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Di Bella S, Sanson G, Monticelli J, Zerbato V, Principe L, Giuffrè M, Pipitone G, Luzzati R. Clostridioides difficile infection: history, epidemiology, risk factors, prevention, clinical manifestations, treatment, and future options. Clin Microbiol Rev 2024; 37:e0013523. [PMID: 38421181 DOI: 10.1128/cmr.00135-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
SUMMARYClostridioides difficile infection (CDI) is one of the major issues in nosocomial infections. This bacterium is constantly evolving and poses complex challenges for clinicians, often encountered in real-life scenarios. In the face of CDI, we are increasingly equipped with new therapeutic strategies, such as monoclonal antibodies and live biotherapeutic products, which need to be thoroughly understood to fully harness their benefits. Moreover, interesting options are currently under study for the future, including bacteriophages, vaccines, and antibiotic inhibitors. Surveillance and prevention strategies continue to play a pivotal role in limiting the spread of the infection. In this review, we aim to provide the reader with a comprehensive overview of epidemiological aspects, predisposing factors, clinical manifestations, diagnostic tools, and current and future prophylactic and therapeutic options for C. difficile infection.
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Affiliation(s)
- Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
| | - Gianfranco Sanson
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
| | - Jacopo Monticelli
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Trieste, Italy
| | - Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Trieste, Italy
| | - Luigi Principe
- Microbiology and Virology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Mauro Giuffrè
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
- Department of Internal Medicine (Digestive Diseases), Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Giuseppe Pipitone
- Infectious Diseases Unit, ARNAS Civico-Di Cristina Hospital, Palermo, Italy
| | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
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Gebremicael MN, Skaletz-Rorowski A, Potthoff A, Lemm J, Kasper-Sonnenberg M, Arefaine ZG, Temizel S, Lemm F. Implementing a multimodal intervention using local resources to improve hand hygiene compliance in a comprehensive specialized hospital in Mekelle, Northern Ethiopia. Int J Hyg Environ Health 2024; 259:114389. [PMID: 38703463 DOI: 10.1016/j.ijheh.2024.114389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/12/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Hand hygiene (HH) is known to be the most effective practice to reduce Healthcare-associated infections (HAIs). The main barriers to HH practices among healthcare workers (HCWs) in Sub-Saharan Africa are heavy workload, infrastructural deficits, and poorly positioned facilities. There is limited data on HH compliance and particularly on the impact of the World Health Organization's (WHO) multimodal HH strategy in low- and middle-income countries. This study aimed to provide insights into a strategy to implement the WHO concept adapted to local conditions and obstacles encountered at a tertiary university hospital in Mekelle, Tigray, Ethiopia. METHODS We conducted a study aiming at increasing the quality of the HH practice of HCWs using the WHO HH improvement strategy. The study adopted a pre-and post-interventional design from April 2018 to May 2019. In the pre-intervention phase, a baseline infrastructural survey was made. The intervention consisted of in-house production of hand sanitizer and dispensers for every patient bed, staff education and motivation, and implementation of a multidisciplinary infection prevention committee. The intervention was followed by two one-week compliance observations of HH practice among HCWs within the six months post-intervention period and microbiological sample collection from HCWs' hands to assess the quality of HH. RESULTS We observed 269 (baseline), 737 (first follow-up) and 574 (second follow-up) indications for HH among HCWs. The overall baseline hand rub compliance was 4.8%, which significantly increased to 37.3% (first follow-up) and 56.1% (second follow-up) (p < 0.0001). Consistent and significant increases in hand rub compliance during the entire follow-up period were observed before touching a patient, after touching a patient, and after touching the patient's surroundings (all p < 0.01). Nurses and medical interns achieved consistent and significant increases in hand rub compliance during the entire follow-up period (all p < 0.01). CONCLUSION Implementing the WHO HH improvement strategy significantly increased HH compliance despite a shortage of water and other resources. Hand rub was accepted as the main HH method in the hospital. HH campaigns in developing settings profit from multimodal strategies, knowledge exchange and utilization of local resources.
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Affiliation(s)
- Mulugeta Naizgi Gebremicael
- Ayder Comprehensive Specialized Hospital, College of Health Science, Mekelle University, P.O. Box 1871, Mekelle, Ethiopia.
| | - Adriane Skaletz-Rorowski
- Department of Dermatology, Venerology, and Allergology, WIR - Walk in Ruhr, Center for Sexual Health and Medicine, Ruhr- University Bochum, Bleichstraße 15, Bochum, D-44787, Bochum, Germany.
| | - Anja Potthoff
- Department of Dermatology, Venerology, and Allergology, WIR - Walk in Ruhr, Center for Sexual Health and Medicine, Ruhr- University Bochum, Bleichstraße 15, Bochum, D-44787, Bochum, Germany.
| | - Joshua Lemm
- Ruhr University Bochum, Department of Philosophy, Universitätsstraße 150, Bochum, D-44801, Bochum, Germany.
| | - Monika Kasper-Sonnenberg
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr-University Bochum (IPA), Bürkle-de-la-Camp-Platz 1, Bochum, D-44789, Bochum, Germany.
| | - Zekarias Gessesse Arefaine
- Ayder Comprehensive Specialized Hospital, College of Health Science, Mekelle University, P.O. Box 1871, Mekelle, Ethiopia.
| | - Selin Temizel
- University Hospital Augsburg, Department of Hygiene and Environmental Medicine, Stenglinstr. 2, Augsburg, D-86156, Augsburg, Germany.
| | - Friederike Lemm
- Department of Hospital Hygiene, St. Josef Hospital, Ruhr University Bochum, Gudrunstraße 56, Bochum, D-44791, Bochum, Germany.
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Enz A, Klinder A, Bisping L, Lutter C, Warnke P, Tischer T, Mittelmeier W, Lenz R. Knot tying in arthroplasty and arthroscopy causes lesions to surgical gloves: a potential risk of infection. Knee Surg Sports Traumatol Arthrosc 2022; 31:1824-1832. [PMID: 36048202 PMCID: PMC10089991 DOI: 10.1007/s00167-022-07136-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/19/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Recent studies have shown that the incidence of glove lesions during arthroscopy is much lower than that during primary and revision arthroplasty. However, the rate of glove damage after knot tying has not yet been systematically recorded. Therefore, the aim of the study was to determine the impact of surgical knot tying on glove integrity. It was hypothesized that knot tying increases the rate of glove damage, especially in arthroscopic surgery, which could be of special relevance in the treatment of rotator cuff tears. METHODS Gloves that were changed immediately before suturing and only worn during knot tying were investigated for their integrity by means of water tightening test according to EN455. A total of 234 gloves from 40 total hip arthroplasties (THAs), 42 total knee arthroplasties (TKAs) and 36 rotator cuff repairs (RCRs) were collected. A bacterial pass-through test (BPTT) on glove lesions was performed under simulated sterile surgical conditions for 3 surgeons after a wear duration of 45 min. RESULTS Glove damage by knot tying occurred in 25% of THA, 36.6% of TKA and 25% of RCR surgeries. In THA, the pulling hand (PH) was affected in 46.2%, and the main area of damage (15.4%) was detected on the tip of the middle finger; in TKAs the PH was damaged in 75%, and in RCRs the PH was affected in 66.7%, with most of the lesions (20% each) occurring on the tip of the index finger and the ring finger. The BPTT showed Staphylococcus hominis and Bacillus cereus. CONCLUSION Intraoperative knot tying causes damage to gloves, which is of special relevance for arthroscopic surgery. Whereas knot tying is only partly responsible for glove damage in arthroplasty, the general rate of glove damage in arthroscopic surgery is low without knot tying. The surgical knot tying process must be understood as a possible damaging impact on the glove. Therefore, single gloving is not recommended, which is especially important in arthroscopic surgery, where double gloving is not yet standard. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Andreas Enz
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, Doberanerstraße 142, 18057, Rostock, Germany.
| | - Annett Klinder
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, Doberanerstraße 142, 18057, Rostock, Germany
| | - Lucas Bisping
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, Doberanerstraße 142, 18057, Rostock, Germany
| | - Christoph Lutter
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, Doberanerstraße 142, 18057, Rostock, Germany
| | - Philipp Warnke
- Institute of Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Thomas Tischer
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, Doberanerstraße 142, 18057, Rostock, Germany
| | - Wolfram Mittelmeier
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, Doberanerstraße 142, 18057, Rostock, Germany
| | - Robert Lenz
- Orthopaedic Clinic and Policlinic, University Medicine Rostock, Doberanerstraße 142, 18057, Rostock, Germany
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Dorotíková K, Kameník J, Bogdanovičová K, Křepelová S, Strejček J, Haruštiaková D. Microbial contamination and occurrence of Bacillus cereus sensu lato, Staphylococcus aureus, and Escherichia coli on food handlers’ hands in mass catering: Comparison of the glove juice and swab methods. Food Control 2022. [DOI: 10.1016/j.foodcont.2021.108567] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Prevalence and Antimicrobial Resistance of Paeniclostridium sordellii in Hospital Settings. Antibiotics (Basel) 2021; 11:antibiotics11010038. [PMID: 35052916 PMCID: PMC8772839 DOI: 10.3390/antibiotics11010038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/27/2021] [Accepted: 12/27/2021] [Indexed: 12/01/2022] Open
Abstract
(1) Background: The purpose of this study was to determine the prevalence of clostridia strains in a hospital environment in Algeria and to evaluate their antimicrobial susceptibility to antibiotics and biocides. (2) Methods: Five hundred surface samples were collected from surfaces in the intensive care unit and surgical wards in the University Hospital of Tlemcen, Algeria. Bacterial identification was carried out using MALDI-TOF-MS, and then the minimum inhibitory concentrations (MICs) of various antimicrobial agents were determined by the E-test method. P. sordellii toxins were searched by enzymatic and PCR assays. Seven products intended for daily disinfection in the hospitals were tested against Clostridium spp. spore collections. (3) Results: Among 100 isolates, 90 P. sordellii were identified, and all strains were devoid of lethal and hemorrhagic toxin genes. Beta-lactam, linezolid, vancomycin, tigecycline, rifampicin, and chloramphenicol all proved effective against isolated strains. Among all strains tested, the spores of P. sordellii exhibited remarkable resistance to the tested biocides compared to other Clostridium species. The (chlorine-based 0.6%, 30 min), (glutaraldehyde solution 2.5%, 30 min), and (hydrogen peroxide/peracetic acid 3%, 15 min) products achieved the required reduction in spores. (4) Conclusions: Our hospital’s current cleaning and disinfection methods need to be optimized to effectively remove spores from caregivers’ hands, equipment, and surfaces.
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Pegu KD, Perrie H, Scribante J, Fourtounas M. Microbial contamination of the hands of healthcare providers in the operating theatre of a central hospital. S Afr J Infect Dis 2021; 36:221. [PMID: 34485495 PMCID: PMC8378170 DOI: 10.4102/sajid.v36i1.221] [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: 05/20/2020] [Accepted: 02/03/2021] [Indexed: 11/22/2022] Open
Abstract
Background Effort is invested in maintaining the sterility of the operating field, but less attention is paid to potential healthcare associated infection (HAI) sources through patient contact with non-scrubbed healthcare providers (HCPs). A single microbiological assessment of hands can provide a good assessment of the potential dynamic transmission of microorganisms. The aim of this study was to identify and quantify the microbial growth on the hands of HCPs in the operating theatres of Chris Hani Baragwanath Academic Hospital. Methods A prospective, contextual and descriptive study design was followed. Seventy-five samples were collected using convenience sampling from an equal number of surgeons, anaesthetists and nurses. Specimens were taken using agar plates and underwent semi-quantitative analysis. Results All the hands of the HCPs displayed growth; 95% grew commensals and 64% grew pathogens. Eighteen commensal microorganisms and 21 pathological microorganisms were noted. Comparisons of commensal, pathological and combined levels of contamination among the three groups were not statistically significant (p = 0.061, p = 0.481, p = 0.236). No significant difference between the growth of combined microorganisms (p = 0.634) and pathological microorganisms (p = 0.499) among the groups. Surgeons had significantly more commensal growth (p = 0.041). There was no statistically significant difference between sexes (p = 0.290). Conclusion It was concerning that 100% of the hands of HCPs who were about to commence with the surgical list had microbial growth. These HCPs could have already been in contact with patients and equipment in the theatre environment.
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Affiliation(s)
- Kylesh D Pegu
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen Perrie
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Juan Scribante
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maria Fourtounas
- Department of Anaesthesiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Nawa M, Nkhoma P, Samutela MT, Simulundu E, Munsaka S, Kwenda G, Kalonda A. Bacteriological profile and antimicrobial efficacy of alcohol-based hand rubs among health care workers and family caregivers at the children's university teaching hospital in Lusaka, Zambia. SCIENTIFIC AFRICAN 2021. [DOI: 10.1016/j.sciaf.2021.e00775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Lee SY, Chan EL, Chan HH, Li CCK, Ooi ZH, Koh RY, Liew YK. ANTIMICROBIAL AGENTS AND ANTI-ADHESION MATERIALS FOR MEDICAL AND SURGICAL GLOVES. RUBBER CHEMISTRY AND TECHNOLOGY 2021. [DOI: 10.5254/rct.21.79901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
Healthcare-associated infections (HAIs) can be common in healthcare settings, such as the intensive care unit and surgical sites, if proper precautions are not followed. Although traditional techniques are encouraged, such as educating the public and healthcare workers to practice proper handwashing or to double glove, they have not been fully effective in combating HAIs. The use of surface-modified antimicrobial gloves may be an alternative approach to prevent the transmission of pathogens between healthcare workers and patients. This paper gives a comprehensive review of strategies to produce antimicrobial gloves. The chemistry of some potential chemically synthesized antimicrobial agents and nature-inspired superhydrophobic surfaces are discussed. The principles of killing microbes must be understood to effectively select these materials and to design and fabricate surfaces for the reduction of bacterial adhesion. Also, current company trends and technologies are presented for gloves proven to effectively kill bacteria. Such glove use, when coupled with in-depth research on diverse surgical procedures and medical examinations, could ease the burden of HAIs.
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Affiliation(s)
- Siang Yin Lee
- Latex Science and Technology Unit (USTL), Technology and Engineering Division (BTK), RRIM Sungai Buloh Research Station, Malaysian Rubber Board (MRB), 47000 Sungai Buloh, Selangor, Malaysia
| | - E-Lyn Chan
- School of Pharmacy, International Medical University, No. 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Hong Hao Chan
- School of Postgraduate Studies and Research, International Medical University, No. 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Claire Chong Khai Li
- School of Health Sciences, International Medical University, No. 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Zhe Hooi Ooi
- School of Pharmacy, International Medical University, No. 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Rhun Yian Koh
- School of Health Sciences, International Medical University, No. 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
| | - Yun Khoon Liew
- School of Pharmacy, International Medical University, No. 126, Jalan Jalil Perkasa 19, Bukit Jalil, 57000 Kuala Lumpur, Malaysia
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Two Bacillus isolates recovered from a radiation therapy facility differ greatly in their ability to attach to four immobilization masks. J Med Imaging Radiat Sci 2020; 51:590-598. [DOI: 10.1016/j.jmir.2020.08.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 02/01/2023]
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Adjidé CC, Léké A, Mullié C. Bacillus cereus contamination of pasteurized human milk donations: frequency, origin, seasonal distribution, molecular typing of strains and proposed corrective/preventive actions. J Matern Fetal Neonatal Med 2020; 35:1554-1561. [PMID: 32393084 DOI: 10.1080/14767058.2020.1763295] [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] [Indexed: 10/24/2022]
Abstract
Objectives: An increase in pasteurized human milk contamination with Bacillus cereus was witnessed in milk donated to the Amiens-Picardie Human Milk Bank over the 2017-2018 period. To better understand the origin of such an increase, this study aimed to describe the frequency of Bacillus cereus contamination in anonymous and personalized human milk donations of Amiens Human Milk Bank in 2018, compare the genetic profiles of Bacillus cereus strains found in pasteurized human milk and set up corrective/preventive actions to reduce Bacillus cereus contamination.Study design: A retrospective cohort study of human milk donated from January to December 2018 was set. Data on the microbiological quality of donated human milk and genetic profiles of Bacillus cereus strains isolated from pasteurized donated human milk and the environment were collected.Results: The overall noncompliance rate related to the microbiological quality in the 1585 batches of analyzed human milk donations was of 27.3%. Post-Holder pasteurization, rejection rates were significantly higher for anonymous donations as compared to personalized ones. Bacillus cereus was the main cause of noncompliance. Bacillus cereus contaminations could not be attributed to a single strain spreading through Amiens human milk bank and Amiens hospital environment as the genetic profiles of the collected strains were different. Corrective actions led to a decrease in the noncompliance rate due to Bacillus cereus (37.7-9.7%) post-Holder pasteurization.Conclusion: Bacillus cereus was the primary cause of rejection for pasteurized human milk donations over the investigated period. These contaminations did not originate from the spread of a single strain. A first round of corrective actions enabled a fair decrease in Bacillus cereus contaminations.
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Affiliation(s)
- Crespin C Adjidé
- Laboratoire Hygiène Risque Biologique & Environnement, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - André Léké
- Lactarium-Biberonnerie, Unité des soins intensifs de néonatologie et de médecine néonatale, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Catherine Mullié
- Laboratoire Hygiène Risque Biologique & Environnement, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France.,Laboratoire AGIR UR UPJV 4294, UFR de Pharmacie, Université de Picardie Jules Verne, Amiens, France
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Sampling of Patient Radiation Therapy Thermoplastic Immobilization Forms Reveals Several Types of Attached Bacteria. J Med Imaging Radiat Sci 2020; 51:117-127. [PMID: 31959543 DOI: 10.1016/j.jmir.2019.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/29/2019] [Accepted: 12/02/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Thermoplastic medical devices used during patient therapy have been shown to harbor microbes, including those causing healthcare-associated infections (HAI). This issue has not been previously evaluated for immobilization forms used during radiation therapy. The present study addresses this matter by sampling immobilization forms used during patient treatment to see if any microbes could be similarly recovered. METHODS Twelve head-only in-use patient forms were sampled at 3 radiation therapy facilities. Sampled form areas included cheeks, forehead, and nose. A site survey was also conducted to determine individual form characteristics and form handling procedures. RESULTS All twelve forms demonstrated at least one type of bacteria being recovered from sampled areas, several forms with multiple types. Bacterium was not recovered from the nose area of a single form, even though bacteria were recovered from the same form's cheeks and forehead areas. Recovered bacteria included Bacillus species spp. (21), coagulase-negative staphylococci or CoNS (19), Staphylococcus aureus (2), Enterococcus species (1), alpha-hemolytic (viridians) streptococci (1), and Gram-negative rods (1). Bacillus species spp. and CoNS were recovered from 10 of 12 (∼84%) forms in at least one sampled area. In addition, a single Bacillus spp. was also recovered from a water bath used to heat forms at one treatment facility. DISCUSSION The detected presence of several bacterial types on patient forms indicates that they can attach to and surviving, for a time, on form surfaces. Two of the bacteria recovered, namely S. aureus and Enterococcus spp. are confirmed HAI pathogens. The remainder are considered as opportunistic bacterial pathogens that can cause HAIs in debilitated patients. Of special concern is the recovery of several different species of the environmental bacterium Bacillus spp. at a higher level than CoNS, a normal skin bacterium. The ability of Bacillus spp. to form spores further enhances its survival capability on form surfaces. The source of the recovered bacteria, including Bacillus spp. was not determined. CONCLUSION The presence of bacteria on stored patient form surfaces indicates that there is a real potential to transfer them to the patient during its reapplication. The actual potential for microbe transfer such as Bacillus spp. or its spores has yet to be determined. Consequently, care should be taken by radiation therapy personnel in handling forms during patient reapplication. Precautions such as donning a fresh pair of gloves and cleaning a form with an approved disinfectant can help to reduce and/or eliminate unintended microbe transfer to the patient wearing it. This procedure should also be considered for patients without apparent open or leaking wounds.
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Saeki M, Sato T, Furuya D, Yakuwa Y, Sato Y, Kobayashi R, Ono M, Nirasawa S, Tanaka M, Nakafuri H, Nakae M, Shinagawa M, Asanuma K, Yanagihara N, Yokota SI, Takahashi S. Clonality investigation of clinical Escherichia coli isolates by polymerase chain reaction-based open-reading frame typing method. J Infect Chemother 2020; 26:38-42. [DOI: 10.1016/j.jiac.2019.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/14/2019] [Accepted: 06/30/2019] [Indexed: 11/28/2022]
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Mutters R, Warnes SL. The method used to dry washed hands affects the number and type of transient and residential bacteria remaining on the skin. J Hosp Infect 2018; 101:408-413. [PMID: 30537524 DOI: 10.1016/j.jhin.2018.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Widespread antibiotic resistance has led to fears that we are entering a post-antibiotic era and the relatively simple premise of hand washing to reduce transfer of bacteria and viruses has never been more important. Much of the emphasis has been on hand-washing technique, type of soap, and maintaining compliance but effective drying of the hands is just as important. AIM To compare the efficacy of drying washed hands with a jet air dryer or paper towels to remove transient bacterial contamination and to determine the effect on residential flora. METHODS Eighty volunteers were recruited. The entire surfaces of volunteers' hands were artificially contaminated with Escherichia coli before being washed and dried; then bacteria remaining on the skin were recovered and enumerated. In the second part of the study the number and types of bacteria comprising the natural flora remaining on washed and dried hands were determined. FINDINGS Significantly fewer transient and residential bacteria remained on the skin if hands were dried with a jet air dryer (P < 0.001). Drying hands with paper towels increased the number of resident bacteria, including potentially pathogenic species, released from the volunteers' skin, compared to a jet air dryer. CONCLUSION The number and types of bacteria remaining on washed hands were affected by the drying method. Hands dried with a jet air dryer harboured fewer viable bacteria, reducing the risk of infection transmission via touch. This could be especially important for healthcare workers who are constantly in contact with large numbers of vulnerable patients.
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Affiliation(s)
- R Mutters
- Institute for Medical Microbiology and Hygiene, Philipps University of Marburg, Marburg, Germany.
| | - S L Warnes
- Independent Scientific Writer, Southampton, UK
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Riley TV, Kimura T. The Epidemiology of Clostridium difficile Infection in Japan: A Systematic Review. Infect Dis Ther 2018; 7:39-70. [PMID: 29441500 PMCID: PMC5840105 DOI: 10.1007/s40121-018-0186-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Indexed: 01/02/2023] Open
Abstract
Abstract To increase understanding of the epidemiology, risks, consequences and resource utilization of Clostridium difficile infection (CDI) in Japan, a systematic literature review was undertaken of relevant publications from January 2006 to November 2017. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and methods, 55 articles met the criteria for full review. The majority (58%) of studies were from a single site, with the most recent data from 2015. The incidence, reported prevalence and recurrence rate of CDI in Japan were 0.8–4.71/10,000 patient-days, 0.3–5.5/1000 patients and 3.3–27.3%, respectively, and varied according to setting, population, CDI definition and detection method. Most C. difficile isolates associated with CDI in Japan were toxin A+B+, with a low level of C. difficile binary toxin-positive (CDT+) strains (0–6.8% reported across studies). The most common C. difficile PCR ribotypes associated with infection in Japan were smz/018, 002, 052 and 369. Data regarding the impact of CDI on length of hospital stay were limited. Reported all-cause mortality in patients with CDI ranged from 3.4 to 15.1% between 2007 and 2013. Two studies assessed risk factors for CDI recurrence, identifying malignant disease, intensive care unit hospitalization and use of proton pump inhibitors as factors increasing the risk of initial and/or recurrent CDI. No study analyzed initial CDI treatment in relation to recurrence. More comprehensive surveillance and coordinated studies are needed to map trends, understand risk factors, and recognize the extent and impact of CDI in Japanese patients. Funding Astellas Pharma, Inc. Plain Language Summary Plain language summary available for this article. Electronic supplementary material The online version of this article (10.1007/s40121-018-0186-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas V Riley
- Murdoch University, Murdoch, Australia. .,Edith Cowan University, Joondalup, Australia. .,PathWest Laboratory Medicine, Nedlands, Australia.
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Lingawi H, Maher Y, Afifi I. Impact of Educational Intervention for Hand Hygiene on Dental Students' Knowledge, Attitude, and Bacterial Contamination Level on Hands. J Contemp Dent Pract 2017; 18:1164-1172. [PMID: 29208792 DOI: 10.5005/jp-journals-10024-2193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM The present study aimed to investigate the impact of the educational intervention for hand hygiene (HH) on knowledge, attitude, and mean colony-forming bacterial counts and type of bacteria on hands of undergraduate dental students. MATERIALS AND METHODS A total of 86 dental students from different clinical grades were included in the study. They were divided into two groups, group I (55 students) received onetime educational session for HH at the start of the academic year and group II (31 students) received an extra reenforce-ment session 6 months later. After 2 weeks of reenforcement session, a self-administrated questionnaire was directed to all participants assessing their knowledge and attitude about HH. Fingertip prints of the five fingers of the dominant hand from every participant were pressed onto blood agar plates in triplets at the same clinical session, before and after HH. Bacterial colony-forming units (CFUs) on each plate were recorded and identified microbiologically. RESULTS The overall scores of knowledge and attitude showed higher levels in group II than in group I with nonsignificant differences between both groups as regards knowledge and significant differences (p < 0.05) as regards attitude. Mean CFUs showed extremely significant differences (p < 0.000) between 2nd and 3rd counts and between 1st and 2nd counts except for students of group I where the difference was only significant (p < 0.05). Normal bacterial flora was identified in 94.9% of the plates (92.2% coagulase-negative Staphylococci and 2.7% Micrococcus). Potentially pathogenic bacteria isolated from the other plates were Klebsiella pneumonia, Pseudomonas spp., and spore-forming aerobic nonhemolytic Bacilli. CONCLUSION Reenforcement session had a positive impact on HH knowledge, attitude, and reduction of bacterial CFUs. CLINICAL SIGNIFICANCE Continuous education with frequent training sessions is recommended to reinforce HH compliance and reduce cross-contamination.
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Affiliation(s)
- Hanadi Lingawi
- Department of Preventive Dentistry, College of Dentistry, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia, e-mail:
| | - Yahia Maher
- Department of Basic Oral Sciences, College of Dentistry, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Ibtesam Afifi
- Department of Microbiology, Medical school, Tanta University Tanta, Egypt
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Freedberg DE, Salmasian H, Cohen B, Abrams JA, Larson EL. Receipt of Antibiotics in Hospitalized Patients and Risk for Clostridium difficile Infection in Subsequent Patients Who Occupy the Same Bed. JAMA Intern Med 2016; 176:1801-1808. [PMID: 27723860 PMCID: PMC5138095 DOI: 10.1001/jamainternmed.2016.6193] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To assess whether receipt of antibiotics by prior hospital bed occupants is associated with increased risk for CDI in subsequent patients who occupy the same bed. DESIGN, SETTING, AND PARTICIPANTS This is a retrospective cohort study of adult patients hospitalized in any 1 of 4 facilities between 2010 and 2015. Patients were excluded if they had recent CDI, developed CDI within 48 hours of admission, had inadequate follow-up time, or if their prior bed occupant was in the bed for less than 24 hours. MAIN OUTCOMES AND MEASURES The primary exposure was receipt of non-CDI antibiotics by the prior bed occupant and the primary outcome was incident CDI in the subsequent patient to occupy the same bed. Incident CDI was defined as a positive result from a stool polymerase chain reaction for the C difficile toxin B gene followed by treatment for CDI. Demographics, comorbidities, laboratory data, and medication exposures are reported. RESULTS Among 100 615 pairs of patients who sequentially occupied a given hospital bed, there were 576 pairs (0.57%) in which subsequent patients developed CDI. Receipt of antibiotics in prior patients was significantly associated with incident CDI in subsequent patients (log-rank P < .01). This relationship remained unchanged after adjusting for factors known to influence risk for CDI including receipt of antibiotics by the subsequent patient (adjusted hazard ratio [aHR], 1.22; 95% CI, 1.02-1.45) and also after excluding 1497 patient pairs among whom the prior patients developed CDI (aHR, 1.20; 95% CI, 1.01-1.43). Aside from antibiotics, no other factors related to the prior bed occupants were associated with increased risk for CDI in subsequent patients. CONCLUSIONS AND RELEVANCE Receipt of antibiotics by prior bed occupants was associated with increased risk for CDI in subsequent patients. Antibiotics can directly affect risk for CDI in patients who do not themselves receive antibiotics.
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Affiliation(s)
- Daniel E Freedberg
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York
| | - Hojjat Salmasian
- Department of Biomedical Informatics, New York-Presbyterian Hospital, New York, New York
| | - Bevin Cohen
- Department of Epidemiology, Mailman School of Public Health, School of Nursing, Columbia University, New York, New York
| | - Julian A Abrams
- Division of Digestive and Liver Diseases, Columbia University Medical Center, New York, New York
| | - Elaine L Larson
- Department of Epidemiology, Mailman School of Public Health, School of Nursing, Columbia University, New York, New York
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