Reduce Infection Rates Research Articles

Nursing protocols to reduce urinary tract infection caused by indwelling catheters: an integrative review.

to analyze the production of knowledge in research articles about the effectiveness of nursing protocols for reducing indwelling urinary catheter dwell time and catheter-associated urinary tract infection rate in hospitalized adult and older patients. an integrative review of three full articles, available in the MEDLINE Complete - EBSCO, Scopus and Web of Science databases, from 01/01/2015 to 04/26/2021. the three protocols reduced infection rates, and from the review/synthesis of their knowledge, a level IV body of evidence emerged to compose the nursing care process aimed at reducing indwelling urinary catheter dwell time and catheter-associated urinary tract infection. this process gathers scientific evidence to support the elaboration of nursing protocols and, consequently, the conduction of clinical trials on its effectiveness in reducing urinary tract infection by indwelling urinary catheter.

Practice of COVID-19 Preventive Measures and its Associated Factors among the Undergraduate Medical Students: A Cross-Sectional Study

Introduction: The COVID-19 is an emerging infectious disease with serious public health consequences. Appropriate practice of preventive measures and adherence to it play an essential role in reducing infection rates and controlling the spread of the disease.
 Objectives: This study aimed to assess the practices of COVID-19 preventive measures and its associated factors among the undergraduate medical students at Birat Medical College Teaching Hospital.
 Methodology: A cross-sectional study was conducted from 25 July 2021 to 25 December 2021 among the medical students at Birat Medical College Teaching Hospital, Morang, Nepal. The complete enumeration of 146 medical students were carried out. Ethical clearance was obtained from the Institutional Review Committee at Birat Medical College Teaching Hospital. A semi-structured questionnaire using Google forms was used for data collection. Univariate and bivariate analysis were done. A p-value less than 0.05 was considered statistically significant.
 Results: The mean score for practices of preventive measures towards COVID-19 was 16.58±2.73. More than half of the participants (54.1%) adopted good practices. The most frequently performed practice was wearing face masks when going outside the home (98.6%), followed by hand washing using soap and water for at least 20 seconds regularly (96.6%) and covering the mouth when coughing or sneezing with a tissue paper/a disposable handkerchief (96.6%). Moreover, most of the participants used alcohol-based hand sanitizer if soap and water were not available (95.2%), stayed at home when they felt flu-like symptoms (95.2%), visited the nearest health facility when getting sick (95.2%), and avoided close contact with sick individuals with flu-like symptoms (93.2%). Age, gender, ethnicity, religion, marital status, academic year, average monthly family income, any health insurance and vaccination status were not significantly associated with the practice of COVID-19 preventive measures.
 Conclusion: More than half of the participants adopted good practices of preventive measures towards COVID-19. Lower practice scores among medical students is the matter of concern.

Total diz artroplastisi sonrası yara kapamada stapler ile prolen sütürün karşılaştırılması: Retrospektif kohort çalışması

Aim: The wound closure method applied after total knee replacement, plays a critical role in the success of the surgery. Various skin closure methods have been described in the literature in order to reduce infection rates, shorten the surgical time, and increase patient satisfaction. However, there is no standardized guideline on which type of suture should be used. The aim of this study was to compare the efficiency and safety of staples with prolene sutures in wound closure after total knee arthroplasty.
 Materials and Methods: Eighty-five patients that underwent total knee arthroplasty between January 2021 and October 2021 were retrospectively assessed. Patients were divided into two groups according to the wound closure method. The two groups were compared in terms of wound complication rate, operative time, postoperative hospitalization duration, and Likert scale level of patient satisfaction.
 Results: The majority (87.1%) of the patients were women . The mean age of the patients was 64.6±7.2 (range, 45-79). The prolene suture group had no wound complications while the staples group had five (11.9%) (p

Pandemic meltdown and economic recovery – A multi-phase dynamic model, empirics, and policy

In this paper a two-phase pandemic-economic model is proposed, with phase-specific modeling and policy variables – as suggested by the chronicle of pandemic and economic policy developments over the period 2020–2021. In a first phase, the spread of a pandemic disease is the primary concern of authorities, that still also pay attention to economic activity. A dynamic model is introduced, embedding a two-way interaction between an extended epidemic Susceptible-Infected-Recovered (SIR) model and output gap dynamics. In the second phase, posterior to lockdowns when waves fade away, monetary policy becomes the control variable, pursuing again a joint objective, of supporting a non-inflationary recovery without causing significant fatalities. We then use a standard stylized model for the macroeconomy with simplified infection dynamics, that also enter the policy objective. The two phases are thus studied in a regime change model where the control and state variables as well as the objective function are allowed to change across phases. We solve the model over a finite horizon and derive the optimal lockdown or monetary policy path that jointly minimizes pandemic and economic losses. The two-phase finite horizon decision model is empirically calibrated and numerically solved by discretization and optimization methods. In the first phase, albeit with lasting adverse effects on output, lockdown-based control can be effective in reducing infection rates, but less so when starting from a negative output gap. In the second phase, accommodative monetary policy appears to be effective on both fronts, with even an eventual need for a return to tightening as output gap closes and inflation resumes.

The impact of a meta-analysis on orthopaedic surgeons' practice with regards to vancomycin graft pre-soaking in anterior cruciate ligament reconstruction: A paper questionnaire survey study.

Understanding the impact of orthopaedic scientific research is vital in identifying facilitators and barriers to its implementation in clinical practice. A meta-analysis was carried out which showed that presoaking hamstring (HT) autografts in vancomycin was associated with a 10-fold reduction in infection rate in anterior cruciate ligament (ACL) reconstruction. Our aim was to determine the practice of orthopaedic surgeons with regards to vancomycin presoaking and explore whether they would adopt the findings of this meta-analysis. A paper questionnaire survey was administered to attendees of an annual EFORT podium presentation of the meta-analysis findings. Descriptive statistics were used to summarize the characteristics of respondents and their responses. A total of 29 senior surgeons/subspecialists performing a median of 40 ACL reconstructions per year completed the survey of whom 7 (24.1%) had encountered an ACL graft infection in the previous 2 years and 14 (48.3%) in the previous 5 years. Only 3 (10.3%) presoaked the ACL graft with an antibiotic. About 1/4 of those who up to then did not pre-soak the graft (6/26, 23.1%) would consider changing their practice to pre-soaking with vancomycin, with similar findings (5/20, 25.0%) in those that used a HT autograft as their first choice. Orthopaedic surgeons are receptive to the findings of a meta-analysis reporting on the effectiveness of vancomycin graft presoaking in ACL reconstruction, which can thus have a substantial impact upon clinical care. Addressing concerns about vancomycin induced graft toxicity and comparing the pre-soaking effect to that of specific intravenous antibiotic regimens may further enhance the uptake of this practice.

Immune Responses to SARS-CoV-2 Infection and Vaccine in a Big Italian COVID-19 Hospital: An 18-Month Follow-Up.

This is a longitudinal prospective study which was designed to assess the trend of anti-SARS-CoV-2 antibodies targeting the Spike (anti-S) and Nucleocapside protein (anti-N) viral antigens over a 9-month period after the administration of an anti-SARS-CoV-2 vaccine in a big COVID-19 hospital located in Northern Italy. 7411 vaccinated workers were included in a linear mixed-effect model analysis performed to model the anti-S decay over the 9 months following the vaccination, during serological screening performed approximately 2, 4, and 9 months following the first jab administration. Serological tests performed in the 9 months preceding vaccine administration were retrospectively analysed to identify the burden of infections occurring before vaccination. The serological assays were used for monitoring the antibody titres during the observational period. Vaccination significantly reduced the rate of infection and elicited a specific humoral response, which lasted during the whole observational period (9 months). A decay was observed in all considered subgroups. At 35 weeks, workers with no history of pre-vaccine infection showed a significantly lower anti-S titre (-2522 U/mL on average (-2589.7 to -2445.7)); younger workers showed significantly higher anti-S titres (140.2 U/mL on average (82.4 to 201.3)). Only seven immunocompromised workers did not show significant levels of anti-S antibodies; three of them, all females, showed a specific T-cell response. Comparing the 9-month periods before and after the first vaccine dose, a significant reduction in infection rate was observed (1708 cases vs. 156). Pre-vaccine infection, especially if contracted during the first pandemic wave, greatly enhanced the response to vaccination, which was significantly affected also by age both in extent and duration (inversely related). A gender effect on the T-cell immune response was observed in a small group of workers who did not produce antibodies after vaccine administration.

Antimicrobial and antiurolithiatic activities of pure and silver doped copper oxide nanoparticles using Moringa Oleifera leaf extract on struvite urinary stones

The development of nanoparticles plays a significant role in contemporary medicament. Struvite stones are associated with urinary tract infection, there are several techniques provided including drug therapy, and extracorporeal shock wave lithotripsy (ESWL) in consequence, the present study was focused onto attain the antiurolithiatic activity of pure and 20% of Ag-doped CuO nanoparticles mediated from Moringa Oleifera leaf extract. The synthesized nanoparticles were characterized using X-ray Diffraction. The Monoclinic structure and the average crystallite size for pure and 20% Ag-doped CuO nanoparticles were found to be 15.22nm and 3.67nm. The surface morphology of the specimens was analyzed by Field-Emission Scanning Electron Microscopy and Transmission Electron Microscopy. FE-SEM images showed nanostructures for pure and 20% Ag-doped CuO nanoparticles. The average particle size obtained for the nanoparticles from FE-SEM was found to be in the range of 12.84 nm-14.52 nm & 2.55 nm-5.04 nm was in good agreement with the average crystallite size from XRD results. TEM images displayed that CuO nanoparticles were distributed uniformly and for 20% Ag-doped CuO nanoparticles, Ag nanoparticles adhered on the surface of CuO nanoparticles. The presence of the synthesized materials was detected by Energy Dispersive X-ray analysis. Functional groups were identified by Fourier Transform Infrared Spectroscopy. From, Zeta Potential analysis, the negative potential value of -34.23 mV and -36.12 mV for green synthesized nanoparticles were identified. The diffraction patterns and functional groups of struvite crystals were confirmed by X-ray diffraction and Fourier Transform Infrared Spectroscopy. The inhibitory effect of synthesized 20% Ag-doped CuO nanoparticles showed a percentage of inhibition of 86.95% as compared with pure CuO showed 81.52% at a 5% concentration. Maximum inhibition was observed for 20% Ag-doped CuO nanoparticles against bacterial pathogens such as S. aureus, Bacillus subtilis, and Escherichia coli (8mm) in diameter and fungal Candida albicans (6mm) in diameter. Therefore the present study revealed that the synthesized pure and 20% Ag-doped CuO Nps mediated from M. Oleifera leaf extract encourage the creation of ammonium magnesium phosphate hexahydrate crystals and reduction in nucleation rate of urinary tract infection causing struvite stones.

Silver-coated versus uncoated locking plates in subjects with fractures of the distal tibia: a randomized, subject and observer-blinded, multi-center non-inferiority study

BackgroundAntimicrobial coatings of implants are of interest to reduce infection rate in orthopedic surgery. Demonstration of clinical effectiveness of such coated implants to obtain market approval is challenging. The objective of this article is to define a design for a randomized controlled trial to evaluate the clinical performance of a silver-coating for locking plates for fracture treatment.MethodsThe study design has to respect different criteria, such as feasibility, focus on overall complications, such as functional impairment, fracture healing, and particularly on infection rates. Distal tibia fractures were chosen due to the high prevalence of infections in this type of injuries, which warrants a particular benefit of antimicrobial prophylaxis and thus might allow to see a statistical trend in favor of the coated product. The study design was defined as a randomized, controlled, subject and observer-blinded, multi-center study in subjects with fractures of the distal tibia with a total of 226 patients. A number of 113 patients are planned for each of the two treatment arms with treatment of the fracture with a silver-coated device (first arm) or with an uncoated device (second arm). Inclusion criteria are closed fractures of the distal tibia according to the Tscherne-Oestern classification or open fractures of the distal tibia according to the Gustilo-Anderson classification in subjects older than 18 years. Primary outcome parameter is the Anticipated Adverse Device Effects (AADE) including all typical complications of this type of injury, such as functional impairment of the affected limb, non-union, and infections based on a non-inferiority study design. Also, silver-typical complications, such as argyria, are included. Secondary parameters are infection rates and fracture healing. Follow-up of patients includes five visits with clinical and X-ray evaluations with a follow-up time of 12 months.DiscussionDemonstration of clinical effectiveness of antimicrobial coatings of fracture fixation devices remains a challenge. Definition of a prospective randomized pre-market trial design and recruitment of clinical sites for such a study is possible. A confirmative proof of the expected clinical benefit in terms of reduction of device-related infections will be addressed with a prospective post-market clinical follow-up study in a second step due to the large sample size required.Trial registrationClinicalTrials.gov NCT05260463. Registered on 02 March 2022.

Make It Less difficile: Understanding Genetic Evolution and Global Spread of Clostridioides difficile

Clostridioides difficile is an obligate anaerobic pathogen among the most common causes of healthcare-associated infections. It poses a global threat due to the clinical outcomes of infection and resistance to antibiotics recommended by international guidelines for its eradication. In particular, C. difficile infection can lead to fulminant colitis associated with shock, hypotension, megacolon, and, in severe cases, death. It is therefore of the utmost urgency to fully characterize this pathogen and better understand its spread, in order to reduce infection rates and improve therapy success. This review aims to provide a state-of-the-art overview of the genetic variation of C. difficile, with particular regard to pathogenic genes and the correlation with clinical issues of its infection. We also summarize the current typing techniques and, based on them, the global distribution of the most common ribotypes. Finally, we discuss genomic surveillance actions and new genetic engineering strategies as future perspectives to make it less difficile.

Comparison of catheter-related bloodstream infection rates in pediatric patients receiving parenteral nutrition with soybean oil-based intravenous fat emulsion versus a mixed oil fat emulsion.

To compare rates of catheter-related bloodstream infections (CR-BSI) in pediatric patients who received parenteral nutrition (PN) with either soybean oil-based intravenous fat emulsion (SO-IFE) or mixed oil-IFE (MO-IFE). We hypothesized that the use of MO-IFE would be independently associated with reduced infection rates compared with SO-IFE. Retrospective cohort study. Tertiary referral children's hospital and its associated gastrointestinal rehabilitation clinic (01 January, 2015-31 July, 2019). Days of IFE exposure were counted for patients aged <18 years on IFE initiated during the review period, who had a central venous catheter (CVC) placed for PN administration, received IFE at least three times weekly, and for at least 7 days. The primary outcome included total and categorical CR-BSI rates expressed as the average with standard error (SE) number of infections per 1000 fat emulsion days. The following categories were specified: Candida albicans, non-albicans Candida spp., coagulase-negative Staphylococcus (CoNS), Enterobacterales, methicillin-resistant S. aureus, methicillin-susceptible S. aureus, and Pseudomonadales. Average infection rate comparisons were quantified as incidence rate ratios (IRR) using generalized linear mixed modeling with a Poisson distribution. Seven hundred and forty-three SO-IFE and 450 MO-IFE exposures were reviewed from 1131 patients, totaling 37,599 and 19,796 days of therapy, respectively. From those found significantly different, the average rate of infections with CoNS was 3.58 (SE 0.5)/1000 days of SO-IFE and 1.39 (SE 0.45)/1000 days of MO-IFE (IRR [95% confidence interval, CI]: 0.27 [0.16-0.46]; p < 0.01). Total average rates of infection were 7.33 (SE 0.76)/1000 days of SO-IFE and 4.52 (SE 0.75)/1000 days of MO-IFE (IRR [95% CI]: 0.60 [0.44-0.81]; p < 0.01). Other factors associated with higher infection rates include female gender, neonatal age, and inpatient-only IFE exposure. Receipt of MO-IFE was associated with lower rates of CoNS and total CR-BSIs compared with SO-IFE in pediatric patients. These findings could have major implications on IFE selection for pediatric patients receiving PN.

Fast inactivation of coronavirus in filtering-facepiece respirators in a reflective cylindrical UV-C chamber

ObjectiveWe report on the development and characterization of a UV-C (λ = 200 – 280 nm, λpeak = 254 nm) chamber designed for the rapid disinfection of N95 class filtering-facepiece respirators contaminated with SARS-CoV-2 coronaviruses. The device was evaluated against Betacoronavirus strain MHV-3 and its virucidal capacity was evaluated as a function of different applied UV-C doses (UV-C exposure times of 60 s, 120 s, 180 s, and 240 s) using two types of respirators geometry (shell and two-panel shapes, 3M 8801 H and 9920 H, respectively), at eight points of the respirators. BackgroundMost chemical disinfection methods are not recommended for N95 masks. UV-C light provided by UVGI lamps (254 nm) is an effective physical agent against viruses and bacteria due to direct photochemical harming effect on DNA/RNA, and can provide rapid disinfection for personal protective equipment such as N95/PFF2 masks. ResultsThe device reached a mean elimination rate of 99.9999% of MHV-3 inoculated into all the assessed different points on the tested PFF2 respirator models in a UV-C cycle of just 60 s. Statistical analysis performed through Person´s chi-square test showed no correlation between the viral infectivity reduction and the viral inoculation point (p = 0.512) and the tested respirator models (p = 0.556). However, a correlation was found between the exposure time and the viral infectivity reduction (p = 0.000*), between UV-C and no UV-C exposure. All the tested UV-C exposure times (60 s, 120 s, 180 s, and 240 s) provided the same reduction in infection rates. Therefore, 60 s was confirmed as the minimum exposure time to achieve a 99.9999% or 6 Log reduction in MHV-3 coronavirus infection rates in the PFF2 samples tested in the device. ConclusionsWe conclude that the assessed UV-C chamber for the inactivation of MHV-3 coronavirus in N95/PFF2 standard masks can be a promising tool for effective and rapid disinfection of coronaviruses, including SARS-CoV-2 virus.

The Cost-Effectiveness of Normal-Saline Pulsed Lavage for Infection Prophylaxis in Total Joint Arthroplasty.

BackgroundProsthetic joint infection (PJI) is a well-described complication after total joint arthroplasty which imposes a substantial burden of morbidity and mortality on the individual, as well as cost to the health-care system. This study used a break-even analysis to investigate the cost-effectiveness of pulsed saline lavage (PSL) for PJI prophylaxis after a primary total knee arthroplasty (TKA) and total hip arthroplasty (THA).MethodsAn established model was used to calculate the minimum cost-effective absolute risk reduction of PSL for infection prophylaxis after a total joint arthroplasty. Baseline infection rates of TKA and THA and the cost of a revision surgery for PJI were derived from the literature while the cost of PSL implementation was obtained from institutional data.ResultsPSL is cost-effective at an initial infection rate of 1.10%, revision costs of $32,132 for TKA PJI, and a protocol cost of $38.28 if it reduces infection rates by 0.12% or prevents infection in 1 out of 839 patients. PSL is cost-effective at an initial infection rate of 1.63% and a revision cost of $39,713 for THA PJI if it reduces infection rates by 0.10% or prevents infection in 1 out of 1037 patients. The absolute risk reduction needed for economic viability did not change with varying baseline infection rates and did not exceed 0.38% for infection treatment costs as low as $10,000 and remained less than 0.47% even if PSL cost was as high as $150.ConclusionsThe use of PSL is a cost-effective protocol for PJI prophylaxis after TKAs and THAs.

Fracture-related infection.

Musculoskeletal trauma leading to broken and damaged bones and soft tissues can be a life-threating event. Modern orthopaedic trauma surgery, combined with innovation in medical devices, allows many severe injuries to be rapidly repaired and to eventually heal. Unfortunately, one of the persisting complications is fracture-related infection (FRI). In these cases, pathogenic bacteria enter the wound and divert the host responses from a bone-healing course to an inflammatory and antibacterial course that can prevent the bone from healing. FRI can lead to permanent disability, or long courses of therapy lasting from months to years. In the past 5 years, international consensus on a definition of these infections has focused greater attention on FRI, and new guidelines are available for prevention, diagnosis and treatment. Further improvements in understanding the role of perioperative antibiotic prophylaxis and the optimal treatment approach would be transformative for the field. Basic science and engineering innovations will be required to reduce infection rates, with interventions such as more efficient delivery of antibiotics, new antimicrobials, and optimizing host defences among the most likely to improve the care of patients with FRI.

Conversion of External Fixator to Intramedullary Nail in Tibial fractures.

Conversion of provisional external fixation to intramedullary nail (IMN) in femur fractures has been reported to be safe within 14 days of initial surgery. However, there is no current literature guiding this practice in tibial fractures. The purpose of this study was to identify the time period when conversion of external fixation to nail in tibial fractures is safe. After obtaining IRB approval, tibial fractures (OTA 41A, 42, 43A) that received provisional ex-fix and were converted to IMN from 2009 to 2019 were retrospectively reviewed. Skeletally mature patients with minimum 6 months of follow-up were included. The primary outcome was deep infection. External fixation days were categorized as less than 7, 8 to 14, and 15+ days. Risk ratios of infection were estimated using generalized linear regression with a Poisson distribution. A separate regression model evaluated risk factors for infection using both the external fixation and non-external fixation tibial cohorts. Twenty-eight patients (32%) were treated for deep infection. The infection rate for closed fractures was 28% (11 of 39 patients) and for open fractures was 35% (17 of 49 patients) ( P = 0.56). Examining both tibial cohorts, external fixation (odds ratio [OR] = 2.39, P = 0.017), open fracture (OR = 3.13, P = 0.002), and compartment syndrome (OR = 2.58, P = 0.01) were all associated with infection in regression modeling. Median external fixation days for patients with deep infection was 8 days (Inter-quartile range, 3 to 18 days) as compared with 4 days (IQR, 2 to 9 days) in patients without infection ( P = 0.06). While controlling for open fractures, the 8- to 14-day group had RR = 1.81 ( P = 0.2), and the 15+-day group had RR = 2.67 ( P = 0.003) as compared with the <7-day group. Infection rates of tibial fracture patients treated with external fixation and converted to IMN were high. Surgeons should strongly consider the necessity of external fixation for these fractures. Earlier conversion of external fixation to definitive fixation reduced infection rates. Level IV-case series.

Biological properties of Cu-bearing and Ag-bearing titanium-based alloys and their surface modifications: A review of antibacterial aspect

The use of titanium dental implants to replace missing teeth represents an important field of daily dental practice worldwide, which is highly reliable for long-term survival and success rates. However, titanium dental implants still have intrinsic problems that cannot meet the clinical requirements. Improving the performance of implants is an increasingly important area of dental research to reduce infection rates. Improved properties can be achieved by two main methods: 1) the overall change in the materials by changing the elemental composition and 2) surface modifications. This review provides an overview of various titanium-based alloys that have been employed to achieve a higher survival rate of implantation by adding elements or modifying the surface, with a special focus on their antibacterial applications. Recent developments in titanium-based alloys containing various antibacterial agents have been described in detail, including Cu-bearing, Ag-bearing, and Zr-bearing Ti alloys. Moreover, the applications of bioactive coatings and 3D printing materials with antibacterial properties are reviewed. This review aims to highlight the antibacterial challenges associated with titanium-based alloys to promote the further development and clinical application of antibacterial alloys.

Rate of COVID-19 Infection and 30 Day Mortality Between Blue and Green (Dedicated COVID-19 Safe) Pathways: Results From the UK Foot and Ankle COVID-19 National-Audit

Category: Other Introduction/Purpose: Objectives: The primary aim was to determine the differences in COVID-19 infection rate and 30-day mortality in patients undergoing foot and ankle surgery between different treatment pathways over the two phases of the UK- FALCON audit, spanning the first and second national lockdowns. Methods: Setting: This was an ambispective (retrospective Phase 1 and prospective Phase 2) national audit of foot and ankle procedures in the UK in 2020 completed between 13th January 2020 and 30th November 2020.Participants: All adult patients undergoing foot and ankle surgery in an operating theatre during the study period were included from 46 participating centres in England, Scotland, Wales and Northern Ireland. Patients were categorised as either a green pathway (designated COVID-19 free) or blue pathway (no protocols to prevent COVID-19 infection). Results: 10,846 patients were included, 6,644 from phase 1 and 4,202 from phase 2. Over the 2 phases the infection rate on a blue pathway was 1.07% (69/6,470) and 0.21% on a green pathway (9/4,280). In phase 1, there was no significant difference in the COVID-19 perioperative infection rate between the blue and green pathways in any element of the first phase (pre-lockdown (p=.109), lockdown (p=.923) or post-lockdown (p=.577)). However, in phase 2 there was a significant reduction in perioperative infection rate when using the green pathway in both the pre-lockdown (p&lt;.001) and lockdown periods (Odd's Ratio 0.077, p&lt;.001). There was no significant difference in COVID-19 related mortality between pathways. Conclusion: There was a five-fold reduction in the perioperative COVID-19 infection rate when using designated COVID-19 green pathways over the whole study period; however the success of the pathways only became significant in phase 2 of the study, where there was a 13-fold reduction in infection rate. The study shows a developing success to using green pathways in reducing the risk to patients undergoing foot and ankle surgery.

Leveraging Primary Care, Public Health and Social Context During the COVID-19 Response Within a University Setting: Considerations for the Osteopathic Family Physician

The COVID-19 pandemic placed a spotlight on both the successes and the needs across the spectrum of the healthcare system. The trusting, enduring relationships developed within the primary care setting served as an important foundation on which to build response strategies throughout the pandemic. Early detection and testing, implementation of telehealth, delivery of continuous comprehensive care, and vaccine education and administration are all key areas where primary care and public health systems successfully served patients and community. Emerging national research from the COVID-19 pandemic experience has also demonstrated the reduction in COVID-19 infection and death rates through the synergy between primary care, public health and social factors, emphasizing once again the critical role these services play and the importance of developing integration strategies for the future. In particular, the COVID-19 experience within the university setting served as a key example of this integration and synergy in action. As osteopathic family physicians, these experiences can serve as lessons learned toward embracing the opportunity afforded by our unique training, expertise and commitment to the osteopathic philosophy.

A longitudinal analysis of nosocomial bloodstream infections among preterm neonates

Nosocomial bloodstream infections (NBSIs), commonly due to central-line associated bloodstream infections (CLABSI), contribute substantially to neonatal morbidity and mortality. We aimed to identify longitudinal changes in incidence of NBSI, microbiological-spectrum, and antibiotic exposure in a large cohort of preterm neonates admitted to the neonatal intensive care unit. We retrospectively assessed differences in annual rates of NBSI (per 1000 patient-days), CLABSI (per 1000 central-line days), and antibiotic consumption (per 1000 patient-days) among preterm neonates (< 32 weeks’ gestation) hospitalized between January 2012 and December 2020. Multi-state Markov models were created to model states of progression of NBSI and infection risk given a central-line on days 0, 3, 7, and 10 of admission. Of 1547 preterm infants, 292 (19%) neonates acquired 310 NBSI episodes, 99 (32%) of which were attributed to a central-line. Over the years, a significant reduction in central-line use was observed (p < 0.001), although median dwell-time increased (p = 0.002). CLABSI incidence varied from 8.83 to 25.3 per 1000 central-line days, with no significant difference between years (p = 0.27). Coagulase-negative staphylococci accounted for 66% of infections. A significant decrease was found in antibiotic consumption (p < 0.001). Probability of NBSI decreased from 16% on day 3 to 6% on day 10. NBSI remains a common problem in preterm neonates. Overall antibiotic consumption decreased over time despite the absence of a significant reduction in infection rates. Further research aimed at reducing NBSI, in particular CLABSI, is warranted, particularly with regard to limiting central-line dwell-time and fine-tuning insertion and maintenance practices.

Reducing Flavobacterium psychrophilum transmission risk via hatchery-rearing practices: An individual-based modeling evaluation

Flavobacterium psychrophilum can be a significant mortality source in hatcheries where trout and salmon (Family Salmonidae) are propagated and raised. Preventing F. psychrophilum outbreaks and controlling its spread in hatcheries is challenged by limited effectiveness of current therapeutics and lack of efficacious commercial vaccines. Consequently, one of the few available options to limit outbreaks and spread within a facility may be modifications to hatchery-rearing practices. We developed an individual-based model to evaluate how rearing practices could limit F. psychrophilum-induced losses of Oncorhynchus mykiss in flow-through, partial-reuse raceway systems. Evaluated practices included frequency of removal of dead individuals, the probability that hatchery personnel found fish that died from infection, and water flow rate through raceways. Practices were assessed under different assumptions about initial number of infected individuals and virulence levels associated with infection. Increasing the frequency of removal of dead individuals led to the largest reductions in cumulative mortality due to disease as well as reductions in peak daily infection rates and time until peak daily infections occurred when compared to changes in flow rates. Under high initial infection, high virulence, and low flow conditions, increasing the frequency of removal from once to two or three times per day decreased cumulative mortality by approximately 150 thousand fish. When initial infection prevalence was high, disease outbreaks were acute with peak daily infection rates occurring 39 to 53 days post-placement in outdoor raceways. Conversely, when initial infection prevalence was low, infection course was more chronic. Increasing the frequency of dead fish removal to hourly and the probability of hatchery personnel finding dead fish in raceways when checks were performed resulted in modest gains in survival, although these results were likely conditional on model assumptions. If the probability of hatchery personnel finding dead fish was lower than what was assumed in our evaluations, larger gains from more frequently checking for dead fish may have resulted. We believe there is considerable potential in using simulation models to explore the benefits of different rearing practices in cultured fish. To that end, we have made the simulation model used in this study available for those interested in adapting or expanding it to address other research questions.

Microstructured Polymer System Containing Proanthocyanidin-Enriched Extract from Limonium brasiliense as a Prophylaxis Strategy to Prevent Recurrence of Porphyromonas gingivalis.

Periodontal diseases are a global oral health problem affecting almost 10% of the global population. Porphyromonas gingivalis is one of the main bacteria involved in the initiation and progression of inflammatory processes as a result of the action of the cysteine proteases lysin- and arginine-gingipain. Surelease/polycarbophil microparticles containing a lyophilized proanthocyanidin-enriched fraction from the rhizomes of Limonium brasiliense, traditionally named "baicuru" (ethyl acetate fraction), were manufactured. The ethyl acetate fraction was characterized by UHPLC by the presence of samarangenins A and B (12.10 ± 0.07 and 21.05 ± 0.44%, respectively) and epigallocatechin-3-O-gallate (13.44 ± 0.27%). Physiochemical aspects of Surelease/polycarbophil microparticles were characterized concerning particle size, zeta potential, entrapment efficiency, ethyl acetate fraction release, and mucoadhesion. Additionally, the presence of the ethyl acetate fraction-loaded microparticles was performed concerning potential influence on viability of human buccal KB cells, P. gingivalis adhesion to KB cells, gingipain activity, and P. gingivalis biofilm formation. In general, all Surelease/polycarbophil microparticles tested showed strong adhesion to porcine cheek mucosa (93.1 ± 4.2% in a 30-min test), associated with a prolonged release of the ethyl acetate fraction (up to 16.5 ± 0.8% in 24 h). Preincubation of KB cells with Surelease/polycarbophil microparticles (25 µg/mL) resulted in an up to 93 ± 2% reduced infection rate by P. gingivalis. Decreased activity of the P. gingivalis-specific virulence factors lysin- and arginine-gingipain proteases by Surelease/polycarbophil microparticles was confirmed. Surelease/polycarbophil microparticles decreased biofilm formation of P. gingivalis (97 ± 2% at 60 µg/mL). Results from this study prove the promising activity of Surelease/polycarbophil microparticles containing ethyl acetate fraction microparticles as a prophylaxis strategy to prevent the recurrence of P. gingivalis.