Surgical site infections surveillance and quality management in Polish hospitals

Wstęp: Celem niniejszej pracy jest prezentacja wyników uzyskanych w 33 polskich szpitalach w latach 2003-2004 w zakresie nadzoru nad zakażeniami miejsca operowanego z zastosowaniem narzędzia do oceny jakości pracy szpitalnych zespołów kontroli zakażeń oraz oddziałów chirurgicznych uczestniczących w badaniu szpitali, to znaczy standaryzowanego indeksu ryzyka jako benchmarking. Materiały i metody: Analizie poddano dane zebrane na oddziałach zabiegowych różnych specjalności w polskich szpitalach o zróżnicowanej strukturze własności oraz stopniu specjalizacji, prowadzących nadzór nad zakażeniami szpitalnymi i ich rejestrację metodą czynną. Program objął pacjentów poddanych zabiegom operacyjnym, u których przeprowadzono ponad 67 000 zabiegów. Rozpoznano 1544 przypadki zakażeń miejsca zoperowanego. Szczegółowej analizie poddano 14 kategorii procedur, zgodnych z programem National Nosocomial Infection System (NNIS). Wyniki: Średnia zachorowalność skumulowana wyniosła 2,7%, a najwyższą stwierdzono po zabiegach w zakresie jelita grubego, układu rozrodczego i po cięciach cesarskich, wartość współczynnika w sposób istotny zależała od typu zabiegu. Wnioski: Rozwój nadzoru nad zakażeniami, jaki nastąpił w polskich szpitalach w ostatnim dziesięcioleciu, umożliwił wprowadzenie nowoczesnej metody kontroli zakażeń, jaką jest celowany nadzór nad wybranymi populacjami pacjentów, oraz zaawansowanych analiz epidemiologicznych. Dużym problemem w polskich szpitalach pozostaje nadzór nad zakażeniami pojawiającymi się po wypisie pacjenta oraz brak dobrej współpracy zespołów kontroli zakażeń z personelem oddziałów, szczególnie na oddziałach ortopedycznych oraz położniczo-ginekologicznych.Background: This study aims at presenting data on Surgical Site Infections (SSIs) obtained from 33 Polish hospitals in the years 2003–2004 making use of a quality control tool - the Standardized Surgical Site Infection ratio (benchmarking) for estimation of work of the infection control teams and surgical wards from participating hospitals. Material and methods: In this study we used data collected from surgical wards of various specialties in Polish hospitals, conducting active nosocomial infections surveillance and registration programme. The hospitals were of different degree of specialisation and ownership. The programme encompassed patients undergoing surgical procedures with a total no. of 67 000 procedures. 1544 cases of SSIs were diagnosed. Detailed analyses were performed on 14 procedure types according to National Nosocomial Infection System (NNIS). Results: Average SSIs incidence was found to be 2.7%, with the highest incidence for colon and reproductive system procedures as well as cesarean sections. The incidence value depended strongly on the type of surgical procedure. Conclusions: The development of infections surveillance that evolved in Polish hospitals over the last decade, allowed to implement a modern method of infection control, i.e. targeted surveillance of selected patient populations and advanced epidemiological analyses. Post discharge surveillance and poor coopetion of infection control teams with the ward personnel still remain a big problem in Polish hospitals, especially in Orthopaedic as well as Obstetrics and Gynaecology wards

The dual role of Escherichia coli in the course of ulcerative colitis

BACKGROUND: This study examines the dual role of Escherichia coli in the course of ulcerative colitis (UC). The intestinal microbiota is considered to play an important role in UC pathogenesis, but how E. coli contributes to inflammation in UC is still unknown. On the one hand, we demonstrated that there was a significant increase in the number of E. coli at the sites of inflammation in patients with UC, which can lead to immune system activation, whilst, on the other hand, E. coli may contribute to the resolution of inflammatory reactions since E. coli can inhibit hydroxyl radical formation by eliminating substrates of the Fenton reaction, by assimilating ferrous iron (Fe(2+)) and inducing the decomposition of hydrogen peroxide (H(2)O(2)). On this way, E. coli may affect the initiation and/or prolongation of remission stages of UC. METHODS: Ten E. coli strains were isolated from the colonic mucosa of patients in the acute phase of UC. Using PCR, we examined the presence of genes encoding catalases (katG and katE) and proteins participating in iron acquisition (feoB, fepA, fhuA, fecA, iroN, fyuA, and iutA) in these E. coli strains. To determine if iron ions influence the growth rate of E. coli and its ability to decompose H(2)O(2), we grew E. coli in defined culture media without iron (M9(-)) or with ferrous ions (M9(Fe(2+))). Expression levels of genes encoding catalases were examined by real-time PCR. RESULTS: All investigated E. coli strains had catalase genes (katG, katE), genes coding for receptors for Fe(2+) (feoB) and at least one of the genes responsible for iron acquisition related to siderophores (fepA, fhuA, fecA, iroN, fyuA, iutA). E. coli cultured in M9(Fe(2+)) grew faster than E. coli in M9(-). The presence of Fe(2+) in the media contributed to the increased rate of H(2)O(2) decomposition by E. coli and induced katG gene expression. CONCLUSIONS: E. coli eliminates substrates of the Fenton reaction by assimilating Fe(2+) and biosynthesizing enzymes that catalyze H(2)O(2) decomposition. Thus, E. coli can inhibit hydroxyl radical formation, and affects the initiation and/or prolongation of remission stages of UC

Urinary and faecal incontinence in hospitals and nursing homes

Knowledge of infection control measures in urinary and faecal incontinence population is limited. This article aimed to assess the incidence of, and potential risk factors for, common and healthcare-associated infection

Visible light induced photocatalytic inactivation of bacteria by modified titanium dioxide films on organic polymers

Commercially available polypropylene foil was pretreated with a low temperature oxygen plasma and covered with a thin fi lm of nanocrystalline titanium dioxide by dip coating. The fi lms were then photos- ensitized by titanium( IV ) surface charge transfer complexes formed by impregnation with catechol. The photoactivity of the coatings up to 460 nm was con fi rmed by photoelectrochemical measurements. The photoinactivation of Escherichia coli and Staphylococcus aureus was evaluated by a glass adhesion test based on ISO 27447:2009(E) in the presence of visible light. The coating showed good antimicrobial activity induced by light from a light-emitting diode (405 nm), in particular towards E. coli ATCC 25922 strain. Adaptation of ISO 27447:2009(E) to assess bacterial photoinactivation by photocatalytic coatings will allow this procedure to be applied for the comparison of photoactivity under a range of irradiation conditions

Effect of a short-time probiotic supplementation on the abundance of the main constituents of the gut microbiota of term newborns delivered by cesarean section-a randomized, prospective, controlled clinical trial

The gut microbiota plays a pivotal role in the maintenance of human health. Numerous factors, including the mode of delivery, impact early gut colonization in newborns. Recent research focuses on the use of probiotics in the prevention of gut dysbiosis in newborns delivered by cesarean section (CS). The objective of this study was to determine whether a probiotic supplement given to newborns delivered by CS during their stay in the maternity ward alters the pattern of early gut colonization by lactic acid bacteria versus potential pathogens. A prospective, randomized trial was conducted. In total, 150 newborns, born at 38–40 weeks gestational age and delivered by CS, were included in the study. They were randomized into the intervention group, supplemented orally with a probiotic containing Bifidobacterium breve PB04 and Lactobacillus rhamnosus KL53A, and the control group. Stool samples were obtained on days 5 and 6 of life and after one month of life and were analyzed for the presence and abundance of the main groups of bacteria. An application of two probiotic bacteria during the first days of life after CS resulted in quick and abundant colonization by days 5 and 6, with high populations of L. rhamnosus and B. breve. The applied bacterial strains were present in the majority of neonates one month after. The supplementation of term neonates delivered by cesarean section immediately after birth with a mixture of L. rhamnosus and B. breve enriched the gut microbiota composition with lactic acid bacteria

Lactobacilli with superoxide dismutase-like or catalase activity are more effective in alleviating inflammation in an inflammatory bowel disease mouse model

Purpose: Some lactobacilli, which possess superoxide dismutase-like activity and catalase activity naturally, have strong antioxidative properties. The aim of this study was to identify such strains and check which of them play a crucial role in alleviating intestinal inflammation. Methods: We selected two Lactobacillus strains for use in animal studies: L. plantarum 30B (which has the highest catalase activity) and L. acidophilus 900 (which has the highest dismutase-like activity). Forty mice (C57B1/6J) were divided into four experimental groups with ten mice in each group. Group I (control group) was not supplemented with Lactobacillus, group II (catalase group) was orally supplemented with L. plantarum 30B, group III (dismutase-like group) was supplemented with L. acidophilus 900, and group IV (mixed group) was supplemented with both Lactobacillus strains. For 23 days, the temperature and body mass of each mouse were recorded and fecal samples for microbiological examination were collected. On day 23, the animals were sacrificed, and their intestines were removed for microbiological and histopathological studies. Results: Compared to the control group, the highest drop in the body temperature was observed in groups II (P,0.05) and IV (P,0.05). Similarly, groups II (P,0.05) and IV (P,0.05) had the highest drop in body mass. Moreover, histopathological evaluation of colon fragments showed intracryptic abscesses in these groups. Group III mice showed most limited degree of inflammation. Conclusion: Lactobacillus strains with dismutase-like activity are more effective in alleviating intestinal inflammation than strains producing catalase, suggesting that superoxide anion radical decomposition is crucial in this process

Effect of hydrogen peroxide of bacterial origin on apoptosis and necrosis of gut mucosa epithelial cells as a possible pathomechanism of inflammatory bowel disease and cancer

A series of in vitro experiments was arranged to assess effects of different concentrations of H2O2 contained in bacterial cultures on apoptosis and necrosis of HT-29 line cells representing human gut epithelium. On the basis of cytofluorimetric assays it was possible to demonstrate that supernatant of the Lactobacillus strain producing hydrogen peroxide (L. delbrueckii CU/22) was able to induce both apoptosis and necrosis in human epithelial culture cells HT-29. Both effects were more prominent than those visible under influence of supernatant of the non-H2O2-producing Lactobacillus strain or chemically pure H2O2 at the same concentration used as a control. In the light of this study and also other reports on damaging effects of hydrogen peroxide and superoxide radicals of bacterial origin on colonic cells, commensal bacteria of the human gut producing H2O2 may be involved in pathomechanisms of IBD by perpetuating the inflammatory reaction and increasing apoptosis and necrosis. There is a promise that probiotic preparations containing Lactobacillus bacteria will be successful as adjunct therapy of IBD and it is, therefore, postulated to make a very careful selection of the Lactobacillus strains as candidates for probiotics indicated to ameliorate the course of IBD, before starting clinical trials