Evaluation of Chlorhexidine Bathing Practices in Trauma/ Surgical Intensive Care Units

Central venous catheters (CVC) are vital in present-day medical practice, particularly in the intensive care unit (ICU). However, their use puts patients at risk for developing central line-associated bloodstream infections (CLABSIs) which are a major concern in today’s health care system. CLABSIs are a significant source of patient mortality, increased length of stay, and healthcare spending. The heightened awareness of these infections along with their escalating cost has amplified implementation of preventative protocols.This practice inquiry project includes three manuscripts, each of which discusses relevant aspects of CLABSIs prevention utilizing daily whole body chlorhexidine gluconate bathing inlcuding a review of literautre and cost benefit analysis. Along with an evaluation of provider adherence to an evidence-based CLABSI prevention guideline utilizing daily chlorhexidine gluconate patient bathing in two trauma/ surigcal ICUs in a level 1 Trauma Center

Strict Isolation Compliance: A Quality Improvement Initiative Implementation Process

This is a retrospective description and evaluation of an implementation process for a quality improvement initiative. The intent of the quality improvement initiative was to improve compliance with isolation as a means of reducing healthcare associated infections. The project evaluates the effectiveness of the implementation strategies through the lens of the Health Belief Modal and Watson\u27s theoretical framework. This evaluation considers the health beliefs of healthcare workers and the impact on behavior and implications of nurse as vigilant guardian, protecting the patients by decreasing the risk of acquiring an infection while receiving medical care. Integral to Watson\u27s theory is the intentional protecting of patients that is a basis to nursing care. Indeed, compliance with practices to protect patients from disease transmission is an important component of providing care. The outcomes of the evaluation will guide how future quality improvement initiatives are actualized to consider the health beliefs of healthcare workers and enhance the role of the nurse as a vigilant guardian

The Infectious Disease Ontology in the Age of COVID-19

The Infectious Disease Ontology (IDO) is a suite of interoperable ontology modules that aims to provide coverage of all aspects of the infectious disease domain, including biomedical research, clinical care, and public health. IDO Core is designed to be a disease and pathogen neutral ontology, covering just those types of entities and relations that are relevant to infectious diseases generally. IDO Core is then extended by a collection of ontology modules focusing on specific diseases and pathogens. In this paper we present applications of IDO Core within various areas of infectious disease research, together with an overview of all IDO extension ontologies and the methodology on the basis of which they are built. We also survey recent developments involving IDO, including the creation of IDO Virus; the Coronaviruses Infectious Disease Ontology (CIDO); and an extension of CIDO focused on COVID-19 (IDO-CovID-19).We also discuss how these ontologies might assist in information-driven efforts to deal with the ongoing COVID-19 pandemic, to accelerate data discovery in the early stages of future pandemics, and to promote reproducibility of infectious disease research

Patient safety in Europe: medication errors and hospital-acquired infections

The Report was commissioned by the European Federation of Nurses Associations (EFN) in November 2007 in order to support its policy statements on Patient Safety (June 2004). In that statement the EFN declares its belief that European Union health services should operate within a culture of safety that is based on working towards an open culture and the immediate reporting of mistakes; exchanging best practice and research; and lobbying for the systematic collection of information and dissemination of research findings. This Report adressess specifically the culture of highly reliable organisations using the work of James Reason (2000). Medication errors and hospital-acquired infections are examined in line with the Reprt´s parameters and a range of European studies are used as evidence. An extensive reference list is provided that allows EFN to explore work in greater detail as required

Food hygiene risks and related practices in central South African HIV/AIDS hospices : a qualitative assessment

Published ThesisPeople living with HIV are at risk of many life-threatening opportunistic infections, the majority of which are caused by exposure to unsafe drinking water and poor hygiene. In South Africa, hospices were established in response to the growing HIV/AIDS pandemic. Hospice is both a programme and a philosophy of care that is dedicated to improving the quality of life for patients with life-threatening illnesses. At the core of a hospice’s work is the concept of “palliative care”, which is defined by the World Health Organization (WHO) as the active total care of patients whose disease is not responsive to curative treatment, and whose goal is the achievement of the best quality of life for patients and their families. The need for palliative care in South Africa has increased with the escalation of HIV/AIDS. Moreover, resources to provide optimum quality healthcare in hospices are very limited. Food safety, synonymous with food hygiene, embraces all aspects of food processing, preparation and handling to ensure the safety thereof for consumption purposes. It has also been defined as the concept that food will not cause harm to the consumer when it is prepared and/or eaten according to the intended use. The meals prepared in a hospice have a remarkable associated safety risk, as they are prepared for vulnerable people who are more susceptible to foodborne illness than the rest of the population. During food preparation, micro-organisms can contaminate foods and storage environments, surfaces, tools, equipment and personnel engaged in handling and production activities (Clayton, Griffith, Price, Peters 2002 and Legnani, Leoni, Berveglieri, Mirolo and Alvaro 2003). Foodhandling practices in the domestic kitchen influence the risk of pathogen survival and multiplication, as well as cross-contamination to other products. Microbiological risk in the kitchen can be significantly reduced by preparing food properly. People, food and domestic animals, including water and bioaerosols, introduce pathogens continually into the home. these potential pathogens can enter the domestic kitchen via various routes, for example, raw foods and respiratory droplets. Various bacterial species can reside in the kitchen, food preparation rooms and storage facilities, and can be direct sources of food contamination. This is a particularly worrying issue for a hospice setting, where meals are prepared on a regular basis every day. Moreover, this is of great concern for a hospice set-up that has limited isolation facilities. This highlights the important role of food handlers in the transmission of foodborne infections, as the hands are probably the single most important transmission route. Consequently, the overall aim of the study was to assess food-related hygiene awareness and practices amongst hospice food handlers, and the associated food safety interventions. The study also identified the emerging food safety risks, including the antimicrobial susceptibility profile of potential foodborne pathogens isolated from the food preparation surfaces in the hospice kitchens and food handlers. In order to achieve this, the following objectives were defined for the study: to conduct an investigation into the hygiene awareness amongst staff of HIV/AIDS hospices using KAP (knowledge, attitudes and practices) as an information collection tool to characterise each hospice’s microbial profile; to compose and implement an intervention programme in selected hospices to improve the food safety awareness and practices; and, lastly, to evaluate the effectiveness of staff’s hygiene awareness and practice interventions. With regard to the KAP objective, it was found that the majority (68%) of the food handlers did not receive food safety training, whilst only 32% of the respondents had attended at least one formal training course on food hygiene. A descriptive survey of the food handlers’ knowledge regarding food safety demonstrated the equivalent of 66.8% correct answers. However, a substantial lack of knowledge regarding the correct temperature for a refrigerator, as well as hot, ready-to-eat food and cold, ready-to-eat food emerged. This was demonstrated by the fact that respectively only 39% and 32% of the respondents were informed about the correct holding temperature of hot and cold ready-to-eat food. Again, this shows that the food handlers in this study had insufficient knowledge regarding time temperature controls. Similar findings on the lack of adequate knowledge of food handlers regarding temperature controls have also been reported (Panchal, Bonhote and Dworkin 2013). This particular knowledge gap could possibly be attributed to a lack of training of food handlers in hospices on this important food-safety control measure. The majority (64%) of the respondents agreed that preparation of food in advance may contribute to the risk of food poisoning, whilst 68% of respondents were aware of the risks related to reheating dishes prior to consumption. To determine the antimicrobial susceptibility profile of the isolated foodborne pathogens, the minimum inhibitory concentration (MIC) was determined using the agar dilution method of the Clinical and Laboratory Standards Institute (CLSI). It was noted with concern that the isolated microbial strains are becoming increasingly drug resistant. For example, a 100% resistance of Acinetobacter baumannii strains to cefoxitin was noted. Although gentamicin is one of the most important antibiotics used in combination with other antibiotics worldwide for the treatment of S. aureus infections, this antibiotic was predominantly inactive against S. aureus in this study, since 75% of the organisms were resistant (MIC >16, range ≤0.25 ->16 mg.ml-1). Oxacillin also proved to have poor activity against the isolated organisms (MIC50 and MIC90, 8 and >16, range (0.25->16 mg.ml-1) respectively. Transmission of antibioticresistant bacteria in hospices and other healthcare facilities could be due to overcrowding and poor hygiene. The development and provision of food safety training courses are important to achieve behavioural changes, coupled with an improvement in skills and knowledge. Focus groups were also conducted with hospice food handlers to explore their food safety management systems, and to identify perceived barriers to implementing food safety practices. The following barriers were identified: lack of management support, inadequate resources, and inconvenient location of the pantry from the kitchen. Suboptimal kitchen infrastructure was also identified as a hurdle to implement safe food-handling practices. In response to the increasing need to educate food handlers about their responsibilities for assuring the safety of food during preparation and handling, food handler training, based on the WHO’s Five Keys to Safer Foods, was implemented as an intervention programme. Before training, 32% of food handlers believed that the same cutting board can be used for raw and cooked foods, provided that it looks clean, whilst 73% of respondents, after receiving training, knew that this could hamper food safety. A hazard categorization tool was developed in the course of the study, and it comprises five focus areas: infrastructure, food preparation facilities, sanitation, food handler training and hospice management

Infection Control in Dentistry and Drug-Resistant Infectious Agents: A Burning Issue. Part 1

Using molecular biological methods and retrospective investigations, some outbreaks in dental settings have been proven to be caused by mainly blood-borne viruses and water-borne bacteria. Nowadays, drug-resistant bacteria seem further hazards taking into account the worldwide overuse of antibiotics in dentistry, the limited awareness on infection prevention guidelines, and the lapses and errors during infection prevention (reported in more detail in Part 2). We chose MRSA and VRE as markers since they are considered prioritized bacteria according antibiotic resistance threats. Antibiotic-resistant bacterial infections inside of dental setting are relevant, and we argue about some hazards in dentistry, including dedicated surgeries. MRSA has a key role for its colonization in patients and dental workers, presence on gloves, resistance (days-months on dry inanimate surfaces), the contamination of different clinical contact surfaces in dental settings, the ability of some strains to produce biofilm, and finally its estimated low infective dose. For better dental patient and healthcare personnel safety, we need evidence-based guidelines to improve education and training initiatives in surgery

Infection Control in Dentistry and Drug-Resistant Infectious Agents: A Burning Issue. Part 1

Using molecular biological methods and retrospective investigations, some outbreaks in dental settings have been proven to be caused by mainly blood-borne viruses and water-borne bacteria. Nowadays, drug-resistant bacteria seem further hazards taking into account the worldwide overuse of antibiotics in dentistry, the limited awareness on infection prevention guidelines, and the lapses and errors during infection prevention (reported in more detail in Part 2). We chose MRSA and VRE as markers since they are considered prioritized bacteria according antibiotic resistance threats. Antibiotic-resistant bacterial infections inside of dental setting are relevant, and we argue about some hazards in dentistry, including dedicated surgeries. MRSA has a key role for its colonization in patients and dental workers, presence on gloves, resistance (days-months on dry inanimate surfaces), the contamination of different clinical contact surfaces in dental settings, the ability of some strains to produce biofilm, and finally its estimated low infective dose. For better dental patient and healthcare personnel safety, we need evidence-based guidelines to improve education and training initiatives in surgery

Psychological Case Record

DIAGNOSTIC CLARIFICATION: PERSISTENT SOMATOFORM PAIN DISORDER: Ms. M.S. presented with a 3 year history of refusing to go to school. Her performance started deteriorating and attendance started falling to below 20%. She started having less interaction with her family and friends. For the last 7 months she started complaining of pain in her feet starting from her toes and gradually progressing proximally. She stopped going to school altogether and started having crying spells frequently. She had been extensively evaluated by various specialists and no medical cause was found for the symptoms and hence she was referred to Child Psychiatry. PERSONALITY ASSESSMENT: HISTRIONIC PERSONALITY DISORDER: The patient is premorbidly described as a very adamant child, very short tempered. She presented with a 11/2 month history of sudden episodes of severe headache followed by stomache and then becoming unaware of her surroundings. Following this she has some altered behavior like shouting and abusing which settles immediately on taking a painkiller. This was precipitated by her Mathematics teacher making a remark about her work and giving her less marks on a project compared to a classmate. Recently the episodes would occur even on the slightest remark form her parents, teachers or friends. She was noticed to be more irritable, demanding of time and attention from her family, teachers and friends. ASSESSMENT OF COMPROMISED INTELLIGENCE: PROFOUND DEVELOPMENTAL DELAY: She has had delayed developmental milestones since birth. Currently she does not talk and has no self care skills. She does not communicate her needs and is fully dependent for self care activities. She started having generalized tonic clonic seizures since 8 months of age and has been on anti epileptic drugs since the past 4 months only. The seizures have continued , her last episode of seizure was 5 days ago. There was no history suggestive of any psychiatric morbidity. DIAGNOSTIC CLARIFICATION: OBSESSIVE COMPULSIVE DISORDER: BIPOLAR DISORDER: Mr. A.L. was apparently well till 2 years ago when he was noticed to be preoccupied a lot of the times. His performance in school started deteriorating slowly. He complained of reduced concentration in studies and reduced memory. He was taken to a psychiatrist where he complained that he had increased sexual thoughts related to watching sexual content in movies. He also complained that he was unable to focus on his academics due to this. Sometimes his finger would get paralyzed due to this and he was unable to write or do any work. He had disturbed sleep and appetite secondary to these problems. NEUROPSYCHOLOGICAL ASSESSMENT: POST ENCEPHALITIC SYNDROME: Ms. S.P. was apparently well till 2 months ago when she suddenly developed high grade fever with severe holocranial headache along with vomiting, which was followed by 3 episodes of generalized tonic clonic seizures. Since then she has been having multiple episodes of seizures. Also she was noticed to have abnormal behavior like shouting without any reason or provocation, anger outbursts and irritability. She was also noticed to have disinhibited behavior. She was noticed to be very restless, constantly pacing up and down and complaining of vague fear, occasionally muttering to herself and gesturing. Her sleep and appetite had markedly reduced. There was no history suggestive of mood disorder, anxiety or obsessive compulsive symptoms

Infection Control

Health care associated infection is coupled with significant morbidity and mortality. Prevention and control of infection is indispensable part of health care delivery system. Knowledge of Preventing HAI can help health care providers to make informed and therapeutic decisions thereby prevent or reduce these infections. Infection control is continuously evolving science that is constantly being updated and enhanced. The book will be very useful for all health care professionals to combat with health care associated infections