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Topic:Staphylococcus

Staphylococcus is a genus of bacteria commonly found on the skin and mucous membranes of horses. These bacteria can be part of the normal flora but may also act as opportunistic pathogens, leading to infections under certain conditions. In horses, Staphylococcus species can cause a range of infections, including skin infections, wound infections, and more severe conditions such as septicemia. The most frequently identified species in equine infections is Staphylococcus aureus, known for its ability to resist certain antibiotics, complicating treatment efforts. This page compiles peer-reviewed research studies and scholarly articles that explore the epidemiology, pathogenic mechanisms, and treatment strategies of Staphylococcus infections in horses.
Livestock-Associated Methicillin Resistant Staphylococcus aureus (LA-MRSA) Clonal Complex (CC) 398 Isolated from UK Animals belong to European Lineages.
Frontiers in microbiology    November 9, 2016   Volume 7 1741 doi: 10.3389/fmicb.2016.01741
Sharma M, Nunez-Garcia J, Kearns AM, Doumith M, Butaye PR, Argudín MA, Lahuerta-Marin A, Pichon B, AbuOun M, Rogers J, Ellis RJ, Teale C, Anjum MF.In recent years, there has been an increase in the number of livestock-associated methicillin resistant Staphylococcus aureus (LA-MRSA) clonal complex (CC) 398 recovered from S. aureus isolated animals in the UK. To determine possible origins of 12 LA-MRSA CC398 isolates collected after screening more than a thousand S. aureus animal isolates from the UK between 2013 and 2015, whole genome sequences (WGS) of CC398 European, including UK, and non-European isolates from diverse animal hosts were compared. Phylogenetic reconstruction applied to WGS data to assess genetic relatedness of all 89 iso...
Effect of Dose on Intra-Articular Amikacin Sulfate Concentrations Following Intravenous Regional Limb Perfusion in Horses.
Veterinary surgery : VS    September 29, 2016   Volume 45, Issue 8 1077-1082 doi: 10.1111/vsu.12564
Harvey A, Kilcoyne I, Byrne BA, Nieto J.To compare synovial concentrations of amikacin following intravenous regional limb perfusion (IVRLP) with two different doses, and to compare their ability to reach target concentrations for bacterial isolates from common orthopedic conditions. Methods: Randomized crossover experiment. Methods: Six adult horses. Methods: Horses received IVRLP with 2 and 3 g of amikacin in the cephalic vein of alternate limbs (20 minutes tourniquet application and ≥14 days washout period). Amikacin concentrations were quantified in synovial fluid collected from the middle carpal and metacarpophalangeal joints...
Serum and Synovial Fluid Serum Amyloid A Response in Equine Models of Synovitis and Septic Arthritis.
Veterinary surgery : VS    September 1, 2016   Volume 45, Issue 7 859-867 doi: 10.1111/vsu.12531
Ludwig EK, Brandon Wiese R, Graham MR, Tyler AJ, Settlage JM, Werre SR, Petersson-Wolfe CS, Kanevsky-Mullarky I, Dahlgren LA.To investigate the serum and synovial fluid serum amyloid A (SAA) response in equine models of synovitis and septic arthritis and to compare handheld and validated immunoturbidometric assays for SAA quantification. Methods: Controlled, experimental study. Methods: Healthy adult horses (n = 9). Methods: Synovitis (n = 4) and septic arthritis (n = 5) were induced using lipopolysaccharide and Staphylococcus aureus, respectively, and serial serum and synovial fluid samples were collected. Serial synovial fluid cytology was performed for both models and synovial fluid from the septic ar...
A retrospective analysis of antimicrobial resistance in bacterial pathogens in an equine hospital (2012-2015).
Schweizer Archiv fur Tierheilkunde    August 10, 2016   Volume 158, Issue 6 433-442 doi: 10.17236/sat00068
van Spijk JN, Schmitt S, Fürst AE, Schoster A.Antimicrobial resistance has become an important concern in veterinary medicine. The aim of this study was to describe the rate of antimicrobial resistance in common equine pathogens and to determine the occurrence of multidrug-resistant isolates. A retrospective analysis of all susceptibility testing results from bacterial pathogens cultured from horses at the University of Zurich Equine Hospital (2012-2015) was performed. Strains exhibiting resistance to 3 or more antimicrobial categories were defined as multidrug-resistant. Susceptibility results from 303 bacterial pathogens were analyzed, ...
Prevalence and antimicrobial susceptibility of bacterial isolates from horses with synovial sepsis: A cross-sectional study of 95 cases.
Veterinary journal (London, England : 1997)    July 16, 2016   Volume 216 117-121 doi: 10.1016/j.tvjl.2016.07.004
Robinson CS, Timofte D, Singer ER, Rimmington L, Rubio-Martínez LM.Bacterial culture and antimicrobial susceptibility testing of septic synovial samples allows instigation of targeted antimicrobial therapy; however, bacterial culture takes more than 24 h and has low sensitivity. This study aimed to identify the most frequently cultured bacteria and their antimicrobial susceptibility profile from septic synovial samples in our referral equine hospital, to allow recommendations regarding appropriate initial antimicrobial therapy prior to culture results. Hospital records for all horses with synovial sepsis and a synovial sample submitted to the microbiology l...
The Effects of Mepivacaine Hydrochloride on Antimicrobial Activity and Mechanical Nociceptive Threshold During Amikacin Sulfate Regional Limb Perfusion in the Horse.
Veterinary surgery : VS    July 15, 2016   Volume 45, Issue 6 798-803 doi: 10.1111/vsu.12515
Colbath AC, Wittenburg LA, Gold JR, McIlwraith CW, Moorman VJ.To determine the effect of intravenous regional limb perfusion (IVRLP) with a combination of mepivacaine hydrochloride and amikacin sulfate on synovial fluid amikacin sulfate concentration, antimicrobial activity, and mechanical nociceptive threshold (MNT). Methods: Experimental study. Methods: Healthy adult horses (n=9). Methods: One IVRLP treatment was randomly administered by cephalic vein of each limb: amikacin alone (1 g amikacin in 60 mL saline) or amikacin with mepivacaine (1 g amikacin and 500 mg mepivacaine in 60 mL saline). Opposite treatments were repeated after a 24 hour wash-out p...
Comparisons Between Staphylectomy and Tie-Forward Procedures in Combination with a Sternothyroideus Myotenectomy for the Treatment of Intermittent Dorsal Displacement of the Soft Palate: An Observational Study.
Veterinary surgery : VS    July 13, 2016   Volume 45, Issue 6 816-823 doi: 10.1111/vsu.12518
Carmalt JL, Johanssen B, Waldner C.To compare the performance of horses with intermittent dorsal displacement of the soft palate (IDDSP) treated surgically with a control group and to determine whether there was a difference in postoperative performance between horses treated with a staphylectomy or a tie-forward procedure. Methods: A retrospective observational study. Methods: Swedish Warmblood trotting horses (Standardbreds) with endoscopically confirmed IDDSP (n=56) and control horses (n=48) with endoscopically normal upper airways tested using overground endoscopy identified from medical records. Methods: Generalized estima...
Fighting Off Wound Pathogens in Horses with Honeybee Lactic Acid Bacteria.
Current microbiology    June 21, 2016   Volume 73, Issue 4 463-473 doi: 10.1007/s00284-016-1080-2
Olofsson TC, Butler É, Lindholm C, Nilson B, Michanek P, Vásquez A.In the global perspective of antibiotic resistance, it is urgent to find potent topical antibiotics for the use in human and animal infection. Healing of equine wounds, particularly in the limbs, is difficult due to hydrostatic factors and exposure to environmental contaminants, which can lead to heavy bio-burden/biofilm formation and sometimes to infection. Therefore, antibiotics are often prescribed. Recent studies have shown that honeybee-specific lactic acid bacteria (LAB), involved in honey production, and inhibit human wound pathogens. The aim of this pilot study was to investigate the e...
MRSA transmission between horses and vets: who’s doing the infecting?
The Veterinary record    May 8, 2016   Volume 178, Issue 19 471-472 doi: 10.1136/vr.i2531
Koop G.No abstract available
Meticillin-resistant Staphylococcus aureus colonisation and infection in Thoroughbred racehorses and veterinarians in Japan.
The Veterinary record    April 25, 2016   Volume 178, Issue 19 473 doi: 10.1136/vr.103576
Kuroda T, Kinoshita Y, Niwa H, Shinzaki Y, Tamura N, Hobo S, Kuwano A.Meticillin-resistant Staphylococcus aureus (MRSA) infections have been confirmed in hospitalised Thoroughbred racehorses at the hospitals of two training centres in Japan since 2009. To investigate the source of infection, the authors examined the rate of nasal MRSA colonisation in 600 healthy Thoroughbred racehorses, 53 veterinarians and 16 office staff at the racehorse hospitals of the two training centres. MRSA was not isolated from healthy Thoroughbred racehorses or hospital office staff. However, MRSA was isolated from 16 veterinarians (30.1 per cent), and the colonisation rate was signif...
A methicillin-resistant Staphylococcus aureus (MRSA) Sequence Type 8, spa type t11469 causing infection and colonizing horses in Italy.
Pathogens and disease    April 5, 2016   Volume 74, Issue 4 ftw025 doi: 10.1093/femspd/ftw025
Carfora V, Caprioli A, Grossi I, Pepe M, Alba P, Lorenzetti S, Amoruso R, Sorbara L, Franco A, Battisti A.A Methicillin-resistantStaphylococcus aureus(MRSA) was isolated in Italy from a pathological sample of a mare presenting chronic purulent sinusitis and that had undergone frontal-sinus surgery three months before. Humans, horses, dogs and environmental samples were subsequently collected at the mare's stable and at the Veterinary Hospital, where the mare was operated/hospitalized, and screened for the presence of MRSA that was detected from other horses and from the environment at both sites. All the MRSA isolates belonged to clonal complex (CC)8, ST8-t11469-SCCmec-IVa, and showed similar phen...
Microbiological characterization of stable resuspended dust.
International journal of occupational medicine and environmental health    March 19, 2016   Volume 29, Issue 3 375-380 doi: 10.13075/ijomeh.1896.00600
Kováts N, Horváth E, Jancsek-Turóczi B, Hoffer A, Gelencsér A, Urbán P, Kiss ÍE, Bihari Z, Fekete C.Air quality in the stables is characterized by elevated level of dust and aeroallergens which are supposed to directly cause or exacerbate several respiratory disorders. The most often recognized problem is recurrent airway obstruction (RAO), previously known as chronic obstructive pulmonary disease (COPD). There is some indication that aeroallergens (among them endotoxins) may also cause inflammation in human airways and may exceed safe levels in stables. Monitoring studies have covered mainly the determination of the concentration of respirable particles and of culturable fungi and their tox...
MRSA in equine hospitals and its significance for infections in humans.
Veterinary microbiology    January 21, 2016   Volume 200 59-64 doi: 10.1016/j.vetmic.2016.01.013
Cuny C, Witte W.MRSA infections in equine clinics were reported from Northern America, Europe, Australia, and Japan. The majority of nosocomial infections in horses is obviously associated with particular MRSA clonal lineages. As already observed for epidemic MRSA in human hospitals more than 10 years ago, a dynamics of MRSA clonal lineages is also observed in European equine clinics: clonal lineages belonging to clonal complex (CC) 8 are on the retreat whereas MRSA attributed to CC398 become increasingly prevalent. The majority of CC398 isolates belong to a subpopulation which is particularly associated with...
Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus Isolated from Australian Veterinarians.
PloS one    January 6, 2016   Volume 11, Issue 1 e0146034 doi: 10.1371/journal.pone.0146034
Groves MD, Crouch B, Coombs GW, Jordan D, Pang S, Barton MD, Giffard P, Abraham S, Trott DJ.This work investigated the molecular epidemiology and antimicrobial resistance of methicillin-resistant Staphylococcus aureus (MRSA) isolated from veterinarians in Australia in 2009. The collection (n = 44) was subjected to extensive molecular typing (MLST, spa, SCCmec, dru, PFGE, virulence and antimicrobial resistance genotyping) and antimicrobial resistance phenotyping by disk diffusion. MRSA was isolated from Australian veterinarians representing various occupational emphases. The isolate collection was dominated by MRSA strains belonging to clonal complex (CC) 8 and multilocus sequence typ...
Antimicrobial susceptibility of bacteria isolated from neonatal foal samples submitted to a New Zealand veterinary pathology laboratory (2004 to 2013).
New Zealand veterinary journal    November 23, 2015   Volume 64, Issue 2 107-111 doi: 10.1080/00480169.2015.1109006
Toombs-Ruane LJ, Riley CB, Kendall AT, Hill KE, Benschop J, Rosanowski SM.To describe antimicrobial susceptibility, and identify antimicrobial resistance (AMR), in bacteria isolated from New Zealand foals. Methods: A database search was performed of submissions to a veterinary pathology laboratory between April 2004 and December 2013 for bacterial culture of samples from foals <3 weeks of age. Culture and susceptibility results were compiled with demographic information. Susceptibility results were as defined for the Kirby-Bauer disk diffusion susceptibility test based on Clinical Laboratory Standards Institute guidelines. Multi-drug resistance (MDR) was defined as ...
Methicillin-resistant Staphylococcus aureus colonization and infection risks from companion animals: current perspectives.
Veterinary medicine (Auckland, N.Z.)    November 6, 2015   Volume 6 373-382 doi: 10.2147/VMRR.S91313
Petinaki E, Spiliopoulou I.Methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most virulent human pathogens and has also recently been recognized as such in the veterinary settings. Companion animals, including dogs, cats, horses, small exotic animals, wildlife animals, and livestock, may constitute a reservoir for MRSA transmission to humans and vice versa. The evolution, emergence, and risk factors for MRSA transmission among colonized or infected animals are reviewed in the present paper, and infection control practices are discussed.
Methicillin-resistant Staphylococcus aureus ulcerative keratitis in a Thoroughbred racehorse.
Journal of equine science    September 30, 2015   Volume 26, Issue 3 95-98 doi: 10.1294/jes.26.95
Kuroda T, Kinoshita Y, Niwa H, Mizobe F, Ueno T, Kuwano A, Hatazoe T, Hobo S.We report the first case of methicillin-resistant Staphylococcus aureus (MRSA) keratitis in a racehorse. A 5-year-old mare developed punctate keratitis after racing. The corneal ulcer continued to expand despite ophthalmic antimicrobial therapy. On day 6, a conjunctival graft surgery was performed. The mare was euthanized, following colitis and laminitis development on day 10. MRSA was isolated from the corneal swab taken at the time of euthanasia. Immunohistochemical analysis demonstrated gram-positive and anti-S. aureus monoclonal antibody-positive cocci infiltration of the corneal stroma; a...
Prevalence and risk factors for colonization with methicillin resistant Staphylococcus aureus and other Staphylococci species in hospitalized and farm horses in Israel.
Preventive veterinary medicine    September 16, 2015   Volume 122, Issue 1-2 135-144 doi: 10.1016/j.prevetmed.2015.09.007
Tirosh-Levy S, Steinman A, Carmeli Y, Klement E, Navon-Venezia S.Methicillin-resistant staphylococci (MRS), and specifically Methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection have become a serious emerging condition in equine hospitals, with complex concerns regarding animals, personnel and public health. The objectives of this study were to evaluate the prevalence and risk factors for colonization by Staphylococci, MRS, and MRSA among horses in Israel. Nasal swabs were collected from horses at 17 riding stables (n=206), and from hospitalized horses admitted to a veterinary hospital (n=84). Species identification was performed by ...
mecC-positive MRSA in horses.
The Journal of antimicrobial chemotherapy    September 14, 2015   Volume 70, Issue 12 3401-3402 doi: 10.1093/jac/dkv278
Haenni M, Châtre P, Dupieux C, Métayer V, Maillard K, Bes M, Madec JY, Laurent F.No abstract available
Anti-biofilm activity of ultrashort cinnamic acid peptide derivatives against medical device-related pathogens.
Journal of peptide science : an official publication of the European Peptide Society    August 27, 2015   Volume 21, Issue 10 770-778 doi: 10.1002/psc.2805
Laverty G, McCloskey AP, Gorman SP, Gilmore BF.The threat of antimicrobial resistance has placed increasing emphasis on the development of innovative approaches to eradicate multidrug-resistant pathogens. Biofilm-forming microorganisms, for example, Staphylococcus epidermidis and Staphylococcus aureus, are responsible for increased incidence of biomaterial infection, extended hospital stays and patient morbidity and mortality. This paper highlights the potential of ultrashort tetra-peptide conjugated to hydrophobic cinnamic acid derivatives. These peptidomimetic molecules demonstrate selective and highly potent activity against resistant b...
Antimicrobial resistance in bacteria from horses: Epidemiology of antimicrobial resistance.
Equine veterinary journal    August 26, 2015   Volume 47, Issue 6 756-765 doi: 10.1111/evj.12471
Maddox TW, Clegg PD, Williams NJ, Pinchbeck GL.Antimicrobial resistance poses a significant threat to the continued successful use of antimicrobial agents for the treatment of bacterial infections. While the epidemiology of antimicrobial resistance in bacteria from man has been studied extensively, less work has been undertaken in companion animals, particularly horses. Methicillin-resistant Staphylococcus aureus has been identified as a cause of infections, with a low prevalence of nasal carriage by horses in the community but higher for hospitalised horses. Molecular characterisation has shown methicillin-resistant Staphylococcus aureus...
[Infection control and hygiene management in equine hospitals].
Berliner und Munchener tierarztliche Wochenschrift    April 16, 2015   Volume 127, Issue 11-12 486-497 
Walther B, Janssen T, Gehlen H, Vincze S, Borchers K, Wieler LH, Barton AK, Lübke-Becker A.With the rising importance of nosocomial infections in equine hospitals, increased efforts with regard to biosecurity and infection control are necessary. This even more since nosocomial infections are often associated with multi-drug resistant pathogens. Consequently, the implementation of targeted prevention programs is essential. Since nosocomial infections are usually multifactorial events, realization of only a single measure is rarely effective to overcome nosocomial spread in clinical practice. Equine patients may be colonized at admission with multi-drug resistant pathogens such as met...
Use of loop-mediated isothermal amplification to detect six groups of pathogens causing secondary lower respiratory bacterial infections in horses.
Microbiology and immunology    April 8, 2015   Volume 59, Issue 6 365-370 doi: 10.1111/1348-0421.12257
Kinoshita Y, Niwa H, Katayama Y.Microbial substitution occasionally occurs following the administration of antimicrobials to horses that have pneumonia or pleuropneumonia. Four specific loop-mediated isothermal amplification (LAMP) assays were developed to detect some equine respiratory pathogens, namely strains of the Bacteroides-Prevotella group, Klebsiella pneumoniae, Stenotrophomonas maltophilia, and Staphylococcus aureus. These four LAMP assays and two previously published LAMP assays targeting Escherichia coli or Pseudomonas aeruginosa were used on clinical respiratory specimens and a high accordance found between the ...
Efficacy and safety of lomefloxacin on bacterial extraocular disease in the horse.
The Journal of veterinary medical science    March 15, 2015   Volume 77, Issue 7 829-835 doi: 10.1292/jvms.14-0507
Hidaka S, Kobayashi M, Ando K, Fujii Y.Lomefloxacin is a broad-spectrum fluoroquinolone antibiotic used for the treatment of bacterial extraocular disease. This study investigated the efficacy and safety of lomefloxacin eye drops for bacterial extraocular disease in horses. Lomefloxacin ophthalmic solution (0.3%) was instilled three times daily for 2-5 days in 65 horses diagnosed with bacterial extraocular disease based on clinical findings. Clinical observations and bacteriological examinations were performed at the start of treatment, 2 and 5 days after the start of treatment, and at the discontinuation or termination of treatmen...
Colostrum hexasaccharide, a novel Staphylococcus aureus quorum-sensing inhibitor.
Antimicrobial agents and chemotherapy    February 2, 2015   Volume 59, Issue 4 2169-2178 doi: 10.1128/AAC.03722-14
Srivastava A, Singh BN, Deepak D, Rawat AK, Singh BR.The discovery of quorum-sensing (QS) systems regulating antibiotic resistance and virulence factors (VFs) has afforded a novel opportunity to prevent bacterial pathogenicity. Dietary molecules have been demonstrated to attenuate QS circuits of bacteria. But, to our knowledge, no study exploring the potential of colostrum hexasaccharide (CHS) in regulating QS systems has been published. In this study, we analyzed CHS for inhibiting QS signaling in Staphylococcus aureus. We isolated and characterized CHS from mare colostrum by high-performance thin-layer chromatography (HPTLC), reverse-phase hig...
Prevalence of methicillin-resistant Staphylococcus haemolyticus in companion animals: a cross-sectional study.
Annals of clinical microbiology and antimicrobials    November 28, 2014   Volume 13 56 doi: 10.1186/s12941-014-0056-y
Ruzauskas M, Siugzdiniene R, Klimiene I, Virgailis M, Mockeliunas R, Vaskeviciute L, Zienius D.Among coagulase-negative staphylococci, Staphylococcus haemolyticus is the second most frequently isolated species from human blood cultures and has the highest level of antimicrobial resistance. This species has zoonotic character and is prevalent both in humans and animals. Recent studies have indicated that methicillin-resistant S. haemolyticus (MRSH) is one of the most frequent isolated Staphylococcus species among neonates in intensive care units. The aim of this study was to determine the presence of MRSH in different groups of companion animals and to characterize isolates according the...
Temporal Bacteriostatic Effect and Growth Factor Loss in Equine Platelet Components and Plasma Cultured with Methicillin-Sensitive and Methicillin-Resistant Staphylococcus aureus: A Comparative In Vitro Study.
Veterinary medicine international    November 24, 2014   Volume 2014 525826 doi: 10.1155/2014/525826
López C, Alvarez ME, Carmona JU.The aims were (1) to evaluate the bacteriostatic effect of platelet-rich plasma (PRP), platelet-rich gel (PRG), leukocyte-poor plasma (LPP), leukocyte-poor gel (LPG), plasma, and heat-inactivated plasma (IP) on both methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) over a period of 24 h; (2) to determine and to compare the concentrations and degradation over time of platelet factor 4 (PF-4), transforming growth factor beta 1 (TGF-β 1), and platelet-derived growth factor isoform BB (PDGF-BB); and (3) to identify any correlations between...
Physiopathologic mechanisms involved in mare endometrosis.
Reproduction in domestic animals = Zuchthygiene    October 4, 2014   Volume 49 Suppl 4 82-87 doi: 10.1111/rda.12397
Rebordão MR, Galvão A, Szóstek A, Amaral A, Mateus L, Skarzynski DJ, Ferreira-Dias G.Endometrosis is a degenerative chronic process, characterized by paramount fibrosis development in mare endometrium. This condition is one of the major causes of subfertility/infertility in mares. As in other organs, fibrosis might be a pathologic sequel of many chronic inflammatory diseases. However, aetiology and physiopathologic mechanisms involved in endometrial fibrosis are still controversial. This review presents new hypotheses based on our newest data. As the first line of innate immune defence, systemic neutrophils arrive in the uterus at mating or in the presence of pathogens. A nove...
Neutrophil extracellular traps formation by bacteria causing endometritis in the mare.
Journal of reproductive immunology    August 27, 2014   Volume 106 41-49 doi: 10.1016/j.jri.2014.08.003
Rebordão MR, Carneiro C, Alexandre-Pires G, Brito P, Pereira C, Nunes T, Galvão A, Leitão A, Vilela C, Ferreira-Dias G.Besides the classical functions, neutrophils (PMNs) are able to release DNA in response to infectious stimuli, forming neutrophil extracellular traps (NETs) and killing pathogens. The pathogenesis of endometritis in the mare is not completely understood. The aim was to evaluate the in vitro capacity of equine PMNs to secrete NETs by chemical activation, or stimulated with Streptococcus equi subspecies zooepidemicus (Szoo), Escherichia coli (Ecoli) or Staphylococcus capitis (Scap) strains obtained from mares with endometritis. Ex vivo endometrial mucus from mares with bacterial endometritis wer...
A pre- and post-intervention study of infection control in equine hospitals in Sweden.
Acta veterinaria Scandinavica    August 22, 2014   Volume 56, Issue 1 52 doi: 10.1186/s13028-014-0052-4
Bergström K, Grönlund U.Detection of nosocomial methicillin-resistant Staphylococcus aureus infections in horses in Sweden has increased attention on infection control (IC) in equine hospitals. This study established baseline data on IC programmes within such settings, evaluated compliance with some IC procedures before and after an education intervention, and examined barriers to compliance.The study was carried out between 2008 and 2011 in four Swedish equine hospitals. Data on current IC of each hospital, purchase data on hand sanitisers and disposable gloves per patient, and direct observations of compliance with...
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