Occupational stress and associated factors among clinical nurses caring for COVID-19 patients in a Vietnamese tertiary hospital.

BACKGROUND: Nursing professional is one of the most stressful jobs, particularly during the COVID-19 pandemic. When caring for COVID-19 patients, nurses face challenging conditions and limited resources, as well as the fear of infecting themselves and their families, putting them at risk for depression, anxiety, and insomnia. The purpose of this study was to determine the frequency, sources, and risk factors for occupational stress among clinical nurses caring for COVID-19 patients in a Vietnamese tertiary hospital. METHODS: A cross-sectional survey was conducted among all clinical nurses (184 nurses) at a tertiary hospital in Vietnam from March 15 to April 15, 2021. A questionnaire was used for collecting data. Data analysis was done by descriptive statistics, bivariate and multivariate logistic regressions. Risk factors were identified by adjusted odds ratio with 95% confidence interval and P values less than 0.05. RESULTS: The survey was completed by 89.7% (165/184) of clinical nurses. Most participants were female (85.5%) and ≤ 40 years old (97.6%). Overall, participants reported a medium stress level with an Extended Nursing Stress Scale (ENSS) mean score of 1.79 points, and 32.1% had occupational stress. Prevalence of occupational stress among participants caring for COVID-19 patients (34.0%) was not statistically significant difference with that among those who did not (29.4%). Nurses' occupational stress in emergency and intensive care units (50.0%) was substantially higher than that in the other departments (11.7%). The most stressors for participants were difficulties connected to inadequate emotional preparedness, patients and families, and death and dying, with subscale mean scores of 1.97, 1.88, and 1.88 points, respectively. In multivariate analysis, working at an emergency and intensive care unit (OR 4.97), usually or more frequently feeling heavy duty for patients (OR 3.17), and income decrease (OR 3.03) were risk factors associated with occupational stress. CONCLUSION: One-third of clinical nurses at a tertiary hospital experienced occupational stress, with highest rate occurred at emergency and intensive care units. Nurses' working conditions at emergency and intensive care units should be essentially addressed to improve nurses' occupational stress.

High prevalence of hospital-acquired infections caused by gram-negative carbapenem resistant strains in Vietnamese pediatric ICUs: A multi-centre point prevalence survey.

There is scarce information regarding hospital-acquired infections (HAIs) among children in resource-constrained settings. This study aims to measure prevalence of HAIs in Vietnamese pediatric hospitals.Monthly point prevalence surveys (PPSs) in 6 pediatric intensive care units (ICUs) in 3 referral hospitals during 1 year.A total of 1363 cases (1143 children) were surveyed, 59.9% male, average age 11 months. Admission sources were: other hospital 49.3%, current hospital 36.5%, and community 15.3%. Reasons for admission were: infectious disease (66%), noninfectious (20.8%), and surgery/trauma (11.3%). Intubation rate was 47.8%, central venous catheter 29.4%, peripheral venous catheter 86.2%, urinary catheter 14.6%, and hemodialysis/filtration 1.7%. HAI was diagnosed in 33.1% of the cases: pneumonia (52.2%), septicemia (26.4%), surgical site infection (2%), and necrotizing enterocolitis (2%). Significant risk factors for HAI included age under 7 months, intubation and infection at admission. Microbiological findings were reported in 212 cases (43%) with 276 isolates: 50 Klebsiella pneumoniae, 46 Pseudomonas aeruginosa, and 39 Acinetobacter baumannii, with carbapenem resistance detected in 55%, 71%, and 65%, respectively. Staphylococcus aureus was cultured in 18 cases, with 81% methicillin-resistant Staphylococcus aureus. Most children (87.6%) received antibiotics, with an average of 1.6 antibiotics per case. Colistin was administered to 96 patients, 93% with HAI and 49% with culture confirmed carbapenem resistance.The high prevalence of HAI with carbapenem resistant gram-negative strains and common treatment with broad-spectrum antibiotics and colistin suggests that interventions are needed to prevent HAI and to optimize antibiotic use.

Antibiotic susceptibility and molecular epidemiology of Acinetobacter calcoaceticus-baumannii complex strains isolated from a referral hospital in northern Vietnam.

Acinetobacter calcoaceticus-baumannii complex is a common cause of hospital-acquired infections (HAIs) globally, remarkable for its high rate of antibiotic resistance, including to carbapenems. There are few data on the resistance of A. baumannii in Vietnam, which are essential for developing evidence-based treatment guidelines for HAIs. Antibiotic susceptibility testing was conducted by VITEK®2, and pulsed-field gel electrophoresis (PFGE) was performed on 66 clinical A. baumannii complex isolates recovered during 2009 at the National Hospital of Tropical Diseases (NHTD), a referral hospital in Hanoi, Vietnam. Basic demographic and clinical data were collected and analysed using descriptive statistics. Most isolates came from lower respiratory tract specimens (59; 89.4%) from intensive care unit (ICU) patients [64/65 (98.5%) with available data] who had been admitted to NHTD for ≥2 days [42/46 (91.3%) with available data]. More than 90% of the isolates were resistant to the tested ß-lactamase/ß-lactamase inhibitors, cephalosporins, carbapenems, fluoroquinolones and trimethoprim/sulfamethoxazole. Moreover, 25.4% (16/63) were resistant to all tested ß-lactams, quinolones and aminoglycosides. All isolates remained sensitive to colistin and 58.7% were susceptible to tigecycline. Of the 66 isolates, 49 could be classified into eight PFGE types (A-H). Every PFGE type, except D, had cluster(s) of three or more isolates with a temporal relationship. In conclusion, these data suggest a significant rise in A. baumannii antibiotic resistance in Vietnam. Clustering within PFGE types supports cross-transmission of A. baumannii within the ICU at NHTD. Increased research and resources in optimising treatment, infection control and antibiotic stewardship are needed.