Upon implantation or insertion into patient''s body for exerting the intended purpose like salvage of normal functions of vital organs, the medical devices are unfortunately becoming the sites of competition between host cell integration and microbial adhesion. To control microbial colonization and subsequent biofilm formation onto the medical devices, different approaches either to enhance the efficiency of certain antimicrobial agents or to disrupt the basic physiology of the pathogenic microorganisms including novel small molecules and antipathogenic drugs are being explored. In addition, the various lipid-and polymer-based drug delivery carriers are also investigated for applying antibiofilm coating onto the medical devices especially over catheters. This book summarizes the major and/breakthrough inventions disclosed in patent literature as well as in research papers related to the preventive strategies for medical device infections. With this coverage, this book provides a range of strategies available for the medical scientist to develop a medical device with antibiofilm property.
The main aim of this study to conduct surveillance program of surgical wound infections and to improve surgical practice by surgeons and otherhealthcare professionals. This study describes the results obtained in an epidemiological study of surgical wound infections through an active surveillance program lasting one year in surgical unit of a rural teaching hospital. It is a prospective observational study including patients of surgery ward of Rajah Muthaiah Medical College Hospital who have developed surgical wound infections during hospitalization. Among admissions in surgery ward, 300 cases were screened to have developed surgical wound infections. The most common microorganisms responsible for the infections observed were mainly gram negative and the most commonly isolated were Staphylococcus aureus and Escherichia coli Highest numbers of cases were observed after Wound debridement and Incision and Drainage operative procedures. Among wound Classes, dirty wounds have found to be highest . Superficial incision site infections were highest among other surgical sites. These nosocomial infection surveillance programs of nosocomial infections in rural setting are very rarely
Nosocomial infections are a major problem worldwide. The literature shows that nosocomial infections are problematic in developed countries and developing countries but a little is known about the prevalence of nosocomial infections in different countries includes Rwanda. This research aimed to explore the prevalence of nosocomial infections in the Butare University Teaching Hospital in Rwanda. The past is the foundation of the future, reason why looking behind gives overview of current event and help in planning the future accordingly. A retrospective, descriptive design guided the research process.
Various types of nosocomial infections are acquired by hospitalized patients after 48-72 hours of their admission, in addition to their prior ailments. The immuno suppressed, immuno compromised and even the patients with normal immune system are vulnerable to nosocomial infections under certain circumstances. The potential impact of nosocomial infections is considerable in terms of incidence, morbidity, mortality, and financial burden (Wenzel R P, 2003). Nosocomial infections have been a serious problem ever since sick patients first congregated in the hospitals (Semmelweiss, 1861; Nightingale, 1863; Simpson and Spensor, 1869). Interest in nosocomial infection grew at a very rapid rate from earlier twentieth century, when new basis of hospital infections was reported, and alarming increase in the number of serious cases of Streptococcus pyogenes infections in hospitals were noted (Cruickshank, 1935). Urinary tract infections (UTI) are considered to be the most common infections which are acquired from the hospitals. The causal pathogens of those infections have been reported as Escherichia coli, Klebsiella spp. Proteus spp.
Staphylococcus epidermidis was previously regarded asan innocuous commensal microorganism on the humanskin. However, nowadays it is seen as an importantopportunistic pathogen and ranks first among thecausative agents of nosocomial infections onindwelling medical devices. Infections with thisleading pathogen are characterized by biofilmdevelopment on devices (heart valves, catheters,contact lenses, etc.) and this factor is consideredthe main virulence mechanism of S. epidermidis.Biofilm cells are organised into structuredcommunities enclosed within a matrix of extracellularmaterial. These cells are phenotypically differentfrom planktonic or suspended cells; notably, theyresist host defences and display a significantlydecreased susceptibility to antimicrobial agents.Since biofilm-associated infections are frequentlyresistant to conventional antimicrobial therapy, thework presented in this book aimed at studying newtherapeutic strategies for treatment and control ofinfections caused by S. epidermidis.
Hospital represents a special environment due to the nature of activities developed. It has many risk factors which can evoke many disorders and can damage the health of patients and also of staff. The microbiological factor in hospitals is the most risky for immuno-compromised patients because it has the potential to start nosocomial infections (hospital acquired infection). Several airborne infectious diseases are related to the indoor air quality. So, Control of airborne transmission of infectious diseases associated with indoor environments is especially important in medical environments. There is also an increasing rate of resistance among the nosocomial pathogens which is particularly disconcerting. Therefore it is necessary to be aware of nosocomial infections caused by bioaerosols in hospital environment and control it to the lowest level. In consideration of above facts air sample from various wards of different hospitals were analysed for microbial load and further screened for the incidence of pathogenic microorganisms with their multidrug resistance ability. Microbial concentration were compared to the available guidelines and draw the conclusions and recommendations.
Biofilm formation is a universal trait of microbes and their implications on wide range of scientific disciplines involving biological wastewater treatment, biogas reactors, water engineering, human infections and evolutionary biology is quite remarkable. Biofilm represent most prevalent type of growth in nature which is crucial in development of clinical infections and emergence of resistance to antimicrobials and thus they pose a serious public health problem. The impact of biofilms on device related infections needs to be studied in detail to design therapeutic guidelines. This book investigates in detail the formation and structure of biofilms, methods used to measure biofilms, risk factors associated with biofilm colonization of medical devices and antimicrobial resistance associated with biofilm- based infections.
Although medical equipment maintenance has been well planned and executed for more than 30 years, very few studies have been conducted to measure and evaluate its effectiveness in terms of reliability and availability for service delivery. The ongoing unresolved debate in clinical engineering is whether preventive maintenance (PM) is actually necessary and, if so, how often and which tasks need to be performed. A mathematical maintenance modelling approach is used to analyse the survival probability of various medical equipment. This approach allows exploring the impact of PM, CM and combined PM/CM on the availability of equipment and will contribute to the intensified debate regarding PM. Maintenance strategies is analysed and a new failure-cost model was developed, which allows adopting appropriate PM intervals for various types of medical equipment. The analytical model to calculate the number of failures and costs associated with PM and CM is a significant contribution. The optimisation problem related to preventive maintenance scheduling using a Mixed-Integer Mathematical Programming solver was solved and compared to a proposed Greedy Algorithm. Simulation results based on the
Diabetes is now a worldwide epidemic. Diabetic foot infections contribute significantly to the increased mortality and morbidity. In the current clinical practice, the possibility of fungal infections; and synergism and antagonism between microbes in diabetic foot wounds (DFWs) is often overlooked. This book reveals that one in four patients with DFWs would have deep seated fungal infections. The authors have developed a new molecular based technique for early detection of fungi from deep tissue of diabetic foot wounds. And proved that targeted antifungal therapy accelerated wound healing almost 30 days earlier than standard care alone in patients with fungal infections. Diabetic foot infections require a careful attention and coordinated management of a multidisciplinary foot-care team, which includes an infectious disease specialist and a medical microbiologist. Reinforcing preventive strategies and educating the diabetic patients about tight glycemic control, appropriate footwear practice, daily self-examination of foot and early reporting to the health professional for any untoward change over the feet would prevent leg amputation and death.
Currently approved antiviral therapy for HCV is PEG-IFN? plus RBV for 48 weeks in genotypes 1 and 4, and for 24 weeks for genotypes 2 and 3. Acute HCV infection is usually asymptomatic and difficult in diagnosis. Occult HCV infection is a new entity that should be taken into account for the diagnosis of patients with elevated liver enzymes or liver disease of unknown aetiology. HCV infection causes many renal diseases especially membrano-proliferative glomerulonephritis type 1 which caused mostly by type II mixed cryoglobulinaemia. HCV infection especially genotype 3 carries higher risk of insulin resistance and hepatic steatosis which in turn help progression of liver diseases. HBV/HCV co-infection is not uncommon, especially within areas of high prevalence of HBV. Dual infections represent unique management challenges. This book is highlight the different treatment modalities of HCV patients in different medical conditions.
Stethoscopes are important vehicle for transmission of nosocomial infection from one patient to others. The study showed assessment of bacteria from diaphragm of stethoscopes of health care workers in a tertiary care hospital, Navi Mumbai. In our study swabs were collected from stethoscopes by rubbing sterile, moist swabs on the entire surface of diaphragms. In the second part of the study, the same stethoscope diaphragm was cleaned with alcohol rubs, allowed to act for 3-5 minutes and again second swab was collected from the same stethoscopes. The swabs were directly inoculated on blood agar, MacConkey agar plates. Standard methods were followed for isolation and identification of bacteria. All Staphylococcus strain was tested for MRSA. Antibiotic sensitivity was performed by Kirby-Bauer disc diffusion method as per CLSI guidelines to study antibiotic susceptibility pattern.Our study highlights the need to disinfect the stethoscopes diaphragms by simply applying the alcohol rubs to prevent any spread of bacteria from patient to patients.
Revision with unchanged content. Secondary data were used to examine the relationships between hospital characteristics, utilization of patient safety practices, and patient outcomes in a stratified probability sample of acute care hospitals in 20 states in the US. Patient safety outcome rates for infections due to medical care, decubitus ulcers, failure to rescue, and post-operative respiratory failure were calculated using the AHRQ Patient Safety Indicator software; multivariate regression was used to determine the statistical significance of the relationships. Hospital characteristics were inconsistently related to patient outcomes. The effects of using patient safety practices, and specifically the effects on patient outcomes, appeared dependent on the outcome measured. Hospitals with poorer performance in the use of patient safety practices exhibited higher rates of infections due to medical care and decubitus ulcers than hospitals with better performance in using patient safety practices, but no differences were noted in hospital rates of postoperative respiratory failure or failure to rescue. Certain adverse events, such as infections and decubitus ulcers, may be amenable to the development of patient safety policies and preventive procedures.
Missed nursing care MNC dangerously impacts on the staff nurse and patient outcomes as for example, units with higher rates of missed care and absenteeism had more dissatisfied staff nurses with intention to leave in addition, the missed care aspects have been correlated with patients’ outcomes such as falls, medication errors, bed sores and nosocomial infections. The research was conducted to determine the correlates of MNC at six selected medical intensive care units in EL Manial Specialized hospital and El Manial University hospital. The convenience sample of staff nurses working on the six units who took a daily patient assignment and provided direct patient care, has more than one year experience in their worked units and accepted to participate in this research. Data were collected by using two different methods as the modified MISSCARE self reporting questionnaire and missed nursing care observational checklist. Results concluded that there was a significant difference between perceived and observed nursing care elements being missed and the most reported factors were related to patient, hospital systems & policies and nursing staff.
Candida tropicalis is a common species related to nosocomial infections, namely candidemia and candiduria. Several virulence factors seem to be responsible for C. tropicalis infections, which present high potential for dissemination and mortality. Adhesion to surfaces (medical devices and host cells) and biofilm formation, are considered important factors that contribute to the development of candidosis. Further, adhesion and invasion of host cells by C. tropicalis is considered the first step to initiate systemic infections. Once adhered to epithelium, C. tropicalis are able to secrete hydrolytic enzymes that cause damage in host cells membrane integrity, leading to dysfunction or disruption of host structures. Thus, the main aim of this work was to characterize the virulence factors of C. tropicalis as well as to evaluate adhesion to biotic and abiotic surfaces, biofilm formation, expression of hydrolytic enzymes and antifungal susceptibility of C. tropicalis clinical isolates from urine and blood cultures and from central venous catheters.