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      Strategies to Prevent Healthcare-Associated Infections: A Narrative Overview

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          Abstract

          Healthcare-associated infections (HCAIs) are a major source of morbidity and mortality and are the second most prevalent cause of death. Furthermore, it has been reported that for every one-hundred patients admitted to hospital, seven patients in high-income economies and ten in emerging and low-income economies acquire at least one type of HCAI. Currently, almost all pathogenic microorganisms have developed antimicrobial resistance, and few new antimicrobials are being developed and brought to market. The literature search for this narrative review was performed by searching bibliographic databases (including Google Scholar and PubMed) using the search terms: “Strategies,” “Prevention,” and “Healthcare-Associated Infections,” followed by snowballing references cited by critical articles. We found that although hand hygiene is a centuries-old concept, it is still the primary strategy used around the world to prevent HCAIs. It forms one of a bundle of approaches used to clean and maintain a safe hospital environment and to stop the transmission of contagious and infectious microorganisms, including multidrug-resistant microbes. Finally, antibiotic stewardship also has a crucial role in reducing the impact of HCAIs through conserving currently available antimicrobials.

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          Most cited references181

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          Using social and behavioural science to support COVID-19 pandemic response

          The COVID-19 pandemic represents a massive global health crisis. Because the crisis requires large-scale behaviour change and places significant psychological burdens on individuals, insights from the social and behavioural sciences can be used to help align human behaviour with the recommendations of epidemiologists and public health experts. Here we discuss evidence from a selection of research topics relevant to pandemics, including work on navigating threats, social and cultural influences on behaviour, science communication, moral decision-making, leadership, and stress and coping. In each section, we note the nature and quality of prior research, including uncertainty and unsettled issues. We identify several insights for effective response to the COVID-19 pandemic and highlight important gaps researchers should move quickly to fill in the coming weeks and months.
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            Antimicrobial resistance: a global multifaceted phenomenon.

            Antimicrobial resistance (AMR) is one of the most serious global public health threats in this century. The first World Health Organization (WHO) Global report on surveillance of AMR, published in April 2014, collected for the first time data from national and international surveillance networks, showing the extent of this phenomenon in many parts of the world and also the presence of large gaps in the existing surveillance. In this review, we focus on antibacterial resistance (ABR), which represents at the moment the major problem, both for the high rates of resistance observed in bacteria that cause common infections and for the complexity of the consequences of ABR. We describe the health and economic impact of ABR, the principal risk factors for its emergence and, in particular, we illustrate the highlights of four antibiotic-resistant pathogens of global concern - Staphylococcus aureus, Klebsiella pneumoniae, non-typhoidal Salmonella and Mycobacterium tuberculosis - for whom we report resistance data worldwide. Measures to control the emergence and the spread of ABR are presented.
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              Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis.

              Health-care-associated infection is the most frequent result of unsafe patient care worldwide, but few data are available from the developing world. We aimed to assess the epidemiology of endemic health-care-associated infection in developing countries. We searched electronic databases and reference lists of relevant papers for articles published 1995-2008. Studies containing full or partial data from developing countries related to infection prevalence or incidence-including overall health-care-associated infection and major infection sites, and their microbiological cause-were selected. We classified studies as low-quality or high-quality according to predefined criteria. Data were pooled for analysis. Of 271 selected articles, 220 were included in the final analysis. Limited data were retrieved from some regions and many countries were not represented. 118 (54%) studies were low quality. In general, infection frequencies reported in high-quality studies were greater than those from low-quality studies. Prevalence of health-care-associated infection (pooled prevalence in high-quality studies, 15·5 per 100 patients [95% CI 12·6-18·9]) was much higher than proportions reported from Europe and the USA. Pooled overall health-care-associated infection density in adult intensive-care units was 47·9 per 1000 patient-days (95% CI 36·7-59·1), at least three times as high as densities reported from the USA. Surgical-site infection was the leading infection in hospitals (pooled cumulative incidence 5·6 per 100 surgical procedures), strikingly higher than proportions recorded in developed countries. Gram-negative bacilli represented the most common nosocomial isolates. Apart from meticillin resistance, noted in 158 of 290 (54%) Staphylococcus aureus isolates (in eight studies), very few articles reported antimicrobial resistance. The burden of health-care-associated infection in developing countries is high. Our findings indicate a need to improve surveillance and infection-control practices. World Health Organization. Copyright © 2011 Elsevier Ltd. All rights reserved.

                Author and article information

                Journal
                Risk Manag Healthc Policy
                rmhp
                rmhp
                Risk Management and Healthcare Policy
                Dove
                1179-1594
                28 September 2020
                2020
                : 13
                : 1765-1780
                Affiliations
                [1 ]Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia) , Kuala Lumpur 57000, Malaysia
                [2 ]Medical Education, Swansea University School of Medicine, Grove Building, Swansea University , Swansea, Wales SA2 8PP, UK
                [3 ]Department of General and Emergency Surgery, Macerata Hospital , Macerata, Italy
                [4 ]School of Pharmacy, The University of the West Indies, St. Augustine Campus, Faculty of Medical Sciences, Eric Williams Medical Sciences Complex, Uriah Butler Highway , Trinidad & Tobago, West Indies
                [5 ]Global Alliance for Infections in Surgery , Vila Nova de Gaia, Portugal
                [6 ]Department of Microbiology, Jahangirnagar University , Savar, Dhaka 1342, Bangladesh
                [7 ]Department of Hematology, Asgar Ali Hospital , Dhaka 1204, Bangladesh
                [8 ]Department of Microbiology, Chittagong Medical College , Chattogram 4203, Bangladesh
                [9 ]Department of Urology, Shaheed Suhrawardy Medical College Hospital , Dhaka 1207, Bangladesh
                [10 ]Department of General Emergency and Trauma Surgery, Pisa University Hospital , Pisa, Italy
                [11 ]School of Pharmacy, Lebanese University , Beirut, Lebanon
                [12 ]Department of Emergency Surgery, Parma Maggiore Hospital , Parma, Italy
                [13 ]Department of Pharmacology, All India Institute of Medical Sciences , Jodhpur, Rajasthan, India
                Author notes
                Correspondence: Mainul HaqueUnit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia) , Kem Perdana Sungai Besi, Kuala Lumpur57000, MalaysiaTel +60 10 926 5543 Email runurono@gmail.com
                Author information
                http://orcid.org/0000-0002-6124-7993
                http://orcid.org/0000-0002-8949-5067
                http://orcid.org/0000-0003-3202-7542
                http://orcid.org/0000-0003-2537-8889
                http://orcid.org/0000-0001-9130-4891
                http://orcid.org/0000-0001-6131-4132
                http://orcid.org/0000-0002-3939-9093
                http://orcid.org/0000-0001-9434-4661
                http://orcid.org/0000-0001-9482-0031
                http://orcid.org/0000-0001-6364-4186
                http://orcid.org/0000-0001-5544-6681
                http://orcid.org/0000-0001-5558-9965
                http://orcid.org/0000-0002-4857-6725
                Article
                269315
                10.2147/RMHP.S269315
                7532064
                33061710
                0073533d-60ff-4d33-bb39-48bae97d6fb7
                © 2020 Haque et al.

                This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms ( https://www.dovepress.com/terms.php).

                History
                : 25 June 2020
                : 09 September 2020
                Page count
                Figures: 0, References: 221, Pages: 16
                Funding
                Funded by: No funding;
                No funding was received to produce this paper.
                Categories
                Review

                Social policy & Welfare
                prevention,hand hygiene,environmental hygiene,surveillance,antibiotic stewardship

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