Implementation of the infection prevention and control core components at the national level: a global situational analysis.

BACKGROUND: Strengthening infection prevention and control (IPC) is essential to combat healthcare-associated infections, antimicrobial resistance, and to prevent and respond to outbreaks. AIM: To assess national IPC programmes worldwide according to the World Health Organization (WHO) IPC core components. METHODS: Between June 1st, 2017 and November 30th, 2018, a multi-country, cross-sectional study was conducted, based on semi-structured interviews with national IPC focal points of countries that pledged to the WHO 'Clean Care is Safer Care' challenge. Results and differences between regions and national income levels were summarized using descriptive statistics. FINDINGS: Eighty-eight of 103 (85.4%) eligible countries participated; 22.7% were low-income, 19.3% lower-middle-income, 23.9% upper-middle-income, and 34.1% high-income economies. A national IPC programme existed in 62.5%, but only 26.1% had a dedicated budget. National guidelines were available in 67.0%, but only 36.4% and 21.6% of countries had an implementation strategy and evaluated compliance with guidelines, respectively. Undergraduate IPC curriculum and in-service and postgraduate IPC training were reported by 35.2%, 54.5%, and 42% of countries, respectively. Healthcare-associated infection surveillance was reported by 46.6% of countries, with significant differences ranging from 83.3% (high-income) to zero (low-income) (P < 0.001); monitoring and feedback of IPC indicators was reported by 65.9%. Only 12.5% of countries had all core components in place. CONCLUSION: Most countries have IPC programme and guidelines, but many less have invested adequate resources and translated them in implementation and monitoring, particularly in low-income countries. Leadership support at the national and global level is needed to achieve implementation of the core components in all countries.

Factors related to the process of seeking and completing treatment for drug abuse (qualitative methods in drug abuse research).

Numerous studies have demonstrated the effectiveness of drug abuse treatment. Yet many drug abusers do not enter treatment, many who do enter leave prematurely, and relapse following treatment is common. Understanding motivation for change and treatment readiness is key to understanding how to induct and engage drug users in treatment. To the extent that treatment programs focus initially on reducing drug use, rather than psychosocial problems that motivate individuals to seek treatment, treatment programs may fail to meet the primary needs of users and thus fail to attract or engage them. Outcomes of substance abuse treatment programs historically have been measured by successful program completion, reduced drug use and illegal activity, and improved social functioning (employment, education etc). There is minimal reference to client expectations of treatment and factors that influenced treatment-seeking behavior. Studies that have assessed client dropout from substance abuse treatment have generally focused upon quantitative measures that attempt to determine what types of clients drop out or stay, or what types of characteristics best predict client dropout. Qualitative methods are the most appropriate to fill these gaps in substance abuse treatment research.

Structural and functional characterization of the Leishmania amazonensis ribosomal RNA promoter.

The promoter region of the ribosomal RNA (rRNA) genes of Leishmania amazonensis was characterised and the transcription start point, defined by primer extension, was shown to be a T residue, 1048 nucleotides upstream of the beginning of the 18S sequence. A repetitive element of 60 bp was identified in the intergenic spacer. This element did not show sequence similarity with the region around the transcription start point. Conserved sequences were found in the external transcribed spacer of L. amazonensis, Trypanosoma cruzi and Crithidia fasciculata rRNA genes, 150 nucleotides downstream of the transcription start point. These sequences might be involved in processing events of the rRNA precursor molecule. The general organisation of the gene resembles the pattern observed for the ribosomal cistron in eukaryotic cells. Constructs containing the L. amazonensis promoter region upstream of the chloramphenicol acetyltransferase (cat) gene were able to drive the expression of the reporter gene in transient transfection experiments. CAT expression could be detected even when no trans-splicing acceptor sequence was added to the constructs, although its presence enhanced 5-fold the level of CAT activity. Species-specificity of the RNA polymerase I promoter activity was also demonstrated since constructs containing the L. amazonensis promoter region were unable to drive CAT expression when transfected into the related trypanosomatids, T. cruzi, C. fasciculata and Endotrypanum schaudini.