Infection prevention in alternative health care settings

Antibiotic prescribing practice using WHO Access, Watch and Reserve classification and its determinants among outpatient prescriptions dispensed to elderly population in six community chain pharmacies in Asmara, Eritrea: a cross-sectional study

OBJECTIVE

To assess antibiotic prescribing practice and its determinants among outpatient prescriptions dispensed to the elderly population.

DESIGN

A prescription-based, cross-sectional study.

SETTING

Six community chain pharmacies in Asmara, Eritrea.

PARTICIPANTS

All outpatient prescriptions dispensed to the elderly population (aged 65 and above) in the six community chain pharmacies in Asmara, Eritrea.

DATA COLLECTION AND ANALYSIS

Data were collected retrospectively, between 16 June 2023 and 16 July 2023. Antibiotic prescribing practice was assessed using the 2023 World Health Organization (WHO) Access, Watch and Reserve (AWaRe) classification system. Descriptive statistics and logistic regression were performed using IBM SPSS (V.26.0). P values less than 0.05 were considered as significant.

RESULTS

Of the 2680 outpatient prescriptions dispensed to elderly population, 35.8% (95% CI: 34.0, 37.6) contained at least one antibiotic. Moreover, a total of 1061 antibiotics were prescribed to the elderly population. The most commonly prescribed antibiotics were ciprofloxacin (n=322, 30.3%) and amoxicillin/clavulanic acid (n=145, 13.7%). The Access category accounted for the majority of antibiotics (53.7%) with 32.1% from the Watch category. Prescriber qualification (Adjusted Odds Ratio (AOR)= 0.60, 95% CI: 0.44, 0.81) and polypharmacy (AOR= 2.32, 95% CI: 1.26, 4.27) were significant determinants of antibiotic prescribing in the elderly population. Besides, sex (AOR=0.74, 95% CI: 0.56, 0.98), prescriber qualification (AOR=0.49, 95% CI: 0.30 to0.81) and level of health facility (AOR 0.52, 95% CI 0.34 to 0.81) were significant determinants of a Watch antibiotic prescription.

CONCLUSION

Antibiotics were prescribed to a considerable number of the elderly population, with more than half of them falling into the Access category. Further efforts by policy-makers are needed to promote the use of Access antibiotics while reducing the use of Watch antibiotics to mitigate risks associated with antimicrobial resistance.

State of the art review. Complications after carpal tunnel release

Carpal tunnel release (CTR) is the most performed surgery of the upper extremity. It is effective but not without complications. This state-of-the-art review covers most common intra- and postoperative complications after CTR. As endoscopic carpal tunnel release (ECTR) has developed over time, severe complications, such as nerve lesions, have diminished. ECTR still has a higher risk on transient nerve lesions. Open CTR on the other hand has a higher incidence of wound-related problems, including scar tenderness, irrespective of incision used. Most complications, such as pillar pain and infection, are ill-defined in the literature, leaving the exact incidence unknown and proposing challenges in treatment. The same is true for failure of treatment. Optimizing the length and location of incisions has played a vital role in reducing intra- and postoperative complications in CTR. It is expected that technical advances, such as ultrasound-guided percutaneous carpal tunnel release, will continue to play a role in the future.Level of evidence: V.

Amplifying anti-flooding electrode to fabricate modular electro-fenton system for degradation of antiviral drug lamivudine in wastewater

The advanced oxidation based on in-situ hydrogen peroxide production using carbon air cathode is very potential for wastewater treatment. However, catalyst flooding and complex assembly patterns are the bottleneck limiting the air cathode to the long-term and large-scale application. In this work, a novel anti-flooding air-breathing cathode (ABC) was prepared by a simple rolling-spraying method with relatively low price commercial materials. The novel method changed the morphology of gas diffusion layer as well as adjusted the hydrophobicity of air side of the catalyst layer. As a result, water-air distribution management was achieved and TPI disequilibrium was prevented. Compare with traditional ABC, the H₂O₂ yield and current efficiency (CE) of optimized anti-flooding ABC (ABC_0.9) increased by 13.5% (941 ± 10 mg·L^-1·h^-1 with CE of 84% at 30 mA·cm^-2), the material cost and fabrication time decreased by 10.1% (2.32 ¥·dm^-2, ~0.36 $·dm^-2) and 40%. Amplified ABC coupled with Ti/IrO₂ anodes were integrated into a modular electrode used for H₂O₂generation. When the current density (j) increased from 10 to 30 mA·cm^-2, the energy cost increased from 0.19 to 0.43 ¥·mol^-1 H₂O₂ (from 0.03 to 0.07 $·mol^-1 H₂O₂). The modular electrode was utilized in a 2 L pre-pilot scale reactor for antiviral drug lamivudine degradation by electro-Fenton (EF) process. 100% of lamivudine and 78.1% of total organic carbon (TOC) were removed within 60 min at 20 mA·cm^-2. The susceptible sites on the lamivudine toward hydroxyl radicals were investigated and transformation products (TP) as well as degradation pathway were studied.

Discharge Disposition and Clinical Outcomes After Spine Surgery

OBJECTIVE

Spinal decompression with or without fusion is one of the most commonly performed procedures in spine surgery. However, there is limited evidence on the effect of discharge environment on outcomes after surgery. The purpose of this study is to identify the effects of discharge disposition setting on clinical outcomes after spine surgery.

METHODS

Patients who underwent lumbar decompression, lumbar decompression and fusion, or posterior cervical decompression and fusion surgery were retrospectively identified. All clinical and demographic data were obtained from electronic health records. Surgical outcomes included wound complications, revision surgery, "30-day" readmission (0-30 d), and "90-day" readmission (31-90 d). Discharge disposition was stratified into home/self-care, acute inpatient rehabilitation, and subacute rehabilitation. Patient-reported outcome measures including VAS Back, VAS Leg, VAS Neck, VAS Arm, PCS-12 and MCS-12, ODI, and NDI were compared between patient discharge disposition settings using the Mann-Whitney U test. Pearson's chi-square analysis was used to assess for differences in wound complications, revision surgery, 30-day readmission, or 90-day readmission rates. Multivariate logistic regression incorporating age, sex, body mass index (BMI), Charlson Comorbidity Index (CCI), and discharge disposition was used to determine independent predictors of wound complications.

RESULTS

A total of 637 patients were included in the study. A significant difference (P = 0.03) was found in wound complication based on discharge disposition, with subacute disposition having the highest proportion of wound complications (6.1%) and home disposition having the lowest (1.5%). There were no significant differences in the rates of revision surgery, 30-day readmission, or 90-day readmission between groups. Subacute rehabilitation (odds ratio: 3.67, P = 0.047) and CCI (odds ratio 1.49, P = 0.01) were independent predictors of wound complications. Significant improvement in PROMs was seen across all postacute discharge dispositions. Baseline (P = 0.02) and postoperative (P = 0.02) ODI were significantly higher among patients discharged to an acute facility (49.4 and 32.0, respectively) compared to home (42.2 and 20.0) or subacute (47.4 and 28.4) environments.

CONCLUSION

Subacute rehabilitation disposition and CCI are independent predictors of wound complications after spinal decompression surgery. Patients undergoing spine surgery have similar readmission and revision rates and experience similar clinical improvement across all postacute discharge dispositions.

Availability, Accessibility and Proper Use of Personal Protective Equipment in Wards at Queen Elizabeth Central Hospital (QECH) Blantyre, Malawi: An Observational Study

Background

The purpose of this study was to evaluate the availability, accessibility and proper use of personal protective equipment (PPE) in the wards at Queen Elizabeth Central Hospital (QECH).

Methods

We conducted an observational study with a cross-section design. Convenience sampling method was used for selection of healthcare workers (HCWs) in wards. HCWs filled a checklist on accessibility of PPEs and they were observed on proper use of PPE while conducting clinical procedures. Nurse ward in-charge was asked to fill out a checklist on availability of PPE in their ward.

Results

PPE was available in 75.8% of wards, not available in 12.5%. Goggles were absent in 70.8% of wards. PPEs were 71.4% accessible and 28.6% inaccessible to healthcare workers in the wards. The most inaccessible PPEs were goggles (83.2%) and footwear (73.7%) while facemasks, sterile and non-sterile gloves and aprons were readily accessible. Non sterile gloves were 100% available and accessible. Only 13.5% of the HCWs had good compliance with PPE standard procedures. The average PPE compliance score of those who had been trained was 6 % greater than those who were not trained.

Conclusion

This study identified areas of improvement in healthcare system delivery regarding standard precautions with emphasis on PPE. Improvements in training during professional college education and in-service refresher training could improve compliance with appropriate use of PPE for relatively low cost. Management support could improve availability and accessibility of PPE in the wards at QECH, with active supervision to improve adherence levels to personal protective equipment usage. The study can also help in the development of policies and guidelines regarding PPE usage by showing that most HCWs need to be trained in proper PPE usage.

Antiviral drugs in aquatic environment and wastewater treatment plants: A review on occurrence, fate, removal and ecotoxicity

The environmental release of antiviral drugs is of considerable concern due to potential ecosystem alterations and the development of antiviral resistance. As a result, interest on their occurrence and fate in natural and engineered systems has grown substantially in recent years. The main scope of this review is to fill the void of information on the knowledge on the worldwide occurrence of antiviral drugs in wastewaters and natural waters and correlate their levels with their environmental fate. According to the conducted literature survey, few monitoring data exists for several European countries, such as Germany, France, and the UK. Lesser data are available for Asia, where approximately 80% of the studies focus on Japan. Several articles study the occurrence of mostly antiretroantivirals in sub-Saharan African countries, while there is a lack of data for other developing regions of the world, including the rest of Africa, South America, and the biggest part of Asia. An importantly smaller number of studies exists for North America, while no studies exist for Oceania. The against innfluenza drug oseltamivir along with its active carboxy metabolite is found to be the most studied antiviral drug. The distribution of antiviral drugs across all geographic regions varies from low ng L^-1 to high μg L^-1 levels, in some cases, even in surface waters. This overarching review reveals that monitoring of antiviral drugs is necessary, and some of those compounds may require toxicological attention, in the light of either spatial and temporal high concentration or potential antiviral resistance. Based on the information provided herein, the need for a better understanding of the water quality hazards posed by antiviral drugs existence in wastewater outputs and freshwater ecosystems is demosntrated. Finally, the future challenges concerning the occurrence, fate, and potential ecotoxicological risk to organisms posed by antiviral drug residues are discussed.

Infection prevention outside of the acute care setting: Results from the MegaSurvey of infection preventionists

BACKGROUND

In recent years, there has been a significant shift of health care delivery to nonacute care settings. However, research on staffing and resources dedicated to infection prevention and control (IPC) in these settings is lacking.

METHODS

The data for this analysis come from the 2015 APIC MegaSurvey. Descriptive statistics were computed to describe infection preventionists (IPs) employed in nonacute care settings. Bivariate analyses were conducted to examine differences in facility and demographic characteristics by type of nonacute care setting.

RESULTS

In total, 861 IPs represented ambulatory surgical centers (33%), long-term care facilities (23%), long-term acute care facilities (20%), inpatient behavioral or mental health care (12%), clinic or outpatient services (10%), and home health care (3%). Few (15%) were Certified in Infection Control. Most (58%) reported that less than half of their job was officially dedicated to IPC. On average, respondents reported spending the largest proportion of their time on surveillance and epidemiologic investigation (19%). IPs lacked support for secretarial functions (23%), data management (14%), and electronic medical records (32%). IPC activities, staffing, and resources differed significantly by type of nonacute care facility.

CONCLUSIONS

This study indicates that resources directed to IPC in nonacute care settings may be lacking and identifies important areas for IPC education and program improvement. Research is needed to further examine staffing and IPC resources in these settings, which represent unique challenges to infection prevention and control.

Surgical site infection after hand surgery outside the operating theatre: a systematic review

We carried out a systematic review to determine the incidence of infection for hand surgery done in settings other than the operating theatre. Databases were searched and a PRISMA chart created by three independent reviewers. From 1200 studies identified, 46 full text articles were reviewed and six were included (two Level 3 studies and four Level 4). In three studies there were no infections after surgery in an office, procedure room or emergency department. Two studies with a combined number of 1962 procedures reviewed carpal tunnel decompressions and reported identical infection rates of 0.4%. Although the current evidence is of poor quality, it suggests that some types of hand surgery may be done outside the operating theatre without increasing the risk of infection.

LEVEL OF EVIDENCE

IV.

Patient safety in rehabilitation medicine: traumatic brain injury

This article describes patient safety after traumatic brain injury (TBI). Patient safety in rehabilitation after TBI is important. Thorough assessment on initial evaluation, vigilance for medical and procedural errors, appropriate communication between medical professionals, and evaluation of systems-based practices increases patient safety. It is the responsibility of the rehabilitation treatment team to ensure that appropriate measures are taken to reduce risk of adverse events. This article is intended to promote discussion of patient safety after TBI within rehabilitation teams and to help improve outcomes throughout the spectrum of recovery.

Characteristics, services, and infection control practices of New York City assisted living facilities, 2010

OBJECTIVES

To describe New York City (NYC) assisted living facility (ALF) characteristics, services offered, and infection control practices and to identify infection control barriers and unmet needs.

DESIGN

Cross-sectional.

SETTING

ALFs licensed or applying to be licensed in NYC.

PARTICIPANTS

Seventy ALFs; 70 of 77 eligible facilities participated (91% participation rate).

MEASUREMENTS

Telephone interview questions assessed ALF characteristics, services offered, and infection control practices, including glucometry practices.

RESULTS

ALFs provided a broad range of services, such as vaccination (90%), assistance with taking medication (75%), bathing and showering (33%), and blood glucose monitoring (90%). Ninety percent of the facilities had nurses on site (directly employed or through a contract agency). Five facilities reported that residents sometimes shared glucometers, and one reported that fingerstick devices were sometimes shared. The majority of facilities wanted educational materials for staff (83%) and residents (77%) on topics including influenza, respiratory illness, norovirus, standard precautions, and general infection control. ALFs had a range of sick leave policies and infection control training requirements. Eighty-nine percent of the facilities reported having designated staff responsible for infection control, although 50% had nonclinical job titles.

CONCLUSION

NYC ALFs were varied in terms of nursing services offered, characteristics, and residents' needs; therefore, public health agencies may need to be flexible in their assistance. Public health agencies should consider strengthening relationships with ALFs to identify unmet needs and gaps in services.

Colonization of pressure ulcers by multidrug-resistant microorganisms in patients receiving home care

Colonization and/or infection with multidrug-resistant microorganisms (MDRO) of pressure ulcers in patients receiving care at home have seldom been investigated. The objective of this study was to assess the prevalence of MDRO colonization in pressure ulcers of patients receiving home care in Palermo, Italy. Vancomycin-resistant Enterococcus (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and multidrug-resistant Gram-negative bacilli (MDRGN) were isolated, identified, and characterized from pressure ulcers and selected home environment surfaces. Thirty-two patients were enrolled, of whom 12 were under antimicrobial therapy. Five patients had been admitted to hospital in the preceding year. Nineteen patients tested positive for 1 or more MDROs. In particular, 1 patient was colonized by a vanA-containing strain of VRE, 5 by MRSA, and 17 by MDRGN of different species. Our findings suggest that pressure ulcers in home care patients could play a role in bringing MDROs into the community setting.