Hidden bugs in a newly opened hospital: the distribution of skin microbiota among healthcare workers in a newly opened teaching hospital.

Background. Skin is a reservoir for millions of micro-organisms, all of which make up the skin microbiota. Hospitals have been identified as a favourable environment for transmitting micro-organisms and thus, it is important to know the distribution of skin microbiota among healthcare workers (HCWs), as such findings may provide baseline information for the distribution of skin microbiota in hospitals.Hypothesis. There is no significant association between the factors (age, gender, type of skin microenvironment, hand hygiene practices, usage of skin care products, current healthcare practices and previous workplace) and the distribution of the skin microbiota among HCWs.Aim. The study aims to identify type of skin microbiota and associated factors (age, gender, type of skin microenvironment, hand hygiene practices, use of skincare products, current healthcare practice, and previous workplace) that influence the growth of skin microbiota.Method. About 102 bacterial isolates were obtained from the skin of 63 healthcare workers in a newly opened teaching hospital, namely Hospital Pengajar Universiti Putra Malaysia (HPUPM). All isolated bacteria were subjected to phenotypic identification according to standard microbiological procedures.Results. The most common isolated skin microbiota were Gram-positive bacteria (84.3%), followed by Gram-negative bacteria (15.7%). A Chi-square test of independence was used to analyse the above factors and there was a significant association between the type of skin microenvironment and the distribution of skin microbiota (P=0.03) (type of skin microenvironment influences the distribution of skin microbiota).Conclusion. Coagulase-negative Staphylococcus spp. was the most common bacteria isolated from the skin of the healthcare workers. Even though coagulase-negative staphylococci (CoNS) are low pathogenic bacteria, but it may cause serious infection in high risk group of patients. Therefore, it is important to emphasize on the good hand hygiene practices and implement strict infection control measures to minimize the risk of HAI in newly opened hospitals.

A multicentre study to determine the in vitro efficacy of flomoxef against extended-spectrum beta-lactamase producing Escherichia coli in Malaysia.

Background: The high burden of extended-spectrum beta-lactamase-producing (ESBL)-producing Enterobacterales worldwide, especially in the densely populated South East Asia poses a significant threat to the global transmission of antibiotic resistance. Molecular surveillance of ESBL-producing pathogens in this region is vital for understanding the local epidemiology, informing treatment choices, and addressing the regional and global implications of antibiotic resistance. Methods: Therefore, an inventory surveillance of the ESBL-Escherichia coli (ESBL-EC) isolates responsible for infections in Malaysian hospitals was conducted. Additionally, the in vitro efficacy of flomoxef and other established antibiotics against ESBL-EC was evaluated. Results: A total of 127 non-repetitive ESBL-EC strains isolated from clinical samples were collected during a multicentre study performed in five representative Malaysian hospitals. Of all the isolates, 33.9% were isolated from surgical site infections and 85.8% were hospital-acquired infections. High rates of resistance to cefotaxime (100%), cefepime (100%), aztreonam (100%) and trimethoprim-sulfamethoxazole (100%) were observed based on the broth microdilution test. Carbapenems remained the most effective antibiotics against the ESBL-EC, followed by flomoxef. Antibiotic resistance genes were identified by PCR. The blaCTX-M-1 was the most prevalent ESBL gene, with 28 isolates (22%) harbouring blaCTX-M-1 only, 27 isolates (21.3%) co-harbouring blaCTX-M-1 and blaTEM, and ten isolates (7.9%) co-harbouring blaCTX-M-1, blaTEM and blaSHV. A generalised linear model showed significant antibacterial activity of imipenem against different types of infection. Besides carbapenems, this study also demonstrated a satisfactory antibacterial activity of flomoxef (81.9%) on ESBL-EC, regardless of the types of ESBL genes.

Draft Genome Sequences of Four Methicillin-Resistant Staphylococcus aureus Strains (M080_2017, M106_2017, M181_2017, and M191_2017), Isolated from a Malaysian Teaching Hospital.

Draft genome sequences were obtained for four methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from various wards of the Hospital Canselor Tuanku Muhriz (HCTM), Kuala Lumpur, Malaysia, in 2017. Using different bioinformatics tools, we annotated the draft genomes and identified multiple antimicrobial resistance genes.

Colonization of Methicillin-Resistant Staphylococcus aureus (MRSA) among Medical Students in Tertiary Institution in Central Malaysia.

Methicillin-resistant Staphylococcus aureus or MRSA infection is virulent and presents with a broad spectrum of severity. Limited regional reports that specifically outlined the potential risk of medical students being part of the dissemination of MRSA in healthcare settings were noted. This study aims to assess the prevalence and contributory factors of colonization of MRSA on neckties, headscarves, and ID badges among medical students in a local medical university in Malaysia. A cross-sectional study was conducted involving 256 medical students. A validated questionnaire was used to collect the data, and sample swabs were collected between July and August 2013 by swabbing neckties, headscarves, or identification badges. The swabs were then streaked onto mannitol salt agar (MSA) and incubated at 37 °C overnight. Out of 433 samples taken, 40 swabs (9.24%) were positive for Staphylococcus aureus. Out of the 40 swabs, five (12.5%) isolates were MRSA (one culture was isolated from the headscarf of a preclinical student, one culture was isolated from the necktie of clinical students, while the remaining three were isolated from identification badges of clinical students. There was no significant association between age, gender, ethnicity, and phase of medical students with the colonization of MRSA (p > 0.05). There was a significant association between knowledge score on hand hygiene practice and phase of medical students. MRSA colonies were present on neckties, headscarves, and identification badges of medical students of all phases. The findings from this study suggest the need for improvement of hand hygiene knowledge and discontinuity of mandatory use of physical ID badges and neckties among medical students.

Assessment on Hand Hygiene Knowledge and Practices Among Pre-school Children in Klang Valley.

Background. Pre-school children are at a higher risk to acquire infectious diseases such as hand, foot and mouth disease due to their immature immune system. Good hand hygiene prevents transmission of infectious diseases. This study aimed to determine the knowledge and practices of hand hygiene among pre-schoolers. Methods. In this prospective, multi-center study, the pre-schools were selected according to the selection criteria. A questionnaire consisting of socio-demographics, knowledge and practices of hand hygiene were administered via face-to-face interview during the pre- and post-intervention period. A total of 435 pre-schoolers aged 5 and 6 years old from 2 pre-schools within Klang Valley, School P (test group) and School C (control group) were involved in this study. The test group was provided with comprehensive hand hygiene education including video on proper handwashing technique during the 2 months intervention period, whereas the control group did not receive any form of intervention. The data were statistically analyzed using descriptive analysis and independent t-test. Results. Majority of pre-schoolers gained knowledge of handwashing from their parents. However, only 63% demonstrated good handwashing technique. Test group were significantly better (P < 0.05) in handwashing technique and hand hygiene routine score. Conclusion. A comprehensive hand hygiene education program should include proper handwashing facilities, resources, and awareness of the care-givers in instilling and sustaining good hand hygiene behavior.

Effect of hand hygiene intervention on the absenteeism of pre-school children in Klang Valley, Malaysia: a quasi-experimental study.

BACKGROUND: Absenteeism amongst pre-school children is often due to illnesses such as hand, foot, and mouth disease, acute gastroenteritis, cold and flu, which are easily spread amongst them. This is because of weak immunity and lack of knowledge on proper hand hygiene. This quasi-experimental study assessed the efficacy of an intervention consisting of a hand hygiene education programme, along with digital tools in bringing about a change in behaviour and health conditions amongst pre-school children in Klang Valley, Malaysia. METHODS: A total of 377 school children, male and female, aged 5-6 years old, participated and were assigned to either the intervention or a control group. During the 2 months intervention period, children in the test group were trained on proper hand hygiene practices and techniques with the aid of the interactive android-based tablets. The numbers of absent days of all the children were recorded for 2 months before the intervention and during the intervention. RESULTS: In the test group, there was a 25% increase in the total number of absent days from the pre-intervention period to the intervention period, a much lesser increment observed as compared to that of control group in which the increase was much higher at 89%. Results showed a significant difference (P < 0·05) between the absenteeism rates for the test and control group during the intervention period. CONCLUSION: These results suggest that proper education and intervention increase hand hygiene compliance, which may help decrease school absenteeism due to illness; however, a longer study duration may be necessary to evaluate the benefit further.

Low Levels of Knowledge, Attitudes and Preventive Practices on Leptospirosis among a Rural Community in Hulu Langat District, Selangor, Malaysia.

Little is known on the knowledge, attitudes and preventive practices (KAP) of leptospirosis worldwide. This study embarked on assessing the KAP of leptospirosis among rural communities in Malaysia. A total of 444 participants (223 male; 221 female) aged between 18 and 81 years old were surveyed by using a self-administered questionnaire. A majority of participants had poor knowledge level (57.0%), unacceptable attitudes (90.3%) and unacceptable preventive practices (69.1%) on leptospirosis, and only 29.7% knew "rat-urine disease" as leptospirosis. Only 34.2% of the participants knew the bacteria could enter via wound lesions. Ethnicity and income were strongly associated with knowledge level and preventive practices, respectively (p-values < 0.05). As for attitudes, ethnicity, income and education type were significantly associated (p-values < 0.05). Only 36.5% of the participants were willing to see a doctor and did not mind if their house or surrounding area is dirty (59.7%). Surprisingly, only 32.9% had used rubber boots during floods. By logistic regression analysis, ethnicity was the only significant predictor for both knowledge level (an odds ratio (AOR) = 0.39, 95% confidence interval (CI) = 0.222-0.680) and preventive practices (AOR = 1.81, 95% CI = 1.204-2.734). Ethnicity (AOR = 0.40, 95% CI = 0.239-0.665), income (AOR = 1.58, 95% CI = 1.041-2.385) and education type (AOR = 3.69, 95% CI = 1.237-10.986) were strong predictors for attitudes. Among the KAP variables, attitude (AOR = 4.357, 95% CI = 2.613-7.264) was the only predictor for the preventive practices by logistic regression analysis. The KAP elements on leptospirosis are still lacking and poor health seeking behavior and attitudes are of our utmost concern. Thus, effective strategies should be planned to impart knowledge, and develop proactive approaches and good preventive modules on leptospirosis to this leptospirosis-prone community.