Implementation of a national bundle care program to reduce catheter-associated urinary tract infection in high-risk units of hospitals in Taiwan

Background/purpose: This study was intended to investigate the impact of implementation of catheter-associated urinary tract infection (CA-UTI) bundle care on the incidence of CA-UTI in high-risk units. Methods: Thirteen high-risk units, including medical (n = 5), surgical (n = 3), cardiac intensive care units (n = 2), respiratory care centers (n = 2), and respiratory care ward (n = 1) were included in this quality-improvement project. This study was divided into pre-intervention phase (from January 1 to July 31) and post-intervention phase (from August 1 to October 31) in 2013. Results: The incidence of CA-UTI decreased by 22.7%, from 3.86 to 2.98 per 1000 catheter-days (95% confidence interval, 0.65–0.82; p < 0.0001) before and after the introduction of the CA-UTI bundle. Among 66 episodes of culture-proven CA-UTIs, Candida spp. were the most common pathogens (n = 17, 25.8%), followed by Escherichia coli (n = 10, 15.2%). For the seven elements of the insertion bundle, the compliance was the lowest for cleaning of the perineum, followed by hand hygiene. The overall compliance rates of the insertion bundle were 93.4%, 99.5%, and 96.3% in medical centers, regional hospitals, and district hospital, respectively. For the six elements of the maintenance bundle, the compliance was the lowest for daily review of the need of a Foley catheter. The overall compliance rates of the maintenance bundle were 95.7%, 99.9%, and 99.9% in medical centers, regional hospitals, and district hospital, respectively. Conclusions: The implementation of CA-UTI bundle care successfully reduced CA-UTI in Taiwanese high-risk units. A process surveillance checklist can be helpful for understanding which parts of the bundle care require improvements

Effect of Butyrate on Collagen Expression, Cell Viability, Cell Cycle Progression and Related Proteins Expression of MG-63 Osteoblastic Cells

<div><p>Aims</p><p>Butyric acid is one major metabolic product generated by anaerobic Gram-negative bacteria of periodontal and root canal infection. Butyric acid affects the activity of periodontal cells such as osteoblasts. The purposes of this study were to investigate the effects of butyrate on MG-63 osteoblasts.</p><p>Methods</p><p>MG-63 cells were exposed to butyrate and cell viability was estimated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The mRNA and protein expression of type I collagen and cell cycle-related proteins were measured by reverse-transcriptase polymerase chain reaction (RT-PCR), western blotting or immunofluorescent staining. Cellular production of reactive oxygen species (ROS) was analyzed by 2',7'-dichlorofluorescein (DCF) fluorescence flow cytometry.</p><p>Results</p><p>Exposure to butyrate suppressed cell proliferation, and induced G2/M (8 and 16 mM) cell cycle arrest of MG-63 cells. Some cell apoptosis was noted. The mRNA expression of cdc2 and cyclin-B1 decreased after exposure to butyrate. The protein expression of type I collagen, cdc2 and cyclin B1 were decreased, whereas the expression of p21, p27 and p57 was stimulated. Under the treatment of butyrate, ROS production in MG-63 cells markedly increased.</p><p>Conclusions</p><p>The secretion of butyric acid by periodontal and root canal microorganisms may inhibit bone cell growth and matrix turnover. This is possibly due to induction of cell cycle arrest and ROS generation and inhibition of collagen expression. These results suggest the involvement of butyric acid in the pathogenesis of periodontal and periapical tissue destruction by impairing bone healing responses.</p></div

Effect of butyrate (1–16 mM) on cellular ROS level of MG-63 cells.

<p>One representative histogram of DCF fluorescence in control MG-63 cell and MG-63 cells exposed to 1–16 mM butyrate. An increase in DCF fluorescence was noted, indicating an increase of ROS production. *denotes statistically significant difference when compared with untreated control (as 100) (P < 0.05).</p

Effect of butyrate on the cell viability of MG-63 cells.

<p>MG63 cells were exposed to various concentrations of butyrate for 5 days. *denotes significant difference when compared with control (P < 0.05).</p

Effect of butyrate on cell cycle distribution of MG-63 cells.

<p><b>(A)</b> The effect of different concentration of butyrate (0–16 mM) on G0/G1, G2/M, and S phase of MG-63 cells (5 x 10⁵ cells/well) after 24 hrs exposure time. *denotes significant difference when compared with control (P < 0.05). <b>(B)</b> The effect of different concentration of butyrate (0–16 mM) on sub G0/G1 population of MG-63 cells (5 x 10⁵ cells/well) after 24 hrs. *denotes significant difference when compared with control (P < 0.05).</p

Effect of butyrate on type I collagen protein expression of MG-63 cells.

<p><b>(A)</b> MG-63 cells were exposed to butyrate (1–16 mM) for 24 hours. Equal amount of proteins from cell lysates were used for western blotting. One representative western blotting picture was shown. Immunofluorescent analysis of type I collagen protein expression in MG-63 cells after treatment by 16 mM butyrate (control:0 mM), <b>(B)</b> Quantitative analysis for the effect of butyrate on collagen protein expression of MG-63 cells. Results were expressed as fold of control (as 1). *denotes statistically significant difference when compared with control. <b>(C)</b> Immunofluorescent analysis of type I collagen protein expression in MG-63 cells after treatment by 16 mM butyrate (control:0 mM), scale bar = 200 μm.</p

Effect of butyrate on cell cycle related genes and protein expression of MG-63 cells.

<p><b>(A)</b> Effect of butyrate on cell cycle related genes (cdc2, cyclinB1, and p21) expression in MG-63 cells. MG-63 cells were exposed to different concentration of butyrate (0–16 mM) for 24 hours. Total RNA was isolated and used for RT-PCR analysis of cellular gene expression. Expression of β–actin was used as control, <b>(B)</b> Effect of butyrate on cell cycle related proteins (cdc2, cyclin B1, p21, p27 and p57) expression in MG-63 cells. MG-63 cells were exposed to butyrate (1–16 mM) for 24 hours. Equal amount of proteins from cell lysates were used for western blotting. One representative western blotting picture was shown.</p