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Chen H, Liu J, Zeng A, Qin N. Analysis of sterilization efficiency and application cost of three low temperature sterilization methods. THE REVIEW OF SCIENTIFIC INSTRUMENTS 2024; 95:045112. [PMID: 38597749 DOI: 10.1063/5.0175121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/24/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE This paper discusses the sterilization efficiency of three low temperature sterilization methods used in thermosensitive medical devices and makes a preliminary analysis of sterilization costs so as to provide the basis for reasonable selection of low temperature sterilizer in Central Sterile Supply Department. METHODS Medical devices compatible with the three sterilization methods were selected for sterilization, and two packaging materials were selected for the three low-temperature sterilization equipment according to the compatibility of the packaging materials. The equipment packed with the same packaging materials were sterilized for five times, and each low-temperature sterilizer was sterilized for a total of ten times. The sterilization effect, sterilization cycle time, energy consumption, and cost of the three sterilizers were compared. RESULTS The cycle time of ethylene oxide sterilizer was 393.6 min, and the cycle time of hydrogen peroxide low temperature plasma sterilizer was 56.1 min. The cycle time of low temperature steam and formaldehyde sterilizer was 105.7 min. The hydrogen peroxide low temperature plasma sterilizes single cycle power consumption at a maximum of 5 kWh. The single cycle energy consumption of compressed air ethylene oxide sterilizer is up to 12 l. In terms of sterilization application cost, hydrogen peroxide low temperature plasma sterilization has the highest cost, followed by ethylene oxide sterilization, and low temperature steam and formaldehyde sterilization is the lowest. CONCLUSION The sterilization efficiency of hydrogen peroxide low temperature plasma sterilization is the highest, followed by low temperature steam and formaldehyde sterilization, and the lowest is ethylene oxide sterilization. The three low temperature sterilization methods can achieve effective sterilization of devices. Each hospital can choose an appropriate low temperature sterilization method according to the characteristics of thermosensitive instruments, turnover efficiency requirements, and financial status.
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Affiliation(s)
- Hui Chen
- West China Hospital/West China School of Nursing, Sichuan University, Guoxuexiang No. 37, Chengdu, Sichuan, China
| | - Jiawei Liu
- West China Hospital/West China School of Nursing, Sichuan University, Guoxuexiang No. 37, Chengdu, Sichuan, China
| | - Aiying Zeng
- West China Hospital/West China School of Nursing, Sichuan University, Guoxuexiang No. 37, Chengdu, Sichuan, China
| | - Nian Qin
- West China Hospital/West China School of Nursing, Sichuan University, Guoxuexiang No. 37, Chengdu, Sichuan, China
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Lenti MV, Girardi D, Muzzi A, Novelli V, Di Sabatino A, Marena C. Prevalence and risk factors for multi-drug resistant bacterial infections in patients undergoing endoscopic retrograde cholangiopancreatography. Dig Liver Dis 2023; 55:1447-1449. [PMID: 37407320 DOI: 10.1016/j.dld.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 05/29/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023]
Affiliation(s)
- Marco Vincenzo Lenti
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniela Girardi
- Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Alba Muzzi
- Medical Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Viola Novelli
- Medical Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy; Internal Medicine Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Carlo Marena
- Medical Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Rowan NJ, Kremer T, McDonnell G. A review of Spaulding's classification system for effective cleaning, disinfection and sterilization of reusable medical devices: Viewed through a modern-day lens that will inform and enable future sustainability. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 878:162976. [PMID: 36963674 DOI: 10.1016/j.scitotenv.2023.162976] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/23/2023] [Accepted: 03/17/2023] [Indexed: 05/13/2023]
Abstract
Despite advances in medicine and innovations in many underpinning fields including disease prevention and control, the Spaulding classification system, originally proposed in 1957, remains widely used for defining the disinfection and sterilization of contaminated re-usable medical devices and surgical instruments. Screening PubMed and Scopus databases using a PRISMA guiding framework generated 272 relevant publications that were used in this review. Findings revealed that there is a need to evolve how medical devices are designed, and processed by cleaning, disinfection (and/or sterilization) to mitigate patient risks, including acquiring an infection. This Spaulding Classification remains in use as it is logical, easily applied and understood by users (microbiologists, epidemiologists, manufacturers, industry) and by regulators. However, substantial changes have occurred over the past 65 years that challenge interpretation and application of this system that includes inter alia emergence of new pathogens (viruses, mycobacteria, protozoa, fungi), a greater understanding of innate and adaptive microbial tolerance to disinfection, toxicity risks, increased number of vulnerable patients and associated patient procedures, and greater complexity in design and use of medical devices. Common cited examples include endoscopes that enable non- or minimal invasive procedures but are highly sophisticated with various types of materials (polymers, electronic components etc), long narrow channels, right angle and heat-sensitive components and various accessories (e.g., values) that can be contaminated with high levels of microbial bioburden and patient tissues after use. Contaminated flexible duodenoscopes have been a source of several significant infection outbreaks, where at least 9 reported cases were caused by multidrug resistant organisms [MDROs] with no obvious breach in processing detected. Despite this, there is evidence of the lack of attention to cleaning and maintenance of these devices and associated equipment. Over the last few decades there is increasing genomic evidence of innate and adaptive resistance to chemical disinfectant methods along with adaptive tolerance to environmental stresses. To reduce these risks, it has been proposed to elevate classification of higher-risk flexible endoscopes (such as duodenoscopes) from semi-critical [contact with mucous membrane and intact skin] to critical use [contact with sterile tissue and blood] that entails a transition to using low-temperature sterilization modalities instead of routinely using high-level disinfection; thus, increasing the margin of safety for endoscope processing. This timely review addresses important issues surrounding use of the Spaulding classification system to meet modern-day needs. It specifically addresses the need for automated, robust cleaning and drying methods combined with using real-time monitoring of device processing. There is a need to understand entire end-to-end processing of devices instead of adopting silo approaches that in the future will be informed by artificial intelligence and deep-learning/machine learning. For example, combinational solutions that address the formation of complex biofilms that harbour pathogenic and opportunistic microorganisms on the surfaces of processed devices. Emerging trends are addressed including future sustainability for the medical devices sector that can be enabled via a new Quintuple Helix Hub approach that combines academia, industry, healthcare, regulators, and society to unlock real world solutions.
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Affiliation(s)
- N J Rowan
- Centre for Sustainable Disinfection and Sterilization, Bioscience Research Institute, Technological University of the Shannon Midlands Midwest, Athlone Campus, Ireland; Department of Nursing and Healthcare, Technological University of the Shannon Midwest Mideast, Athlone Campus, Ireland; SFI-funded CURAM Centre for Medical Device Research, University of Galway, Ireland.
| | - T Kremer
- Centre for Sustainable Disinfection and Sterilization, Bioscience Research Institute, Technological University of the Shannon Midlands Midwest, Athlone Campus, Ireland; Microbiological Quality & Sterility Assurance, Johnson & Johnson, 1000 Route 202, South Raritan, NJ 08869, USA
| | - G McDonnell
- Microbiological Quality & Sterility Assurance, Johnson & Johnson, 1000 Route 202, South Raritan, NJ 08869, USA
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Zhang H, Hu S, Li L, Jin H, Yang J, Shen H, Zhang X. Development and Assessment of a Novel Predictive Nomogram to Predict the Risk of Secondary CR-GNB Bloodstream Infections among CR-GNB Carriers in the Gastroenterology Department: A Retrospective Case-Control Study. J Clin Med 2023; 12:jcm12030804. [PMID: 36769451 PMCID: PMC9918196 DOI: 10.3390/jcm12030804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND With the number of critically ill patients increasing in gastroenterology departments (GEDs), infections associated with Carbapenem-resistant Gram-negative bacteria (CR-GNB) are of great concern in GED. However, no CR-GNB bloodstream infection (BSI) risk prediction model has been established for GED patients. Almost universally, CR-GNB colonization precedes or occurs concurrently with CR-GNB BSI. The objective of this study was to develop a nomogram that could predict the risk of acquiring secondary CR-GNB BSI in GED patients who are carriers of CR-GNB. METHODS We conducted a single-center retrospective case-control study from January 2020 to March 2022. Univariate and multivariable logistic regression analysis was used to identify independent risk factors of secondary CR-GNB bloodstream infections among CR-GNB carriers in the gastroenterology department. A nomogram was constructed according to a multivariable regression model. Various aspects of the established predicting nomogram were evaluated, including discrimination, calibration, and clinical utility. We assessed internal validation using bootstrapping. RESULTS The prediction nomogram includes the following predictors: high ECOG PS, severe acute pancreatitis, diabetes mellitus, neutropenia, a long stay in hospital, and parenteral nutrition. The model demonstrated good discrimination and good calibration. CONCLUSIONS With an estimate of individual risk using the nomogram developed in this study, clinicians and nurses can identify patients with a high risk of secondary CR-GNB BSI early.
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Affiliation(s)
- Hongchen Zhang
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310003, China
- The Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
- Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, China
- Hangzhou Institute of Digestive Disease, Hangzhou 310000, China
| | - Shanshan Hu
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310003, China
- The Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
- Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, China
- Hangzhou Institute of Digestive Disease, Hangzhou 310000, China
| | - Lingyun Li
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310003, China
- The Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
- Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, China
- Hangzhou Institute of Digestive Disease, Hangzhou 310000, China
| | - Hangbin Jin
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310003, China
- The Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
- Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, China
- Hangzhou Institute of Digestive Disease, Hangzhou 310000, China
| | - Jianfeng Yang
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310003, China
- The Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
- Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, China
- Hangzhou Institute of Digestive Disease, Hangzhou 310000, China
| | - Hongzhang Shen
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310003, China
- The Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
- Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, China
- Hangzhou Institute of Digestive Disease, Hangzhou 310000, China
| | - Xiaofeng Zhang
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou 310003, China
- The Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China
- Key Laboratory of Integrated Traditional Chinese and Western Medicine for Biliary and Pancreatic Diseases of Zhejiang Province, Hangzhou 310000, China
- Hangzhou Institute of Digestive Disease, Hangzhou 310000, China
- Correspondence: ; Tel.: +86-135-8829-6257; Fax: +86-571-5600-5600
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Birgand G, Ahmad R, Bulabula ANH, Singh S, Bearman G, Sánchez EC, Holmes A. Innovation for infection prevention and control-revisiting Pasteur's vision. Lancet 2022; 400:2250-2260. [PMID: 36528378 PMCID: PMC9754656 DOI: 10.1016/s0140-6736(22)02459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/20/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022]
Abstract
Louis Pasteur has long been heralded as one of the fathers of microbiology and immunology. Less known is Pasteur's vision on infection prevention and control (IPC) that drove current infection control, public health, and much of modern medicine and surgery. In this Review, we revisited Pasteur's pioneering works to assess progress and challenges in the process and technological innovation of IPC. We focused on Pasteur's far-sighted conceptualisation of the hospital as a reservoir of microorganisms and amplifier of transmission, aseptic technique in surgery, public health education, interdisciplinary working, and the protection of health services and patients. Examples from across the globe help inform future thinking for IPC innovation, adoption, scale up and sustained use.
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Affiliation(s)
- Gabriel Birgand
- Centre d'appui pour la Prévention des Infections Associées aux Soins, Nantes, France; National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK
| | - Raheelah Ahmad
- National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK; School of Health and Psychological Sciences, City University of London, London, UK; Institute of Business and Health Management, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Sanjeev Singh
- Department of Medicine, Amrita Institute of Medical Sciences, Amrita University, Kerala, India
| | - Gonzalo Bearman
- Division of Infectious Diseases, Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Enrique Castro Sánchez
- National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK; College of Nursing, Midwifery and Healthcare, Richard Wells Centre, University of West London, London, UK
| | - Alison Holmes
- National Institute for Health and Care Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, London, UK; Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
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6
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Jelacic S, Bowdle A, Madhavaram SK, Garana BB. Design and Evaluation of Novel Bite Block for Invasive Imaging Procedures. A A Pract 2022; 16:e01601. [DOI: 10.1213/xaa.0000000000001601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Deb A, Perisetti A, Goyal H, Aloysius MM, Sachdeva S, Dahiya D, Sharma N, Thosani N. Gastrointestinal Endoscopy-Associated Infections: Update on an Emerging Issue. Dig Dis Sci 2022; 67:1718-1732. [PMID: 35262904 DOI: 10.1007/s10620-022-07441-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/07/2022] [Indexed: 02/06/2023]
Abstract
Over 17.7 million gastrointestinal (GI) endoscopic procedures are performed annually, contributing to 68% of all endoscopic procedures in the United States. Usually, endoscopic procedures are low risk, but adverse events may occur, including cardiopulmonary complications, bleeding, perforation, pancreatitis, cholangitis, and infection. Infections after the GI endoscopies most commonly result from the patient's endogenous gut flora. Although many studies have reported infection after GI endoscopic procedures, a true estimate of the incidence rate of post-endoscopy infection is lacking. In addition, the infection profile and causative organisms have evolved over time. In recent times, multi-drug-resistant microorganisms have emerged as a cause of outbreaks of endoscope-associated infections (EAI). In addition, lapses in endoscope reprocessing have been reported, with some but not all outbreaks in recent times. This systematic review summarizes the demographical, clinical, and management data of EAI events reported in the literature. A total of 117 articles were included in the systematic review, with the majority reported from North America and Western Europe. The composite infection rate was calculated to be 0.2% following GI endoscopic procedures, 0.8% following ERCP, 0.123% following non-ERCP upper GI endoscopic procedures, and 0.073% following lower GI endoscopic procedures. Pseudomonas aeruginosa was the most common culprit organism, followed by other Enterobacteriaceae groups of organisms and Gram-positive cocci. We have also elaborated different prevention methods such as antimicrobial prophylaxis, adequate sterilization methods for reprocessing endoscopes, periodic surveillance, and current evidence supporting their utilization. Finally, we discuss disposable endoscopes, which could be an alternative to reprocessing to minimize the chances of EAIs with their effects on the environmental and financial situation.
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Affiliation(s)
- Anasua Deb
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, 79430, USA
| | - Abhilash Perisetti
- Advance Endoscopy, Interventional Oncology & Surgical Endoscopy (IOSE), Parkview Cancer Institute, 11050 Parkview Circle, Fort Wayne, IN, 46845, USA
| | - Hemant Goyal
- The Wright Center for Graduate Medical Education, 501 S. Washington Avenue, Scranton, PA, 18503, USA.
| | - Mark M Aloysius
- Department of Internal Medicine, The Wright Center for Graduate Medical Education, 501 S. Washington Avenue, Scranton, PA, 18505, USA
- Geisinger Commonwealth School of Medicine, 525, Pine Street, Scranton, PA, 18510, USA
| | - Sonali Sachdeva
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Dushyant Dahiya
- Central Michigan University College of Medicine, 1000 Houghton Ave, Saginaw, MI, 48603, USA
| | - Neil Sharma
- Division of Interventional Oncology & Surgical Endoscopy (IOSE), Parkview Cancer Institute, 11050 Parkview Circle, Fort Wayne, IN, 46845, USA
- Indiana University School of Medicine, Fort Wayne, IN, USA
| | - Nirav Thosani
- Division of Gastroenterology, Hepatology & Nutrition, Center for Interventional Gastroenterology at UTHealth (iGUT), Atilla Ertan MD Chair in Gastroenterology, Hepatology & Nutrition, McGovern Medical School, UTHealth, Houston, USA
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8
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Risk Factors for Multidrug-Resistant Gram-Negative Bacteria Carriage upon Admission to the Intensive Care Unit. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031039. [PMID: 35162062 PMCID: PMC8834020 DOI: 10.3390/ijerph19031039] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/13/2022] [Accepted: 01/15/2022] [Indexed: 01/27/2023]
Abstract
Multidrug-resistant Gram-negative bacteria (MDR-GNB) are microorganisms that have acquired resistance to extended-spectrum antibacterials and constitute an emerging threat to public health. Although carriers are an important source of transmission in healthcare settings, data about risk factors for MDR-GNB carriage are limited. Therefore, we aimed to identify risk factors for MDR-GNB carriage upon intensive care unit (ICU) admission and to optimise screening strategies. We conducted a case–control study. Admissions of adult patients to the ICU of a 1000-bed hospital during a year were included. We collected sociodemographic, clinical and microbiological data and performed a multivariate logistic regression model. A total of 1342 patients resulted in 1476 episodes of ICU admission, 91 (6.2%) of whom harboured MDR-GNB (38.5% women; median age 63.9 years). The most frequently isolated pathogens were Escherichia coli (57%) and Klebsiella pneumoniae (16%). The most frequent resistance mechanism was production of extended-spectrum beta lactamases. MDR-GNB carriage was associated to liver cirrhosis (OR 6.54, 95% CI 2.17–19.17), previous MDR-GNB carriage (OR 5.34, 1.55–16.60), digestive surgery (OR 2.83, 1.29–5.89) and length of hospital stay (OR 1.01 per day, 1.00–1.03). Several risk factors for MDR-GNB carriage upon admission to a high-risk setting were identified; the main comorbidity was liver cirrhosis.
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Tran VN, Park S, Khan F, Truong VG, Jeong S, Lee DH, Kim YM, Kang HW. Collective bacterial disinfection by opto-chemical treatment on mature biofilm in clinical endoscope. JOURNAL OF PHOTOCHEMISTRY AND PHOTOBIOLOGY. B, BIOLOGY 2022; 226:112367. [PMID: 34847498 DOI: 10.1016/j.jphotobiol.2021.112367] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 02/07/2023]
Abstract
The present study proposes an innovative opto-chemical treatment using a basket-integrated optical device (BIOD) to disinfect mature bacterial biofilm on endoscope channels. A BIOD was designed to position an optical diffuser on the central axis of an endoscope channel and to distribute laser light concentrically to the bacterial biofilm on the channel surface. To apply thermal damage and oxidative stress to the bacterial biofilm, a low concentration of a crosslinking agent (glutaraldehyde ~0.5%) was combined with 808 nm infrared (IR) and 405 nm blue (BL) laser lights. The applied irradiances of IR and BL were 10 W/cm2 and 1.6 W/cm2 for Teflon channel model and 20 W/cm2 and 3.2 W/cm2 for a clinical model, respectively. Individual irradiation of either IR or BL for 180 s induced the maximum temperatures of 62 ± 2 °C and 53 ± 3 °C on the biofilm, respectively. The simultaneous opto-chemical treatment reduced a significant population of the bacterial biofilms (7.5-log10 for Staphylococcus aureus and 7.1-log10 for Pseudomonas aeruginosa), which were 2.9-fold and 3.9-fold higher than that of the standard treatment with 2% glutaraldehyde (GA) solution, respectively. The proposed opto-chemical disinfection method can help reduce multi-drug resistant bacteria and prevent cross-infection during the clinical usage of a flexible endoscope.
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Affiliation(s)
- Van Nam Tran
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan 48513, South Korea
| | - Suhyun Park
- Department of Electronic and Electrical Engineering, Ewha Womans University, Seoul 03760, South Korea
| | - Fazlurrahman Khan
- Research Center for Marine Integrated Bionics Technology, Pukyong National University, Busan 48513, South Korea
| | - Van Gia Truong
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan 48513, South Korea
| | - Seok Jeong
- Division of Gastroenterology, Department of Internal Medicine, Inha University College of Medicine, Incheon 22212, South Korea
| | - Don Haeng Lee
- Division of Gastroenterology, Department of Internal Medicine, Inha University College of Medicine, Incheon 22212, South Korea
| | - Young-Mog Kim
- Research Center for Marine Integrated Bionics Technology, Pukyong National University, Busan 48513, South Korea; Department of Food Science and Technology, Pukyong National University, Busan 48513, South Korea
| | - Hyun Wook Kang
- Industry 4.0 Convergence Bionics Engineering, Pukyong National University, Busan 48513, South Korea; Research Center for Marine Integrated Bionics Technology, Pukyong National University, Busan 48513, South Korea; Department of Biomedical Engineering, Pukyong National University, Busan 48513, South Korea.
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10
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Li DF, Shi RY, Tian YH, Xu ZL, Zhou YS, Sun XJ, Cai JW, Fang YY, Peng H, Wang JM, Dong T, Cai YD, Yao J, Wang LS. The feasibility and safety of disposable endoscope vs. conventional endoscope for upper gastrointestinal tract examination: a multicenter, randomized, parallel, non-inferiority trial. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 60:1314-1319. [PMID: 34768288 PMCID: PMC9477113 DOI: 10.1055/a-1555-0568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background
A disposable upper gastrointestinal endoscope can effectively decrease infectious outbreaks associated with endoscope reuse. In the present study, we aimed to evaluate the feasibility and safety of a disposable endoscope for upper gastrointestinal examination.
Methods
In a prospective, randomized trial, 144 upper endoscopic procedures were allocated to either the disposable endoscope group or the conventional endoscope group. The primary outcomes were rates of excellent and good image qualities and maneuverability satisfaction. The second outcome included procedure duration, endoscopic diagnosis, and adverse events.
Results
A total of 144 subjects were enrolled in the present analysis and prospectively randomized to 2 study groups. Finally, 70 and 69 subjects were enrolled in the novel disposable endoscope group and the conventional endoscope group, respectively, due to the schedule cancellation of 5 subjects. The baseline characteristics of the patients were similar in both groups. The excellent and good image quality rates and maneuverability satisfaction of the novel disposable endoscope were not inferior to the conventional endoscope (p = 0.99 and p = 0.99, respectively). Moreover, no significant between-group difference was observed in the endoscopic results and adverse events (p = 0.30 and p = 1, respectively). However, the procedure duration in the novel disposable endoscope was longer compared with the conventional endoscope (8.40 ± 4.28 min
vs.
5.12 ± 2.65 min, p < 0.001).
Conclusions
The novel disposable endoscope was as safe, effective, and maneuverable as a conventional endoscope. However, the novel disposable endoscope was associated with a longer procedure duration.
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Affiliation(s)
- De-Feng Li
- Department of Gastroenterology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology)
| | - Rui-Yue Shi
- Department of Gastroenterology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology)
| | - Yan-Hui Tian
- Department of Gastroenterology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology)
| | - Zheng-Lei Xu
- Department of Gastroenterology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology)
| | - Ying-Sheng Zhou
- Department of Gastroenterology, University of Chinese Academy of Sciences Affiliated Shenzhen Hospital
| | - Xian-Jiu Sun
- Department of Gastroenterology, University of Chinese Academy of Sciences Affiliated Shenzhen Hospital
| | - Jin-Wei Cai
- Department of Gastroenterology, University of Chinese Academy of Sciences Affiliated Shenzhen Hospital
| | - Yuan-Yuan Fang
- Department of Gastroenterology, University of Chinese Academy of Sciences Affiliated Shenzhen Hospital
| | - Huan Peng
- Department of Gastroenterology, University of Chinese Academy of Sciences Affiliated Shenzhen Hospital
| | - Jia-Min Wang
- Department of Gastroenterology, University of Chinese Academy of Sciences Affiliated Shenzhen Hospital
| | - Tao Dong
- Shenzhen Pengrui Intelligent Image Co., Ltd
| | | | - Jun Yao
- Department of Gastroenterology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology)
| | - Li-Sheng Wang
- Department of Gastroenterology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology)
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Mills JP, Marchaim D. Multidrug-Resistant Gram-Negative Bacteria: Infection Prevention and Control Update. Infect Dis Clin North Am 2021; 35:969-994. [PMID: 34752228 DOI: 10.1016/j.idc.2021.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Multidrug-resistant gram-negative bacteria (MDR-GNB) pose one of the greatest challenges to health care today because of their propensity for human-to-human transmission and lack of therapeutic options. Containing the spread of MDR-GNB is challenging, and the application of multifaceted infection control bundles during an evolving outbreak makes it difficult to measure the relative impact of each measure. This article will review the utility of various infection control measures in containing the spread of various MDR-GNB and will provide the supporting evidence for these interventions.
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Affiliation(s)
- John P Mills
- Division of Infectious Diseases, University of Michigan Medical School, F4177 University Hospital South, 1500 E. Medical Center Dr, Ann Arbor, MI 48109-5226, USA.
| | - Dror Marchaim
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Infectious Diseases, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
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12
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Mora-Guzmán I, Rubio-Perez I, Domingo-Garcia D, Martin-Perez E. Risk Factors for Intra-Abdominal Infections Caused by Carbapenemase-Producing Enterobacteriaceae in a Surgical Setting. Surg Infect (Larchmt) 2021; 22:864-870. [PMID: 33857380 DOI: 10.1089/sur.2020.472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: The aim of this study was to identify risk factors for acquisition of intra-abdominal infections (IAI) caused by carbapenemase-producing Enterobacteriaceae (CPE) in surgical patients. Methods: A matched case-control study was performed. We included all cases with CPE-related IAI acquired during admission to a general surgery department from January 2013 to December 2018, and they were matched with control subjects with IAI caused by non-resistant bacteria (ratio 1:3). Independent risk factors were obtained by logistic regression. Results: Forty patients with IAI-CPE were matched with 120 control subjects. Independent risk factors for acquisition of IAI-CPE were previous hospitalization (odds ratio [OR] 2.56; 95% confidence interval [CI] l 1.01-6.49; p = 0.047), digestive endoscopy (OR 4.11; 95% CI 1.40-12.07; p = 0.010), carbapenem therapy (OR 9.54; 95% CI 3.33-27.30; p < 0.001), and aminoglycoside use (OR 45.41; 95% CI 7.90-261.06; p < 0.001). Conclusions: Four clinical factors can identify patients at high-risk of IAI-CPE.
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Affiliation(s)
- Ismael Mora-Guzmán
- Department of General Surgery. Hospital General La Mancha Centro, Alcázar de San Juan, Spain
| | - Inés Rubio-Perez
- Department of General Surgery, Hospital Universitario La Paz, Madrid, Spain
| | - Diego Domingo-Garcia
- Department of Clinical Microbiology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Elena Martin-Perez
- Department of General Surgery, Hospital Universitario de La Princesa, Madrid, Spain
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13
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Risk factors associated with carbapenem-resistant Klebsiella pneumoniae bloodstream infections in a tertiary-care hospital in India. Infect Control Hosp Epidemiol 2020; 42:1418-1420. [PMID: 33168118 DOI: 10.1017/ice.2020.1280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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14
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Santos LCS, Parvin F, Huizer-Pajkos A, Wang J, Inglis DW, Andrade D, Hu H, Vickery K. Contribution of usage to endoscope working channel damage and bacterial contamination. J Hosp Infect 2020; 105:176-182. [PMID: 32169614 DOI: 10.1016/j.jhin.2020.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 03/04/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Biofilm formation has been shown to be associated with damaged areas of endoscope channels. It was hypothesized that the passage of instruments and brushes through endoscope channels during procedures and cleaning contributes to channel damage, bacterial attachment and biofilm formation. AIM To compare surface roughness and bacterial attachment in used and new endoscope channels in vivo and in vitro. METHODS Surface roughness of 10 clinically used (retired) and seven new colonoscope biopsy channels was analysed by a surface profiler. For the in-vitro study, a flexible endoscope biopsy forceps was passed repeatedly through a curved 3.0-mm-diameter Teflon tube 100, 200 and 500 times. Atomic force microscopy was used to determine the degree of inner surface damage. The number of Escherichia coli or Enterococcus faecium attached to the inner surface of the new Teflon tube and the tube with 500 forceps passes in 1 h at 37oC was determined by culture. RESULTS The average surface roughness of the used biopsy channels was found to be 1.5 times greater than that of the new biopsy channels (P=0.03). Surface roughness of Teflon tubes with 100, 200 and 500 forceps passes was 1.05-, 1.12- and 3.2-fold (P=0.025) greater than the roughness of the new Teflon tubes, respectively. The number of E. coli and E. faecium attached to Teflon tubes with 500 forceps passes was 2.9-fold (P=0.021) and 4.3-fold (P=0.004) higher compared with the number of E. coli and E. faecium attached to the new Teflon tubes, respectively. CONCLUSION An association was found between endoscope usage with damage to the biopsy channel and increased bacterial attachment.
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Affiliation(s)
- L C S Santos
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia; Ribeirao Preto Nursing School, Sao Paulo University, Ribeirao Preto, Sao Paulo, Brazil
| | - F Parvin
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - A Huizer-Pajkos
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - J Wang
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - D W Inglis
- School of Engineering, Macquarie University, Sydney, Australia
| | - D Andrade
- Ribeirao Preto Nursing School, Sao Paulo University, Ribeirao Preto, Sao Paulo, Brazil
| | - H Hu
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - K Vickery
- Surgical Infection Research Group, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia.
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A prolonged multispecies outbreak of IMP-6 carbapenemase-producing Enterobacterales due to horizontal transmission of the IncN plasmid. Sci Rep 2020; 10:4139. [PMID: 32139745 PMCID: PMC7057946 DOI: 10.1038/s41598-020-60659-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 02/04/2020] [Indexed: 12/03/2022] Open
Abstract
A multispecies outbreak of IMP-6 carbapenemase-producing Enterobacterales (IMP-6-CPE) occurred at an acute care hospital in Japan. This study was conducted to understand the mechanisms of IMP-6-CPE transmission by pulsed-field gel electrophoresis (PFGE), multilocus sequence typing and whole-genome sequencing (WGS), and identify risk factors for IMP-6-CPE acquisition in patients who underwent abdominal surgery. Between July 2013 and March 2014, 22 hospitalized patients infected or colonized with IMP-6-CPE (Escherichia coli [n = 8], Klebsiella oxytoca [n = 5], Enterobacter cloacae [n = 5], Klebsiella pneumoniae [n = 3] and Klebsiella aerogenes [n = 1]) were identified. There were diverse PFGE profiles and sequence types (STs) in most of the species except for K. oxytoca. All isolates of K. oxytoca belonged to ST29 with similar PFGE profiles, suggesting their clonal transmission. Plasmid analysis by WGS revealed that all 22 isolates but one shared a ca. 50-kb IncN plasmid backbone with blaIMP-6 suggesting interspecies gene transmission, and typing of plasmids explained epidemiological links among cases. A case-control study showed pancreatoduodenectomy, changing drains in fluoroscopy room, continuous peritoneal lavage and enteric fistula were associated with IMP-6-CPE acquisition among the patients. Plasmid analysis of isolates in an outbreak of IMP-6-CPE suggested interspecies gene transmission and helped to clarify hidden epidemiological links between cases.
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Spinzi G, Milano A, Brosolo P, Da Massa Carrara P, Labardi M, Merighi A, Riccardi L, Torresan F. The Italian Society for Digestive Endoscopy (SIED) accreditation and quality improving project based on international standards. Endosc Int Open 2020; 8:E338-E345. [PMID: 32140556 PMCID: PMC7055624 DOI: 10.1055/a-1096-0219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 12/03/2019] [Indexed: 12/21/2022] Open
Abstract
Background and study aims Accreditation of endoscopy services, using valid quality indicators, may address failures to comply with quality standards between endoscopy services. The aim of this work was to present the Italian Society for Digestive Endoscopy (SIED) accreditation model and its effectiveness. Methods A team of eight endoscopists identified quality indicators derived from international guidelines and assessed them in each center voluntarily requesting accreditation. During a 1-day site visit, two expert endoscopists, the representative of the independent and international administrative certification body and a professional nurse evaluated the endoscopy center, by direct observation of the endoscopy team and examination of the medical records Results In all centers we noted shortcomings in instrument reprocessing. In 30 of 40 centers (75 %) the information in the nursing charts was incomplete. Sampling for Helicobacter pylori had not been done in 12 of 40 centers (30 %). In six of 40 centers (15 %) the adenoma detection rate for each endoscopist had not been evaluated. Post-polypectomy intervals were inappropriate in 12 of 40 centers (30 %). We noted a statistically significant difference ( P < 0.001) between the answers to the SIED checklist of indicators submitted to the inspection team for accreditation before the site visit and the situation found for colonoscopy on site. As of June 30, 2018, 18 endoscopy centers had been accredited and 10 centers had not yet being accredited because they had not completed the measures to correct points raised at the visits. Conclusions Numerous Italian endoscopy centers fail to meet important quality indicators. Our accreditation program can provide means for detecting these problems and correcting them by implementing SIED standards.
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An outbreak of Pseudomonas aeruginosa urinary tract infections following outpatient flexible cystoscopy. Am J Infect Control 2019; 47:1510-1512. [PMID: 31277997 DOI: 10.1016/j.ajic.2019.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/08/2019] [Accepted: 05/08/2019] [Indexed: 11/20/2022]
Abstract
The investigation of an outbreak of Pseudomonas aeruginosa urinary tract infections after ambulatory cystoscopies identified a damaged cystoscope contaminated by P aeruginosa and acting as a relay object. This outbreak urges us not to trivialize urinary tract infections occurring after an elective cystoscopy. Patients should be advised to signal the occurrence of urologic symptoms after urologic exploration.
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A Prospective, Randomized Comparison of Duodenoscope Reprocessing Surveillance Methods. Can J Gastroenterol Hepatol 2019; 2019:1959141. [PMID: 31828050 PMCID: PMC6885784 DOI: 10.1155/2019/1959141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/26/2019] [Indexed: 01/24/2023] Open
Abstract
Duodenoscope use in healthcare facilities has been associated with transmission of multidrug resistant pathogens between patients. To assist healthcare facilities in monitoring the quality of their duodenoscope reprocessing procedures and limit patient risk of infection, the Centers for Disease Control and Prevention (CDC) deployed voluntary interim duodenoscope sampling and culturing surveillance protocols in 2015. Though the interim methods were widely adopted, alternative surveillance protocols were developed and implemented at individual institutions. Here, we compared two sampling methods-the 2015 CDC interim protocol and an alternative protocol developed by the University of Wisconsin Hospitals and Clinics (UWHC). We hypothesized that the UWHC protocol would detect a higher incidence of bacterial contamination from reprocessed duodenoscopes. A total of 248 sampling events were performed at UWHC. The CDC protocol (n = 129 sampling events) required culturing samples collected from each duodenoscope after brushing its terminal end and flushing its lumen with sterile water. The UWHC protocol (n = 119 sampling events) required culturing samples collected from each duodenoscope after swabbing its elevator, immersing its terminal end into broth and flushing its lumen with saline. With the CDC method, 8.53% (n = 11) of the duodenoscopes sampled were positive for bacterial growth with 15 isolates recovered. Using the UWHC method, 15.13% (n = 18) of cultures were positive for bacterial growth with 20 isolates recovered. The relative risk of identifying a contaminated duodenoscope using the CDC interim method, however, was not different than when using the UWHC protocol. Mean processing time (27.35 and 5.11 minutes, p < 0.001) and total cost per sample event ($17.87 and $15.04) were lower using the UWHC method. As the UWHC protocol provides similar detection rates as the CDC protocol, the UWHC method is useful, provided the shorter processing time and lower cost to perform.
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Thornhill G, David M. Endoscope-associated infections: A microbiologist's perspective on current technologies. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.150625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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20
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Weber DJ, Sickbert-Bennett EE, Kanamori H, Rutala WA. New and emerging infectious diseases (Ebola, Middle Eastern respiratory syndrome coronavirus, carbapenem-resistant Enterobacteriaceae, Candida auris): Focus on environmental survival and germicide susceptibility. Am J Infect Control 2019; 47S:A29-A38. [PMID: 31146847 PMCID: PMC7132701 DOI: 10.1016/j.ajic.2019.03.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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21
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22
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Tu B, Bi J, Wu D, Zhao P, Shi L, Xie Y, Zhang X, Xu Z, Liu S, Wang X, Li X, Wang F, Qin E. Bloodstream infection due to Escherichia coli in liver cirrhosis patients: clinical features and outcomes. Oncotarget 2018; 9:35780-35789. [PMID: 30515269 PMCID: PMC6254670 DOI: 10.18632/oncotarget.23200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 05/29/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The study aimed to investigate the clinical characteristics and antibiotic management, as well as independent indicators for survival within 30 days for Escherichia coli bloodstream infection (BSI) in liver cirrhosis. RESULTS Hospital-acquired BSI accounted for 60.07%, with prolonged hospital stay (P = 0.000). The prevalence of Extended Spectrum Beta-Lactamases (ESBL) producing bacteria was 48.26%, which correlated with ICU admission (P = 0.015) and high model for end-stage liver disease (MELD) score at onset of BSI (P = 0.035). Moreover, ESBL producing pathogens showed a high resistant to the common antibiotic families and 27.5% pathogens were confirmed as multidrug-resistant (MDR). MDR infection was significantly correlated with ESBL production, ICU admission, inappropriate empiric therapy, resistance to firstly selected antibiotic, and infection duration (P < 0.05 for all). In addition, appropriate empiric therapy within 48 h (HR = 2.581, 95% CI = 1.166-5.715), ICU admission (HR = 4.434, 95% CI = 2.130-8.823), HE (HR = 2.379, 95% CI = 1.115-5.073) and final MELD (HR = 1.074, 95% CI = 1.044-1.106) were independent indicators for 30-day mortality. MATERIALS AND METHODS The clinical data were collected from 288 eligible patients, and compared according to survival status and sites of infection acquisition. Drug resistance was recorded according to ESBL. In addition, cox regression analysis model was applied to evaluate the risk factors for 30-day mortality. CONCLUSIONS ESBL production can promote resistance to antibiotics in Escherichia coli. Antibiotic regimens, ICU admission, HE and MELD score can help identify the risk individuals who will benefit from the improved therapeutic regimens.
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Affiliation(s)
- Bo Tu
- Center for Infectious Disease, Beijing 302 Hospital, Beijing 100039, China
| | - Jingfeng Bi
- Center for Clinical Research Management, Beijing 302 Hospital, Beijing 100039, China
| | - Dan Wu
- Center for Infectious Disease, Beijing 302 Hospital, Beijing 100039, China
| | - Peng Zhao
- Center for Infectious Disease, Beijing 302 Hospital, Beijing 100039, China
| | - Lei Shi
- Center for Infectious Disease, Beijing 302 Hospital, Beijing 100039, China
| | - Yangxin Xie
- Center for Infectious Disease, Beijing 302 Hospital, Beijing 100039, China
| | - Xin Zhang
- Center for Infectious Disease, Beijing 302 Hospital, Beijing 100039, China
| | - Zhe Xu
- Center for Infectious Disease, Beijing 302 Hospital, Beijing 100039, China
| | - Suxia Liu
- Center for Liver Failure, Beijing 302 Hospital, Beijing 100039, China
| | - Xinhua Wang
- Center for Obstetrics and Gynecology, Beijing 302 Hospital, Beijing 100039, China
| | - Xiaoxi Li
- Center for Clinical Laboratory, Beijing 302 Hospital, Beijing 100039, China
| | - Fusheng Wang
- Center for Infectious Disease, Beijing 302 Hospital, Beijing 100039, China
| | - Enqiang Qin
- Center for Infectious Disease, Beijing 302 Hospital, Beijing 100039, China
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McCafferty CE, Aghajani MJ, Abi-Hanna D, Gosbell IB, Jensen SO. An update on gastrointestinal endoscopy-associated infections and their contributing factors. Ann Clin Microbiol Antimicrob 2018; 17:36. [PMID: 30314500 PMCID: PMC6182826 DOI: 10.1186/s12941-018-0289-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/06/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION During clinical use, gastrointestinal endoscopes are grossly contaminated with patient's native flora. These endoscopes undergo reprocessing to prevent infectious transmission upon future use. Endoscopy-associated infections and outbreaks have been reported, with a recent focus on the transmission of multi-drug resistant organisms. This review aims to provide an update on endoscopy-associated infections, and the factors contributing to their occurrence. METHODS PubMed, ScienceDirect, and CINAHL were searched for articles describing gastrointestinal endoscopy-associated infections and outbreaks published from 2008 to 2018. Factors contributing to their occurrence, and the outcomes of each outbreak were also examined. RESULTS This review found 18 articles, 16 of which described duodenoscope-associated infections, and the remaining two described colonoscope- and gastroscope-associated infection respectively. Outbreaks were reported from the United States, France, China, Germany, the Netherlands and the United Kingdom. The causative organisms reported were Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli and Salmonella enteritidis. CONCLUSIONS A number of factors, including lapses in reprocessing, biofilm formation, endoscope design issues and endoscope damage, contribute to gastrointestinal endoscopy associated infection. Methods of improving endoscope reprocessing, screening for contamination and evaluating endoscope damage may be vital to preventing future infections and outbreaks.
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Affiliation(s)
- Charles Eugenio McCafferty
- Ingham Institute for Applied Medical Research, 1 Campbell Street, Sydney, NSW, 2560, Australia. .,Western Sydney University, School of Medicine, Sydney, 2560, Australia.
| | - Marra Jai Aghajani
- Ingham Institute for Applied Medical Research, 1 Campbell Street, Sydney, NSW, 2560, Australia.,Western Sydney University, School of Medicine, Sydney, 2560, Australia
| | - David Abi-Hanna
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney, 2170, Australia.,School of Medicine, University of New South Wales, Sydney, 2033, Australia
| | | | - Slade Owen Jensen
- Ingham Institute for Applied Medical Research, 1 Campbell Street, Sydney, NSW, 2560, Australia.,Western Sydney University, School of Medicine, Sydney, 2560, Australia
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Abstract
PURPOSE OF REVIEW This review summarizes the current body of research, define high-risk patients and endoscopic processes, and outline evidence-based countermeasures aimed at minimizing the incidence of complications during endoscopy in children. RECENT FINDINGS Significant complications of endoscopy requiring emergency department or inpatient admission in otherwise healthy children are unusual, but more common with therapeutic procedures; risk from procedures increases incrementally with preoperative coexisting conditions. Duodenal hematoma is predominantly a pediatric endoscopic complication and is more likely in hematology-oncology patients. Air embolism is a well-defined endoscopic retrograde cholangiopancreatography (ERCP) complication in adults and is likely to increase in children with increased performance of pediatric ERCP. Increased physician expertise is the most often proposed countermeasure, especially in the context of endoscopy complications in the higher-risk patient and procedure. Endoscopy in children remains a very safe group of procedures, although a more detailed understanding of risk factors and ideal training and practice organization is lacking.
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Affiliation(s)
- Thomas M Attard
- Department of Gastroenterology, Children's Mercy Hospital, 1MO2.37; 2401 Gilham Road, Kansas City, MO, 64108, USA.
| | - Anne-Marie Grima
- Pediatric Liver, Gastroenterology and Nutrition Centre, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Mike Thomson
- Sheffield Children's Hospital, Western Bank, Sheffield, S10 2TH, UK
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Bourigault C, Le Gallou F, Bodet N, Musquer N, Juvin ME, Corvec S, Ferronnière N, Wiesel S, Gournay J, Birgand G, Le Rhun M, Lepelletier D. Duodenoscopy: an amplifier of cross-transmission during a carbapenemase-producing Enterobacteriaceae outbreak in a gastroenterology pathway. J Hosp Infect 2018; 99:422-426. [DOI: 10.1016/j.jhin.2018.04.015] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/13/2018] [Indexed: 12/01/2022]
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Kanamori H, Rutala WA, Weber DJ. The Role of Patient Care Items as a Fomite in Healthcare-Associated Outbreaks and Infection Prevention. Clin Infect Dis 2018; 65:1412-1419. [PMID: 28520859 DOI: 10.1093/cid/cix462] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/11/2017] [Indexed: 01/28/2023] Open
Abstract
Patient-care items can serve as a source or reservoir for healthcare-associated pathogens in hospitals. We reviewed healthcare- associated outbreaks from medical equipment and provide infection prevention recommendations. Multiple healthcare-associated outbreaks via a contaminated patient-care item were identified, including infections with multidrug-resistant organisms. The type of patient care items implicated as a fomite causing healthcare-associated infections (HAIs) has changed over time. Patient populations at risk were most commonly critically ill patients in adult and neonatal intensive care units. Most fomite related healthcare-associated outbreaks were due to inappropriate disinfection practices. Repeated healthcare-associated outbreaks via medical equipment highlight the need for infectious disease professionals to understand that fomites/medical devices may be a source of HAIs. The introduction of new and more complex medical devices will likely increase the risk that such devices serve as a source of HAIs. Assuring appropriate cleaning and disinfection or sterilization of medical equipment is necessary to prevent future fomite-associated outbreaks.
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Affiliation(s)
- Hajime Kanamori
- Division of Infectious Diseases, University of North Carolina School of Medicine, North Carolina.,Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
| | - William A Rutala
- Division of Infectious Diseases, University of North Carolina School of Medicine, North Carolina.,Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina School of Medicine, North Carolina.,Hospital Epidemiology, University of North Carolina Health Care, Chapel Hill, North Carolina
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Armellino D, Cifu K, Wallace M, Johnson S, DiCapua J, Dowling O, Jacobs M, Browning S. Implementation of remote video auditing with feedback and compliance for manual-cleaning protocols of endoscopic retrograde cholangiopancreatography endoscopes. Am J Infect Control 2018; 46:594-596. [PMID: 29195779 DOI: 10.1016/j.ajic.2017.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 10/11/2017] [Accepted: 10/12/2017] [Indexed: 10/18/2022]
Abstract
A pilot initiative to assess the use of remote video auditing in monitoring compliance with manual-cleaning protocols for endoscopic retrograde cholangiopancreatography (ERCP) endoscopes was performed. Compliance with manual-cleaning steps following the initiation of feedback was measured. A video feed of the ERCP reprocessing room was provided to remote auditors who scored items of an ERCP endoscope manual-cleaning checklist. Compliance feedback was provided in the form of reports and reeducation. Outcomes were reported as checklist compliance. The use of remote video auditing to document manual processing is a feasible approach and feedback and reeducation increased manual-cleaning compliance from 53.1% (95% confidence interval, 34.7-71.6) to 98.9% (95.0% confidence interval, 98.1-99.6).
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Ling ML, Ching P, Widitaputra A, Stewart A, Sirijindadirat N, Thu LTA. APSIC guidelines for disinfection and sterilization of instruments in health care facilities. Antimicrob Resist Infect Control 2018; 7:25. [PMID: 29468053 PMCID: PMC5819152 DOI: 10.1186/s13756-018-0308-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 01/26/2018] [Indexed: 01/08/2023] Open
Abstract
Background The Asia Pacific Society of Infection Control launched its revised Guidelines for Disinfection and Sterilization of Instruments in Health Care Facilities in February 2017. This document describes the guidelines and recommendations for the reprocessing of instruments in healthcare setting. It aims to highlight practical recommendations in a concise format designed to assist healthcare facilities at Asia Pacific region in achieving high standards in sterilization and disinfection. Method The guidelines were revised by an appointed workgroup comprising experts in the Asia Pacific region, following reviews of previously published guidelines and recommendations relevant to each section. Results It recommends the centralization of reprocessing, training of all staff with annual competency assessment, verification of cleaning, continual monitoring of reprocessing procedures to ensure their quality and a corporate strategy for dealing with single-use and single-patient use medical equipment/devices. Detailed recommendations are also given with respect to reprocessing of endoscopes. Close working with the Infection Prevention & Control department is also recommended where decisions related to reprocessing medical equipment/devices are to be made. Conclusions Sterilization facilities should aim for excellence in practices as this is part of patient safety. The guidelines that come with a checklist help service providers identify gaps for improvement to reach this goal. Electronic supplementary material The online version of this article (10.1186/s13756-018-0308-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Moi Lin Ling
- 1Infection Prevention & Control, Singapore General Hospital, Singapore, 169608 Singapore
| | - Patricia Ching
- Hong Kong Infection Control Nurses Association (HKICNA), Hong Kong, Hong Kong
| | | | - Alison Stewart
- New Zealand Sterile Services Association (NZSSA), Waikiwi, New Zealand
| | | | - Le Thi Anh Thu
- Ho Chi Minh City Infection Control Society (HICS), Ho Chi Minh City, Vietnam
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Kohli DR, Grys TE, Pannala R. Eliminating Duodenoscope-Associated Transmission of Carbapenem-Resistant Enterobacteriaceae (CRE): In Search of an Optimal Strategy. Dig Dis Sci 2017; 62:2961-2963. [PMID: 28932932 DOI: 10.1007/s10620-017-4761-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- Divyanshoo R Kohli
- Division of Gastroenterology and Hepatology, Departments of Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Thomas E Grys
- Laboratory Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Rahul Pannala
- Division of Gastroenterology and Hepatology, Departments of Medicine, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA.
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Pennathur PR, Herwaldt LA. Role of Human Factors Engineering in Infection Prevention: Gaps and Opportunities. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2017; 9:230-249. [PMID: 32226329 PMCID: PMC7100866 DOI: 10.1007/s40506-017-0123-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Human factors engineering (HFE), with its focus on studying how humans interact with systems, including their physical and organizational environment, the tools and technologies they use, and the tasks they perform, provides principles, tools, and techniques for systematically identifying important factors, for analyzing and evaluating how these factors interact to increase or decrease the risk of Healthcare-associated infections (HAI), and for identifying and implementing effective preventive measures. We reviewed the literature on HFE and infection prevention and control and identified major themes to document how researchers and infection prevention staff have used HFE methods to prevent HAIs and to identify gaps in our knowledge about the role of HFE in HAI prevention and control. Our literature review found that most studies in the healthcare domain explicitly applying (HFE) principles and methods addressed patient safety issues not infection prevention and control issues. In addition, most investigators who applied human factors principles and methods to infection prevention issues assessed only one human factors element such as training, technology evaluations, or physical environment design. The most significant gap pertains to the limited use and application of formal HFE tools and methods. Every infection prevention study need not assess all components in a system, but investigators must assess the interaction of critical system components if they want to address latent and deep-rooted human factors problems.
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Affiliation(s)
- Priyadarshini R. Pennathur
- Department of Mechanical and Industrial Engineering, 2132 Seamans Center for the Engineering Arts and Sciences, University of Iowa, Iowa City, IA USA
| | - Loreen A. Herwaldt
- Department of Medicine, University of Iowa School of Medicine, Iowa City, IA USA
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Abstract
Carbapenems are the broadest spectrum antimicrobials utilized in the treatment of serious infections since the 1980s. Soon after their introduction, the discovery of carbapenem-resistant Enterobacteriaceae (CRE) was reported in the 1990s. Invasive CRE infections are associated with high mortality and limited treatment options making care for patients with these infections challenging for clinicians. Current practice has reverted back to the use of "older" antimicrobials, such as the polymyxins, tigecycline, and fosfomycin, to combat invasive CRE infections. However, recent approval of ceftazidime-avibactam has added another treatment option to the current antimicrobial armamentarium. Resistance among the "older" agents is still rare but has been reported. Currently, there are numerous agents that are under investigation as well as combination therapy that looks promising in the treatment of CRE infections.
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Spencer M. Overview of Recent Issues and Advances in Infection Prevention. AORN J 2016; 104:502-505. [DOI: 10.1016/j.aorn.2016.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 09/29/2016] [Indexed: 11/25/2022]
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