Day 1 :
Keynote Forum
Dong H. Kwon
Long Island University, USA
Keynote: The Effects of Exogenous Glutathione on Antibiotic Resistant Bacteria
Time : 09:30
Biography:
Dr. Kwon’s research has centered on pharmaceutical biotechnology focusing on molecular details of drug resistance and susceptibility mechanisms. The overall goal of his research is to develop a new drug and a novel strategy to treat drug-resistant bacterial pathogens. He has studied the bacterial pathogens causing infections of bloodstream, urinary tract, respiratory system, and gastric ulcers/cancers. These bacterial pathogens readily acquire resistance to multiple antibiotics and become a major public health problem worldwide. Dr. Kwon was educated at Georgia State University (Atlanta, GA, USA) and Baylor College of Medicine (Houston, TX, USA). He worked as a faculty member at Baylor College of Medicine before moving to Long Island University (Brooklyn, NY, USA).
Abstract:
Antibiotic resistance is a major global healthcare problem. In 2019, estimated 4.95 million deaths were associated with antibiotic resistance infections including 1.27 million deaths attributable to antibiotic resistance. To reduce antibiotic resistance a new antibiotic or strategy is an urgent priority in bacterial infections. Glutathione (GSH) is a biogenic thiol-compound for an optimal intracellular redox-potential required for various normal cellular processes. Antibacterial activity of exogenous (extracellular) GSH has been reported in some clinical isolates of bacterial pathogens but its molecular details are currently unclear. We have studied the effects of exogenous GSH on antibiotic susceptibility in clinical isolates of Acinetobacter baumannii, Pseudomonas aeruginosa, and methicillin-resistant Staphylococcus aureus. Our results concluded that i) exogenous GSH exhibited antibacterial activity regardless of antibiotic resistance (or susceptibility), ii) the antibacterial activity of GSH synergistically enhanced susceptibility of conventional antibiotics, and iii) GSH- mediated acidity was substantially associated with the antibacterial activity of GSH. These findings suggest that GSH may be a potential antibacterial agent or an adjuvant for conventional antibacterial regimens.
Keynote Forum
Paul J Caesar
PENTAX Medical EMEA, Germany
Keynote: Endoscope reprocessing: Future has already started
Biography:
Paul J Caesar has been worked for more than 25 years as an infection control expert and expert (sterile) medical devices and endoscope reprocessing in different hospitals. He was also a manager of an endoscopy ward and reprocessing unit. He has published some articles on hygiene, and endoscope reprocessing and gave presentations on international conferences. In his actual role he is responsible for hygiene, infection control and reprocessing for PENTAX Medical EMEA.
Abstract:
In todays medical world flexible endoscopes are important medical devices for diagnose and treatment of various medical diseases. Although sterile single use flexible endoscopes have been introduced, most flexible endoscopes are still reusable. As reusable flexible endoscopes are defined as semi-critical devices. After each use reprocessing of the flexible endoscope is needed to have a clean and safe endoscope for the subsequent paptient. The reprocessing process is a multi-step process, consisting of several steps from bedside cleaning to high level disinfectioen, which must all be performed consequently. Although some steps are done manually, last decades many improvements have been made to improve the reprocessing process, like automated endoscope reprocessors and drying cabinets. Even with the introduction of an automated endoscope reprocessor, the manual cleaning should never be neglected to guarantee a successsful next disinfection step. Many studies have indicated human factors as a risk in successful manual cleaning. Also many studies indicate not all health-care facilities dry their endoscopes after reprocessing in a sufficient way or do not dry them at all. So it is challenging to look for improvements and new techniques challenging to optimize reprocessing, minimizing the risk of infection and maximizing patient safety, espacially related to the manual cleaning step and drying and storage. Recently three novell techniques are introduced to improve the reprocessing process. The first one is a device that is an automated alternative to classical brushing and flushing. It will standardize the cleaning process, without the use of brushes and chemicals. The secondo ne is an alternative to the traditional drying- and storage cabine. Using an unique airflow technique, endoscope channels are dried in only a few minutes. Storing the endoscope afterwards in a special bag and inflating some ozone, the endoscope can be stored under dry, dust free, and aseptic conditions up to 31 days. Finally the third one, is an automated disinfection device that will channel-less endoscopes and TEE probes in only 60 seconds.
Introducing these novell techniques and products, infection risks will be minimized, workflow effciency will be improved, and – most important – patient safety will be maximized. When it comes to modern endoscope reprocessing, the future has already started.
- Disinfection
Session Introduction
Michael Mark Dalauidao
King’s College Hospital, UK
Title: Establishing a new standard method to assess the effectiveness and improve the environmental cleaning and disinfection in an acute district general hospital
Biography:
Mark is currently working as a Band 8a Modern Matron in Infection Prevention and Control at King’s College hospital NHS Foundation Trust. He is a member of the Scientific programme Committee of the Infection Prevention Society UK. He is also one of the current Regional Board of Director for London Region for the Filipino Nurses Association -UK (FNAUK). The Association was founded on the 2nd July 2020 in the midst of the COVID-19 pandemic to provide a forum for Filipino nurses in the UK to network and discuss issues of collective interest that have an effect on all of us, including signposting individual members to the right place if they have specific issues that need to be addressed. As an IPC Nurse Specialist he was given a once in a lifetime opportunity to contribute in a national level during the COVID 19 pandemic. Together with the other IPC specialists they managed the London Nightingale Hospital during the 1st and 2nd wave of the pandemic.
Abstract:
Introduction:
Environmental cleaning and disinfection is paramount in minimising and preventing hospital acquired infections. One of the most important responsibilities of healthcare facilities is to ensure high standards of the environmental cleaning and disinfection. However, there is a lack of standard process to check and assess cleaning effectiveness.
Methods: A quality improvement model based on Plan Do Study Act (PDSA) Cycle approach was utilised for this project. Process mapping, stakeholder analysis and a driver diagram were undertaken to understand the current practice. A questionnaire was developed for cleaning staff in the hospital in order to understand and establish their current knowledge and practice. This survey helped to identify gaps and establish the focus of the intervention. An invisible fluorescent marker gel was used as the method of assessment in conjunction with the traditional visual inspection, feedback and education. Ten high touch areas around the patient’s bed space were identified where the fluorescent gel was applied and these were checked using a portable ultraviolet light by the author and later on the project he was joined by the zonal managers from the cleaning team at a weekly to twice weekly intervals. The expectation is that the gel must be either partially (at least three quarters of the gel) or completely removed for the surface to be considered clean.
Results: The survey showed that there is a need for further training among the cleaning staff and they feel that their role is not valued in the clinical area, hence morale is quite low. At the initiation of the new assessment method in February 2021, compliance with the cleaning and disinfection standard was 27%. Weekly to twice weekly assessment, education and feedback was commenced. At the end of the implementation phase, the compliance had increased to 91%. In addition, the cleaning staff morale had increased and they now feel more valued and appreciated. This is demonstrated by the improvement in quality of cleaning they have consistently delivered throughout the duration of the project.
Conclusion: The introduction of the fluorescent marker gel and the portable UV light, in conjunction with visual inspection, training and feedback has improved and sustained the quality of environmental cleaning and disinfection.
- HIV Prevention, Treatment and Cure
Session Introduction
Chatuphon Phuwongsa
Bankruat Hospital, Thailand
Title: The Impact of the COVID-19 pandemic and the real-world on Pre-Exposure Prophylaxis (PrEP) in Men Who Have Sex with Men (MSM) in High-Risk HIV groups in Thailand
Biography:
Dr Chatuphon Phuwongsa graduated with a Doctor of Medicine degree with 2nd class honours, currently aged 30, working as a general practitioner at Ban Kruat Hospital, Buriram Province, Thailand, performing duties taking charge of the patient care system both for prevention, surveillance, and treatment of disease, especially during the Covid-19 pandemic. He has worked to help patients receive safe medical services. Previous research, he participated in the AMEE 2014 research paper in Milan Italy on the research topic “Stress, Depression and Psychological factors among Medical Students”. A cross-sectional study at Buriram Medical Education Centre, Institute of Medicine, Suranaree University of Technology.
Abstract:
The Impact of the COVID-19 Pandemic and the Real-World on Pre-Exposure Prophylaxis (PrEP) in Men Who Have Sex with Men (MSM) in High-Risk HIV Groups in Thailand: It performs each type during three evolutionary stages: (1) before the COVID-19 evolution stage (1 January–30 April 2021),
(2) the COVID-19 evolution stage (1 May–30 August 2021), and (3) the plateau phase (1 September– 31 December 2021). Most scrutinized literature was collected from different sources including PubMed. Mixed methods were used in a total of 245 who responded to online questionnaires (Google Form) (100%) and 30 in-depth interviews (In-depth Interview) (100%). The results showed that PrEP was known before the survey 62.04%. The most cited sources of information about PrEP were Internet/Social Media (33.47%). At 42.04% admitted that they had multiple sexual partners during the past year. An average 17.14% had sex without a condom in the last half year, 62.04% had mental health problems in the past, and an average of 51.43% of them had partially disclosed their sexual orientation to the public. The results of the in-depth interviews were 1) gaining knowledge or perceived negatively receiving PrEP services. 2) Understand that HIV prevention is more convenient and cost-effective than PrEP. 3) Use of PrEP is limited by relatively low access to services. 4) Inconvenience of accessing services during each Covid epidemic period VID-19 and 5) restrictions on access to medical services for MSM only. It should be made in order to meet the needs of each time period.
- Infection Control Treatment & Diagnosis
Session Introduction
Luis Martin Moltrasio
Instituto Cordis, Argentina
Title: CIED (Cardiac implantable Electronic Device)-related endocarditis. Diagnostic/treatment algorithm proposal in a limited resources setting
Biography:
Luis Martin Moltrasio has formal training in Intensive Medicine (Residence and head of residents, Hospital Julio C. Perrando, Resistencia, Argentina), Infectious Diseases (fellowship, Hospital Italiano de Buenos Aires). He was head of the Emergency Service and head of the Stroke Unit at Hospital Julio C. Perrando. From 2018 to January 2022 He worked as Head of the Intensive Medicine, Infectious Diseases services and also coordinator of the cardiovascular recovery area of the Cordis Institute, a health facility specialized in cardiac pathology. Since February 2022, He has been in charge of the Cordis Institute's Medical Directorate.
Abstract:
CIED-related endocarditis refers to infection involving the transvenous portion of the lead (with involvement of the contiguous endocardium or tricuspid valve). CIED systemic infection can occur with or without involvement of the generator pocket. Patients with systemic infection generally have positive blood cultures and/or vegetation on TEE. This infection primarily involve the intracardiac portion of the lead and essentially represent a right-sided endocarditis. The approach to evaluation of suspected CIED-related endocarditis is summarized in various algorithms and includes, clinical presentations, blood cultures and echocardiography.
The limitations of TEE for discriminating between infectious lead vegetations and thrombus were demonstrated, infectious and noninfectious echodensities did not differ in their echocardiographic characteristics.
In general, successful management of CIED-related endocarditis requires an antibiotic therapy and explantation of the entire CIED (leads, including residual leads that are non-functional, and pulse generator). For patients with echocardiography demonstrating a valve or lead vegetation, without definitive diagnostic of endocarditis, in general physicians favor presumptive treatment for endocarditis, but antimicrobial treatment up to four weeks without device removal has a very low chance of success and raise antimicrobial resistance. Otherwise device removal without a define endocarditis, in a low resources setting is associated, due our experience, with increased morbimortality.
In many cases with suspected infection, fluorine-18 fluorodeoxyglucose positron emission tomography computed tomography (18F-FDG-PET/CT) scanning may be helpful to define, however such diagnostic test, involves transfers of more than one thousand kilometers in our region. Our team have developed an evidence and experience based algorithm to try to resolve these problems in a low resource setting.
Fuxiang Wang
Shenzhen Third People Hospital, China
Title: Young MSM changed HIV-1 epidemic pattern in Northeast China
Biography:
Fuxiang Wang has completed his PhD at the age of 32 years from The Fourth Military Medical University. He is the director of Department of Infectious Diseases,Shenzhen Third People's Hospital, Shenzhen, China. He has published more than 90 papers in journals.
Abstract:
Background: Human immunodeficiency virus type 1 (HIV-1) epidemic in China is featured by geographical diversity of epidemic patterns. Understanding the characteristics of regional HIV epidemic allows carrying out targeted prevention and control measures. However, in some regions of Northeast China, current HIV-1 epidemic feature is largely unknown.
Methods: Information of 1006 newly diagnosed HIV-1 infected participants were collected before antiretroviral therapy during 2010-2016 in Heilongjiang province of Northeast China. HIV-1 genotype was identified based on the viral gag and env gene sequences. Recent infection was determined by Limiting-Antigen Avidity assays and the coreceptor usage of HIV-1 strains was predicted by Geno2Pheno software. Comparison analyses were made among different participant groups and sampling time periods to understand HIV-1 epidemic situation in this region.
Results: Homosexual contact among men who have sex with men (MSM) was the main transmission route and CRF01_AE was the most dominant HIV-1 genotype. Newly diagnosed cases showed a younger trend, which was mainly due to the continuous increase in young cases (aged < 30 years) among MSM population, especially the young MSM infected by CRF01_AE virus. CRF01_AE had surpassesd subtype B and become the dominant HIV-1 genotype among young MSM cases. The young MSM infected by CRF01_AE exhibited higher CD4 cell counts and a higher recent infection rate, and contained viruses with lower frequency of predicted CXCR4/CRR5CXCR4 usage. The MSM participants who were recently infected by CRF01_AE virus had a lower CD4 cell count than those by non_CRF01_AE virus.
Conclusions: Young MSM have become a new vulnerable group for HIV-1 transmission in Northeast China. This group is changing local HIV-1 epidemic pattern. Measures for preventing and controlling HIV-1 infection among this population are urgently needed in the future.
- Nosocomial Infections & Control
Session Introduction
Ogra Marufu
Sidra Medicine, Qatar
Title: Implementing a robust and successful multidrug resistant organisms screening program in a new tertiary pediatric and women’s hospital
Biography:
Ogra Marufu is a holder of MSc Health and Environment from Cranfield University, UK. She is the Manager – Infection Prevention and Control at Sidra Medicine, Qatar. She has published one paper in a peer reviewed journal on C.difficile which has been cited in international guidelines and other artciles. She has co-authored numerous abstracts and presented at international conferences. She is a Forbes Ignite Impact Fellowship Fellow (2021) and worked as part of a team of women from across the globe using artificial intelligence (AI) to develop solutions for healthcare challenges. She has a keen interest in AI and how this can impact infection control.
Abstract:
Multidrug resistant organisms (MDROs) are spreading across the globe in healthcare facilities leading to protracted hospital stays, increased healthcare costs and mortality. Sidra Medicine. a women’s and children hospital, opened in 2018 in Doha, Qatar. It was important to establish a robust MDRO screening programme in order to determine the epidemiology of the MDROs in the population served by the hospital. The goals of the programme are to ensure the early detection of colonised and infected patients on admission to ensure their appropriate managment and prevent outbreaks. The MDRO surveillance programme and risk based screening protocol were developed based on international guidelines. The targeted MDROs are Methicilin resistant Staphylococcus aureus (MRSA), Carbapenemase producing organisms (CPO), Vancomycin resistant Enterococci (VRE) and Candida auris. The decision to target these four was based on the global MDRO epidemiology and on Qatar’s population profile. The Infection Prevention and Control (IPAC) team met with all key stakeholders and agreed on the screening worklows for each clinical division, the practicalities of impelementing the programme and the management of positive patients. This allowed for clear designation of responsibilities. In addition to the admission screening and swabbing of patients, the long stay patients (i.e. those who are inpatient for ≥14 days) are swabbed. The compliance with screening and swabbing is audited every month by the IPAC team and results are shared with the clinical units. The compliance with MDRO admission screening across the clinical units has been sustained ≥90% for the past 12 months.
- Infection Control Bacteriology
Session Introduction
Jibi Thankachan
Tertiary Care Hospital, UK
Title: “Neonatal Sepsisâ€- Gram Positive & Negative Bacteria’s and their Antibiotic Susceptibility in NICU
Biography:
Jibi T has completed his Bachelor Degree in Nursing from Rajiv Gandhi University, India. After completing the studies he has joined one of the prestigious Hospitals based in USA, Columbia Asia from where he completed his basic Training in Infection Control. he had also completed his advanced training in Infection Control From Columbia Asia Bangalore India. Later he took Specialty training in Surgical Site Infection Prevention from ANCC. Since 2011 he works with King Saud Medical City, Riyadh Saudi Arabia as a Specialist/Senior Preventionist of Infection Control.
In 2021 he has completed his Advanced Training in Covid19 Tracing Methodogy from John Hopkins University and also Covid 19 advanced Practices Training from Stanford University Online. He also works a Covid-19 Rapid Response at Central First Health Cluster, MOH, and Riyadh.
Abstract:
Back Ground:
Neonatal sepsis is one of the most common causes of Neonatal Mortality and Morbidity in developing countries. Its causative bacteria’s and their sensitive patterns are different in each hospitals and regions. The objective of the study was to determine the causation bacteria’s and their pattern of susceptibility to antibiotic s in NICU of a tertiary care center.
Material and Methods:
The prospective study was carried out at a tertiary care hospital during the period from January 2020 to January 2021. A total of 1712 blood cultures sent from different sites of the patients in NICU during this period. Out of which 1011 cultures came with positive bacterial growth (Includes gram +ve & -ve, Cons and other Recognized pathogens). All cultures were screened by using a micro ESR & Culture and Sensitivity methods.
Results:
A total of 1011 cultures were found to be positive out of 1712 cultures sent. Out of 1011 positive cultures 450+ are of gram positive organisms and remaining are of positive results with growth. The most common organisms isolated was Staph Epidermidis (68%), followed by Staph Heamolyticus (10%), Staph Hominis(7%), Enterococcus Fecalis(5%). Other Organisms where much less in number which includes Pathogenic Streptococcus, Enterococcus Feacium, Staph Capitis, Bacillus Species etc. There was Incidence of Gram Negative Organisms like E - Coli, Proteus Mirabilis, Serratia Marcescens were also got isolated from Cultures. The Gram Positive Organisms except Streptococcus displayed a high degree of resistance to most Penicillin and Ciprofloxacin and were most time sensitive to Vancomycin, Amikacin and Cefepime. In some cases high incidence of resistance noted with Ampicillin, Gentamicin amongst most Gram Negative Organisms, where in Cefepime, Amikacin and Meropenem were effective in most cases
Conclusion:
There is an increasing trend of antibiotic resistance to the commonly used front line drugs. Continuo’s surveillance for antibiotic susceptibility is needed to ensure proper empirical therapy.