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Han Y, Yu X, Cao Y, Liu J, Wang Y, Liu Z, Lyu C, Li Y, Jin X, Zhang Y, Zhang Y. Transport and risk of airborne pathogenic microorganisms in the process of decentralized sewage discharge and treatment. WATER RESEARCH 2024; 256:121646. [PMID: 38657309 DOI: 10.1016/j.watres.2024.121646] [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: 11/30/2023] [Revised: 04/03/2024] [Accepted: 04/18/2024] [Indexed: 04/26/2024]
Abstract
Sewage treatment processes are a critical anthropogenic source of bioaerosols and may present significant health risks to plant workers. Compared with the specialization and scale of urban sewage treatment, many decentralized treatment models are flexible and extensive. These treatment facilities are usually close to residential areas owing to the pipe network layout and other restrictions. Bioaerosols generated by these facilities may present a serious and widespread occupational and non-occupational exposure risk to nearby residents, particularly the elderly and children. An understanding of the characteristics and exposure risks of bioaerosols produced during decentralized sewage treatment is lacking. We compared bioaerosol emission characteristics and potential exposure risks under four decentralized sewage discharge methods and treatment models: small container collection (SCC), open-channel discharge (OCD), single household/combined treatment (SHCT), and centralized treatment (CT) in northwest China. The OCD mode had the highest bioaerosol production, whereas the CT mode had the lowest. The OCD model contained the most pathogenic bacterial species, up to 43 species, including Sphingomonas, Pseudomonas, Cladosporium, and Alternaria. Risk assessments indicated bioaerosol exposure was lower in the models with sewage treatment (SHCT and CT) than in those without (SCC and OCD). Different populations exhibited large variations in potential risks owing to differences in time spent indoors and outdoors. The highest risk was observed in males exposed to the SCC model. This study provides a theoretical basis and theories for the future joint prevention and control of the bioaerosol exposure risk from decentralized sewage treatment.
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Affiliation(s)
- Yunping Han
- State Key Laboratory of Environmental Aquatic Chemistry, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, PR China; University of Chinese Academy of Sciences, Beijing 100049, PR China.
| | - Xuezheng Yu
- State Key Laboratory of Environmental Aquatic Chemistry, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, PR China; Key Laboratory of Environmental Pollution Control and Remediation at Universities of Inner Mongolia Autonomous Region, College of Energy and Power Engineering, Inner Mongolia University of Technology, Hohhot 010051, Inner Mongolia, PR China
| | - Yingnan Cao
- Key Laboratory of Environmental Pollution Control and Remediation at Universities of Inner Mongolia Autonomous Region, College of Energy and Power Engineering, Inner Mongolia University of Technology, Hohhot 010051, Inner Mongolia, PR China
| | - Jianguo Liu
- Key Laboratory of Environmental Pollution Control and Remediation at Universities of Inner Mongolia Autonomous Region, College of Energy and Power Engineering, Inner Mongolia University of Technology, Hohhot 010051, Inner Mongolia, PR China.
| | - Ying Wang
- State Key Laboratory of Environmental Aquatic Chemistry, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, PR China; University of Chinese Academy of Sciences, Beijing 100049, PR China
| | - Zipeng Liu
- Key Laboratory of Environmental Pollution Control and Remediation at Universities of Inner Mongolia Autonomous Region, College of Energy and Power Engineering, Inner Mongolia University of Technology, Hohhot 010051, Inner Mongolia, PR China
| | - Chenlei Lyu
- Key Laboratory of Environmental Pollution Control and Remediation at Universities of Inner Mongolia Autonomous Region, College of Energy and Power Engineering, Inner Mongolia University of Technology, Hohhot 010051, Inner Mongolia, PR China
| | - Yilin Li
- Key Laboratory of Environmental Pollution Control and Remediation at Universities of Inner Mongolia Autonomous Region, College of Energy and Power Engineering, Inner Mongolia University of Technology, Hohhot 010051, Inner Mongolia, PR China
| | - Xu Jin
- Key Laboratory of Environmental Pollution Control and Remediation at Universities of Inner Mongolia Autonomous Region, College of Energy and Power Engineering, Inner Mongolia University of Technology, Hohhot 010051, Inner Mongolia, PR China
| | - Yuxiang Zhang
- Key Laboratory of Environmental Pollution Control and Remediation at Universities of Inner Mongolia Autonomous Region, College of Energy and Power Engineering, Inner Mongolia University of Technology, Hohhot 010051, Inner Mongolia, PR China
| | - Yu Zhang
- State Key Laboratory of Environmental Aquatic Chemistry, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, PR China; University of Chinese Academy of Sciences, Beijing 100049, PR China
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Vega AD, DeRonde K, Jimenez A, Piazza M, Vu C, Martinez O, Rojas LJ, Marshall S, Yasmin M, Bonomo RA, Abbo LM. Difficult-to-treat (DTR) Pseudomonas aeruginosa harboring Verona-Integron metallo-β-lactamase ( blaVIM): infection management and molecular analysis. Antimicrob Agents Chemother 2024; 68:e0147423. [PMID: 38602418 PMCID: PMC11064525 DOI: 10.1128/aac.01474-23] [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] [Received: 11/08/2023] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
Pseudomonas aeruginosa harboring Verona Integron-encoded metallo-β-lactamase enzymes (VIM-CRPA) have been associated with infection outbreaks in several parts of the world. In the US, however, VIM-CRPA remain rare. Starting in December 2018, we identified a cluster of cases in our institution. Herein, we present our epidemiological investigation and strategies to control/manage these challenging infections. This study was conducted in a large academic healthcare system in Miami, FL, between December 2018 and January 2022. Patients were prospectively identified via rapid molecular diagnostics when cultures revealed carbapenem-resistant P. aeruginosa. Alerts were received in real time by the antimicrobial stewardship program and infection prevention teams. Upon alert recognition, a series of interventions were performed as a coordinated effort. A retrospective chart review was conducted to collect patient demographics, antimicrobial therapy, and clinical outcomes. Thirty-nine VIM-CRPA isolates led to infection in 21 patients. The majority were male (76.2%); the median age was 52 years. The majority were mechanically ventilated (n = 15/21; 71.4%); 47.6% (n = 10/21) received renal replacement therapy at the time of index culture. Respiratory (n = 20/39; 51.3%) or bloodstream (n = 13/39; 33.3%) were the most common sources. Most infections (n = 23/37; 62.2%) were treated with an aztreonam-avibactam regimen. Six patients (28.6%) expired within 30 days of index VIM-CRPA infection. Fourteen isolates were selected for whole genome sequencing. Most of them belonged to ST111 (12/14), and they all carried blaVIM-2 chromosomally. This report describes the clinical experience treating serious VIM-CRPA infections with either aztreonam-ceftazidime/avibactam or cefiderocol in combination with other agents. The importance of implementing infection prevention strategies to curb VIM-CRPA outbreaks is also demonstrated.
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Affiliation(s)
- Ana D. Vega
- Department of Pharmacy, Jackson Health System, Miami, Florida, USA
| | - Kailynn DeRonde
- Department of Pharmacy, Jackson Health System, Miami, Florida, USA
| | - Adriana Jimenez
- Department of Pharmacy, Jackson Health System, Miami, Florida, USA
- Department of Epidemiology, Florida International University, Miami, Florida, USA
| | - Michael Piazza
- Department of Medicine, Virtua Medical Group, Medford, New Jersey, USA
| | - Christine Vu
- Department of Pharmacy, Jackson Health System, Miami, Florida, USA
| | - Octavio Martinez
- Department of Pharmacy, Jackson Health System, Miami, Florida, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Laura J. Rojas
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio, USA
| | - Steven Marshall
- Department of Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Mohamad Yasmin
- Department of Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Robert A. Bonomo
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- CWRU-Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, Ohio, USA
- Department of Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
- Departments of Proteomics, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Department of Biochemistry, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Lilian M. Abbo
- Department of Pharmacy, Jackson Health System, Miami, Florida, USA
- Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
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Lena P, Karageorgos S, Liatsou M, Agouridis AP, Spernovasilis N, Lamnisos D, Papageorgis P, Tsioutis C. In vitro study on the transmission of multidrug-resistant bacteria from textiles to pig skin. World J Exp Med 2023; 13:134-141. [PMID: 38173547 PMCID: PMC10758659 DOI: 10.5493/wjem.v13.i5.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/22/2023] [Accepted: 10/23/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND The survival of microorganisms on textiles and specifically on healthcare professionals' (HCP) attire has been demonstrated in several studies. The ability of microorganisms to adhere and remain on textiles for up to hours or days raises questions as to their possible role in transmission from textile to skin via HCP to patients. AIM To evaluate the presence, survival and transmission of different multidrug-resistant bacteria (MDRB) from HCP attire onto skin. METHODS Three MDRB [methicillin-resistant Staphylococcus aureus (MRSA); vancomycin-resistant Enterococcus faecium (VRE); carbapenem-resistant Klebsiella pneumoniae, CRKP)] were inoculated on textiles from scrubs (60% cotton-40% polyester) and white coat (100% cotton) at concentrations of 108 colony-forming units (CFU), 105 CFU, and 103 CFU per mL. The inoculation of swatches was divided in time intervals of 1 min, 5 min, 15 min, 30 min, 1 h, 2 h, 3 h, 4 h, 5 h, and 6 h. At the end of each period, textiles were imprinted onto pig skins and each skin square was inverted onto three different selective chromogenic media. Growth from the pig skin squares was recorded for the 3 MDRB at the three above concentrations, for the whole length of the 6-h experiment. RESULTS MRSA was recovered from pig skins at all concentrations for the whole duration of the 6-h study. VRE was recovered from the concentration of 108 CFU/mL for 6 h and from 105 CFU/mL for up to 3 h, while showing no growth at 103 CFU/mL. CRKP was recovered from 108 CFU/mL for 6 h, up to 30 min from 105 CFU/mL and for 1 min from the concentration of 103 CFU/mL. CONCLUSION Evidence from the current study shows that MRSA can persist on textiles and transmit to skin for 6 h even at low concentrations. The fact that all MDRB can be sustained and transferred to skin even at lower concentrations, supports that textiles are implicated as vectors of bacterial spread.
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Affiliation(s)
- Pavlina Lena
- Mpn Unilab Clinical Laboratory, Nicosia 1066, Cyprus
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia 2404, Cyprus
| | - Spyridon Karageorgos
- First Department of Pediatrics, “Aghia Sophia” Children’s Hospital, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Maria Liatsou
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia 2404, Cyprus
| | - Aris P Agouridis
- School of Medicine, European University Cyprus, Nicosia 2404, Cyprus
- Infectious Diseases, German Oncology Center, Limassol 4108, Cyprus
| | | | - Demetris Lamnisos
- Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia 2404, Cyprus
| | - Panagiotis Papageorgis
- Department of Life Sciences, School of Sciences, European University Cyprus, Nicosia 2404, Cyprus
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McLean M, Khaira A, Alexander C. Symbols and rituals are alive and well in clinical practice in Australia: Perspectives from a longitudinal qualitative professional identity study. MEDICAL TEACHER 2023; 45:1425-1430. [PMID: 37339497 DOI: 10.1080/0142159x.2023.2225722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
PURPOSE Many factors impact an individual's professional identity on their journey to becoming a doctor, including their experiences, the learning environment, role models, and symbols and rituals. Rituals and symbols associated with the medical profession have historically included wearing a white coat (now rare) and the stethoscope. This study explored two medical students' perspectives of symbolic identifiers in a six-year longitudinal study in Australia (2012-2017). METHODOLOGY A 2012 qualitative cross-sectional qualitative professional identity study in an Australian five-year undergraduate medical programme was extended to a longitudinal study with annual interviews. A conversation about the symbolism of the stethoscope and other identifiers began in Year 1 and concluded when the students were junior doctors. FINDINGS Symbols and rituals remain part of the 'becoming' and 'being' a doctor. In the context of Australian hospitals, the stethoscope appears to no longer be exclusively associated with the medical profession, with 'professional attire' distinguishing medical students and doctors from other team members (uniform). The study identified lanyard colour and design as a symbol and language as a ritual. CONCLUSIONS Although symbols and rituals may change over time and across cultural contexts, some forms of treasured material possessions and rituals will persist in medical practice.[Box: see text].
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Affiliation(s)
- Michelle McLean
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Arjun Khaira
- Mental Health, Mayo Private Hospital, Taree, New South Wales, Australia
| | - Charlotte Alexander
- Emergency Department, Gold Coast University Hospital, Gold Coast, Queensland, Australia
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Kopp J, Cawcutt KA, Musil L, Huang X, Minard CG, Hetland B. Efficacy of a bioburden reduction intervention on mobile phones of critical care nurses. Am J Infect Control 2023; 51:35-40. [PMID: 35569614 DOI: 10.1016/j.ajic.2022.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Current literature identifies mobile phones of staff as potential vectors for hospital-acquired infection. METHODS A pre-post, quasi-experimental study was conducted in a 20 bed intensive care unit (ICU). Surface bioburden of personal and shared mobile phones was estimated with a luminometer, expressed in Relative Light Units (RLU). Effects of a simple sanitizing wipe-based disinfection routine were measured at baseline, and at 1, 3, 6, and 12 months after implementation of the disinfection routine. RESULTS Personal mobile phones and shared phones of 30 on-shift ICU nurses were analyzed at each collection. RLUs for personal phones decreased from baseline to 12 months post-intervention (Geometric mean 497.1 vs 63.36 RLU; adj P < .001), while shared unit phones also demonstrated a decrease from baseline to 12 months post-intervention (Geometric mean 417.4 vs 45.90 RLU; adj P < .001). DISCUSSION No recommended practice yet exists for disinfection of mobile phones in the acute care setting. The disinfection method and routine used in this study may have implications for use in acute care settings to reduce opportunities for infectious disease transmission.
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Affiliation(s)
- Jennifer Kopp
- Cardiovascular Intensive Care Unit, Nebraska Medicine, Omaha, NE, United States; School of Health Professions, Nurse Anesthesia, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States.
| | - Kelly A Cawcutt
- Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, United States
| | - Lauren Musil
- Department of Infection Control and Epidemiology, Nebraska Medicine, Omaha, NE, United States
| | - Xiaofan Huang
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United States
| | - Charles G Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United States
| | - Breanna Hetland
- College of Nursing, University of Nebraska Medical Center, Omaha, NE, United States
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Argyropoulos CD, Skoulou V, Efthimiou G, Michopoulos AK. Airborne transmission of biological agents within the indoor built environment: a multidisciplinary review. AIR QUALITY, ATMOSPHERE, & HEALTH 2022; 16:477-533. [PMID: 36467894 PMCID: PMC9703444 DOI: 10.1007/s11869-022-01286-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 11/17/2022] [Indexed: 06/17/2023]
Abstract
The nature and airborne dispersion of the underestimated biological agents, monitoring, analysis and transmission among the human occupants into building environment is a major challenge of today. Those agents play a crucial role in ensuring comfortable, healthy and risk-free conditions into indoor working and leaving spaces. It is known that ventilation systems influence strongly the transmission of indoor air pollutants, with scarce information although to have been reported for biological agents until 2019. The biological agents' source release and the trajectory of airborne transmission are both important in terms of optimising the design of the heating, ventilation and air conditioning systems of the future. In addition, modelling via computational fluid dynamics (CFD) will become a more valuable tool in foreseeing risks and tackle hazards when pollutants and biological agents released into closed spaces. Promising results on the prediction of their dispersion routes and concentration levels, as well as the selection of the appropriate ventilation strategy, provide crucial information on risk minimisation of the airborne transmission among humans. Under this context, the present multidisciplinary review considers four interrelated aspects of the dispersion of biological agents in closed spaces, (a) the nature and airborne transmission route of the examined agents, (b) the biological origin and health effects of the major microbial pathogens on the human respiratory system, (c) the role of heating, ventilation and air-conditioning systems in the airborne transmission and (d) the associated computer modelling approaches. This adopted methodology allows the discussion of the existing findings, on-going research, identification of the main research gaps and future directions from a multidisciplinary point of view which will be helpful for substantial innovations in the field.
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Affiliation(s)
| | - Vasiliki Skoulou
- B3 Challenge Group, Chemical Engineering, School of Engineering, University of Hull, Cottingham Road, Hull, HU6 7RX UK
| | - Georgios Efthimiou
- Centre for Biomedicine, Hull York Medical School, University of Hull, Cottingham Road, Hull, HU6 7RX UK
| | - Apostolos K. Michopoulos
- Energy & Environmental Design of Buildings Research Laboratory, University of Cyprus, P.O. Box 20537, 1678 Nicosia, Cyprus
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Passenger Pathogens on Physicians. Am J Infect Control 2022:S0196-6553(22)00759-3. [DOI: 10.1016/j.ajic.2022.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/20/2022]
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Latha T, Bhat AK, Hande HM, Mukhopadhyay C, Devi ES, Nayak BS, George A. Effectiveness of Extended Infection Control Measures on Methicillin-Resistant Staphylococcus aureus Infection Among Orthopaedic Patients. Indian J Orthop 2022; 56:1804-1812. [PMID: 36187590 PMCID: PMC9485330 DOI: 10.1007/s43465-022-00713-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 07/28/2022] [Indexed: 02/04/2023]
Abstract
Purpose The purpose of the study was to find the effectiveness of Extended Infection Control Measures (EICM) in reducing the rate of methicillin-resistant Staphylococcus aureus (MRSA) infection among orthopaedic surgery patients. Methods The study adopted a quasi-experimental design and was conducted in the orthopaedic units of a tertiary care hospital. This study recruited 168 orthopaedic patients and 154 healthcare professionals (HCPs). EICM included hand hygiene, decolonizing the patients and HCPS, staff education, feedback of surveillance data, treatment of high-risk and MRSA-infected patients, having separate equipment for MRSA-infected patients, and appropriate cleaning of patient's unit. Results The EICM effectively reduced MRSA infection from 21.2 to 6% (p < 0.001). It also resulted in improving the knowledge of HCPs in the prevention and management of MRSA infection (p < 0.001), and all colonized HCPs were successfully (100%) decolonized. Conclusion EICM is a promising intervention to combat MRSA infection among orthopaedic wards. Hence, it can be executed in orthopaedic wards, thereby improving the treatment quality and reducing the infection-related consequences. Supplementary Information The online version contains supplementary material available at 10.1007/s43465-022-00713-5.
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Affiliation(s)
- T. Latha
- College of Nursing, All India Institute of Medical Sciences, Kalyani, West Bengal India
- Manipal-McGill Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Anil K. Bhat
- Department of Orthopedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka 576104 India
- Manipal-McGill Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - H. Manjunatha Hande
- Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka India
- Manipal-McGill Centre for Infectious Diseases, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Elsa Sanatombi Devi
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Baby S. Nayak
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka India
| | - Anice George
- Department of Medical Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka India
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Sajdeya R, Wijayabahu AT, Stetten NE, Sajdeya O, Dasa O. What's Up Your Sleeve? A Scoping Review of White Coat Contamination and Horizontal Microbial Transmission. South Med J 2022; 115:360-365. [PMID: 35649520 DOI: 10.14423/smj.0000000000001405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES White coats have been suggested to serve as fomites carrying and transmitting pathogenic organisms and potentially increasing the risk of healthcare-associated infections (HAIs). We aimed to examine the current evidence regarding white coat contamination and its role in horizontal transmission and HAIs risk. We also examined handling practices and policies associated with white coat contamination in the reviewed literature. METHODS We conducted a literature search through PubMed and Web of Science Core Collection/Cited Reference Search, and manually searched the bibliographies of the articles identified in electronic searches. Studies published up to March 3, 2021 that were accessible in English-language full-text format were included. RESULTS Among 18 included studies, 15 (83%) had ≥100 participants, 16 (89%) were cross-sectional studies, and 13 (72%) originated outside of the United States. All of the studies showed evidence of microbial colonization. Colonization with Staphylococcus aureus and Escherichia coli was reported in 100% and 44% of the studies, respectively. Antibacterial-resistant strains, including methicillin-resistant Staphylococcus aureus and multidrug-resistant organisms were reported in 8 (44%) studies. There was a lack of studies assessing the link between white coat contamination and HAIs. The data regarding white coat handling and laundering practices showed inconsistencies between healthcare facilities and a lack of clear policies. CONCLUSIONS There is robust evidence that white coats serve as fomites, carrying dangerous pathogens, including multidrug-resistant organisms. A knowledge gap exists, however, regarding the role of contaminated white coats in HAI risk that warrants further research to generate the evidence necessary to guide the current attire policies for healthcare workers.
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Affiliation(s)
- Ruba Sajdeya
- From the Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, and the Department of Occupational Therapy, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, and the Department of Internal Medicine, University of Toledo Medical Centre, Toledo, Ohio
| | - Akemi T Wijayabahu
- From the Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, and the Department of Occupational Therapy, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, and the Department of Internal Medicine, University of Toledo Medical Centre, Toledo, Ohio
| | - Nichole E Stetten
- From the Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, and the Department of Occupational Therapy, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, and the Department of Internal Medicine, University of Toledo Medical Centre, Toledo, Ohio
| | - Omar Sajdeya
- From the Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, and the Department of Occupational Therapy, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, and the Department of Internal Medicine, University of Toledo Medical Centre, Toledo, Ohio
| | - Osama Dasa
- From the Department of Epidemiology, College of Public Health and Health Professions, College of Medicine, and the Department of Occupational Therapy, College of Public Health and Health Professions, College of Medicine, University of Florida, Gainesville, and the Department of Internal Medicine, University of Toledo Medical Centre, Toledo, Ohio
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Discordance among Belief, Practice, and the Literature in Infection Prevention in the NICU. CHILDREN 2022; 9:children9040492. [PMID: 35455536 PMCID: PMC9027430 DOI: 10.3390/children9040492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/16/2022]
Abstract
This study evaluates practices of infection control in the NICU as compared with the available literature. We aimed to assess providers’ awareness of their institutional policies, how strongly they believed in those policies, the correlation between institution size and policies adopted, years of experience and belief in a policy’s efficacy, and methods employed in the existing literature. An IRB-approved survey was distributed to members of the AAP Neonatal Section. A systematic review of the literature provided the domains of the survey questions. Data was analyzed as appropriate. A total of 364 providers responded. While larger NICUs were more likely to have policies, their providers are less likely to know them. When a policy is in place and it is known, providers believe in the effectiveness of that policy suggesting consensus or, at its worst, groupthink. Ultimately, practice across the US is non-uniform and policies are not always consistent with best available literature. The strength of available literature is adequate enough to provide grade B recommendations in many aspects of infection prevention. A more standardized approach to infection prevention in the NICU would be beneficial and is needed.
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Møller SA, Rasmussen PU, Frederiksen MW, Madsen AM. Work clothes as a vector for microorganisms: Accumulation, transport, and resuspension of microorganisms as demonstrated for waste collection workers. ENVIRONMENT INTERNATIONAL 2022; 161:107112. [PMID: 35091375 DOI: 10.1016/j.envint.2022.107112] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 05/04/2023]
Abstract
Work clothes may act as a vector for the transport of microorganisms leading to second-hand exposure; however, this has not been studied in work environments. We investigated whether microorganisms accumulate on workers' clothes in environments with elevated microbial exposures, and whether they are transported with the clothes and subsequently resuspended to the air. To study this, we selected waste collection workers and potential transport of bacteria and fungi to waste truck cabs via clothes, and compared the microbial communities within truck cabs, in waste collection workers' personal exposure, and on clean T-shirts worn by the workers. Microbial communities were also investigated for the presence of potentially harmful microorganisms. Results showed that microorganisms accumulated in large quantities (GM = 3.69 × 105 CFU/m2/h for bacteria, GM = 8.29 × 104 CFU/m2/h for fungi) on workers' clothes. The concentrations and species composition of airborne fungi in the truck cabs correlated significantly with the accumulation and composition of fungi on clothes and correlated to concentrations (a trend) and species composition of their personal exposures. The same patterns were not found for bacteria, indicating that work clothes to a lesser degree act as a vector for bacteria under waste collection workers' working conditions compared to fungi. Several pathogenic or allergenic microorganisms were present, e.g.: Klebsiella oxytoca, K. pneumoniae, Proteus mirabilis, Providencia rettgeri, Pseudomonas aeruginosa, and Aspergillus fumigatus, A. glaucus, A. nidulans, A. niger, and various Penicillium species. The potential 'take-home' exposure to these microorganisms are of most concern for immunocompromised or atopic individuals or people with open wounds or cuts. In conclusion, the large accumulation of microorganisms on workers' clothes combined with the overlap between fungal species for the different sample types, and the presence of pathogenic and allergenic microorganisms forms the basis for encouragement of good clothing hygiene during and post working hours.
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Affiliation(s)
- Signe Agnete Møller
- The National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen Ø, Denmark
| | - Pil Uthaug Rasmussen
- The National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen Ø, Denmark
| | - Margit W Frederiksen
- The National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen Ø, Denmark
| | - Anne Mette Madsen
- The National Research Centre for the Working Environment, Lersø Parkallé 105, DK-2100 Copenhagen Ø, Denmark.
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Multidrug-Resistant Bacteria on Healthcare Workers' Uniforms in Hospitals and Long-Term Care Facilities in Cyprus. Antibiotics (Basel) 2021; 11:antibiotics11010049. [PMID: 35052926 PMCID: PMC8773169 DOI: 10.3390/antibiotics11010049] [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: 11/30/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
Abstract
Healthcare workers’ (HCW) clothing has been shown to harbor multidrug-resistant bacteria (MDRB) and may contribute to transmission. The aim of this study was to evaluate presence of MDRB on HCW uniforms in Cyprus. A cross-sectional study was carried out in 9 hospital wards and 7 long-term care facilities (LTCFs) in Nicosia, Cyprus, from April–August 2019. Sampling of HCW uniform pockets was conducted at the end of the first shift. Personal hygiene and other habits were recorded during personal interviews. Among 140 sampled HCW (69 from hospitals, 71 from LTCFs), 37 MDRB were identified, including 16 vancomycin-resistant enterococci (VRE), 15 methicillin-resistant Staphylococcus aureus (MRSA), 5 extended spectrum b-lactamase (ESBL)-producing bacteria, and 1 carbapenem-resistant Acinetobacter baumannii. Presence of MDRB was higher in LTCFs compared to hospitals (p = 0.03). Higher MDRB rates in uniforms were noted in HCWs that worked <1 year (41.7% vs. 21.1%) and in HCWs that opted for home laundering (23.5% vs. 12.5%) or visited the toilet during shifts (38.1% vs. 20.2%). Our findings indicate that HCW uniforms harbor MDRB and relevant interventions may reduce transmission risk. We identified LTCFs as an important area for targeted measures. Additional factors associated with HCW practices, characteristics, and attire laundering practices represent areas for improvement, particularly in LTCFs.
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Pelzer ES, Stewart Z, Peters H, O'Callaghan J, Bryan E, Wager L, Chiruta J. Implementation of a structured practical activity to analyse student healthcare worker perceptions and compliance with prescribed infection control procedures. BMC MEDICAL EDUCATION 2021; 21:617. [PMID: 34906108 PMCID: PMC8672573 DOI: 10.1186/s12909-021-03048-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/12/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Non-compliance with infection control guidelines has been reported within healthcare settings. Infection control education in undergraduate healthcare education programs forms a critical component in preparing student healthcare workers for vocational roles. METHODS Clinical sciences students (nutrition science, paramedicine, pharmacy, podiatry, optometry studying for qualifications recognised by the Australian Health Practitioner Regulation Agency) self-reported hygiene perceptions and practices and collected microbiological swabs from personal or medical equipment items before and after recommended disinfection procedures. RESULTS Cultivable microorganisms were isolated from 95% of student medical equipment items. Disinfection significantly reduced microbial growth on student medical equipment items (P < 0.05). CONCLUSIONS Student perceptions of infection control procedures do not always correlate with infection control practice. Infection control education of undergraduate healthcare students requires ongoing assessment to ensure successful translation into clinical practice.
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Affiliation(s)
- Elise S Pelzer
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia.
- Queensland University of Technology, PO Box 2434, Brisbane, Queensland, 4001, Australia.
| | - Zachary Stewart
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
| | - Holly Peters
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
| | - Jessica O'Callaghan
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
| | - Emily Bryan
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
| | - Lucas Wager
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
| | - Juliana Chiruta
- Queensland University of Technology, School of Biomedical Sciences, Faculty of Health, 2 George Street, Brisbane City, QLD, 4000, Australia
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Appiah EO, Appiah S, Menlah A, Baidoo M, Awuah DB, Isaac NB. Experiences of infection prevention and control in clinical practice of nursing students in the Greater Accra Region, Ghana: An exploratory qualitative study. SAGE Open Med 2021; 9:20503121211054588. [PMID: 34721873 PMCID: PMC8552381 DOI: 10.1177/20503121211054588] [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: 07/27/2021] [Accepted: 10/02/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Globally, infections acquired from hospitals pose a major obstacle to patients' safety. Health care workers, especially, nursing students are at high risk for Hospital Acquired Infections (HAIs) as they are always in contact with clients. Therefore, this study aims to explore experiences of infection prevention and control in the clinical practice of nursing students in the Greater Accra Region, Ghana. Methods The study utilized a qualitative exploratory design to interview 42 participants (7 focus groups, comprising of 6 members each). A purposive sampling technique was employed to select the participants, who were engaged in 50-90 min' focus group discussions. Data collection lasted for 3 months and was analyzed using content analysis. NVivo version 12 Software was used to identify recurrent themes from the transcribed data. Results The results revealed two main themes: preventive practices against hospital-acquired infections and barriers toward infection prevention practices. The subthemes under the preventive practices were as follows: views on HAIs preventive practices, barrier nursing, hand washing and use of sanitizers, aseptic techniques, and sterilization. Increased workload, lack of superior support, and inadequate resources emerged under the barriers toward infection prevention practices. Conclusion It was concluded from the study that most of the student nurses had adequate information about HAIs and wish to adhere to the Infection prevention protocols. However, the participants observed poor infection prevention practices among the staff they were learning from. It is therefore recommended that more attention is focused on infection prevention and control in clinical practice among nurses.
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Affiliation(s)
- Evans Osei Appiah
- Department of Midwifery, School of Nursing and Midwifery, Valley View University, Oyibi, Ghana
| | - Stella Appiah
- Department of Nursing, School of Nursing and Midwifery, Valley View University, Oyibi, Ghana
| | - Awube Menlah
- Department of Nursing, School of Nursing and Midwifery, Valley View University, Oyibi, Ghana
| | | | - Dorothy Baffour Awuah
- Department of Nursing, School of Nursing and Midwifery, Valley View University, Oyibi, Ghana
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15
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Baroja I, Guerra S, Coral-Almeida M, Ruíz A, Galarza JM, de Waard JH, Bastidas-Caldes C. Methicillin-Resistant Staphylococcus aureus Nasal Colonization Among Health Care Workers of a Tertiary Hospital in Ecuador and Associated Risk Factors. Infect Drug Resist 2021; 14:3433-3440. [PMID: 34471363 PMCID: PMC8403571 DOI: 10.2147/idr.s326148] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/07/2021] [Indexed: 12/19/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is resistant to most of the commonly used antibiotics and is therefore a public health issue. Colonization with MRSA is a risk factor for infection or transmission. Purpose To determine the prevalence of colonization with Staphylococcus aureus (SA) and MRSA strains in health care workers (HCWs) at a tertiary hospital in Ecuador and to determine the risk factors associated with carriage. Methods Out of a cohort of 3800 HCWs, 481 individuals from different hospital departments were randomly selected, and a single nasal swab was collected. Detection of SA and MRSA was carried out with the LightCycler® MRSA Advanced Test. A questionnaire was performed that gathered demographic and occupational information of the participants to determine risk factors for MRSA colonization. Statistical analysis was performed with univariate and multivariate analysis and the R-software version 4.0.2. Results Colonization with SA and MRSA occurred in respectively 23.7% (95% CI, 22.7–24.6) and 5% (95% CI, 3.39–7.58) of the individuals. The multivariate analysis showed that being older in age (OD 1.09) and being male (OD 2.78) were risk factors for SA and MRSA colonization (p-value < 0.001). Previous use of antibiotics or the use of nasal ointments diminished the colonization rates of SA (24% versus 3.7% and 10.1% respectively). Conclusion About 20% of the HCWs who were colonized with SA were colonized with MRSA, representing a risk for nosocomial infections and hospital outbreaks. Active monitoring and a decolonization treatment of the HCWs can reduce these risks.
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Affiliation(s)
- Isabel Baroja
- Facultad de Ingenierías y Ciencias Aplicadas, Biotecnología, Universidad de Las Américas, Quito, Ecuador.,Unidad Técnica de Genética Molecular, Hospital de Especialidades Carlos Andrade Marín, Quito, Ecuador
| | - Sara Guerra
- Facultad de Ingenierías y Ciencias Aplicadas, Biotecnología, Universidad de Las Américas, Quito, Ecuador.,Unidad Técnica de Genética Molecular, Hospital de Especialidades Carlos Andrade Marín, Quito, Ecuador
| | - Marco Coral-Almeida
- Grupo de Bio-Quimioinformatica, Facultad de Ciencias de la Salud, Universidad de Las Américas, Quito, Ecuador
| | - Alejandra Ruíz
- Unidad Técnica de Genética Molecular, Hospital de Especialidades Carlos Andrade Marín, Quito, Ecuador.,IESS Quito Sur General Hospital, Institutional Coordination of Epidemiological Surveillance and Infectology, Molecular Microbiology, Quito, Ecuador.,Facultad de Ciencias Médicas, Universidad Central del Ecuador, Quito, Ecuador
| | - Juan Miguel Galarza
- Unidad Técnica de Genética Molecular, Hospital de Especialidades Carlos Andrade Marín, Quito, Ecuador.,Unidad de Biociencias, Gerencia de Molecular y Oncodiagnóstico, SIMED S.A., Quito, Ecuador
| | - Jacobus H de Waard
- One Health Research Group, Facultad de Ingenierías y Ciencias Aplicadas, Biotecnología, Universidad de Las Américas, Quito, Ecuador
| | - Carlos Bastidas-Caldes
- Facultad de Ingenierías y Ciencias Aplicadas, Biotecnología, Universidad de Las Américas, Quito, Ecuador.,One Health Research Group, Facultad de Ingenierías y Ciencias Aplicadas, Biotecnología, Universidad de Las Américas, Quito, Ecuador.,Programa de Doctorado en Salud Pública y Animal, Universidad de Extremadura, Extremadura, España
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16
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Cham P, Laventhal N, Burrows H, Chopra V, Weiner GM. Parent Preferences for Neonatal Intensive Care Unit Physician Attire: A Cross-Sectional Study. Am J Perinatol 2021; 40:898-905. [PMID: 34396496 DOI: 10.1055/s-0041-1732419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Physician attire may influence the parent-provider relationship. Previous studies in adult and outpatient pediatrics showed that formal attire with a white coat was preferred. We aimed to describe parent preferences for physician attire in the neonatal intensive care unit (NICU). STUDY DESIGN We surveyed 101 parents in a level IV NICU. The survey included photographs of a physician in seven different attires. Attire was scored in five domains and parents selected the most preferred attire in different contexts. All attires were compared with formal attire with white coat. Descriptive statistics, Fisher's exact tests, and one-way analysis of variance were used to compare parent responses. RESULTS Scrubs without white coat (40.8 [7.0]) and formal attire without white coat (39.7 [8.0]) had the highest mean (standard deviation) composite preference scores. However, no significant differences between formal attire with white coat (37.1 [9.0]) versus any other attire were observed. When asked to choose a single most preferred attire, scrubs with a coat (32%) and formal with a coat (32%) were chosen most often, but preferences varied by clinical context and parent age. For example, parents preferred surgical scrubs for physicians performing procedures. Parents indicated that physician attire is important to them but does not influence their satisfaction with care. CONCLUSION Although parents generally favored formal attire and scrubs, the variations based on the context of care and lack of significant preference of one attire suggests that a single dress code policy for physicians in a NICU is unlikely to improve the patient-provider relationship. KEY POINTS · Adult patients prefer doctors to wear formal attire.. · Physician attire preferences influenced by age, setting, and context of care.. · Little is known about physician attire preferences of the parents of neonates.. · Unlike adult patients, NICU parents did not prefer formal attire with a white coat..
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Affiliation(s)
- Parul Cham
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Naomi Laventhal
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, Michigan.,University of Michigan, Center for Bioethics and Social Sciences in Medicine, Ann Arbor, Michigan
| | - Heather Burrows
- Division of General and Ambulatory Pediatrics, Department of Pediatrics, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Vineet Chopra
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.,Department of Internal Medicine, Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Gary M Weiner
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, Michigan
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A pilot metagenomic study reveals that community derived mobile phones are reservoirs of viable pathogenic microbes. Sci Rep 2021; 11:14102. [PMID: 34239006 PMCID: PMC8266881 DOI: 10.1038/s41598-021-93622-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022] Open
Abstract
There is increasing attention focussed on the risks associated with mobile phones possibly serving as ‘Trojan Horse’ fomites for microbial transmission in healthcare settings. However, little is reported on the presence of microbes on community derived mobile phones which in 2021, numbered in the billions in circulation with majority being used on a daily basis. Identify viable microbial organisms swabbed from smartphones on a university campus. Entire surfaces of 5 mobile phones were swabbed and examined for their microbial content using pre-agar-based growths followed by downstream DNA metagenomic next-generation sequencing analysis. All phones were contaminated with viable microbes. 173 bacteria, 8 fungi, 8 protists, 53 bacteriophages, 317 virulence factor genes and 41 distinct antibiotic resistant genes were identified. While this research represents a pilot study, the snapshot metagenomic analysis of samples collected from the surface of mobile phones has revealed the presence of a large population of viable microbes and an array of antimicrobial resistant factors. With billions of phones in circulation, these devices might be responsible for the rise of community acquired infections. These pilot results highlight the importance of public health authorities considering mobile phones as ‘Trojan Horse’ devices for microbial transmission and ensure appropriate decontamination campaigns are implemented.
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18
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Xun H, Chen J, Sun AH, Jenny HE, Liang F, Steinberg JP. Public Perceptions of Physician Attire and Professionalism in the US. JAMA Netw Open 2021; 4:e2117779. [PMID: 34328503 PMCID: PMC8325071 DOI: 10.1001/jamanetworkopen.2021.17779] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE In recent years, casual physician attire (fleece jackets and softshell jackets) has become increasingly popular, but to our knowledge, public perceptions of these garments have not been studied. Furthermore, gender biases may result in differing expectations and perceptions of female and male physicians and may be associated with patient rapport and trust building. OBJECTIVE To characterize public perceptions of casual physician attire and implicit gender biases in public assessment of physicians' professional attire. DESIGN, SETTING, AND PARTICIPANTS This survey study used a population-based survey administered via Amazon Mechanical Turk from May to June 2020 among individuals aged 18 years or older who were US residents and for whom English was the primary language. INTERVENTION Survey featuring photographs of a male or female model wearing various types of physician attire (white coat, business attire, and scrubs). MAIN OUTCOMES AND MEASURES Respondents' ratings of professionalism, experience, and friendliness of the male and female models in various attire and perceptions of the models' most likely health care profession. Preference scores for various outfits were calculated as the difference between the preference score for an outfit and the mean preference score for the outfit-role pairing. RESULTS Of 522 surveys completed, 487 were included for analysis; the mean (SD) age of respondents was 36.2 (12.4) years, 260 (53.4%) were female, and 372 (76.4%) were White individuals. Respondents perceived models of health care professionals wearing white coats vs those wearing fleece or softshell jackets as significantly more experienced (mean [SD] experience score: white coat, 4.9 [1.5]; fleece, 3.1 [1.5]; softshell, 3.1 [1.5]; P < .001) and professional (mean [SD] professionalism score: white coat, 4.9 [1.6]; fleece, 3.2 [1.5]; softshell, 3.3 [1.5]; P < .001). A white coat with scrubs attire was most preferred for surgeons (mean [SD] preference index: 1.3 [2.3]), whereas a white coat with business attire was preferred for family physicians and dermatologists (mean [SD] preference indexes, 1.6 [2.3] and 1.2 [2.3], respectively; P < .001). Regardless of outerwear, female models in business attire as inner wear were rated as less professional than male counterparts (mean [SD] professionalism score: male, 65.8 [25.4]; female, 56.2 [20.2]; P < .001). Both the male and the female model were identified by the greater number of respondents as a physician or surgeon; however, the female model vs the male model was mistaken by more respondents as a medical technician (39 [8.0] vs 16 [3.3%]; P < .005), physician assistant (56 [11.5%] vs 11 [2.3%]; P < .001), or nurse (161 [33.1%] vs 133 [27.3%]; P = .050). CONCLUSIONS AND RELEVANCE In this survey study, survey respondents rated physicians wearing casual attire as less professional and experienced than those wearing a white coat. Gender biases were found in impressions of professionalism, with female physicians' roles being more frequently misidentified. Understanding disparate public perceptions of physician apparel may inform interventions to address professional role confusion and cumulative career disadvantages for women in medicine.
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Affiliation(s)
- Helen Xun
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jonlin Chen
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alexander H. Sun
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hillary E. Jenny
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Fan Liang
- Division of Plastic Surgery, R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore
| | - Jordan P. Steinberg
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Clostridioides difficile Infection. Dis Colon Rectum 2021; 64:650-668. [PMID: 33769319 DOI: 10.1097/dcr.0000000000002047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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20
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Kaiki Y, Kitagawa H, Hara T, Nomura T, Omori K, Shigemoto N, Takahashi S, Ohge H. Methicillin-resistant Staphylococcus aureus contamination of hospital-use-only mobile phones and efficacy of 222-nm ultraviolet disinfection. Am J Infect Control 2021; 49:800-803. [PMID: 33186680 DOI: 10.1016/j.ajic.2020.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mobile phones may be contaminated with nosocomial pathogens such as methicillin-resistant Staphylococcus aureus (MRSA). The aim of this study was to investigate the MRSA contamination rate on doctors' hospital-use-only mobile phones and the efficacy of 222-nm ultraviolet light (UV) disinfection. METHODS We investigated the MRSA contamination rate of doctors' hospital-use-only mobile phones, as well as the reduction in MRSA counts on plastic plates and aerobic bacteria (AB) on mobile phones before and after exposure to 222-nm UV irradiation. RESULTS Five (10%) of the 50 mobile phones investigated were contaminated with MRSA. Exposure to 0.1 mJ/cm2 222-nm UVC irradiation for 1.5 and 2.5 min (9 and 15 mJ/cm2) achieved mean log10 MRSA colony-forming units reductions of 2.91 and 3.95, respectively. Exposure to 9 mJ/cm2 222-nm UVC irradiation (0.1 mW/cm2 for 1.5 minutes) significantly reduced AB contamination on mobile phones (P < .001). CONCLUSIONS The use of 222-nm UV disinfection resulted in effective in vitro reduction of MRSA and significantly reduced AB contamination of mobile phone surfaces.
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21
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Limited impact of an ultraviolet disinfection intervention on hygienic behaviors of nursing staff in a military hospital. Infect Control Hosp Epidemiol 2021; 43:797-799. [PMID: 33843525 DOI: 10.1017/ice.2021.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ultraviolet disinfection (UV-C), though effective, has not been thoroughly evaluated at the level of the clinical end user. We assessed behavioral outcomes related to environmental hygiene among 60 nursing staff in a medical-surgical section after introduction of a UV-C tool aimed at disinfecting 4 high-touch surfaces, and we noted limited changes.
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22
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Genetic Similarity of Staphylococcus aureus Strains Isolated from Nose and Mobile Phones of Healthcare Providers Working in the Operating Room and Intensive Care Unit. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2021. [DOI: 10.30621/jbachs.854473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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23
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Jaradat ZW, Ababneh QO, Sha’aban ST, Alkofahi AA, Assaleh D, Al Shara A. Methicillin Resistant Staphylococcus aureus and public fomites: a review. Pathog Glob Health 2020; 114:426-450. [PMID: 33115375 PMCID: PMC7759291 DOI: 10.1080/20477724.2020.1824112] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Staphylococcus genus is a Gram-positive coccus normally associated with skin and mucous membranes of warm-blooded animals. It is part of the commensal human microflora, or found in animals, or contaminating surfaces in the community and hospital settings. Staphylococcus aureus is the most pathogenic species belonging to this genus, as it possesses a collection of virulence factors that are expressed solely to evade the immune system. The increase in the misuse of antimicrobial agents predisposed S. aureus to develop antibiotic resistance, including the resistance to methicillin which led to the emergence of Methicillin-Resistant S. aureus (MRSA). MRSA is considered one of the most dangerous nosocomial pathogens causing many hard to treat infections in hospitals and was named as Hospital Associated MRSA (HA-MRSA). Over the past 20-25 years, MRSA was isolated from community settings and thus Community Associated MRSA (CA-MRSA) has emerged. Inside hospitals, MRSA has been isolated from fomites in contact with patients, as well as staff's protective and personal items. This review highlights the worldwide prevalence of MRSA on fomites within the contexts of hospital and community settings.
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Affiliation(s)
- Ziad W Jaradat
- Jordan University of Science and Technology, Irbid, 22110, Jordan
| | | | - Sherin T Sha’aban
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Ayesha A Alkofahi
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Duaa Assaleh
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Anan Al Shara
- Department of Applied Biological Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan
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da Silva LS, Andrade YM, Oliveira AC, Cunha BC, Oliveira EG, Cunha TS, Mafra SS, Almeida JB, Carvalho SP, Nascimento FS, Santos Junior MN, Chamon RC, Santos KR, Campos GB, Marques LM. Prevalence of methicillin-resistant Staphylococcus aureus colonization among healthcare workers at a tertiary care hospital in northeastern Brazil. Infect Prev Pract 2020; 2:100084. [PMID: 34368723 PMCID: PMC8336055 DOI: 10.1016/j.infpip.2020.100084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/18/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Staphylococcus aureus is a human pathogen of clinical importance related to a variety of infections. AIM The objective of this study was to analyze the molecular and epidemiological characteristics of S. aureus obtained from healthcare professionals (HCP) of a hospital in southwestern Bahia, Brazil. METHODS Samples were collected from hands, nasal cavity, and laboratory coats of 80 HCP. The bacterial isolates recovered from 240 samples were identified as S. aureus, and then analyzed for their antimicrobial resistance profile, genotypic characterization, and pathogenicity. FINDINGS 178 isolates were identified as S. aureus, being mostly isolated from the nasal cavity. Thirty isolates (16.8%) were characterized as MRSA. The virulence gene frequency varied according to isolate source. All virulence genes were identified in at least one hand isolate. Isolates from laboratory coats did not show seb and pvl. Isolates from the nasal cavity did not exhibit pvl. The SCCmec type I was identified in 56.7% of MRSA isolates. Among MRSA isolates, 14 PFGE pulsotypes were characterized, with profile A being predominant (nine isolates). Clonal complexes CC5, CC45, and CC398 were found. MRSA isolates induced cytokine gene expression in macrophages, with IL-10 and IL-17 being expressed more often. CONCLUSION We found a high colonization rate for S. aureus among HCP. Moreover, we observed that MRSA strains presented different virulence factors and could induce cytokine gene expression, indicating an urgent need to control colonization rates of HCP by MRSA isolates in order to protect hospital patients and the general public.
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Affiliation(s)
- Lucas S.C. da Silva
- State University of Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Ilhéus, Brazil
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil
| | - Yasmin M.F.S. Andrade
- State University of Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Ilhéus, Brazil
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil
| | - Arianne C. Oliveira
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil
| | - Beatriz C. Cunha
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil
| | - Eliana G. Oliveira
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil
| | - Tamara S. Cunha
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil
| | - Suzelle S. Mafra
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil
| | - Jéssica B. Almeida
- State University of Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Ilhéus, Brazil
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil
| | - Suzi P. Carvalho
- State University of Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Ilhéus, Brazil
| | - Flávia S. Nascimento
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil
| | - Manoel Neres Santos Junior
- State University of Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Ilhéus, Brazil
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil
| | - Raiane C. Chamon
- Institute of Microbiology Paulo de Góes, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- Pathology Department, Medicine Faculty, Fluminense Federal University (UFF), Niterói, Brazil
| | - Kátia R.N. Santos
- Institute of Microbiology Paulo de Góes, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Guilherme B. Campos
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil
| | - Lucas M. Marques
- State University of Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Ilhéus, Brazil
- Multidisciplinary Institute of Health, Federal University of Bahia (UFBA), Vitória da Conquista, Brazil
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Arora HS, Kamat D, Choudhry S, Asmar BI, Abdel-Haq N. Are Stethoscopes, Coats, and Pagers Potential Sources of Healthcare Associated Infections? Glob Pediatr Health 2020; 7:2333794X20969285. [PMID: 33195748 PMCID: PMC7604979 DOI: 10.1177/2333794x20969285] [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] [Received: 06/26/2020] [Revised: 09/02/2020] [Accepted: 09/30/2020] [Indexed: 11/15/2022] Open
Abstract
We conducted a study to determine the rate of bacterial colonization of
stethoscopes, coats, and pagers of residents at a pediatric residency training
program as compared to that of badges, sleeves, and pagers of non-patient care
staff (control group). Among 213 cultures obtained from 71 residents, 27
potential pathogens were isolated from 22 residents (27/213, 12.7%) as compared
to 10 potential pathogens out of 162 samples obtained from 54 control
participants (10/162, 6.2%) (P = .0375). The most common
pathogen isolated from residents and control participants was methicillin
sensitive Staphylococcus aureus (MSSA). The source of positive
cultures among the residents was the stethoscope (8/22, 36.3%), pager (8/22,
36.3%), and coat sleeve (11/22, 50%). The rates of colonization with potential
pathogens were higher among residents than control participants and about 12% of
residents’ stethoscopes, coats and pagers were colonized with bacterial
pathogens. These are potential sources of nosocomial transmission of pathogenic
organisms.
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Affiliation(s)
- Harbir S Arora
- Children's Hospital of Michigan, Detroit, MI, USA.,Wayne State University, Detroit, MI, USA
| | - Deepak Kamat
- UT Health Sciences Center San Antonio, San Antonio, TX, USA
| | | | - Basim I Asmar
- Children's Hospital of Michigan, Detroit, MI, USA.,Wayne State University, Detroit, MI, USA
| | - Nahed Abdel-Haq
- Children's Hospital of Michigan, Detroit, MI, USA.,Wayne State University, Detroit, MI, USA
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Salazar-Vargas K, Padilla-Orozco M, Garza-González E, Camacho-Ortiz A. Chlorhexidine impregnated surgical scrubs and whole-body wash for reducing colonization of health care personnel. Am J Infect Control 2020; 48:1216-1219. [PMID: 32057510 DOI: 10.1016/j.ajic.2020.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The use of chlorhexidine as a strategy to reduce nosocomial infections in patients has been proven useful. Bacterial contamination of health care worker's uniforms during routine patient care has been demonstrated to have potential for horizontal transmission of pathogens. METHODS We performed a prospective, open comparative trial. We included nurses who were in direct patient care and evaluated clothing microbial growth during 3 interventions: (1) participants were given a sterile surgical scrub (SSS) to put on the beginning of the shift, (2) they were instructed to take a chlorhexidine bath (CHG-B) before putting on the SSS, and (3) participants were given a chlorhexidine impregnated SSS (CI-SSS). Cultures were obtained from 3 areas (chest pocket, chest, and abdominal) at hour 0, 6, and 12 hours after the start of the shift. RESULTS A total of 306 cultures processed with 17 bacterial groups. The uniform area with the highest number of CFU was the abdomen (818 CFU), followed by the thorax (654 CFU). Over 50% of the bacterial load occurred at 12 hours (1,092 CFU at 12 hours, 766 CFU at 6 hours, and 184 CFU at 0 hour). There was a significant reduction in CFU when SSS was compared to CHG-B (CFU mean = 12.5 [0-118] vs CFU mean = 3.5 [0-22], P = .003); and SSS versus CI-SSS (CFU mean = 12.5 [0-118] vs CFU mean = 3 [0-39], P = .007). No severe adverse events were reported. CONCLUSIONS Bacterial load in uniforms decreased when chlorhexidine was used (bathing of personnel or impregnation) when compared to the use of a sterile uniform.
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Affiliation(s)
- Karina Salazar-Vargas
- Department of Internal Medicine, Hospital Universitario Dr. José Eleuterio González, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Magaly Padilla-Orozco
- Department of Hospital Epidemiology and Infectious Disease Service, Hospital Universitario Dr. José Eleuterio González, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Elvira Garza-González
- Gastroenterology service, Hospital Universitario Dr. José Eleuterio González, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México
| | - Adrián Camacho-Ortiz
- Department of Hospital Epidemiology and Infectious Disease Service, Hospital Universitario Dr. José Eleuterio González, Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
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27
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Bentley E, Kellihan H, Longhurst C, Chun R. Effect of attire on client perceptions of veterinarians. Vet J 2020; 265:105550. [PMID: 33129551 DOI: 10.1016/j.tvjl.2020.105550] [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: 01/23/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Abstract
This study examined the effect that veterinarian attire and gender had on clients' perceptions of veterinarians in a large academic specialty hospital. Clients volunteered to answer a survey in the small animal waiting area over a 3-month period. The survey consisted of demographic information, information about the nature of their appointment with their pet, and questions regarding clients' levels of comfort with and the perceived trustworthiness of a Caucasian male and Caucasian female model in four different types of attire: surgical scrubs, surgical scrubs with white lab coat, business casual, and business casual with white lab coat. Relevant effects of interest were estimated using linear mixed models. Five hundred and five clients participated in the survey, yielding a total of 6217 completed survey questions. Clients perceived veterinarians wearing white lab coats as more competent and reported more comfort with those veterinarians (P < 0.0001). When comparing surgical scrubs with no white lab coat to business attire with no white lab coat, surgical scrubs resulted in higher perceived competence and comfort levels (P < 0.0001). Wearing a white lab coat over both surgical scrubs and business casual increased clients' perceived competency and comfort levels compared to not wearing a white lab coat.
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Affiliation(s)
- E Bentley
- School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706, USA.
| | - H Kellihan
- School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706, USA
| | - C Longhurst
- Biostatistics and Medical Informatics, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI 53792, USA
| | - R Chun
- School of Veterinary Medicine, University of Wisconsin-Madison, 2015 Linden Dr, Madison, WI 53706, USA
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28
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Owen L, Laird K. The role of textiles as fomites in the healthcare environment: a review of the infection control risk. PeerJ 2020; 8:e9790. [PMID: 32904371 PMCID: PMC7453921 DOI: 10.7717/peerj.9790] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Infectious diseases are a significant threat in both healthcare and community settings. Healthcare associated infections (HCAIs) in particular are a leading cause of complications during hospitalisation. Contamination of the healthcare environment is recognised as a source of infectious disease yet the significance of porous surfaces including healthcare textiles as fomites is not well understood. It is currently assumed there is little infection risk from textiles due to a lack of direct epidemiological evidence. Decontamination of healthcare textiles is achieved with heat and/or detergents by commercial or in-house laundering with the exception of healthcare worker uniforms which are laundered domestically in some countries. The emergence of the COVID-19 pandemic has increased the need for rigorous infection control including effective decontamination of potential fomites in the healthcare environment. This article aims to review the evidence for the role of textiles in the transmission of infection, outline current procedures for laundering healthcare textiles and review studies evaluating the decontamination efficacy of domestic and industrial laundering. METHODOLOGY Pubmed, Google Scholar and Web of Science were searched for publications pertaining to the survival and transmission of microorganisms on textiles with a particular focus on the healthcare environment. RESULTS A number of studies indicate that microorganisms survive on textiles for extended periods of time and can transfer on to skin and other surfaces suggesting it is biologically plausible that HCAIs and other infectious diseases can be transmitted directly through contact with contaminated textiles. Accordingly, there are a number of case studies that link small outbreaks with inadequate laundering or infection control processes surrounding healthcare laundry. Studies have also demonstrated the survival of potential pathogens during laundering of healthcare textiles, which may increase the risk of infection supporting the data published on specific outbreak case studies. CONCLUSIONS There are no large-scale epidemiological studies demonstrating a direct link between HCAIs and contaminated textiles yet evidence of outbreaks from published case studies should not be disregarded. Adequate microbial decontamination of linen and infection control procedures during laundering are required to minimise the risk of infection from healthcare textiles. Domestic laundering of healthcare worker uniforms is a particular concern due to the lack of control and monitoring of decontamination, offering a route for potential pathogens to enter the clinical environment. Industrial laundering of healthcare worker uniforms provides greater assurances of adequate decontamination compared to domestic laundering, due to the ability to monitor laundering parameters; this is of particular importance during the COVID-19 pandemic to minimise any risk of SARS-CoV-2 transmission.
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Affiliation(s)
- Lucy Owen
- Infectious Disease Research Group, The Leicester School of Pharmacy, De Montfort University, Leicester, United Kingdom
| | - Katie Laird
- Infectious Disease Research Group, The Leicester School of Pharmacy, De Montfort University, Leicester, United Kingdom
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Martin G, Koizia L, Kooner A, Cafferkey J, Ross C, Purkayastha S, Sivananthan A, Tanna A, Pratt P, Kinross J. Use of the HoloLens2 Mixed Reality Headset for Protecting Health Care Workers During the COVID-19 Pandemic: Prospective, Observational Evaluation. J Med Internet Res 2020; 22:e21486. [PMID: 32730222 PMCID: PMC7431236 DOI: 10.2196/21486] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The coronavirus disease (COVID-19) pandemic has led to rapid acceleration in the deployment of new digital technologies to improve both accessibility to and quality of care, and to protect staff. Mixed-reality (MR) technology is the latest iteration of telemedicine innovation; it is a logical next step in the move toward the provision of digitally supported clinical care and medical education. This technology has the potential to revolutionize care both during and after the COVID-19 pandemic. OBJECTIVE This pilot project sought to deploy the HoloLens2 MR device to support the delivery of remote care in COVID-19 hospital environments. METHODS A prospective, observational, nested cohort evaluation of the HoloLens2 was undertaken across three distinct clinical clusters in a teaching hospital in the United Kingdom. Data pertaining to staff exposure to high-risk COVID-19 environments and personal protective equipment (PPE) use by clinical staff (N=28) were collected, and assessments of acceptability and feasibility were conducted. RESULTS The deployment of the HoloLens2 led to a 51.5% reduction in time exposed to harm for staff looking after COVID-19 patients (3.32 vs 1.63 hours/day/staff member; P=.002), and an 83.1% reduction in the amount of PPE used (178 vs 30 items/round/day; P=.02). This represents 222.98 hours of reduced staff exposure to COVID-19, and 3100 fewer PPE items used each week across the three clusters evaluated. The majority of staff using the device agreed it was easy to set up and comfortable to wear, improved the quality of care and decision making, and led to better teamwork and communication. In total, 89.3% (25/28) of users felt that their clinical team was safer when using the HoloLens2. CONCLUSIONS New technologies have a role in minimizing exposure to nosocomial infection, optimizing the use of PPE, and enhancing aspects of care. Deploying such technologies at pace requires context-specific information security, infection control, user experience, and workflow integration to be addressed at the outset and led by clinical end-users. The deployment of new telemedicine technology must be supported with objective evidence for its safety and effectiveness to ensure maximum impact.
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Affiliation(s)
- Guy Martin
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Louis Koizia
- Cutrale Perioperative and Ageing Group, Imperial College London, London, United Kingdom
| | - Angad Kooner
- Division of Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John Cafferkey
- Division of Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Clare Ross
- Division of Medicine, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sanjay Purkayastha
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Arun Sivananthan
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Anisha Tanna
- West London Renal and Transplant Centre, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Philip Pratt
- The Helix Centre, Imperial College London, London, United Kingdom
| | - James Kinross
- Department of Surgery and Cancer, Imperial College London, London, United Kingdom
- Division of Surgery, Imperial College Healthcare NHS Trust, London, United Kingdom
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White coat wearing and laundering frequency among internal medicine department physicians. Am J Infect Control 2020; 48:834-836. [PMID: 31761291 DOI: 10.1016/j.ajic.2019.10.017] [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: 08/14/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 11/21/2022]
Abstract
Self-reported awareness of recommendations by the Society of Healthcare Epidemiology of America on white coat laundering remains low (21%) among physicians from the internal medicine department. Factors such as modifying the laundry schedule of the hospital and personalization of white coats can be considered by hospitals to increase adherence to such recommendations to decrease the risk of health care-associated infection and may also improve professional appearance.
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31
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Knowledge and Perception on Prevention of Hospital Acquired Infections (HAI) among Health Care Professionals in Tertiary Care Teaching Hospital. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.2.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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32
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One Health in hospitals: how understanding the dynamics of people, animals, and the hospital built-environment can be used to better inform interventions for antimicrobial-resistant gram-positive infections. Antimicrob Resist Infect Control 2020; 9:78. [PMID: 32487220 PMCID: PMC7268532 DOI: 10.1186/s13756-020-00737-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 05/11/2020] [Indexed: 12/19/2022] Open
Abstract
Despite improvements in hospital infection prevention and control, healthcare associated infections (HAIs) remain a challenge with significant patient morbidity, mortality, and cost for the healthcare system. In this review, we use a One Health framework (human, animal, and environmental health) to explain the epidemiology, demonstrate key knowledge gaps in infection prevention policy, and explore improvements to control Gram-positive pathogens in the healthcare environment. We discuss patient and healthcare worker interactions with the hospital environment that can lead to transmission of the most common Gram-positive hospital pathogens – methicillin-resistant Staphylococcus aureus, Clostridioides (Clostridium) difficile, and vancomycin-resistant Enterococcus – and detail interventions that target these two One Health domains. We discuss the role of animals in the healthcare settings, knowledge gaps regarding their role in pathogen transmission, and the absence of infection risk mitigation strategies targeting animals. We advocate for novel infection prevention and control programs, founded on the pillars of One Health, to reduce Gram-positive hospital-associated pathogen transmission.
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Liu S, Zheng J, Hao L, Yegin Y, Bae M, Ulugun B, Taylor TM, Scholar EA, Cisneros-Zevallos L, Oh JK, Akbulut M. Dual-Functional, Superhydrophobic Coatings with Bacterial Anticontact and Antimicrobial Characteristics. ACS APPLIED MATERIALS & INTERFACES 2020; 12:21311-21321. [PMID: 32023023 DOI: 10.1021/acsami.9b18928] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Bacterial pathogens are responsible for millions of cases of illnesses and deaths each year throughout the world. The development of novel surfaces and coatings that effectively inhibit and prevent bacterial attachment, proliferation, and growth is one of the crucial steps for tackling this global challenge. Herein, we report a dual-functional coating for aluminum surfaces that relies on the controlled immobilization of lysozyme enzyme (muramidase) into interstitial spaces of presintered, nanostructured thin film based on ∼200 nm silica nanoparticles and the sequential chemisorption of an organofluorosilane to the available interfacial areas. The mean diameter of the resultant lysozyme microdomains was 3.1 ± 2.5 μm with an average spacing of 8.01 ± 6.8 μm, leading to a surface coverage of 15.32%. The coating had an overall root-mean-square (rms) roughness of 539 ± 137 nm and roughness factor of 1.50 ± 0.1, and demonstrated static, advancing, and receding water contact angles of 159.0 ± 1.0°, 155.4 ± 0.6°, and 154.4 ± 0.6°, respectively. Compared to the planar aluminum, the coated surfaces produced a 6.5 ± 0.1 (>99.99997%) and 4.0 ± 0.1 (>99.99%) log-cycle reductions in bacterial surfaces colonization against Gram-negative Salmonella Typhimurium LT2 and Gram-positive Listeria innocua, respectively. We anticipate that the implementation of such a coating strategy on healthcare environments and surfaces and food-contact surfaces can significantly reduce or eliminate potential risks associated with various contamination and cross-contamination scenarios.
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Affiliation(s)
- Shuhao Liu
- Artie McFerrin Department of Chemical Engineering, Texas A&M University, College Station, Texas 77843, United States
| | - Jeremy Zheng
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas 77843, United States
| | - Li Hao
- School of Chemistry and Chemical Engineering, Zhongkai University of Agriculture and Engineering, Guangzhou 510408, People's Republic of China
| | - Yagmur Yegin
- Department of Nutrition and Food Science, Texas A&M University, College Station, Texas 77843, United States
| | - Michael Bae
- Artie McFerrin Department of Chemical Engineering, Texas A&M University, College Station, Texas 77843, United States
| | - Beril Ulugun
- Department of Biomedical Engineering, Texas A&M University, College Station, Texas 77843, United States
| | - Thomas Matthew Taylor
- Department of Nutrition and Food Science, Texas A&M University, College Station, Texas 77843, United States
| | - Ethan A Scholar
- Artie McFerrin Department of Chemical Engineering, Texas A&M University, College Station, Texas 77843, United States
| | - Luis Cisneros-Zevallos
- Department of Nutrition and Food Science, Texas A&M University, College Station, Texas 77843, United States
- Department of Horticultural Sciences, Texas A&M University, College Station, Texas 77843, United States
| | - Jun Kyun Oh
- Department of Polymer Science and Engineering, Dankook University, 152 Jukjeon-ro, Suji-gu, Yongin-si, Gyeonggi-do 16890, Republic of Korea
| | - Mustafa Akbulut
- Artie McFerrin Department of Chemical Engineering, Texas A&M University, College Station, Texas 77843, United States
- Department of Materials Science and Engineering, Texas A&M University, College Station, Texas 77843, United States
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Dalton KR, Waite KB, Ruble K, Carroll KC, DeLone A, Frankenfield P, Serpell JA, Thorpe RJ, Morris DO, Agnew J, Rubenstein RC, Davis MF. Risks associated with animal-assisted intervention programs: A literature review. Complement Ther Clin Pract 2020; 39:101145. [PMID: 32379677 PMCID: PMC7673300 DOI: 10.1016/j.ctcp.2020.101145] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/12/2020] [Indexed: 02/04/2023]
Abstract
The benefits of animal-assisted interventions (AAI), to utilize companion animals as an adjunctive treatment modality, is well-established and a burgeoning research field. However, few studies have evaluated the potential hazards of these programs, such as the potential for therapy animals to transfer hospital-associated pathogens between individuals and the hospital environment. Here we review the current literature on the possible risks of hospital-based AAI programs, including zoonotic pathogen transmission. We identified twenty-nine articles encompassing reviews of infection control guidelines and epidemiological studies on zoonotic pathogen prevalence in AAI. We observed substantial heterogeneity in infection control practices among hospital AAI programs. Few data confirmed pathogen transmission between therapy animals and patients. Given AAI's known benefits, we recommend that future research utilize a One Health framework to evaluate microbial dynamics among therapy animals, patients, and hospital environments. This framework may best promote safe practices to ensure the sustainability of these valuable AAI programs.
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Affiliation(s)
- Kathryn R Dalton
- Johns Hopkins University Bloomberg School of Public Health, Department of Environmental Health and Engineering, Baltimore, MD, USA.
| | - Kaitlin B Waite
- Johns Hopkins University Bloomberg School of Public Health, Department of Environmental Health and Engineering, Baltimore, MD, USA
| | - Kathy Ruble
- Johns Hopkins University School of Medicine, Department of Pediatric Oncology, Baltimore, MD, USA
| | - Karen C Carroll
- Johns Hopkins University School of Medicine, Department of Pathology, Division of Medical Microbiology, Baltimore, MD, USA
| | - Alexandra DeLone
- Johns Hopkins University School of Medicine, Department of Pediatric Oncology, Baltimore, MD, USA
| | - Pam Frankenfield
- Johns Hopkins University School of Medicine, Department of Pediatric Oncology, Baltimore, MD, USA
| | - James A Serpell
- University of Pennsylvania School of Veterinary Medicine, Department of Clinical Sciences & Advanced Medicine, Philadelphia, PA, USA
| | - Roland J Thorpe
- Johns Hopkins University Bloomberg School of Public Health, Department of Health, Behavior and Society, Baltimore, MD, USA
| | - Daniel O Morris
- University of Pennsylvania School of Veterinary Medicine, Department of Clinical Sciences & Advanced Medicine, Philadelphia, PA, USA
| | - Jacqueline Agnew
- Johns Hopkins University Bloomberg School of Public Health, Department of Environmental Health and Engineering, Baltimore, MD, USA
| | - Ronald C Rubenstein
- The Children's Hospital of Philadelphia, Cystic Fibrosis Center, Philadelphia, PA, USA; The University of Pennsylvania Perelman School of Medicine, Department of Pediatrics, Philadelphia, PA, USA
| | - Meghan F Davis
- Johns Hopkins University Bloomberg School of Public Health, Department of Environmental Health and Engineering, Baltimore, MD, USA; Johns Hopkins Medicine, Department of Molecular and Comparative Pathobiology, Baltimore, MD, USA
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35
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Allen EM, McTague MF, Bay CP, Esposito JG, von Keudell A, Weaver MJ. The effectiveness of germicidal wipes and ultraviolet irradiation in reducing bacterial loads on electronic tablet devices used to obtain patient information in orthopaedic clinics: evaluation of tablet cleaning methods. J Hosp Infect 2020; 105:200-204. [PMID: 32289385 DOI: 10.1016/j.jhin.2020.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 04/07/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Electronic tablet devices are commonly used in outpatient clinics to obtain patient information for both clinical and research purposes. These devices are often colonized with bacteria; there are many cleaning methods to reduce this bacterial load. AIM The primary purpose of this study was to evaluate whether regular cleaning with either germicidal wipes or ultraviolet (UV) irradiation leads to lower bacterial levels compared with irregular cleaning. METHODS A randomized blinded trial was conducted of tablet cleaning strategies between each patient encounter in orthopaedic clinics. The cleaning method was randomized to either germicidal wipes, UV irradiation, or cleaning only when the tablet was visibly soiled. Research assistants (blinded to the treatment) obtained bacterial cultures from the tablets at the beginning and end of each clinic day. FINDINGS Using germicidal wipes between each patient encounter vs no routine cleaning resulted in a marked decrease in the amount of bacterial contamination (risk ratio (RR) = 0.17 (0.04-0.67)). Similarly, using UV irradiation between each patient encounter led to significantly lower bacterial contamination rates (RR = 0.29 (95% confidence interval (CI) = 0.09-0.95)) compared with no routine cleaning. The majority of bacteria identified were normal skin flora. No meticillin-resistant Staphylococcus aureus was identified and only sparse colonies of meticillin-sensitive S. aureus. CONCLUSION Electronic tablets used in orthopaedic trauma clinics are colonized with bacteria if no routine cleaning is performed. Routine use of either UV irradiation or germicidal wipes significantly decreases this bacterial burden. Providers should implement routine cleaning of tablets between each patient encounter to minimize exposure to potential pathogens.
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Affiliation(s)
- E M Allen
- Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
| | - M F McTague
- Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - C P Bay
- Center for Clinical Investigation, Brigham and Women's Hospital, Boston, MA, USA
| | - J G Esposito
- Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA; Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - A von Keudell
- Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - M J Weaver
- Harvard Medical School Orthopedic Trauma Initiative, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
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36
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Spruce L. Back to Basics 2.0: Surgical Attire. AORN J 2020; 111:349-356. [DOI: 10.1002/aorn.12978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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37
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Nardi-Hiebl S, Eberhart LHJ, Gehling M, Koch T, Schlesinger T, Kranke P. Quo Vadis PCA? A Review on Current Concepts, Economic Considerations, Patient-Related Aspects, and Future Development with respect to Patient-Controlled Analgesia. Anesthesiol Res Pract 2020; 2020:9201967. [PMID: 32099543 PMCID: PMC7040376 DOI: 10.1155/2020/9201967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 12/30/2019] [Indexed: 02/07/2023] Open
Abstract
This review assesses four interrelating aspects of patient-controlled analgesia (PCA), a long-standing and still widely used concept for postoperative pain management. Over the years, anaesthesiologists and patients have appreciated the benefits of PCA alike. The market has seen new technologies leveraging noninvasive routes of administration and, thus, further increasing patient and staff satisfaction as well as promoting safety aspects. Pharmaceutical research focuses on the reduction or avoidance of opioids, side effects, and adverse events although influence of these aspects appears to be minor. The importance of education is still eminent, and new educational formats are tested to train healthcare professionals and patients likewise. New PCA technology can support the implementation of efficient processes to reduce workload and human errors; however, these new products come with a cost, which is not necessarily reflected through beneficial budget impact or significant improvements in patient outcome. Although first steps have been taken to better recognize the importance of postoperative pain management through the introduction of value-based reimbursement, in most western countries, PCA is not specifically compensated. PCA is still an effective and valued technique for postoperative pain management. Although there is identifiable potential for future developments in various aspects, this potential has not materialized in new products.
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Affiliation(s)
- S. Nardi-Hiebl
- Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany
| | - L. H. J. Eberhart
- Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany
| | - M. Gehling
- Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany
| | - T. Koch
- Department of Anesthesia and Intensive Care, University Hospital Marburg, Marburg, Germany
| | - T. Schlesinger
- Department of Anaesthesia and Critical Care, University Hospitals of Wuerzburg, Wuerzburg, Germany
| | - P. Kranke
- Department of Anaesthesia and Critical Care, University Hospitals of Wuerzburg, Wuerzburg, Germany
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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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The efficacy of a simulated tunnel washer process on removal and destruction of Clostridioides difficile spores from health care textiles. Am J Infect Control 2019; 47:1375-1381. [PMID: 31239175 DOI: 10.1016/j.ajic.2019.04.180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Research on reducing Clostridioides difficile spore contamination of textiles via laundering is needed. We evaluated the sporicidal properties of 5 laundry chemicals and then determined the ability of a peracetic acid (PAA) laundry cycle to inactivate and/or remove spores from cotton swatches during a simulated tunnel washer (TW) process. METHODS In phase I, spore-inoculated swatches were immersed in alkaline detergent, sodium hypochlorite, hydrogen peroxide, or PAA for 8 minutes. In phase II, inoculated swatches were passed through a simulated 24-minute TW process employing 5 wash liquids. Spore survivors on swatches and in test chemical fluids in both studies were enumerated using standard microbiologic assay methods. RESULTS In phase I, hypochlorite solutions achieved >5 log10 spore reductions on swatches and >3 log10 reductions for wash solutions. PAA achieved minimal spore reduction in the wash solution (0.26 log10). In phase II, the PAA equilibrium-containing process achieved a >5 log10 spore reduction on swatches. In wash solution tests, the cumulative spore reduction peaked at >3.08 log10 in the final module. CONCLUSIONS Sodium hypochlorite as a laundry additive is sporicidal. The cumulative effects of a TW process, coupled with a PAA bleach agent at neutral pH, may render textiles essentially free of C difficile spore contamination.
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Zehra D, Iqbal M, Safdar A, Jamil H, Inam SHA, Zahid MA. Awareness Among Healthcare Professionals Regarding Contaminated Stethoscopes as a Source of Nosocomial Infections. Cureus 2019; 11:e5968. [PMID: 31777697 PMCID: PMC6867348 DOI: 10.7759/cureus.5968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/22/2019] [Indexed: 11/14/2022] Open
Abstract
Objectives The objective of this study was to determine the awareness among healthcare professionals regarding stethoscopes as a source of nosocomial infections, their cleaning practices in this regard before or after examination, and to find out about the existence of any guidelines and accountability criteria issued by the hospitals in this regard. Methodology A descriptive cross-sectional study of 243 healthcare professionals using non-probability convenience sampling was done to include consultants, residents, final-year medical students, and nursing staff and excluding medical students from pre-clinical years as well as doctors of those departments with infrequent use of a stethoscope. The study was conducted for a period of nine months at tertiary health care facilities of Rawalpindi and Islamabad. A self-administered structured questionnaire was used for data collection. Results Participants from both genders included 54 participants (22.2%) from the final year, 48 (19.8%) house officers, 106 (43.6%) postgraduate trainees, nine (3.7%) specialists, and 26 (10.7%) nurses. A total of 210 (86.4%) were aware of stethoscopes as a source of nosocomial infections. Among participants, 23 (9.5%) cleaned their stethoscope per patient, 50 (20.6%) did it daily, 48 (19.8%) did it weekly, 41 (16.9%) did it monthly, 12 (4.9%) participants cleaned it six-monthly while 69 (28.4%) respondents had never cleaned their stethoscope. Almost 127 participants (52.3%) used alcohol wipes to clean their stethoscopes, 11 (4.5%) used a wet cloth, six (2.5%) used tissue paper. Sixty-one (24.9%) agreed that the hospital issued protocols for the decontamination of stethoscopes while 189 (77.8%) did not. A total of 241 (99.2%) believed that there were no accountability criteria set for the assessment of the cleanliness of stethoscopes in their hospitals. Conclusion A majority of the participants were aware of stethoscopes being a source of nosocomial infections and believed in cleaning stethoscopes regularly. However, a majority of the participants believed that their hospital did not issue any protocols for the decontamination of stethoscopes. Further research can expand our recommendations.
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Affiliation(s)
- Desaar Zehra
- Internal Medicine, Army Medical College, Rawalpindi, PAK
| | - Mishal Iqbal
- Internal Medicine, Military Hospital, Rawalpindi, PAK
| | - Ayesha Safdar
- Internal Medicine, Army Medical College, Rawalpindi, PAK
| | - Hamza Jamil
- Internal Medicine, Army Medical College, Rawalpindi, PAK
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Harrod M, Petersen L, Weston LE, Gregory L, Mayer J, Samore MH, Drews FA, Krein SL. Understanding Workflow and Personal Protective Equipment Challenges Across Different Healthcare Personnel Roles. Clin Infect Dis 2019; 69:S185-S191. [DOI: 10.1093/cid/ciz527] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Abstract
Background
Hospitals use standard and transmission-based precautions, including personal protective equipment (PPE), to prevent the spread of infectious organisms. However, little attention has been paid to the potentially unique challenges of various healthcare personnel (HCP) in following precaution practices.
Methods
From September through December 2016, 5 physicians, 5 nurses, and 4 physical therapists were shadowed for 1 hour 30 minutes to 3 hours 15 minutes at an academic medical center. Observers documented activities using unstructured field notes. Focus groups were conducted to better understand HCP perspectives about precautions and PPE-related challenges. Data were analyzed by comparing workflow and challenges (observed and stated) in precaution practices across HCP roles.
Results
Precaution patients were interspersed throughout physician rounds, which covered a broad geographic range throughout the hospital. Patient encounters were generally brief, and appropriate use of gowns and cleaning of personal stethoscopes varied among observed physicians. Nurses were unit based and frequently entered/exited rooms. Frustration with donning/doffing was especially apparent when needing supplies while in a precaution room, which nurses acknowledged was a time when practice lapses could occur. The observed physical therapists worked in one geographic location, spent extended periods of time with patients, and noted that given their close physical contact with patients, gowns do not fully protect them.
Conclusions
Movement patterns, time with patients, care activities, and equipment use varied across HCP, leading to a diverse set of challenges in following precaution practices and PPE use. Attention to these differences among HCP is important for understanding and developing effective strategies to prevent the potential spread of infectious organisms.
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Affiliation(s)
- Molly Harrod
- Veterans Affairs Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
| | - Laura Petersen
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Lauren E Weston
- Veterans Affairs Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
| | - Lynn Gregory
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Jeanmarie Mayer
- Department of Internal Medicine, University of Utah, Salt Lake City
- Department of Veterans Affairs Medical Center, Salt Lake City
| | - Matthew H Samore
- Department of Veterans Affairs Medical Center, Salt Lake City
- Department of Psychology, University of Utah, Salt Lake City
| | - Frank A Drews
- Department of Internal Medicine, University of Utah, Salt Lake City
- Department of Veterans Affairs Medical Center, Salt Lake City
- Department of Psychology, University of Utah, Salt Lake City
| | - Sarah L Krein
- Veterans Affairs Ann Arbor Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
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Ogg MJ, Anderson MA. Clinical Issues—August 2019. AORN J 2019; 110:195-203. [DOI: 10.1002/aorn.12767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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44
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Wiemken TL, Hei H. Journal Club: Clothing and shoes of personnel as a potential vector for transfer of health care-associated pathogens to the community. Am J Infect Control 2019; 47:580-581. [PMID: 31023458 DOI: 10.1016/j.ajic.2019.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/26/2022]
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Bacterial load and pathogenic species on healthcare personnel attire: implications of alcohol hand-rub use, profession, and time of duty. J Hosp Infect 2019; 101:414-421. [DOI: 10.1016/j.jhin.2018.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/22/2018] [Indexed: 11/17/2022]
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The Spatial and Temporal Variability of the Indoor Environmental Quality during Three Simulated Office Studies at a Living Lab. BUILDINGS 2019. [DOI: 10.3390/buildings9030062] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The living lab approach to building science research provides the ability to accurately monitor occupants and their environment and use the resulting data to evaluate the impact that various components of the built environment have on human comfort, health, and well-being. A hypothesized benefit of the living lab approach is the ability to simulate the real indoor environment in an experimentally controlled setting over relatively long periods of time, overcoming a significant hurdle encountered in many chamber-type experimental designs that rarely reflect typical indoor environments. Here, we present indoor environmental quality measurements from a network of sensors as well as building system design and operational data demonstrating the ability of a living lab to realistically simulate a wide range of environmental conditions in an office setting by varying air temperature, lighting, façade control, and sound masking in a series of three human subject experiments. The temporal variability of thermal and lighting conditions was assessed on an hourly basis and demonstrated the significant impact of façade design and control on desk-level measurements of both factors. Additional factors, such as desk layout and building system design (e.g., luminaires, speaker system), also contributed significantly to spatial variability in air temperature, lighting, and sound masking exposures, and this variability was reduced in latter experiments by optimizing desk layout and building system design. While ecologically valid experimental conditions are possible with a living lab, a compromise between realism and consistency in participant experience must often be found by, for example, using an atypical desk layout to reduce spatial variability in natural light exposure. Based on the experiences from these three studies, experimental design and environmental monitoring considerations for future office-based living lab experiments are explored.
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Ide N, Frogner BK, LeRouge CM, Vigil P, Thompson M. What's on your keyboard? A systematic review of the contamination of peripheral computer devices in healthcare settings. BMJ Open 2019; 9:e026437. [PMID: 30852549 PMCID: PMC6429971 DOI: 10.1136/bmjopen-2018-026437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the extent and type of microbial contamination of computer peripheral devices used in healthcare settings, evaluate the effectiveness of interventions to reduce contamination of these devices and establish the risk of patient and healthcare worker infection from contaminated devices. DESIGN Systematic review METHODS: We searched four online databases: MEDLINE, CINAHL, Embase and Scopus for articles reporting primary data collection on contamination of computer-related equipment (including keyboards, mice, laptops and tablets) and/or studies demonstrating the effectiveness of a disinfection technique. Pooling of contamination rates was conducted where possible, and narrative synthesis was used to describe the rates of device contamination, types of bacterial and viral contamination, effectiveness of interventions and any associations between device contamination and human infections. RESULTS Of the 4432 records identified, a total of 75 studies involving 2804 computer devices were included. Of these, 50 studies reported contamination of computer-related hardware, and 25 also measured the effects of a decontamination intervention. The overall proportion of contamination ranged from 24% to 100%. The most common microbial contaminants were skin commensals, but also included potential pathogens including methicillin-resistantStaphylococcus aureus, Clostridiumdifficile, vancomycin-resistantenterococci and Escherichia coli. Interventions demonstrating effective decontamination included wipes/pads using isopropyl alcohol, quaternary ammonium, chlorhexidine or dipotassium peroxodisulfate, ultraviolet light emitting devices, enhanced cleaning protocols and chlorine/bleach products. However, results were inconsistent, and there was insufficient data to demonstrate comparative effectiveness. We found little evidence on the link between device contamination and patient/healthcare worker colonisation or infection. CONCLUSIONS Computer keyboards and peripheral devices are frequently contaminated; however, our findings do not allow us to draw firm conclusions about their relative impact on the transmission of pathogens or nosocomial infection. Additional studies measuring the incidence of healthcare-acquired infections from computer hardware, the relative risk they pose to healthcare and evidence for effective and practical cleaning methods are needed.
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Affiliation(s)
- Nicole Ide
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Bianca K Frogner
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
| | - Cynthia M LeRouge
- Department of Information Systems & Business Analytics, Florida International University, Miami, Florida, USA
| | - Patrick Vigil
- Family Medicine, Pacific Northwest University, Yakima, Washington, USA
| | - Matthew Thompson
- Department of Family Medicine, University of Washington, Seattle, Washington, USA
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Stephens B, Azimi P, Thoemmes MS, Heidarinejad M, Allen JG, Gilbert JA. Microbial Exchange via Fomites and Implications for Human Health. CURRENT POLLUTION REPORTS 2019; 5:198-213. [PMID: 34171005 PMCID: PMC7149182 DOI: 10.1007/s40726-019-00123-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
PURPOSE OF REVIEW Fomites are inanimate objects that become colonized with microbes and serve as potential intermediaries for transmission to/from humans. This review summarizes recent literature on fomite contamination and microbial survival in the built environment, transmission between fomites and humans, and implications for human health. RECENT FINDINGS Applications of molecular sequencing techniques to analyze microbial samples have increased our understanding of the microbial diversity that exists in the built environment. This growing body of research has established that microbial communities on surfaces include substantial diversity, with considerable dynamics. While many microbial taxa likely die or lay dormant, some organisms survive, including those that are potentially beneficial, benign, or pathogenic. Surface characteristics also influence microbial survival and rates of transfer to and from humans. Recent research has combined experimental data, mechanistic modeling, and epidemiological approaches to shed light on the likely contributors to microbial exchange between fomites and humans and their contributions to adverse (and even potentially beneficial) human health outcomes. SUMMARY In addition to concerns for fomite transmission of potential pathogens, new analytical tools have uncovered other microbial matters that can be transmitted indirectly via fomites, including entire microbial communities and antibiotic-resistant bacteria. Mathematical models and epidemiological approaches can provide insight on human health implications. However, both are subject to limitations associated with study design, and there is a need to better understand appropriate input model parameters. Fomites remain an important mechanism of transmission of many microbes, along with direct contact and short- and long-range aerosols.
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Affiliation(s)
- Brent Stephens
- Department of Civil, Architectural, and Environmental Engineering, Illinois Institute of Technology, Alumni Memorial Hall 228E, 3201 South Dearborn Street, Chicago, IL 60616 USA
| | - Parham Azimi
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Megan S. Thoemmes
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA USA
| | - Mohammad Heidarinejad
- Department of Civil, Architectural, and Environmental Engineering, Illinois Institute of Technology, Alumni Memorial Hall 228E, 3201 South Dearborn Street, Chicago, IL 60616 USA
| | - Joseph G. Allen
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Jack A. Gilbert
- Department of Pediatrics, University of California San Diego School of Medicine, San Diego, CA USA
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West GF, Resendiz M, Lustik MB, Nahid MA. Bacterial Contamination of Military and Civilian Uniforms in an Emergency Department. J Emerg Nurs 2018; 45:169-177.e1. [PMID: 30573161 DOI: 10.1016/j.jen.2018.10.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 10/04/2018] [Accepted: 10/21/2018] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The emergency department is a fast-paced, high-volume environment, serving patients with diverse and evolving acuities. Personnel providing direct care are continually exposed to pathogenic microorganisms from patients and everyday surfaces, to which the organisms may spread. Indeed, hospital items-such as electronic devices, stethoscopes, and staff clothing-have demonstrated high rates of contamination. Despite this, policies governing the use, disinfection, and wear of various environmental surfaces remain relaxed, vague, and/or difficult to enforce. This study aimed to examine the bacterial contamination on 2 hospital uniform types in a large military hospital within the emergency department. METHODS Environmental sampling of military and civilian nursing staff uniforms was performed on 2 separate occasions. Emergency nurses wore hospital-provided freshly laundered scrubs on the first sampling day and home-laundered personally owned uniforms complicit with ED policy on the second sampling day. Samples were collected by impressing of contact blood agar growth medium at arrival (0 hour), 4 hours, and 8 hours of wear. Microbiological methods were used to enumerate and identify bacterial colonies. RESULTS Bacterial contamination of personally owned uniforms was significantly higher than freshly laundered hospital-provided scrubs on 4 different sampling sites and across the span of an 8-hour workday. No significant differences were observed between military and civilian personally owned uniforms. However, several risk factors for nosocomial infection were increased in the military subgroup. DISCUSSION Re-evaluating organizational factors (such as uniform policies) that increase the propensity for pathogenic contamination are critical for mitigating the spread and acquisition of multidrug-resistant organisms in the emergency department.
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Krein SL, Mayer J, Harrod M, Weston LE, Gregory L, Petersen L, Samore MH, Drews FA. Identification and Characterization of Failures in Infectious Agent Transmission Precaution Practices in Hospitals: A Qualitative Study. JAMA Intern Med 2018; 178:1016-1057. [PMID: 29889934 PMCID: PMC6583062 DOI: 10.1001/jamainternmed.2018.1898] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IMPORTANCE Using personal protective equipment (PPE) and transmission-based precautions are primary strategies for reducing the transmission of infectious agents. OBJECTIVE To identify and characterize failures in transmission-based precautions, including PPE use, by health care personnel that could result in self-contamination or transmission during routine, everyday hospital care. DESIGN, SETTING, AND PARTICIPANTS This qualitative study involved direct observation inside and outside patient rooms on clinical units from March 1, 2016, to November 30, 2016. Observations occurred in the medical and/or surgical units and intensive care units at an academic medical center and a Veterans Affairs hospital, as well as the emergency department of the university hospital. Trained observers recorded extensive field notes while personnel provided care for patients in precautions for a pathogen transmitted through contact (eg, Clostridium difficile, methicillin-resistant Staphylococcus aureus) or respiratory droplet (eg, influenza). Specific occurrences involving potential personnel self-contamination were identified through a directed content analysis. These occurrences were further categorized, using a human factors model of human error, as active failures, such as violations, mistakes, or slips. MAIN OUTCOMES AND MEASURES Number and type of failures involving use of transmission-based precautions. RESULTS In total, 325 room observations were conducted at 2 sites. At site 1, a total of 280 observations were completed (196 in medical/surgical units, 64 in intensive care units, and 20 in emergency departments). At site 2, there were 45 observations (36 in medical/surgical units and 9 in the intensive care unit). Of the total observations, 259 (79.7%) occurred outside and 66 (20.3%) inside the room. Two hundred eighty-three failures were observed, including 102 violations (deviations from safe operating practices or procedures), 144 process or procedural mistakes (failures of intention), and 37 slips (failures of execution). Violations involved entering rooms without some or all recommended PPE. Mistakes were frequently observed during PPE removal and encounters with challenging logistical situations, such as badge-enforced computer logins. Slips included touching one's face or clean areas with contaminated gloves or gowns. Each of these active failures has a substantial likelihood of resulting in self-contamination. The circumstances surrounding failures in precaution practices, however, varied not only across but within the different failure types. CONCLUSIONS AND RELEVANCE Active failures in PPE use and transmission-based precautions, potentially leading to self-contamination, were commonly observed. The factors that contributed to these failures varied widely, suggesting the need for a range of strategies to reduce potential transmission risk during routine hospital care.
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Affiliation(s)
- Sarah L Krein
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.,Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Jeanmarie Mayer
- Department of Internal Medicine, University of Utah, Salt Lake City.,Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Molly Harrod
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Lauren E Weston
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Lynn Gregory
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Laura Petersen
- Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Matthew H Samore
- Department of Internal Medicine, University of Utah, Salt Lake City.,Department of Veterans Affairs Medical Center, Salt Lake City, Utah
| | - Frank A Drews
- Department of Internal Medicine, University of Utah, Salt Lake City.,Department of Veterans Affairs Medical Center, Salt Lake City, Utah.,Department of Psychology, University of Utah, Salt Lake City
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