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Sarkies MN, Testa L, Carrigan A, Roberts N, Gray R, Sherrington C, Mitchell R, Close JCT, McDougall C, Sheehan K. Perioperative interventions to improve early mobilisation and physical function after hip fracture: a systematic review and meta-analysis. Age Ageing 2023; 52:afad154. [PMID: 37596922 PMCID: PMC10439513 DOI: 10.1093/ageing/afad154] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Perioperative interventions could enhance early mobilisation and physical function after hip fracture surgery. OBJECTIVE Determine the effectiveness of perioperative interventions on early mobilisation and physical function after hip fracture. METHODS Ovid MEDLINE, CINAHL, Embase, Scopus and Web of Science were searched from January 2000 to March 2022. English language experimental and quasi-experimental studies were included if patients were hospitalised for a fractured proximal femur with a mean age 65 years or older and reported measures of early mobilisation and physical function during the acute hospital admission. Data were pooled using a random effect meta-analysis. RESULTS Twenty-eight studies were included from 1,327 citations. Studies were conducted in 26 countries on 8,192 participants with a mean age of 80 years. Pathways and models of care may provide a small increase in early mobilisation (standardised mean difference [SMD]: 0.20, 95% confidence interval [CI]: 0.01-0.39, I2 = 73%) and physical function (SMD: 0.07, 95% CI 0.00 to 0.15, I2 = 0%) and transcutaneous electrical nerve stimulation analgesia may provide a moderate improvement in function (SMD: 0.65, 95% CI: 0.24-1.05, I2 = 96%). The benefit of pre-operative mobilisation, multidisciplinary rehabilitation, recumbent cycling and clinical supervision on mobilisation and function remains uncertain. Evidence of no effect on mobilisation or function was identified for pre-emptive analgesia, intraoperative periarticular injections, continuous postoperative epidural infusion analgesia, occupational therapy training or nutritional supplements. CONCLUSIONS Perioperative interventions may improve early mobilisation and physical function after hip fracture surgery. Future studies are needed to model the causal mechanisms of perioperative interventions on mobilisation and function after hip fracture.
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Affiliation(s)
- Mitchell N Sarkies
- School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney NSW 2006, Australia
| | - Luke Testa
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park NSW 2113, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park NSW 2113, Australia
| | - Natalie Roberts
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park NSW 2113, Australia
| | - Rene Gray
- James Paget University Hospital Foundation Trust, Norfolk NR31, UK
| | - Catherine Sherrington
- Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney NSW 2006, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney NSW 2006, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Macquarie Park NSW 2113, Australia
| | - Jacqueline C T Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, Sydney NSW 2031, Australia
- Prince of Wales Clinical School, University of New South Wales, Sydney NSW 2052, Australia
| | - Catherine McDougall
- The University of Queensland, Brisbane 4072, Australia
- The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane 4032, Australia
| | - Katie Sheehan
- Department of Population Health Sciences, School of Life Course and Population Sciences, King’s College London, London WC2R, UK
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Aldarhami A, Bazaid AS, Qanash H, Ahmad I, Alshammari FH, Alshammari AM, Alshammari AH, Aljanfawe FM, Aldamiri B, Aldawood E, Alghamdi MA, Binsaleh NK, Saeedi NH, Snoussi M. Effects of Repeated in-vitro Exposure to Saudi Honey on Bacterial Resistance to Antibiotics and Biofilm Formation. Infect Drug Resist 2023; 16:4273-4283. [PMID: 37424668 PMCID: PMC10327913 DOI: 10.2147/idr.s410159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 06/28/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Although Sumra and Sidr Saudi honey is widely used in traditional medicine due to its potent activity, it is unknown whether its prolonged usage has impact upon bacterial virulence or leading to reduced antibiotic sensitivity. Thus, the study aims to investigate the effect of prolonged (repeated) in-vitro exposure to Saudi honey on the antibiotic susceptibility profiles and biofilm formation of pathogenic bacteria. Methods Several bacteria, including Staphylococcus aureus, Escherichia coli, and Acinetobacter baumannii, were in-vitro exposed ten times [passaged (P10)]to Sumra and Sider honey individually to introduce adapted bacteria (P10). Antibiotic susceptibility profiles of untreated (P0) and adapted (P10) bacteria were assessed using disc diffusion and microdilution assays. The tendency regarding biofilm formation following in-vitro exposure to honey (P10) was assessed using the Crystal violet staining method. Results Adapted (P10) bacteria to both Sumra and Sidr honey showed an increased sensitivity to gentamicin, ceftazidime, ampicillin, amoxycillin/clavulanic acid, and ceftriaxone, when compared with the parent strains (P0). In addition, A. baumannii (P10) that was adapted to Sidr honey displayed a 4-fold increase in the minimal inhibitory concentration of the same honey following in-vitro exposure. 3-fold reduction in the tendency toward biofilm formation was observed for the Sumra-adapted (P10) methicillin resistant S. aureus strain, although there was a lower rate of reduction (1.5-fold) in biofilm formation by both the Sumra- and Sidr-adapted A. baumannii (P10) strains. Conclusion The data highlight the positive impact of prolonged in-vitro exposure to Saudi honey (Sumra and Sider) for wound-associated bacteria since they displayed a significant increase in their sensitivity profiles to the tested antibiotic and a reduction in their ability to form biofilm. The increased bacterial sensitivity to antibiotics and a limited tendency toward biofilm formation would suggest the great potential therapeutic use of this Saudi honey (Sumra and Sidr) to treat wound infections.
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Affiliation(s)
- Abdu Aldarhami
- Department of Medical Microbiology, Qunfudah Faculty of Medicine, Umm Al-Qura University, Al-Qunfudah, 21961, Saudi Arabia
| | - Abdulrahman S Bazaid
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha’il, Hail, 55476, Saudi Arabia
- Medical and Diagnostic Research Center, University of Ha’il, Hail, 55473, Saudi Arabia
| | - Husam Qanash
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha’il, Hail, 55476, Saudi Arabia
- Medical and Diagnostic Research Center, University of Ha’il, Hail, 55473, Saudi Arabia
| | - Iqbal Ahmad
- Department of Agricultural Microbiology, Faculty of Agricultural Sciences, Aligarh Muslim University, Aligarh, 202002, India
| | - Fahad H Alshammari
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha’il, Hail, 55476, Saudi Arabia
- Medical and Diagnostic Research Center, University of Ha’il, Hail, 55473, Saudi Arabia
| | - Abdulrahman M Alshammari
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha’il, Hail, 55476, Saudi Arabia
- Medical and Diagnostic Research Center, University of Ha’il, Hail, 55473, Saudi Arabia
| | - Abdulrahman H Alshammari
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha’il, Hail, 55476, Saudi Arabia
- Medical and Diagnostic Research Center, University of Ha’il, Hail, 55473, Saudi Arabia
| | - Fahad M Aljanfawe
- Medical and Diagnostic Research Center, University of Ha’il, Hail, 55473, Saudi Arabia
| | - Bushra Aldamiri
- Biochemistry Department, College of Science, King Saud University, Riyadh, 12372, Saudi Arabia
| | - Esraa Aldawood
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, 12372, Saudi Arabia
| | - Mashail A Alghamdi
- Biology Department, Faculty of Science, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Naif K Binsaleh
- Department of Medical Laboratory Science, College of Applied Medical Sciences, University of Ha’il, Hail, 55476, Saudi Arabia
- Medical and Diagnostic Research Center, University of Ha’il, Hail, 55473, Saudi Arabia
| | - Nizar H Saeedi
- Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, University of Tabuk, Tabuk, Saudi Arabia
| | - Mejdi Snoussi
- Medical and Diagnostic Research Center, University of Ha’il, Hail, 55473, Saudi Arabia
- Department of Biology, College of Science, University of Ha’il, Hail, 81451, Saudi Arabia
- Laboratory of Genetics, Biodiversity and Valorization of Bio-Resources, Higher Institute of Biotechnology of Monastir, University of Monastir, Monastir, 5000, Tunisia
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Adane F, Dessalegn M. Magnitude and predictors of unfavorable management outcome in surgically treated patients with intestinal obstruction in Ethiopia: a systematic review and meta-analysis. BMC Surg 2023; 23:132. [PMID: 37193961 DOI: 10.1186/s12893-023-02017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/26/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Unless an emergency surgical intervention is conducted, intestinal obstruction may result in high morbidity and mortality. In Ethiopia, the magnitude and predictors of unfavorable management outcomes in surgically treated patients with intestinal obstruction are highly variable and inconsistent. The aim of this study was; therefore, to estimate the overall prevalence of unfavorable management outcome and its predictors among surgically treated patients with intestinal obstruction in Ethiopia. METHOD We searched articles from databases from June 1, 2022, to August 30, 2022. Cochrane Q test statistics and I2 tests were applied. We used a random-effect meta-analysis model to overcome the impact of heterogeneity among the included studies. In addition, the association between risk factors and unfavorable management outcome in surgically treated patients with intestinal obstruction was investigated. RESULTS This study included a total of twelve articles. The pooled prevalence of unfavorable management outcome in surgically treated patients with intestinal obstruction was 20.22% (95% CI: 17.48-22.96). According to a sub-group analysis by region, Tigray region had the highest prevalence of poor management outcome, which was 25.78% (95% CI: 15.69-35.87). Surgical site infection was the most commonly reported symptom of poor management outcome (8.63%; 95% CI: 5.62, 11.64). The length of postoperative hospital stays (95% CI: 3.02, 29.08), duration of illness (95% CI: 2.44, 6.12), presence of comorbidity (95% CI: 2.38, 10.11), dehydration (95% CI: 2.07, 17.40), and type of intraoperative procedure (95% CI: 2.12, 6.97) were all significantly associated with unfavorable management outcome of intestinal obstruction among surgically treated patients in Ethiopia. CONCLUSION According to this study, the magnitude of unfavorable management outcome was high among surgically treated patients in Ethiopia. Unfavorable management outcome was significantly associated with the length of postoperative hospital stays, duration of illness, comorbidity, dehydration, and type of intraoperative procedure. Medical, surgical and public health measures are pivotal to reduce unfavorable management outcome in surgically treated intestinal obstruction patients in Ethiopia.
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Affiliation(s)
- Fentahun Adane
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia.
| | - Megbar Dessalegn
- Department of Surgery, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
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Al-Asmari F, Ismail AI. Evaluating food safety knowledge and practices among Saudi women in Al-Ahsa Region, Saudi Arabia. Ital J Food Saf 2023; 12:10716. [PMID: 37064517 PMCID: PMC10102962 DOI: 10.4081/ijfs.2023.10716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/16/2023] [Indexed: 04/18/2023] Open
Abstract
Foodborne illnesses are responsible for about half a million deaths annually, of which 30% occur among kids. This study aimed to assess the current food safety knowledge and practice level of Saudi women in Al-Ahsa region, Saudi Arabia. A cross-sectional study was conducted through personal interviews among 239 Saudi women. The questionnaire consisted of close-ended questions covering different aspects of food safety knowledge and practices at home and during shopping. Descriptive analyses were used to identify the level of participant's awareness, and the scores were shown in three categories (good - fair - poor) based on their food safety knowledge and practice awareness. The effect of socio-demographic characteristics and their correlation to food safety knowledge and practices was conducted using Chisquare analysis. The results about food safety knowledge showed that around 50% of participants achieved a good score, and 37.5% achieved a fair score, while 12.5% achieved a poor score. In comparison, the participants achieved 75% good score, whereas 12.5% achieved both fair and poor in food safety practices. The results also highlighted a significant correlation (P<0.05) between level of food safety knowledge, practices of participants and their age, marital status, work status, and educational level, while there's no correlation with their family size and total income. Although, the overall result showed good level in food safety knowledge and slightly less in food safety practices among Saudi women living in Al-Ahsa region, continuous education, training, awareness, and motivation are highly recommended to improve women's knowledge and practices to higher levels.
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Affiliation(s)
- Fahad Al-Asmari
- Department of Food Science and Nutrition, College of Agriculture and Food Sciences, King Faisal University, Al-Hofuf, Saudi Arabia
- Department of Food Science and Nutrition, College of Agriculture and Food Sciences, King Faisal University, P.O. Box 400, Al-Ahsa 31982, Al-Hofuf, Saudi Arabia. +966135895747.
| | - Ahmed I.H. Ismail
- Department of Agribusiness and Consumer Sciences, College of Agriculture and Food Sciences, King Faisal University, Al-Hofuf, Saudi Arabia
- Rural Community and Agric. Extension Department, College of Agriculture, Ain Shams University, Egypt
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Popa SL, Pop C, Dita MO, Brata VD, Bolchis R, Czako Z, Saadani MM, Ismaiel A, Dumitrascu DI, Grad S, David L, Cismaru G, Padureanu AM. Deep Learning and Antibiotic Resistance. Antibiotics (Basel) 2022; 11:1674. [PMID: 36421316 PMCID: PMC9686762 DOI: 10.3390/antibiotics11111674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 09/25/2023] Open
Abstract
Antibiotic resistance (AR) is a naturally occurring phenomenon with the capacity to render useless all known antibiotics in the fight against bacterial infections. Although bacterial resistance appeared before any human life form, this process has accelerated in the past years. Important causes of AR in modern times could be the over-prescription of antibiotics, the presence of faulty infection-prevention strategies, pollution in overcrowded areas, or the use of antibiotics in agriculture and farming, together with a decreased interest from the pharmaceutical industry in researching and testing new antibiotics. The last cause is primarily due to the high costs of developing antibiotics. The aim of the present review is to highlight the techniques that are being developed for the identification of new antibiotics to assist this lengthy process, using artificial intelligence (AI). AI can shorten the preclinical phase by rapidly generating many substances based on algorithms created by machine learning (ML) through techniques such as neural networks (NN) or deep learning (DL). Recently, a text mining system that incorporates DL algorithms was used to help and speed up the data curation process. Moreover, new and old methods are being used to identify new antibiotics, such as the combination of quantitative structure-activity relationship (QSAR) methods with ML or Raman spectroscopy and MALDI-TOF MS combined with NN, offering faster and easier interpretation of results. Thus, AI techniques are important additional tools for researchers and clinicians in the race for new methods of overcoming bacterial resistance.
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Affiliation(s)
- Stefan Lucian Popa
- 2nd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
| | - Cristina Pop
- Department of Pharmacology, Physiology and Pathophysiology, Faculty of Pharmacy, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
| | - Miruna Oana Dita
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
| | - Vlad Dumitru Brata
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
| | - Roxana Bolchis
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
| | - Zoltan Czako
- Department of Computer Science, Technical University of Cluj-Napoca, 400114 Cluj-Napoca, Romania
| | - Mohamed Mehdi Saadani
- Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
| | - Abdulrahman Ismaiel
- 2nd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
| | - Dinu Iuliu Dumitrascu
- Department of Anatomy, “Iuliu Hatieganu“ University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania
| | - Simona Grad
- 2nd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
| | - Liliana David
- 2nd Medical Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania
| | - Gabriel Cismaru
- Fifth Department of Internal Medicine, Cardiology Rehabilitation, Faculty of Medicine, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
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Saito S, Thao PTN, Ishikane M, Xuan PT, Kutsuna S, Dai HQ, Ohtsu H, Kimura T, Kiyohara H, Shimada Y, Maruoka Y, Thuy PTP, Phu TT, Phuong HK, Tra TT, Duy NLM, Ohara H, Kurosu H, Son NT, Ohmagari N. Physical oral care prevents ventilator-associated pneumonia in Vietnam: A prospective interventional study. J Infect Chemother 2022; 28:1632-1638. [PMID: 36049613 DOI: 10.1016/j.jiac.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 08/14/2022] [Accepted: 08/20/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) has emerged as a critical issue in the intensive care unit (ICU) because of its high burden on patients and medical staff. Here, we examined the potential for reducing VAP incidence through physical oral care interventions without any medication. METHODS This prospective interventional study compared VAP incidence during an 8-month baseline period (usual oral care) and a 9-month intervention period (physical oral care with sponge brush) among patients who received mechanical ventilation for >48 h in a tertiary care hospital in Vietnam from 2017 to 2019. Physical oral care was provided by general ICU nurses who had been trained by dentists and infection control nurses. VAP was diagnosed using the Clinical Pulmonary Infection Score. RESULTS In total, 423 patients were enrolled in the baseline group and 454 patients were enrolled in the intervention group; 303 and 300 patients, respectively, were included in the analysis. Two hundred thirty-eight VAP episodes were identified: 135 (44.6%) during the baseline period and 103 (34.3%) during the intervention period. Univariate analysis revealed significant reduction of VAP occurrence in the intervention period (odds ratio = 0.65; 95% confidence interval = 0.47-0.90; P = 0.010). The incidences of VAP per 1000 ventilator-days were 63.4 (135/2128) during the baseline period and 48.4 (103/2128) during the intervention period (P = 0.038). CONCLUSIONS Physical oral care without any medication (e.g., chlorhexidine) reduced VAP incidence in the ICU. This method could be used to reduce VAP incidence, particularly in countries with limited medical resources.
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Affiliation(s)
- Sho Saito
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Pham Thi Ngoc Thao
- General Intensive Care Unit, Cho Ray Hospital, Ho Chi Minh City, Viet Nam; Department of Critical Care, Emergency Medicine and Clinical Toxicology, University of Medicine and Pharmacy Ho Chi Minh City, Viet Nam
| | - Masahiro Ishikane
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan; Ministry of Health, Viet Nam.
| | - Phan Thi Xuan
- General Intensive Care Unit, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Huynh Quang Dai
- General Intensive Care Unit, Cho Ray Hospital, Ho Chi Minh City, Viet Nam; Department of Critical Care, Emergency Medicine and Clinical Toxicology, University of Medicine and Pharmacy Ho Chi Minh City, Viet Nam
| | - Hiroshi Ohtsu
- Joint Center for Researchers, Associates and Clinicians Data Center, Department of Data Science, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tomomi Kimura
- Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Kiyohara
- Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yasuyuki Shimada
- Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yutaka Maruoka
- Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | | | | | | | - Ton Thanh Tra
- Quality Control Management, Cho Ray Hospital, Viet Nam
| | - Nguyen Ly Minh Duy
- Department of Critical Care, Emergency Medicine and Clinical Toxicology, University of Medicine and Pharmacy Ho Chi Minh City, Viet Nam
| | - Hiroshi Ohara
- , JICA Project for Improvement of Hospital Management Competency, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Hitomi Kurosu
- JICA Expert, JICA Project for Improvement of Hospital Management Competency at Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Nguyen Truong Son
- Cho Ray Hospital, Ho Chi Minh City, Viet Nam; Ministry of Health, Viet Nam
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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Hussain SM, Jamshed W, Eid MR. Solar-HVAC Thermal Investigation Utilizing (Cu-AA7075/C6H9NaO7) MHD-Driven Hybrid Nanofluid Rotating Flow via Second-Order Convergent Technique: A Novel Engineering Study. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2022. [DOI: 10.1007/s13369-022-07140-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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The Composites of Polyamide 12 and Metal Oxides with High Antimicrobial Activity. Polymers (Basel) 2022; 14:polym14153025. [PMID: 35893987 PMCID: PMC9330415 DOI: 10.3390/polym14153025] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/03/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022] Open
Abstract
The lack of resistance of plastic objects to various pathogens and their increasing activity in our daily life have made researchers develop polymeric materials with biocidal properties. Hence, this paper describes the thermoplastic composites of Polyamide 12 mixed with 1-5 wt % of the nanoparticles of zinc, copper, and titanium oxides prepared by a twin-screw extrusion process and injection moulding. A satisfactory biocidal activity of polyamide 12 nanocomposites was obtained thanks to homogenously dispersed metal oxides in the polymer matrix and the wettability of the metal oxides by PA12. At 4 wt % of the metal oxides, the contact angles were the lowest and it resulted in obtaining the highest reduction rate of the Escherichia coli (87%), Candida albicans (53%), and Herpes simplex 1 (90%). The interactions of the nanocomposites with the fibroblasts show early apoptosis (11.85-27.79%), late apoptosis (0.81-5.04%), and necrosis (0.18-0.31%), which confirms the lack of toxicity of used metal oxides. Moreover, the used oxides affect slightly the thermal and rheological properties of PA12, which was determined by oscillatory rheology, thermogravimetric analysis, and differential scanning calorimetry.
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Revolutionizing non-conventional wound healing using honey by simultaneously targeting multiple molecular mechanisms. Drug Resist Updat 2022; 62:100834. [DOI: 10.1016/j.drup.2022.100834] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/02/2022] [Accepted: 04/04/2022] [Indexed: 12/12/2022]
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Effect of a preoperative mobilization program on perioperative complications and function recovery in older adults with femoral neck fracture. Geriatr Nurs 2022; 44:69-75. [DOI: 10.1016/j.gerinurse.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/23/2022]
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Characteristics and Outcomes for Low-Risk Hospital Admissions Admitted to the ICU: A Multisite Cohort Study. Crit Care Explor 2021; 3:e0596. [PMID: 34909699 PMCID: PMC8663905 DOI: 10.1097/cce.0000000000000596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Supplemental Digital Content is available in the text. IMPORTANCE: Prognostication following ICU admission can often be determined based on known risk factors, including demographics and illness severity; however, little is known about outcomes of patients deemed to be “low-risk” at the time of hospital admission who subsequently are admitted to the ICU. OBJECTIVES: The objectives of this study were to determine the characteristics, outcomes, and costs for patients requiring ICU admission despite having lower predicted mortality when they were admitted to the hospital. DESIGN, SETTING, AND PARTICIPANTS: In this historical cohort study, we used a prospectively maintained ICU registry that included all ICU admissions to The Ottawa Hospital for patients 18 years or older from January 2011 to December 2016. We classified patients as low-risk using the Hospital-patient 1-year Mortality Risk at admission score, a hospital admission score validated to predict 1-year mortality. MAIN OUTCOMES AND MEASURES: The primary outcome was inhospital mortality. Secondary outcomes included adverse events, resource utilization, and costs. RESULTS: Of the 17,173 total ICU patients, 3,445 (20.1%) were classified as low-risk at hospital admission. Low-risk patients were younger (48.7 vs 67.5 yr; p < 0.001) and had a lower Multiple Organ Dysfunction Score (2.37 vs 4.14; p < 0.001). Mortality for low-risk patients was significantly lower than for non–low-risk patients (4.1% vs 25.4%; p < 0.001). For low-risk patients, multivariable logistic regression showed mortality was independently associated with older age (odds ratio, 1.02 per 1 yr; 95% CI, 1.00–1.03 per 1 yr), Multiple Organ Dysfunction Score (odds ratio, 1.42 per 1 point; 95% CI, 1.31–1.54 per 1 point), fluid management adverse events (odds ratio, 2.84; 95% CI, 1.29–6.25), hospital-acquired infections (odds ratio, 1.60; 95% CI, 1.02–2.51), and mechanical ventilation (odds ratio, 1.98; 95% CI, 1.20–3.26). CONCLUSIONS AND RELEVANCE: Despite their robust premorbid status, low-risk patients admitted to the ICU had significant inhospital mortality. Fluid management adverse events, hospital-associated infections, multiple organ dysfunction, and mechanical ventilation are important prognostic factors for low-risk patients.
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Arıkan I, Genç Ö, Uyar C, Tokur ME, Balcı C, Perçin Renders D. Effectiveness of air purifiers in intensive care units: an interventional study. J Hosp Infect 2021; 120:14-22. [PMID: 34688796 DOI: 10.1016/j.jhin.2021.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/22/2021] [Accepted: 10/15/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Effective design and operation of Intensive Care Unit (ICU) ventilation systems is important to prevent hospital-acquired infections. Air purifiers may contribute to that. AIM In this study we aimed at detecting the number and types of microorganisms present in the air and on the high touch surfaces in the ICU; evaluating the effectiveness of the air purifying device in reducing the microbial load and thus the rate of nosocomial infections in the ICU. METHOD This interventional study was conducted in two similar ICUs between December 2019 and May 2020. Novaerus brand air purifiers were located in the "intervention ICU" for two months. Routine cleaning procedures and HEPA filtered ventilation continued in "control ICU" as well as in the "Intervention ICU". After two months the units were moved to the other ICU for the next two months to reduce any possible bias in the results. Air and surface samples were evaluated. FINDINGS The evaluation of the change in the interventional ICU over time revealed a significantly lower colony concentration in the air and on surfaces on Day 60 compared to Day 1 (pair<0.001 and psurface<0.001). There was a significant positive correlation between the number of colonies detected and the rate of hospital-acquired infections in the interventional ICU (r:0.406, p:0.049) and in the control ICU (r:0.698, p:0.001). CONCLUSION Using air purifiers in addition to the hospital HVAC systems might be an effective way to reduce the microbial load in the air and surfaces and thus hospital-acquired infections.
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Affiliation(s)
- I Arıkan
- Department of Public Health, School of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Ö Genç
- Department of Medical Microbiology, School of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - C Uyar
- Department of Infectious Diseases, Kutahya Health Sciences University, Evliya Celebi Education and Research Hospital, Kutahya, Turkey
| | - M E Tokur
- Department of Anaesthesiology and Reanimation, School of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - C Balcı
- Department of Anaesthesiology and Reanimation, School of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - D Perçin Renders
- Department of Medical Microbiology, School of Medicine, Kutahya Health Sciences University, Kutahya, Turkey.
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13
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Marquer C, Guindo O, Mahamadou I, Job E, Rattigan SM, Langendorf C, Grais RF, Isanaka S. An exploratory qualitative study of caregivers' knowledge, perceptions and practices related to hospital hygiene in rural Niger. Infect Prev Pract 2021; 3:100160. [PMID: 34647010 PMCID: PMC8498679 DOI: 10.1016/j.infpip.2021.100160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 06/29/2021] [Indexed: 11/19/2022] Open
Abstract
Background The risk of healthcare-associated infections is exacerbated by poor hygiene practices in health care facilities and can contribute to increased patient morbidity and mortality. In low-income settings, caregivers play a key role in maintaining proper hygiene during inpatient stays. We aimed to explore caregivers' knowledge, perceptions and practices related to hospital hygiene in a rural, sub-Saharan African setting. Methods We conducted an exploratory qualitative study among caregivers of children admitted to an inpatient therapeutic feeding center in Madarounfa, Niger. Individual interviews with 28 caregivers of hospitalized children were conducted to explore their knowledge, perceptions and practices of hygiene in the health facility. Findings Caregivers described a broad understanding of hygiene and reported knowledge of its importance in the hospital, particularly to prevent disease transmission and protect child health. Hygiene was perceived as a collective rather than individual responsibility. Caregivers reported on the poor hygiene practice of others and cited a lack of space and hygiene materials as barriers to correct hygiene practice. Caregivers described educational sessions and informal sharing with other caregivers as tools to gain knowledge and improve practice. Conclusion This exploratory study is unique in describing the perspective of caregivers in a low-resource hospital setting, a group often underrepresented when designing health interventions to improve hospital hygiene. Our findings suggest a strong knowledge of hospital hygiene among caregivers in this setting, with positive perception of its importance in health promotion. Poor individual practice was reported but may be improved through additional education and provision of hygiene materials.
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Affiliation(s)
| | | | | | | | | | | | | | - Sheila Isanaka
- Department of Research, Epicentre, Paris, France
- Departments of Nutrition and Global Health and Population, Harvard T.H. Chan School of Public Health, USA
- Corresponding author. Address: 14-34 Avenue Jean Juarès, Paris, 75019, France. Tel.: +33 (0)1 4021 5498; fax: +33 (0)1 4021 5100.
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14
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Montazer M, Soleimani N, Vahabi M, Abtahi M, Etemad K, Zendehdel R. Assessment of Bacterial Pathogens and their Antibiotic Resistance in the Air of Different Wards of Selected Teaching Hospitals in Tehran. Indian J Occup Environ Med 2021; 25:78-83. [PMID: 34421242 PMCID: PMC8341418 DOI: 10.4103/ijoem.ijoem_234_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 07/25/2020] [Accepted: 09/25/2020] [Indexed: 11/09/2022] Open
Abstract
Context: Exposure to bio-aerosols in a variety of environments has been of great interest due to the health effects on humans. Hospitals can be the reservoir of these biological agents because of the presence of infectious patients; which can lead to hospital infections and various occupational hazards. In this way, we assessed bacterial contamination in two teaching hospitals in Tehran. Aims: Our purpose in this study assessment of bacterial pathogens and their antibiotic resistance in the air of different wards of selected teaching hospitals in Tehran. Settings and Design: In this study, sampling was done according to NIOSH 0800. Methods and Material: This descriptive study was carried out in the different sections of two hospitals in Tehran. A total of 180 air samples were evaluated according to NIOSH 0800. In each section sampling was performed on the culture media in three stations including primary room, end room, and nursing position then the number of colonies counted. The zone of inhibition was measured in antibiotic disks to determine antibiotic resistance of samples. Statistical Analysis Used: Data analysis was performed using SPSS version 21. Initially, the data were normalized using the Kolmogorov–Smirnov test. The difference between the two hospitals was achieved with Mann–Whitney U test for un-normal distribution data. Results: Bacterial contamination in hospital 2 was significantly higher than the hospital 1(P < 0.001). The median number of colonies in hospital 1 was 129.87 (87.46–268.97) CFU/m3 and 297.97 (217.66–431.85) CFU/m3 for hospital 2. Bacterial contamination in the all of stations in hospital 2 and 87% of samples in hospital 1 was higher than the acceptable range of ACGIH (75 CFU/m3). Conclusions: High bacterial contamination may be related to a lack of hygiene management and poor ventilation system. It seems effective infection control processes, appropriate ventilation systems and supervision systems should be improved.
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Affiliation(s)
- Marzieh Montazer
- MSc in Occupational Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Soleimani
- Department of Microbiology, Faculty of Biological Sciences and Technology, Shahid Beheshti University, Tehran, Iran
| | - Masoomeh Vahabi
- Ph.D. Candidate in Occupational Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrnosh Abtahi
- Depatment of Environmental Health Engineering, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Korosh Etemad
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rezvan Zendehdel
- Associate Professor in Occupational Health Engineering, Tehran, Iran.,Department of Environmental and Occupational Hazards Control Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Heibati B, Rivas I, Veysi R, Hoek G, Perez-Martinez PJ, Karimi A. Evaluating size-fractioned indoor particulate matter in an urban hospital in Iran. ENVIRONMENTAL MONITORING AND ASSESSMENT 2021; 193:521. [PMID: 34313867 DOI: 10.1007/s10661-021-09327-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 07/17/2021] [Indexed: 06/13/2023]
Abstract
Hospitals host vulnerable people with potentially enhanced sensitivity to air pollutants. We measured particulate matter (PM) including PM1, PM2.5, and PM10 with a portable device in a hospital, a nearby reference building, and ambient air in Shiraz, Iran. Indoor/outdoor (I/O) ratio values were calculated to infer on the origin of size-fractioned PM. The mean hospital indoor concentrations of PM2.5 and PM10 (4.7 and 38.7 μg/m3, respectively) but not PM1 were higher than in the reference building and lower than in ambient air. The highest hospital PM10 mean concentrations were found in the radiotherapy ward (77.5 μg/m3) and radiology ward (70.4 μg/m3) while the lowest were found in the bone marrow transplantation (BMT) ward (18.5 μg/m3) and cardiac surgery ward (19.8 μg/m3). The highest PM2.5 concentrations were found in the radiology (8.7 μg/m3) and orthopaedic wards (7.7 μg/m3) while the lowest were found in the BMT ward (2.8 μg/m3) and cardiac surgery ward (2.8 μg/m3). The I/O ratios and the timing of peak concentrations during the day (7 a.m. to 4 p.m.) indicated the main roles of outdoor air and human activity on the indoor levels. These suggest the need for mechanical ventilation with PM control for a better indoor air quality (IAQ) in the hospital.
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Affiliation(s)
- Behzad Heibati
- Center for Environmental and Respiratory Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Biocenter Oulu, University of Oulu, Oulu, Finland
| | - Ioar Rivas
- Barcelona Institute for Global Health (ISGlobal), C/ Dr. Aiguader 88, 08003, Barcelona, Spain
| | - Rahmat Veysi
- Department of Occupational Health Engineering, School of Public Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Gerard Hoek
- Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3594cm, Utrecht, The Netherlands
| | - Pedro Jose Perez-Martinez
- School of Civil Engineering, Architecture and Urban Design, University of Campinas, Rua Saturnino de Brito, SP, 224, Campinas, Brazil
| | - Ali Karimi
- Department of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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16
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Reducing hospital-acquired infections in a regional health system. Infect Control Hosp Epidemiol 2021; 42:1542-1544. [PMID: 33858536 DOI: 10.1017/ice.2020.1347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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17
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Ghosh S, Jolly L, Haldar J. Polymeric paint coated common-touch surfaces that can kill bacteria, fungi and influenza virus. MRS COMMUNICATIONS 2021; 11:610-618. [PMID: 34522468 PMCID: PMC8428207 DOI: 10.1557/s43579-021-00083-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/18/2021] [Indexed: 05/04/2023]
Abstract
In the current situation of COVID-19 pandemic, the role of surfaces in transmitting pathogens is clearer than ever. Herein, we report an organo-soluble, quaternary antimicrobial paint (QAP) based on polyethyleneimine (PEI) which was coated on a wide range of surfaces such as polyvinylchloride (PVC), nylon, rubber, aluminum. The coating completely killed drug-resistant bacteria. It showed rapid bactericidal properties with complete killing in 45 min of exposure and lowered bacterial adherence, asserting self-sterilizing nature. The coating exhibited complete killing of stationary phase cells of bacteria. The coating killed drug-resistant C. albicans strains. Importantly, QAP coating showed complete killing of influenza virus (H1N1).
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Affiliation(s)
- Sreyan Ghosh
- Antimicrobial Research Laboratory, New Chemistry Unit and School of Advanced Materials, Jawaharlal Nehru Centre for Advanced Scientific Research, Jakkur, Bengaluru, Karnataka 560064 India
| | - Logia Jolly
- Antimicrobial Research Laboratory, New Chemistry Unit and School of Advanced Materials, Jawaharlal Nehru Centre for Advanced Scientific Research, Jakkur, Bengaluru, Karnataka 560064 India
| | - Jayanta Haldar
- Antimicrobial Research Laboratory, New Chemistry Unit and School of Advanced Materials, Jawaharlal Nehru Centre for Advanced Scientific Research, Jakkur, Bengaluru, Karnataka 560064 India
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18
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Saran S, Gurjar M, Azim A, Maurya I. Structural Risk Factors for Hospital-Acquired Infections in Intensive Care Unit. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 14:328-336. [PMID: 33353423 DOI: 10.1177/1937586720978825] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There are risk factors related to architecture and designing labeled as "structural risk factors," causing hospital-acquired infections (HAIs) which are less highlighted in the literature. Through this communication, we wish to reiterate the importance of structural risk factors such as space surrounding the patient, furniture with focus on construction and finishing materials used, and ventilation systems surrounding the patient as risk factors for HAIs and expect that these find a place in HAI prevention guidelines in the future.
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Affiliation(s)
- Sai Saran
- Department of Critical Care Medicine, Super Speciality Cancer Institute & Hospital, Lucknow, Uttar Pradesh, India
| | - Mohan Gurjar
- Department of Critical Care Medicine, 30093Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Afzal Azim
- Department of Critical Care Medicine, 30093Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India
| | - Indubala Maurya
- Department of Anaesthesiology, Super Speciality Cancer Institute & Hospital, Lucknow, Uttar Pradesh, India
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19
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Borglin G, Eriksson M, Rosén M, Axelsson M. Registered nurses' experiences of providing respiratory care in relation to hospital- acquired pneumonia at in-patient stroke units: a qualitative descriptive study. BMC Nurs 2020; 19:124. [PMID: 33342427 PMCID: PMC7750009 DOI: 10.1186/s12912-020-00518-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
Objective This study aimed to describe registered nurses’ (RNs) experiences of providing respiratory care in relation to hospital acquired pneumonia (HAP), specifically among patients with acute stroke being cared for at in-patient stroke units. Background One of the most common and serious respiratory complications associated with acute stroke is HAP. Respiratory care is among the fundamentals of patient care, and thus competency in this field is expected as part of nursing training. However, there is a paucity of literature detailing RNs’ experiences with respiratory care in relation to HAP, specifically among patients with acute stroke, in the context of stroke units. As such, there is a need to expand the knowledge base relating to respiratory care focusing on HAP, to assist with evidence-based nursing. Design A qualitative descriptive study. Method Eleven RNs working in four different acute stroke units in Southern Sweden participated in the current study. The data were collected through semi-structured interviews, and the transcribed interviews were analysed using inductive content analysis. Results Three overarching categories were identified: (1), awareness of risk assessments and risk factors for HAP (2) targeting HAP through multiple nursing care actions, and (3) challenges in providing respiratory care to patients in risk of HAP. These reflected the similarities and differences in the experiences that RNs had with providing respiratory care in relation to HAP among in-patients with acute stroke. Conclusions The findings from this study suggest that the RNs experience organisational challenges in providing respiratory care for HAP among patients with acute stroke. Respiratory care plays a vital role in the identification and prevention of HAP, but our findings imply that RNs’ knowledge needs to be improved, the fundamentals of nursing care need to be prioritised, and evidence-based guidelines must be implemented. RNs would also benefit from further education and support, in order to lead point-of-care nursing in multidisciplinary stroke teams.
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Affiliation(s)
- Gunilla Borglin
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06, Malmö, Sweden. .,Department of Nursing Education, Lovisenberg Diaconal University College, 0456, Oslo, Norway.
| | - Miia Eriksson
- Department of Neurology, Skåne University Hospital, SE-222 42, Malmö, Sweden
| | - Madeleine Rosén
- Department of Neurology, Skåne University Hospital, SE-222 42, Malmö, Sweden
| | - Malin Axelsson
- Department of Care Science, Faculty of Health and Society, Malmö University, SE-205 06, Malmö, Sweden
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20
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Laurent M, Oubaya N, David JP, Engels C, Canoui-Poitrine F, Corsin L, Liuu E, Audureau E, Bastuji-Garin S, Paillaud E. Functional decline in geriatric rehabilitation ward; is it ascribable to hospital acquired infection? A prospective cohort study. BMC Geriatr 2020; 20:433. [PMID: 33121435 PMCID: PMC7597031 DOI: 10.1186/s12877-020-01813-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/30/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In some European countries, including France, older patients with functional decline in acute units are transferred to geriatric rehabilitation units. Some patients may not benefit from their stay in a geriatric rehabilitation unit and paradoxically worsened their functional status. Previous prognostic models of functional decline are based on only baseline parameters. However, some events can occur during rehabilitation and modify the association between baseline parameters and rehabilitation performance such as heart failure episode, falls or hospital-acquired infection (HAI). The incidence of functional decline in these units and factors associated with this decline have not been clearly identified. METHODS We used a prospective cohort of consecutive patients aged ≥75 years admitted to a geriatric rehabilitation unit in a French university hospital. The main endpoint was functional decline defined by at least an one-point decrease in Activities of Daily Living (ADL) score during the stay. Baseline social and geriatric characteristics were recorded and comorbidities were sought by the Cumulative Illness Rating Scale for Geriatrics (CIRS-G). During follow-up, hospital-acquired infection (HAI) was recorded, as was ADL score at discharge. Multivariate logistic regression and mediation analyses were used to identify factors associated with ADL decrease. RESULTS Among the 252 eligible patients, 160 (median age 84 years [interquartile range (IQR) 80-88] had available ADL scores at baseline (median score 7 [IQR 4-10]) and at discharge (median 9 [6-12]). Median CIRS-G score was 11 [8-13], 23 (14%) had a pulmonary HAI; 28 (17.5%) showed functional decline. On multivariable analysis, functional decline was associated with comorbidities (global CIRS-G score, P = 0.02, CIRS-G for respiratory disease [CIRS-G-R] ≥2, P = 0.02, or psychiatric disease, P = 0.02) and albumin level < 35 g/l (p = 0.03). Significant associations were found between functional decline and CIRS-G-R (OR 3.07 [95%CI 1.27-7.41], p = 0.01), between functional decline and pulmonary HAI (OR 3.12 [1.17-8.32],p = 0.02), and between CIRS-G-R and pulmonary HAI (OR 12.9[4.4-37.7], p = 0.0001). Theses associations and the reduced effect of CIRS-G-R on functional decline after adjusting for pulmonary HAI (OR 2.26 [0.83-6.16], p = 0.11) suggested partial mediation of pulmonary HAI in the relation between CIRS-G-R and functional decline. CONCLUSION Baseline comorbidities were independently associated with functional decline in patients hospitalized in a geriatric rehabilitation unit. Pulmonary HAI may have mediated this association. We need to better identify patients at risk of functional decline before transfer to a rehabilitation unit and to test the implementation of modern and individual programs of rehabilitation outside the hospital for these patients.
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Affiliation(s)
- Marie Laurent
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, F-94010, Creteil, France. .,AP-HP, Hopital Henri Mondor, Departement de médecine interne et gériatrie, F-94010, Creteil, France.
| | - Nadia Oubaya
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, F-94010, Creteil, France.,Service de Santé Publique, AP-HP, Hôpital Henri Mondor, F- 94010, Creteil, France
| | - Jean-Philippe David
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, F-94010, Creteil, France.,Service de Gériatrie, AP-HP, Hôpital Emile Roux, F- 94450, Limeil Brévannes, France
| | - Cynthia Engels
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, F-94010, Creteil, France.,Univ Paris Est Creteil, Occupational Therapy Institute (IFE), F -94010, Creteil, France
| | - Florence Canoui-Poitrine
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, F-94010, Creteil, France.,Service de Santé Publique, AP-HP, Hôpital Henri Mondor, F- 94010, Creteil, France
| | - Lola Corsin
- AP-HP, Hopital Henri Mondor, Departement de médecine interne et gériatrie, F-94010, Creteil, France
| | - Eveline Liuu
- CHU de Poitiers, Service de gériatrie, 2, rue de la Milétrie, F-86021, Poitiers, France
| | - Etienne Audureau
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, F-94010, Creteil, France.,Service de Santé Publique, AP-HP, Hôpital Henri Mondor, F- 94010, Creteil, France
| | - Sylvie Bastuji-Garin
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, F-94010, Creteil, France.,Service de Santé Publique, AP-HP, Hôpital Henri Mondor, F- 94010, Creteil, France
| | - Elena Paillaud
- Univ Paris Est Creteil, INSERM, IMRB, CEpiA Team, F-94010, Creteil, France.,Service de Gériatrie, AP-HP, Hôpital Europeen Georges Pompidou, F-75015, Paris, France
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Li S, Yang Z, Hu D, Cao L, He Q. Understanding building-occupant-microbiome interactions toward healthy built environments: A review. FRONTIERS OF ENVIRONMENTAL SCIENCE & ENGINEERING 2020; 15:65. [PMID: 33145119 PMCID: PMC7596174 DOI: 10.1007/s11783-020-1357-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 08/30/2020] [Accepted: 09/16/2020] [Indexed: 06/11/2023]
Abstract
Built environments, occupants, and microbiomes constitute a system of ecosystems with extensive interactions that impact one another. Understanding the interactions between these systems is essential to develop strategies for effective management of the built environment and its inhabitants to enhance public health and well-being. Numerous studies have been conducted to characterize the microbiomes of the built environment. This review summarizes current progress in understanding the interactions between attributes of built environments and occupant behaviors that shape the structure and dynamics of indoor microbial communities. In addition, this review also discusses the challenges and future research needs in the field of microbiomes of the built environment that necessitate research beyond the basic characterization of microbiomes in order to gain an understanding of the causal mechanisms between the built environment, occupants, and microbiomes, which will provide a knowledge base for the development of transformative intervention strategies toward healthy built environments. The pressing need to control the transmission of SARS-CoV-2 in indoor environments highlights the urgency and significance of understanding the complex interactions between the built environment, occupants, and microbiomes, which is the focus of this review.
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Affiliation(s)
- Shuai Li
- Department of Civil and Environmental Engineering, University of Tennessee, Knoxville, TN 37996 USA
| | - Zhiyao Yang
- Lyles School of Civil Engineering, Purdue University, West Lafayette, IN 47907 USA
| | - Da Hu
- Department of Civil and Environmental Engineering, University of Tennessee, Knoxville, TN 37996 USA
| | - Liu Cao
- Department of Civil and Environmental Engineering, University of Tennessee, Knoxville, TN 37996 USA
| | - Qiang He
- Department of Civil and Environmental Engineering, University of Tennessee, Knoxville, TN 37996 USA
- Institute for a Secure & Sustainable Environment, University of Tennessee, Knoxville, TN 37996 USA
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Ståhl A, Westerdahl E. Postoperative Physical Therapy to Prevent Hospital-acquired Pneumonia in Patients Over 80 Years Undergoing Hip Fracture Surgery-A Quasi-experimental Study. Clin Interv Aging 2020; 15:1821-1829. [PMID: 33061332 PMCID: PMC7534857 DOI: 10.2147/cia.s257127] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/31/2020] [Indexed: 01/21/2023] Open
Abstract
Background Hip fracture requiring surgical fixation is a common condition with high mortality and morbidity in the geriatric population. The patients are usually frail, and vulnerable to postoperative complications and delayed recovery. Few studies have investigated physical therapy methods to prevent hospital-acquired pneumonia (HAP) after hip fracture surgery. Objective To explore whether an intensified physical therapy regimen can prevent HAP and reduce hospital length of stay in patients aged 80 and older, following hip fracture surgery. Patients and Methods The inclusion criterion was patients aged 80 or older who had undergone hip fracture surgery at Örebro University Hospital, Sweden during eight months in 2015–2016 (the “physical therapy group”) (n=69). The study has a quasi-experimental design with a historical control group (n=64) who had received routine physical therapy treatment. The physical therapy group received intensified postoperative physical therapy treatment, which included daily supervised early mobilization and coached deep breathing exercises with positive expiratory pressure (PEP). The patients were instructed to take deep breaths, and then exhale through the PEP-valve in three sessions of 10 deep breaths, at least four times daily. Early mobilization to a sitting position and walking was advised as soon as possible after surgery. Results There was a significantly lower incidence of HAP in the physical therapy group; 2/69 (3%, 95%CI: 1– 10) compared to the historical control group 13/64 (20%, 95%CI: 12–32%) (p=0.002). Patients in the physical therapy group had a significantly shorter length of stay than the control group (10.6±4 vs 13.4±9 days, p=0.022). Conclusion Intensified physical therapy treatment after hip fracture surgery may be of benefit to reduce the incidence of HAP in patients over 80 years; however, the results need to be confirmed in randomized controlled trials.
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Affiliation(s)
- Anna Ståhl
- Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden.,Department of Knowledge-Driven Management, Health Care Administration, Region Örebro County, Örebro, Sweden
| | - Elisabeth Westerdahl
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Transpicuous-Cum-Fouling Resistant Copolymers of 3-Sulfopropyl Methacrylate and Methyl Methacrylate for Optronics Applications in Aquatic Medium and Healthcare. ADVANCES IN POLYMER TECHNOLOGY 2020. [DOI: 10.1155/2020/5392074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The scope of optical sensors and scanners in aquatic media, fluids, and medical diagnostics has been limited by paucity of transparent shielding materials with antifouling potential. In this research endeavor, facile synthesis, characterization, and bioassay of antifouling transparent functional copolymers are reported. Copolymers of 3-sulfopropyl methacrylate (SPMA) and methyl methacrylate (MMA) were synthesized by free radical polymerization in various proportions. Samples PSM20, PSM30, PSM40, PSM50, and PSM60 contain 20%, 30%, 40%, 50%, and 60% SPMA by weight, respectively. Resultant products were characterized by FTIR and 1H-NMR spectroscopy. The synthesized copolymers have exhibited excellent transparency, i.e., 75% to 88%, as determined by the UV-Vis spectroscopic analysis. Transmittance was decreased from 6% to 2% in these copolymers upon changing the concentration of 3-sulfopropyl methacrylate from 20% to 50% owing to bacterial and algal biofilm formation. Water contact angle values were ranged from 18° to 63° and decreased with the increase in the polarity of copolymers. The surface energy lowest value 58 mJ/m2 and highest value 72 mJ/m2 were calculated for PSM20 and PSM50, respectively, by the Chibowski approach and Young equation. Sample PSM50 has exhibited the highest antibacterial activities, i.e., 18 mm and 19 mm, against Escherichia coli and Staphylococcus aureus, respectively, by the disk diffusion method. Copolymer PSM50 has shown minimum algal adhesion for Dictyosphaerium algae as observed by optical microscopy. This lower bacterial and algal adhesion is attributed to higher concentrations of anionic SPMA monomer that cause electrostatic repulsion between functional groups of the polymer and microorganisms. Thus, the resultant PSM50 product has exhibited good potential for optronics shielding application in aquatic medium and medical diagnostics.
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Moosavian M, Ahmadi K, Shoja S, Mardaneh J, Shahi F, Afzali M. Antimicrobial resistance patterns and their encoding genes among clinical isolates of Acinetobacter baumannii in Ahvaz, Southwest Iran. MethodsX 2020; 7:101031. [PMID: 32983919 PMCID: PMC7492985 DOI: 10.1016/j.mex.2020.101031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 08/10/2020] [Indexed: 01/08/2023] Open
Abstract
Acinetobacter baumannii is one of the most important organisms in nosocomial infections. Antibiotic resistance in this bacterium causes many problems in treating patients. This study aimed to investigate antibiotic resistance patterns and resistance-related, genes in clinical isolates of Acinetobacter baumannii. This descriptive study was conducted on 124 isolates of Acinetobacter baumannii collected from clinical samples in two teaching hospitals in Ahvaz. The antibiotic resistance pattern was determined by disk diffusion. The presence of genes coding for antibiotic resistance was determined using the polymerase chain reaction method. Out of 124 isolates, the highest rate of resistance was observed for rifampin (96.8%). The resistance rate for imipenem, meropenem, colistin, and polymyxin-B were 78.2%, 73.4%, 0.8% and 0.8%, respectively. The distribution of qnrA, qnrB, qnrS, Tet A, TetB, and Sul1genes were 52.6%, 0%, 3.2%, 93.5% 69.2%, and 6.42%, respectively. High prevalence of tetA, tetB, and qnrA genes among Acinetobacter baumannii isolated strains in this study indicate the important role of these genes in multidrug resistance in this bacteria. • Acinetobacter baumannii is an important human pathogen that has attracted the attention of many researchers Antibiotic resistance in this bacterium causes many problems in treating patients. • The resistance rate for imipenem, meropenem, colistin, and polymyxin-B were 78.2%, 73.4%, 0.8% and 0.8%, respectively. The distribution of qnrA, qnrB, qnrS, Tet A, TetB, and Sul1genes were 52.6%, 0%, 3.2%, 93.5% 69.2%, and 6.42%, respectively.
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Affiliation(s)
- Mojtaba Moosavian
- Infectious and Tropical Diseases Research Center, Health Research Institue, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Khadijeh Ahmadi
- Infectious and Tropical Diseases Research Center, Health Research Institue, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Saeed Shoja
- Infectious and Tropical Disease Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Jalal Mardaneh
- Department of Microbiology, School of Medicine, and Infectious Diseases Research Center, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Fatemeh Shahi
- Infectious and Tropical Diseases Research Center, Health Research Institue, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Maryam Afzali
- Infectious and Tropical Diseases Research Center, Health Research Institue, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Branco MJC, Lucas APM, Marques RMD, Sousa PP. The role of the nurse in caring for the critical patient with sepsis. Rev Bras Enferm 2020; 73:e20190031. [PMID: 32578735 DOI: 10.1590/0034-7167-2019-0031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/13/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to know the nursing interventions in the identification, prevention and control of sepsis in critical patients. METHODS integrative review of the literature, with two parallel researches using different MesH terms, using the EBSCO database and Google Scholar. Nine studies were included in the sample. RESULTS nursing interventions are centered on the creation/implementation of protocols for the early recognition of sepsis, the training of teams to ensure a safe and effective approach and the adoption of measures for infection prevention and control as a way to prevent sepsis. FINAL CONSIDERATIONS the evidence shows that nurses are fundamental in the early identification, control and prevention of sepsis, preventing disease progression and contributing to decreased morbidity and mortality.
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Saran S, Gurjar M, Baronia A, Sivapurapu V, Ghosh PS, Raju GM, Maurya I. Heating, ventilation and air conditioning (HVAC) in intensive care unit. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:194. [PMID: 32375844 PMCID: PMC7201115 DOI: 10.1186/s13054-020-02907-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/17/2020] [Indexed: 02/08/2023]
Abstract
The aim of this review is to describe variation in standards and guidelines on ‘heating, ventilation and air-conditioning (HVAC)’ system maintenance in the intensive care units, across the world, which is required to maintain good ‘indoor air quality’ as an important non-pharmacological strategy in preventing hospital-acquired infections. An online search and review of standards and guidelines published by various societies including American Institute of Architects (AIA), American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), Centers for Disease Control and Prevention (CDC), Department of Health Estates and Facilities Division, Health Technical Memorandum 2025 (HTM) and Healthcare Infection Control Practices Advisory Committee (HICPAC) along with various national expert committee consensus statements, regional and hospital-based protocols available in a public domain were retrieved. Selected publications and textbooks describing HVAC structural aspects were also reviewed, and we described the basic structural details of HVAC system as well as variations in the practised standards of HVAC system in the ICU, worldwide. In summary, there is a need of universal standards for HVAC system with a specific mention on the type of ICU, which should be incorporated into existing infection control practice guidelines.
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Affiliation(s)
- Sai Saran
- Department of Critical Care Medicine, Super Speciality Cancer Institute and Hospital, Lucknow, Uttar Pradesh, 226002, India
| | - Mohan Gurjar
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, 226014, India.
| | - Arvind Baronia
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, 226014, India
| | - Vijayalakshmi Sivapurapu
- Department of Anaesthesiology, Indira Gandhi Medical College and Research Institute, Puducherry, 605 006, India
| | - Pralay S Ghosh
- Department of Critical Care Medicine, Tata Medical Centre, Kolkata, West Bengal, 700156, India
| | - Gautham M Raju
- Department of Critical Care Medicine, Manipal Hospitals, Benguluru, Karnataka, 560017, India
| | - Indubala Maurya
- Department of Anesthesiology, Super Speciality Cancer Institute and Hospital, Lucknow, Uttar Pradesh, 226002, India
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Wu B, Qi C, Wang L, Yang W, Zhou D, Wang M, Dong Y, Weng H, Li C, Hou X, Long X, Wang H, Chai T. Detection of microbial aerosols in hospital wards and molecular identification and dissemination of drug resistance of Escherichia coli. ENVIRONMENT INTERNATIONAL 2020; 137:105479. [PMID: 32070803 DOI: 10.1016/j.envint.2020.105479] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/29/2019] [Accepted: 01/09/2020] [Indexed: 05/22/2023]
Abstract
Antibiotic-resistant bacteria (ARB) present a global public health problem. Microorganisms are the main cause of hospital-acquired infections, and the biological contamination of hospital environments can cause the outbreak of a series of infectious diseases. Therefore, it is very important to understand the spread of antibiotic-resistant bacteria in hospital environments. This study examines the concentrations of aerobic bacteria and E. coli in ward environments and the airborne transmission of bacterial drug resistance. The results show that the three wards examined have an average aerobic bacterial concentration of 132 CFU∙m-3 and an average inhalable aerobic bacterial concentration of 73 CFU∙m-3, with no significant difference (P > 0.05) among the three wards. All isolated E. coli showed multi-drug resistance to not only third-generation cephalosporin antibiotics, but also quinolones, aminoglycosides, and sulfonamides. Furthermore, 51 airborne E. coli strains isolated from the air in the three wards and the corridor were screened for ESBLs, and 12 (23.53%) were ESBL-positive. The drug-resistance gene of the 12 ESBL-positive strains was mainly TEM gene, and the detection rate was 66.67% (8/12). According to a homology analysis with PFGE, 100% homologous E. coli from the ward at 5 m and 10 m outside the ward in the corridor shared the same drug-resistance spectrum, which further proves that airborne E. coli carrying a drug-resistance gene spreads out of the ward through gas exchange. This leads to biological pollution inside, outside, and around the ward, which poses a direct threat to the health of patients, healthcare workers, and surrounding residents. It is also the main reason for the antibiotic resistance in the hospital environment. More attention should be paid to comprehensive hygiene management in the surrounding environment of hospitals.
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Affiliation(s)
- Bo Wu
- College of Animal Science and Veterinary Medicine, Shandong Agricultural University; Key Laboratory of Animal Bioengineering and Animal Disease of Shandong Province; Sino-German Cooperative Research Centre for Zoonosis of Animal Origin, Shandong Province; 61 Daizong Road, Tai'an 271000, Shandong Province, China
| | | | | | - Wenhui Yang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, No. 20, Dongdajie, Fengtai, Beijing 100071, China
| | - Dongsheng Zhou
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, No. 20, Dongdajie, Fengtai, Beijing 100071, China
| | - Meng Wang
- College of Animal Science and Veterinary Medicine, Shandong Agricultural University; Key Laboratory of Animal Bioengineering and Animal Disease of Shandong Province; Sino-German Cooperative Research Centre for Zoonosis of Animal Origin, Shandong Province; 61 Daizong Road, Tai'an 271000, Shandong Province, China
| | - Yunxiang Dong
- College of Animal Science and Veterinary Medicine, Shandong Agricultural University; Key Laboratory of Animal Bioengineering and Animal Disease of Shandong Province; Sino-German Cooperative Research Centre for Zoonosis of Animal Origin, Shandong Province; 61 Daizong Road, Tai'an 271000, Shandong Province, China
| | - Hongyu Weng
- College of Animal Science and Veterinary Medicine, Shandong Agricultural University; Key Laboratory of Animal Bioengineering and Animal Disease of Shandong Province; Sino-German Cooperative Research Centre for Zoonosis of Animal Origin, Shandong Province; 61 Daizong Road, Tai'an 271000, Shandong Province, China
| | - Changming Li
- College of Animal Science and Veterinary Medicine, Shandong Agricultural University; Key Laboratory of Animal Bioengineering and Animal Disease of Shandong Province; Sino-German Cooperative Research Centre for Zoonosis of Animal Origin, Shandong Province; 61 Daizong Road, Tai'an 271000, Shandong Province, China
| | - Xiaohong Hou
- College of Animal Science and Veterinary Medicine, Shandong Agricultural University; Key Laboratory of Animal Bioengineering and Animal Disease of Shandong Province; Sino-German Cooperative Research Centre for Zoonosis of Animal Origin, Shandong Province; 61 Daizong Road, Tai'an 271000, Shandong Province, China
| | - Xianrong Long
- College of Animal Science and Veterinary Medicine, Shandong Agricultural University; Key Laboratory of Animal Bioengineering and Animal Disease of Shandong Province; Sino-German Cooperative Research Centre for Zoonosis of Animal Origin, Shandong Province; 61 Daizong Road, Tai'an 271000, Shandong Province, China
| | - Hairong Wang
- College of Animal Science and Veterinary Medicine, Shandong Agricultural University; Key Laboratory of Animal Bioengineering and Animal Disease of Shandong Province; Sino-German Cooperative Research Centre for Zoonosis of Animal Origin, Shandong Province; 61 Daizong Road, Tai'an 271000, Shandong Province, China.
| | - Tongjie Chai
- College of Animal Science and Veterinary Medicine, Shandong Agricultural University; Key Laboratory of Animal Bioengineering and Animal Disease of Shandong Province; Sino-German Cooperative Research Centre for Zoonosis of Animal Origin, Shandong Province; 61 Daizong Road, Tai'an 271000, Shandong Province, China.
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Marik PE, Shankaran S, King L. The effect of copper-oxide-treated soft and hard surfaces on the incidence of healthcare-associated infections: a two-phase study. J Hosp Infect 2020; 105:265-271. [PMID: 32068014 DOI: 10.1016/j.jhin.2020.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 02/08/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Copper-oxide-impregnated linens and hard surfaces within the hospital environment have emerged as a novel technology to reduce environmental contamination and thereby potentially reduce the risk of healthcare-associated infections (HCAIs). METHODS This was a two-phase study. Phase 1 was a prospective, cluster-randomized, cross-over clinical trial in which one pod (eight beds) of our general ICU (GICU) utilized copper-oxide-impregnated linens whereas the other pod (eight beds) used standard hospital linens. Phase 2 was a two-year before-after study, following the relocation of three ICUs into a new ICU tower in which all the hard surfaces were treated with copper oxide (in addition to copper-impregnated linens). HCAIs were recorded using the National Healthcare Safety Network definitions. FINDINGS A total of 1282 patients were enrolled in phase 1. There was no difference in the rate of HCAI between the patients who received standard compared with copper oxide linen. In phase 2 there was a significant reduction in the number of infections due to Clostridioides difficile (2.4 per 1000 vs 0.7 per 1000 patient-days; incidence rate ratio: 3.3; 95% confidence interval: 1.4-8.7; P = 0.002) but no difference in the rate of central-line-associated bloodstream infections nor of catheter-associated urinary tract infections. CONCLUSION Copper-oxide-impregnated linens alone had no effect on the rate of HCAI. Our data suggest that copper-oxide-treated hard surfaces reduced the rate of infections due to C. difficile; however, important confounders cannot be excluded.
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Affiliation(s)
- P E Marik
- Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School, Norfolk, VA, USA.
| | - S Shankaran
- Division of Infectious Diseases, Eastern Virginia Medical School, Norfolk, VA, USA; Division of Infectious Diseases, Rush University Medical Center, Chicago, IL, USA
| | - L King
- Infection Prevention and Control Coordinator, Sentara Norfolk General Hospital, Norfolk, VA, USA
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Copper Complex: A Key Role in the Synthesis of Biocidal Polymer Coatings. CHEMISTRY AFRICA-A JOURNAL OF THE TUNISIAN CHEMICAL SOCIETY 2019. [DOI: 10.1007/s42250-019-00045-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Tripathy A, Kumar A, Chowdhury AR, Karmakar K, Purighalla S, Sambandamurthy V, Chakravortty D, Sen P. A Nanowire-Based Flexible Antibacterial Surface Reduces the Viability of Drug-Resistant Nosocomial Pathogens. ACS APPLIED NANO MATERIALS 2018; 1:2678-2688. [DOI: 10.1021/acsanm.8b00397] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Affiliation(s)
| | | | | | | | - Swathi Purighalla
- Mazumdar Shaw Centre for Translational Research, NH Health City, Bangalore 560099, India
| | - Vasan Sambandamurthy
- Mazumdar Shaw Centre for Translational Research, NH Health City, Bangalore 560099, India
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Fungal Assessment of Indoor Air Quality in Wards and Operating Theatres in an Organ Transplantation Hospital. HEALTH SCOPE 2018. [DOI: 10.5812/jhealthscope.60208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Secombe P, Harley S, Chapman M, Aromataris E. Feeding the critically ill obese patient: a systematic review protocol. ACTA ACUST UNITED AC 2018; 13:95-109. [PMID: 26571286 DOI: 10.11124/jbisrir-2015-2458] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this review is to identify effective enteral nutritional regimens targeting protein and calorie delivery for the critically ill obese patient on morbidity and mortality.More specifically, the review question is:In the critically ill obese patient, what is the optimal enteral protein and calorie target that improves mortality and morbidity? BACKGROUND The World Health Organization (WHO) defines obesity as abnormal or excessive fat accumulation that may impair health, or, empirically, as a body mass index (BMI) ≥ 30 kg/m. Twenty-eight percent of the Australian population is obese with the prevalence rising to 44% in rural areas, and there is evidence that rates of obesity are increasing. The prevalence of obese patients in intensive care largely mirrors that of the general population. There is concern, however, that this may also be rising. A recently published multi-center nutritional study of critically ill patients reported a mean BMI of 29 in their sample, suggesting that just under 50% of their intensive care population is obese. It is inevitable, therefore, that the intensivist will care for the critically ill obese patient.Managing the critically ill obese patient is challenging, not least due to the co-morbid diseases frequently associated with obesity, including diabetes mellitus, cardiovascular disease, dyslipidaemia, sleep disordered breathing and respiratory insufficiency, hepatic steatohepatitis, chronic kidney disease and hypertension. There is also evidence that metabolic processes differ in the obese patient, particularly those with underlying insulin resistance, itself a marker of the metabolic syndrome, which may predispose to futile cycling, altered fuel utilization and protein catabolism. These issues are compounded by altered drug pharmacokinetics, and the additional logistical issues associated with prophylactic, therapeutic and diagnostic interventions.It is entirely plausible that the altered metabolic processes observed in the obese intensify and compound the metabolic changes that occur during critical illness. The early phases of critical illness are characterized by an increase in energy expenditure, resulting in a catabolic state driven by the stress response. Activation of the stress response involves up-regulation of the sympathetic nervous system and the release of pituitary hormones resulting in altered cortisol metabolism and elevated levels of endogenous catecholamines. These produce a range of metabolic disturbances including stress hyperglycemia, arising from both peripheral resistance to the effects of anabolic factors (predominantly insulin) and increased hepatic gluconeogenesis. Proteolysis is accelerated, releasing amino acids that are thought to be important in supporting tissue repair, immune defense and the synthesis of acute phase reactants. There is also altered mobilization of fuel stores, futile cycling, and evidence of altered lipoprotein metabolism. In the short term this is likely to be an adaptive response, but with time and ongoing inflammation this becomes maladaptive with a concomitant risk of protein-calorie malnutrition, immunosuppression and wasting of functional muscle tissue resulting from protein catabolism, and this is further compounded by disuse atrophy. Muscle atrophy and intensive care unit (ICU) acquired weakness is complex and poorly understood, but it is postulated that the provision of calories and sufficient protein to avoid a negative nitrogen balance mitigates this process. Avoiding lean muscle mass loss in the obese intuitively has substantial implications, given the larger mass that is required to be mobilized during their rehabilitation phase.There is, in addition, evolving evidence that hormones derived from both the gut and adipose tissue are also involved in the response to stress and critical illness, and that adipose tissue in particular is not a benign tissue bed, but rather should be considered an endocrine organ. Some of these hormones are thought to be pro-inflammatory and some anti-inflammatory; however both the net result and clinical significance of these are yet to be fully elucidated.The provision of adequate nutrition has become an integral component of supportive ICU care, but is complex. There is ongoing debate within critical care literature regarding the optimal route of delivery, the target dose, and the macronutrient components (proportion of protein and non-protein calories) of nutritional support. A number of studies have associated caloric deficit with morbidity and mortality, with the resultant assumption that prescribing sufficient calories to match energy expenditure will reduce morbidity and mortality, although the evidence base underpinning this assumption is limited to observational studies and small, randomized trials.There is research available that suggests hyper-caloric feeding or hyper-alimentation, particularly of carbohydrates, may result in increased morbidity including hyperglycemia, liver steatosis, respiratory insufficiency with prolonged duration of mechanical ventilation, re-feeding syndrome and immune suppression. But the results from studies of hypo-caloric and eucaloric feeding regimens in critically ill patients are conflicting, independent of the added metabolic complexities observed in the critically ill obese patient.Notwithstanding the debate regarding the dose and components of nutritional therapy, there is consensus that nutrition should be provided, preferably via the enteral route, and preferably initiated early in the ICU admission. The enteral route is preferred for a variety of reasons, not the least of which is cost. In addition there is evidence to suggest the enteral route is associated with the maintenance of gut integrity, a reduction in bacterial translocation and infection rates, a reduction in the incidence of stress ulceration, attenuation of oxidative stress, release of incretins and other entero-hormones, and modulation of systemic immune responses. Yet there is evidence that the initiation of enteral nutritional support for the obese critically ill patient is delayed, and that when delivered is at sub-optimal levels. The reasons for this remain obscure, but may be associated with the false assumption that every obese patient has nutritional reserves due to their adipose tissues, and can therefore withstand longer periods with no, or reduced nutritional support. In fact obesity does not necessarily protect from malnutrition, particularly protein and micronutrient malnutrition. It has been suggested by some authors that the malnutrition status of critically ill patients is a stronger predictor of mortality than BMI, and that once malnutrition status is controlled for, the apparent protective effects of obesity observed in several epidemiological studies dissipate. This would be consistent with the large body of evidence that associates malnutrition (BMI < 20 kg/m) with increased mortality, and has led some authors to postulate that the weight-mortality relationship is U-shaped. This has proven difficult to demonstrate, however, due to recognized confounding influences such as chronic co-morbidities, baseline nutritional status and the nature of the presenting critical illness.This has led to interest in nutritional regimens targeting alternative calorie and protein goals to protect the obese critically ill patient from complications arising from critical illness, and particularly protein catabolism. However, of the three major nutritional organizations, the American Society of Parenteral and Enteral Nutrition (ASPEN) is the only professional organization to make specific recommendations about providing enteral nutritional support to the critically ill obese patient, recommending a regimen targeting a hypo-caloric, high-protein goal. It is thought that this regimen, in which 60-70% of caloric requirements are provided promotes steady weight loss, while providing sufficient protein to achieve a neutral, or slightly positive, nitrogen balance, mitigating lean muscle mass loss, and allowing for wound healing. Targeting weight loss is proposed to improve insulin sensitivity, improve nursing care and reduce the risk of co-morbidities, although how this occurs and whether it can occur over the relatively short time frame of an intensive care admission (days to weeks) remains unclear. Despite these recommendations observational data of international nutritional practice suggest that ICU patients are fed uniformly low levels of calories and protein across BMI groups.Supporting the critically ill obese patient will become an increasingly important skill in the intensivist's armamentarium, and enteral nutritional therapy forms a cornerstone of this support. Yet, neither the optimal total caloric goal nor the macronutrient components of a feeding regimen for the critically ill obese patient is evident. Although the suggestion that altering the macronutrient goals for this vulnerable group of patients appears to have a sound physiological basis, the level of evidence supporting this remains unclear, and there are no systematic reviews on this topic. The aim of this systematic review is to evaluate existing literature to determine the best available evidence describing a nutritional strategy that targets energy and protein delivery to reduce morbidity and mortality for the obese patient who is critically ill.
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Affiliation(s)
- Paul Secombe
- 1The Joanna Briggs Institute, Faculty of Health Science, University of Adelaide, Australia2School of Medicine, University of Adelaide, Australia3Alice Springs Hospital, Alice Springs, Australia4Royal Adelaide Hospital, Adelaide, Australia
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Esfandiari A, Salari H, Rashidian A, Masoumi Asl H, Rahimi Foroushani A, Akbari Sari A. Eliminating Healthcare-Associated Infections in Iran: A Qualitative Study to Explore Stakeholders' Views. Int J Health Policy Manag 2018; 7:27-34. [PMID: 29325400 PMCID: PMC5745865 DOI: 10.15171/ijhpm.2017.34] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 03/13/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Although preventable, healthcare-associated infections (HAIs) continue to pose huge health and economic burdens on countries worldwide. Some studies have indicated the numerous causes of HAIs, but only a tiny literature exists on the multifaceted measures that can be used to address the problem. This paper presents stakeholders' opinions on measures for controlling HAIs in Iran. METHODS We used the qualitative research method in studying the phenomenon. Through a purposive sampling approach, we conducted 24 face-to-face interviews using a semi-structured interview guide. Participants were mainly key informants, including policy-makers, health professionals, and technical officers across the national and subnational levels, including the Ministry of Health (MoH), medical universities, and hospitals in Iran. We performed thematic framework analysis using the software MAXQDA10. RESULTS Four main interdisciplinary themes emerged from our study of measures of controlling HAIs: strengthening governance and stewardship; strengthening human resources policies; appropriate prescription and usage of antibiotics; and environmental sanitation and personal hygiene. CONCLUSION According to our findings, elimination of HAIs demands multifactorial interventions. While the ultimate recommendation of policy-makers is to have HAIs among the priorities of the national agenda, financial commitment and the creation of an enabling work environment in which both patients and healthcare workers can practice personal hygiene could lead to a significant reduction in HAIs in Iran.
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Affiliation(s)
| | | | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Masoumi Asl
- Center for Communicable Diseases Control, Ministry of Health and Medical Education, Tehran, Iran.,Research Center of Pediatric Infectious Diseases, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Sepahvand S, Davarpanah MA, Roudgari A, Bahador A, Karbasizade V, Kargar Jahromi Z. Molecular evaluation of colistin-resistant gene expression changes in Acinetobacter baumannii with real-time polymerase chain reaction. Infect Drug Resist 2017; 10:455-462. [PMID: 29225477 PMCID: PMC5708186 DOI: 10.2147/idr.s141196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Acinetobacter baumannii is an important human pathogen which has recently gained increased attention due to the occurrence of drug-resistant nosocomial infections in patients suffering from immune system disorders, and those in hospital intensive care units. The aim of this research was to identify and isolate A. baumannii strains resistant to colistin, determine antibiotic resistance pattern of this bacteria, investigate the presence of colistin-resistant genes, and finally assess the effect of expression changes in pmrA and pmrB genes resistant to A. baumannii against colistin via real-time polymerase chain reaction. Methods The samples were initially purified and isolated using biochemical tests and Micro-gen kit. Later, the resistance pattern evaluation of validated samples to different antibiotics and colistin was carried out using two methods viz., disc diffusion and E-test. This was followed by the assessment of genes resistant to colistin via polymerase chain reaction besides gene expression changes via real-time polymerase chain reaction. Results The results of this study indicated that eleven strains of A. baumannii isolated from Shahid Rajaee Trauma Hospital were resistant to colistin. However, in the resistance pattern evaluation of A. baumannii isolated from Ali Asghar Hospital, all the strains were sensitive to colistin. In the evaluation of genes resistant to pmrA and pmrB, most of the strains resistant to colistin were carriers of these genes. Besides, in the expression assessment of these genes, it was demonstrated that expression of pmrA in the strains resistant to colistin significantly increased in relation to sensitive strains, but the expression of pmrB increased at a lower rate in the strains resistant to colistin as compared to the sensitive strains. Conclusion Thus, it can be safely mentioned that increased expression of pmrA was due to the resistance of A. baumannii to colistin.
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Affiliation(s)
- Shahriar Sepahvand
- Department of Microbiology, Falavarjan Branch, Islamic Azad University, Isfahan, Iran
| | - Mohammad Ali Davarpanah
- Shiraz HIV/AIDS Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Amir Roudgari
- Shiraz Trauma Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Bahador
- Department of Microbiology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Vajihe Karbasizade
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Tripathi A, Melo JS. Development of Nano-Antimicrobial Biomaterials for Biomedical Applications. ADVANCES IN BIOMATERIALS FOR BIOMEDICAL APPLICATIONS 2017; 66. [PMCID: PMC7122509 DOI: 10.1007/978-981-10-3328-5_12] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Around the globe, there is a great concern about controlling growth of pathogenic microorganisms for the prevention of infectious diseases. Moreover, the greater incidences of cross contamination and overuse of drugs has contributed towards the development of drug resistant microbial strains making conditions even worse. Hospital acquired infections pose one of the leading complications associated with implantation of any biomaterial after surgery and critical care. In this regard, developing non-conventional antimicrobial agents which would prevent the aforementioned causes is under the quest. The rapid development in nanoscience and nanotechnology has shown promising potential for developing novel biocidal agents that would integrate with a biomaterial to prevent bacterial colonization and biofilm formation. Metals with inherent antimicrobial properties such as silver, copper, zinc at nano scale constitute a special class of antimicrobials which have broad spectrum antimicrobial nature and pose minimum toxicity to humans. Hence, novel biomaterials that inhibit microbial growth would be of great significance to eliminate medical device/instruments associated infections. This chapter comprises the state-of-art advancements in the development of nano-antimicrobial biomaterials for biomedical applications. Several strategies have been targeted to satisfy few important concern such as enhanced long term antimicrobial activity and stability, minimize leaching of antimicrobial material and promote reuse. The proposed strategies to develop new hybrid antimicrobial biomaterials would offer a potent antibacterial solution in healthcare sector such as wound healing applications, tissue scaffolds, medical implants, surgical devices and instruments.
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Affiliation(s)
- Anuj Tripathi
- Nuclear Agriculture & Biotechnology Div, Bhabha Atomic Research Centre, Mumbai, Maharashtra India
| | - Jose Savio Melo
- Nuclear Agriculture & Biotechnology Div, Bhabha Atomic Research Centre, Mumbai, Maharashtra India
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Park K, Hong GRS. Predictors of chewing ability among community-residing older adults in Korea. Geriatr Gerontol Int 2017; 17:78-84. [PMID: 28112491 DOI: 10.1111/ggi.12677] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 11/30/2022]
Abstract
AIMS Decreased chewing ability in older adults can lead to poor nutritional and physical conditions, and eventually death. The present study examined the relationships between chewing ability and related characteristics (e.g. health promotion habits, health status and functional status), and identified predictors of chewing ability in community-residing older adults. METHODS Among the total of 11 542 participants in the 2011 National Survey on Older Adults in Korea, data from 10 543 participants were used for analysis. Chewing ability was evaluated using a self-report of chewing ability. Exercise ability was assessed by objective exercise ability and perceived exercise ability in both the upper and lower extremities. Depression and cognitive functions were measured using the Geriatric Depression Scale-Short Form and the Mini-Mental State Examination, respectively. RESULTS A total of 56.9% of participants had poor chewing abilities. After adjusting for age and sex, logistic regression analysis showed that depression (OR 1.76, 95% CI 1.60-1.92), cognitive impairment (OR 1.28, 95% CI 1.17-1.40), objective exercise ability (OR 1.24, 95% CI 1.11-1.41), regular exercise habits (OR 1.23, 95% CI 1.13-1.34), medical check-up history (OR 1.17, 95% CI 1.05-1.32), number of chronic diseases (OR 1.12, 95% CI 1.09-1.15) and perceived exercise ability in the lower extremities (OR 1.08, 95% CI 1.05-1.10) were significant predictors of chewing ability. CONCLUSION Chewing ability in older adults should be improved in consideration of mental and general health condition. Geriatr Gerontol Int 2017; 17: 78-84.
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Affiliation(s)
- Kyongok Park
- Nursing Department, Far East University, Eumseong, Korea
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Zhou Y, Cui Y, Wang H, Wang F, Lu C, Shen Y. Developing a tool for nurses to assess risk of infection in pediatric oncology patients in China: a modified Delphi study. J Biomed Res 2016; 30:386-392. [PMID: 27845302 PMCID: PMC5044711 DOI: 10.7555/jbr.30.20160014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 02/24/2016] [Accepted: 05/24/2016] [Indexed: 11/23/2022] Open
Abstract
Infections are identified as the most common preventable cause of death in pediatric oncology patients. Assessing and stratifying risk of infections are essential to prevent infection in these patients. To date, no tool can fulfill this demand in China. This study aimed to develop a nursing work-based and Chinese-specific tool for pediatric nurses to assess risk of infection in oncology patients. This research was a modified Delphi study. Based on a literature review, a 37-item questionnaire rating on a 0–5 scale was developed. Twenty-four experts from 8 hospitals in 6 provinces of China were consulted for three rounds. Consensus for each item in the first round was defined as: the rating mean was > 3 and the coefficient of variation (CV) was < 0.5. Consensus for each item in the second round was defined as CV < 0.3. Consensus among experts was defined as: P value of Kendall's coefficient of concordance (W) < 0.05. After three rounds of consultation, a two-part tool was developed: the Immune Status Scale (ISS) and the Checklist of Risk Factors of Infection (CRFI). There were 5 items in the ISS and 14 in the CRFI. Based on the ISS score, nurses could stratify children into the low-risk and high-risk groups. For high-risk children, nurses should screen risk factors of infection every day by the CRFI, and twice weekly for low-risk children. Further study is needed to verify this tool's efficacy.
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Affiliation(s)
- Yufeng Zhou
- Department of Basic and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, JIangsu 211166, China
| | - Yan Cui
- Department of Basic and Community Nursing, School of Nursing, Nanjing Medical University, Nanjing, JIangsu 211166, China;
| | - Hong Wang
- Department of Respiratory, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China;
| | - Fang Wang
- Department of Paediatric, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Chao Lu
- Department of Paediatric, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
| | - Yan Shen
- Department of Paediatric, The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu 210029, China
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Battistella G, Berto G, Bazzo S. Developing professional habits of hand hygiene in intensive care settings: An action-research intervention. Intensive Crit Care Nurs 2016; 38:53-59. [PMID: 27720317 DOI: 10.1016/j.iccn.2016.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 08/18/2016] [Accepted: 08/21/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To explore perceptions and unconscious psychological processes underlying handwashing behaviours of intensive care nurses, to implement organisational innovations for improving hand hygiene in clinical practice. RESEARCH METHODOLOGY An action-research intervention was performed in 2012 and 2013 in the intensive care unit of a public hospital in Italy, consisting of: structured interviews, semantic analysis, development and validation of a questionnaire, team discussion, project design and implementation. Five general workers, 16 staff nurses and 53 nurse students participated in the various stages. RESULTS Social handwashing emerged as a structured and efficient habit, which follows automatically the pattern "cue/behaviour/gratification" when hands are perceived as "dirty". The perception of "dirt" starts unconsciously the process of social washing also in professional settings. Professional handwashing is perceived as goal-directed. The main concern identified is the fact that washing hands requires too much time to be performed in a setting of urgency. These findings addressed participants to develop a professional "habit-directed" hand hygiene procedure, to be implemented at beginning of workshifts. CONCLUSIONS Handwashing is a ritualistic behaviour driven by deep and unconscious patterns, and social habits affect professional practice. Creating professional habits of hand hygiene could be a key solution to improve compliance in intensive care settings.
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Affiliation(s)
- Giuseppe Battistella
- Epidemiology and Statistic Unit, Azienda ULSS n.9 "Treviso", Borgo Cavalli 31, 31100 Treviso, Italy.
| | - Giuliana Berto
- Intensive Care Unit, Azienda ULSS n.9 "Treviso", Via Sant' Ambrogio di Fiera, 37, 31100 Treviso, Italy.
| | - Stefania Bazzo
- Health Education and Research consultant, Azienda ULSS n.9 "Treviso", Via Vittoria, 54, 31010 Cimadolmo, Treviso, Italy.
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The Activity of Antimicrobial Surfaces Varies by Testing Protocol Utilized. PLoS One 2016; 11:e0160728. [PMID: 27494336 PMCID: PMC4975443 DOI: 10.1371/journal.pone.0160728] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 07/25/2016] [Indexed: 01/04/2023] Open
Abstract
Background Contaminated hospital surfaces are an important source of nosocomial infections. A major obstacle in marketing antimicrobial surfaces is a lack of efficacy data based on standardized testing protocols. Aim We compared the efficacy of multiple testing protocols against several “antimicrobial” film surfaces. Methods Four clinical isolates were used: one Escherichia coli, one Klebsiella pneumoniae, and two Staphylococcus aureus strains. Two industry methods (modified ISO 22196 and ASTM E2149), a “dried droplet”, and a “transfer” method were tested against two commercially available antimicrobial films, one film in development, an untreated control, and a positive (silver) control film. At 2 (only ISO) and 24 hours following inoculation, bacteria were collected from film surfaces and enumerated. Results Compared to untreated films in all protocols, there were no significant differences in recovery on either commercial brand at 2 or 24 hours after inoculation. The silver surface demonstrated significant microbicidal activity (mean loss 4.9 Log10 CFU/ml) in all methods and time points with the exception of 2 hours in the ISO protocol and the transfer method. Using our novel droplet method, no differences between placebo and active surfaces were detected. The surface in development demonstrated variable activity depending on method, organism, and time point. The ISO demonstrated minimal activity at 2 hours but significant activity at 24 hours (mean 4.5 Log10 CFU/ml difference versus placebo). The ASTEM protocol exhibited significant differences in recovery of staphylococci (mean 5 Log10 CFU/ml) but not Gram-negative isolates (10 fold decrease). Minimal activity was observed with this film in the transfer method. Conclusions Varying results between protocols suggested that efficacy of antimicrobial surfaces cannot be easily and reproducibly compared. Clinical use should be considered and further development of representative methods is needed.
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Mirhoseini SH, Nikaeen M, Shamsizadeh Z, Khanahmad H. Hospital air: A potential route for transmission of infections caused by β-lactam-resistant bacteria. Am J Infect Control 2016; 44:898-904. [PMID: 27021512 DOI: 10.1016/j.ajic.2016.01.041] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 01/24/2016] [Accepted: 01/26/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The emergence of bacterial resistance to β-lactam antibiotics seriously challenges the treatment of various nosocomial infections. This study was designed to investigate the presence of β-lactam-resistant bacteria (BLRB) in hospital air. METHODS A total of 64 air samples were collected in 4 hospital wards. Detection of airborne bacteria was carried out using culture plates with and without β-lactams. BLRB isolates were screened for the presence of 5 common β-lactamase-encoding genes. Sequence analysis of predominant BLRB was also performed. RESULTS The prevalence of BLRB ranged between 3% and 34%. Oxacillin-resistant bacteria had the highest prevalence, followed by ceftazidime- and cefazolin-resistant bacteria. The frequency of β-lactamase-encoding genes in isolated BLRB ranged between 0% and 47%, with the highest and lowest detection for OXA-23 and CTX-m-32, respectively. MecA had a relatively high frequency in surgery wards and operating theaters, whereas the frequency of blaTEM was higher in intensive care units and internal medicine wards. OXA-51 was detected in 4 wards. Acinetobacter spp, Acinetobacter baumannii, and Staphylococcus spp were the most predominant BLRB. CONCLUSIONS The results revealed that hospital air is a potential route of transmission of BLRB, such as Acinetobacter and Staphylococcus, 2 important causative agents of nosocomial infections. Therefore, improvement of control measures against the spreading of airborne bacteria in hospital environments is warranted.
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Affiliation(s)
- Seyed Hamed Mirhoseini
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran; Student Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Environmental Health Engineering, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - Mahnaz Nikaeen
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Zahra Shamsizadeh
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran; Student Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hossein Khanahmad
- Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Capelletti RV, Moraes ÂM. Waterborne microorganisms and biofilms related to hospital infections: strategies for prevention and control in healthcare facilities. JOURNAL OF WATER AND HEALTH 2016; 14:52-67. [PMID: 26837830 DOI: 10.2166/wh.2015.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Water is the main stimulus for the development of microorganisms, and its flow has an important role in the spreading of contaminants. In hospitals, the water distribution system requires special attention since it can be a source of pathogens, including those in the form of biofilms often correlated with resistance of microorganisms to various treatments. In this paper, information relevant to cases of nosocomial infections involving water circuits as a source of contaminants is compiled, with emphasis on the importance of microbiological control strategies to prevent the installation, spreading and growth of microorganisms in hospitals. An overview of the worldwide situation is provided, with emphasis on Brazilian hospitals. Different approaches normally used to control the occurrence of nosocomial infections due to waterborne contaminants are analyzed, and the use of the polysaccharide chitosan for this specific application is briefly discussed.
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Affiliation(s)
- Raquel Vannucci Capelletti
- Department of Engineering of Materials and of Bioprocesses, School of Chemical Engineering, University of Campinas (UNICAMP), CEP 13083-852, Campinas, São Paulo, Brazil E-mail:
| | - Ângela Maria Moraes
- Department of Engineering of Materials and of Bioprocesses, School of Chemical Engineering, University of Campinas (UNICAMP), CEP 13083-852, Campinas, São Paulo, Brazil E-mail:
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Nombela-Franco L, Trigo MD, Morrison-Polo G, Veiga G, Jimenez-Quevedo P, Abdul-Jawad Altisent O, Campelo-Parada F, Biagioni C, Puri R, DeLarochellière R, Dumont E, Doyle D, Paradis JM, Quirós A, Almeria C, Gonzalo N, Nuñez-Gil I, Salinas P, Mohammadi S, Escaned J, Fernández-Ortiz A, Macaya C, Rodés-Cabau J. Incidence, Causes, and Predictors of Early (≤30 Days) and Late Unplanned Hospital Readmissions After Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2015; 8:1748-57. [DOI: 10.1016/j.jcin.2015.07.022] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 07/30/2015] [Indexed: 11/30/2022]
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Yatvin J, Gao J, Locklin J. Durable defense: robust and varied attachment of non-leaching poly"-onium" bactericidal coatings to reactive and inert surfaces. Chem Commun (Camb) 2015; 50:9433-42. [PMID: 24882521 DOI: 10.1039/c4cc02803a] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Developing antimicrobial coatings to eliminate biotic contamination is a critical need for all surfaces, including medical, industrial, and domestic materials. The wide variety of materials used in these fields, from natural polymers to metals, require coatings that not only are antimicrobial, but also contain different surface chemistries for covalent immobilization. Alkyl "-onium" salts are potent biocides that have defied bacterial resistance mechanisms when confined to an interface. In this feature article, we highlight the various methods used to covalently immobilize bactericidal polymers to different surfaces and further examine the mechanistic aspects of biocidal action with these surface bound poly"-onium" salts.
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Affiliation(s)
- Jeremy Yatvin
- Department of Chemistry, College of Engineering, and Nanoscale Science and Engineering Center, 220 Riverbend Rd., Athens, GA, USA.
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Caldeira SM, Cunha ARD, Akazawa RT, Moreira RG, Souza LDRD, Fortaleza CMCB. Weather parameters and nosocomial bloodstream infection: a case-referent study. Rev Saude Publica 2015; 49:19. [PMID: 25830871 PMCID: PMC4390072 DOI: 10.1590/s0034-8910.2015049005438] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 10/20/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate if temperature and humidity influenced the etiology of bloodstream infections in a hospital from 2005 to 2010. METHODS The study had a case-referent design. Individual cases of bloodstream infections caused by specific groups or pathogens were compared with several references. In the first analysis, average temperature and humidity values for the seven days preceding collection of blood cultures were compared with an overall “seven-days moving average” for the study period. The second analysis included only patients with bloodstream infections. Several logistic regression models were used to compare different pathogens and groups with respect to the immediate weather parameters, adjusting for demographics, time, and unit of admission. RESULTS Higher temperatures and humidity were related to the recovery of bacteria as a whole (versus fungi) and of gram-negative bacilli. In the multivariable models, temperature was positively associated with the recovery of gram-negative bacilli (OR = 1.14; 95%CI 1.10;1.19) or Acinetobacter baumannii (OR = 1.26; 95%CI 1.16;1.37), even after adjustment for demographic and admission data. An inverse association was identified for humidity. CONCLUSIONS The study documented the impact of temperature and humidity on the incidence and etiology of bloodstream infections. The results correspond with those from ecological studies, indicating a higher incidence of gram-negative bacilli during warm seasons. These findings should guide policies directed at preventing and controlling healthcare-associated infections.
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Palza H. Antimicrobial polymers with metal nanoparticles. Int J Mol Sci 2015; 16:2099-116. [PMID: 25607734 PMCID: PMC4307351 DOI: 10.3390/ijms16012099] [Citation(s) in RCA: 319] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 01/09/2015] [Indexed: 11/23/2022] Open
Abstract
Metals, such as copper and silver, can be extremely toxic to bacteria at exceptionally low concentrations. Because of this biocidal activity, metals have been widely used as antimicrobial agents in a multitude of applications related with agriculture, healthcare, and the industry in general. Unlike other antimicrobial agents, metals are stable under conditions currently found in the industry allowing their use as additives. Today these metal based additives are found as: particles, ions absorbed/exchanged in different carriers, salts, hybrid structures, etc. One recent route to further extend the antimicrobial applications of these metals is by their incorporation as nanoparticles into polymer matrices. These polymer/metal nanocomposites can be prepared by several routes such as in situ synthesis of the nanoparticle within a hydrogel or direct addition of the metal nanofiller into a thermoplastic matrix. The objective of the present review is to show examples of polymer/metal composites designed to have antimicrobial activities, with a special focus on copper and silver metal nanoparticles and their mechanisms.
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Affiliation(s)
- Humberto Palza
- Departamento de Ingeniería Química y Biotecnología, Facultad de Ciencias Físicas y Matemáticas, Universidad de Chile, Beauchef 850, Santiago 8320000, Chile.
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Liu Y, Li J, Cheng X, Ren X, Huang TS. Self-assembled antibacterial coating by N-halamine polyelectrolytes on a cellulose substrate. J Mater Chem B 2015; 3:1446-1454. [PMID: 32264496 DOI: 10.1039/c4tb01699h] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In this research, two N-halamine polymer precursors, a cationic homopolymer poly((3-acrylamidopropyl)trimethylammonium chloride) (CHP) and an anionic homopolymer poly(2-acrylamido-2-methylpropane sulfonic acid sodium salt) (AHP), have been successfully synthesized and coated onto cotton fabrics via a layer-by-layer (LbL) deposition technique. The coated cotton fabrics were characterized using scanning electron microscopy, X-ray photoelectron spectroscopy, and Fourier transform infrared spectroscopy. The biocidal efficacies of uncoated and coated cotton fabrics were evaluated against Staphylococcus aureus and Escherichia coli. The chlorinated swatches (CHP-Cl and AHP-Cl) inactivated 100% S. aureus and 99.73% E. coli O157:H7 in 30 min. Over 51% of the chlorine is retained after the equivalent of 50 machine washes. A skin stimulation test showed that CHP-Cl and AHP-Cl compounds have no irritation to rabbit skin, and so these swatches might be utilized for biomedical applications in the future. As an easy and efficient way of coating fabrics, the LbL deposition technique can broaden the use of N-halamine biocides in other polar substances as antimicrobial functional coatings.
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Affiliation(s)
- Ying Liu
- Key Laboratory of Eco-Textiles of Ministry of Education, College of Textiles and Clothing, Jiangnan University, Wuxi 214122, Jiangsu, China.
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Khan BA, Wang J, Warner P, Wang H. Antibacterial properties of hemp hurd powder againstE. coli. J Appl Polym Sci 2014. [DOI: 10.1002/app.41588] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Belas Ahmed Khan
- Centre of Excellence in Engineered Fibre Composite; University of Southern Queensland; Toowoomba, Queensland 4350 Australia
| | - Jing Wang
- Centre of Excellence in Engineered Fibre Composite; University of Southern Queensland; Toowoomba, Queensland 4350 Australia
| | - Philip Warner
- Ecofibre Industries Operations Pty Ltd; Maleny, Queensland 4552 Australia
| | - Hao Wang
- Centre of Excellence in Engineered Fibre Composite; University of Southern Queensland; Toowoomba, Queensland 4350 Australia
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Tsai DM, Caterson EJ. Current preventive measures for health-care associated surgical site infections: a review. Patient Saf Surg 2014; 8:42. [PMID: 25328539 PMCID: PMC4200194 DOI: 10.1186/s13037-014-0042-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/23/2014] [Indexed: 12/22/2022] Open
Abstract
Healthcare-associated infections (HAIs) continue to be a tremendous issue today. It is estimated 1.7 million HAIs occur per year, and cost the healthcare system up to $45 billion annually. Surgical site infections (SSIs) alone account for 290,000 of total HAIs and approximately 8,000 deaths. In today's rapidly changing world of medicine, it is ever important to remain cognizant of this matter and its impact both globally and on the individual lives of our patients. This review aims to impress upon the reader the unremitting significance of HAIs in the daily practice of medicine. Further, we discuss the etiology of HAIs and review successful preventive measures that have been demonstrated in the literature. In particular, we highlight preoperative, intraoperative, and postoperative interventions to combat SSIs. Finally, we contend that current systems in place are often insufficient, and emphasize the benefits of institution-wide adoption of multiple preventive interventions. We hope this concise update and review can inspire additional dialogue for the continuing progress towards improving patient care and patient lives.
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Affiliation(s)
- David M Tsai
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, 02115 Boston, MA USA
| | - Edward J Caterson
- Division of Plastic Surgery, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, 02115 Boston, MA USA
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Ferranti G, Marchesi I, Favale M, Borella P, Bargellini A. Aetiology, source and prevention of waterborne healthcare-associated infections: a review. J Med Microbiol 2014; 63:1247-1259. [DOI: 10.1099/jmm.0.075713-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The purpose of this review is to discuss the scientific literature on waterborne healthcare-associated infections (HCAIs) published from 1990 to 2012. The review focuses on aquatic bacteria and describes both outbreaks and single cases in relation to patient characteristics, the settings and contaminated sources. An overview of diagnostic methods and environmental investigations is summarized in order to provide guidance for future case investigations. Lastly, on the basis of the prevention and control measures adopted, information and recommendations are given. A total of 125 reports were included, 41 describing hospitalized children. All cases were sustained by opportunistic pathogens, mainly Legionellaceae, Pseudomonadaceae and Burkholderiaceae. Hot-water distribution systems were the primary source of legionnaires’ disease, bottled water was mainly colonized by Pseudomonaceae, and Burkholderiaceae were the leading cause of distilled and sterile water contamination. The intensive care unit was the most frequently involved setting, but patient characteristics were the main risk factor, independent of the ward. As it is difficult to avoid water contamination by microbes and disinfection treatments may be insufficient to control the risk of infection, a proactive preventive plan should be put in place. Nursing staff should pay special attention to children and immunosuppressed patients in terms of tap-water exposure and also their personal hygiene, and should regularly use sterile water for rinsing/cleaning devices.
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Affiliation(s)
- Greta Ferranti
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Isabella Marchesi
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Marcella Favale
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Borella
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Annalisa Bargellini
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Azevedo AS, Almeida C, Melo LF, Azevedo NF. Interaction between atypical microorganisms and E. coli in catheter-associated urinary tract biofilms. BIOFOULING 2014; 30:893-902. [PMID: 25184430 DOI: 10.1080/08927014.2014.944173] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Most biofilms involved in catheter-associated urinary tract infections (CAUTIs) are polymicrobial, with disease causing (eg Escherichia coli) and atypical microorganisms (eg Delftia tsuruhatensis) frequently inhabiting the same catheter. Nevertheless, there is a lack of knowledge about the role of atypical microorganisms. Here, single and dual-species biofilms consisting of E. coli and atypical bacteria (D. tsuruhatensis and Achromobacter xylosoxidans), were evaluated. All species were good biofilm producers (Log 5.84-7.25 CFU cm(-2) at 192 h) in artificial urine. The ability of atypical species to form a biofilm appeared to be hampered by the presence of E. coli. Additionally, when E. coli was added to a pre-formed biofilm of the atypical species, it seemed to take advantage of the first colonizers to accelerate adhesion, even when added at lower concentrations. The results suggest a greater ability of E. coli to form biofilms in conditions mimicking the CAUTIs, whatever the pre-existing microbiota and the inoculum concentration.
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Affiliation(s)
- Andreia S Azevedo
- a Laboratory for Process Engineering, Environment, and Energy and Biotechnology Engineering (LEPABE), Department of Chemical Engineering, Faculty of Engineering , University of Porto , Rua Dr Roberto Frias, 4200-465 Porto , Portugal
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