Antibiotic Resistant Superbugs: Assessment of the Interrelationship of Occurrence in Clinical Settings and Environmental Niches

The increasing threat to global health posed by antibiotic resistance remains of serious concern. Human health remains at higher risk due to several reported therapeutic failures to many life threatening drug resistant microbial infections. The resultant effects have been prolonged hospital stay, higher cost of alternative therapy, increased mortality, etc. This opinionated review considers the two main concerns in integrated human health risk assessment (i.e., residual antibiotics and antibiotic resistant genes) in various compartments of human environment, as well as clinical dynamics associated with the development and transfer of antibiotic resistance (AR). Contributions of quorum sensing, biofilms, enzyme production, and small colony variants in bacteria, among other factors in soil, water, animal farm and clinical settings were also considered. Every potential factor in environmental and clinical settings that brings about AR needs to be identified for the summative effects in overall resistance. There is a need to embrace coordinated multi-locational approaches and interrelationships to track the emergence of resistance in different niches in soil and water versus the hospital environment. The further integration with advocacy, legislation, enforcement, technological innovations and further research input and recourse to WHO guidelines on antibiotic policy would be advantageous towards addressing the emergence of antibiotic resistant superbugs.

Infections and interaction rituals in the organisation: clinician accounts of speaking up or remaining silent in the face of threats to patient safety

Clinician silence in the face of known threats to patient safety is a source of growing concern. Current explanations for the difficulties clinicians have of speaking up are conceptualised at the individual or organisational level, with little attention paid to the space between--the interaction context. Drawing on 103 interviews with clinicians at one hospital in the United States this article examines how clinicians talk about speaking up or not in the face of breaches in infection prevention technique. Accounts are analysed using a microsociological lens as stories of interaction, through which respondents appeal to situational and organisational realities of medical work that serve to justify speaking up or remaining silent. Analysis of these accounts reveals three influences on the decision to speak up, shaped by background conditions in the organisation; mutual focus of attention, interactional path dependence and the presence of an audience. These findings suggest that the decision to speak up in a clinical setting is dynamic, highly context-dependent, embedded in the interaction rituals that suffuse everyday work and constrained by organisational dynamics. This article develops a more sophisticated and distinctly sociological understanding of the reasons why speaking up in healthcare is so difficult.

The best of intentions: patients' intentions to request health care workers cleanse hands before examinations

The Centers for Disease Control and Prevention (CDC) recommends that patients ask health care providers to cleanse their hands in the patients' presence for each examination. This study investigates the utility of the recommendation in light of potential challenges stemming from norms in the provider-patient relationship. In addition, we investigate the role of individual differences that may make such a discussion especially difficult (e.g., interaction anxiety) or seem inappropriate (e.g., authoritarianism). We also seek to identify how well-known predictors of behavioral intentions (i.e., attitudes, subjective norms, efficacy, outcome benefits and costs) affect intentions to perform this specific behavior. In total, 250 hospitalized, postsurgical patients were asked about their own likelihood of following the CDC recommendation. They were also asked to view and respond to video depictions of a doctor and patient interaction that varied the presence of a patient request and a doctor's cleansing. Results of the study suggest the CDC recommendation, without additional considerations, is unlikely to reduce dangers posed by health care worker transmission of infectious disease.