BackgroundHand hygiene is recognized as an important measure to prevent healthcare-associated infections. Hand hygiene adherence among healthcare workers is associated with their knowledge and perception. This study aimed to evaluate the effect of three different educational programs on improving hand hygiene compliance, knowledge, and perception among healthcare workers in a tertiary care hospital in Indonesia.MethodsThe study was performed from May to October 2014 and divided into a pre-intervention, intervention, and post-intervention phase. This cluster randomized controlled trial allocated the implementation of three interventions to the departments, including role model training-pediatrics, active presentation-surgery, a combination of role model training and active presentation-internal medicine, and a control group-obstetrics-gynecology. Both direct observation and knowledge-perception survey of hand hygiene were performed using WHO tools.ResultsHand hygiene compliance was observed during 2,766 hand hygiene opportunities, and knowledge-perception was assessed among 196 participants in the pre-intervention and 88 in the post-intervention period. After intervention, the hand hygiene compliance rate improved significantly in pediatrics (24.1% to 43.7%; P < 0.001), internal medicine (5.2% to 18.5%; P < 0.001), and obstetrics-gynecology (10.1% to 20.5%; P < 0.001). The nurses’ incorrect use of hand rub while wearing gloves increased as well (P < 0.001). The average knowledge score improved from 5.6 (SD = 2.1) to 6.2 (SD = 1.9) (P < 0.05). In the perception survey, “strong smell of hand alcohol” as a reason for non-compliance increased significantly in the departments with intervention (10.1% to 22.9%; P = 0.021).ConclusionThe educational programs improved the hand hygiene compliance and knowledge among healthcare workers in two out of three intervention departments in a limited-resource hospital in Indonesia. Role model training had the most impact in this setting. However, adjustments to the strategy are necessary to further improve hand hygiene.

Latar belakang. Infeksi kandidiasis invasif meliputi infeksi aliran darah dan infeksi invasif dalam lainnya yang disebabkan oleh spesies Kandida dan merupakan penyebab morbiditas dan mortalitas yang signifikan, khususnya pada pasien dengan status immunocompromised, seperti pada kondisi keganasan hematologis, kelainan limfoproliferatif, dan gangguan myeloproliferative.Tujuan. Menginvestigasi peran skor Kandida, dibandingkan dengan kultur darah dan PCR, sebagai alat diagnostik kandidiasis invasif pada pasien dengan neutropenia berat, khususnya pada kasus keganasan.Metode. Penelitian ini menggunakan desain penelitian cross sectional. Data yang diperoleh diolah dan dianalisis menggunakan metode Receiver operating characteristic (ROC) untuk mendapatkan nilai area under curve (AUC). Berdasarkan kurva AUC kemudian dilakukan pencarian titik potong yang paling optimal untuk mendapatkan nilai sensitivitas dan spesifisitasHasil. Hasil penelitian menunjukkan bahwa pada kedua kelompok dengan kultur positif dan negatif tidak didapatkan perbedaan bermakna berdasarkan karakteristik jenis kelamin, usia, berat badan, status gizi, dan diagnosis klinis (uji Mann-Whitney, p>0,05).Kesimpulan. Berdasarkan hasil tersebut, dapat disimpulkan bahwa tidak didapatkan perbedaan pada sensitivitas dan spesifisitas skor Kandida dibandingkan dengan hasil kultur pada pada pasien anak dengan neutropenia berat.

Introduction:Elizabethkingia meningoseptica is a Gram-negative Bacillus associated with various nosocomial infections. These bacteria cause meningitis, sepsis, bacteremia, pneumonia, infections of the skin and soft tissue, ocular infections, sinusitis, epididymitis, and endocarditis. They can be opportunistic pathogens in newborns and immunocompromised patients.Case Presentation: The current study reported a case of bacteremia caused by E. meningoseptica in an infant presented with clinical presentations suggestive of necrotizing fasciitis with cerebral salt wasting and disseminated intravascular coagulation. Based on clinical diagnosis and preliminary blood culture report, the patient started receiving intravenous antibiotic (cefepime plus fludrocortisone) and fluid therapy for electrolyte imbalance. The patient also had fasciotomy and an amputation through the distal phalanges due to necrotizing fasciitis. The patient improved clinically after eight weeks of treatment. Conclusions: E. meningoseptica bacteremia is commonly associated with complications; therefore, an appropriate and adequate antibiotic therapy, and also intensive care procedures and multidisciplinary interventions were crucial for the management of this case.

Abstract Introduction: Candida is the cause of most systemic fungal infections that plays a role in the pathophysiology of sepsis in newborns, especially in premature infants with late-onset sepsis. The candida score can be used to assess the occurrence of systemic candidosis where a candida score 2.5 can accurately identify patients who are at high risk for candidiasis infection. Monocytes also play an important role in preventing candida invasion. Materials and methods: This study used a cross sectional research design. Data was collected from premature infants with late-onset sepsis being suspected of systemic candidosis in neonatology inpatient ward. It was submitted from the period of November-December 2021. It takes a minimum of 31 samples to meet the criteria to process and analyze the data. The data obtained were processed and analyzed using the Receiver Operating Characteristic (ROC) method to obtain the Area Under Curve (AUC) value. Based on the AUC curve, the search for the most optimal intersection is carried out to obtain the sensitivity and specificity values. Results: Of the 31 research subjects, the number of subjects with positive PCR results was 27 (76.93%) while negative were 4 respondents (12.9%). The mean value of PCR density in the positive group of subjects was 76.93 and the range was 40.23 122.78. Meanwhile, in the group of subjects who were negative, the PCR density value was 0. The results of the candida score diagnostic test showed that the sensitivity obtained was 81%. Higher sensitivity and specificity 70% were found in the combined examination of candida scores and monocyte counts according to cut-off compared with separate examinations. Conclusions: The combined examination of candida score and monocyte count can be used as a diagnostic test for systemic candidosis in premature infants with late-onset sepsis, and could be used to consider the initiation of empirical antifungal therapy, either prophylactically or therapeutically, especially in limited laboratory facilities in Indonesia.

Background Early recognition of septic shock in terms of clinical, macrocirculatory hemodynamic, and microcirculatory laboratory parameters is a fundamental challenge in the emergency room and intensive care unit for early identification, adequate management, prevention of disease progression, and reduction of mortality risk. Objective To evaluate for possible correlations between survival outcomes of post-resuscitation pediatric septic shock patients and parameters of clinical signs, macrocirculatory hemodynamics, as well as microcirculatory laboratory findings. Methods This prospective, study was conducted in the PICU at Saiful Anwar Hospital, Malang, East Java. Inclusion criteria were children diagnosed with septic shock according to the 2005 Surviving Sepsis Campaign (SSC) criteria, aged >30 days-18 years, who were followed up for 72h after resuscitation. The measured variables such as cardiac index (CI), systemic vascular resistance index (SVRI), stroke volume index (SVI) were obtained from ultrasonic cardiac output monitor (USCOM). Blood gas and lactate were obtained from laboratory findings. Heart rate, pulse strength, extremity temperature, mean arterial pressure (MAP), systolic blood pressure (SBP), capillary refill time (CRT), Glasgow coma scale (GCS), and diuretic used were obtained from hemodynamic monitoring tools. Survival outcomes of post-resuscitation pediatric septic shock patients were noted. Results There was a significant correlation between the outcomes of the pediatric septic shock patients 72h after fluid resuscitation and clinical, macrocirculatory hemodynamic, and microcirculatory laboratory parameters. After the 6th hour of observation, strong pulse was predictive of survival, with 88.2% area under the curve (AUC). At the 12th hour of observation, MAP >50th percentile for age was predictive of survival, with 94% AUC. Conclusion For pediatric patients with septic shock, the treatment target in the first 6 hours is to improve strength of pulse, and that in the first 12 hours is to improve MAP >50th percentile for age to limit mortality.