SummaryBackgroundSurgical-site infections are a major concern in obstetric surgery. In Ukraine, evolving national guidelines and institutional antimicrobial stewardship (AMS) initiatives have sought to optimize peri-operative antibiotic prophylaxis (PAP), but their impact on clinical outcomes requires rigorous evaluation.MethodsWe conducted a retrospective cohort study (2018–2023) of 474 obstetric surgeries to evaluate changes in PAP adherence and its association with length of stay (LOS). Adherence was assessed using a 3-point compliance score (timing, choice, and duration). The association between compliance and time to discharge was analysed using a multi-variable Cox proportional hazards model.FindingsA marked improvement in practice was observed; full compliance increased from 11% to 71%, while mean LOS decreased from 9.9 to 4.7 days. Component analysis showed that structural interventions eliminated duration errors, while errors in antibiotic choice persisted. In the multi-variable model, the ‘year of surgery’ was the strongest predictor of earlier discharge (P < 0.001), acting as a proxy for holistic systemic improvements. While the compliance score was not an independent predictor in the overall cohort, binary compliance showed a trend towards significance (P = 0.098), remaining statistically subordinate to secular trends. A significant association was found only in the highly standardized laparoscopy subgroup, suggesting the impact of protocol adherence is most visible in predictable clinical environments.ConclusionMulti-faceted AMS programs can successfully optimize PAP adherence and improve outcomes. While the overall reduction in LOS is driven by broad improvements over time, specific guideline adherence remains a crucial quality indicator, particularly for standardized procedures.

SummaryBackgroundPatient education regarding hand hygiene (HH) and the correct use of non-sterile clinical gloves (NSCGs) are important parts of infection prevention and control. Unnecessary use of NSCGs can be harmful, has associated financial costs, and harms the environment. This study aimed to explore healthcare workers' (HCWs) adherence to patient education regarding HH and the correct use of NSCGs in an observation unit.MethodsData in this observational descriptive cross-sectional study were collected from patients using a questionnaire. The questionnaire asked about the patient education received and the use of NSCGs by HCWs. The correctness of NSCG use was determined by the investigators based on standard precautions on infection prevention and control. Statistical analysis and qualitative content analysis were performed.ResultsThe convenience sample consisted of 174 patients in an observation unit at Helsinki University Hospital, and 600 care, examination or test procedures conducted for patients. The response rate was 87%. Of the participating patients, 8.6% reported that they had received patient education on HH. Eighteen different procedures were conducted for the study patients. The use of NSCGs was always correct for six procedures. Unnecessary use of NSCGs was found (to varying degrees) for nine procedures, and insufficient use of NSCGs was found for three procedures. An association was found between a procedure/procedure type conducted for a patient and the correct use of NSCGs (P<0.001).ConclusionsDeviations from the standard precautions existed. Interventions for HCWs are needed to support routine patient education on HH and evidence-based use of NSCGs.

SummaryKlebsiella pneumoniae is a major cause of healthcare-associated infections. Although colonisation with Gram-negative bacteria in hospitalised patients is well recognised, the relative contributions of patient-to-patient versus environment-to-patient transmission remain unclear. Most outbreak investigations focus on multi-drug-resistant (MDR) strains. This study investigates a non-MDR K. pneumoniae outbreak in an intensive care unit (ICU) to examine the role of the hospital environment in nosocomial transmission. Clinical isolates of Klebsiella spp. were obtained from six patients between January 2021 and June 2021. Environmental swabs were collected from handwashing sinks in patient and preparation rooms, 3 months apart. Whole-genome sequencing (WGS) assessed singlenucleotide polymorphism (SNP)-based relatedness using literature-informed thresholds. WGS identified five distinct clusters of genetically related K. pneumoniae isolates, linking clinical and environmental sources. The closest relationships (2—5 SNPs) were observed between patient and sink isolates within the same room, consistent with recent transmission or a shared source. Additional clusters (5—23 SNPs) involved isolates from sinks in different rooms, indicating environmental persistence and potential inter-room dissemination. Two Klebsiella varicola subspecies variicola bloodstream isolates from spatially distinct patients differed by only 2 SNPs, forming an additional cluster consistent with a common clonal lineage. Following enhanced daily sink disinfection and staff education, no further clinical acquisitions were identified. WGS demonstrated genetic relatedness between nonMDR Klebsiella spp. strains and ICU environmental isolates, underscoring the role of environmental reservoirs in transmitting antimicrobial-susceptible Gram-negative organisms and the importance of targeted surveillance beyond MDR settings.