Antimicrobial Resistance & Infection Control

BackgroundAntimicrobial resistance (AMR) is a global public health threat driven significantly by antimicrobial misuse in agriculture, particularly in poultry farming. This study assessed the awareness, knowledge, practices, and associated factors related to antimicrobial resistance among poultry farmers in Osun State, Nigeria. MethodsA cross-sectional study was conducted among 289 poultry farmers selected through stratified random sampling across Osun State. The study included actively practicing poultry farmers aged 18 years and above who used antimicrobials in their operations. Farmers not using antimicrobials were excluded. Data were collected using a pre-tested, structured, interviewer-administered questionnaire and analyzed with SPSS version 27. Descriptive statistics, chi-square tests, and inferential analyses were used to examine relationships between variables. ResultsThe majority of respondents (89.6%) had heard of AMR, the majority 239 (92.3%) of the respondents heard it from veterinary doctors. The majority (77.2%) also demonstrated good knowledge. Most farmers (89.6%) used antibiotics, with 52.9% using them occasionally. Personal experience (57.8%) was the primary basis for antibiotic selection. About 71.6% implemented biosecurity measures, and 57.8% had received training on AMR. Significant associations were found between knowledge and practice (p<0.001) and between attitude and practice (p<0.001). ConclusionDespite high awareness, antibiotic misuse persists, driven by factors such as reliance on personal experience and limited veterinary consultation. There is a need for enhanced farmer education, stricter regulatory enforcement, and the implementation of targeted antimicrobial stewardship programs to mitigate AMR risks in poultry farming.

PurposeThe quality improvement (QI) initiative integrated the use of the Monk Skin Tone (MST) scale into routine nursing skin assessments to reduce hospital-acquired pressure injuries (HAPIs) among patients with dark skin tones (DST). The project addressed disparities in early detection of subtle skin changes, which are less visible in DST, and sought to advance equity in patient safety. Participants and SettingThe initiative was implemented in 900-bed, academic Level I trauma hospital in Los Angeles, California. Seventy-nine registered nurses (RNs) from the Medical Unit participated, excluding agency, float pool, and nurse residency program nurses. Implementation phase was from May to July 2025. ApproachGuided by the Plan-Do-Study-Act (PDSA) framework, the MST scale was embedded into comprehensive skin assessment protocols. RNs received structured training and education, laminated MST badge buddies, and documentation reinforcement within the electronic health record (EHR). Compliance was monitored through chart audits and electronic data capture documentation review. OutcomesPre-implementation HAPI incidence was 3.18 per 1,000 patient days. Post-implementation, incidence decreased to 0.18, representing a 94% reduction. Among DST patients, only 2% developed HAPIs. Nursing compliance with MST documentation reached 95%, surpassing the 60% benchmark. Implications for PracticeIntegration of the MST scale improved documentation accuracy, reduced disparities in PI detection, and enhanced nurse compliance in skin assessments and documentation. Sustained adoption requires embedding MST training into staff onboarding, continuous education, and EHR workflows. Expansion across inpatient and outpatient settings may further advance equity, patient safety, and organizational performance.

BackgroundIrrational use of antibiotics is a major factor in antibiotic resistance and poor patient outcomes. Globally, 50% of antibiotics are prescribed inappropriately, in Sub-Saharan Africa alone, antimicrobial resistance was linked to approximately 1.27 million deaths in 2019, mainly due to the misuse and overuse of antibiotics. In this study, we collected data to understand the prescribing patterns and factors associated with irrational antibiotic use among hospitalized patients. MethodologyA hospital-based observational cross-sectional study was conducted between October and December 2024 among 655 patients. The study was conducted at a University Teaching Hospital in Rwanda. ResultsAmong 655 inpatients, 1,265 antibiotics were prescribed, equivalent to 1.95 per patient. Out of 1463 inpatients in the hospital, 44.76% received at least one antibiotic. The most prescribed antibiotics were Ceftriaxone (34.6%), followed by Flagyl (20%). The majority of antibiotics (83%) were prescribed in injectable forms. Culture and antibiogram testing were performed in 23.20% of cases, this was associated with deviation from national Standard Treatment Guidelines (STGs) adherence (Adjusted OR = 0.07, CI: 0.03-0.14, p = 0.001). there is a significant likelihood of non-adherence to STGs in internal medicine (Adjusted OR=0.25, CI: 0.10-0.62, p = 0.003) and pediatrics (Adjusted OR=0.33, CI: 0.16-0.67, p = 0.002). ConclusionIn this study, we found improper use of antibiotics, deviating from WHO-endorsed standards and a high empiric prescription of antibiotics. Deviation from national STGs was highly associated with empirical prescription. Improving adherence to diagnostic support and antimicrobial stewardship programs could address the problem.

AimThis study aims to deepen our understanding of how outpatient clinic nurses experience the use of video consultations. Further, the prerequisites that outpatient clinic nurses find important to increase the usage of video consultations in outpatient clinics. Materials and methodsA hermeneutic qualitative exploratory approach was utilised to investigate these experiences and perceptions comprehensively. Data were collected through two qualitative focus group interviews with a purposive sample of 12 nurses from two Danish cardiology outpatient clinics. ResultsData provided insights into the perspectives of nurses, resulting in three main themes: Video consultations must be used at the right time, Nursing care must remain as a relational practice, and Missing initiatives for enabling nurses to use video consultations. The study highlights the importance of organisational support and infrastructure in shaping nurses attitudes toward video consultations. Strategies for successful implementation include targeted training programmes, user-friendly technology, and a well-defined approach. Public ContributionsNo Patient or Public Contribution

Background: workforce innovative solutions are warranted to respond to the critical global lack of healthcare professionals and sustain delivery of quality patient care. The Patient Care Technician program was one of the strategies implemented to address this challenge by developing a timely pool of workforce who can take non-complex tasks, alleviating workload on other professionals such as registered nurses. However, since this strategy was recently introduced, its implementation and impact on the delivery of care have not yet been sufficiently investigated. Objectives: This study examines the motivations, experiences, and career aspirations of patient care technician students, alongside program providers perceptions and challenges in program delivery. Design & Methods: A qualitative phenomenological study was conducted at three institutions in Western Saudi Arabia, including two tertiary hospitals and a university. Semi-structured interviews were conducted with 27 participants; students, lecturers, preceptors, and management staff. Policy documents were also analyzed, and data were examined using Colaizzis seven-step method. Findings: Four key themes emerged: (1) reconciling motivations and influences, (2) training dynamics, (3) career advancement, and (4) navigating acceptance. patient care technician students often felt overqualified for their roles, leading to dissatisfaction and career redirection. The programs effectiveness was hindered by unclear career pathways and the need for greater cultural sensitivity. Conclusions: Recruiting bachelors degree graduates for patient care technician students roles may be inefficient, as these positions could be filled by lower-degree holders, potentially reducing costs. Implications: To enhance workforce stability, healthcare policymakers should establish clear career pathways, align job roles with educational qualifications, and adapt the program to local cultural and professional expectations. Addressing these issues can optimize the roles of patient care technician students within the healthcare system and serve as a model for similar workforce strategies globally.

BackgroundPreventing Stage 1 pressure injuries (PIs) from worsening in the ICU is a key clinical challenge. Early prediction of high-risk patients enables targeted prevention. We aimed to develop a model for this progression using admission data. MethodsIn this retrospective cohort study, eligible ICU patients with Stage 1 pressure injuries were randomly allocated into training (70%) and validation (30%) sets. Predictors were selected using LASSO regression. A multivariable logistic regression model was constructed and visualized as a nomogram. Model performance was evaluated by discrimination (AUC), calibration, and clinical utility (decision curve analysis). ResultsA total of 278 patients were randomly divided into training (n=195) and validation (n=83) sets. LASSO regression identified four independent predictors: diabetes (OR: 3.266; 95% CI: 1.451-7.352), maximum norepinephrine dose (OR: 13.032; 95% CI: 1.212-140.137), use of pneumatic compression pumps (OR: 3.308; 95% CI: 1.444-7.579), and albumin level at ICU admission (OR: 0.836 per unit increase; 95% CI: 0.777-0.900). The nomogram demonstrated excellent discrimination, with an AUC of 0.810 (95% CI: 0.748-0.872) in the training set and 0.805 (95% CI: 0.696-0.914) in the validation set. Good calibration and clinical utility were confirmed. ConclusionsA nomogram incorporating four readily available factors at ICU admission effectively predicts the risk of Stage 1 PI progression. This tool may aid early risk stratification and guide precise preventive measures.

Antimicrobial resistance (AMR) in ESKAPE pathogens represents a major global health threat. Although these organisms are well established as causes of healthcare-associated infections, aquatic environments may function as reservoirs and transmission pathways for resistance. This systematic review aimed to estimate the prevalence of AMR in ESKAPE pathogens isolated from water and wastewater and to compare resistance patterns with those observed in human clinical isolates. The review followed PRISMA guidelines and was registered in PROSPERO (CRD420251020930). PubMed, Embase, and the Cochrane Library were searched to January 14, 2025. Eligible studies were original research reporting antimicrobial susceptibility data for ESKAPE pathogens isolated from both aquatic environmental matrices and clinical samples. Pooled resistance prevalence was estimated using generalized linear mixed models, with heterogeneity assessed using {tau}{superscript 2} and I{superscript 2} statistics and small-study effects evaluated by funnel plots and Eggers test. Of 304 records identified, 18 studies met the inclusion criteria. The pooled overall resistance prevalence was 0.46 (95% CI: 0.36-0.57), with heterogeneity (I{superscript 2} = 98.8%). Resistance was higher in clinical isolates (0.67; 95% CI: 0.55-0.77) than in environmental isolates (0.24; 95% CI: 0.14-0.39), and environmental resistance was greater in effluent-impacted waters than in non-effluent sources. Interpretation is limited by methodological heterogeneity, selective isolation approaches in environmental studies, and imprecision due to small and unevenly distributed samples. Overall, AMR in ESKAPE pathogens remains more prevalent in clinical settings, but aquatic environments, particularly wastewater, represent resistance reservoirs, underscoring the need for standardized methodologies within a One Health framework. Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251020930, CRD420251020930 HighlightsAntimicrobial resistance was higher in clinical isolates than in aquatic isolates. Resistance patterns showed extreme heterogeneity across studies. Effluent-impacted waters showed higher resistance than non-effluent sources. Higher environmental resistance in some classes reflected methodological artifacts.

BackgroundAntimicrobial resistance (AMR) is a major global health threat, with sub-Saharan Africa bearing a disproportionate burden. Community-level antibiotic dispensing practices remain poorly described in Kenya outside Nairobi. MethodsA total of 504 antibiotic dispensing events were prospectively recorded across 22 community pharmacies in Kakamega County, western Kenya, between 3rd and 22nd August 2025. Data collected included dispensing source (over-the-counter [OTC] versus prescription), clinical indication, antibiotics dispensed, course completion, and self-reported repeat antibiotic use within the preceding month. Descriptive analyses were performed, and {chi}2 tests were used to examine associations between dispensing source and selected non-antibiotic dispensing characteristics. ResultsOf the 504 dispensing events, 224 (44.4%) involved OTC dispensing and 278 (55.2%) were prescription-based. The most frequent indications for antibiotic dispensing were upper respiratory tract infections (URTI; n = 156, 31.0%), lower respiratory tract infections (LRTI; n = 95, 18.8%), gastrointestinal infections (n = 65, 12.9%), and skin or soft-tissue infections (n = 55, 10.9%). Across all events, amoxicillin, azithromycin, and metronidazole were the most frequently dispensed antibiotics, with broad-spectrum agents--including fluoroquinolones and cephalosporins--commonly used for lower respiratory tract infections, urinary tract infections, and sepsis. Partial antibiotic courses were supplied in 33 (6.5%) dispensing events, most commonly due to financial constraints (15/33, 45.5%). Self-reported antibiotic use within the preceding month occurred in 156 (31.0%) cases. ConclusionsOTC antibiotic access remains widespread in Kakamega County, with substantial use of broad-spectrum agents across multiple clinical indications. Financial barriers contribute to incomplete antibiotic courses. These findings highlight the importance of incorporating community pharmacy dispensing data into county-level antimicrobial stewardship programmes and informing national strategies to optimise antibiotic use.

BackgroundEthical decision-making is a core competency for nursing interns, supported by critical thinking as a central cognitive skill. However, the mechanisms linking these constructs remain unclear. This study examined the influence of critical thinking on ethical decision-making and the chain mediating roles of ethical sensitivity and sense of power. MethodsA cross-sectional study was conducted from December 2024 to June 2025 among 429 nursing interns at a tertiary hospital in Zhejiang Province, using validated scales and structural equation modeling. ResultsCritical thinking, ethical sensitivity, sense of power, and ethical decision-making were positively correlated (P < 0.01). Ethical sensitivity and sense of power each mediated, and jointly serially mediated, the relationship between critical thinking and ethical decision-making. ConclusionCritical thinking enhances nursing interns ethical decision-making through ethical sensitivity and sense of power. Strengthening these factors in education may better translate cognition into ethical action.

BackgroundWhile veterinary surgeons are known to have particularly high rates of injury compared to other sectors, little is known about rates of injury among veterinary students. This study aims to understand animal-related injury rates, injury context and mechanisms, attitudes to reporting injuries, and behaviour change among UK and Irish veterinary students. MethodsA survey was distributed to students across all veterinary schools operating in the UK and Ireland in 2021. Questions explored participants experience of injury through asking about their most recent and most severe injuries via quantitative and free-text questions. Data were analysed using descriptive statistics, logistic regression, and qualitative content analysis. Results533 responses were included in the analyses. Overall, 47.5% of students reported having been injured by an animal during the veterinary degree, 35.5% of students reported being injured within the last 12 months. Most recent injuries were caused by companion animals (38.0%), livestock (37.6%), and equids (23.5%). For their most severe injuries, 48.7% involved livestock, 28.7% companion animals, and 22.1% equids. The content analysis highlighted that students normalised injuries and infrequently reported injuries to the university. It was very rare for students to take time off from their studies or placements, due to course pressures. ConclusionsThese findings reflect concerningly high levels of injury, which are being under-reported and reflect a culture of injury acceptance and expectation among students. Veterinary schools should consider lessons learnt in other work environments which have been successful in changing safety culture.

BackgroundIn neonatal hospital care where the population with severe illness has a high mortality rate, around 14.9% of drug prescriptions have errors in Low- and Middle- Income Countries (LMICs) settings. However, there is scant research on interventions to improve medication safety to mitigate such errors. ObjectiveOur objective was to explore a theory-informed pharmacist-led Audit and Feedback (A&F) intervention to improve routine prescribing practices with the aim of reducing gentamicin prescribing errors in neonatal care. MethodsWe used interrupted time series analysis modelling changes in prescribing errors for neonates [&le;]28 days admitted to newborn units (NBU) in 22 hospitals in Kenya between July 2021 to June 2024 and explored intervention effects in a feedback meeting at the end of the study. The study had three phases, pre-intervention period (July 2021 to June 2022), intervention period (July 2022 to June 2023), and post-intervention period (July 2023 to June 2024). The primary study was a standard single-group interrupted time-series study (ITS) design to evaluate the comparative effectiveness of enhanced A&F in reducing prescribing error trends after its introduction in 16 hospitals. Secondary analysis included comparison to prescribing error outcomes in an additional six hospitals in a contemporaneous control group that received basic A&F reports without pharmacist involvement in the NBU prescribing practices. ResultsBetween July 2021 and June 2024, the 16 hospitals in the primary outcome analysis and the 6 additional hospitals for the secondary outcome analysis had 36,668 and 8,943 neonates with Gentamicin prescriptions at admission retrospectively. From the incidence rate ratios (IRR) of incorrect prescribing at admission, there was no step change (IRR 1.115, 95% CI: 0.920 to 1.352, p-value=0.265) or trend change (IRR 1.014, 95% CI: 0.986 to 1.042, p-value=0.344) due to the enhanced pharmacist-led A&F intervention in the 16 hospitals in the primary study. From the secondary study, change in the trend post-intervention in the 16 primary study hospitals in the primary study relative to the 6 hospitals acting as a contemporaneous control group was positive (IRR 0.933, 95% CI: 0.878 to 0.985, p-value=0.014), despite no step change due to the enhanced A&F intervention. ConclusionWe found no statistically significant effect of the team-based pharmacist-led A&F intervention on reducing gentamicin medication errors in neonatal care. Prescribing errors during intervention and post-intervention periods were increasing across all hospitals in both arms of the study during and post-intervention periods. However, relative to control hospitals sites receiving routine feedback but without pharmacist involvement or pharmacist-led CMEs, the primary study sites had a positive trend in reducing Gentamicin prescription error rates at admission during and post-introduction of the pharmacist-led A&F intervention. Trial registrationPACTR, PACTR202203869312307. Registered 17th March 2022, https://pactr.samrc.ac.za/Search.aspx?TrialID=PACTR202203869312307 Why was this study done?O_LIIn newborn hospital care where the population with severe illness has a high mortality rate, around 14.9% of drug prescriptions have errors in settings such as sub-Saharan Africa (SSA). C_LIO_LIHowever, there is scant research in SSA on actionable audit and feedback interventions over time to reduce the rates of inappropriate and potentially harmful prescribing of antibiotics. C_LIO_LITherefore, we evaluated whether such an intervention is associated with sustained changes when it provides continuous feedback championed by pharmacists. C_LI What did the researchers do and find?O_LIWe evaluated the impact of a pharmacist-led audit-and feedback intervention for in-hospital newborn care across Kenya. C_LIO_LIWe found that the intervention was not associated with sustained reduction in the level or trend in incorrect antibiotic prescribing across practices, until the study was completed (after 12 months). C_LIO_LIDespite the overall increase in prescribing errors during the study period and the 12 months after the study period, a marked difference in inaccurate prescribing trend was also seen between hospital groups where the hospital pharmacist agreed to be involved with the audit and feedback intervention. C_LI What do these findings mean?O_LIThe extent to which actionable audit and feedback interventions reflect the complexity of routine hospital care in SSA determine whether long-term improvements in prescribing practices can be delivered on an ongoing basis. C_LIO_LIMore research is needed to understand why and how to obtain sustained reductions in antibiotic prescribing errors during hospital stay in SSA. C_LI

ObjectiveTo investigate the attitude and behavior intention of community medical staff towards respite services and analyze its influencing factors, so as to provide reference for the development of respite services. MethodsA multi-stage stratified cluster sampling method was used to select 348 community medical staff to conduct a survey through the questionnaire star. Single factor and multiple linear regression were used to analyze the factors affecting the attitude and behavior intention of community medical staff. ResultsThe attitude score of community medical staff was 43.64, the behavioral intention score was 27.79, and the attitude and behavioral intention scores were low. The results of multivariate linear regression analysis showed that educational background, occupation, relationship with the elderly at home, whether there were family members who could not take care of themselves due to major diseases, whether they had the experience of taking care of the elderly, and whether they had received knowledge training in respite services were the factors affecting the attitude of community medical staff to respite services ( P < 0.05 ). Educational background, working years, whether there are family members who cannot take care of themselves due to major diseases, whether they have the experience of taking care of the elderly, whether they know the respite services, whether they have received knowledge training in respite services and whether they know the respite services are the factors affecting the behavioral intention of community medical staff (P < 0.05). ConclusionThe attitude of community medical staff towards respite services is not positive, and their behavioral intention is low. There are many factors affecting attitude and behavioral intention. It is necessary to strengthen the training of respite services knowledge for medical staff with low education and short working years, strengthen the cultivation of empathy and empathy ability of medical staff, carry out multi-level publicity of respite services, and improve peoples awareness and acceptance of respite services, so as to promote the development of respite services industry and promote healthy aging.

BackgroundRespiratory syncytial virus (RSV) is a major cause of lower respiratory tract infections in children, often leading to hospitalisation in infants. In low-resource settings where routine RSV diagnostics are unavailable, clinical overlap with bacterial pneumonia frequently results in unnecessary antibiotic use, contributing to antimicrobial resistance. ObjectiveTo evaluate the frequency and clinical determinants of antibiotic use among RSV-positive children under two years at a tertiary hospital in Ghana. MethodsThis cross-sectional study was conducted from June to November 2023 at the Department of Child Health, Korle Bu Teaching Hospital. Children with acute respiratory illness were enrolled and tested for RSV using molecular point-of-care and reverse transcriptase-polymerase chain reaction methods. Antibiotic use and clinical characteristics were analysed among RSV-positive cases. ResultsOf 128 children enrolled, 72 (56.2%) tested positive for RSV. Among these, 48 (66.7%) received antibiotics. Antibiotic use was significantly associated with markers of disease severity, including hypoxia (p = 0.009), tachypnea (p = 0.015), dyspnea (p < 0.001), and hospital admission (p < 0.001). Only 11 (23%) had suspected or confirmed bacterial co-infections. ConclusionA substantial proportion of RSV-positive children received antibiotics. These findings underscore the importance of antimicrobial stewardship programs, rapid diagnostics, and preventive interventions, such as maternal RSV vaccination. Strengthening diagnostic capacity and clinical decision-making in pediatric care is crucial for reducing inappropriate antibiotic use and addressing antimicrobial resistance in low-resource settings.

ObjectiveTo evaluate the views of physicians in Trinidad and Tobago towards low value care MethodsPhysicians were surveyed using a cross sectional study design. An online questionnaire was disseminated through social media platforms using convenience sampling. A descriptive analysis was performed. ResultsData from 218 physicians were analysed. Most participants worked in internal medicine (n=59, 27.1%) and the majority of participants were junior doctors (n=147, 67.4%). Most participants (n=97, 44.1%) said they rarely recommended low value care to patients while 51.8% (n=113) said their colleagues sometimes recommended low value care. Almost all participants (n=210, 97.1%) were interested in learning more about evidence-based recommendations that could address when a test/procedure is unnecessary. Reasons for ordering unnecessary tests included because it was an order from the senior doctor in the specialty or the admitting doctor requested the test (68.3%, n=149), inadequate information (61.5%, n=134), difficulty accessing prior medical records (126, n=57.8) and fear of litigation (57.3%, n=125). Strategies to reduce unnecessary care were training (92.2%, n=201), ease of access to external records (72.9%, n= 159), clinical pathways (64.2%, n= 140) and educational materials for patients (64.2%, n=140) ConclusionLow value care is an area of concern in Trinidad and Tobago. Identifying areas of overuse and developing targeted plans to reduce unnecessary care are important next steps.

Sepsis caused by drug-resistant pathogens remains a major contributor to under-five mortality in low- and middle-income countries, threatening progress toward Sustainable Development Goal (SDG) 3.2. Blood culture, the gold standard for sepsis diagnosis and antimicrobial stewardship, remains underutilised in routine pediatric care. This study assessed the extent and determinants of blood culture utilisation among hospitalised children under five years with suspected sepsis at four antimicrobial resistance (AMR) surveillance sites in Uganda. We conducted a cross-sectional mixed-methods study involving retrospective review of 384 pediatric patient records and in-depth interviews with 20 clinicians. Modified Poisson regression was used to identify factors associated with blood culture requests, while thematic analysis explored behavioral and contextual influences on diagnostic practices. Blood cultures were requested in 28.1% of suspected sepsis cases. Higher utilisation was independently associated with markers of clinical severity, including severe acute malnutrition (adjusted prevalence ratio [aPR] 1.3, 95% CI: 1.14-1.34), sickle cell disease (aPR 1.3, 95% CI: 1.19-1.40), and presence of WHO danger signs (aPR 1.1, 95% CI: 1.00-1.14). Senior clinician involvement (aPR 1.2, 95% CI: 1.08-1.32) and consultant review (aPR 1.4, 95% CI: 1.21-1.48) were also associated with higher use, while prior antibiotic exposure reduced the likelihood of blood culture request (aPR 0.9, 95% CI: 0.84-0.96). Qualitative findings identified four overarching themes influencing diagnostic behavior: motivation amid systemic constraints, institutional and environmental barriers, mentorship and teamwork, and emotional fatigue in the context of adaptive practices. Despite high clinician awareness, blood culture utilisation remains low, driven primarily by health system fragility, inefficient workflows, and emotional exhaustion rather than knowledge gaps. Improving utilisation will require integrated behavioral, workflow, and structural interventions, including clinical decision support and strengthened microbiology laboratory capacity, to enhance pediatric sepsis care, antimicrobial stewardship, and progress toward SDG 3.2.

ObjectiveTo meet the World Health Organization (WHO) requirement of strengthening integrated Emergency, Critical and Operative (ECO) care, it is necessary to develop ECO-related guidance and tools for Quality Improvement (QI) in Emergency Units (EUs). This study aimed to identify the barriers and facilitators for QI in EUs in Low- or Middle-Income- countries (LMICs) and explore potential measures for assessing quality of care, to inform guidance and tool development across all quality domains. MethodsWe conducted in-depth interviews (IDIs) with 11 specialist emergency physicians from LMICs and organized a workshop with global technical experts in emergency care. Transcribed interviews were thematically analysed, integrating WHO quality domains and the WHO Health Systems Framework. The workshop included presentations, discussions, and interactive ranking exercises to evaluate QI measurement methods and identify priority WHO quality domains. Related outcomes were synthesized to generate insights for the development of QI guidance and tools. FindingsQI efforts in LMICs primarily focused on effectiveness, timeliness, safety, and occasionally patient centeredness. Key barriers to QI specific to LMIC EUs included high patient turnover, a lack of skilled staff, limited funds and resources, and prioritizing patient care quantity over quality. Facilitators included the availability of QI guidance, training, initiating small-scale projects, enhancing documentation and communication, and supportive hospital management. Safety and effectiveness were considered the most feasible QI domains for improvement, though all were recognized as important. Inconsistencies in how participants defined the domains highlighted the need to develop clear guidance on definitions, and importance of all domains and measures appropriate to each. ConclusionsEmergency unit is a unique environment handling time-critical health conditions and therefore requires the development of specific tools and guidance for delivery of QI. Addressing barriers and leveraging facilitators identified in this study can inform the development of effective QI strategies for LMIC EUs.

This study aimed to systematically review and critically evaluate the risk of bias and applicability of surgical site infection (SSI) risk prediction models after spinal surgery. China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database (VIP), SinoMed, PubMed, Web of Science, The Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, and Embase were searched from inception to April 10, 2025. The prediction model risk of bias assessment tool-artificial intelligence (AI) and transparent reporting of a multivariable prediction model for individual prognosis or diagnosis-AI were used to assess the quality of the included studies, and RevMan software was used to perform a meta-analysis of the odds ratio values for certain model predictors. A total of 37 studies were included, identifying 43 predictive models. The incidence of SSI after spinal surgery ranged from 1.5% to 50%. Among these, 11 studies focused solely on model development, 4 studies included external validation, 22 studies were only internally validated, and 1 study was both internally and externally validated. The area under the curve values ranged from 0.610 to 0.991. The meta-analysis of high-frequency predictors identified statistically significant factors, including diabetes, age, surgery duration, albumin, body mass index, drainage time, smoking history, and American Society of Anesthesiologists score. All studies were rated as having a high risk of bias, primarily due to poor reporting related to study participants and the analysis domain. The evaluation using the prediction model risk of bias assessment tool indicated a considerable risk of bias in current predictive models for postoperative SSI after spinal surgery. Although the predictive model for SSI after spinal surgery is generally acceptable, most studies have methodological flaws. Moreover, studies with larger sample sizes and multicenter external validation are necessary to enhance the robustness of predictive models.

BackgroundThe COVID-19 pandemic required South African public sector HIV viral load (VL) laboratories to scale up Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) testing while maintaining essential HIV services. This placed additional pressure on diagnostic services. This dual mandate introduced significant occupational and environmental challenges (OEC) for staff that remain underexplored. ObjectiveThis study aimed to investigate the OEC and effects that staff experienced during the implementation of COVID-19 testing at public sector VL laboratories in South Africa. MethodsA quantitative, cross-sectional study utilised a census approach among technical and support staff. Data were collected via a structured REDCap questionnaire using 5-point Likert scales. Pre- and post-implementation challenges were assessed across four domains: workload, environmental conditions (space, ventilation, waste), communication, and PPE availability. Statistical analyses included the Wilcoxon Signed-Rank and Spearmans correlation tests. ResultsPerceived occupational challenges increased significantly across all domains post-implementation. Staff workload saw the highest rise (mean score 3.02 to 3.53). Adverse health effects were pervasive; 80.2% of staff reported burnout/fatigue, and 76.5% reported increased anxiety/stress. A strong positive correlation was observed between post-COVID-19 challenges and adverse mental and physical health outcomes (rho = 0.449, p < 0.001). Furthermore, 35.8% of staff considered resigning due to increased job demands. ConclusionIntegrating COVID-19 testing exacerbated systemic weaknesses, causing measurable psychological injury and threatening workforce retention. Findings suggest that the diagnostic workforce requires formal crisis surge staffing models and institutionalised mental health support to safeguard personnel and maintain essential services during future health emergencies.

ObjectiveThere is no validated questionnaire in Japan to measure the culture of safety in ambulatory care clinics. Therefore, we developed the Japanese version of the Medical Office Survey on Patient Safety Culture (MOSPSC) of the Agency of Healthcare Research and Quality (AHRQ) in the United States with the aim to establish a tool for evaluating and benchmarking the safety culture of outpatient clinics in Japan. Materials and methodsThis research uses both qualitative and quantitative approaches to translate, adapt and validate the MOSPSC questionnaire which consists of 62 questions. The process involved seven steps such as translation by two independent bilingual physicians, drafting and reviewing, backtranslation by two separate translation companies, semantic equivalence assessment by AHRQ and revision, pretest, focused discussion, and finalizing the questionnaire after expert review and proofreading. An actual safety culture survey was conducted with mainly online and paper versions at four clinics in Tokyo. The survey results were then evaluated for patient safety dimensions, reliability and construct validity. ResultsEfforts are made to select appropriate terminology during tool adaptation processes due to different language and medical system between Japan and the United States. The response rate in the actual survey was 66.4% (242/364). Confirmatory factor analysis showed that factor loading and goodness of fit indices were better when 3 items were removed from the original 10-composite model with 38 items. The Cronbachs alpha coefficients of composite measures ranged from 0.62 to 0.78 in the original model and 0.62 to 0.85 in the new model, indicating good internal consistencies. ConclusionsConsidering the differences in medical systems, culture, and language between the United States and Japan, the instrumented was adapted with a satisfactory content validity and reliability.

BackgroundHealthcare-associated carbapenemase-producing Enterobacterales (CPE) outbreaks are a major healthcare challenge. Epidemiological studies have identified patient-level risk factors for CPE transmission, and genomic studies have highlighted high-risk lineages or mobile genetic elements (MGEs); however, a unified dissemination risk-prediction framework is lacking. ObjectivesTo synthesise available data on epidemiological, microbiological and genomic risk factors to quantify healthcare-associated CPE outbreak potential. MethodsO_ST_ABSDataC_ST_ABSSix bibliographic databases and other sources were searched ( carbapenemase AND outbreak AND MGE; [&le;]31/01/24). Data were extracted on primary (patients infected/colonised) and secondary (outbreak duration/resolution, mortality) outcomes, and risk/protective factors including epidemiological, microbiological/genomic and infection control measures. Study eligibilityStudies reporting healthcare-associated CPE outbreaks involving MGE-associated IMP/KPC/NDM/OXA-48-like/VIM carbapenemases confirmed by whole-genome sequencing. Study qualityReporting quality was assessed against the ORION checklist (random subset). Data synthesisAfter descriptive summaries, multivariable linear mixed effect modelling was used to estimate associations between risk/protective factors and outbreak size. Results179 records (272 outbreaks) were included from 3,188 screened (41 countries, 2004-2023), affecting median 10 patients (IQR=5-27, range=2-223), and lasting 12 months (IQR=5-30, range=1 day-16 years). Data on outbreak size (primary outcome) was 99.6% complete (271/272) but more limited for secondary outcomes (29-97% complete) and risk/protective factors (70/91 factors had [&ge;]10% missingness). 39% (107/272) of outbreaks involved MGE-mediated transmission, which is a potential underestimate as 66% (104/157) of reports used clonal outbreak definitions. The involvement of more institutions (adjusted relative outbreak size: 1.10 per institution [95% CI: 1.04-1.16];p=0.001), and more Enterobacterales sequence types (1.04 per sequence type [1.01-1.08];p=0.011), were associated with larger outbreaks. Reporting quality assessment (n=98 studies) revealed adequate reporting on median 11/19 relevant ORION items (IQR=8-13; range=1-18). ConclusionsHeterogenous/incomplete reporting of CPE outbreaks precludes integrated risk evaluation based on epidemiological, microbiological, and genomic factors. Systematic sampling, sequencing and epidemiological metadata reporting may strengthen data quality for quantifying healthcare-associated CPE dissemination risk.