The second most prevalent healthcare-associated infection in neonatal intensive care units (NICUs) is ventilator-associated pneumonia (VAP). This review aims to update the knowledge regarding the incidence of neonatal VAP and to summarize possible strategies for prevention. The VAP incidence ranges from 1.4 to 7 episodes per 1000 ventilator days in developed countries and from 16.1 to 89 episodes per 1000 ventilator days in developing countries. This nosocomial infection is linked to higher rates of illness, death, and longer hospital stays, which imposes a substantial financial burden on both the healthcare system and families. Due to the complex nature of the pathophysiology of VAP, various approaches for its prevention in the neonatal intensive care unit have been suggested. There are two main categories of preventative measures: those that attempt to reduce infections in general (such as decontamination and hand hygiene) and those that target VAP in particular (such as VAP care bundles, head of bed elevation, and early extubation). Some of the interventions, including practicing good hand hygiene and feeding regimens, are easy to implement and have a significant impact. One of the measures that seems very promising and encompasses a lot of the preventive measures for VAP are the bundles. Some preventive measures still need to be studied.

Background: According to the World Health Organization, approximately 280 million individuals worldwide suffer from depression. One occupational group that is more prone to mental health issues is healthcare workers (HCWs). However, very little is known about the mental health of HCWs in Afghanistan. Therefore, the present study examined depression, quality of life (QOL), and related factors among Afghan HCWs. Methods: A cross-sectional survey was administered in June 2022 among healthcare workers (N = 299) in the Herat province of Afghanistan. The survey examined depression, its risk factors and predictors among HCWs. Results: Of the 299 participants, 73.6% of them reported depression symptoms. Low monthly income, working in a private hospital, and being a cigarette smoker were some of the main variables associated with depression symptoms among Afghan HCWs. Multiple regression analysis indicated that field of work (aOR = 3.774, p = 0.0048), monthly income (aOR = 0.746, p = 0.0088), job type (aOR = 8.970, p < 0.0001), cigarette smoking (aOR = 2.955, p = 0.0069), a bad event happening during the past month (aOR = 2.433, p = 0.0157), physical domain of quality of life (aOR = 0.966, p = 0.0186), and psychological domain of quality of life (aOR = 0.950, p = 0.0005) were significantly associated with depression symptoms. Conclusion: The prevalence of depression symptoms is high among healthcare workers in the Herat province of Afghanistan. One of the variables found to have a major impact on the prevalence of depression was their monthly income. Considering its impact on quality of life and the overall quality of healthcare services, the government should implement regular screening for depression, psychological counselling services, and psychiatric treatment for vulnerable healthcare workers.

Depression is a very common mental health illness characterized by a cluster of signs and symptoms ranging from mood disturbances and sleep or appetite disorders to physical manifestations of the body. The purpose of the present study was to estimate the prevalence of depression and its related factors among Afghan women. A cross-sectional study was conducted among women between July 14, 2021, to August 15, 2021, in Kabul, Mazar-e-Sharif and Samangan provinces (Afghanistan). A total of 664 Afghan women participated in the study (mean age = 28.85 years; SD ± 11.57). In order to assess depression among participants, the 19-item validated Dari version of the Center for Epidemiological Studies–Depression Scale was used. Approximately four-fifths of the sample had depression symptoms (79.1%). Participants with depression symptoms were significantly more likely to (i) be aged over 30 years, (ii) live in rural areas, (iii) have a low-income level, (iv) not have an occupation, (v) have any disease/illness, and (vi) have experienced an event that had mentally affected them in the past month. Considering the high prevalence of depression symptoms among Afghan women, there is a need to integrate mental health services for women in Afghanistan. The use of interventions including regular screening for depression symptoms, and educating women and girls concerning the symptoms of depression for early self-diagnosis are essential.

The concept of improving the quality and safety of healthcare is well known. However, a follow-up question is often asked about whether these improvements are cost-effective. The prevalence of nosocomial infections (NIs) in the neonatal intensive care unit (NICU) is approximately 30% in developing countries. Ventilator-associated pneumonia (VAP) is the second most common NI in the NICU. Reducing the incidence of NIs can offer patients better and safer treatment and at the same time can provide cost savings for hospitals and payers. The aim of the study is to assess the direct costs of VAP in the NICU. This is a prospective study, conducted between January 2017 and June 2018 in the NICU of University Hospital “St. George” Plovdiv, Bulgaria. During this period, 107 neonates were ventilated for more than 48 h and included in the study. The costs for the hospital stay are based on the records from the Accounting Database of the setting. The differences directly attributable to VAP are presented both as an absolute value and percentage, based on the difference between the values of the analyzed variables. There are no statistically significant differences between patients with and without VAP in terms of age, sex, APGAR score, time of admission after birth and survival. We confirmed differences between the median birth weight (U = 924, p = 0.045) and average gestational age (t = 2.14, p = 0.035) of the patients in the two study groups. The median length of stay (patient-days) for patients with VAP is 32 days, compared to 18 days for non-VAP patients (U = 1752, p < 0.001). The attributive hospital stay due to VAP is 14 days. The median hospital costs for patients with VAP are estimated at €3675.77, compared to the lower expenses of €2327.78 for non-VAP patients (U = 1791.5, p < 0.001). The median cost for antibiotic therapy for patients with VAP is €432.79, compared to €351.61 for patients without VAP (U = 1556, p = 0.024). Our analysis confirms the results of other studies that the increased length of hospital stays due to VAP results in an increase in hospital costs. VAP is particularly associated with prematurity, low birth weight and prolonged mechanical ventilation.

Introduction: Nosocomial infections (NI) are frequent complications in neonatal intensive care units (NICU) which result in high morbidity and mortality. Aim: To determine and analyze the incidence, risk factors and etiologic agents of NI in newborns admitted in the NICU to help plan-ning future surveillance and prevention strategies. Materials and methods: A prospective cohort study was carried out at the NICU of St George University Hospital, Plovdiv, Bul-garia from January 1, 2017 to June 31, 2018. The number of neonates included in the study was 507. Descriptive statistics such as count, percent, mean and standard deviation was used. Chi-square test was performed to prove associations. Odds ratios, with 95% confidence intervals, were computed from the results of the binominal logistic regression analyses. Results: Of the 507 hospitalized newborns in NICU, 48 presented with 54 NI. The incidence and the density incidence rates were 9.5% and 7.67 per 1,000 patient-days, respectively. Nosocomial infections were detected in neonates from all birth weight (BW) classes, but it was low BW and premature neonates that were at major risk to acquire them. The most common infection sites were ventilator-asso-ciated pneumonia (VAP) (67.27%), bloodstream infection (23.64%) and conjunctivitis (9.09%). Major pathogens were Gram-negative such as Klebsiella pneumoniae, E. coli, Pseudomonas aeruginosa and Acinetobacter baumannii. In the multivariate logistic regression analysis NIs were strongly associated with intubation, presence of a venous catheter, the duration of antibiotic treatment and increased CRP> 10 mg/l. Conclusions: This report highlights the burden of NIs, identifies the major focus for future NI control and prevention programs.

The prevalence of hepatitis E virus (HEV) in the Bulgarian population remains underestimated. The aim of the present study was to evaluate age and gender trends in HEV prevalence in the heterogeneous Bulgarian population. Stored serum samples from blood donors and different patient sub-populations—kidney recipients (KR), patients with Guillain–Barre syndrome (GBS), Lyme disease (LD), patients with liver involvement and a clinical diagnosis other than viral hepatitis A and E (non-AE), hemodialysis (HD) and HIV-positive patients (HIV)—were retrospectively investigated for markers of past and recent/ongoing HEV infection. The estimated overall seroprevalence of past infection was 10.6%, ranging from 5.9% to 24.5% for the sub-populations evaluated, while the seroprevalence of recent/ongoing HEV infection was 7.5%, ranging from 2.1% to 20.4%. The analysis of the individual sub-populations showed a different prevalence with respect to sex. In regard to age, the cohort effect was preserved, as a multimodal pattern was observed only for the GBS sub-population. Molecular analysis revealed HEV 3f and 3e. The type of the population is one of the main factors on which the anti-HEV prevalence depends, highlighting the need for the development of guidelines related to the detection and diagnosis of HEV infection with regard to specific patient populations.