who use them. In order to solve the problem, all interdisciplinary teams must collaborate and analyze the issue using the PDSA methodology.

Background and objectiveVentilator-associated pneumonia (VAP), a leading cause of ICU mortality, remains prevalent in Southeast Asia, with limited data on critical care nurses knowledge and prevention practices in Malaysia. The purpose of this study was to assess knowledge, practices, barriers, and predictors of VAP prevention among critical care nurses in Sarawak, Malaysia. MethodsThis cross-sectional study was conducted from July to August 2023 at four public hospitals in Sarawak, Malaysia. Universal sampling was used to recruit nurses from various critical care units managing patients requiring ventilator support. A self-administered questionnaire, consisting of four sections, was employed to gather background information from nurses, assess their knowledge, perceived practices, and identify barriers related to VAP prevention. ResultsA total of 298 critical care nurses participated in the study. Of these, 66.8% demonstrated poor knowledge of ventilator-associated pneumonia (VAP) prevention; however, compliance with VAP prevention practices was significantly high at 76.5%. A Pearsons correlation test revealed a significant association between the nurses knowledge and their practices related to VAP prevention (p<0.001). Additionally, multiple regression analyses identified several significant predictors of critical care nurses perceived practices in VAP prevention, including their level of knowledge, type of unit, number of official beds, and sociodemographic factors (p <0.05). While knowledge positively influenced perceived practice, its impact was relatively minor compared to sociodemographic factors. Barriers to VAP prevention included nursing staff shortages, forgetfulness, and lack of written protocols. ConclusionsThe prevention of ventilator-associated pneumonia (VAP) is a multidisciplinary challenge, emphasizing the crucial role of critical care nurses. The findings from this study underscore the necessity for updated, evidence-based interventions that target knowledge gaps, perceived practices, and barriers to effective VAP prevention.

BackgroundPreoperative overnight fasting of patients (no oral intake from midnight until the time of surgery) is a potentially harmful practice; nevertheless, it remains common. Prolonged preoperative fasting is frequent, at times up to 24 hours of fluid and nutrition deprivation. International guidelines recommend reduced fasting time to improve patient outcomes, but this evidence is not well implemented. This study investigated clinician perspectives on two interventions designed to reduce preoperative fasting. MethodsThe qualitative study was informed by the Consolidated Framework for Implementation Research (CFIR). Semi-structured interviews were conducted virtually or in person, with a purposive sample of perioperative health professionals. Thematic analysis revealed codes, some of which were specific to the two reduced fasting interventions (SipTilSend and oral carbohydrate loading), organised according to the CFIR constructs. Results and ConclusionsTwenty-one multidisciplinary clinicians were interviewed. Within the CFIR domains, adaptability enabled the tailoring of interventions to clinical contexts, while governance and policy updates supported adoption (Innovation). Progressive anaesthesia team leaders and leadership engagement drove change (Individuals). However, outdated policies and disincentives hindered progress (Outer Setting). Barriers included a lack of knowledge, while knowledge dissemination and clinician commitment to patient safety facilitated uptake (Inner setting). Champions among anaesthesia leaders and perioperative interdisciplinary collaboration played key roles in implementation success (Process). University of Newcastle Human Research and Ethics Committee Approval No: H-2021-0328

BackgroundHealthcare-associated infections (HAIs) are a major problem in healthcare facilities. In Cameroon, maternal and neonatal mortality remain a concern. The underlying determinants include shortcomings in the quality of care, inadequate infrastructure and inconsistent application of infection control and prevention (ICP) measures. The objective of this study was to identify risks that increase the likelihood of HAIs in the obstetrics-gynecology unit of a referral hospital of Yaounde. MethodsA descriptive cross-sectional study was conducted in the obstetrics-gynecology department of referral hospital of Yaounde from April to July 2024. Exposure data were collected using a self-administered questionnaire with a scoring grid to assess the level of implementation of the ICP framework. Samples were collected from the ward environment for identification of the bacterial flora of the care environment and antibiotic susceptibility testing. ResultsA total of 41 healthcare workers were enrolled in the study. Participants were predominantly female (78%) and aged 20 to 57 (median of 30) years. Hand hygiene knowledge of was average, with a median score of 60%. More than two-thirds of respondents (n=30; 73%) reported that they did not systematically practice hand hygiene before and after patient care. The most common reason for not practicing hand hygiene was the absence of a hand-washing site nearby healthcare post (57%). Face shields were the most reported unavailable equipment (81%). The overall score indicated that the obstetrics-gynecology department had a basic level of implementation of ICP interventions. Microbial analysis revealed that taps and trolleys were the most commonly soiled equipment, harboring bacterial flora of Staphylococcus aureus (36%) and other Staphylococcus spp. (24%). Proteus mirabilis (13%) and Klebsiella spp. (7%). The isolated bacterial strains showed varying degrees of resistance to antibiotics, including cephalosporin, methicillin and penicillin. ConclusionsSuboptimal IPC implementation was observed in this obstetrics-gynecology setting. Comprehensive interventions are needed, including: strengthened IPC adherence, national antibiotic regulation, healthcare worker education, and establishment of antimicrobial resistance surveillance programs.

The "Does longer peripheral intravenous catheter (PIVC) Length optimise Antimicrobial Delivery: a randomised controlled trial to reduce interruptions to intravenous antimicrobial delivery (The LEADER Study)", is a randomised controlled trial (RCT). This RCT aims to assess if long peripheral intravenous catheters (PIVCs) (4.5-6.4 cm) when compared with short-PIVCs (<4 cm) optimise antimicrobial delivery by reducing PIVC failure rates. The purpose for this document is to minimise bias and ensure transparency and internal validity for the findings of the trial, by defining and making publicly available the analysis approach prior to reviewing or analysing trial data. The statistical analysis plan (SAP) will inform analysis and reporting of the main effectiveness findings of the trial. It provides a detailed description of the primary and secondary trial outcomes and the methods for statistical comparison.

BackgroundThe paucity of data on the epidemiology of bloodstream infection (BSI) in low and middle-income countries (LMICs) limits its effective prevention and management. This review sought to determine the prevalence, bacteriological and antimicrobial resistance profiles of bacteria implicated in BSI in Cameroon. MethodsPubMed and Google Scholar databases were searched to identify relevant articles, which were screened according to the PRISMA guidelines. The data were analysed using comprehensive meta-analysis software. The I2 was used to evaluate heterogeneity between studies, Beggs and Eggers regression tests were used to evaluate publication bias, and random effects analysis was used to calculate the pooled prevalence. ResultsA total of 4223 blood cultures were obtained from the 10 included studies. The overall pooled prevalence of bacterial BSI was 26.31% (95% CI= 17.01%-38.35%). Escherichia coli (23.09%; 95% CI= 9.21%-47.05%), Klebsiella spp. (22.95%; 95% CI= 13.09%-37.07%), and Staphylococcus aureus (16.09%; 95% CI= 8.11%-29.43%) were the most common bacteria species. E. coli and Klebsiella spp. displayed the highest resistance to amoxicillin (82.65%; 95% CI= 63.25%-92.95% vs 86.42%; 95% CI= 55.90%-96.97%), amoxicillin + clavulanic acid (71.74%; 43.96-89.15% vs 73.06%; 95% CI= 38.70%-92.09%) and cotrimoxazole (76.22%; 95% CI= 51.33%-90.79% vs 65.81%; 95% CI= 45.08-81.86%). However, meropenem (26.73%; 95% CI= 20.76%-33.68%) and fosfomycin (14.85%; 95% CI= 9.07%-23.37%) were the least resistant in E. coli and Klebsiella spp., respectively. Staphylococcus aureus strains exhibited highest resistance to penicillin (84.37%; 95% CI= 68.13%-93.16%), erythromycin (44.80%; 95% CI= 33.37%-56.79%) and oxacillin (37.35%; 95% CI= 8.76%-78.74%) and lowest resistance to rifampicin (2.94%; 95% CI= 0.59%-13.39%), fusidic acid (6.73%; 95% CI= 2.55%-16.62%) and vancomycin (13.18%; 95% CI= 2.26%-49.86%). ConclusionThis study reports a high prevalence of bacterial BSIs in Cameroon and the high resistance of these bacteria to common antibiotics. There is a pressing need to conduct BSI surveillance studies in all regions of Cameroon to generate data for evidence-based measures regarding BSI prevention and management. Prospero registration numberCRD42023482760

ObjectiveThe aim of this review is to highlight the efficacy of nurse-performed ultrasound guidance compared with the conventional cannulation technique in patients with difficult peripheral intravenous access. DesignA systematic litterature review. Data sourcesThe CINAHL and PubMed databases were searched for articles from the period 2011-2021. MethodThe following search words were used: peripheral intravenous AND ultrasonography OR ultrasound guided AND catheterization, peripheral/methods. The keyword catheterization, peripheral/methods was found via MeSH Terms (Medical Subject Headings) which PubMed recommended as keyword within the intervention of the conventional cannulation technique. Results2 out of 3 articles prove that success rate on the first attempt (primary outcome) was significantly higher in the nurse-performed ultrasound-guided technique compared with the conventional palpation technique. The results of the secondary outcomes; time consumption, complications, patient satisfaction and nurse satisfaction between the two groups proved to be heterogeneous. ConclusionNurse-performed ultrasound guidance in hospital wards increases the success rate in patients with difficult peripheral intravenous access.

IntroductionHealth promotion and patient safety are the main targets of the healthcare provision by the National Health Systems. As for the nursing profession, nursing students make medication errors during clinical interventions, which could be a potential danger to patient safety. AimThe investigation of the frequency of nursing student medication errors, as well as the frequency of each type of nursing student medication errors. MethodsA systematic review of the literature was conducted on the electronic database "PubMed" with the keywords: "medication error", "prescribing error", "drug error", "drug use error", "drug mistake", "wrong drug", "wrong dose", "administration error", "dispensing error", "incorrect drug", "incorrect dose", "inappropriate prescribing", "inappropriate medication", "transcription error", "nursing student", "nursing trainee" and on the Greek electronic database IATROTEK-online with the keywords: "medication errors" and "nursing students", without time limit for the publication of scientific papers. On PubMed, the keywords were searched in the title and abstract of the studies. Studies were excluded if they were not published in English and Greek language, were conducted on animals, and were case studies, editorials, and letters to the editor. ResultsOf the 47 scientific papers retrieved, 6 were included in the systematic review. A total of 1,904 nursing student medication errors were recorded by nursing students. The majority of errors were: 1) wrong dose form (330,17%), 2) omission error (313, 16.4%), and 3) wrong time (259, 13.6%). ConclusionsThe frequency of nursing student medication errors is high. The safe administration of medications is an important skill that nursing students should learn. At a theoretical and practical/clinical level, it would be advisable for clinical nurses and academics to jointly develop an educational program to acquire correct knowledge and perceptions regarding safe medication administration.

IntroductionOne of the complications of endotracheal tube (ETT) installation is unplanned extubation (UE). UE is an initial inappropriate removal of an ETT by a patient or medical personnel. This literature review are to describe interventions to prevent unplanned extubation in NICU and PICU. MethodLiterature review searches using Sciencedirect, Google Scholar and Pubmed. The keywords used in searching articles were unplanned extubation PICU NICU. The search criteria were publication year 2017-2023, quasi-experimental design and full text. ResultThe results show that actions that can reduce the incidence of UE are standardization interventions for ETT safety, protocols for moving patients (patient transportation), and collaborative interventions for providing sedation. Conclusionstandardization of ETT safety, protocols for moving patients (patient transport), and collaboration in providing sedation can be used to reduce unplanned extubation.

BackgroundMost studies investigating the association between hospital staff levels and mortality have focused on single professional groups, in particular nursing. However, single staff group studies might overestimate effects or neglect important contributions to patient safety from other staff groups. We aimed to examine the association between multiple clinical staff levels and case-mix adjusted patient mortality in English hospitals. Methods and FindingsThis retrospective observational study used routinely available data from all 138 National Health Service hospital trusts that provided general acute adult services in England between 2015 and 2019. Standardised mortality rates were derived from the Summary Hospital level Mortality Indicator dataset. Estimates for the effect of clinical staffing from the single staff models were generally higher than estimates from models with multiple staff groups. Using a multilevel negative binomial random effects model, hospitals with higher levels of medical and allied healthcare professional (AHP) staff had significantly lower mortality rates (1.04, 95%CI 1.02 to 1.06, and 1.04, 95%CI 1.02 to 1.06, respectively), while those with higher support staff had higher mortality rates (0.85, 95%CI 0.79 to 0.91 for nurse support, and 1.00, 95%CI 0.99 to 1.00 for AHP support), after adjusting for multiple staff groups and hospital characteristics. Estimates of staffing levels on mortality were higher in magnitude between- than within-hospitals, which were not statistically significant in a within-between random effects model. ConclusionsWe showed the importance of considering multiple staff groups simultaneously when examining the association between hospital mortality and clinical staffing levels. Despite not being included in previous workforce studies, AHP and AHP support levels have a significant impact on hospital mortality. As the main variation was seen between-as opposed to within-hospitals, structural recruitment and retention difficulties coupled with financial constraints could contribute to the effect of staffing levels on hospital mortality.

AimTo understand how preferences and constraints of nursing staff, nurse managers and hospital directors interact and influence decisions around nurse shift patterns BackgroundGlobally, many nursing staff have expressed intention to leave the profession and high levels of stress and burnout. Shift patterns are often cited as a key driver of negative nurse outcomes. How preferences and constraints of staff groups involved in nurse shift scheduling interact to shape decisions remains unexplored. DesignQualitative study. We interviewed 17 nursing staff, 5 nurse managers and 6 hospital directors. MethodsStaff were recruited through 5 NHS Trusts based in the North, Midlands, East and South of England. The results were analysed using inductive and deductive framework analysis. ResultsThree themes were identified that influenced nurses decisions for shift scheduling: 1/ Balancing Choice with Consistency, Predictability and Flexibility; 2/Adequate Rest and Recovery Between Shifts; and 3/Enjoyment and Engagement at Work. There was a meta-theme of conflicting priorities for shift scheduling between nursing staff, nurse managers and hospital directors across these three themes. ConclusionsDifferent priorities for shift scheduling of nursing staff, nurse managers and hospital directors created potential or actual conflict. Solutions appeared to consist of compromises where priorities of different staff groups were simultaneously upheld to an acceptable level. This occurred through collaborative interactions across staff groups. Implications for PracticeNursing staff, nurse managers and hospital directors can facilitate choice and flexibility and navigate conflicts in nurse shift scheduling through collaborative approaches that enhance awareness and effective communication. Reporting MethodQualitative data was reported using the EQUATOR checklist COREQ. No Patient or Public Contribution What does this paper contribute to the wider global clinical community? Collaborative approaches can influence conflicting priorities of staff groups in relation to nurse shift scheduling. Staff understanding other staff priorities for nurse shift scheduling enhances awareness.

We present one method of a Training-of-Trainers (ToT) program supported by a partnership between a low-middle income country (LMIC) hospital and a high income country (HIC) organization through lectures, group discussions, assessments, and bedside coaching over a period of two weeks. The goal was to build capacity in ICU nurses by teaching standards of care and documentation, improving interdisciplinary communication, and scaling up participants knowledge and comfort levels in providing quality care. Nurse educators from the Alliance for Global Clinical Training (Alliance) designed the program and conducted the critical care nursing curriculum. Topics were selected by Muhimbili National Hospital (MNH) nursing peers who also provided facility information. Understanding what resources and infrastructure are routinely available is essential to applying concepts to practice. The MNH administrative team and nursing education liaison sought out the best suited participants. Identifying talent in participants for ToT programs is crucial to their success. Nurse participants were chosen as effective representatives of their individual units to be future agents of change. Participants described what they most wanted from the program, including: increased knowledge in documentation, communication, and overall critical care specialized training. Pre- and post-knowledge assessments tested critical care knowledge. The nursing process ADPIE (Assessment, Diagnosis, Problem, Intervention, Evaluation) and SBAR communication (Situation, Background, Assessment, Recommendation) were provided tools for standard operating procedures which enhance interdisciplinary management of care. Clear and consistent documentation with ADPIE requires clinical assessment and evidence-based diagnoses. Standardized communication with SBAR provides an organized framework to professionally relay critical information and provide recommendations. All materials were provided in an open-access format for the program to be easily replicated by the participants. A long-term goal of this training was to assess impact and sustainability.

BackgroundHospital nurses performance within their clinical authority is pivotal to patient safety and care quality. Recent scholarship (2021-2025) indicates that performance is not solely a function of individual competence but is shaped by a dynamic interplay of organizational, individual, and environmental factors. PurposeThis literature review aimed to synthesize current evidence on the determinants that facilitate or impede hospital nurses performance in accordance with their clinical authority, and to highlight gaps for future research. MethodsA systematic search of peer-reviewed articles published between 2021 and 2025 was conducted across major nursing and health services databases. Inclusion criteria comprised empirical studies (qualitative, quantitative, or mixed methods) that examined factors influencing nurses performance, leadership, empowerment, workload, or environmental considerations. Selected articles were screened, coded, and thematically analyzed to identify recurring determinants, barriers, and facilitators. ResultsThe synthesis revealed four core determinants: (1) supportive clinical leadership, which exerts the strongest direct and indirect influence on performance (0.35); (2) manageable workloads, mitigating role conflict between patient care priority and environmental stewardship; (3) structural empowerment and professional autonomy, linked to innovative behaviours (0.63) mediated by organizational climate; and (4) positive organizational climate/team climate, fostering collaboration. Prominent barriers included hierarchical cultures, resource shortages, and insufficient mentorship. Environmental awareness, while present, was often subordinated to immediate clinical duties due to time constraints and lack of institutional support. ConclusionHospital nurses performance under clinical authority is governed by a complex nexus of leadership, workload, empowerment, and climate factors. Targeted organizational interventions, coupled with rigorous research in diverse contexts, are essential to optimize nursing performance and sustain high-quality patient care.

BackgroundThe World Health Organization (WHO) (AWaRe (Access/Watch/Reserve) book gives detailed guidance on the optimal use of antibiotics across primary care and hospitals for adults and children with the aim of improving the quality of use. ObjectivesTo develop universally applicable, model sets of appropriate and feasible quality indicators based on the WHO AWaRe system for primary care, hospital, and general indicators for optimal antibiotic use. MethodsIndicators from a scoping review were revised to focus on clinical infections in the AWaRe book. They were assessed using consensus techniques through two rounds each of the Global Delphi Technique and RAND/UCLA Appropriateness Method, evaluating appropriateness and feasibility at national and global levels respectively. In Round 1 of each method, panellists rated clarity and suggested revisions or new indicator. Round 2 results are reported. FindingsThere were 102 quality indicators (Primary Care: 46; Hospital: 39; General: 17) included in Round 2 of the Delphi Technique and 136 indicators (Primary Care: 56; Hospital: 60; General: 20) in Round 2 of the RAND/UCLA method, which are presented as model sets of indicators. From these broad sets, 12 indicators from the Delphi Technique and 31 indicators from the RAND/UCLA method were rated both appropriate and feasible with agreement respectively. ConclusionThese model AWaRe-based, universally applicable quality indicators can be locally adapted to improve the optimal use of antibiotics and inform global and country specific antimicrobial stewardship programs (AMS).

IntroductionAntimicrobial stewardship (AMS) strategies, such as intravenous-to-oral switch (IVOS), promote optimal antimicrobial use, contributing to safer and more effective patient care and tackling antimicrobial resistance (AMR). AimThis study aimed to achieve nationwide multidisciplinary expert consensus on antimicrobial IVOS criteria for timely switch in hospitalised adult patients and to design an IVOS decision aid to operationalise agreed IVOS criteria in the hospital setting. MethodA 4-step Delphi process was chosen to achieve expert consensus on IVOS criteria and decision aid; it included Step One) Pilot/1st round questionnaire, Step Two) Virtual meeting, Step Three) 2nd round questionnaire and Step 4) Workshop. This study follows the Appraisal of Guidelines for Research and Evaluation II instrument checklist. ResultsStep One questionnaire of 42 IVOS criteria had 24 respondents, 15 of whom participated in Step Two, where 37 criteria were accepted for the next step. Step Three had 242 respondents (England n=195, Northern Ireland n=18, Scotland n=18, Wales n=11); 27 criteria were accepted. Step Four had 48 survey respondents and 33 workshop participants; where consensus was achieved for 24 criteria and comments received on a proposed IVOS decision aid. Research recommendations include the use of evidence-based standardised IVOS criteria. Discussion and ConclusionThis study achieved nationwide expert consensus on antimicrobial IVOS criteria for timely switch in the hospitalised adult population. For criteria operationalisation, an IVOS decision aid was developed. Further research is required to provide clinical validation of the consensus IVOS criteria and to expand this work into the paediatric and international settings.

BackgroundThe mortality rate in pediatric emergency rooms within developing countries remains alarmingly high, primarily due to preventable and treatable conditions. effective pediatric emergency triage is critical for identifying and prioritizing children with serious health issues. However, there is currently limited evidence regarding the practices and factors influencing pediatric emergency triage among healthcare providers, specifically in Western Oromia, Ethiopia. MethodsAn institutional-based cross-sectional study was conducted from February 30 to March 30, 2025 on a total of 422 health care providers selected using a simple random sampling technique. The data were collected using pretested and interviewed based questionnaires. The data were cleaned, entered into Epi-data 4.7.0.0 and exported to SPSS-27 for analysis. Bivariate and multivariate logistic regressions were done to identify factors associated with triage practice. Variables with a p-value of [&le;] 0.05 at 95% CI were considered statistically significant variables. ResultsFrom a total of 422 respondents, 414 (98.10 %) of them gave complete responses. Majority of respondents (60.1%) had a good triage practice. Variables like training on guideline [AOR = 1.74, 95% CI: (1.07 - 2.84)], good knowledge [AOR = 3.40, 95% CI: (2.07 - 5.57)], triage experience [AOR = 2.76; 95% CI:(1.66 - 4.58)], presence of essential drugs and equipment [AOR = 2.16; 95% CI: (1.30 - 3.59)], and good attitudes [AOR = 3.26; 95% CI: (1.96 - 5.42)], were significantly associated with triage practice of healthcare providers. Conclusion and RecommendationAbout three fifth of respondents had a good triage practice. Key factors associated with triage practice included good knowledge, presence of essential drugs and laboratory support, triage experience, training on guidelines, and attitude of healthcare providers were factors associated with triage practice. Therefore, stakeholders including hospital managers should implement targeted strategies like training on increasing knowledge and enhancing positive attitude among healthcare providers to prevent the occurrence of poor triage practice.

IntroductionAccording to the National Institute for Health and Care Excellence, motor neuron disease assessment and management should be a coordinated, clinic-based, multidisciplinary team approach. However, the wellbeing, work experiences, and the alignment with national frameworks and standards of the motor neuron disease (MND) nurses and allied health professionals workforce are severely underreported and under-researched within the literature. Therefore, this report aimed to capture the workforce and their alignment with national frameworks and standards, and to assess their experiences working as an MND health care professional. MethodsA pragmatic research paradigm and a mixed methods approach was employed using a cross-sectional questionnaire survey to collect, compare, and interpret quantitative and qualitative data points. Data was gathered under the remit of an audit and service evaluation under NHS Lothian. Demographics data and work-related characteristics were collected. Job experience and wellbeing were collected using Likert scales and open-ended questions. The level of burnout was assessed using the validated tool, the Burnout Assessment Tool (BAT). Compliance with national frameworks were based on the NICE Guidelines and the Scottish MND Advanced Clinical Nurse Specialist Pillars of Practice Competencies. Results64 HCPs completed the questionnaire, with the majority of respondents from England (54.7%) and Scotland (35.9%). Education level was mainly having a Bachelors (or equivalent) degree (40%) or a Masters (or equivalent) degree (31%), with the remaining having a diploma-based qualification (29%). The analysis revealed three key themes: the importance of the multi-disciplinary team (MDT), the roles and the level of competencies, and the benefits and challenges in providing direct care. DiscussionThis report highlighted the importance of a collaborative MDT to support the needs of patients, their carers/ family members and HCPs themselves. The workforce found the flexibility, autonomy, and variety within their role beneficial where almost 80% of the respondents engaged in 8 of the 15 competencies. The benefits of providing direct care were found to be associated with feeling valued by the patients, their carers/ family members, and the core and extended MDT, and feeling satisfied about their work. The perceived challenges of providing direct care involved isolation, lack of direct funding, and a high caseload with complex needs and not enough time to provide quality care, and this was associated with 14% and 12% being at medium and high risk of burnout, respectively. It is recommended that a national competency programme or a Masters level course in MND care should be developed to maintain the quality of care, and future research should aim to evaluate the entire workforce longitudinally, address organisational barriers, and explore burnout preventative strategies to maintain a resilient workforce.

BackgroundPublic health guidance recommending isolation of individuals with group A streptococcal (GAS) infection or carriage for 12-24 hours from antibiotic initiation to prevent onward transmission requires a strong evidence-base. MethodsWe conducted a systematic review (PROSPERO CRD42021290364) and meta-analysis to estimate the pooled proportion of individuals who remain GAS culture-positive at set intervals after initiation of antibiotics. We searched Ovid MEDLINE (1946-), EMBASE (1974-) and the Cochrane library. We included interventional or observational studies with ten or more participants reporting rates of GAS throat culture during antibiotics for culture confirmed GAS pharyngitis, scarlet fever, and asymptomatic pharyngeal GAS carriage. We did not apply age, language, or geographical restrictions. FindingsOf 5,058 unique records identified, 43 were included; 37 (86%) randomised controlled studies, three (7%) non-randomised controlled trials and three (7%) before-and-after studies. The proportion of individuals who remained culture-positive at day 1, day 2, and day 3-9 were 6.9% (95% CI 2.7-16.8%), 5.4% (95% CI 2.1-13.3%) and 2.6% (95% CI 1.6-4.2%). For penicillins and cephalosporins, day 1 positivity was 6.5% (95% CI 2.5-16.1%) and 1.6% (95% CI 0.04-42.9%) respectively. Overall, for 9.1% (95% CI 7.3-11.3), throat swabs collected after completion of therapy were GAS culture-positive. InterpretationOur review provides evidence that antibiotics for pharyngeal GAS achieve a high rate of culture conversion within 24 hours but highlights the need for further research given the methodological limitations of published studies and imprecision of pooled estimates. Further evidence is needed for non-beta-lactam antibiotics and for asymptomatic individuals.