Can mupirocin prevent methicillin-resistant Staphylococcus aureus infections?

In a retrospective study, Dr Muller and colleagues have assessed the efficacy of mupirocin nasal ointment alongside hygienic measures in methicillin-resistant Staphylococcus aureus (MRSA)-positive patients admitted to the intensive care unit (ICU). Their findings, which suggest that intranasal mupirocin can prevent ICU-related MRSA infections, need confirmation in a well-designed clinical trial. In general: early identification, isolation and treatment of all MRSA carriers, including health care workers, and disinfection of contaminated environments, are the main 'ingredients' of an effective MRSA 'search and destroy' program

Continuous arteriovenous hemodiafiltration

As demonstrated by the above examples, in CAVHD blood access is usually obtained through femotal catheters, the blood flow rate is not routinely measured and the dialysate flow rate is arbitratily set to 1 to 2 L/hr. In this way, the treatment proved genetally effective. However, sometimes problems were encountered. In some patients frequent clotting of dialyzers occurred, probably because blood flow rate was too low. Sometimes plasma urea levels did not come down as quickly as we had expected or levels of phosphate were found to become too low. There was vinually no insight in the determinants of transpon rates and the dialysate flow rate that is necessary. It was not known to what extent CAVHD treatment had influence on the disappearance rate of drugs. Therefore, in 1989 a study was begun of the detenninams of blood flow rate, ultrafiltration and solute transpon rate in CAVHD, so as to be able to optimize CAVHD treatmentThe aims of this srudy can be sUllllilalized as follows: 1. Analysis of the determinants of blood flow rate. The resistance to flow rate of catheters and dialyzers was studied and the influence of blood viscosity was analyzed. A method was investigated for the determination of blood flow rate by using a probe outside the blood line. 2. Analysis of the determinants of ultrafiltration and convective rranspon rate. The transmembrane pressure difference and the hydraulic permeability of dialyzers were determined as well as the change in hydraulic permeability over time. Funhermore, the 'sieving coefficients' were determined for a number of clinically relevant solutes. 3. Analysis of the determinants of the diffusive transpon rate. A mathematical model of combined convection and diffusion was developed and used to determine the diffusive mass transfer coefficiem of a number

Proximal Esophageal Cancer

Proximal esophageal cancer (PEC) is a highly mortal cancer with a five-year survival rate of 30%. Because second primary tumors could decrease survival in PEC patients, this research is aiming at finding out about tumors associated with PEC and their infuence on survival. With the use of a database with PEC patients, diagnosed between 1989 and 2014, it was found that head and neck cancers (H&N) are the most prevalent previous tumor in PEC patients. Previous tumors have a negative effect on surivval. Prospective studies are needed to investigate on the effectiveness of prevention and surveillance methods for H&N patients

An analytical solution to solute transport in continuous arterio-venous hemodiafiltration (CAVHD)

In conventional intermittent hemodialysis, the overall mass transfer coefficient (Ko) of a dialyser is mostly calculated at zero ultrafiltration and at relatively high dialysate flow rates. In continuous arterio-venous hemodiafiltration (CAVHD), the dialysate flow rates are low as comparable to the rates of ultrafiltration flows, making the dialysis treatment as slow as possible. Therefore the overall mass transfer coefficient (Kd) of a CAVHD hemofilter has to be calculated in the presence of ultrafiltration. A mathematical model of CAVHD is presented in order to calculate the diffusive mass transfer coefficient (Kd) for a solute when blood, filtrate and dialysate flow rates and solute concentrations are known. The ultrafiltration volume flux (Jv) is assumed to vary linearly along the axial direction of the hemofilter. The calculated mass transfer coefficient Kd shows that at high values of dialysate flow and low values of ultrafiltration, the overall mass transfer coefficient (Kd) of a CAVHD hemofilter equals mass transfer coefficient (Ko) of a dialyser in conventional intermittent hemodialysis. Also, the calculated mass transfer coefficient Kd shows no significant differences when the ultrafiltration volume flux is assumed to be constant along the length of the hemofilter if no backfiltration occurs in the hemofilter

Incidence of surgical site infections cannot be derived reliably from point prevalence survey data in Dutch hospitals

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Brengt ultraschone lucht op de OK meer veiligheid?

• Het ‘Beheersplan luchtbehandeling voor de operatieafdeling’ (2005) beschrijft het beheer en het onderhoud van de luchtbehandelingsinstallatie. • In dit Beheersplan wordt een norm voorgesteld voor luchtkwaliteit op operatieafdelingen type 1, die is aangenomen door de Nederlandse Orthopedische Vereniging, doch niet door andere wetenschappelijke verenigingen. • De Britse studie die ten grondslag ligt aan de voorgestelde norm voor luchtkwaliteit van operatieafdelingen type 1 is van 1982, en onvoldoende gecorrigeerd voor profylaxe met antibiotica. Die profylaxe leidt op zich namelijk ook al tot minder postoperatieve wondinfecties. • Recentere studies naar ultraschone lucht op de operatieafdeling laten geen infectiepreventief effect zien. • Er ligt een ta

Nasal microbiome disruption and recovery after mupirocin treatment in Staphylococcus aureus carriers and noncarriers

Nasal decolonization procedures against the opportunistic pathogen Staphylococcus aureus rely on topical antimicrobial drug usage, whose impact on the nasal microbiota is poorly understood. We examined this impact in healthy S. aureus carriers and noncarriers. This is a prospective interventional cohort study of 8 S. aureus carriers and 8 noncarriers treated with nasal mupirocin and chlorhexidine baths. Sequential nasal swabs were taken over 6 months. S. aureus was detected by quantitative culture and genotyped using spa typing. RNA-based 16S species-level metabarcoding was used to assess the living microbial diversity. The species Dolosigranulum pigrum, Moraxella nonliquefaciens and Corynebacterium propinquum correlated negatively with S. aureus carriage. Mupirocin treatment effectively eliminated S. aureus, D. pigrum and M. nonliquefaciens, but not corynebacteria. S. aureus recolonization in carriers occurred more rapidly than recolonization by the dominant species in noncarriers (median 3 vs. 6 months, respectively). Most recolonizing S. aureus isolates had the same spa type as the initial isolate. The impact of mupirocin-chlorhexidine treatment on the nasal microbiota was still detectable after 6 months. S. aureus recolonization predated microbiota recovery, emphasizing the strong adaptation of this pathogen to the nasal niche and the transient efficacy of the decolonization procedure

Mediating scarcity in pandemic times: an ethnographic study on the prevention and control of SARS-CoV-2 infections during the emergence of the corona crisis in the Netherlands.

peer reviewed[en] BACKGROUND: In this paper we explore how staff involved with infection prevention managed the emerging COVID-19 crisis in the context of scarcity of Personal Protective Equipment (PPE), focussing specifically on the (re)writing of guidelines. We conceptualize guidelines as 'mediating devices' as they translate between evidence and clinical practice, between management and the workplace, as well as the different values embedded in these domains. It is this mediation, we argue, that adds to the resilience of healthcare organizations. The setting for this research is an elite academic hospital in the Netherlands during the emergence of the COVID-19 pandemic. METHODS: We conducted non-participative observations, semi-structured interviews, and document analysis during the emerging pandemic (March-July 2020). We observed meetings from the crisis team and the unit for infection prevention (210 hours), interviewed members of these teams (21 interviews) and analysed guidelines and flowcharts concerning infection prevention, as such collecting a unique and rich qualitative dataset. Analysis was done through thematic coding. RESULTS: Our results show the writing and rewriting of guidelines as a fundamental characteristic of dealing with scarcity and adding to resilience. We found three main practices our research participants engage in while trying to manage the uncertain situations emerging from the scarcity of personal protection equipment. The first practice we observe is defining safety; dealing with different perspectives and experiences of what 'working safely' means. The second entails the anticipation of scarcity by which our participants aim to control the situation through monitoring, research and creating scenarios. The third practice we observe is finding new ways to use PPE that is available, by experimenting and tinkering with the material. CONCLUSION: Infection prevention guidelines are crucial in managing the emerging crisis. We discuss how the writing of guidelines mediates between different settings, timeframes, and different worlds of quality. Through (re)writing there is a constant negotiation and discussion with the various actors about what works, and there is a continuous adaptive attitude. At the cost of a lot of work and struggle, this creates a resilient and inclusive work environment useful in a long-lasting crisis