Introduction: We propose to develop a Unique Device Identification (UDI) barcode tracking system for surgical instruments. This system aims to enhance hospital processes, thereby benefiting both patients and staff members. Methods: The UDI barcode tracking system for surgical instruments was implemented in March 2023: 1. Each surgical instrument underwent laser engraving with a UDI barcode, encompassing relevant data such as instrument name, image, model, specifications, origin, license, Instructions for Use (IFU), and total distribution quantity. 2. Upon scanning the engraved serial number, the system automatically discerns whether the instrument belongs to the designated set. 3. Mechanical, chemical, and biological monitoring indicators are integrated into the tracking system, with automatic adjudication for release into storage if criteria are met; otherwise, notifications are issued for review and retrieval by personnel. Results: 1. Between March 2023 and February 2024, a total of 157,614 instrument sets were equipped with this system, enabling staff to achieve a zero-error rate in rapid and precise instrument identification. 2.During this period, 4,026 cycles of high-temperature sterilization monitoring and 380 cycles of low- temperature H2O2 plasma sterilization monitoring were recorded. 3.Each monitoring cycle was digitally recorded, obviating the necessity for paper-based documentation and saving a total of 4,406 A4 paper sheets. 4. In the same timeframe, a total of 85,899 packages were dispensed, each linked to patient medical record numbers. Conclusions: The adoption of the surgical instrument UDI barcode tracking system by our institution’s central sterilization supply department has garnered participation from 622 individuals. It not only reduces the time spent by staff searching for items and conducting educational training but also automatically identifies whether the instrument belongs to the package, thereby enhancing inventory efficiency and reducing the incidence of errors. Sterilization monitoring indicators are automatically uploaded and intercepted to uphold patient safety.

Background: Hospital antibiotic stewardship programs (ASPs) are essential for reducing unnecessary antibiotic use and combating antimicrobial resistance. While many ASP interventions have been described, their feasibility and sustainability remain unclear, particularly for smaller hospitals with limited informatics resources. This study aimed to assess the feasibility and sustainability of common ASP interventions and examine the impact of hospital bed size on sustainability. Methods: A cross-sectional survey was conducted between April and May 2023 across 69 hospitals in Michigan participating in the Michigan Hospital Medicine Safety Consortium, representing both large (<200 beds) hospitals. Quality improvement or antimicrobial stewardship staff from each hospital ranked the feasibility of 7 common antibiotic stewardship interventions on a scale from 1 (easiest) to 7 (hardest). Respondents were then asked to report their status with 43 individual stewardship interventions as: a) implemented and sustained, b) implemented, but not sustained, c) tried but unable to implement, or d) never done. We used descriptive statistics and Fisher’s exact tests to compare reported intervention feasibility and implementation by hospital bed size (small vs. large). Results: All 69 hospitals responded to our survey (100% response rate). Across all hospitals, increasing audit and feedback by pharmacists was reported as the easiest new intervention to implement, whereas starting clinician peer comparison was reported as the hardest (Figure 1). Hospitals had implemented and sustained multiple stewardship interventions with substantial variation by intervention (Figure 2). Reported feasibility of the 7 common stewardship interventions did not significantly differ between large and small hospitals. However, small hospitals had significantly higher implementation of five antibiotic stewardship interventions: removal or change in order sets in urine culture testing (implemented by 73.1% of small hospitals vs. 46.3% of large hospitals; p=0.04), two-step urine culture initiative to reduce unnecessary testing (27% vs. 7%; p=0.04), Emergency Department order set with decision support de-emphasizing broad-spectrum antibiotics for CAP (77% vs. 48%; p = 0.02), daily pharmacy review of antibiotics for UTIs (58% vs. 30%; p=0.04), and daily pharmacy review of anti-pseudomonal antibiotics for CAP (73% vs. 46%; p=0.04). Conclusions: Feasibility and implementation of ASP interventions varied widely, with most interventions sustained once implemented. Technical solutions were 26.4% more likely to be sustained than adaptive ones. Small hospitals showed higher implementation rates for several interventions, potentially due to smaller patient populations and fewer administrative barriers. Hospitals should tailor ASP priorities to their local context, focusing on feasible and sustainable interventions.

Introduction: Urinary tract infection (UTI) is a common healthcare-associated problem. UTI has a lower mortality prevalence than other infections, but it is at high risk of leading to sepsis and increased treatment costs. Therefore, the objective of the study is to describe the epidemiology and burden of disease and determine factors associated with healthcare-associated UTI in the intensive care units (ICUs). Methods: A cross-sectional study was conducted on 4.028 patients admitted to the ICU, Neuro Surgical ICU, and ICU - Cardiovascular Surgery Department at a teaching hospital in Ho Chi Minh City from 2017 to 2022. The study collected secondary data through electronic medical records, including age, gender, diagnosis, department, urinary catheter use, urinary catheter retention time, treatment, and urine test results. Results: The prevalence of UTI in ICUs was 4.0%, of which CAUTI accounts for the highest prevalence, with the typical pathogen being E. coli. The Neuro Surgical ICU had the highest incidence and catheter-used prevalence in ICUs. UTIs were concentrated in people over 80 years old, females, and brain diseases. The length of the hospital stay was long, and the cost of the hospital stay was unaffordable, up to hundreds of millions of VND. The study found factors associated with the prevalence of UTI, such as age, gender, department, diseases, and urinary catheters. Patients with urinary catheters have a 10.98 times higher prevalence of UTI (p < 0.001; PR = 10.98, 95% CI 4.87–24.76) compared to patients without urinary catheters. Conclusions: The results of the study demonstrated that UTI remains a burden on the healthcare system, especially in ICUs. Implementing a UTI prevention package for patients with catheters is important. Besides, it is necessary to maintain continuous training for healthcare workers to properly and timely insert, remove, and replace catheters.

Background: Negative-pressure isolation room was considered the standard for Tuberculosis (TB) isolation ward, but it tends to be high in cost and maintenance. Alternatively natural ventilation with the combination of mechanical ventilation (exhaust fan) room were more commonly used in resource-limited settings. However, its efficacy to prevent TB to the medical staffs are unknown. Objective: To compare the prevalence of latent TB among medical staffs that works in negative-pressure isolation ward against natural ventilation isolation ward at Kandou General Hospital Manado. Methods: An cross-sectional study involving 20 medical personnel that have worked for more than 6 months in negative -pressure isolation ward and natural ventilation isolation ward at Kandou General Hospital Manado, North Celebes, Indonesia. Exclusion criteria were history of TB disease or TB latent, immunodeficiency and long term steroid uses. Fischer exact test and regression analysis was used to evaluate the differences between variables. Results : There were 7 medical personnel (35%) from the negative-pressure isolation ward compared to 11 medical personnel (55%) in natural ventilation isolation ward that were positive for Interferon Gamma Release Assay (IGRA). There were no significance differences between the type of isolation room and the prevalence of latent tuberculosis (p= 0.341). There were also no significant correlations between room type (p = 0.633), work duration (p = 0.181), and the prevalence of latent TB (R2 = 0.06). Conclusion : There is no significant difference between latent TB prevalence among medical presonnel in negative- pressure isolation room and natural ventilation isolation room. Natural ventilation room could be used as an alternative to negative-pressure isolation room.

Background: Calls within the clinical community for revising guidance on the appropriate durations of antibiotic therapy (i.e., shorter is better) and adherence (i.e., no longer advising to always finish a course), reflect important gains in evidence-based prescribing. However, changing medical guidance can have negative public effects (e.g., frustration, distrust, and disengagement) when not communicated in ways that resonate with patients. To inform efforts to effectively communicate evolving evidence on appropriate antibiotic use, we examined US adults’ perceptions and preferences regarding antibiotic durations and adherence. Methods: From March to April 2024, we invited US adults, aged ≥18 years, to an online survey about antibiotics. Question topics included durations of antibiotic therapy, adherence to a prescribed course of antibiotics, and demographic characteristics. Results: Table 1 shows the characteristics of the 1,476 respondents [completion=89%]. Most respondents reported they preferred to take a longer course of antibiotics (≥7 days) than a shorter one (3-5 days) for a bacterial respiratory infection (60.4% vs. 39.5%) and rated longer courses as both safer and more effective (Table 2). In open-text questions, respondents who preferred shorter courses described a general aversion to medication and concerns about side effects and resistance, whereas those who preferred longer courses saw them as familiar and a ‘better safe than sorry’ approach, associating longer durations with greater efficacy. In addition, 88.4% of respondents agreed that ‘it is important to always finish a prescribed course of antibiotics, even if you start to feel better’ and had either been told this by a medical professional (76.3%) or seen this guidance in a public health message (61.2%). Conversely, only 17.5% said they had ever been told they could stop taking antibiotics early. Preference for longer antibiotic courses was associated with older age, trusting their doctor’s advice about antibiotic therapy durations, having been told by their doctor to ‘always finish a course of antibiotics’, less worry about antibiotic side effects, discomfort about potentially being asked by a clinician to stop taking antibiotics when they start to feel better, and perceiving the clinician suggesting that as less competent. Conclusions: Many US adults prefer longer durations of antibiotic therapy for respiratory infections than are likely necessary. Almost all survey respondents believed it important to always finish a course and many were uncomfortable with advice to the contrary. These findings highlight the need for evidence-based communication strategies for aligning US adults’ antibiotic duration and adherence preferences with current guidance.

Background: In University Medical Center Ho Chi Minh City (UMC), shelf life of sterilized packed items has been followed by time-related principle. However, duration of sterility has not been based on strong scientific evidence. Objectives: To determine the most appropriate shelf life for sterilized products according to packaging material and sterilization methods. Methods: All the experimental and the control samples (surgical instruments and linen) were prepared by four types of packaging materials (peel pouch, nonwoven, linen, and rigid container) and three types of sterilization methods (steam, Hydrogen Peroxide, Ethylene Oxide). After sterilization, sterilized samples were stored at CSSD’s storage and tested for microbial contamination in 07 periods: after 07 days, 14 days, 01 month, 03 months, 06 months, 12 months, and 18 months. Identification of the storage environment (shelf location, temperature, and relative humidity) were recorded as the same time collected samples. Results: Positive microbial cultures were seen in 0.44% (07 samples) of 1,574 samples. Up to 18 months, no organisms was cultured from any sample of (1) autoclaved surgical instrument packages wrapped in peel pouches, nonwoven, linen, (2) Hydrogen Peroxide sterilized surgical instrument packages wrapped in nonwoven, (3) Ethylene Oxide sterilized surgical instrument packages, and (4) autoclaved linen packages wrapped in nonwoven. Organisms detected were both Gram–Positive and Gram-Negative bacteria. Just only approximately 17% control samples grew bacteria. There was no any statistically significant relationship between positive experimental samples and packaging materials, sterilization methods, or storage conditions. Conclusions: Based on results of this experiment, shelf life of sterilized packed items should be still followed by time-related principle in UMC. However, the currently shelf life can be extended to reduce unnecessary costs and increase the usage rotation.

Introduction: Community-acquired pneumonia (CAP) is the leading infectious cause for hospitalization. Guidelines recommend use of a macrolide antibiotic with a beta-lactam for coverage of atypical organisms; however, data supporting macrolide coverage disproportionately include patients with severe CAP. Debate remains regarding the benefit of macrolide coverage among patients hospitalized with non-severe CAP. Methods: We emulated a target trial to evaluate outcomes associated with azithromycin use among patients hospitalized with non-severe CAP between 7/2017 and 8/2024 across 69 hospitals in Michigan. Included patients had an ICD-10 discharge diagnosis code of pneumonia, >2 signs or symptoms of CAP, and radiographic findings. Patients with severe CAP, risk factors for multi-drug-resistant organisms, those not started on standard CAP therapy with a narrow-spectrum beta-lactam with or without azithromycin, or those initially receiving doxycycline were excluded. Time zero was the time of first antibiotic administration on encounter day 1 or 2. Groups receiving and not-receiving azithromycin were balanced using inverse probability of treatment weighting (IPTW) assessed using standardized mean differences (SMD). The primary outcome was time to clinical stability. Secondary outcomes included intensive care unit (ICU) transfer, 30-day rehospitalization, 30-day mortality, and protocol deviation (i.e., azithromycin initiation after time zero [no-azithromycin group], patients receiving <5 days of azithromycin [azithromycin group]). We used the Cox model and multivariable Poisson regression for time-to-event and binary outcomes, respectively. Based on point prevalence of outcomes within our cohort, we were well powered to detect the demonstrated relative differences in all outcomes. Results: Of the 59,698 patients meeting criteria for pneumonia, 19,108 patients were included in the final post-exclusion cohort. Of these, 93.7% (17,904/19,108) received azithromycin on day 1 or 2 (median antibiotic duration 4.0 days [IQR 3,5]), while 6.3% (1,204/19,108) did not. After IPTW, groups receiving and not-receiving azithromycin were well balanced (SMDs <0.1). After adjustment, median time to clinical stability did not differ between the azithromycin and no-azithromycin groups (3 vs 3 days; HR 1.01 [95% confidence interval 0.97–1.14], p=0.74), nor did rate of ICU transfer (0.9% vs 1.3%; HR 0.90 [0.51–1.62], p=0.73). Patients receiving azithromycin had lower rates of 30-day rehospitalization (10.8% vs 15.3%, HR 0.69 [0.58–0.82], p<0.001) and 30-day mortality (2.3% vs. 4.0%; HR 0.70 [0.50–0.93), p=0.03). Protocol deviation occurred more commonly in those initially receiving azithromycin (56.5% vs 11.1%; HR 1.58 [1.32–1.82], p<0.001). Conclusions: Addition of azithromycin to beta-lactam therapy in patients hospitalized with CAP did not influence short-term outcomes but may reduce 30-day rehospitalization and mortality.

Antibiotic prophylaxis in children with vesicoureteral reflux (VUR) remains controversial. We reviewed patients diagnosed with VUR after an index urinary tract infection (UTI) who subsequently received antibiotic prophylaxis. Recurrent UTIs in patients with and without urologic anomalies occurred in 57% and 33%, respectively. Multidrug-resistant organisms accounted for 25% of first UTI recurrences.

Background: A comprehensive understanding of antimicrobial prescribing practices, requires antimicrobial stewardship (AMS) clinicians to assess both the quantity and quality of antimicrobial prescribing. In Australia, two national programs collect and analyse such data in the hospital setting; the National Antimicrobial Utilisation Surveillance Program (NAUSP) a continuous, volume-based surveillance program that monitors antimicrobial usage trends; and the Hospital National Antimicrobial Prescribing Survey (Hospital NAPS) a standardised auditing program that assesses antimicrobial prescribing appropriateness. This study aims to analyse the 2023 NAUSP and Hospital NAPS data to compare the volume and appropriateness of inpatient antimicrobial use in Australian hospitals. Methods: Data were extracted from hospitals that participated in both programs in 2023, including systemically administered antimicrobials for adult patients. NAUSP data were aggregated and acute inpatient usage rates relative to patient activity were calculated as Defined Daily Doses (DDD) per 1,000 Occupied Bed Days (OBD) for individual antimicrobials.

Hospital NAPS data on appropriateness of prescribing, as assessed by local auditors as a point prevalence survey and using a standardised assessment matrix, were aggregated and calculated for each antimicrobial. Antimicrobials with high-volume use (NAUSP data), high rates of antimicrobial prescribing (NAPS data), or classified as medium to high risk for antimicrobial resistance potential according to the World Health Organization AWaRe classifications were further investigated. Results: There were 192 acute care hospitals that contributed in 2023 to both NAUSP (representing 12, 619, 253 OBDs) and Hospital NAPS (representing 21,017 antimicrobial prescriptions). Figure 1 summarizes the aggregate usage rates and appropriateness for antimicrobials of interest. Antimicrobials with the highest usage rates, including amoxicillin-clavulanic acid and cefazolin (92.2 and 78.8 DDD/1,000 OBD respectively), had moderate levels of appropriateness (67.8% and 69.9% respectively). Similar ‘Access‘ antimicrobials such as doxycycline, amoxicillin and metronidazole, which tend to be unrestricted in hospital formularies, had moderate levels of appropriateness. Cefalexin had the lowest rate of appropriateness (52.2%). In comparison, ‘Watch‘ antimicrobials, including meropenem and vancomycin, which tend to be restricted, had lower usage rates (14.3 and 19.8 DDDs/1,000 OBD respectively) but higher rates of appropriateness (83.5%, 82.8% respectively). Conclusion: This analysis highlights the importance of assessing and analyzing antimicrobial quantity and quality concurrently, providing a holistic view of prescribing practices. Furthermore, AMS efforts should include all antimicrobials, regardless of restriction category, as commonly used, unrestricted antimicrobials may have substantial rates of inappropriate prescribing.

Introduction: Bloodborne pathogens’ exposures are defined as injuries to contaminated sharps and exposures to patients’ blood or body fluids continue to present risks to healthcare workers (HCWs). This study was conducted to investigate the epidemiological characteristics of sharps injuries and evaluate the effectiveness of prevention strategies in an Academic Medical Centre (AMC) in Singapore. Method: This retrospective study was conducted at a 1,700 bedded AMC. The data was retrieved from the hospital’s electronic incident reporting system over a five-year period between 2019 and 2023 at Singapore General Hospital. Results: There are a total of 719 bloodborne pathogens’ exposures incidents. The highest incidence of bloodborne pathogens’ exposures was reported among doctors (3.5 incidents per 1000 healthcare workers per month), followed by nurses (1.4), allied health (0.4) and ancillary staff (0.3) during the 5- year period. Intraoperative procedures (IOP) 198 (27.5%) see the most frequent incidents followed by minor procedures 112(15.6%), splash incidents 91 (12.7%), blood taking 87(12.1%), IVIM (8.3%). The highest incidents among IOP were associated with use of suture needles. Approximately 2.9%, 2.3% and 0.7% of the source patients were carriers for Hepatitis B, Hepatitis C and HIV respectively. No seroconversion occurred among all injured HCWs. The overall sharps injury incidence has improved from 21.5 to 11.2 per 1000 healthcare workers per year following targeted preventive measures implementation. Conclusion: A comprehensive bloodborne pathogen exposures programme greatly helps to improve and mitigate the risk of exposures where key preventive measures are identified, followed by timely implementation of appropriate post-exposure management.

Introduction: Razors were being used for pre-operative hair removal in our Institute. As per international guidelines recommending the use of surgical clippers, we opted to study the effects of two pre-operative skin preparations in our Neurosurgical centre Objectives: Primary; Pre auditing period -Assess knowledge and skill in usage of Razor/Clipper as preoperative skin preparation methods, Provide training on Clipper method and assess the knowledge /awareness on merits and demerits of both methods, To implement the Clipper method as against Shaving Secondary ; Post auditing period -Investigate the efficacy and safety of clippers versus razors, on variety of biophysical parameters and Surgical Site Infection (SSI) Methods : PICO questions ; Population: Adult patients undergoing any type of surgical procedure, Intervention: Hair removal, Comparator: Different methods of Hair removal, Outcomes: Biophysical parameters and SSI •Target population: Sixty adult patients undergoing neurosurgical procedures. •Subjects: 30 each subjected to shaving and clipper methods •Pre and Post assessment of on 25 parameters /sub-parameters •Analysis by MS-Excel and SPSS. Results:•Preoperative -Prior skin injuries and/or reactions; adequacy of hair removal •Complete hair removal : 30 (100%) in the clipper group versus 3 (10%) by shaving (p = 0.0001). •30 mins after hair removal ; significantly less skin issues in the clipper group •Post operative - Skin injuries in 20 (66.6%) of the razor and none in the clipper group. •SSI - Two (6.6%) in the razor and none in the clipper group. Conclusions: The assessment showed that shaving leads to partial hair removal increasing the scores for skin issues, significant association between preoperative skin injuries and SSI, implying inverse correlation with the clipper method. This study provides insights into significance of among other biophysical parameters underscoring adoption of clipper as the standard practice for preoperative hair removal, in our setting thus enhancing patient safety.

Background: In summer 2024, our institution implemented enhanced blood culture (BCx) stewardship due to a global BCx shortage. Centers for Medicare and Medicaid Services’ (CMS) SEP-1 quality measure requires BCx. We evaluated whether the BCx shortage and stewardship impacted SEP-1 compliance. Methods: A retrospective review of SEP-1 data from an academic and a community hospital (1/1/2022-9/30/24) was performed and grouped by quarter. SEP-1 compliance was abstracted per CMS criteria. Failures due to BCx were categorized by timing of antibiotics prior to BCx: short delay (0-3 hours after antibiotics), long delay (>3 to 24 hours or no BCx). SEP-1 failures due to no BCx underwent manual chart review to determine infectious source, alternative culture obtainment, and adjudication if BCx would have changed clinical management. BCx failures were compared descriptively by quarter with emphasis on the BCx shortage (quarter 3 of 2024). Results: Over 11 quarters, 690 cases were abstracted for SEP-1 review (mean 62.7 cases/quarter). The mean SEP-1 success rate pre-shortage was 51.1%, while SEP-1 success rate during BCx shortage was 40.3%, the lowest rate since 2022. SEP-1 failures due to improper BCx obtainment were the cause of SEP-1 failure in a mean of 12.3% of cases reviewed pre-shortage, but this increased to 30.6% during the BCx shortage (Figure 1). Pre-shortage BCx failures were due to short delays (77.9%), long delays (15.6%), and no BCx (6.5%). During the shortage, BCx failures were more commonly due to long delays (31.6%) or no BCx obtained (31.6%) (Figure 2). The majority (7/12) of cases with no BCx obtained were during the shortage. Upon adjudication of no BCx cases, positive BCx would have significantly changed management in only 2/12 cases. Reasons BCx would not have changed management included urinary tract infection with positive urine culture (5/12), non-infectious/non-bacteremic diagnoses (3/12), and community-acquired peritonitis with surgery (2/12). Specifically during the shortage, 5 were UTIs (4 had positive cultures), 1 with peritonitis (positive intra-abdominal cultures), and 1 without bacterial infection. Conclusion: SEP-1 failures increased during the BCx shortage, possibly driven by efforts to reduce unnecessary BCx use. Use of alternative culture sites with higher yield than blood cultures resulted in SEP-1 failures that did not result in patient harm. SEP-1 should be re-evaluated, as BCx are not the only means of diagnosing the microbiologic etiology of infection and are often low yield in select patients with sepsis.

Advancement of antimicrobial stewardship (AS) programs requires partnership with clinicians, quality assurance teams, and laboratorians. Inevitably, AS programs also practice diagnostic stewardship (DS), as stewards are aptly placed to connect key stakeholders and help steer processes toward higher value care for pediatric patients. In this review, we illustrate five moments of collaboration between stakeholders in the interplay between AS and DS in pediatrics. These moments include (1) Observation, (2) Reflection, (3) Exploration, (4) Enactment and (5) Evaluation. We offer a targeted narrative of examples in current literature using common relatable scenarios (ie, endotracheal aspirates, blood cultures, gastrointestinal samples, and urine testing) including impact on financial and environmental waste.

Background: Antimicrobial Stewardship Program (ASP) is a global issue. World Health Organization (WHO) stated, there are 3 categories of antimicrobial: ACCESS, WATCH, and RESERVE. e-RASPRO as a digital ASP may alter antibiotic prescribing pattern by prioritizing ACCESS category as suggested by WHO. Methods: This manuscript was a ward retrospective survey data of 9 months Define Daily Dose (DDD) average before-after implementing the electronic-RASPRO (e-RASPRO) on ACCESS & WATCH antibiotic. Results: Number of inpatients 9 months before-after e-RASPRO implementation were 7,754 and 6,794. Within 9 months after implementing e-RASPRO there was a trend of antibiotic prescription shifting from WATCH category antibiotic to ACCESS category antibiotic. There was a trend of reduced Define Daily Dose (DDD) average of WATCH category antibiotic. 24.82% of 3rd generation Cephalosporin, 33.20% of Quinolones, 14.76% of Carbapenems and 100% of Piperacillin Tazobactam DDD average were reduced. While, in ACCESS Category Antibiotic, there were an elevation of Penicillin and Aminoglycosides DDD average up to 528.66% and 137.66%. Conclusion: T here are trend changing of DDD average from WATCH to ACCESS category antibiotic following the 9 months implementation of e-RASPRO. We need further study to judge the effectiveness of e- RASPRO as a digital ASP tools.

Introduction: The prevention of colonization of new inpatient room sinks with epidemiologically important pathogen (EIP) is poorly understood. Methods: We performed a randomized controlled trial and microbiological analysis to describe the timing and frequency of EIP contamination of in-room handwashing sinks in a renovated general medicine unit and to test the efficacy of a disinfectant on wastewater drains. Unit renovations included new distal plumbing for all unit sinks. Sinks were randomized 1:1 to intervention and control. 15 intervention sinks underwent the application of a foamed disinfectant into each study sink’s drain (Virasept [Ecolab]) every Monday, Wednesday, and Friday. 15 control sinks underwent standard disinfection. Microbiological samples were taken every week from 3 locations from each study sink: the top of the bowl, the tail pipe, and the p-trap. The primary outcome was sink conversion events (SCEs), defined as species-specific-EIP contamination of a sink in which that EIP had not previously been detected. EIPs were defined as Enterobacterales, Acinetobacter spp., Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. Sink hygiene compliance was also measured. Results: Sink samples were obtained 11 times from July 2024 to October 2024 giving 990 total cultures, 495 in each study arm. The first sampling occurred after renovations were completed and one week before patients returned to the unit. In total, 314 patients were admitted to the study unit during the study period. We observed 15 SCEs (68%) overall; 3 sinks (20%) in the intervention and 12 (80%) in the control arms (p < 0 .01) (Figure 1). Overall, 135 EIPs were recovered: 27 from intervention and 108 from control sinks (p < 0 .01). On the first sampling, 6 intervention and 3 control sinks already harbored EIP. Of those, all 6 in the intervention arm were not detected in subsequent samplings whereas all 3 in the control arm were. The [DAM1] [A2] most common organisms recovered were Acinetobacter spp. (70 [52%]), Stenotrophomonas maltophilia (29 [21%]), and Enterobacter spp. (23 [17%]). Of the 300 opportunities to measure sink hygiene compliance, 229 (76%) did not meet compliance, most commonly containing absorbent pads. Discussion: In a renovated general medicine unit, the application of the intervention led to significantly lower SCEs (20% vs. 80%) and EIPs (27 vs. 108) recovered from study stinks compared to control. Sink hygiene compliance was suboptimal, with 76% of observed instances involving inappropriate sink use. These findings highlight the importance of effective sink disinfection and sink hygiene protocols in reducing the risk of pathogen transmission.

Background: Occupa(onal blood and body fluid exposure is one of the major public health problems in healthcare workers (HCW). This condi(on had the risk of transmission of infec(ous diseases. Educa(on level is oEen considered a key factor influencing the frequency and dura(on of exposure. This study inves(gates the correla(on between medical profession and the (me of occupa(onal exposure among health workers at RSUD dr. Saiful Anwar Malang from 2020 to 2024. Objective : The primary objec(ve of this study is to determine whether there is a significant correla(on between the educa(on level of health workers and their exposure, with the aim of iden(fying poten(al areas for interven(on to reduce occupa(onal hazards. Methods : A cross sec(onal study from health workers from at RSUD dr. Saiful Anwar Malang. Data included gender, medical profession (nurse, resident, doctor, medical student, cleaning service), and (me of exposure (work hour, duty hour), and status immuniza(on. Sta(s(cal analysis was performed using the chi-square test to determine the significance of the rela(onship between employment status and exposure (me. Result: From 93 responden, distribution gender (60.6% female, 39.4% male), medical profession (35.5% nurse, 33.3% resident, 3.2% doctor, 23.7% medical student and 4.3% others), exposure time (53.2% duty hour, 46.8% working hour), source of exposure (61.3% needle, 34.4% blood, 5% others body fluid), 86.2% used PPE and 68,1% already had hepatitis B immunization. The analysis showed significant relationship with exposure time (p = 0.046) among medical profession and time of exposure. Conclussion : This study is important in identifying specific risks related to the group status of medical personnel and the time of exposure to needles, blood and body fluids to identify vulnerable workers. In addition, with this basic study, more effective safety policies and protocols can be developed by adapting to the needs of each work group. Research recommendation is needed to explore the impact of specific education and training programs in reducing the risk of exposure in HCW.