Treatment Unit Research Articles

A long short-temory relation network for real-time prediction of patient-specific ventilator parameters.

Accurate prediction of patient-specific ventilator parameters is crucial for optimizing patient-ventilator interaction. Current approaches encounter difficulties in concurrently observing long-term, time-series dependencies and capturing complex, significant features that influence the ventilator treatment process, thereby hindering the achievement of accurate prediction of ventilator parameters. To address these challenges, we propose a novel approach called the long short-term memory relation network (LSTMRnet). Our approach uses a long, short-term memory bank to store rich information and an important feature selection step to extract relevant features related to respiratory parameters. This information is obtained from the prior knowledge of the follow up model. We also concatenate the embeddings of both information types to maintain the joint learning of spatio-temporal features. Our LSTMRnet effectively preserves both time-series and complex spatial-critical feature information, enabling an accurate prediction of ventilator parameters. We extensively validate our approach using the publicly available medical information mart for intensive care (MIMIC-III) dataset and achieve superior results, which can be potentially utilized for ventilator treatment (i.e., sleep apnea-hypopnea syndrome ventilator treatment and intensive care units ventilator treatment.

Assessment of Wastewater Characteristics of Treatment Units in some Hospitals in the City of Basra

This paper presents the results of the flowing water characteristics from the sanitation system studied in targeted hospitals in the city of Basra, Iraq, in four sites from the 1st of December 2021 to the 1 st of March 2022, including two major sites for government hospitals and two main sites for private hospitals. Statistical analysis of a set of physicochemical water quality parameters of flowing water collected directly from hospitals and water flowing before mixing with public sewage was conducted to investigate the efficiency of a hospital wastewater treatment plant in Basra, Iraq. The study concluded that the operational capacity in the selected treatment stations is commensurate with the hospital’s absorptive capacity and that all stations from different global origins operate as efficiently. The efficiency of removing Al–Saadi Hospital is 44.7% higher than other hospitals (Al–sader teaching, Al Mawanee, and Al–Mawadda) the efficiency of removing was (43.06%, 41.35%, 37.73%) respectively that have been studied. It is necessary to provide government and private hospitals with biological treatment stations to achieve the water environment in a city that suffers from severe pollution of water resources.

Mental Health of Nurses Employed in Surgical and Non-invasive Treatment Wards

Introduction. The nursing profession requires employees to be highly resistant to stress. Assisting patients in their experience of pain, illness, helplessness is a stressful experience can be a traumatic experience especially in the face of an immediate threat to a patient’s life. Nursing staff working in treatment wards is exposed to particularly intense stress, in contact with a patient experiencing fear of a surgery and a patient after a surgery experiencing postoperative pain and requiring specialist care.
 Aim. The exploratory goal of the study was to diagnose the level of mental health in case of the nurses working in two types of wards: surgical and non-invasive treatment ones. The nurses working in hospital non-invasive treatment wards were expected to have better mental health than the ones working in treatment units.
 Material and Methods. An anonymous questionnaire survey was conducted among N=244 nurses of randomly selected hospital wards in a district town in the north of Poland. In the study there were used: General Health Questionnaire GHQ-28 by D. Goldberg and Life Satisfaction Scale by E. Diener and co-workers.
 Results. Contrary to the expectations, nurses from non-invasive treatment wards experienced stronger anxiety, insomnia, social dysfunction and lower life satisfaction than their colleagues from surgical units.
 Conclusions. Counter to the intuitively imposing image of the work of a nurse in various types of hospital wards, professional burden and mental condition, the need for mental health prevention of nursing staff applies primarily to staff employed in non-invasive treatment wards. With the aging of the population, it is becoming increasingly important to equip these nurses with the skills to cope with prolonged exposure to occupational stressors. (JNNN 2023;12(2):69–73)

Kolekalsiferol sonrası endotel disfonksiyonu ve damar sertliğinin diyaliz modalitesine göre değerlendirilmesi

ABSTRACT
 Objective: The risk of developing cardiovascular disease (CVD) increases significantly in children with chronic kidney disease (CKD) especially with low serum 25- hydroxyvitamin D (25OHD) levels. Herein; we aimed to compare the effects of vitamin D deficiency and the impact of cholecalciferol treatment on endothelial functions and vascular stiffness in children with CKD receiving hemodialysis (HD), peritoneal dialysis (PD) and non- dialysis(ND).
 Methods: 7 HD, 7 PD and 27 ND patient groups consisting of 41 children totally with low 25OHD levels were compared among each other in regards of biochemical parameters, flow-mediated dilatation(FMD) and local arterial stiffness before and after a single dose of 300.000 units of cholecalciferol treatment.
 Results: There was no difference in FMD and local arterial stiffness values between HD, PD and ND patient groups before vitamin D supplementation. Significant increase in endothelium-dependent FMD was observed in all patient groups after intervention with cholecalciferol; however the improvement in endothelium-independent FMD and local arterial stiffness measurements was demonstrated in patients with PD and ND. Baseline parathormon level was higher in patients on dialysis; at the end of the study, significant decrease was detected only in patient group not receiving diaysis.
 Conclusions: Endothelial dysfunction and impaired vascular stiffness were determined in children with CKD with low 25OHD levels regardless of the disease severity.. Recovery with cholecalciferol therapy revealed that vitamin D deficiency should be corrected even in early stages of CKD to prevent the development of CVD

Trends and Patterns of Long Bone Fractures in Relation to The Road Traffic Accidents, Assaults, and Falls Among Patients Admitted to Emergency Treatment Unit in Teaching Hospital Karapitiya

Trends and Patterns of Long Bone Fractures in Relation to The Road Traffic Accidents, Assaults, and Falls Among Patients Admitted to Emergency Treatment Unit in Teaching Hospital Karapitiya

Relationships between common mental disorders, Burnout, and poor sleep quality in healthcare professionals working on the frontline of COVID-19 combat

The SARS-CoV-2 pandemic directly impacted the mental health of frontline health care workers fighting COVID-19. This study aims to investigate whether the working conditions of these professionals acted as predictors of common mental disorders, poor sleep quality, and burnout. Cross-sectional study conducted with 133 health professionals from three COVID-19 treatment units in the Agreste of Pernambuco-Brazil. The prevalence of depressive symptoms, anxiety, stress, and poor sleep quality were 26.3%, 36.8%, 28.6%, and 80%, respectively. The prevalence of high emotional exhaustion and high depersonalization was 47.4% and 57.1%, respectively. Weekly workload of more than 40 hours and high level of occupational stress were significant predictors of burnout and sleep disorders. The symptoms of mental illness among health professionals suffer a cumulative effect, and it is necessary to establish measures for the prevention of health problems among these workers.

Ethical challenges and dilemmas in the rationing of health commodities and provision of high-risk clinical services during COVID-19 pandemic in Ethiopia: the experiences of frontline health workers

BackgroundEthical reasoning and sensitivity are always important in public health, but it is especially important in the sensitive and complex area of public health emergency preparedness. Here, we explored the ethical challenges, and dilemmas encountered by frontline health workers amid the coronavirus disease-19 (COVID-19) pandemic in Ethiopia.MethodsA nationwide survey was conducted amongst the frontline health workers from nineteen public hospitals. Health workers were invited to respond to a self-administered questionnaire. Data were weighted and analyzed using descriptive statistics.ResultsOf the 285 frontline health workers to whom questionnaires were distributed, 217 of them gave their responses (response rate 76.1%). Respondents frequently reported encountering rationing dilemmas on health commodities directly used for the prevention and treatment of COVID-19. Most (83.9%) of the health workers agreed that they encountered ethical challenges very frequently or frequently. Almost all [215(99.1%)] claimed that the limitation of resources was directly used for the treatment and prevention of COVID-19. The frequency of difficulty in the provision of essential clinical services varied between 77% and 98.7% for different services. More than half of the study participants reported that they had encountered difficulty in the provision of clinical care on a daily or weekly basis. Regarding rationing strategies, isolating COVID-19 treatment units and limiting admission were the most frequent rationing strategies used by two-thirds of health workers on a daily or weekly basis.ConclusionFront-line health workers encountered numerous ethically challenging situations during COVID-19. More than half of health workers reported that they encountered ethical challenges in rationing the resources and delivery of different clinical services such as family planning services, maternal and childcare, immunization, and chronic care. With limited resources such as ventilators and hospital beds, healthcare providers have been faced with the difficult task of deciding who gets access to these resources and who doesn't. Overall, the COVID-19 pandemic has presented numerous ethical challenges for healthcare providers, highlighting the importance of ethical considerations in healthcare delivery. By being aware of these dilemmas and having policies in place to address them, healthcare providers can ensure that they are providing the best possible care to their patients while upholding ethical standards.

Evaluasi Kandungan Hasil Pengolahan Limbah Cair pada Unit Effluent Treatment Pabrik III B PT. Petrokimia Gresik

Fertilizer is a supporter of the country's food security, the government through State-Owned Enterprises (BUMN), one of which is PT Petrokimia Gresik, which is the most complete and largest fertilizer producer in Indonesia which produces several wastes, one of which is industrial wastewater. The existence of liquid waste is not expected in the environment because it has no economic value, therefore the need for waste treatment is very important. PT Petrokimia Gresik uses physical processing and chemical processing. PT Petrokimia Gresik has a wastewater treatment plant with a series of processes consisting of 2 effluent treatment units, equalizer, line injection, Urea Plant hydrolizer stripper, and sludge treatment. The parameters analyzed were Chemical Oxygen Demand (COD), Total Suspended Solid (TSS), Ammonia (NH3), Total Kjehdal Nitrogen (TKN), Fluoride, Degree of Acidity (pH), Oil and Fat. After conducting the research, the results of the analysis showed that the effluent pollutant load data was at the quality standards regulated in regulations. However, it was found that the results of TKN (Total Kjeldahl Nitrogen) or the amount of bound nitrogen in an organic substance varied.

Aquatic connectivity treatments increase fish and macroinvertebrate use of Typha‐invaded Great Lakes coastal wetlands

Abstract Coastal wetlands provide critical habitat for aquatic organisms and important ecosystem services for the terrestrial and aquatic landscapes that they bridge, but increasingly common invasive macrophytes disrupt plant communities, food webs, habitat structure and littoral–pelagic linkages. In Laurentian Great Lakes coastal wetlands, invasive cattails (Typha × glauca and T. angustifolia, hereafter Typha) homogenise ecosystem structure and reduce nearshore dissolved oxygen, and plant, fish and macroinvertebrate diversity. We hypothesised that management treatments which reduce Typha and its abundant litter promote structural heterogeneity and mitigate physicochemical and biodiversity impacts. To test this hypothesis, we implemented a large‐scale (2,048 m2 treatment units), multi‐site (four coastal wetlands) experiment in northern Michigan (U.S.A.) to examine how invasive Typha mechanical harvesting treatments (biomass harvest, aquatic connectivity channels, Typha‐dominated control) altered fish, macroinvertebrate, plant, larval amphibian abundance and diversity, and water quality for 2‐year post‐treatment. Both harvest and channel treatments reduced Typha biomass, cover and dominance; harvest increased multi‐taxa species richness, fish diversity and abundance; and channels altered plant, fish, and macroinvertebrate community structures. Dissolved oxygen was greater and litter was reduced by both treatments, indicating likely mechanisms for shifts in fish and macroinvertebrate use. Our results suggest that harvesting invasive macrophytes can ameliorate biodiversity impacts and improve habitat quality, and that adding aquatic connectivity channels can increase community complexity. Typha management that incorporates both harvesting and aquatic connectivity channels appears to provide the greatest benefit to several taxonomic groups, likely by reducing Typha and its litter, increasing dissolved oxygen availability, and increasing the connection between open water and wetland interiors. Increasing habitat complexity and aquatic connectivity of invaded wetlands can promote biodiversity and provides a more realistic management goal than the complete elimination of invasive macrophytes.

A State-of-The-Art Technical Review on Chemically Enhanced Primary Treatment Plant

This review paper aims to provide a comprehensive assessment of chemically enhanced primary treatment (CEPT) processes in wastewater treatment plants (WWTPs). The outdated and ineffective performance of existing treatment plants has raised concerns regarding public health and environmental safety. CEPT has emerged as a promising alternative approach to enhance the efficiency and effectiveness of primary treatment. By adding chemical coagulants or precipitants to the wastewater, CEPT facilitates the aggregation and settling of suspended solids and contaminants, leading to improved treatment outcomes. This review evaluates the performance and effectiveness of different chemical coagulants, including ferric chloride (FeCl3), polyaluminum chloride (PACl), and alum, in terms of their ability to remove various pollutants such as suspended solids, turbidity, organic matter, nutrients, and emerging contaminants.
 The findings from the reviewed studies indicate that different coagulants exhibit varying efficiencies in removing specific parameters such as turbidity, total suspended solids (TSS), chemical oxygen demand (COD), and phosphorous. Alum, ferric chloride, and ferric sulfate showed effectiveness in tannery wastewater treatment, while PACl maximized the removal of macro pollutants. The use of organic carbon sources and sludge recycling demonstrated cost reductions and improved nutrient removal. CEPT was found to be effective in TSS and BOD removal, potentially allowing for compact treatment facilities and enhancing the capacity of biological treatment units. The utilization of recovered alum from water treatment sludge (WTS) in CEPT showed comparable efficiencies to fresh alum. The paper also identifies research gaps and future directions in the field of chemically enhanced primary treatment, while discussing the challenges and limitations associated with CEPT processes. While the reviewed studies provide valuable insights into the performance of different coagulants and coagulant aids, further research is necessary to assess their long-term effects and cost-effectiveness in large-scale applications. The optimal choice of coagulant depends on specific wastewater characteristics and treatment goals. Understanding and optimizing CEPT processes will contribute to the development of innovative solutions for challenges in wastewater treatment systems caused by urbanization, population growth, and emerging contaminants in the major city like Kathmandu.

Why am I still in hospital? Evaluation of delayed discharges from two learning disability assessment and treatment units in England

PurposeThis paper aims to examine the prevalence and reasons for delayed discharge from two regional assessment and treatment units (ATUs) for people with learning disabilities, in line with the transforming care agenda.Design/methodology/approachThis is a retrospective evaluation of 44 admissions and discharges from two ATUs from February 2019 to March 2022.FindingsOf 44 admissions who were discharged during the included period, 20 experienced delays in their discharge. Delayed discharges occurred despite the two ATUs meeting standards for length of assessment and treatment as specified by the Learning Disability Professional Senate. The most prevalent reasons for discharge delays were identification of a new placement, recruitment of care staff and building work.Originality/valueThis paper offers an in-depth evaluation of recent delayed discharges from two regional ATUs, highlighting the most common reasons for delays and offering suggestion for reducing delays in future.

Investigation of high-turbidity tap water problem in Najaf governorate/middle of Iraq

Abstract Turbidity is a fundamental measure for assessing the quality of water supplied by water treatment plants (WTPs) employing a conventional treatment process. If it is present in amounts exceeding the permitted limit, disinfectants are less effective in killing microorganisms and the water becomes unsafe to drink. This article is a part of a comprehensive study that aims to investigate the high-turbidity problem of tap water in two cities of Najaf governorate and offer suitable measures to solve this problem. The purpose of this study was to determine how WTPs impact the turbidity of tap water. The work covered two main WTPs located in Najaf governorate: Unified Najaf and The Old Kufa. It included the collection of water samples from three locations in each plant: the influent of flash mix unit (raw water samples), the effluent of clariflocculation unit (settled water samples), and the effluent of filtration unit (filtered water samples). The samples were analyzed for turbidity using a turbidity meter. The efficacy of each plant's treatment units was revealed by monitoring the turbidity of the water inside each facility. For the Unified Najaf WTP, out of 99 TRE readings, there were 3, 92, and 60 positive values for TREc, TREf, and TREp, respectively. The maximum values of TREc, TREf, and TREp were 22.3, 86.5, and 61.5%, respectively. The performance of Old Kufa WTP was worse than that of Unified Najaf WT. Out of 99 TRE values, the number of positive values was 6, 76, and 31 for TREc, TREf, and TREp, respectively. They also showed that only 26 out of 99 and 9 out of 99 effluent turbidity readings in Unified Najaf and Old Kufa WTPs, respectively, satisfy Iraqi standards for tap water turbidity. The bad performance of the WTPs was the main reason behind the high-turbidity tap water in Najaf governorate. This study identified the causes of that performance and proposed solutions.

The Potential of Bacillus spp. in Suppressing Colletotrichum capsici that Causes Antracnose in Red Chili

Red Chili (Capsicum annum L.) is a horticultural plants that is classified as an important commodity and has high economic value. One of the main problems in the production of red chili is anthracnose disease caused by the Colletotrichum capsici pathogen. Bacillus spp. expected to have the potential to inhibit the growth of C. capsici and stimulate the growth of plant. This study aims to determine the potential of Bacillus spp., in suppressing the growth of the C. capsici fungus and stimulating the growth of red chili. This study used a Completely Randomized Design (CRD) with the treatment without Bacillus spp., chemical fungicides, Bacillus sp. (Ba-6), Bacillus sp. (Ba-9), Bacillus sp. (Ba-12), Bacillus sp. (Ba-15), and Bacillus sp. (Ba-17). The treatment was repeated 4 times and the treatment unit contained 5 red chili/polybag. The results showed that the highest suppression of C. capsici in the treatment of Bacillus sp. Ba-15 was 6.25% compared to the negative control. The best bacteria that can stimulate the growth of red chili is Bacillus sp. Ba-9 with an average plant height 20.10 cm and an average number of leaves 10.49

Commentary on “Why am I still in hospital? Evaluation of delayed discharges from two learning disability assessment and treatment units in England”

PurposeThis commentary explores the challenges and themes enumerated by the associated article “Why am I still in hospital? Evaluation of delayed discharges from two learning disability assessment and treatment units in England”. This commentary broadens and outlines the research’s background, premise and potential impact. This paper aims to critically examine the evidence on this subject.Design/methodology/approachThis commentary considers the attitudes to inpatient care for people with learning disabilities in the past decade and outlines a possible compact for the future.FindingsContrary to popular and emotive beliefs that using specialist inpatient psychiatric settings for people with learning disabilities is universally a poor practice, there are defined occasions when such settings are needed and imperative in the clinical pathway. If people with learning disabilities can access inpatient settings at the right time for the right reason, psychiatric outcomes could be improved. Timely discharge is imperative and currently lacking due to a lack of suitable engagement mechanisms between inpatient settings and the community. Thus, evidence-based outcome tools are essential to facilitate appropriate discharge.Originality/valueThere is an ongoing debate on the value and utility of specialist inpatient psychiatric units for people with learning disabilities. This commentary provides a balanced, evidence-based insight into this discussion.

Effective nutrient removal using nutrient film technique hydroponics unit under varying nitrate nitrogen concentrations

AbstractSurface and groundwater are both susceptible to nitrate nitrogen contamination that has emerged as an issue around the globe in past few years. The main goal of this research was to treat nitrate‐contaminated water through phytoremediation in a hydroponic system with reduced cost and also assess the root and shoot growth of plants cultivated in NFT hydroponic systems. Four different nitrate‐nitrogen concentrations (30, 60, 90, and 120 mg/L) were given to hydroponic treatment unit. The results revealed that shoot growth, root growth, leaf number, and shoot numbers were increased with increasing nutrient solution concentration. The study's findings demonstrated that the average elimination efficiencies of nitrate‐nitrogen varied from 44.5% to 88% for money plants, 30.77% to 80.66% for crotons, 42.56% to 86% for arrowhead plants, 32.03% to 72.25% for vetiver grass, 28.08% to 70% for spinach, and 38.11% to 75.5% for brinjal plants, respectively. Thus, hydroponic phytoremediation has emerged as the environmental and cost‐effective technique for diminishing and removing nitrate nitrogen from wastewater.

Occurrence and transformation of heavy metals during swine waste treatment: A full scale study

This study tracked the fate of nine detected heavy metals in an industrial swine farm with integrated waste treatment, including anoxic stabilization, fixed-film anaerobic digestion, anoxic-oxic (A/O), and composting. Results show that heavy metals exhibited different transformation behaviors in the treatment streamline with Fe, Zn, Cu and Mn as the most abundant ones in raw swine waste. The overall removal of water-soluble heavy metals averaged at 30 %, 24 % and 42 % by anoxic stabilization, anaerobic digestion and A/O unit, respectively. In particular, anoxic stabilization could effectively remove Cu, Mn and Ni; while A/O unit was highly effective for Fe, Cr and Zn elimination from water-soluble states. As such, the environmental risk of liquid products for agricultural irrigation decreased gradually to the safe pollution level in swine waste treatment. Furthermore, heavy metals in the solid (slurry) phase of these bioprocesses could be immobilized with the passivation rate in the range of 42–70 %. Nevertheless, heavy metals preferably transformed from liquid to biosolids to remain their environmental risks when biosolids were used as organic fertilizer in agriculture, thereby requiring effective strategies to advance their passivation in all bioprocesses, particularly composting as the last treatment unit.

Tracing the fate of microplastic in wastewater treatment plant: A multi-stage analysis of treatment units and sludge

Microplastic (MP) pollution is ubiquitous in the environment presenting a global problem for both scientists and the general public. One of the major pathways of MPs entering the natural environment is through wastewater treatment plants (WWTPs). Once MPs reach the natural environment, they are posing threat to aquatic ecosystems and public health. The aim of this study is to investigate the concentration, morphology, and composition of MPs in different treatment units of a WWTP. Sampling included different points across WWTP in the water and sludge lines. Pre-treatment of the samples consists of advanced Fenton oxidation, and alkaline and enzymatic digestion followed by density separation. Once the particles were isolated, their morphology and size were studied using a stereoscopic and optical microscope followed by final confirmation with ATR-FTIR and micro-FTIR spectroscopy. Microplastic particle concentrations exhibit significant reductions as water undergoes treatment in the WWTP. For summer sampling, concentrations decreased from 351 MP/L (influent) to 35 MP/L (primary clarifier), 32 MP/L (biological reactor), and 13 MP/L (2.3 MP/L) (secondary clarifier). Similarly, winter sampling showed reductions from 403 MP/L (influent) to 159 MP/L (primary clarifier), 178 MP/L (biological reactor), and 26 MP/L (5.6 MP/L) (secondary clarifier). Removal efficiency of WWTP is high and exceeds 96%. The most abundant morphology is fibers followed by fragments and films. Polymers such as PE, synthetic cellulose, PP, PVC, PE-PP, PEEA, PA, acrylamide, and PES are widely detected in different units of WWTP. The number of MPs that are avoided from being emitted into the environment through direct water discharge was estimated to be 9.1 × 1012 MP/year. Removed MPs tend to accumulate in the sludge that is used for agricultural purposes although it should be managed as waste properly, avoiding the transition of MPs pollutants to terrestrial ecosystems adding to the number of MPs that will inevitably end up in receiving water bodies through direct WWTP effluent discharge that was set in 5.1 × 1010 MP/year in the studied WWTP.

İleri Yaş ve Engelli Turizmi Yapılarının Sürdürülebilirlik Kavramı Özelinde İrdelenmesi

Environmental problems and heavy living conditions, which are the result of industrialization and intense urbanization, affect health negatively. In addition, developments in the level of welfare and health have extended the human lifespan and increased the proportion of the elderly population. These developments, combined with people’s efforts to be physically and mentally well, have started a movement to regain their health, and over time, the concept of health tourism has emerged. Buildings for health tourism are mixed-function that includes tourism activities as well as treatment units. In this article, a schema has been created by considering the sustainability concept of the buildings that serve the elderly and disabled tourism, which have a place under the title of health tourism. With the evaluations to be made on the schema obtained within the scope of this study, it is aimed to ensure the development of the facilities and suggestions are forth.

#3849 PERITONEAL DIALYSIS CATHETER LOCK: PREVENTING RELAPSES

Abstract Background and Aims The incidence of peritonitis has markedly decreased in the last decades, nevertheless it remains one of the main causes of catheter removal and subsequent dialysis modality change. In the long-term severe peritonitis and relapses can lead to peritoneal membrane failure. Some bacteria can form biofilms in the peritoneal catheter lumen granting them resistance against antibiotics and thus being one of the causes for infection recurrences. To find a viable way to avoid or/and eradicate the bacterial biofilm in the peritoneal catheters given the importance of infections. Method We present the experience in our peritoneal dialysis unit in the coadjuvant treatment of peritoneal dialysis-associated peritonitis with peritoneal catheter locks in the past few years. We used two kinds of peritoneal catheter lock depending on the isolated germ and divided them in two groups. Group I for the gram-positive staphylococcus group and Group II for gram-negative germs, specifically pseudomona. We reported 12 cases from which 10 were the first episode of gram-positive staphylococcus (epidermidis and Aureus) peritonitis. For the treatment we locked the catheter with 350mg of daptomycin in 7ml of saline solution once a week without using the catheter for 12 hours. For the other 2 cases of pseudomona peritonitis we locked the catheter with taurolidine/urokinase during the exchange with icodextrin twice a week with a 12 hours dwell time until 9 locks were archived. Results We treated 12 patients (Table 1). Peritonitis was resolved without recurrences in 9 of 10 patients in group I. In one case were a Methicillin-resistant Staphylococcus aureus was involved there was no response to the treatment and the peritoneal catheter was removed. In Group II both patients resolved their peritoneal infection without recurrences. Conclusion In our study peritoneal catheter locking seems to avoid the biofilm and reduce the peritoneal infection recurrences.

#4562 OUTBREAK OF RALSTONIA SPP AND BURKHOLDERIA SPP CATHETER-RELATED BLOODSTREAM INFECTION IN A HAEMODIALYSIS UNIT

Abstract Background and Aims Ralstonia (RB) and Burkholderia (BB) species are environmental Gram-negative bacilli responsible for several nosocomial infections in immunocompromised or frail patients. RB and BB may contaminate medical devices because of their ability to survive in a biofilm and with low nutrient requests. Reports of infection outbreaks due to RB and BB are very few and only in sporadic cases, the source of contamination was identified. We describe here: i) how we managed an outbreak of bacteremia caused by RB and BB occurred in our dialysis unit, ii) what we have done to identify the source of infection and iii) the countermeasures we adopted to reduce the risk of new events. Method From 7 to 16 April 2021, 6 out of 39 (15.4%) hemodialyzed (HD) patients with a long-term indwelling central venous catheter (CVC) developed symptoms related to infection. Blood cultures revealed the presence of RB and BB. Thus, a prompt check of the blood cultures of all HD patients with CVC was performed. Blood samples were incubated in an automated microbial detection system (VIRTUO BIOMERIEUX) and subsequently, blood positive samples were inoculated in Chocolate and Columbia blood Agar plates. In addition, a microbiological analysis of disinfectants, drugs used in dialysis unit and samples collected from the reverse osmosis water unit (ROW) and from the ROW delivery line were performed. None of the samples obtained from the ROW and from the ROW delivery line resulted positive. Thus, a microbiological analysis of the biofilm attached on the loading pipes (LP) and on the loading plastic tubes (LPT) that connect the hemodialyzer consoles (HC) to the ROW delivery line were performed. Briefly, LTP were subjected to ultrasound sonication at 30-40 KHz (BactoSonic-Bandelin), to disrupt the bacterial biofilm. The material obtained from sonication was cultured. Bacteria was identified by an automated mass spectrometry (MALDI-TOF VITEK®MS, Biomerieux). Results Bacteremia due to RB and BB was confirmed in 7 out of 39 (17.9%) of the hemodialyzed patients with a long-term indwelling CVC. 1 out of 7 was asymptomatic. Baseline characteristics of the 6 symptomatic patients were: mean age 68±16 years; mean C-reactive protein 4.48±1.3 mg/dl; mean procalcitonin 13.27±11.07 ng/ml; mean body temperature 37.9±1.4°C. The antibiotic therapy was decided according to antibiogram and included meropenem and ciprofloxacin. CVC were removed in all infected patients between 6 to 11 days from the diagnosis. Concomitantly, a new one was placed. None of the HD patients with arterio-venous fistulae developed bacteremia. RB and BB were isolated in the biofilm of 11 out of 37 LPT. Thus, we modified the ROW delivery line in order to set up a scheduled chemical and physical disinfections of the ROW delivery line with the hemodialysis consoles connected avoiding the risk of new contamination of the LPT and loading pipes. Briefly, on alternate months the whole system that include ROW delivery line (PE-Xa Medical Device, Fresenius Medical Care), loading pipes, LPT and hemodialysis consoles are disinfected by hot water (90°C) produced by a water heater (AquaB plus HF, Fresenius Medical Care) and by chemical disinfectant, 5% peracetic acid according to the protocols made by the console fabricant. In addition, we added to the reverse osmosis system a filtration module of 0.01 μm (AquaUF, Fresenius Medical Care) prior to the ROW delivery line, Figure 1. Awaiting for the modification of the ROW delivery line, the patients with CVC were dialyzed using a portable water treatment unit. After more than 14 months from the modification of the whole system for production and delivery of ROW none of the hemodialyzed patients developed infection by RB and BB. Conclusion Our experience suggests that infection outbreak by unusual bacteria such as RB and BB could be successful treated using antibiotic therapy. Nevertheless, in dialysis unit the source of infection should be investigated in order to adopt the countermeasures necessary to reduce the risk of new infections.