Hospital Environment Research Articles

Parental Perspectives From the Survey of Sleep Quality in the PICU Validation Study on Environmental Factors Causing Sleep Disruption in Critically Ill Children.

Sleep promotion bundles being tested in PICUs use elements adapted from adult bundles. As children may react differently than adults in ICU environments, this study investigated what parents report disrupted the sleep of their child in a PICU. Secondary analysis of a multicenter validation study of the Survey of Sleep quality in the PICU. Four Northeastern U.S. PICUs, one hospital-based pediatric sleep laboratory. Parents sleeping at the bedside of a child in the PICU or hospital-based sleep laboratory. Anonymous one-time survey eliciting parts of hospital or ICU environments that have been described as disruptive to sleep in validated adult ICU and pediatric inpatient questionnaires. Level of sleep disruption was scored by Likert scale, with higher scores indicating more disruption. Age, demographics, baseline sleep, and PICU exposures were used to describe causes of sleep disruption in a PICU. Of 152 PICU parents, 71% of their children's sleep was disrupted significantly by at least one aspect of being in the PICU. The most prevalent were "being in pain or uncomfortable because they are sick" (38%), "not sleeping at home" (30%), "alarms on machines" (28%), and "not sleeping on their home schedule" (26%). Only 5% were disrupted by excessive nocturnal light exposure. Overall sleep disruption was not different across four PICUs or in those receiving sedation. The validation study control group, healthy children undergoing polysomnography, had less sleep disruption than those in a PICU despite sleeping in a hospital-based sleep laboratory. There are multiple aspects of critical care environments that affect the sleep of children, which are different from that of adults, such as disruption to home schedules. Future interventional sleep promotion bundles should include sedated children and could be applicable in multicenter settings.

Prevalence, risk factors, and characterisation of extended-spectrum β-lactamase -producing Enterobacterales (ESBL-E) in horses entering an equine hospital and description of longitudinal excretion

BackgroundExtended-spectrum β-lactamase -producing Enterobacterales (ESBL-E) are important zoonotic pathogens that can cause serious clinical infections, also in horses. Preventing the spread of ESBL-E, especially in the equine hospital environment, is key to reducing the number of difficult-to-treat infections. Estimating the local prevalence of ESBL-E in horses is crucial to establish targeted infection control programs at equine hospitals. We conducted a prevalence and risk factor study in equine patients on admission to an equine teaching hospital in Finland through a rectal ESBL-E screening specimen of the horse and a questionnaire.ResultsThe prevalence of ESBL-E in admitted horses was 3% (5/161, 95% CI 1–7%); none of the tested factors remained statistically significant in multivariate analysis, although antimicrobial treatment within three months was borderline significant (p = 0.052). Extended-spectrum β-lactamase -producing Klebsiella pneumoniae ST6179:CTX-M-15 was detected in three horses using whole-genome sequencing, which in combination with patient records suggested nosocomial transmission. Escherichia coli isolates were ST1250:CTX-M-1 (n = 1), ST1079:CTX-M-1 (n = 1), and ST1245:CTX-M-14 (n = 1). Multiple virulence genes were detected in the ESBL-E isolates. In the ESBL-E positive horses enrolled in a one-year follow-up study, ESBL-E were unlikely to be isolated in rectal screening specimens after the initial positive specimen.ConclusionsThe prevalence of ESBL-E in horses visiting a veterinary teaching hospital in Finland is low, indicating an overall low prevalence estimate in the country’s equine population. No statistically significant risk factors were identified, likely due to the low number of cases. The duration of ESBL-E carriage is likely to be very short in horses.

Baby-Friendly Hospitals, Social Determinants of Health, and Disparities in Breastfeeding Initiation in a Low-Income Population, 2017-2020.

Organizational-level interventions (i.e., Baby-Friendly Hospital Initiative) that support breastfeeding and target breastfeeding initiation are critical to reducing breastfeeding disparities and promoting breastfeeding equity. To determine the association between delivery in a Baby-Friendly accredited hospital and breastfeeding initiation among United States recipients of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Washington DC, the majority of whom report their race as Black. We conducted a secondary analysis of de-identified program data collected as part of routine WIC visits from the Washington DC WIC program, 2017-2020. Women who delivered a firstborn, singleton infant were included (N = 8,225). Multivariable logistic regression models accounted for social determinants of health and other factors. One set of models included a binary exposure variable (Baby-Friendly accredited vs. non-accredited hospitals), and another set included a categorical exposure variable for hospitals (1) Baby-Friendly accredited, (2) Baby-Friendly activities but not accredited, and (3) neither Baby-Friendly activities nor accredited. Breastfeeding initiation was 57.4% (n = 1988) for women delivering in accredited hospitals versus 55.4% (n = 2540) in non-accredited hospitals and multivariable model results were non-significant (OR = 0.95, 95% CI [0.86, 1.05]). However, more women initiated breastfeeding who delivered in either accredited hospitals (57.4%, n = 1988) or hospitals with Baby-Friendly activities but not accredited (55.9%, n = 2430) compared to those delivering in hospitals with neither (45.3%, n = 110), and multivariable models results concurred (Baby-Friendly accredited hospitals OR = 1.44, 95% CI [1.07, 1.94]; Baby-Friendly activities but not accredited, (OR = 1.55, 95% CI [1.16, 2.09]). Organizational-level interventions that create hospital environments supportive of breastfeeding initiation are important to promote equity in breastfeeding, but underlying social determinants of breastfeeding outcomes must be addressed.

No Place to Go: The Relationship Between Care Partner Inclusion Practices and the Hospital Environment.

The objective of this was to explore how the physical environment in a hospital contributes to care partner inclusion practices. Despite their vital efforts in caring for people living with dementia (PLWD), care partners of PLWD often report feeling not included in their loved ones' hospitalizations. This phenomenon goes against research, policy initiatives, and hospital design frameworks that underscore the importance of including care partners in hospital care. To ensure that care partners are systematically included in hospital care, health systems must create an environment that prioritizes care partners' presence. This descriptive qualitative design employs a multimethod approach to data collection. Our team conducted direct observations in a large academic hospital and interviewed 23 clinicians/administrators and 15 care partners of PLWD to understand the relationship between hospital environments and care partner inclusion. Observational data were analyzed using a framework analysis, and interview data were analyzed through thematic analysis. Direct observations revealed an underutilization of environmental resources such as family-centered spaces and environmental communication tools. Interview data revealed that adequate space for care partners, the layout of patient rooms, parking accessibility, room personalization, and comfort level of the hospital space all impact care partner inclusion. Our findings highlight opportunities for health systems to create hospital environments that support PLWD and their care partners. In pursuit of systematic care partner inclusion, health systems can make adequate space for care partners, allocate dementia-friendly parking spaces, increase utilization of environmental communication tools, and increase comfort level of the environment.

Near-zero magnetic field disturbance suppression method based on adaptive filtering and quasi-proportional resonance control

The cardiac magnetic field used for magnetocardiographic (MCG) imaging must be detected in a stable near-zero magnetic field environment. In the hospital environment, there are mainly two kinds of magnetic field disturbances that affect the signal-to-noise ratio of cardiac magnetic field detection. One is the magnetic field disturbance with high power spectral density at a specific frequency, and the other is the random magnetic field disturbance with low frequency. To suppress magnetic field disturbances, this paper proposed a near-zero magnetic field disturbance suppression method that combined a PI controller with adaptive filtering and quasi-proportional resonance control (PI-APF-QPR). The magnetic field disturbance with high amplitude and specific frequency was extracted by the adaptive filter (APF) and suppressed by the quasi-proportional resonance (QPR) controller. Additionally, the low-frequency random disturbance was suppressed by the PI controller. The experimental results showed that compared with the PI controller, the peak-to-peak value of the magnetic field by the PI-APF-QPR controller was reduced by 39.1%, and the suppression ratio of the magnetic field noise by the PI-APF-QPR controller was improved by 29.5%, which verified the effectiveness of the proposed magnetic field disturbance suppression method.

Prevention of contaminated aerosol and the transmission during nebulized therapy in hospital settings: a systematic review

Inhalation nebulization therapy is important for administering medications to patients in aerosolized form. However, there are persistent apprehensions in healthcare settings regarding aerosol contamination because of the significant infection risk. Despite rigorous adherence to established hospital protocols, concerns about potential contamination and transmission persist, raising considerable apprehension about nosocomial pneumonia. This condition shows the urgent need for implementing highly effective strategies to ensure patient safety during nebulization therapy. Therefore, this study aimed to review current investigations, focusing on interventions to mitigate aerosol contamination and minimize the transmission of contaminated aerosols.Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this systematic review included an exhaustive analysis of randomized and non-randomized clinical trials as well as, simulated experimental and in vitro studies published in English in the past decade. A meticulous search was conducted across four major databases, namely ScienceDirect, Cumulative Index to Nursing & Allied Health (CINAHL), PubMed, and Scopus. A total of 37 pertinent studies were identified and subjected to rigorous analysis.The preventive measures include a range of strategies, such as the use of masks by therapists, thorough disinfection of nebulizers, integration of filters, and regular environmental cleaning in the vicinity of the patient.In conclusion, these multifaceted interventions are significant in preventing the administration of contaminated aerosols and curbing the proliferation of infectious agents in the hospital environment.

SP8.13 - Exploring General Surgeons' Experiences of Adverse Events Perceptions of Support: A Scoping Review and Qualitative Study of General Surgical Trainees

Abstract Aims This study aimed to deepen understanding of the psychosocial impacts of adverse events on general surgical trainees and evaluate the experiences of current support mechanisms. Methods The study was conducted in two parts: a scoping review and a qualitative focus group study. The scoping review was conducted in accordance with the PRISMA-ScR guidelines and JBI methodology. These themes were taken forward for extended discussion as part of a focus group study of general surgical trainees (n = 10; split in two discrete groups of five participants). Reflexive thematic analysis using anonymised transcripts and contemporary field notes were used to analyse the data. Results The scoping review identified six themes related to the impact of adverse events on surgeons' well-being and professional performance. These were clarified and elaborated on through qualitative analysis of focus group data, developing three key themes with associated subthemes: (1) Support structures and external factors influencing responses to adverse events, (2) impact on clinical practice and professional development and (3) methods of learning from adverse events. Surgical trainees experience significant emotional and professional repercussions in the aftermath of adverse events, often exacerbated by insufficient formal support and a prevalent blame culture within hospital environments. Conclusions Substantial deficiencies exist in the support structures available to surgical trainees dealing with adverse events. It is evident that the existing systems fail to adequately address the complex needs of trainees, leading to significant emotional distress and professional insecurity. System changes are necessary for surgical trainees, including the establishment of mentorship and peer support networks.

Phenotypic and genotypic determination of resistance to common disinfectants among strains of Acinetobacter baumannii producing and non-producing biofilm isolated from Iran

BackgroundNosocomial infections are a global problem in hospitals all around the world. It is considered a major health problem, especially in developing countries. The increase in the patient’s stay in hospitals has increased the mortality rate, and consequently, the costs drastically increase. The main purpose of using disinfectants in the hospital environment is to reduce the risk of nosocomial infections. Ethylene diamine tetra acetic acid (EDTA) causes lysis and increases susceptibility to antimicrobial agents in the planktonic form of bacteria. This substance affects the permeability of the outer membrane of bacteria. It also prevents the formation of biofilms by bacteria.Materials and methodsIn the current study, 120 isolates of Acinetobacter baumannii (A. baumannii) were confirmed by phenotypic and genotypic methods. Antibiogram was performed and then the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of isolates against 5% sodium hypochlorite, ethanol %70, sayasept-HP 2%, chlorhexidine 2%, dettol 4/8% were evaluated. In addition, the disinfectant effect was re-evaluated with the mixture of EDTA solution. All isolates were examined for biofilm presence by crystal violet staining method in triplicates and repeated three times for each strain. Also for all isolates detection of efflux pump genes (Qac-E, qacE-Δ1, SUG-E) by PCR technique was done.ResultsAntibiogram results of A. baumannii showed that 6.7% were Multi-drug-resistant (MDR), and 89.2% were Extensively drug-resistant (XDR) isolates. The highest effect of disinfectants was related to 5% sodium hypochlorite, and the least effect was 70% ethanol. EDTA increases the efficacy of selected disinfectants significantly. The highest prevalence of the efflux pump genes was related to SUG-E (95%) and Qac-E (91.7%), and, the qacE-Δ1 gene with 12.5%. The biofilm production rate was 91.3% among all isolates.ConclusionThe best and safest way to disinfect hospital floors and surfaces is to choose the right disinfectants, and learn how to use them properly. In this study, a mixture of disinfectants and EDTA had a significant effect on bactericidal activity. it was found that improper use of disinfectants, especially the use of sub-inhibitory dilutions, increases the resistance of bacteria to disinfectants.

Italian Version of the Hospital Aggressive Behaviour Scale-Users: Initial Psychometric Evaluation among Hospital Healthcare Professionals.

Healthcare professionals frequently encounter various forms of aggression, ranging from verbal abuse to physical assaults, which can compromise both their occupational well-being and patient-care quality. Despite its prevalence and serious consequences, workplace aggression is often underreported due to a lack of standardized assessment tools. This study aims to develop a valid Italian version of the Hospital Aggressive Behaviour Scale-Users. The scale's structure was evaluated using exploratory (EFA) and confirmatory (CFA) factor analyses on two samples of healthcare professionals during and after the pandemic. Reliability, measurement invariance, and nomological validity were examined. EFA revealed a two-factor structure comprising eight items (χ2 = 59.651, df = 13, p = 0.00; CFI = 0.98; TLI = 0.95; RMSEA = 0.07; SRMR = 0.02), distinguishing non-physical and physical aggression, and meeting all recommended criteria. CFA confirmed this structure, demonstrating good reliability and outperforming alternative models. The same factor structure was confirmed in standard (χ2 = 35.01, df = 19, p = 0.00; CFI = 0.99; TLI = 0.99; RMSEA = 0.03; SRMR = 0.02) and emergency (χ2 = 30.65, df = 19, p = 0.04; CFI = 0.98; TLI = 0.97; RMSEA = 0.06; SRMR = 0.04) contexts. Full residual invariance was found across job tenure groups. Aggression was positively associated with emotional exhaustion, psychological distance, psychosomatic symptoms, post-traumatic stress symptoms, and turnover intentions while negatively related to job satisfaction. Nurses and healthcare assistants reported higher levels of aggression than doctors. This study provides a reliable, context-specific instrument for documenting and analysing outsider aggression. The insights can inform targeted interventions, contributing to a healthier hospital environment.

Penetrating Barriers: Noncontact Measurement of Vital Bio Signs Using Radio Frequency Technology.

The noninvasive measurement and sensing of vital bio signs, such as respiration and cardiopulmonary parameters, has become an essential part of the evaluation of a patient's physiological condition. The demand for new technologies that facilitate remote and noninvasive techniques for such measurements continues to grow. While previous research has made strides in the continuous monitoring of vital bio signs using lasers, this paper introduces a novel technique for remote noncontact measurements based on radio frequencies. Unlike laser-based methods, this innovative approach offers the advantage of penetrating through walls and tissues, enabling the measurement of respiration and heart rate. Our method, diverging from traditional radar systems, introduces a unique sensing concept that enables the detection of micro-movements in all directions, including those parallel to the antenna surface. The main goal of this work is to present a novel, simple, and cost-effective measurement tool capable of indicating changes in a subject's condition. By leveraging the unique properties of radio frequencies, this technique allows for the noninvasive monitoring of vital bio signs without the need for physical contact or invasive procedures. Moreover, the ability to penetrate barriers such as walls and tissues opens new possibilities for remote monitoring in various settings, including home healthcare, hospital environments, and even search and rescue operations. In order to validate the effectiveness of this technique, a series of experiments were conducted using a prototype device. The results demonstrated the feasibility of accurately measuring respiration patterns and heart rate remotely, showcasing the potential for real-time monitoring of a patient's physiological parameters. Furthermore, the simplicity and low-cost nature of the proposed measurement tool make it accessible to a wide range of users, including healthcare professionals, caregivers, and individuals seeking to monitor their own health.

The efficiency evaluation of traditional Chinese medicine hospitals by data envelopment analysis in Zhengzhou, China.

This study aimed to evaluate the operational efficiency of traditional Chinese medicine (TCM) hospitals in China. Pearson's analysis was used to test the correlation between the input and output variables. Data envelopment analysis (DEA) was utilized to analyze the input and output variables of 16 TCM hospitals, and each hospital efficiency score was computed by Deap 2.1, assuming variable return to scale (VRS), which is an input-oriented model. t tests were conducted to confirm the significant difference of efficiency scores at the hospital level and by hospital type, and ANOVA was used to test for significant differences in efficiency scores according to hospitals' size. The correlation coefficient of the input and output indicators was between 0.613 and 0.956 (p < 0.05). The difference in number of doctors (ND) and numbers of pharmacists (NP) were statistically significant (p < 0.05) at the hospital level. The mean efficiency scores for technical efficiency (TE), pure technical efficiency (PTE), and scale efficiency (SE) in secondary TCM hospitals were 0.766, 0.919, and 0.838, respectively. Additionally, the lowest TE, PTE, and SE were 0.380, 0.426, and 0.380, respectively. Eight TCM hospitals in this study were DEA efficient, with an efficiency score of 1. There were no statistically significant differences in TE, PTE, and SE among hospital levels, hospital types or hospital sizes groups (p > 0.05). This study revealed that tertiary TCM hospitals had a greater level of efficiency than secondary TCM hospitals. In our study, 50% of TCM hospitals had inefficient management. Therefore, to activate the new development power of TCM hospitals, it is necessary to reform and improve the management system and mechanism of TCM hospitals, optimize the development environment of TCM hospitals and formulate development plans and measures based on local conditions.

Examining the audiovisual therapy effects on hospital groups of varying linear canopy landscapes and those with hydrodynamic forces.

Recent research has highlighted the beneficial effects of urban green spaces on physical and mental health. This study focused on the hospital population and innovatively subdivided the population into four groups: doctors, caregivers, patients and nurses. A total of 96 volunteers participated in this virtual reality experiment to assess the restoration of a linear canopy landscape and a landscape with different levels of hydrodynamics through interactive audiovisual immersion. We utilized pre-research method, brainwave monitoring technique, psychological scales, observation and interviews in this experiment. The research identified five key findings. First, both linear canopy landscapes and those with low to medium hydrodynamic forces significantly enhance physiological and psychological restoration for all groups, with the most substantial physiological benefits observed in doctors and patients, and the greatest psychological relief noted in caregivers. Second, landscapes with medium hydrodynamic forces yield higher restorative effects than those with low forces in hospital settings. Third, green landscapes with medium and low-density canopies prove more conducive to patient recovery compared to those with high-density canopies. Fourth, the inclusion of bird songs does not markedly affect physiological restoration across the hospital groups. Finally, landscapes that incorporate elements of water dynamics, open skies, and lightly foliated canopies draw significant interest from all groups involved. This study advocates for the integration of natural blue and green elements into hospital environments as complementary therapeutic interventions, aiming to alleviate stress and promote health recovery among hospital communities.

Harnessing next-generation sequencing to monitor unculturable pathogenic bacteria in the indoor hospital building

The hospital indoor air microbiome, a diverse range of microorganisms, gains prominence amid the COVID-19 pandemic. Elevated awareness underscores implications for patient and staff well-being. Concerns about risks to indoor air quality persist due to prolonged indoor exposure, necessitating further research on specific threats within the hospital environment. In this study, an independent culture-based approach was used to analyze the baseline core microbiome present in hospital environments, utilizing amplicon sequencing on the next-generation sequencing technology to target the V3 region of the 16S rRNA gene. Firmicutes, Proteobacteria, and Actinobacteria were the main bacterial phyla that were most isolated from the wards and clinics with different orders of abundance; Firmicutes being associated more in clinics and Actinobacteriota in wards. The bacteria Niallia taxi, Methyloversatilis universalis, unclassified Rummeliibacillus, unclassified Clostridium, and unclassified Sphingomonadaceae dominated the clinic area while ward areas reported Pseudonocardia bannensis, Rubrobacter aplysinae, unclassified Brachybacterium, unclassified Bradyrhizobium, and unclassified Mycobacterium to be the top five features. While the alpha-diversity index showed no significant differences, the beta-diversity analysis showed a significant difference between clinic and ward areas (p<0.05). Certain bacterial species associated with opportunistic pathogens as well as normal skin flora such as Methylobacterium spp., Cutibacterium spp., unclassified Sphingomonadaceae, and Anoxybacillus B spp., were also identified across all samples. The methods described in this research aim to establish a rapid and sensitive screening process that could be valuable for disease surveillance within the healthcare setting, shedding light on the potential impacts of the hospital microbiome on human illness.

Effectiveness of water system chemical disinfection against Pseudomonas aeruginosa infections, despite a not-so-obvious connection

Pseudomonas aeruginosa is a well-recognized opportunistic pathogen frequently responsible for hospital-acquired infections. Acquisition routes of P aeruginosa are both endogenous and exogenous, including transmission from a portion of the hospital water system. The impact of disinfection procedures of the water system and description routes of P aeruginosa transmission in a surgical intensive care unit over a 2-year period were investigated. Two distinct periods A and B were considered, respectively, before and after the disinfection. Fourier transform infrared spectroscopy was used to compare isolates recovered from patients and tap water. Overall, 21.3% of tap water samples were positive but with a significantly lower rate in period B. Concomitantly, the prevalence of patients positive for P aeruginosa decreased from 2.6% to 1%, suggesting a correlation between the presence of environmental sources and patient contaminations. The results revealed that 18% of patients were involved in cross-transmission events not related to any isolate recovered from water, suggesting transmission through care practices. Conversely, only 1 environmental transmission event was suspected in a patient. Although the link between the hospital environment and patients was unclear, HCW-associated care practices could be related to contaminated point-of-use waters and then indirect spreading to patients.

Phenotypic and genotypic identification of class C and D β-lactamases in clinical isolates of Pseudomonas aeruginosa: a cross-sectional study.

The emergence of Pseudomonas aeruginosa (P. aeruginosa) antibiotic resistance is an important public health problem worldwide that can negatively affect infection control. Therefore, obtaining knowledge about antibiotic resistance mechanisms is necessary for infection control policies. This study aimed to determine the frequency of class C and D β-lactamases in P. aeruginosa strains isolated from patients referred to Ardabil hospitals using phenotypic and genotypic tests. Phenotypic detection of β-lactamases including AmpC cephalosporinase, oxacillinase (OXA)-type extended-spectrum β-lactamases (ESBLs), and OXA-type carbapenemases were performed using the disk diffusion-based methods. Amplification of genes encoding classes C (ampC and FOX genes) and D (OXA-1, OXA-2, OXA-10, OXA-23, and OXA-48 genes) β-lactamases was performed using the polymerase chain reaction (PCR) method. A quantitative reverse transcription PCR (qRT-PCR) method was used to determine the expression level of the ampC gene among multiple drug-resistant and imipenem-resistant P. aeruginosa strains. In phenotypic tests, the prevalence of AmpC cephalosporinase, OXA-type ESBLs, and OXA-type carbapenemases were 52.5%, 7.2%, and 95.8%, respectively. In genotypic tests, the prevalence of ampC, FOX, OXA-1, OXA-2, OXA-10, OXA-23, and OXA-48 genes were 100%, 0%, 4.3%, 60.8%, 42%, 29.7%, and 2.9%, respectively. In addition, the ampC gene overexpression was seen in 16 (33.3%) drug-resistant P. aeruginosa clinical isolates. Given the presence of class C and D β-lactamases in clinical isolates of P. aeruginosa in Ardabil hospitals, early detection of these strains can help prevent the spread of resistant strains in hospital environments and subsequent treatment failure.

Klebsiella Pneumoniae – Taxonomy, Occurrence, Identification, Virulence Factors and Pathogenicity

Abstract Gram-negative bacilli Klebsiella pneumoniae are among the most important pathogens responsible for healthcare-associated infections (HAIs). These bacteria often have high pathogenic and epidemic potential, contributing to infection outbreaks worldwide. K. pneumoniae is part of the natural microbiota of humans. At the same time, as an opportunistic microorganism, when the host organism is weakened, it can cause serious infections such as pneumonia, urinary tract infections, septic infections and intra-organ abscesses. Widespread distribution in nature and exceptional adaptability provide K. pneumoniae with the opportunity to master new niches in the hospital environment, which poses a threat to hospitalized patients. Also, the bacteria are increasingly causing life-threatening infections in the non-hospital environment. The pathogenicity of K. pneumoniae is determined by the presence of many virulence factors such as capsular polysaccharide (CPS, K antigen), lipopolysaccharid (LPS, O antigen), fimbrial and non-fimbrial adhesins, siderophores (aero-bactin, enterobactin, salmochelin and yersiniabactin), heat-stabile and heat-labile enterotoxins, cytotoxins and biofilm-forming ability. Currently, hypervirulent strains of K. pneumoniae (hvKp) equipped with new virulence traits constitute a significant danger. The paper presents these bacteria concerning the global threat arising from the dynamic spread of hvKp strains in hospitals in Poland and worldwide.

Pheno- and Genotypic Epidemiological Characterization of Vancomycin-Resistant Enterococcus faecium Isolates from Intensive Care Unit Patients in Central Türkiye.

Vancomycin-resistant Enterococcus faecium (VRE) has been detected in Türkiye. Only limited information is available on its dissemination in the central regions of the country. This study describes the first epidemiological characterization of VRE clinical isolates detected in patients in a hospital in the province of Aksaray. In this one-year study conducted between 2021 and 2022, stool samples from intensive care unit patients were screened for VRE using the phenotypic E-test method, and the antibiotic sensitivity test was analyzed by using the VITEK® 2 system. A molecular assay for confirmation of species level was carried out by 16S rRNA gene-based sequencing and testing for antibiotic resistance (vanA or vanB) and virulence factor-encoding genes (esp, asa1, and hyl). Further, genotypic characterization was determined by macro-restriction fragment pattern analysis (MRFPA) of genomic DNA digested with SmaI restriction enzyme. Of the total 350 Enterococcus positive patients from different hospital intensive care units, 22 (6.3%) were positive for VRE using the phenotypic E-test method. All isolates showed resistance to ampicillin, ciprofloxacin, vancomycin, and teicoplanin and positive amplification for the vanA gene. However, none of the isolates was positive for the vanB gene. The most prevalent virulence gene was esp. The results indicate that the isolates are persistent in the hospital environment and subsequently transmitted to hospitalized patients, thus representing challenges to an outbreak and infection control. These study results would also help formulate more effective strategies to reduce the transmission and propagation of VRE contamination in various hospital settings.

Office Practice Customer Service Plan

Quint Studer revolutionized the hospital environment with his programs in customer service and excellence. Although some of Studer’s initiatives can be used in the office practice environment, overall application is not ideal. The information here should complement the Studer standards and provide best-practice components for customer service in the office practice environment.

Stability of Epinephrine in a Normal Saline Solution

Objective Dilution of concentrated epinephrine prior to intravenous use during clinical emergencies can delay urgent interventions. The objective of this study was to determine whether diluted epinephrine remains stable and sterile over time in common hospital settings. Methods Epinephrine samples were prepared by clinically relevant double dilution techniques. Samples were stored in 10-mL syringes and incubated under 1 of 4 simulated hospital environments with a mixture of lighting and temperature settings: 4°C/20°C, with or without fluorescent lighting. Samples were incubated for 0, 15, 30, 60, or 90 days. Capillary zonal electrophoresis was used to quantify the concentration of epinephrine and/or presence of any degradation products. All samples were tested for the presence of bacterial growth using blood agar cultures. Results Diluted epinephrine samples remained stable for up to 90 days in all 4 simulated clinical storage conditions. No bacterial colony-forming units were detected in any of the environmental samples regardless of incubation duration, light, or temperature conditions. Conclusion Diluted epinephrine for anticipated clinical emergencies may remain clinically useful for up to 90 days, thus improving patient safety, access to medications, and overhead costs by reducing waste.

Identification, Antibiotic Profiling of Potential Pathogenic Bacteria from Fomites in Neonatal Intensive Care Units in a Tertiary Teaching Hospital of North Karnataka

This study was taken up to determine the prevalence of potential pathogens in most touched fomites in Neonatal Intensive Care Units (NICUs) and to determine their antibiogram. Fifty swabs each were collected from fomites from In-born (for babies born in our center) and out-born (for babies born elsewhere, brought to our center) NICUs, before and after cleaning. Samples were processed using standard Microbiological techniques. Antibiogram was determined by Kirby-Bauer disc diffusion method. From In-born NICU, before cleaning, 42 (84%) samples yielded growth with 48 bacterial isolates of which 31 (64.6%) were pathogens and after cleaning, 40 (80%) samples yielded growth with 41 bacterial isolates, of which 30 (73.1%) were pathogens. Most frequent isolates were non-fermenting gram-negative bacilli (NFGNB) and Klebsiella pneumoniae before and after cleaning, respectively. Prevalence of bacteria from In-born NICU before and after the cleaning was statistically significant (p = 0.025). From Out-born NICU, before cleaning, 42 (84%) samples yielded growth with 45 bacterial isolates, of which 25 (55.55%) were pathogens. Samples collected after cleaning; 42 (84%) samples yielded growth with 43 bacterial isolates of which 19 (44.18%) were pathogens. Most frequent isolates were NFGNB and Klebsiella pneumoniae from In-born NICU and K. pneumoniae and Escherichia coli from Out-born NICU before and after cleaning, respectively. Overall prevalence of pathogens was significant (p = 0.007). Staphylococcal isolates were resistant to Methicillin. NFGNB exhibited highest resistance (55.9%) towards Gentamicin. Significant decrease in the frequency of pathogens after cleaning indicates stringent practice of sterilization protocol would be essential in hospital environment.