Reduce Infection Risk Research Articles

Oral Postoperative Antibiotic Prophylaxis for Outpatient Total Hip and Knee Arthroplasty: Describing Current Practices

BackgroundDespite an increase in outpatient total hip arthroplasty (THA) and total knee arthroplasty (TKA), large-scale data are lacking on current practice for antibiotic prophylaxis prescribing. We aimed to describe current oral antibiotic prophylaxis practices nationally for outpatient THA and TKA. MethodsThis nationwide retrospective cohort study included primary outpatient THA or TKA procedures in patients aged 18 to 64 years from 2018 to 2021 using a national claims database. Oral antibiotic prescriptions filled perioperatively (defined as 5 days before to 3 days after surgery) were extracted; these were categorized and assumed to represent postoperative prophylaxis. Multivariable logistic regression measured associations between patient and surgery characteristics and perioperative oral antibiotic prophylaxis. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) are reported. ResultsOral antibiotic prescriptions were filled in 16.5% of 73,015 outpatient THA and TKA (18.4% of 24,857 THAs, 15.5% of 48,158 TKAs) procedures. Prescriptions were most often for cephalosporins (74.3%), with cephalexin (52.8%), and cefadroxil (19.1%) being the most common. Non-cephalosporin antibiotics prescribed were mainly clindamycin (6.8%), sulfamethoxazole-trimethoprim (6.7%), and doxycycline (6.2%). The odds of receiving oral antibiotic prophylaxis were higher for THA compared to TKA (OR 1.13, 95% CI 1.09 to 1.18, P < .001) and in the presence of obesity, diabetes, and autoimmune conditions (OR 1.08 to 1.13, P < .001 to .01). Ambulatory surgery center procedures also had significantly increased odds of prophylaxis compared to hospital-based outpatient surgeries (OR 2.62, 95% CI 2.51 to 2.73, P < .001). Additionally, regional and time-based variations were noted. ConclusionsPerioperative oral antibiotic prophylaxis prescriptions were filled in only 16.5% of outpatient THA and TKA cases, with variation in the type of antibiotic prescribed. The receipt of any prophylaxis and specific medications was associated with demographic, clinical, and procedure-related characteristics. Follow-up research will evaluate associations with infection risk reduction.

The impact of elective surgery postponement during COVID-19 on emergency bellwether procedures in a large tertiary centre in Singapore.

The coronavirus disease 2019 (COVID-19) pandemic drove many healthcare systems worldwide to postpone elective surgery to increase healthcare capacity, manpower, and reduce infection risk to staff. The aim of this study was to assess the impact of an elective surgery postponement policy in response to the COVID-19 pandemic on surgical volumes and patient outcomes for three emergency bellwether procedures. A retrospective cohort study of patients who underwent any of the three emergency procedures [Caesarean section (CS), emergency laparotomy (EL), and open fracture (OF) fixation] between 1 January 2018 and 31 December 2021 was conducted using clinical and surgical data from electronic medical records. The volumes and outcomes of each surgery were compared across four time periods: pre-COVID (January 2018-January 2020), elective postponement (February-May 2020), recovery (June-November 2020), and postrecovery (December 2020-December 2021) using Kruskal-Wallis test and segmented negative binomial regression. There was a total of 3886, 1396, and 299 EL, CS, and OF, respectively. There was no change in weekly volumes of CS and OF fixations across the four time periods. However, the volume of EL increased by 47% [95% confidence interval: 26-71%, P = 9.13 × 10-7) and 52% (95% confidence interval: 25-85%, P = 3.80 × 10-5) in the recovery and postrecovery period, respectively. Outcomes did not worsen throughout the four time periods for all three procedures and some actually improved for EL from elective postponement onwards. Elective surgery postponement in the early COVID-19 pandemic did not affect volumes of emergency CS and OF fixations but led to an increase in volume for EL after the postponement without any worsening of outcomes.

Uropathogenic Infection Associated with Prostate Hypertrophy and Transurethral Resection of Prostate

Benign prostatic hyperplasia (BPH) is a prevalent condition among elderly and middle-aged men characterized by symptoms such as dysuria, urinary incontinence, and frequent micturition. The gold standard procedure for relieving BPH symptoms is transurethral resection of the prostate (TURP). However, some patients undergoing TURP are at risk of developing urinary tract infections (UTIs) due to uropathogenic bacteria. This prospective study aimed to investigate post TURP bacteruria alongside with multifactoria risk factors that implicated postoperatively compared to preoperative and intraoperative periods. Ninety patients undergoing TURP and 30 control subjects were included in the study. Urine specimen for urine analysis from pateints were conducted on three occasions: (60 mid-stream urine and 30 catheterized urine samples) were taken preoperatively, (90 samples via cystoscopy) were taken intraoperastively, and (90 mid-stream urine samples after catheter removal) were taken at the third day post-TURP procedure. The study findings were analyzed in correlation with various pre-, intra-, and postoperative potential risk factors to underscores the vulnerability of BPH patients to UTIs, particularly during the postoperative recovery phase. The Escherichia coli was the most commonly isolated uropathogen preoperatively, while Pseudomonas aeruginosa emerged as the primary pathogen intra- and post-operatively. Several risk factors were identified as significantly associated with post-TURP bacteriuria. These include preoperatively, positive pre-operative culture analysis, diabetic patients, and preoperative catheterization. Additionally, intraoperative factors such as prolonged operation duration were also implicated. Postoperatively, persistent bacteriuria was significantly linked with the duration of catheterization. In conclusion, the findings highlight the complex interplay of factors contributing to post-TURP UTIs and stresses the significance of thorough risk evaluation and customized preventative measures to reduce infection risks among BPH patients undergoing TURP.

Sexually transmitted and blood-borne infection risk reduction with methadone and buprenorphine/naloxone among people with prescription-type opioid use disorder: Findings from a Canadian pragmatic randomized trial.

People who use drugs are disproportionally affected by sexually transmitted and blood-borne infections (STBBIs). While the benefits of methadone in reducing injecting-risk behaviours are well documented, less is known on its impacts on sexual-related risks, as well as its comparative effectiveness to buprenorphine/naloxone, particularly in the context of highly potent opioids. The aim of this study was to estimate the relative effects of buprenorphine/naloxone and methadone on injecting and STBBI risks among people with prescription-type opioid use disorder (POUD). Secondary analysis of a pan-Canadian pragmatic 24-week randomized clinical trial comparing methadone and buprenorphine/naloxone models of care among 272 people with POUD (including licit or illicit opioid analgesics, fentanyl). The Risk Behaviour Survey was used to collect injecting and sexual risks at baseline, and weeks 12 and 24. In total, 210 participants initiated treatment (103 buprenorphine/naloxone and 107 methadone). At baseline, 113/205 (55.1%) participants reported recently injecting drugs, 37/209 (17.7%) unsafe injection practices and 67/162 (41.4%) high-risk sex. Both methadone and buprenorphine/naloxone were associated with reductions in the prevalence of injection drug use and high-risk sex at weeks 12 and 24 with no interactions between treatment arm and time. Methadone and buprenorphine/naloxone were similarly effective in reducing injecting and sexual risk behaviours among people with POUD. clinicaltrials.gov NCT03033732.

The Bioburden Associated with Severe Open Tibial Fracture Wounds at the Time of Definitive Closure or Coverage: The BIOBURDEN Study.

Infection is common following high-energy open tibial fractures. Understanding the wound bioburden may be critical to infection risk reduction strategies. This study was designed to identify the bioburden profile of high-energy open tibial fractures at the time of definitive wound closure or coverage and determine the relationship to subsequent deep infection. This multicenter prospective study enrolled 646 patients with high-energy open tibial fractures requiring a second debridement surgery and delayed wound closure or coverage. Wound samples were obtained at the time of definitive closure or coverage and were cultured in a central laboratory. Cultures were also subsequently obtained from patients who underwent a fracture-site reoperation. Two hundred and six (32%) of the wounds had a positive culture at the time of closure or coverage. A single genus was identified in 154 (75%) of these positive cultures and multiple genera, in 52 (25%). Gram-positive cocci (GPCs) were identified in 98 (47%) of the positive cultures. Staphylococci were identified in 64 (31%) of the cultures, and 53 (83%) of these were coagulase-negative (CONS). Enterococci were identified in 26 (13%) of the cultures. Gram-negative rods (GNRs) were identified in 100 (49%) of the cultures; the most frequent GNR genera identified were Enterobacter (39, 19%) and Pseudomonas (21, 10%). Positive cultures were subsequently obtained from 154 (50%) of 310 revision surgeries. A single genus was identified in 85 (55%) of the 154 and multiple genera, in 69. GPCs were identified in 134 (87%) of the 154 positive cultures, staphylococci were identified in 94 (61%), and GNRs were identified in 100 (65%). The bioburden in high-energy open tibial fractures at delayed closure or coverage was often characterized by pathogens of multiple genera and of genera that are nonresponsive to typically employed antibiotic prophylaxis. Awareness of the final wound bioburden might inform strategies to lower the infection rate. Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.

The worldwide COVID-19 pandemic caused a decline in sonographic examinations - is this a continuing trend?

Due to the increasing number of COVID-19 infections since spring 2020 the patient care workflow underwent changes in Germany. To minimize face-to-face exposure and reduce infection risk, non-time-critical elective medical procedures were postponed. Since ultrasound examinations include non-time-critical elective examinations and often can be substituted by other imaging modalities not requiring direct patient contact, the number of examinations has declined significantly. The aim of this study is to quantify the baseline number of ultrasound examinations in the years before, during, and in the early post-pandemic period of the COVID-19 pandemic (since January 2015 to September 2023), and to measure the number of examinations at different German university hospitals. The number of examinations was assessed based on a web-based database at all participating clinics at the indicated time points. N = 288 562 sonographic examinations from four sites were included in the present investigation. From January 2020 to June 2020, a significantly lower number of examinations of n = 591.21 vs. 698.43 (p = 0.01) per month and included center was performed. Also, excluding the initial pandemic period until June 2020, significantly fewer ultrasound examinations were performed compared to pre-pandemic years 648.1 vs. 698.4 (p < 0.05), per month and included center, while here differences between the individual centers were observed. In the late phase of the pandemic (n = 681.96) and in the post-pandemic phase (as defined by the WHO criteria from May 2023; n = 739.95), the number of sonographic examinations returned to pre-pandemic levels. The decline in the number of sonographic examinations caused by the COVID-19 pandemic was initially largely intentional and can be illustrated quantitatively. After an initial abrupt decline in sonographic examinations, the pre-pandemic levels could not be reached for a long time, which could be due to restructuring of patient care and follow-up treatment. In the post-pandemic phase, the pre-pandemic level has been achieved again. The reasons for a prolonged reduction in ultrasound examinations are discussed in this article. · During the pandemic, significantly fewer ultrasound examinations were performed in the included centers.. · The number of examinations could not be reach the pre-pandemic level for a long time, which could be due to restructuring of patient care and follow-up treatment.. · Identifying causes for sonographic exam reduction is crucial in pandemic preparedness to uphold healthcare quality and continuity for all patients.. · The prolonged decline in sonographic examinations during the pandemic does not represent a lasting trend, as evidenced by the return to pre-pandemic levels..

Effectiveness of interventions to reduce COVID-19 transmission in schools

School reopenings in 2021 and 2022 coincided with the rapid emergence of new SARS-CoV-2 variants in the United States. In-school mitigation efforts varied, depending on local COVID-19 mandates and resources. Using a stochastic age-stratified agent-based model of SARS-CoV-2 transmission, we estimate the impacts of multiple in-school strategies on both infection rates and absenteeism, relative to a baseline scenario in which only symptomatic cases are tested and positive tests trigger a 10-day isolation of the case and 10-day quarantine of their household and classroom. We find that monthly asymptomatic screening coupled with the 10-day isolation and quarantine period is expected to avert 55.4% of infections while increasing absenteeism by 104.3%. Replacing quarantine with test-to-stay would reduce absenteeism by 66.3% (while hardly impacting infection rates), but would require roughly 10-fold more testing resources. Alternatively, vaccination or mask wearing by 50% of the student body is expected to avert 54.1% or 43.1% of infections while decreasing absenteeism by 34.1% or 27.4%, respectively. Separating students into classrooms based on mask usage is expected to reduce infection risks among those who wear masks (by 23.1%), exacerbate risks among those who do not (by 27.8%), but have little impact on overall risk. A combined strategy of monthly screening, household and classroom quarantine, a 50% vaccination rate, and a 50% masking rate (in mixed classrooms) is expected to avert 81.7% of infections while increasing absenteeism by 90.6%. During future public health emergencies, such analyses can inform the rapid design of resource-constrained strategies that mitigate both public health and educational risks.

Risk Factors for Tissue Expander-Related Infections in Pediatric Scar Reconstruction: A 10-Year Retrospective Study.

Tissue expansion addresses limited soft tissue availability and provides natural-looking skin for scar reconstruction. However, infection is a common complication in expander surgeries. This 10-year retrospective cohort study aims to investigate the infection risk factors in pediatric scar reconstruction. This single-center observational cohort study was conducted at the Central Hospital Affiliated with Shandong First Medical University, China, and analyzed data from pediatric patients undergoing tissue expander surgeries for scar reconstruction from January 2012 to June 2022. Patients were carefully selected, and after grouping into infection and non-infection categories, their demographic and clinical data were analyzed. Propensity score matching (PSM) ensured balanced comparisons, and logistic regression identified infection risk factors. Among the 4,539 patient records, 1,756 eligible pediatric patients were included (142 with infections, 1,614 without). Multivariate analysis revealed that factors increasing infection risk included having three or more expanders (OR: 2.39, P < 0.05), a total expander volume of 300 cc or more (OR: 2.33, P < 0.05), back or gluteal implants (OR: 1.33, P < 0.05), lack of antibiotic prophylaxis (OR: 0.65, P < 0.05), and absence of hematoma evacuation (OR: 3.29, P < 0.05). Microbiological analysis found no significant bacterial differences among antibiotic prophylaxis groups, with Staphylococcus aureus being the predominant bacterium in infections. Patients with multiple expanders, larger expander volumes, back or gluteal implants, lack of antibiotic prophylaxis, and hematoma evacuation absence have higher infection risks. Short-term (< 24h) use of Staphylococcus aureus-sensitive antibiotics post-surgery may benefit pediatric infection risk reduction.

Propensity Score-Weighted Analysis of Postoperative Infection in Patients With and Without Preoperative Urine Culture

Although recent guidelines recommend against performance of preoperative urine culture before nongenitourinary surgery, many clinicians still order preoperative urine cultures and prescribe antibiotics for treatment of asymptomatic bacteriuria in an effort to reduce infection risk. To assess the association between preoperative urine culture testing and postoperative urinary tract infection (UTI) or surgical site infection (SSI), independent of baseline patient characteristics or type of surgery. This cohort study analyzed surgical procedures performed from January 1, 2017, to December 31, 2019, at any of 112 US Department of Veterans Affairs (VA) medical centers. The cohort comprised VA enrollees who underwent major elective noncardiac, nonurological operations. Machine learning and inverse probability of treatment weighting (IPTW) were used to balance the characteristics between those who did and did not undergo a urine culture. Data analyses were performed between January 2023 and January 2024. Performance of urine culture within 30 days prior to surgery. The 2 main outcomes were UTI and SSI occurring within 30 days after surgery. Weighted logistic regression was used to estimate odds ratios (ORs) for postoperative infection based on treatment status. A total of 250 389 VA enrollees who underwent 288 858 surgical procedures were included, with 88.9% (256 753) of surgical procedures received by males and 48.9% (141 340) received by patients 65 years or older. Baseline characteristics were well balanced among treatment groups after applying IPTW weights. Preoperative urine culture was performed for 10.5% of surgical procedures (30 384 of 288 858). The IPTW analysis found that preoperative urine culture was not associated with SSI (adjusted OR [AOR], 0.99; 95% CI, 0.90-1.10) or postoperative UTI (AOR, 1.18; 95% CI, 0.98-1.40). In analyses limited to orthopedic surgery and neurosurgery as a proxy for prosthetic implants, the adjusted risks for UTI and SSI were also not associated with preoperative urine culture performance. This cohort study found no association between performance of a preoperative urine culture and lower risk of postoperative UTI or SSI. The results support the deimplementation of urine cultures and associated antibiotic treatment prior to surgery, even when using prosthetic implants.

The effect of room air cleaners on infection control in day care centres

The aim of this study was to assess the effectiveness of air cleaning in reducing the risk of respiratory infection in two day care centres using a simple and robust calculation model. Additionally, we aimed to identify potential hotspots for infections in indoor setting and focus countermeasures accordingly. Initial results from an interventional clinical study are provided as proof-of-concept for the model. We constructed a mathematical model to assess the number of persons at risk for airborne infection transmission in day care. Utilizing the model, we used portable air cleaners in two day care units (A and B, number of children participating in the study n = 43) and compared infection incidents between the two intervention units to the rest of the units in city of Helsinki (n = 607). The intervention buildings had mechanical supply and exhaust air ventilation. The risk modelling suggests that the use of air cleaners reduced the expected number of persons at infection transmission risk significantly. At day care centre A the average reduction was 60% (range 52% - 88%) and at day care centre B 53% (range 14% - 59%). During the approximately six month study period, we observed a significant difference in the days absent from day care due to infections between the intervention and reference day care units. On average, the parents were absent from work due to child’s illness in reference day care centers for 5.53 days and 3.77 days in intervention day care centers during the study period (p=0.009). In relative terms the reduction was approximately 32%. Our study offers compelling evidence to support increasing non-infectious air flow rates in daycare centers during periods requiring infection risk management. This can be implemented with portable air cleaners as an effective and cost-efficient strategy for mitigating the spread of respiratory infections among children. The clinical results support the findings suggested by the theoretical model. Implications and impacts–Air cleaning seems to be an effective way to reduce infection risk in day cares–Identification of infection risk hotspot will help in desgining the preventive methods–Portable air cleaners offer an affordable and versatile solution also in buildings where existing ventilation is insufficient for infection risk management”

Integrating energy efficiency and health safety in building design: A multi-objective optimization approach to minimize virus transmission risk

This study aims to develop an integrated design strategy for an office building in Tehran, optimizing energy efficiency and minimizing virus infection risk, addressing global challenges such as energy conservation and virus transmission. A multi-objective optimization model is developed to identify optimal design parameters for energy performance and infection risk reduction. Environmentally sustainable materials and energy-efficient equipment, such as solar panels, high-efficiency heat pump systems, and advanced air filtration techniques, are employed. The modified Wells-Riley Risk Model calculates infection risk, while energy efficiency is formulated based on the technologies used. Results showcase a significant 14% increase in energy efficiency and a 46% decrease in infection risk compared to traditional building designs, demonstrating the effectiveness of the proposed integrated approach. The optimal design parameters include ventilation rate, the number of solar panels, hot water pipe diameter, and heat pump condenser temperature. This study presents a practical, sustainable solution for designing office buildings that actively address pressing global concerns while fostering healthier, energy-efficient environments. The novelty of this research lies in the development of a multi-objective optimization model that synergizes infection control and energy efficiency, accounting for real equipment parameters and providing a new paradigm for HVAC design. This integrated strategy optimizes decision variables like ventilation rate, filtration level, solar panels, and heat pump operating conditions, offering a comprehensive approach to co-optimize infection control and energy performance.

Coxiella burnetii infection persistence in a goat herd during seven kidding seasons after an outbreak of abortions: the effect of vaccination.

Q fever is a zoonosis distributed worldwide. Ruminants are the main reservoir, and infection can cause high rates of abortion. After entering a farm, Coxiella burnetii infection can persist in the animal population over several lambing/kidding periods. Once infection is established in a herd, vaccination with the inactivated Phase I vaccine significantly reduces bacterial shedding, but although at low levels, excretion may continue to occur for several lambing/kidding seasons. The time that C. burnetii remains viable in the farm environment after an outbreak of Q fever determines the period when risk of infection is high for the people in close contact. This work showed that this period extends at least three kidding seasons after the outbreak. These results provided valuable information on the epidemiology of C. burnetii infection in goat herds and may help to develop guidelines for controlling the disease and reducing infection risk for susceptible people and animals.

Analysis of characteristic and postexposure practices of occupational blood and body fluid exposures among health care workers in Chinese tertiary hospitals: a retrospective ten-year study

BackgroundOccupational blood and body fluid exposure (OBEs) is a highly concerning global health problem in health facilities. Improper or inadequate post-exposure practices increase the risk of infection with bloodborne pathogens. Understanding risk factors for OBEs and evaluating the post-exposure practices will contribute to healthcare workers’ (HCWs) well-being.MethodsThis study retrospectively synthesized and reviewed the 10-year data (from 2010 to 2020) on OBEs in a tertiary teaching hospital.ResultsA total of 519 HCWs have reported OBEs, increasing yearly from 2010 to 2020. Of these, most were nurses (247 [47.2%]), female (390 [75.1%]), at 23–27 years old (207 [39.9%]). The hepatitis B was the primary bloodborne pathogen exposed to HCWs, with 285 (54.9%) cases, internal medicine was the main exposure site (161 [31.0%]), and sharp injury was the main exposure route (439 [84.6%]). Data analysis shows that there are significant differences between exposure route, exposed pathogens, and exposure site among the different occupational categories (X2 = 14.5, 43.7, 94.3, all P < 0.001). 3.3% of HCWs did not take any post-exposure practices. For percutaneous exposure, 4.7% did not rinse the wound, 3.3% did not squeeze out the wound, and 2.3% did not disinfect the wound. In the case of mucosal exposure, 90.4% clean the exposure area immediately.ConclusionsThe data from the past decade underscores the seriousness of current situation of OBEs in Chinese tertiary hospital, particularly among young HCWs, and with hepatitis B as the predominant blood-borne pathogen. This study also identifies HCWs may take incorrect post-exposure practices. It’s crucial in the future to discuss the effectiveness of main groups targeted for focused specialty-specific guidance for the prevention of such accidents, meanwhile, to include blood-borne disease immunity testing in mandatory health check-ups. Additionally, focus on optimizing post-exposure practices, offering significant steps toward prevention of such incidents and reducing infection risks should also be considered in future studies.

Maternal COVID-19 Vaccination and Prevention of Symptomatic Infection in Infants.

Maternal vaccination may prevent infant coronavirus disease 2019 (COVID-19). We aimed to quantify protection against infection from maternally derived vaccine-induced antibodies in the first 6 months of an infant's life. Infants born to mothers vaccinated during pregnancy with 2 or 3 doses of a messenger RNA COVID-19vaccine (nonboosted or boosted, respectively) had full-length spike (Spike) immunoglobulin G (IgG), pseudovirus 614D, and live virus D614G, and omicron BA.1 and BA.5 neutralizing antibody (nAb) titers measured at delivery. Infant severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was determined by verified maternal-report and laboratory confirmation through prospective follow-up to 6 months of age between December 2021 and July 2022. The risk reduction for infection by dose group and antibody titer level was estimated in separate models. Infants of boosted mothers (n = 204) had significantly higher Spike IgG, pseudovirus, and live nAb titers at delivery than infants of nonboosted mothers (n = 271), and were 56% less likely to acquire infection in the first 6 months (P = .03). Irrespective of boost, for each 10-fold increase in Spike IgG titer at delivery, the infant's risk of acquiring infection was reduced by 47% (95% confidence interval 8%-70%; P = .02). Similarly, a 10-fold increase in pseudovirus titers against Wuhan Spike, and live virus nAb titers against D614G, and omicron BA.1 and BA.5 at delivery were associated with a 30%, 46%, 56%, and 60% risk reduction, respectively. Higher transplacental binding and nAb titers substantially reduced the risk ofSARS-CoV-2 infection in infants, and a booster dose amplified protection during a period of omicron predominance. Until infants are age-eligible for vaccination, maternal vaccination provides passive protection against symptomatic infection during early infancy.

(310) Severe Delayed Skin Reaction to Antiseptic Irrigation Solution Managed with Pinch Skin Grafting After Inflatable Penile Prosthesis Surgery: A Case Report

Abstract Introduction Inflatable penile prosthesis (IPP) surgery is a common procedure for treating erectile dysfunction, and skin preparation with antiseptic solutions is a standard practice to reduce infection risk. However, some antiseptic solutions, such as chlorhexidine-based Irrisept, have been associated with severe skin reactions. Several studies have reported cases of contact dermatitis, blistering, and chemical burns following the use of chlorhexidine-based antiseptic solutions before surgery. Objective This case report aims to highlight the potential risk of severe skin reactions when using Irrisept and other chlorhexidine antiseptic solutions during penile prosthesis surgery. It also explores the novel technique of pinch skin autografting used to salvage the implant and achieve successful wound healing after delayed skin necrosis. Methods 61-year-old male with a history of prostate cancer and erectile dysfunction who underwent insertion of an IPP. Results The patient's penile shaft developed blisters 3 weeks post-implantation, which progressed to full-thickness necrosis despite conservative treatment. The distribution and location of the reaction led to the hypothesis that it was caused by the chlorhexidine-based Irrisept antiseptic. The antiseptic solution used copiously throughout the case and 10CC was injected under pressure into the drain which also may explain the reaction observed. The patient underwent wound debridement and was treated with pinch skin autografts from the bilateral thighs. The autografts resulted in 95% epithelialization with excellent cosmetic outcomes with no other complications. To the best of our knowledge, this is the first reported case of Irrisept-induced delayed skin necrosis and the use of pinch skin grafting to salvage the implant after penile prosthesis surgery. Conclusions Skin reactions to Irrisept antiseptic solution during penile prosthesis surgery are rare but can be severe. Surgeons should be cautious and consider alternative skin preparation methods in patients with a history of skin allergies or sensitivities. This case also highlights the potential of pinch skin autografting as a salvage technique for post-IPP skin reactions. A multidisciplinary approach involving reconstructive burn surgeons and specialty wound care teams may be beneficial in optimizing outcomes in such cases. Disclosure No.

A Comprehensive Index for Evaluating the Effectiveness of Ventilation-Related Infection Prevention Measures with Energy Considerations: Development and Application Perspectives

In the wake of the COVID-19 pandemic, prioritizing indoor air quality has emerged as a crucial measure for preventing infections. Effective ventilation is vital in mitigating airborne pathogen transmission and maintaining a healthy indoor environment by diluting and removing infectious particles from enclosed spaces. However, increasing the supply of pathogen-free air to enhance infection control can lead to a rise in energy consumption. Nevertheless, evaluating the overall efficacy of ventilation-based infection prevention strategies while considering their energy requirements has posed challenges. This scientific paper introduces the ICEE (Infection Control’s Energy Efficiency) index, a newly developed simple integrated index to assess the effectiveness of ventilation strategies in reducing infection risks while accounting for associated energy demands. The paper reviews the current understanding of ventilation strategies, their impact on infection prevention, and their corresponding energy consumption. By employing a straightforward analytical approach, this metric offers a comprehensive framework to optimize ventilation systems for both infection prevention and energy efficiency. To quantify infection risk, a simplified equation model is utilized, incorporating factors such as ventilation effectiveness and filter efficiency, in case of recirculation. Energy demand is determined using approximations and relevant values from existing literature. Reference cases are defined, distinguishing between natural and mechanically ventilated scenarios, as these reference situations influence the energy-related effects of any implemented measures. The paper outlines the methodology employed to develop the index and illustrates its applicability through exemplary measures. The proposed index yields valuable insights for the design, operation, and retrofitting of ventilation systems, enabling informed decision-making towards fostering a healthier and more sustainable built environment.

Vascular Access Team Central Line Dressing Changes to Reduce Infection Risk: A Focused Two-Person Approach in High-Risk Patients.

Due to low compliance by bedside nursing with a central line-associated bloodstream infection (CLABSI) prevention bundle and increased CLABSI rates, a mandatory re-education initiative at a 1200-bed university-affiliated hospital was undertaken. Despite this, 2 units, housing high-risk immunocompromised patients, continued to experience increased CLABSI rates. A quality improvement before-after project design in these units replaced bedside nursing staff with 2 nurses from the vascular access team (VAT) to perform central vascular access device (CVAD) dressing changes routinely every 7 days or earlier if needed. The VAT consistently followed the bundled components, including use of chlorhexidine gluconate (CHG)-impregnated dressings on all patients unless an allergy was identified. In this case, a non-CHG transparent semipermeable membrane dressing was used. There were 884 patients with 14 211 CVAD days in the preimplementation period and 1136 patients with 14 225 CVAD days during the postimplementation period. The VAT saw 602 (53.0%) of the 1136 patients, performing at least 1 dressing change in 98% of the patients (n = 589). The combined CLABSI rate for the 2 units decreased from 2.53 per 1000 CVAD days preintervention to 1.62 per 1000 CVAD days postintervention. The estimated incidence rate ratio (IRR) for the intervention was 0.639, a 36.1% reduction in monthly CLABSI rates during the postimplementation period.

Sustainable application of biocides to promote hygiene and minimize antimicrobial resistance

Abstract Biocidal (microbicidal) products play a critical role in controlling microorganisms in healthcare, industrial, community, and home environments. There is, however, concern that their use and misuse might contribute to the evolution of antimicrobial resistance (AMR). When evaluating the risk associated with biocides, it is important to adopt an objective approach towards the evidence regarding both the benefits of their appropriate deployment as well as potential contribution to AMR. Biocide use should be restricted to applications where there are tangible benefits but also not unnecessarily restricted where genuine benefits can be demonstrated. From the perspective of sustainability, such benefits include the control and prevention of infections in clinical settings with associated reductions in antibiotic use, preservation of a range of products and materials, substantial reduction in infection risk for consumers, hygiene in the community (e.g. in public swimming baths), and microbial control in many facets of industry. Here, we will provide a critical assessment of the contribution of biocides to sustainability based on a critical evaluation of the literature, followed by offering our views on the future management of biocide use across the globe.

Outcomes and Safety with Utilization of Metallic Midfoot Wedges in Foot and Ankle Orthopedic Surgery: A Systematic Review of the Literature

The use of midfoot wedges for the correction of flatfeet disorders, such as progressive collapsing foot disorder, has increased greatly in recent years. However, the wedge material/composition has yet to be standardized. Metallic wedges offer advantages such as comparable elasticity to bone, reduced infection risk, and minimized osseous resorption, but a comprehensive review is lacking in the literature. Therefore, the objective of this systematic review was to organize all studies pertaining to the use of metallic wedges for flatfoot correction to better understand their efficacy and safety. This systematic review adhered to PRISMA guidelines, and articles were searched in multiple databases (PubMED, SPORTDiscus, CINAHL, MEDLINE, and Web of Science) until August 2023 using a defined algorithm. Inclusion criteria encompassed midfoot surgeries using metallic wedges, observational studies, and English-language full-text articles. Data extraction, article quality assessment, and statistical analyses were performed. Among 11 included articles, a total of 444 patients were assessed. The average follow-up duration was 18 months. Radiographic outcomes demonstrated that patients who received metallic wedges experienced improvements in lateral calcaneal pitch angle and Meary’s angle, with an enhancement of up to 15.9 degrees reported in the latter. Success rates indicated superior outcomes for metallic wedges (99.3%) compared to bone allograft wedges (89.9%), while complications were generally minor, including hardware pain and misplacement. Notably, there were no infection complications due to the inert nature of the metallic elements. This review summarizes the effectiveness, success rates, and safety of metallic wedges for flatfoot correction. Radiographic improvements and high success rates highlight their efficacy. Minor complications, including pain and mispositioning, were reported, but the infection risk remained low. Our results demonstrate that metallic midfoot wedges may be a viable option over allograft wedges with proper planning. Future research should prioritize long-term studies and standardized measures.

Mask wearing detection algorithm based on improved YOLOv7

The ongoing COVID-19 pandemic remains a significant threat, emphasizing the critical importance of mask-wearing to reduce infection risks. However, existing methods for mask detection encounter challenges such as identifying small targets and achieving high accuracy. In this paper, we present an enhanced YOLOv7 model tailored for mask-wearing detection. we employing a Generative Adversarial Network (GAN) to augment the original dataset, introducing the Convolutional Block Attention Module (CBAM) mechanism into the YOLOv7 model to enhance its small target detection capabilities, and replacing the model’s activation function with Parametric Rectified Linear Unit (FReLU) to improve overall performance. Experimental validation on a dataset showcases an average precision of 97.8% and a real-time inference speed of 64 frames per second (fps), meeting the real-time mask-wearing detection requirements effectively.