Healthcare Premises Research Articles

Integration of ZnO‐Ag Nanocomposites into PMMA Thin Film for Enhanced Antibacterial Applications

AbstractThe exploration of advanced materials has become imperative for addressing challenges in diverse fields, including healthcare and infection prevention. This research contributes to this domain by focusing on the synthesis, characterization, and evaluation of ZnO‐Ag nanocomposites and embedding them in PMMA matrix to obtain free‐standing flexible membrane with enhanced antibacterial potential and reusability of material. The study employs a solvothermal method for the decoration of silver nanoparticles onto zinc oxide nanorods, with the objective of harnessing the synergistic antibacterial properties of both materials. The study evaluates the antibacterial potential of the nanocomposites through well diffusion and growth kinetic assays, revealing their enhanced efficacy with a zone of inhibition (ZOI) of 21 ± 1.05 mm against Escherichia coli (E. coli). The implications of this research extend to the realm of biomedical applications, positioning the nanocomposite‐polymer membrane as promising candidates for infection prevention in healthcare premises.

Architectural interventions to mitigate the spread of SARS-CoV-2 in emergency departments

Emergency departments (EDs) are a critical entry gate for infectious agents into hospitals. In this interdisciplinary study, we explore how infection prevention and control (IPC) architectural interventions mitigate the spread of emerging respiratory pathogens using the example of SARS-CoV-2 in a prototypical ED. Using an agent-based approach, we integrated data on patients' and healthcare workers' (HCWs) routines and the architectural characteristics of key ED areas. We estimated the number of transmissions in the ED by modelling the interactions between and among patients and HCWs. Architectural interventions were guided towards the gradual separation of pathogen carriers, compliance with a minimum interpersonal distance, and deconcentrating airborne pathogens (higher air exchange rates (AERs)). Interventions were epidemiologically evaluated for their mitigation effects on diverse endpoints. Simulation results indicated that higher AERs in the ED (compared with baseline) may provide a moderate level of infection mitigation (incidence rate ratio (IRR) of 0.95 (95% confidence interval (CI) 0.93-0.98)) while the overall burden decreased more when rooms in examination areas were separated (IRR of 0.78 (95% CI 0.76-0.81)) or when the size of the ED base was increased (IRR of 0.79 (95% CI 0.78-0.81)). The reduction in SARS-CoV-2-associated nosocomial transmissions was largest when architectural interventions were combined (IRR of 0.61 (95% CI 0.59-0.63)). These modelling results highlight the importance of IPC architectural interventions; they can be devised independently of profound knowledge of an emerging pathogen, focusing on technical, constructive, and functional components. These results may inform public health decision-makers and hospital architects on how IPC architectural interventions can be optimally used in healthcare premises.

Analyses of the energy efficiency enhancement in Bulgarian health care premises

The presented study examines how hospital buildings in Bulgaria consume energy, reduce emissions, and save energy. The study uses data from energy efficiency surveys of 38 hospital buildings, where 137 energy-saving measures were implemented between 2015 and 2021. These hospital buildings range in size from 465 m2 to 19,026 m2, with a total studied area of 151,306 m2, divided into three groups for analytical convenience. The study presents detailed findings on annual energy savings, with the highest savings achieved in Group 2 (G2), reaching an impressive 51.1% in 2021. Furthermore, the study analyzes the reduction in carbon emissions, with Group 2 again showing the largest decrease, reducing emissions by 2,097 tCO2 in 2019. These results underscore the significant positive impact of the implemented energy-saving measures, demonstrating substantial improvements in the energy efficiency of the studied hospital buildings. In addition, to highlight the financial and environmental benefits of the reduced energy consumption and lower carbon emissions, the study also offers a valuable model for similar initiatives in other regions. It emphasizes the critical importance of energy efficiency and how targeted measures can effectively contribute to sustainable development in the healthcare sector. This comprehensive analysis provides policymakers, healthcare administrators, and energy efficiency advocates with valuable insights and effective strategies for reducing energy use and emissions in hospital buildings. By showcasing the success of these measures, the study aims to inspire broader adoption of energy efficiency practices, ultimately contributing to global sustainability efforts.

Implications of immersive technologies in healthcare sector and its built environment.

This research focuses on how built environment experts can contribute to the MXR-enabled digital innovation as part of the multidisciplinary team effort to ensure post-pandemic resilience in healthcare built environment. The goal of this research is to help healthcare providers, built environment experts, and policy makers respectively: (1) Advocate the benefits of MXR for innovating health and social care; (2) Spark debate across networks of expertise to create health-promoting environment; and (3) Understand the overriding priorities in making effective pathways to the implementation of MXR. To highlight the novelty of this research, the study relies on two qualitative methodologies: exploratory literature review and semi-structured interviews. Based on the evaluation of prior works and cross-national case studies, hypotheses are formulated from three arenas: (1) Cross-sectional Initiatives for Post-pandemic Resilience; (2) Interoperability and Usability of Next-gen Medicines; and (3) Metaverse and New Forms of Value in Future Healthcare Ecosystems. To verify those hypotheses, empirical findings are derived from in-depth interviews with nine key informants. The main findings are summarized under the following three themes: (1) Synergism between Architecture and Technology; (2) Patient Empowerment and Staff Support; and (3) Scalable Health and Wellbeing in Non-hospital and Therapeutic Settings. Firstly, both built environment and healthcare sectors can benefit from the various capabilities of MXR through cross-sectional initiatives, evidence-based practices, and participatory approaches. Secondly, a confluence of knowledge and methods of HCI and HBI can increase the interoperability and usability of MXR for the patient-centered and value-based healthcare models. Thirdly, the MXR-enabled technological regime will largely affect the new forms of value in healthcare premises by fostering more decentralized, preventive, and therapeutic characteristics in the future healthcare ecosystems. Whether it's virtual or physical, our healthcare systems have placed great emphasis on the rigor of evidence-based approach linking health outcome to a clinical environment. Henceforth, built environment experts should seek closer ties with the MXR ecosystems for the co-production of scalable health and wellbeing in non-hospital and therapeutic settings. Ultimately, this is to improve resource efficiency in the healthcare sector while considering the transition of health resources towards in silico status by increasing the implementation of MXR.

The Future of Healthcare in the Cloud

"Cloud" is a symbolic definition of Internet storage that can be accessed everywhere. This technology is swiftly gaining fame.1 Cloud computing is the state-of-the-art modernization in Information Technology (IT) and has provided a substitute mode for managing and accessing health data. It caters to various computing services such as intelligence, servers, storage, databases, networking, software, and analytics. Cloud computing administers fast modernization, flexible resources, and a range of economies. It is a colossal change from the traditional method due to its cost-effectiveness, high speed, security, global scale, performance, productivity, and reliability.2 Nowadays, hospitals/clinics successfully address patients needs through the cloud, and tech-savvy healthcare professionals are switching to this advancement for its benefits.3 Furthermore, it is an important step to move health systems and data to the cloud as it has achieved popularity during the pandemic. Cloud computing is accomplishing innovative systems to attain patient portals, offering interoperability and a protective way for important data to be transmitted quickly and efficiently anytime and everywhere. 4 Moreover, experts have predicted that cloud computing can improve services in healthcare and assets in healthcare research that have changed the appearance of information technology (IT).5 Because of these gains, there is a boost in the adoption of cloud computing to establish more satisfaction among patients and healthcare providers with low costs.6 Many healthcare systems still rely on old software systems. Healthcare workers' access to data such as electronic health records (EHR), patients' prescriptions, test results, and images/scans are more equipped to diagnose and identify the good management course. Decisions regarding large amounts of information help researchers and healthcare professionals identify patterns, and clues, uncover insights and provide evidence-based management.7 As a result of the cloud, the healthcare industry is regulated, and it makes sense that the first wave of moves to the cloud is those that have no direct impact on patient care. Healthcare providers are now comfortable with the impressive benefits of the cloud. The next wave of migration of information seems to be quicker and easier. Furthermore, telemedicine is the next strong contender for modernization in the future. A survey estimated that approximately 70 per cent of face-to-face interactions with the medical care provider did not require a routine appointment. A fraction of these interactions, telemedicine, would end in significant cost-effective healthcare delivery. It is a key objective for healthcare providers as insurers, and consumer costs would continue to arise. Another significant rise is patient empowerment tools which are cloud benefits as cloud-based applications (CBA) on smartwatches that help those with health-related chronic diseases, regular monitoring, and daily management. These are nutrition, exercise, medication reminders, and blood glucose monitoring that can be easily tracked through CBA, providing a platform for doctors to improve patient’s management further. Bettering outcomes, increased efficiency, and cost-effectiveness via CBA are important components that impact the healthcare system.8 Compliance and security are the main barriers to implementing community cloud in Pakistan’s healthcare system, and the challenges are fat.9 Pakistan’s medical system is still in the initial stages of shifting to this new technology. Healthcare information, X-Rays, medications, and patient history of government and non-government health services are increasing significantly in size, diversity, and rate in this country. 10 The demand for cloud services in Pakistan is improving daily.11 To sharpen and enhance the healthcare model of the health system, cloud-based solutions provide flexibility. Today, hospitals and physicians are gathering more information from patients and places due to this advancement. Virtual care services have grown over the past year when and where patients receive care. Doctors and physicians now have regular access to patient’s information from smartwatches that help update a patient’s treatment. Health information systems (HIS) and Health Management systems (HMS) have all the data for improving patient healthcare delivery connected across the healthcare continuum, and almost all healthcare providers have moved to the cloud. Historically it was a challenging process. The command of the cloud in healthcare is innovative in storing health information. It regards permission for the right care at the right time and place. CBS also provides a secure, integrated, and scalable foundation that supports a patient's health information within healthcare premises to develop the changes needed for tomorrow. HMS will provide a cost-effective and secure platform that will be important for data integrity and high-performance data replication for evidence-based decision and management.

Primary SARS-CoV-2 Infections, Re-infections and Vaccine Effectiveness during the Omicron Transmission Period in Healthcare Workers of Trieste and Gorizia (Northeast Italy), 1 December 2021-31 May 2022.

Objective: To evaluate the incidence of primary and recurrent COVID-19 infections in healthcare workers (HCWs) routinely screened for SARS-CoV-2 by nasopharyngeal swabs during the Omicron wave. Design: Dynamic Cohort study of HCWs (N = 7723) of the University Health Agency Giuliano Isontina (ASUGI), covering health services of the provinces of Trieste and Gorizia (Northeast Italy). Cox proportional hazard model was employed to estimate the risk of primary as well as recurrent SARS-CoV-2 infection from 1 December 2021 through 31 May 2022, adjusting for a number of confounding factors. Results: By 1 December 2021, 46.8% HCWs of ASUGI had received the booster, 37.2% were immunized only with two doses of COVID-19 vaccines, 6.0% only with one dose and 10.0% were unvaccinated. During 1 March 2020-31 May 2022, 3571 primary against 406 SARS-CoV-2 recurrent infections were counted among HCWs of ASUGI, 59.7% (=2130/3571) versus 95.1% (=386/406) of which occurring from 1 December 2021 through 31 May 2022, respectively. All HCWs infected by SARS-CoV-2 during 1 December 2021 through 31 May 2022 presented mild flu-like disease. Compared to staff working in administrative services, the risk of primary as well as recurrent SARS-CoV-2 infection increased in HCWs with patient-facing clinical tasks (especially nurses and other categories of HCWs) and in all clinical wards but COVID-19 units and community health services. Regardless of the number of swab tests performed during the study period, primary infections were less likely in HCWs immunized with one dose of COVID-19 vaccine. By contrast, the risk of SARS-CoV-2 re-infection was significantly lower in HCWs immunized with three doses (aHR = 0.58; 95%CI: 0.41; 0.80). During the study period, vaccine effectiveness (VE = 1-aHR) of the booster dose declined to 42% against re-infections, vanishing against primary SARS-CoV-2 infections. Conclusions: Though generally mild, SARS-CoV-2 infections and re-infections surged during the Omicron transmission period. Compared to unvaccinated colleagues, the risk of primary SARS-CoV-2 infection was significantly lower in HCWs immunized just with one dose of COVID-19 vaccines. By Italian law, HCWs immunized only with one dose were either suspended or re-assigned to job tasks not entailing patient facing contact; hence, while sharing the same biological risk of unvaccinated colleagues, they arguably had a higher level of protection against COVID-19 infection. By contrast, SARS-CoV-2 re-infections were less likely in HCWs vaccinated with three doses, suggesting that hybrid humoral immunity by vaccination combined with natural infection provided a higher level of protection than vaccination only. In this stage of the pandemic, where SARS-CoV-2 is more infectious yet much less pathogenic, health protection measures in healthcare premises at higher biological risk seem the rational approach to control the transmission of the virus.

Health Beyond Healthcare Premises

Angiomyolipoma are mostly asymptomatic and are diagnosed incidentally through imaging usually from an unrelated clinical presentation. The bleeding risk is directly proportional to its size. Angiomyolipoma that are less than 4cm has a bleeding risk of about 13% compared to those that are more than 4cm which is about 51%

An Energy Model for the Calculation of Room Acoustic Parameters in Rectangular Rooms with Absorbent Ceilings

The most common acoustical treatment of public rooms, such as schools, offices, and healthcare premises, is a suspended absorbent ceiling. The non-uniform distribution of the absorbent material, as well as the influence of sound-scattering objects such as furniture or other interior equipment, has to be taken into account when calculating room acoustic parameters. This requires additional information than what is already inherent in the statistical absorption coefficients and equivalent absorption areas provided by the reverberation chamber method ISO 354. Furthermore, the classical diffuse field assumption cannot be expected to be valid in these types of rooms. The non-isotropic sound field has to be considered. In this paper, a statistical energy analysis (SEA) model is derived. The sound field is subdivided into a grazing and non-grazing part where the grazing part refers to waves propagating almost parallel to the suspended ceiling. For estimation of all the inherent parameters in the model, the surface impedance of the suspended ceiling has to be known. A method for estimating the scattering and absorbing effects of furniture and objects is suggested in this paper. The room acoustical parameters reverberation time T20, speech clarity C50, and sound strength G were calculated with the model and compared with calculations according to the classical diffuse field model. Comparison with measurements were performed for a classroom configuration. With regard to all cases, the new model agrees better with measurements than the classical one.

Gastrointestinal Tract Colonization Rate of Extended-Spectrum Beta-Lactamase-Producing Gram-Negative Bacteria and Associated Factors Among Orthopaedic Patients in a Tertiary Hospital in Tanzania: Implications for Infection Prevention.

BackgroundThe dual burden of road traffic accidents and antimicrobial resistance in orthopaedic infections is challenging already strained health-care systems. Limited information exists in Tanzania on antimicrobial resistance surveillance to delineate the potential sources of multi-drug-resistant bacteria for specific mitigation strategies among orthopaedic patients.MethodsA longitudinal study was conducted at Bugando Medical Centre in Mwanza city between January and May 2020. It involved the collection of rectal swabs/stools, hand swabs, and environmental sampling to identify extended-spectrum beta-lactamase (ESBL)-producing gram-negative bacteria. Participants’ data were collected using a structured questionnaire and analysed to determine factors associated with ESBL colonization among index orthopaedic patients and correlates with other ESBL sources using OR (95% CI) and a cut-off p-value of ≤0.05.ResultsWe found that 47.2% (125/265) of index patients, 77.8% (14/18) of neighbouring patients, 8.3% (2/24) of health-care workers, 72.2% (13/18) of non-medical caregivers, and 31.4% (27/86) of samples taken from the hospital environment had ESBL producers. Escherichia coli and Klebsiella spp. predominated among participants and Acinetobacter spp. predominated in the environmental samples. Patients with open fractures had increased odds of being colonized with ESBL producers [OR (95% CI): 2.08 (1.16–3.75); p=0.015]. The floor below patients’ beds was commonly contaminated; however, the odds of environmental contamination decreased on the third round of sampling [OR (95% CI: 0.16 (0.04–0.67); p=0.012], apparently as a result of parallel infection prevention and control responsive measures against coronavirus disease 2019 (COVID-19).ConclusionWe found a high occurrence of ESBL colonization among participants and in the environmentat this tertiary hospital. The importance of routine ESBL surveillance among orthopaedic patients with open fractures on admission and strengthened decontamination of health-care premises is reiterated.

COVID-19 Outbreak and Hospital Air Quality: A Systematic Review of Evidence on Air Filtration and Recirculation.

The outbreak of SARS-CoV-2 has made us all think critically about hospital indoor air quality and the approaches to remove, dilute, and disinfect pathogenic organisms from the hospital environment. While specific aspects of the coronavirus infectivity, spread, and routes of transmission are still under rigorous investigation, it seems that a recollection of knowledge from the literature can provide useful lessons to cope with this new situation. As a result, a systematic literature review was conducted on the safety of air filtration and air recirculation in healthcare premises. This review targeted a wide range of evidence from codes and regulations, to peer-reviewed publications, and best practice standards. The literature search resulted in 394 publications, of which 109 documents were included in the final review. Overall, even though solid evidence to support current practice is very scarce, proper filtration remains one important approach to maintain the cleanliness of indoor air in hospitals. Given the rather large physical footprint of the filtration system, a range of short-term and long-term solutions from the literature are collected. Nonetheless, there is a need for a rigorous and feasible line of research in the area of air filtration and recirculation in healthcare facilities. Such efforts can enhance the performance of healthcare facilities under normal conditions or during a pandemic. Past innovations can be adopted for the new outbreak at low-to-minimal cost.

Environmental contamination of SARS-CoV-2 in healthcare premises

ObjectivesA large number of healthcare workers (HCWs) were infected by SARS-CoV-2 during the ongoing outbreak of COVID-19 in Wuhan, China. Hospitals are significant epicenters for the human-to-human transmission of the SARS-CoV-2 for HCWs, patients, and visitors. No data has been reported on the details of hospital environmental contamination status in the epicenter of Wuhan. MethodsWe collected 626 surface swabs within the Zhongnan Medical Center in Wuhan in the mist of the COVID-19 outbreak between February 7 - February 27, 2020. Dacron swabs were aseptically collected from the surfaces of 13 hospital function zones, five major objects, and three major PPE. The SARS-CoV-2 RNAs were detected by reverse transcription-PCR. ResultsThe most contaminated zones were the intensive care unit specialized for taking care of novel coronavirus pneumonia (NCP) (31.9%), Obstetric Isolation Ward specialized for pregnant women with NCP (28.1%), and Isolation Ward for NCP (19.6%). We classified the 13 zones into four contamination levels. The most contaminated objects were self-service printers (20.0%), desktop/keyboard (16.8%), and doorknob (16.0%). Both hand sanitizer dispensers (20.3%) and gloves (15.4%) were the most contaminated PPE. ConclusionOur findings emphasize the urgent need to ensure adequate environmental cleaning, strengthen infection prevention training, and improve infection prevention among HCWs during the outbreak of COVID-19.

Reconstruction and Analysis of the Energy Demand of a Healthcare Facility in Italy

The energy demand in healthcare and hospital premises has distinctive features. Due to specific constraints in terms of service continuity and indoor air quality, the demand is at a large extent constant during the day and throughout the year. Indeed, a healthcare facility must fulfil several different activities. Medical equipment needs electric energy, while the Heating, Ventilation and Air Conditioning systems require thermal energy. It is extremely difficult to define reference characteristics for the energy demand, since the proportions of the different consumptions are strongly connected with the specific activities/services carried out within each structure. The present work aims at analysing the energy demand of a healthcare facility located near Firenze (Italy). The energy demand has been analysed by means of the available documentation to get a basic knowledge of the expected consumption of each component of the facility. These data have been then correlated with information on the actual healthcare activity parameters (e.g. staff in service, medical services) and on weather conditions. As a result, the study led to the definition of the principal energy drivers that characterize the Healthcare Facility. The analysis procedure is thought of general interest for the community working in the field, representing a benchmark for the calibration of energy digital twins and a reference data set useful to carry out building energy efficiency optimization strategies.

Hand hygiene knowledge and attitude of medical students in western Saudi Arabia.

BackgroundThe practice of hand hygiene (HH) has prime importance among Health Care Professionals (HCPs) and non-compliance could cause adverse consequences. By keeping the importance of HH in mind, this study aims at investigating the knowledge and attitudes towards HH among medical students and interns at King Abdulaziz University (KAU), Jeddah, Saudi Arabia (SA).MethodsThe study includes 453 medical students and interns (189 males & 264 females). This study was completed in three months; from September to November 2017. The World Health Organization (WHO) HH questionnaire was used and data were analyzed on SPSS-21.ResultsTwo-third of the participants 292 (64.2%) had formal training in HH in the last three years. Almost half of the participants 254 (56.1%) had correct knowledge regarding the major course of transmission of potentially detrimental microbes among patients in the healthcare premises. Just 124 (27.4%) of the respondents had the correct knowledge about the most common basis of germs accountable for healthcare-related infections. Females had significantly better knowledge than males regarding the type of HH technique needed before palpation of the abdomen (177(54%) Vs. 151(46%); P < 0.002), before an injection (175(54.5%) Vs. 146(45.5%); P < 0.007), after emptying a bedpan (207(64.7%) Vs. 113(35.3%); P < 0.001), following discarding examination gloves (256(60.4% Vs. 168(39.6%); P < 0.001] and after exposure to blood (200(64.1%) Vs. 112(35.%); P < 0.001). Female participants had better knowledge than males regarding the type of HH actions. Females also had a significantly better attitude towards the importance of HH than males (240(62.5%) Vs. 144(37.5%); P < 0.001).ConclusionThe majority of the participants’ knowledge regarding HH was not up to the mark; however, female students had better knowledge compared to male students. The medical students and interns’ knowledge and positive attitude towards HH can play a pivotal role in preventing HCPs associated infections and it would overall decrease the infection-related burden on the hospital and governmental budgets. It is suggested that multi-dimensional plans are required to change this low compliance to a higher rate.

Contamination of a hospital plumbing system by persister cells of a copper-tolerant high-risk clone of Pseudomonas aeruginosa

BackgroundPseudomonas aeruginosa (PA) is an important opportunistic pathogen that thrives best in the distal elements of plumbing and waste-water systems. Although nosocomial outbreaks of PA have been associated with water sources, the role of the plumbing system of healthcare premises as a reservoir for this pathogen is still unclear. Materials and methodsWe collected water samples from 12 technical areas, distant from any medical activity, in a teaching hospital in France once a week for 11 weeks. We used a method that resuscitates persister cells because of the nutrient-poor conditions and the presence of inhibitors (e.g. chlorine and copper ions). Briefly, water was sampled in sterile bottles containing 100 μM of the copper-ion chelating agent diethyldithiocarbamate (DDTC). A portion of the samples was immediately filtered through 0.45-μm membranes, deposited on R2A agar plates, and incubated seven days at 22 °C (following European recommendations). The remaining water was incubated 14 days at 22 °C and then filtered and cultured on R2A, blood-, or cetrimide-containing agar plates. PA isolates were identified by MS MALDI-TOF, genotyped by PFGE and WGS, and tested for survival in a 150 μg/L copper (II) sulphate solution. ResultsAlthough the 12 water sampling points always tested negative with the recommended method, 67% were positive at least once for PA with the adapted method (i.e. with DDTC). The 14 PA persister isolates found throughout the plumbing system were clonal and belong to the high-risk clone ST308. Their genome harbours a 37-kb genomic island (GI-7) containing 13 genes linked to copper resistance. ST308 survived better in the copper solution than comparators that did not harbour GI-7 (P. aeruginosa strains PAO1, PA14, and ST235). The deletion of GI-7 in ST308 abrogated its tolerance to copper. The GI-7 nucleotide sequence shares 98% and 72% identity with sequences from the environmental species Pseudomonas putida and the phytopathogenic species Pseudomonas syringae, respectively. ConclusionWe report the contamination of the plumbing system of a healthcare premises by persister cells of the high-risk clone P. aeruginosa ST308. New recommendations for the monitoring of water contamination should consider persister cells. The genomic island GI-7, which confers tolerance to copper, probably originates from Pseudomonas species found in copper-contaminated soils and plants. Agricultural practices may have an unexpected consequence, allowing copper-tolerant pathogens to survive in the hospital environment and contaminate fragile patients.

Bacteremia due to ESKAPE pathogens: An emerging problem in cancer patients

Background and aimIn recent years, a few of the antibiotic-resistant bacteria, known as ESKAPE pathogens, have been found responsible for serious infections. We investigated the risk factors, and impact of ESKAPE pathogens on course of blood stream infections (BSIs) in cancer patients in comparison to coagulase negative Staphylococci (CoNS). Patients and methodsThe data of patients with ESKAPE positive blood cultures at National Cancer Institute, Cairo University were analyzed. Identification and antimicrobial susceptibility of isolates were done using Microscan Walk Away 96. ResultsIn a 6month period, ESKAPE pathogens were isolated from non-duplicate blood cultures in 81 episodes of 72 cases of pediatric cancer patients, while CoNS were isolated from 135 blood cultures of 116 patients. The ESKAPE pathogens isolated were Enterobacter spp., methicillin-resistant Staphylococcus aureus (MRSA), Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterococci in 12%, 23%, 37%, 10%, 9%, and 9% of episodes, respectively. Health-care acquired infections constituted 75% of ESKAPE infections. Duration of episodes and overall mortality were significantly higher in ESKAPE BSIs when compared to CoNS (14.5±7.6 versus 09.9±6.9), and (26% versus 4%); respectively, p value <0.001. ConclusionsESKAPE pathogens were significantly associated with higher rates of morbidity and mortality indicating the need for improving the means of prevention of these types of infections within health care premises. Microbiology laboratories have a role in defining more dangerous infections and rapid diagnostics are required in the era of resistance.

First Report on Vancomycin-Resistant Staphylococcus aureus in Bovine and Caprine Milk.

The present investigation was carried out to study the vancomycin resistance pattern of Staphylococcus aureus isolates (n = 274) obtained from 352 milk samples of bovine (269) and caprine (63) clinical and subclinical mastitis from different districts of West Bengal, India. Of them, seven isolates (vancomycin-resistant S. aureus [VRSA] 1-7) exhibited resistance to vancomycin. Minimum inhibitory concentration of vancomycin (MICvan) for VRSA2 and VRSA3 was ≥16 μg/ml; thus categorized as VRSA. For rest of the isolates, MICvan was 8 μg/ml and they were grouped as vancomycin intermediate S. aureus (VISA). Even though all the isolates were resistant to cefoxitin and oxacillin and possessed mecA gene, none of them carried vancomycin resistance gene. Furthermore, all the seven isolates were subjected to Staphylococcal cassette chromosome mec (SCCmec) typing, Staphylococcal protein A (spa) typing, and enterobacterial repetitive intergenic consensus polymerase chain reaction. All the isolates except VRSA3 and VRSA4 from Kolkata district exhibited diverse genetic lineage, irrespective of their host and antibiotic resistance pattern. These two isolates showed clonal similarity (MRSA-SCCmec-V-spa t267) with methicillin-resistant S. aureus (MRSA) strains previously reported in human and animal infection. Isolation of VRSA and VISA could probably be due to intensive use of vancomycin in healthcare premises, which might have led to the development of glycopeptide-resistant strains and thereafter, further disseminated in the environment, including livestock farms. Detection of VRSA in milk is a serious concern as it may further cause health problems in the consumers. This is the first ever report of VRSA in food animals, even though the pathogen is otherwise prevalent in humans.

Prevention and control of multi-drug-resistant Gram-negative bacteria: recommendations from a Joint Working Party

Multi-drug-resistant (MDR) Gram-negative bacterial infections have become prevalent in some European countries. Moreover, increased use of broad-spectrum antimicrobial agents selects organisms with resistance and, by increasing their numbers, increases their chance of spread. This report describes measures that are clinically effective for preventing transmission when used by healthcare workers in acute and primary healthcare premises. Methods for systematic review 1946–2014 were in accordance with SIGN 501 and the Cochrane Collaboration;2 critical appraisal was applied using AGREEII.3 Accepted guidelines were used as part of the evidence base and to support expert consensus. Questions for review were derived from the Working Party Group, which included patient representatives in accordance with the Patient Intervention Comparison Outcome (PICO) process. Recommendations are made in the following areas: screening, diagnosis and infection control precautions including hand hygiene, single-room accommodation, and environmental screening and cleaning. Recommendations for specific organisms are given where there are species differences. Antibiotic stewardship is covered in a separate publication.

The principle of spirituality in healthcare establishments, the role of healthcare supervisors

Healthcare teams are sometimes questioned by patients and their loved ones concerning respect for their desires or performing rites, whether religious or part of their own personal beliefs. While caregivers are convinced that it is part of their job to meet these needs, this is sometimes contrary to the requirements of neutrality and laïcité--the French concept of secularity--on healthcare premises. Nonetheless, each can contribute to the evolution of the general reflections undertaken by a team or an organization.

Monochloramine for Remediation of &amp;lt;i&amp;gt;Legionella&amp;lt;/i&amp;gt; Only in Domestic Hot Water Systems: An Iron Fist in a Velvet Glove

Monochloramine is a well-known disinfectant for drinking water with several advantages over chlorine and chlorine dioxide. With these two biocides, monochloramine is included in the US-EPA list of disinfectants for drinking water. At the beginning of XXI century, epidemiological studies demonstrated its superior ability to control Legionella in hot water health-care premises. In 2005 a research program started to set up a reliable and effective method to produce monochloramine directly in domestic hot water systems, at the safest concentration and without accumulation of by-products. Results of these researches, which has been carried out with the collaboration of Italian and American Institutions showed that monochloramine can be safely and reliably prepared and that it is the best approach to Legionella remediation in health-care facilities.

Root cause analysis to support infection control in healthcare premises

Infection control teams (ICTs) seek to prevent healthcare-associated infections (HCAIs). They undertake surveillance and prevention, promote safety and quality of care, and evaluate and manage risk. Root cause analysis (RCA) can support this work but is not widely used by ICTs. This paper describes how ICTs can use RCA to enhance their day-to-day work. Many different tools and methods exist for RCA. Its primary aim is to identify the factors that have led to HCAI, but RCA can also be used for near-misses. A team effort and multidisciplinary work are usually required. Published accounts and personal experience in the field indicate that an ICT that correctly uses RCA implements more effective prevention measures, improves practice and collaborative working, enhances teamwork, and reduces the risk of HCAI. RCA should be promoted among ICTs because it adds value to their work and helps to develop a hospital culture that anticipates and pre-empts problems.