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Baker MA, Septimus E, Kleinman K, Moody J, Sands KE, Varma N, Isaacs A, McLean LE, Coady MH, Blanchard EJ, Poland RE, Yokoe DS, Stelling J, Haffenreffer K, Clark A, Avery TR, Sljivo S, Weinstein RA, Smith KN, Carver B, Meador B, Lin MY, Lewis SS, Washington C, Bhattarai M, Shimelman L, Kulldorff M, Reddy SC, Jernigan JA, Perlin JB, Platt R, Huang SS. A Trial of Automated Outbreak Detection to Reduce Hospital Pathogen Spread. NEJM EVIDENCE 2024; 3:EVIDoa2300342. [PMID: 38815164 DOI: 10.1056/evidoa2300342] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND Detection and containment of hospital outbreaks currently depend on variable and personnel-intensive surveillance methods. Whether automated statistical surveillance for outbreaks of health care-associated pathogens allows earlier containment efforts that would reduce the size of outbreaks is unknown. METHODS We conducted a cluster-randomized trial in 82 community hospitals within a larger health care system. All hospitals followed an outbreak response protocol when outbreaks were detected by their infection prevention programs. Half of the hospitals additionally used statistical surveillance of microbiology data, which alerted infection prevention programs to outbreaks. Statistical surveillance was also applied to microbiology data from control hospitals without alerting their infection prevention programs. The primary outcome was the number of additional cases occurring after outbreak detection. Analyses assessed differences between the intervention period (July 2019 to January 2022) versus baseline period (February 2017 to January 2019) between randomized groups. A post hoc analysis separately assessed pre-coronavirus disease 2019 (Covid-19) and Covid-19 pandemic intervention periods. RESULTS Real-time alerts did not significantly reduce the number of additional outbreak cases (intervention period versus baseline: statistical surveillance relative rate [RR]=1.41, control RR=1.81; difference-in-differences, 0.78; 95% confidence interval [CI], 0.40 to 1.52; P=0.46). Comparing only the prepandemic intervention with baseline periods, the statistical outbreak surveillance group was associated with a 64.1% reduction in additional cases (statistical surveillance RR=0.78, control RR=2.19; difference-in-differences, 0.36; 95% CI, 0.13 to 0.99). There was no similarly observed association between the pandemic versus baseline periods (statistical surveillance RR=1.56, control RR=1.66; difference-in-differences, 0.94; 95% CI, 0.46 to 1.92). CONCLUSIONS Automated detection of hospital outbreaks using statistical surveillance did not reduce overall outbreak size in the context of an ongoing pandemic. (Funded by the Centers for Disease Control and Prevention; ClinicalTrials.gov number, NCT04053075. Support for HCA Healthcare's participation in the study was provided in kind by HCA.).
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Affiliation(s)
- Meghan A Baker
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston
- Department of Medicine, Brigham and Women's Hospital, Boston
| | - Edward Septimus
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston
- Texas A&M College of Medicine and Memorial Hermann Health System, Houston
| | - Ken Kleinman
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst
| | | | - Kenneth E Sands
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston
- HCA Healthcare, Nashville
| | - Neha Varma
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston
| | - Amanda Isaacs
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston
| | | | - Micaela H Coady
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston
| | | | - Russell E Poland
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston
- HCA Healthcare, Nashville
| | - Deborah S Yokoe
- Department of Medicine, University of California, San Francisco School of Medicine, San Francisco
| | - John Stelling
- Department of Medicine, Brigham and Women's Hospital, Boston
| | | | - Adam Clark
- Department of Medicine, Brigham and Women's Hospital, Boston
| | - Taliser R Avery
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston
| | - Selsebil Sljivo
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston
| | - Robert A Weinstein
- Rush University Medical Center, Chicago
- John Stroger Hospital of Cook County, Chicago
| | | | | | | | | | | | - Chamaine Washington
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston
| | - Megha Bhattarai
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston
| | - Lauren Shimelman
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston
| | | | | | | | | | - Richard Platt
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston
| | - Susan S Huang
- Division of Infectious Diseases, University of California, Irvine School of Medicine, Irvine
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Casini B, Spagnolo AM, Sartini M, Tuvo B, Scarpaci M, Barchitta M, Pan A, Agodi A, Cristina ML, Castiglia P, De Giusti M, Distefano M, Longhitano A, Laganà P, Mentore B, Canale F, Mantero F, Opezzi M, Marciano E, Zurlo L, Segata A, Torre I, Vay D, Vecchi E, Vincenti S. Microbiological surveillance post-reprocessing of flexible endoscopes used in digestive endoscopy: a national study. J Hosp Infect 2023; 131:139-147. [PMID: 36244520 DOI: 10.1016/j.jhin.2022.09.024] [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: 06/20/2022] [Revised: 08/17/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Microbiological surveillance of endoscopes is a safety measure for verifying the quality of reprocessing procedures and identifying contaminated devices, but duodenoscope-related outbreaks are still reported. AIM To assess the effectiveness of duodenoscope reprocessing procedures in Italy. METHODS Between December 2019 and April 2020, data obtained from microbiological surveillance post-reprocessing in 15 Italian endoscopy units were collected. Sampling was carried out after reprocessing or during storage in a cabinet. In keeping with international guidelines and the Italian position paper, the micro-organisms were classified as high-concern organisms (HCOs) and low-concern organisms (LCOs). FINDINGS In total, 144 samples were collected from 51 duodenoscopes. Of these, 36.81% were contaminated: 22.92% were contaminated with HCOs and 13.89% were contaminated with LCOs [2.08% with an LCO load of 11-100 colony-forming units (CFU)/device and 0.69% with an LCO load of >100 CFU/device]. The contamination rate was 27.5% in samples collected after reprocessing, 40% in samples collected during storage in a cabinet that was compliant with EN 16442:2015 (C-I), and 100% in samples collected during storage in a cabinet that was not compliant with EN 16442:2015 (NC-I). The respective HCO rates were 15.00%, 27.27% and 66.67%. Correlation between LCO contamination and storage time was demonstrated (Spearman's rho=0.3701; P=0.0026). The Olympus duodenoscope TJFQ180V demonstrated the lowest rate of contamination (29.82%), although the contamination rate was 100% for duodenoscopes stored in an NC-I cabinet. CONCLUSION Microbiological surveillance, along with strict adherence to reprocessing protocols, may help to detect endoscope contamination at an early stage, and reduce the risk of duodenoscope-associated infections.
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Affiliation(s)
- B Casini
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - A M Spagnolo
- Department of Health Sciences, University of Genova, Genova, Italy; Operating Unit Hospital Hygiene, Galliera Hospital, Genoa, Italy.
| | - M Sartini
- Department of Health Sciences, University of Genova, Genova, Italy; Operating Unit Hospital Hygiene, Galliera Hospital, Genoa, Italy.
| | - B Tuvo
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - M Scarpaci
- Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - M Barchitta
- Department of Medical, Surgical and Advanced Technology Sciences "G.F. Ingrassia", University of Catania, Catania, Italy
| | - A Pan
- Operating Unit of Infectious Diseases, ASST Cremona, Cremona, Italy
| | - A Agodi
- Department of Medical, Surgical and Advanced Technology Sciences "G.F. Ingrassia", University of Catania, Catania, Italy
| | - M L Cristina
- Department of Health Sciences, University of Genova, Genova, Italy; Operating Unit Hospital Hygiene, Galliera Hospital, Genoa, Italy
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Scarpaci M, Cosci T, Tuvo B, Guarini A, Iannone T, Zullo A, Casini B. Good Practices on Endoscope Reprocessing in Italy: Findings of a Nationwide Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12082. [PMID: 36231398 PMCID: PMC9566799 DOI: 10.3390/ijerph191912082] [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: 08/25/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
Background: Correct reprocessing and microbiological surveillance on endoscopes are fundamental for preventing the transmission of multi-drug resistant strains and device-related infections. Methods: A questionnaire with three domains was created: (1) centre characteristics; (2) endoscope reprocessing procedures; and (3) application of microbiological surveillance. Nurses working in endoscopic units across Italy were invited to anonymously fill out the questionnaire on the SurveyMonkey platform between November 2021 and February 2022. Results: A total of 82 out of 132 endoscopic centres participated in the survey, with at least one centre from each Italian region. Data found different concerns regarding the current practice of both reprocessing and microbiological surveillance. According to respondents, the training on reprocessing was performed through theoretical training and only in 10% of centres; the microbiological surveillance was regularly performed in 59% of centres; and sampled endoscopes were not excluded for use in 31% of centres performing the surveillance until the outcome was pending, and when positive, 72% maintained them in quarantine until a successive negative result. Conclusions: Reprocessing and microbiological surveillance currently present several criticisms along the endoscopic centres in Italy. Our survey highlights the need for the correct application of the national recommendations in each endoscopic centre to prevent the potential transmission of endoscope-related infections.
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Affiliation(s)
- Michela Scarpaci
- Department of Translational Research, N.T.M.C. University of Pisa, Via S. Zeno 35-37, 56127 Pisa, Italy
| | - Tommaso Cosci
- Department of Translational Research, N.T.M.C. University of Pisa, Via S. Zeno 35-37, 56127 Pisa, Italy
| | - Benedetta Tuvo
- Department of Translational Research, N.T.M.C. University of Pisa, Via S. Zeno 35-37, 56127 Pisa, Italy
| | - Alessandra Guarini
- Gastroenterology and Digestive Endoscopy, ‘Nuovo Regina Margherita’ Hospital, 00153 Rome, Italy
| | - Teresa Iannone
- Gastroenterology Unit, ‘Polistena’ Hospital, 89024 Reggio Calabria, Italy
| | - Angelo Zullo
- Gastroenterology and Digestive Endoscopy, ‘Nuovo Regina Margherita’ Hospital, 00153 Rome, Italy
| | - Beatrice Casini
- Department of Translational Research, N.T.M.C. University of Pisa, Via S. Zeno 35-37, 56127 Pisa, Italy
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New Pharmacokinetic and Microbiological Prediction Equations to Be Used as Models for the Search of Antibacterial Drugs. Pharmaceuticals (Basel) 2022; 15:ph15020122. [PMID: 35215235 PMCID: PMC8879282 DOI: 10.3390/ph15020122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 02/04/2023] Open
Abstract
Currently, the development of resistance of Enterobacteriaceae bacteria is one of the most important health problems worldwide. Consequently, there is a growing urge for finding new compounds with antibacterial activity. Furthermore, it is very important to find antibacterial compounds with a good pharmacokinetic profile too, which will lead to more efficient and safer drugs. In this work, we have mathematically described a series of antibacterial quinolones by means of molecular topology. We have used molecular descriptors and related them to various pharmacological properties by using multilinear regression (MLR) analysis. The regression functions selected by presenting the best combination of a number of quality and validation metrics allowed for the reliable prediction of clearance (CL), and minimum inhibitory concentration 50 against Enterobacter aerogenes (MIC50Ea) and Proteus mirabilis (MIC50Pm). The obtained results clearly reveal that the combination of molecular topology methods and MLR provides an excellent tool for the prediction of pharmacokinetic properties and microbiological activities in both new and existing compounds with different pharmacological activities.
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Snyder GM. Introduction to Transmission of Infection: Potential Agents Transmitted by Endoscopy. Gastrointest Endosc Clin N Am 2020; 30:611-618. [PMID: 32891220 DOI: 10.1016/j.giec.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pathogen contamination of endoscopes depends on pathogen factors, surface factors, and environmental conditions. The most common pathogens associated with transmission and infections associated with gastrointestinal endoscope contamination are Klebsiella pneumoniae, Escherichia coli, and Pseudomonas aeruginosa. Biofilm production together with disruption to device surfaces play an outsized role in the risk of contamination. Sampling schemes are limited by these factors, and further developments are needed to improve the accuracy of sampling.
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Affiliation(s)
- Graham M Snyder
- Department of Infection Control and Hospital Epidemiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Morii D, Tomono K, Imanaka Y. Economic impact of antimicrobial-resistant bacteria outbreaks on Japanese hospitals. Am J Infect Control 2020; 48:1195-1199. [PMID: 31955855 DOI: 10.1016/j.ajic.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/04/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Economic evaluation from the perspective of hospitals is important for the optimization of resources for infection control measures. METHODS We considered outbreaks that occurred from 2006 to 2016 in Japan. Cost identification analyses were conducted using data from 23 outbreaks by antimicrobial-resistant bacteria. Linear and multivariable regression analyses were conducted to explore the association between potential factors and main outcomes. The potential factors included duration of the outbreaks, duration of bed blocking, timely public announcement, delay of external consultation, and number of patients at the time of external consultation. RESULTS The largest productivity loss was 4.62 million USD. The maximum total cost for containment was 678,000 USD. After considering the overall interactions, timely public announcement was significantly associated with productivity loss (adjusted estimate of coefficient: 1.24 USD, 95% confidence interval [CI] 179,000 to 2.31 million USD, P = .02), and the number of patients at external consultation was significantly associated with containment costs (3 430 USD, 630 to 6 240 USD, P = .02). CONCLUSIONS The costs of healthcare-associated infection outbreaks of antimicrobial-resistant bacteria can be significant. The productivity loss was much greater than the containment costs. Therefore, hospitals should meet the costs for prevention of these outbreaks.
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Benowitz I, Moulton-Meissner HA, Epstein L, Arduino MJ. The Centers for Disease Control and Prevention Guidance on Flexible Gastrointestinal Endoscopes: Lessons Learned from Outbreaks, Infection Control. Gastrointest Endosc Clin N Am 2020; 30:723-733. [PMID: 32891228 PMCID: PMC7962740 DOI: 10.1016/j.giec.2020.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Flexible endoscopes require cleaning, high-level disinfection, and sterilization between each patient use to reduce risk of transmitting pathogens. Public health investigations have identified concerns, including endoscope damage, mishandling, and reprocessing deficiencies, placing patients at risk for transmission of bacterial, viral, and other pathogens. Findings from outbreak investigations and other studies have led to innovations in endoscope design, use, and reprocessing, yet infection risks related to contaminated or damaged endoscopes remain. Strict adherence to infection control guidelines and manufacturer instructions for use, utilization of supplemental guidance, and training and oversight of reprocessing personnel, reduce risk of pathogen transmission by flexible endoscopes.
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Suay‐Garcia B, Bueso‐Bordils JI, Falcó A, Pérez‐Gracia MT, Antón‐Fos G, Alemán‐López P. Quantitative structure–activity relationship methods in the discovery and development of antibacterials. WIRES COMPUTATIONAL MOLECULAR SCIENCE 2020. [DOI: 10.1002/wcms.1472] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Beatriz Suay‐Garcia
- Departamento de Matemáticas, Física y Ciencias Tecnológicas Universidad Cardenal Herrera‐CEU, CEU Universities Alfara del Patriarca, Valencia Spain
| | - Jose Ignacio Bueso‐Bordils
- Departamento de Farmacia, Universidad Cardenal Herrera‐CEU CEU Universities Alfara del Patriarca, Valencia Spain
| | - Antonio Falcó
- Departamento de Matemáticas, Física y Ciencias Tecnológicas Universidad Cardenal Herrera‐CEU, CEU Universities Alfara del Patriarca, Valencia Spain
| | - María Teresa Pérez‐Gracia
- Departamento de Farmacia, Universidad Cardenal Herrera‐CEU CEU Universities Alfara del Patriarca, Valencia Spain
| | - Gerardo Antón‐Fos
- Departamento de Farmacia, Universidad Cardenal Herrera‐CEU CEU Universities Alfara del Patriarca, Valencia Spain
| | - Pedro Alemán‐López
- Departamento de Farmacia, Universidad Cardenal Herrera‐CEU CEU Universities Alfara del Patriarca, Valencia Spain
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Abstract
Introduction and regular application of multiplex polymerase chain reaction analysis of bronchoalveolar specimens for community-acquired respiratory viruses in January 2017 led to the identification of adenovirus in multiple patients in a surgical intensive unit in July 2017, which was attributed to a pseudo-outbreak.
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Fan Y, Zou J, Cao X, Wu Y, Gao F, Xiong L. Data on antibiotic use for detecting clusters of healthcare-associated infection caused by multidrug-resistant organisms in a hospital in China, 2014 to 2017. J Hosp Infect 2019; 101:305-312. [DOI: 10.1016/j.jhin.2018.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/12/2018] [Indexed: 01/09/2023]
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Abstract
BACKGROUND Some nurse-driven interventions have successfully reduced rates of healthcare-associated infections, though incidence remains unacceptably high. Bacterial contamination in patient rooms may be a source of exposure for patients and thus a target for future interventions; however, few studies have investigated the role of the patient room on organism acquisition. OBJECTIVES The purpose of this study was to determine the incidence of concurrent detection of bacterial pathogens among patients sharing a hospital room. METHODS We performed a retrospective network analysis using electronic administrative and clinical data collected from all patients admitted in 2006 through 2012 to four New York City hospitals, totaling 2,065 beds within 183 inpatient units. A computerized algorithm identified concurrent organism detection among roommates, defined as two patients who shared a room on at least 1 day and had a first positive culture for the same organism within 3 days following cohabitation. RESULTS In total, 741,271 patient admissions were included. The algorithm identified 373 concurrent detection events: 158 (42%) in which the patients' first positive cultures were drawn after they were no longer sharing a room but within 3 days of cohabitation, 144 (39%) in which the patients' first positive cultures were drawn while they were still sharing a room but on different days, and 71 (19%) in which the patients' first positive cultures were drawn while they were sharing a room on the same day. DISCUSSION Methods to improve environmental decontamination should be included as part of a comprehensive approach to infection prevention in hospitals. Nurses have an important role to play in the planning and implementation of interventions to reduce bioburden in the patient environment.
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Schiavano GF, De Santi M, Sisti M, Amagliani G, Brandi G. Disinfection of Mycobacterium avium subspecies hominissuis in drinking tap water using ultraviolet germicidal irradiation. ENVIRONMENTAL TECHNOLOGY 2018; 39:3221-3227. [PMID: 28862077 DOI: 10.1080/09593330.2017.1375028] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/30/2017] [Indexed: 06/07/2023]
Abstract
Nontuberculous mycobacteria are resistant to conventional water treatments, and are opportunistic human pathogen, particularly in hospitalized patients. The aim of this investigation was to assess the effectiveness of an ultraviolet UV-C lamp treatment against Mycobacterium avium subspecies hominissuis in drinking tap water. Ultraviolet treatments (0-192 mJ/cm2) were performed using UV lamp immerged onto cylindrical glass tubes containing artificially contaminated water. The results showed that susceptibility to UV varied considerably according to the strains and the diameter of the tube. With a dose of 32 mJ/cm2, a significant inactivation (p < .05) of 3 log (99.9%) or more was obtained in only 5 of the 14 strains. To obtain a complete inactivation of all strains an irradiation of 192 mJ/cm2 was needed, a dose that is much higher than the limits recommended by the international standards for UV disinfection of drinking water. In conclusion, it may be difficult to standardize a UV dose for the elimination of waterborne mycobacteria.
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Affiliation(s)
- Giuditta Fiorella Schiavano
- a Department of Biomolecular Science, Toxicological, Hygiene and Environmental Sciences Unit , University of Urbino Carlo Bo , Urbino , PU , Italy
| | - Mauro De Santi
- a Department of Biomolecular Science, Toxicological, Hygiene and Environmental Sciences Unit , University of Urbino Carlo Bo , Urbino , PU , Italy
| | - Maurizio Sisti
- a Department of Biomolecular Science, Toxicological, Hygiene and Environmental Sciences Unit , University of Urbino Carlo Bo , Urbino , PU , Italy
| | - Giulia Amagliani
- a Department of Biomolecular Science, Toxicological, Hygiene and Environmental Sciences Unit , University of Urbino Carlo Bo , Urbino , PU , Italy
| | - Giorgio Brandi
- a Department of Biomolecular Science, Toxicological, Hygiene and Environmental Sciences Unit , University of Urbino Carlo Bo , Urbino , PU , Italy
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Abstract
Antibiotic stewardship programs (ASPs) play a crucial role in controlling the emergence of resistant organisms, reducing rates of Clostridium difficile infections and associated hospital length of stay, promoting judicious use of antibiotics, and minimizing associated adverse events. There is a significant overlap between the goals of infection control programs and ASPs, and both programs can benefit from a synergistic relationship. Hospital epidemiologists can support these programs by providing leadership support, sharing surveillance data, bridging gaps between ASPs and departments such as microbiology, integrating educational programs with ASPs, sharing outbreak alerts, and assisting with the development of treatment algorithms.
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Affiliation(s)
- Salma Abbas
- Division of Infectious Diseases, Virginia Commonwealth University, 1000 East Marshall Street, Suite 205, PO Box 980049, Richmond, VA 23298, USA
| | - Michael P Stevens
- Department of Hospital Epidemiology and Infection Control, Virginia Commonwealth University, North Hospital, 2nd Floor, Room 2-073, 1300 East Marshall Street, Richmond, VA 23298, USA; Department of Infectious Diseases, Virginia Commonwealth University, North Hospital, 2nd Floor, Room 2-073, 1300 East Marshall Street, Richmond, VA 23298, USA.
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Stachel A, Pinto G, Stelling J, Fulmer Y, Shopsin B, Inglima K, Phillips M. Implementation and evaluation of an automated surveillance system to detect hospital outbreak. Am J Infect Control 2017; 45:1372-1377. [PMID: 28844384 DOI: 10.1016/j.ajic.2017.06.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 06/27/2017] [Accepted: 06/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The timely identification of a cluster is a critical requirement for infection prevention and control (IPC) departments because these events may represent transmission of pathogens within the health care setting. Given the issues with manual review of hospital infections, a surveillance system to detect clusters in health care settings must use automated data capture, validated statistical methods, and include all significant pathogens, antimicrobial susceptibility patterns, patient care locations, and health care teams. METHODS We describe the use of SaTScan statistical software to identify clusters, WHONET software to manage microbiology laboratory data, and electronic health record data to create a comprehensive outbreak detection system in our hospital. We also evaluated the system using the Centers for Disease Control and Prevention's guidelines. RESULTS During an 8-month surveillance time period, 168 clusters were detected, 45 of which met criteria for investigation, and 6 were considered transmission events. The system was felt to be flexible, timely, accepted by the department and hospital, useful, and sensitive, but it required significant resources and has a low positive predictive value. CONCLUSIONS WHONET-SaTScan is a useful addition to a robust IPC program. Although the resources required were significant, this prospective, real-time cluster detection surveillance system represents an improvement over historical methods. We detected several episodes of transmission which would have eluded us previously, and allowed us to focus infection prevention efforts and improve patient safety.
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Fink R, Oder M, Stražar E, Filip S. Efficacy of cleaning methods for the removal of Bacillus cereus biofilm from polyurethane conveyor belts in bakeries. Food Control 2017. [DOI: 10.1016/j.foodcont.2017.05.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Topological pattern for the search of new active drugs against methicillin resistant Staphylococcus aureus. Eur J Med Chem 2017; 138:807-815. [PMID: 28734246 DOI: 10.1016/j.ejmech.2017.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/13/2017] [Accepted: 07/06/2017] [Indexed: 11/22/2022]
Abstract
Molecular topology was used to develop a mathematical model capable of classifying compounds according to antimicrobial activity against methicillin resistant Staphylococcus aureus (MRSA). Topological indices were used as structural descriptors and their relation to antimicrobial activity was determined by using linear discriminant analysis. This topological model establishes new structure activity relationships which show that the presence of cyclopropyl, chlorine and ramification pairs at a distance of two bonds favor this activity, while the presence of tertiary amines decreases it. This model was applied to a combinatorial library of a thousand and one 6-fluoroquinolones, from which 117 theoretical active molecules were obtained. The compound 10 and five new quinolones were tested against MRSA. They all showed some activity against MRSA, although compounds 6, 8 and 9 showed anti-MRSA activity similar to ciprofloxacin. This model was also applied to 263 theoretical antibacterial agents described by us in a previous work, from which 34 were predicted as theoretically active. Anti-MRSA activity was found bibliographically in 9 of them (ensuring at least 26% of success), and from the rest, 3 compounds were randomly chosen and tested, finding mitomycin C to be more active than ciprofloxacin. The results demonstrate the utility of the molecular topology approaches for identifying new drugs active against MRSA.
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Abstract
Timely identification of outbreaks of hospital-associated infections is needed to implement control measures and minimize impact. Survey results from 33 hospitals indicated that most hospitals lacked a formal cluster definition and all targeted a very limited group of prespecified pathogens. Standardized, statistically based outbreak detection could greatly improve current practice.
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Radonovich LJ, Bessesen MT, Cummings DA, Eagan A, Gaydos C, Gibert C, Gorse GJ, Nyquist AC, Reich NG, Rodrigues-Barradas M, Savor-Price C, Shaffer RE, Simberkoff MS, Perl TM. The Respiratory Protection Effectiveness Clinical Trial (ResPECT): a cluster-randomized comparison of respirator and medical mask effectiveness against respiratory infections in healthcare personnel. BMC Infect Dis 2016; 16:243. [PMID: 27255755 PMCID: PMC4890247 DOI: 10.1186/s12879-016-1494-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 02/18/2016] [Indexed: 12/04/2022] Open
Abstract
Background Although N95 filtering facepiece respirators and medical masks are commonly used for protection against respiratory infections in healthcare settings, more clinical evidence is needed to understand the optimal settings and exposure circumstances for healthcare personnel to use these devices. A lack of clinically germane research has led to equivocal, and occasionally conflicting, healthcare respiratory protection recommendations from public health organizations, professional societies, and experts. Methods The Respiratory Protection Effectiveness Clinical Trial (ResPECT) is a prospective comparison of respiratory protective equipment to be conducted at multiple U.S. study sites. Healthcare personnel who work in outpatient settings will be cluster-randomized to wear N95 respirators or medical masks for protection against infections during respiratory virus season. Outcome measures will include laboratory-confirmed viral respiratory infections, acute respiratory illness, and influenza-like illness. Participant exposures to patients, coworkers, and others with symptoms and signs of respiratory infection, both within and beyond the workplace, will be recorded in daily diaries. Adherence to study protocols will be monitored by the study team. Discussion ResPECT is designed to better understand the extent to which N95s and MMs reduce clinical illness among healthcare personnel. A fully successful study would produce clinically relevant results that help clinician-leaders make reasoned decisions about protection of healthcare personnel against occupationally acquired respiratory infections and prevention of spread within healthcare systems. Trial registration The trial is registered at clinicaltrials.gov, number NCT01249625 (11/29/2010).
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Affiliation(s)
- Lewis J Radonovich
- U.S. Department of Veterans Affairs, National Center for Occupational Health and Infection Control, 1601 SW Archer Road, Mailstop 151E, Gainesville, FL, 32608, USA.
| | - Mary T Bessesen
- Veterans Affairs Eastern Colorado Healthcare System, Denver, CO, USA.,University of Colorado School of Medicine, Denver, CO, USA
| | - Derek A Cummings
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,University of Florida, Gainesville, Florida, USA
| | - Aaron Eagan
- U.S. Department of Veterans Affairs, National Center for Occupational Health and Infection Control, 1601 SW Archer Road, Mailstop 151E, Gainesville, FL, 32608, USA
| | | | - Cynthia Gibert
- Veterans Affairs Medical Center and George Washington University School of Medical and Health Sciences, Washington, DC, USA
| | - Geoffrey J Gorse
- Veterans Affairs St. Louis Healthcare System and Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Ann-Christine Nyquist
- Children's Hospital Colorado, Aurora, CO, USA.,University of Colorado School of Medicine, Denver, CO, USA
| | - Nicholas G Reich
- Department of Biostatistics and Epidemiology, University of Massachusetts, Amherst, MA, USA
| | | | - Connie Savor-Price
- Denver Health, Denver, CO, USA.,University of Colorado School of Medicine, Denver, CO, USA
| | - Ronald E Shaffer
- National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Pittsburgh, PA, USA
| | | | - Trish M Perl
- Johns Hopkins School of Medicine, Baltimore, MD, USA
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Dovriki E, Gerogianni I, Petinaki E, Hadjichristodoulou C, Papaioannou A, Gourgoulianis K. Isolation and identification of nontuberculous mycobacteria from hospitalized patients and drinking water samples--examination of their correlation by chemometrics. ENVIRONMENTAL MONITORING AND ASSESSMENT 2016; 188:247. [PMID: 27021690 DOI: 10.1007/s10661-016-5258-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 03/17/2016] [Indexed: 06/05/2023]
Abstract
Nontuberculous mycobacteria (NTM) have been found to be widely dispersed in the environment and are being considered potentially pathogenic for humans and animals, while reports of their human to human transmission are absent. Water and aerosols are potential transmission modes of NTM to humans. Hospitalized patients with NTM infections were studied together with drinking water samples from their respective residence areas during 2003-2013. Cluster analysis and factor analysis were used to analyze the data matrix. A total of 367 hospitalized patients living in 30 localities in the Prefecture of Larissa were tested positive for NTM. The most frequently isolated NTM species of the 383 NTM isolates from the clinical specimens were Mycobacterium fortuitum (n = 118, 30.8 %), M. gordonae (n = 87, 22.7 %), M. peregrinum (n = 46, 12.0 %), M. chelonae (n = 11, 2.9 %), M. avium (n = 8, 2.1 %), and M. intracellulare (n = 7, 1.8 %), while 88 (23.0 %) of these isolates were not identified. It is noted that in 8 patients, M. tuberculosis was isolated simultaneously with one NTM, in 15 patients, together with two types of NTM, while in 1 patient, it was found at the same time as three different NTM. In addition, 3360 drinking water samples were collected from 30 localities and analyzed during 2010 to 2013; they were found 11.2 % NTM positive. Cluster analysis and factor analysis results confirm that NTM strains are correlated to each other in both isolated samples from patients and drinking water, while the strength of their correlation varied from weak to moderate (e.g., factor loadings ranged from 0.69 to 0.74 when all data are considered). These results provide indications that drinking water could be linked with NTM cases in humans.
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Affiliation(s)
- Eleni Dovriki
- Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece.
| | - Irini Gerogianni
- Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Efi Petinaki
- Department of Microbiology, Medical School, University of Larissa, Larissa, Greece
| | | | - Agelos Papaioannou
- Department of Medical Laboratories, Technological Education Institution of Thessaly, Larissa, Greece
| | - Kostas Gourgoulianis
- Department of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
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Loftus RW, Koff MD, Brown JR, Patel HM, Jensen JT, Reddy S, Ruoff KL, Heard SO, Yeager MP, Dodds TM. The epidemiology of Staphylococcus aureus transmission in the anesthesia work area. Anesth Analg 2015; 120:807-18. [PMID: 24937345 DOI: 10.1213/ane.0b013e3182a8c16a] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Little is known regarding the epidemiology of intraoperative Staphylococcus aureus transmission. The primary aim of this study was to examine the mode of transmission, reservoir of origin, transmission locations, and antibiotic susceptibility for frequently encountered S aureus strains (phenotypes) in the anesthesia work area. Our secondary aims were to examine phenotypic associations with 30-day postoperative patient cultures, phenotypic growth rates, and risk factors for phenotypic isolation. METHODS S aureus isolates previously identified as possible intraoperative bacterial transmission events by class of pathogen, temporal association, and analytical profile indexing were subjected to antibiotic disk diffusion sensitivity. The combination of these techniques was then used to confirm S aureus transmission events and to classify them as occurring within or between operative cases (mode). The origin of S aureus transmission events was determined via use of a previously validated experimental model and links to 30-day postoperative patient cultures confirmed via pulsed-field gel electrophoresis. Growth rates were assessed via time-to-positivity analysis, and risk factors for isolation were characterized via logistic regression. RESULTS One hundred seventy S aureus isolates previously implicated as possible intraoperative transmission events were further subdivided by analytical profile indexing phenotype. Two phenotypes, phenotype P (patients) and phenotype H (hands), accounted for 65% of isolates. Phenotype P and phenotype H contributed to at least 1 confirmed transmission event in 39% and 28% of cases, respectively. Patient skin surfaces (odds ratio [OR], 8.40; 95% confidence interval [CI], 2.30-30.73) and environmental (OR, 10.89; 95% CI, 1.29-92.13) samples were more likely than provider hands (referent) to have phenotype P positivity. Phenotype P was more likely than phenotype H to be resistant to methicillin (OR, 4.38; 95% CI, 1.59-12.06; P = 0.004) and to be linked to 30-day postoperative patient cultures (risk ratio, 36.63 [risk difference, 0.174; 95% CI, 0.019-0.328]; P < 0.001). Phenotype P exhibited a faster growth rate for methicillin resistant and for methicillin susceptible than phenotype H (phenotype P: median, 10.32H; interquartile range, 10.08-10.56; phenotype H: median, 10.56H; interquartile range, 10.32-10.8; P = 0.012). Risk factors for isolation of phenotype P included age (OR, 14.11; 95% CI, 3.12-63.5; P = 0.001) and patient exposure to the hospital ward (OR, 41.11; 95% CI, 5.30-318.78; P < 0.001). CONCLUSIONS Two S aureus phenotypes are frequently transmitted in the anesthesia work area. A patient and environmentally derived phenotype is associated with increased risk of antibiotic resistance and links to 30-day postoperative patient cultures as compared with a provider hand-derived phenotype. Future work should be directed toward improved screening and decolonization of patients entering the perioperative arena and improved intraoperative environmental cleaning to attenuate postoperative health care-associated infections.
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Affiliation(s)
- Randy W Loftus
- From the *Department of Anesthesiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; †The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; ‡Department of Anesthesiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa; §Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and ∥Departments of Anesthesiology and Surgery, University of Massachusetts Medical School and UMass Memorial Medical Center, Worcester, Massachusetts
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Loftus RW, Koff MD, Brown JR, Patel HM, Jensen JT, Reddy S, Ruoff KL, Heard SO, Yeager MP, Dodds TM. The Dynamics of Enterococcus Transmission from Bacterial Reservoirs Commonly Encountered by Anesthesia Providers. Anesth Analg 2015; 120:827-36. [DOI: 10.1213/ane.0000000000000123] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Kalyantanda G, Shumyak L, Archibald LK. Cronobacter Species Contamination of Powdered Infant Formula and the Implications for Neonatal Health. Front Pediatr 2015; 3:56. [PMID: 26191519 PMCID: PMC4489094 DOI: 10.3389/fped.2015.00056] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/01/2015] [Indexed: 11/13/2022] Open
Abstract
Cronobacter is a class of Enterobacteriaceae that cause infections in neonates, especially those born prematurely. Over 90% of these infections have been linked epidemiologically to powdered infant formula (PIF). Contamination of PIF can occur at manufacture, reconstitution, or storage of reconstituted product. Intrinsic properties that enable Cronobacter to cause disease include resistance to heat, ultraviolet radiation, oxygen radicals, stomach acids, and pasteurization; an ability to utilize sialic acid (a nutrition additive to PIF that facilitates the organism's growth and survival), and an exceptional affinity for biofilms in enteral feeding tubes. As part of ongoing endeavors to reduce the incidence of neonatal PIF-associated Cronobacter infections, the World Health Organization and the US Food and Drug Administration have established guidelines for PIF production, preparation for infant feeding, and storage of reconstituted product.
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Affiliation(s)
- Gautam Kalyantanda
- Division of Infectious Diseases, College of Medicine, University of Florida , Gainesville, FL , USA
| | - Lyudmila Shumyak
- Division of Infectious Diseases, College of Medicine, University of Florida , Gainesville, FL , USA
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Cleaning assessment of disinfectant cleaning wipes on an external surface of a medical device contaminated with artificial blood or Streptococcus pneumoniae. Am J Infect Control 2013; 41:901-7. [PMID: 23643450 DOI: 10.1016/j.ajic.2013.01.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 01/24/2013] [Accepted: 01/24/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Improperly cleaned, disinfected, or sterilized reusable medical devices are a critical cause of health care-associated infections. More effective studies are required to address the improvement of cleaning and disinfection instructions, as well as selection of cleaning and disinfecting agents, for surfaces of reusable devices and equipment. METHODS Six commercially available disinfectant cleaning wipes were evaluated for their effectiveness to remove a coagulated blood test soil or Streptococcus pneumoniae bacteria from the surface of a reusable medical device. Liquid aliquots of the coagulated blood or bacteria were dried onto the surface of the device and removed with the wipes. Effectiveness of the wipes was assessed by 3 methods: residual protein debris by o-phthaldialdehyde analysis, bacterial survival by adenosine triphosphate measurement, and force required to remove the dried debris by force measurement. RESULTS A sodium hypochlorite wipe was most effective in removing protein debris from the device surface. All tested wipes were equivalent in disinfecting bacterial contamination from the device surface. CONCLUSION The active ingredient, wipe design, and wipe wetness are important factors to consider when selecting a disinfectant cleaning wipe. Additionally, achieving conditions that effectively clean, disinfect, and/or inactivate surface bacterial contamination is critical to preventing the spread of health care-associated infections.
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Hui C, Lin MC, Jao MS, Liu TC, Wu RG. Previous antibiotic exposure and evolution of antibiotic resistance in mechanically ventilated patients with nosocomial infections. J Crit Care 2013; 28:728-34. [DOI: 10.1016/j.jcrc.2013.04.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 04/07/2013] [Accepted: 04/13/2013] [Indexed: 11/28/2022]
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Do wheelchairs spread pathogenic bacteria within hospital walls? World J Microbiol Biotechnol 2013; 30:385-7. [DOI: 10.1007/s11274-013-1458-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 08/06/2013] [Indexed: 12/22/2022]
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Abstract
<b><i>Hintergrund: </i></b>Postoperative Wundinfektionen gehören zu den häufigsten nosokomialen Infektionen. Die Zunahme von mehrfachresistenten gramnegativen Erregern bereitet gerade in der Viszeralmedizin besondere Sorge. <b><i>Methode und Ergebnisse: </i></b>Da nicht alle Risiken für nosokomiale Infektionen beherrschbar sind, können diese Infektionen niemals vollständig vermieden werden. Umso wichtiger ist es, die vorhandenen Maßnahmen konsequent anzuwenden, um den medizinischen Fortschritt, der in der Viszeralmedizin gerade auch durch neue endoskopische und operative Verfahren in den letzten Jahren erkennbar ist, nutzen zu können. Das Verständnis der Erreger und der Infektionsbiologie ist dabei genauso wichtig wie die Kenntnis der nötigen Präventionsmaßnahmen und ihre Einbindung in klinische Prozesse. Bei invasiven Maßnahmen greifen dabei mit dem Patientenweg, dem Weg der Instrumente, der sonstigen OP/Endoskopie-Materialien und Medikamente, der OP-Einrichtung und dem Team mehrere Prozesse ineinander. <b><i>Schlussfolgerung: </i></b>Eine optimale Infektionsprävention ist nur bei einer Optimierung aller Prozesse sowie ihrer Interaktion zu erreichen. Anhand einer Übersicht zu Epidemiologie, Risikofaktoren und Möglichkeiten zur Vermeidung von Infektionen in der Viszeralmedizin soll ein Beitrag geleistet werden, um Viszeralmediziner für das Thema Infektionsprävention und Hygiene zu sensibilisieren und die Patientensicherheit zu erhöhen.
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O'Brien TR. Editorial: epidemic-assistance investigations by the centers for disease control and prevention: the first 60 years. Am J Epidemiol 2011; 174:1211-2. [PMID: 22120937 DOI: 10.1093/aje/kwr336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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