The 2018 World Health Organization SAVE LIVES: Clean Your Hands Campaign targets sepsis in health care

The roles and potential mechanisms of plant polysaccharides in liver diseases: a review

Plant polysaccharides (PP) demonstrate a diverse array of biological and pharmacological properties. This comprehensive review aims to compile and present the multifaceted roles and underlying mechanisms of plant polysaccharides in various liver diseases. These diseases include non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease (ALD), fibrosis, drug-induced liver injury (DILI), and hepatocellular carcinoma (HCC). This study aims to elucidate the intricate mechanisms and therapeutic potential of plant polysaccharides, shedding light on their significance and potential applications in the management and potential prevention of these liver conditions. An exhaustive literature search was conducted for this study, utilizing prominent databases such as PubMed, Web of Science, and CNKI. The search criteria focused on the formula "(plant polysaccharides liver disease) NOT (review)" was employed to ensure the inclusion of original research articles up to the year 2023. Relevant literature was extracted and analyzed from these databases. Plant polysaccharides exhibit promising pharmacological properties, particularly in the regulation of glucose and lipid metabolism and their anti-inflammatory and immunomodulatory effects. The ongoing progress of studies on the molecular mechanisms associated with polysaccharides will offer novel therapeutic strategies for the treatment of chronic liver diseases (CLDs).

Effectiveness of an Active and Continuous Surveillance Program for Intensive Care Units Infections Based on the EPIC III (Extended Prevalence of Infection in Intensive Care) Approach

We evaluated the effectiveness of the Extended Prevalence of Infection in Intensive Care (EPIC) III data collection protocol as an active surveillance tool in the eight Intensive Care Units (ICUs) of the Intensive and Critical Care Department of the University Hospital of Turin. A total of 435 patients were included in a six-day study over 72 ICU beds. 42% had at least one infection: 69% at one site, 26% at two sites and 5% at three or more sites. ICU-acquired infections were the most common (64%), followed by hospital-associated infections (22%) and community-acquired (20%), considering that each patient may have developed more than one infection type. 72% of patients were receiving at least one antibiotic: 48% for prophylaxis and 52% for treatment. Mortality, the length of ICU and hospital stays were 13%, 14 and 29 days, respectively, being all estimated to be significantly different in patients without and with infection (8% vs. 20%; 4 vs. 20 and 11 vs. 50 (p < 0.001). Our data confirm a high prevalence of infections, sepsis and the use of antimicrobials. The repeated punctual prevalence survey seems an effective method to carry out the surveillance of infections and the use of antimicrobials in the ICU. The use of the European Centre for Disease Prevention and Control (ECDC) definitions and the EPIC III protocol seems strategic to allow comparisons with national and international contexts.

Can Flu-Like Absenteeism in Kindergartens Be Reduced Through Hand Hygiene Training for Both Parents and Their Kindergarteners?

Background: Hand hygiene has been found as an effective method to prevent the spread of infectious diseases. Parents, however, were found to have inadequate knowledge, reporting skills, and parenting practices related to seasonal influenza. The aim of our study was to investigate if there was any correlation between the flu infection among parents and their kindergarteners and ascertain the effectiveness of using hand hygiene interventions in kindergartens to lower kindergarteners’ absenteeism attributable to seasonal flu. Methods: This study was a quasi-experimental study with a pretest-posttest design. Fifteen kindergartens were randomly selected from the kindergarten lists in different districts displayed on the Hong Kong government website. From these 15 kindergartens, parents and their kindergarteners were then randomly selected to participate in our hand hygiene program. To support the validity of the program, the WHO hand hygiene checklist was used to ensure sufficient coverage of the objectives. All kindergarteners attended 45-minute session for 4 weeks, while their parents attended a separate session lasting 1 hour. Parents monitored their kindergartners on a daily basis for any flu symptoms and kindergartens monitored their school attendance. Results: The study results showed that kindergarteners with strong parenting and proper hand hygiene compliance had fewer recorded signs and symptoms of flu-like illnesses. Our findings also showed that the kindergarteners’ absence rates in all participating kindergartens owing to flu decreased from 21.5% to 12% of the study period in 3 months. Conclusion: It was found that the flu infection rates of the parents and their kindergarteners were significantly correlated with P = .005. The awareness and personal hygiene skills of the parents and kindergarteners were both raised after the program. The findings in this study supported that positive parenting on hand hygiene can help reduce kindergarteners’ flu-like absenteeism.

Graph Convolutional Networks-Based Noisy Data Imputation in Electronic Health Record

OBJECTIVES

A deep learning-based early warning system is proposed to predict sepsis prior to its onset.

DESIGN

A novel algorithm was devised to detect sepsis 6 hours prior to its onset based on electronic medical records.

SETTING

Retrospective cohorts from three separate hospitals are used in this study. Sepsis onset was defined based on Sepsis-3. Algorithms are evaluated based on the score function used in the Physionet Challenge 2019.

PATIENTS

Over 60,000 ICU patients with 40 clinical variables (vital signs, laboratory results) for each hour of a patient's ICU stay were used.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

The proposed algorithm predicted the onset of sepsis in the preceding n hours (where n = 4, 6, 8, or 12). Furthermore, the proposed method compared how many sepsis patients can be predicted in a short time with other methods. To interpret a given result in a clinical perspective, the relationship between input variables and the probability of the proposed method were presented. The proposed method achieved superior results (area under the receiver operating characteristic curve, area under the precision-recall curve, and score) and predicted more sepsis patients in advance. In official phase, the proposed method showed the utility score of -0.101, area under the receiver operating characteristic curve 0.782, area under the precision-recall curve 0.041, accuracy 0.786, and F-measure 0.046.

CONCLUSIONS

Using Physionet Challenge 2019, the proposed method can accurately and early predict the onset of sepsis. The proposed method can be a practical early warning system in the environment of real hospitals.

Impact of Lifestyle Behaviors on Cancer Risk and Prevention

Cancer incidences are rising globally. Therefore, in order to prevent and treat cancer, understanding cancer pathology is crucial. Tumors reprogram their metabolic phenotype to meet their needs for bioenergy, biosynthesis, and redox control. Alteration of the metabolic pathway has been proposed as the hallmark of cancer and explains the distinction between normal and cancer cells concerning nutrient utilization. Changes in the metabolism of nutrients such as glucose, amino acid, and fatty acid are associated with cancer risk. Luckily, this can be controlled with lifestyle modifications. Improvements in lifestyle behaviors to reduce cancer risks include a healthy diet, calorie restriction, and regular physical activity. This review begins with the understandings of metabolic reprogramming in cancer. Then, there will be evidence on the correlation between lifestyle factors and altered nutrient metabolism suggesting an application of lifestyle intervention for cancer risk reduction.

Epidemiology and burden of sepsis acquired in hospitals and intensive care units: a systematic review and meta-analysis

PURPOSE

Sepsis is recognized as a global public health problem, but the proportion due to hospital-acquired infections remains unclear. We aimed to summarize the epidemiological evidence related to the burden of hospital-acquired (HA) and ICU-acquired (ICU-A) sepsis.

METHODS

We searched MEDLINE, Embase and the Global Index Medicus from 01/2000 to 03/2018. We included studies conducted hospital-wide or in intensive care units (ICUs), including neonatal units (NICUs), with data on the incidence/prevalence of HA and ICU-A sepsis and the proportion of community and hospital/ICU origin. We did random-effects meta-analyses to obtain pooled estimates; inter-study heterogeneity and risk of bias were assessed.

RESULTS

Of the 13,239 studies identified, 51 met the inclusion criteria; 22 were from low- and middle-income countries. Twenty-eight studies were conducted in ICUs, 13 in NICUs, and ten hospital-wide. The proportion of HA sepsis among all hospital-treated sepsis cases was 23.6% (95% CI 17-31.8%, range 16-36.4%). In the ICU, 24.4% (95% CI 16.7-34.2%, range 10.3-42.5%) of cases of sepsis with organ dysfunction were acquired during ICU stay and 48.7% (95% CI 38.3-59.3%, range 18.7-69.4%) had a hospital origin. The pooled hospital incidence of HA sepsis with organ dysfunction per 1000 patients was 9.3 (95% CI 7.3-11.9, range 2-20.6)). In the ICU, the pooled incidence of HA sepsis with organ dysfunction per 1000 patients was 56.5 (95% CI 35-90.2, range 9.2-254.4) and it was particularly high in NICUs. Mortality of ICU patients with HA sepsis with organ dysfunction was 52.3% (95% CI 43.4-61.1%, range 30.1-64.6%). There was a significant inter-study heterogeneity. Risk of bias was low to moderate in ICU-based studies and moderate to high in hospital-wide and NICU studies.

CONCLUSION

HA sepsis is of major public health importance, and the burden is particularly high in ICUs. There is an urgent need to improve the implementation of global and local infection prevention and management strategies to reduce its high burden among hospitalized patients.

Impact of hand hygiene intervention: a comparative study in health care facilities in Dodoma region, Tanzania using WHO methodology

Background

Compliance with guidelines on hand hygiene (HH) is pivotal to prevent and control health-care associated infections and contributes to mitigating antimicrobial resistance. A baseline assessment in Dodoma region, Tanzania in March 2018 showed inadequate HH levels across health care facilities. We evaluated the impact of training in HH as part of a water, sanitation and hygiene (WASH) interventions of “Maji kwa Afya ya Jamii” (MKAJI) project.

Methods

A comparative HH assessment was conducted in June 2019 involving health care facilities under MKAJI project (n = 87 from which 98 units were assessed) vs non-MKAJI facilities (n = 85 from which 99 units were assessed). Irrespective of MKAJI interventional status, baseline assessment in March 2018 were compared to re-assessment in June 2019 in all health care facility units (unpaired comparison: 261 vs 236 units, respectively), and in facilities assessed in both surveys (paired comparison: 191 versus 191 units, respectively). The ‘WHO HH Self-Assessment Framework Tool, 2010’ with five indicators each counting 100 points was used. The cumulative scores stratified each health facility’s unit into inadequate (0–125), basic (126–250), intermediate (251–375) or advanced (376–500) HH level (score). The HH compliance rates were also assessed and compared.

Results

The overall post-intervention median HH score [interquartile range (IQR)] was 187.5 (112.5–260). MKAJI health facilities had significantly higher median HH scores (IQR) [190 (120–262.5)] compared with non-MKAJI facilities [165 (95–230); p = 0.038]. Similarly, the HH compliance rate of ≥51% was significantly higher in MKAJI than non-MKAJI facilities [56.1% versus 30.3%; chi2 = 13.39, p < 0.001]. However, the recommended WHO compliance rate of ≥81% was only reached by 6.1 and 3.0% units of MKAJI and non-MKAJI facilities, respectively. Both paired and unpaired comparisons during baseline and re-assessment surveys showed increase in HH level from inadequate to basic level.

Conclusion

The overall HH level after the combined WASH and training intervention was at basic level. Higher median HH scores (IQR) and HH compliance rates were evident in health facilities of the MKAJI project, underscoring the impact of the intervention and the potential value of a national roll-out.

Hand hygiene compliance in intensive care units: An observational study

Aim

Health care–associated infections along with antibiotic resistance are a leading risk for patient safety in intensive care units. Hygienic hand disinfection is still regarded as the most effective, simplest, and most cost‐effective measure to reduce health care–associated infections. To improve hand hygiene compliance and to prevent health care–associated infections, interventions of the “German Clean Hands Campaign” were implemented in a university hospital.

Methods

Observational single‐center study using direct observation and feedback. Hand hygiene performance was assessed in 12 intensive care units between 2013 and 2017. Linear mixed model regression analyses were used to estimate the compliance trend over time.

Results

In total, 10 315 “my five moments for hand hygiene” were observed. The mean hand hygiene compliance rates increased from 75.1% to 88.6% during the study period, yielding an estimated increase of about 4.5% per year. However, there are differences in compliance between occupational groups (physicians: between 61.2% and 77.1%; nurses: between 80.2% and 90.9%; others: between 61.3% and 82.4%).

Conclusions

After implementation of the “German Clean Hands Campaign” interventions, an overall significant improvement of hand hygiene was detected. Compliance measurements helped to raise awareness among health care professional groups.

What is already known about this topic?

A significantly higher prevalence of infections has been observed in intensive care unit patients compared with patients in other wards.

Hygienic hand disinfection is still regarded as the most effective, simplest, and most cost‐effective measure to reduce health care–associated infections.

Low hand hygiene rates in intensive care units are a major problem for patient safety.

What is already known about this topic?

Implementation of the “German Clean Hands Campaign” showed continuous improvement in hand hygiene for all health care professionals in intensive care units over a period of 5 years.

There are differences in compliance rates between health care profession and intensive care unit types.

Pediatric intensive care units had the highest hand hygiene compliance rates.

The implications of this paper:

Overall, hand hygiene compliance in intensive care units increased over a period of 5 years after continuous campaigning, training, observation, compliance measurements, and direct feedback.

It is necessary to raise awareness for hand hygiene in a repetitive manner within all health care professional groups now and in the future.

Because of the differences in compliance rates between health care professionals, more tailored and evidence‐based interventions should be implemented.