This document discusses the role of physician attire, such as white coats, in the transmission of pathogens in healthcare settings. It summarizes evidence that white coats and other articles of clothing, like neckties, can become contaminated with pathogens like MRSA and C. difficile. While removing white coats has not been definitively proven to reduce infection rates, there is biological plausibility that contaminated clothing can transmit pathogens between patients. The document concludes that given the potential benefits and lack of risks, changing attire policies to "bare below the elbows" is a reasonable precautionary measure.
The document discusses hand hygiene and efforts to reduce healthcare-associated infections. While hand hygiene compliance has improved due to numerous interventions, evidence shows infections have not significantly decreased. Other factors like overcrowding, understaffing, and contamination of the hospital environment may negate the benefits of hand hygiene. Strict enforcement of hand hygiene policies alone may not be effective and a balanced approach is needed that addresses systemic issues in healthcare systems.
1) Copper-infused patient gowns and linens have been shown in multiple peer-reviewed studies to lower infection rates of harmful bacteria like MRSA and C. difficile.
2) A study across 6 hospitals found infection rates reduced by 40-60% when copper gowns and linens were used.
3) Similarly, a study of over 175,000 patient days across 12 hospitals saw infection rates drop significantly with the use of copper textiles.
This document summarizes a study on the prevalence of Methicillin-Resistant Staphylococcus aureus (MRSA) among surgical patients visiting hospitals in Kathmandu Valley, Nepal. The study found a MRSA prevalence of 9.9%. MRSA prevalence was higher in males, older patients, those with longer hospital stays, and those with wound or tissue samples. All MRSA strains showed resistance to multiple antibiotics and were considered multi-drug resistant. Vancomycin was found to be an effective antibiotic against MRSA.
This dissertation examines the bacterial etiology of wound infections and the antibiotic susceptibility patterns of isolates from patients visiting B and B Hospital in Nepal. Cultures were taken from 1164 wound samples over one year. Common gram-positive isolates included Staphylococcus aureus (92.46%) and gram-negative isolates included E. coli (28.1%), Pseudomonas spp. (30.91%). Antibiotics like amikacin and vancomycin were effective against most isolates. The study concludes that wound infections are commonly caused by resistant bacteria, so alternative antibiotics need to be used for treatment.
This study analyzed 280 samples collected from the hands and mobile phones of 140 healthcare workers at a tertiary hospital to assess the role of poor hand hygiene and mobile phone use in transmitting hospital-acquired infections. Bacterial growth was detected in 220 samples, with pathogenic organisms found in 75 samples. Escherichia coli was the most common isolate, followed by Klebsiella species. Several isolates were found to be methicillin-resistant Staphylococcus aureus and extended-spectrum beta-lactamase producers. The results suggest that healthcare workers' hands and mobile phones can transmit pathogenic bacteria in hospitals and may contribute to the spread of antimicrobial resistance.
This document summarizes a study on surgical site infections (SSIs) following elective general surgery cases. The study aimed to identify the incidence and risk factors of SSIs, common causative organisms, and antibiotic sensitivity patterns. The overall SSI rate was 4.57%. The most common type of SSI was superficial infections. Staphylococcus aureus was the most commonly isolated organism. Antibiotics like linezolid, amikacin and cefotaxim were generally effective. SSIs increased hospital stay by an average of 10 days and posed significant morbidity.
This study compared outcomes of 120 burn patients who underwent either early excision and grafting (E&G) within 4-7 days, or delayed excision and grafting (D&G) within 1-4 weeks. Significant differences favored the E&G group: fewer culture-positive wounds, better graft take, shorter post-graft hospital stay, and no mortality. While early excision improves outcomes, the optimal timing requires further study. However, this study supports performing excision as early as possible when stabilization has occurred.
The document discusses hand hygiene and efforts to reduce healthcare-associated infections. While hand hygiene compliance has improved due to numerous interventions, evidence shows infections have not significantly decreased. Other factors like overcrowding, understaffing, and contamination of the hospital environment may negate the benefits of hand hygiene. Strict enforcement of hand hygiene policies alone may not be effective and a balanced approach is needed that addresses systemic issues in healthcare systems.
1) Copper-infused patient gowns and linens have been shown in multiple peer-reviewed studies to lower infection rates of harmful bacteria like MRSA and C. difficile.
2) A study across 6 hospitals found infection rates reduced by 40-60% when copper gowns and linens were used.
3) Similarly, a study of over 175,000 patient days across 12 hospitals saw infection rates drop significantly with the use of copper textiles.
This document summarizes a study on the prevalence of Methicillin-Resistant Staphylococcus aureus (MRSA) among surgical patients visiting hospitals in Kathmandu Valley, Nepal. The study found a MRSA prevalence of 9.9%. MRSA prevalence was higher in males, older patients, those with longer hospital stays, and those with wound or tissue samples. All MRSA strains showed resistance to multiple antibiotics and were considered multi-drug resistant. Vancomycin was found to be an effective antibiotic against MRSA.
This dissertation examines the bacterial etiology of wound infections and the antibiotic susceptibility patterns of isolates from patients visiting B and B Hospital in Nepal. Cultures were taken from 1164 wound samples over one year. Common gram-positive isolates included Staphylococcus aureus (92.46%) and gram-negative isolates included E. coli (28.1%), Pseudomonas spp. (30.91%). Antibiotics like amikacin and vancomycin were effective against most isolates. The study concludes that wound infections are commonly caused by resistant bacteria, so alternative antibiotics need to be used for treatment.
This study analyzed 280 samples collected from the hands and mobile phones of 140 healthcare workers at a tertiary hospital to assess the role of poor hand hygiene and mobile phone use in transmitting hospital-acquired infections. Bacterial growth was detected in 220 samples, with pathogenic organisms found in 75 samples. Escherichia coli was the most common isolate, followed by Klebsiella species. Several isolates were found to be methicillin-resistant Staphylococcus aureus and extended-spectrum beta-lactamase producers. The results suggest that healthcare workers' hands and mobile phones can transmit pathogenic bacteria in hospitals and may contribute to the spread of antimicrobial resistance.
This document summarizes a study on surgical site infections (SSIs) following elective general surgery cases. The study aimed to identify the incidence and risk factors of SSIs, common causative organisms, and antibiotic sensitivity patterns. The overall SSI rate was 4.57%. The most common type of SSI was superficial infections. Staphylococcus aureus was the most commonly isolated organism. Antibiotics like linezolid, amikacin and cefotaxim were generally effective. SSIs increased hospital stay by an average of 10 days and posed significant morbidity.
This study compared outcomes of 120 burn patients who underwent either early excision and grafting (E&G) within 4-7 days, or delayed excision and grafting (D&G) within 1-4 weeks. Significant differences favored the E&G group: fewer culture-positive wounds, better graft take, shorter post-graft hospital stay, and no mortality. While early excision improves outcomes, the optimal timing requires further study. However, this study supports performing excision as early as possible when stabilization has occurred.
Oral Health & Its Effect on COVID 19: Systematic Review & Meta Analysis.DrHeena tiwari
This document summarizes a systematic review and meta-analysis on the relationship between oral health and COVID-19. The review included 13 studies. Key findings included:
1) Infection control measures like telephone screening, social distancing and PPE were discussed across many studies as important for dental practices during the pandemic.
2) Pre-procedural mouthwashes and use of rubber dams and high-volume evacuation were recommended to reduce aerosol transmission during dental procedures.
3) Guidelines varied on types of masks to use, but N95 or equivalent masks were suggested for aerosol-generating procedures by many studies.
4) Psychological impacts of COVID-19 on dental workers and appropriate waste
The document discusses cryosurgery techniques for treating common warts. It recommends using a liquid nitrogen spray gun with the timed-spot freeze technique, freezing the wart for 10 seconds and treating in 2-3 sessions spaced 3-4 weeks apart. For plantar warts, it advises using the spray gun with a double freeze-thaw cycle to fully destroy the wart. Margin sizes of 2mm for common warts are sufficient.
This document discusses efforts to reduce central line-associated bloodstream infections (CLABSIs) at Rush-Copley Medical Center. An infection control collaborative was established in 2008 using the IHI Central Line Bundle. Despite these efforts, the goal of zero CLABSIs was not initially achieved due to inconsistent practices. Additional measures were implemented from 2008-2011 including education, protocols, product improvements, and monitoring. As a result of these efforts, the CLABSI rate decreased from 1.27 per 1000 line days in 2007-2008 to zero infections from July 2010 to June 2011.
Over four semesters, nose and throat swabs were collected from 380 undergraduate nursing students to analyze Staphylococcus aureus and MRSA carriage rates. 48.9% of participants were found to carry S. aureus in their nose or throat. While most carriers had nasal carriage only, 16.8% had throat carriage exclusively. The overall MRSA carriage rate was low at 1.31%, suggesting clinical exposure has not increased rates. Continued monitoring of nursing students is needed to understand how carriage changes over time with increased clinical experience.
This study evaluated digital palmar dermatoglyphic patterns in patients with oral submucous fibrosis (OSMF) and oral leukoplakia. The study included 200 patients divided into 4 groups - group I had patients with oral leukoplakia, group II had patients with OSMF, group III had patients with habits but no lesions, and group IV was a control group without habits or lesions. Fingerprints and palm prints were taken digitally and analyzed qualitatively and quantitatively. The results found an increase in whorls, palmar patterns in the I2-I3 area, total finger ridge count, total triradius count, and a decrease in atd angle and a-b ridge
This study examined the diagnostic validity of three swab techniques for identifying chronic wound infection by comparing quantitative cultures from swab specimens to quantitative cultures from tissue specimens. The three swab techniques tested were wound exudate, the Z-technique, and Levine's technique. Of the 83 chronic wounds studied, 30 (36%) were found to be infected based on the tissue culture results. Levine's technique was found to have the highest accuracy at 0.80 when compared to the tissue cultures. A critical threshold of 37,000 organisms per swab using Levine's technique provided a sensitivity of 90% and specificity of 57% for detecting infected wounds. The mean concordance between swab specimens using Levine's technique and tissue specimens was 78%.
This study analyzed burn wound swabs collected from 187 hospitalized patients over 3 years to identify aerobic bacterial pathogens and their antibiotic resistance patterns. The most common isolate was Pseudomonas aeruginosa (49.4% of isolates), followed by Staphylococcus aureus (22.2%) and various Enterobacteriaceae species. P. aeruginosa demonstrated high resistance to many commonly used antibiotics but was most susceptible to piperacillin/tazobactam and imipenem. 59% of S. aureus isolates were methicillin-resistant but all were susceptible to vancomycin and linezolid. The high prevalence of multidrug-resistant bacteria indicates a need for improved infection control and empiric antibiotic strategies tailored to
Knowledge and Attitude of Prosthodontic Post Graduates on COVID 19: A Qualita...DrHeena tiwari
This document summarizes a study that surveyed 60 prosthodontic post-graduate students regarding their knowledge and attitudes about COVID-19. The results found that 80% felt they received adequate training on COVID-19 prevention and control, while over 60% were confident in managing patients with required precautions. However, only around 63% knew who to contact if they encountered a suspected COVID-19 patient. Nearly all (96.6%) agreed that the pandemic has affected their academic activities. The study concludes that understanding aerosol transmission in dentistry can help identify risks and improve practices to prevent disease spread.
1) The study evaluated the role of antibiotics in preventing postoperative complications after routine periodontal surgery. 45 patients receiving either amoxicillin, doxycycline, or no antibiotics were evaluated.
2) No significant differences were found between groups in postoperative pain, swelling, or infection rates. Properly performed periodontal surgery does not typically result in postoperative infections.
3) While antibiotics are often prescribed following regenerative or implant surgeries, this study found no additional benefit to prescribing antibiotics for routine periodontal surgeries to prevent postoperative infections when performed aseptically. Larger studies are still needed to confirm findings.
This study compared the clinical, radiographic, histopathologic, and histobacteriologic features of true and bay apical cysts. The study found no significant differences between true and bay cysts for any of the parameters evaluated. Both cyst types always exhibited intraradicular infection and sometimes extraradicular infection as well. The findings question the need to differentiate between true and bay cysts and do not support the assumption that true cysts are self-sustaining entities not associated with infection.
This document provides information on anti-retroviral therapy (ART) for HIV/AIDS:
1. It outlines the diagnostic criteria for HIV based on lab tests and the WHO clinical case definition for AIDS.
2. It states that as of 2008-09, there were an estimated 22.7 lakh people living with HIV/AIDS in India.
3. It provides details on optimal diagnostic approaches, investigations, treatment and referral criteria for ART in both secondary hospital/non-metro situations and super specialty facilities in metro locations.
Post-operative Wound Infection in Cases operated in a Tertiary Level Hospital Jaipur (Rajasthan) India-Wound infection is the second commonest nosocomial infection and most troublesome disorder of wound healing. This study was carried out on 100 post-operative cases of Surgical Unit 1st of General Surgery Department of Sawai Man Singh Hospital, Jaipur (Rajasthan) India in years 2014.
After interview of these, swab from post-operative wound was taken and sent for culture and sensitivity test in Microbiology. Results were inferred by Chi-square test and unpaired‘t’ test. Among all operative cases 21% were found infected. Cases, who were operated in emergency have significantly more post-operative wound infection. Mean age and mean postoperative stay of cases with post-operative infected wound was significantly higher than in cases without post-operative infected wound. But mean pre-operative stay, mean duration of operation and type of operation was not associated with post-operative wound infection. Pre-operative antibiotics lowered the occurrence of post-operative wound infection. Maximum proportion of causative agent found in post-operative infected wound was Staphylococci (90.48%) followed with Streptococci, E. Coli, Klebsella and Pseudomonas.
EFFICACY OF TRANSDERMAL PATCHES IN THE MANAGEMENT OF POSTOPERATIVE PAIN: AN O...DrHeena tiwari
This study compared the efficacy of a single 100mg transdermal diclofenac patch to a single 75mg intramuscular diclofenac injection for managing postoperative pain in 30 patients who underwent maxillofacial surgery. Patients were randomly assigned to receive either the patch or injection. Pain levels were assessed at various timepoints using a visual analogue scale. The results found that the patch provided longer lasting analgesia (15 hours on average) compared to the injection (9 hours), and fewer patients in the patch group required rescue pain medication. No local complications occurred with the patch. The study concluded that a single diclofenac patch was more effective than intramuscular diclofenac for managing immediate postoperative pain
Necessity of COVID-19 vaccination in previously infected individualsMattisHallsteinVolla
This study examined the incidence of COVID-19 among 52,238 employees in an American healthcare system over 5 months. The study found:
1) The cumulative incidence of COVID-19 remained almost zero among those previously infected who remained unvaccinated, those previously infected who were vaccinated, and those not previously infected who were vaccinated.
2) In contrast, there was a steady increase in cumulative incidence among those not previously infected who remained unvaccinated.
3) Not one of the 1,359 previously infected subjects who remained unvaccinated had COVID-19 over the duration of the study.
The results suggest individuals who have had COVID-19 are unlikely to benefit from vaccination, and vaccines
This study analyzed urine samples from 1,670 patients in rural Odisha, India to determine the prevalence and etiology of community-acquired urinary tract infections (CA-UTIs). The key findings were:
1) The overall prevalence of CA-UTI was 34.5%, significantly higher in females (45.2%) than males (18.4%). Young women aged 18-37 and elderly men aged 68+ had the highest prevalence.
2) Escherichia coli was the most common causative organism (68.8%), followed by Enterococcus species. Gram-negative rods accounted for 78.2% of isolates.
3) Amikacin and nitrofurant
1) The initial management of open fractures, including timing of debridement, choice of antibiotics, and timing of wound coverage, involves several controversies with little consensus in the literature.
2) While early antibiotic administration and debridement are agreed upon, there is no evidence that debridement must occur within 6 hours as was once believed; many surgeons now find urgent rather than emergency debridement acceptable.
3) Timing of wound coverage is also debated, but most evidence suggests covering Type III wounds within 7 days is appropriate once tissues have stabilized and debridement is complete.
Briefing to invigilator for aiims mbbs exam By Dr Anil Kumar, Assist Prof , A...Anil Kumar
This document outlines the responsibilities and instructions for an examination duty invigilator at the All India Institute of Medical Sciences in Patna. It details the invigilator's tasks such as allowing entry of candidates at specified times, taking attendance, collecting materials, monitoring the exam, and making announcements to candidates. The invigilator is instructed to maintain security, confidentiality, and prevent malpractice. They must use a red pen for all tasks and not offer any clarification to technical questions.
Invest in a good quality professional wardrobe that can be worn multiple times to save money in the long run and project a better image. Dress professionally for career fairs, job fairs, employer sessions, and interviews. Men should wear long-sleeved shirts and dark socks, keep facial hair well-groomed, and remove earrings. Women should wear pants or skirts at least knee-length, avoid tight or shiny fabrics, and keep jewelry simple with natural makeup. Be well-groomed with clean hair, shoes, hands, and fitted clothing without cologne overuse or visible flaws. Common mistakes include short sleeves, unpressed shirts, beltless pants, plastic watchbands, and badly worn
Oral Health & Its Effect on COVID 19: Systematic Review & Meta Analysis.DrHeena tiwari
This document summarizes a systematic review and meta-analysis on the relationship between oral health and COVID-19. The review included 13 studies. Key findings included:
1) Infection control measures like telephone screening, social distancing and PPE were discussed across many studies as important for dental practices during the pandemic.
2) Pre-procedural mouthwashes and use of rubber dams and high-volume evacuation were recommended to reduce aerosol transmission during dental procedures.
3) Guidelines varied on types of masks to use, but N95 or equivalent masks were suggested for aerosol-generating procedures by many studies.
4) Psychological impacts of COVID-19 on dental workers and appropriate waste
The document discusses cryosurgery techniques for treating common warts. It recommends using a liquid nitrogen spray gun with the timed-spot freeze technique, freezing the wart for 10 seconds and treating in 2-3 sessions spaced 3-4 weeks apart. For plantar warts, it advises using the spray gun with a double freeze-thaw cycle to fully destroy the wart. Margin sizes of 2mm for common warts are sufficient.
This document discusses efforts to reduce central line-associated bloodstream infections (CLABSIs) at Rush-Copley Medical Center. An infection control collaborative was established in 2008 using the IHI Central Line Bundle. Despite these efforts, the goal of zero CLABSIs was not initially achieved due to inconsistent practices. Additional measures were implemented from 2008-2011 including education, protocols, product improvements, and monitoring. As a result of these efforts, the CLABSI rate decreased from 1.27 per 1000 line days in 2007-2008 to zero infections from July 2010 to June 2011.
Over four semesters, nose and throat swabs were collected from 380 undergraduate nursing students to analyze Staphylococcus aureus and MRSA carriage rates. 48.9% of participants were found to carry S. aureus in their nose or throat. While most carriers had nasal carriage only, 16.8% had throat carriage exclusively. The overall MRSA carriage rate was low at 1.31%, suggesting clinical exposure has not increased rates. Continued monitoring of nursing students is needed to understand how carriage changes over time with increased clinical experience.
This study evaluated digital palmar dermatoglyphic patterns in patients with oral submucous fibrosis (OSMF) and oral leukoplakia. The study included 200 patients divided into 4 groups - group I had patients with oral leukoplakia, group II had patients with OSMF, group III had patients with habits but no lesions, and group IV was a control group without habits or lesions. Fingerprints and palm prints were taken digitally and analyzed qualitatively and quantitatively. The results found an increase in whorls, palmar patterns in the I2-I3 area, total finger ridge count, total triradius count, and a decrease in atd angle and a-b ridge
This study examined the diagnostic validity of three swab techniques for identifying chronic wound infection by comparing quantitative cultures from swab specimens to quantitative cultures from tissue specimens. The three swab techniques tested were wound exudate, the Z-technique, and Levine's technique. Of the 83 chronic wounds studied, 30 (36%) were found to be infected based on the tissue culture results. Levine's technique was found to have the highest accuracy at 0.80 when compared to the tissue cultures. A critical threshold of 37,000 organisms per swab using Levine's technique provided a sensitivity of 90% and specificity of 57% for detecting infected wounds. The mean concordance between swab specimens using Levine's technique and tissue specimens was 78%.
This study analyzed burn wound swabs collected from 187 hospitalized patients over 3 years to identify aerobic bacterial pathogens and their antibiotic resistance patterns. The most common isolate was Pseudomonas aeruginosa (49.4% of isolates), followed by Staphylococcus aureus (22.2%) and various Enterobacteriaceae species. P. aeruginosa demonstrated high resistance to many commonly used antibiotics but was most susceptible to piperacillin/tazobactam and imipenem. 59% of S. aureus isolates were methicillin-resistant but all were susceptible to vancomycin and linezolid. The high prevalence of multidrug-resistant bacteria indicates a need for improved infection control and empiric antibiotic strategies tailored to
Knowledge and Attitude of Prosthodontic Post Graduates on COVID 19: A Qualita...DrHeena tiwari
This document summarizes a study that surveyed 60 prosthodontic post-graduate students regarding their knowledge and attitudes about COVID-19. The results found that 80% felt they received adequate training on COVID-19 prevention and control, while over 60% were confident in managing patients with required precautions. However, only around 63% knew who to contact if they encountered a suspected COVID-19 patient. Nearly all (96.6%) agreed that the pandemic has affected their academic activities. The study concludes that understanding aerosol transmission in dentistry can help identify risks and improve practices to prevent disease spread.
1) The study evaluated the role of antibiotics in preventing postoperative complications after routine periodontal surgery. 45 patients receiving either amoxicillin, doxycycline, or no antibiotics were evaluated.
2) No significant differences were found between groups in postoperative pain, swelling, or infection rates. Properly performed periodontal surgery does not typically result in postoperative infections.
3) While antibiotics are often prescribed following regenerative or implant surgeries, this study found no additional benefit to prescribing antibiotics for routine periodontal surgeries to prevent postoperative infections when performed aseptically. Larger studies are still needed to confirm findings.
This study compared the clinical, radiographic, histopathologic, and histobacteriologic features of true and bay apical cysts. The study found no significant differences between true and bay cysts for any of the parameters evaluated. Both cyst types always exhibited intraradicular infection and sometimes extraradicular infection as well. The findings question the need to differentiate between true and bay cysts and do not support the assumption that true cysts are self-sustaining entities not associated with infection.
This document provides information on anti-retroviral therapy (ART) for HIV/AIDS:
1. It outlines the diagnostic criteria for HIV based on lab tests and the WHO clinical case definition for AIDS.
2. It states that as of 2008-09, there were an estimated 22.7 lakh people living with HIV/AIDS in India.
3. It provides details on optimal diagnostic approaches, investigations, treatment and referral criteria for ART in both secondary hospital/non-metro situations and super specialty facilities in metro locations.
Post-operative Wound Infection in Cases operated in a Tertiary Level Hospital Jaipur (Rajasthan) India-Wound infection is the second commonest nosocomial infection and most troublesome disorder of wound healing. This study was carried out on 100 post-operative cases of Surgical Unit 1st of General Surgery Department of Sawai Man Singh Hospital, Jaipur (Rajasthan) India in years 2014.
After interview of these, swab from post-operative wound was taken and sent for culture and sensitivity test in Microbiology. Results were inferred by Chi-square test and unpaired‘t’ test. Among all operative cases 21% were found infected. Cases, who were operated in emergency have significantly more post-operative wound infection. Mean age and mean postoperative stay of cases with post-operative infected wound was significantly higher than in cases without post-operative infected wound. But mean pre-operative stay, mean duration of operation and type of operation was not associated with post-operative wound infection. Pre-operative antibiotics lowered the occurrence of post-operative wound infection. Maximum proportion of causative agent found in post-operative infected wound was Staphylococci (90.48%) followed with Streptococci, E. Coli, Klebsella and Pseudomonas.
EFFICACY OF TRANSDERMAL PATCHES IN THE MANAGEMENT OF POSTOPERATIVE PAIN: AN O...DrHeena tiwari
This study compared the efficacy of a single 100mg transdermal diclofenac patch to a single 75mg intramuscular diclofenac injection for managing postoperative pain in 30 patients who underwent maxillofacial surgery. Patients were randomly assigned to receive either the patch or injection. Pain levels were assessed at various timepoints using a visual analogue scale. The results found that the patch provided longer lasting analgesia (15 hours on average) compared to the injection (9 hours), and fewer patients in the patch group required rescue pain medication. No local complications occurred with the patch. The study concluded that a single diclofenac patch was more effective than intramuscular diclofenac for managing immediate postoperative pain
Necessity of COVID-19 vaccination in previously infected individualsMattisHallsteinVolla
This study examined the incidence of COVID-19 among 52,238 employees in an American healthcare system over 5 months. The study found:
1) The cumulative incidence of COVID-19 remained almost zero among those previously infected who remained unvaccinated, those previously infected who were vaccinated, and those not previously infected who were vaccinated.
2) In contrast, there was a steady increase in cumulative incidence among those not previously infected who remained unvaccinated.
3) Not one of the 1,359 previously infected subjects who remained unvaccinated had COVID-19 over the duration of the study.
The results suggest individuals who have had COVID-19 are unlikely to benefit from vaccination, and vaccines
This study analyzed urine samples from 1,670 patients in rural Odisha, India to determine the prevalence and etiology of community-acquired urinary tract infections (CA-UTIs). The key findings were:
1) The overall prevalence of CA-UTI was 34.5%, significantly higher in females (45.2%) than males (18.4%). Young women aged 18-37 and elderly men aged 68+ had the highest prevalence.
2) Escherichia coli was the most common causative organism (68.8%), followed by Enterococcus species. Gram-negative rods accounted for 78.2% of isolates.
3) Amikacin and nitrofurant
1) The initial management of open fractures, including timing of debridement, choice of antibiotics, and timing of wound coverage, involves several controversies with little consensus in the literature.
2) While early antibiotic administration and debridement are agreed upon, there is no evidence that debridement must occur within 6 hours as was once believed; many surgeons now find urgent rather than emergency debridement acceptable.
3) Timing of wound coverage is also debated, but most evidence suggests covering Type III wounds within 7 days is appropriate once tissues have stabilized and debridement is complete.
Briefing to invigilator for aiims mbbs exam By Dr Anil Kumar, Assist Prof , A...Anil Kumar
This document outlines the responsibilities and instructions for an examination duty invigilator at the All India Institute of Medical Sciences in Patna. It details the invigilator's tasks such as allowing entry of candidates at specified times, taking attendance, collecting materials, monitoring the exam, and making announcements to candidates. The invigilator is instructed to maintain security, confidentiality, and prevent malpractice. They must use a red pen for all tasks and not offer any clarification to technical questions.
Invest in a good quality professional wardrobe that can be worn multiple times to save money in the long run and project a better image. Dress professionally for career fairs, job fairs, employer sessions, and interviews. Men should wear long-sleeved shirts and dark socks, keep facial hair well-groomed, and remove earrings. Women should wear pants or skirts at least knee-length, avoid tight or shiny fabrics, and keep jewelry simple with natural makeup. Be well-groomed with clean hair, shoes, hands, and fitted clothing without cologne overuse or visible flaws. Common mistakes include short sleeves, unpressed shirts, beltless pants, plastic watchbands, and badly worn
The Pythagorean theorem states that in a right triangle, the square of the hypotenuse is equal to the sum of the squares of the other two sides. It is named after Pythagoras, who is often credited with its proof, although it was known by earlier mathematicians as well. There are many different proofs of the theorem, including Pythagoras' original proof by rearrangement of triangles and Euclid's algebraic proof in his Elements which constructs squares on each side and uses their areas to prove the relationship.
The document provides tips for dressing professionally for meetings and conferences. It recommends considering the audience and environment, dressing appropriately for the occasion, and choosing comfortable, versatile clothing. Specific tips include wearing a blazer, skirt at an appropriate length, closed-toe shoes, simple jewelry and hair, and daytime perfume for women. For men, it suggests a well-fitting suit, attention to detail, classic rather than trendy styles, well-groomed appearance, and leather shoes. The document emphasizes that first impressions from attire matter, as you don't get a second chance to make a first impression.
Precautions to Prevent Transmission of Infectious Agents Among Patients and P...icsp
1. The document discusses isolation precautions and strategies to prevent the transmission of infectious agents among patients and healthcare personnel.
2. It argues that traditional isolation based only on recognized infections may be less effective than universal "generic precautions" applied to all patients due to delays in diagnosis and protection of susceptible sites.
3. Generic barrier precautions like gloves, gowns, and hand hygiene have been shown in research to reduce the transmission of various pathogens when used consistently for all patient interactions involving contact with moist body substances.
Challenges in healthcare and infection controlLee Oi Wah
The document discusses various challenges in healthcare-associated infection control and prevention. It outlines key challenges like multidrug-resistant organisms, changing healthcare settings, and emerging diseases. It also summarizes strategies like surveillance, standard and transmission-based precautions, and the roles of infection control personnel in outbreak prevention and management. Effective infection control requires a multifaceted approach including education, environmental controls, and collaboration across the healthcare system.
1) Infectious diseases pose risks to healthcare workers, as evidenced by past outbreaks like SARS, Ebola, and seasonal influenza. During the 2013-2015 Ebola outbreak, over 20,000 cases and 11,000 deaths occurred, and healthcare workers were over 20 times more likely to be infected.
2) The SARS outbreak of 2002-2003 highlighted these risks. Attack rates for SARS among healthcare workers ranged from 1-35% depending on their role and exposure. Proximity to infected patients, aerosol-generating procedures, and lack of proper personal protective equipment increased risk.
3) General infection control principles like isolation, quarantine, hand hygiene, and use of masks and other
Patient safety assistantship Professor Vinod PatelVinod0901
This document provides an overview of a lecture on promoting patient safety in the NHS after the Berwick Report. It discusses the four ethical principles of autonomy, beneficence, non-maleficence and justice. It then describes elements of a professional skills suite including reducing inequalities, health promotion, patient safety, consent and more. Key models for understanding medical errors like the Swiss cheese model and human factors are presented. The document summarizes the Berwick Report which examined failings in care and made recommendations to improve patient safety, including being more open, transparent and prioritizing patient needs. It also discusses tools like the surgical safety checklist and their impact in reducing complications and deaths.
The study characterized 270 MRSA isolates from Colombia to determine molecular epidemiology and virulence genes. PFGE analysis identified dominant clones related to the Chilean and USA300-0114 clones. MLST found sequence types ST1110 and ST1111 related to known clones. SCCmec typing showed types I, II, IVa-c. Virulence genes like enterotoxins, exfoliative toxins, and adhesins were present. Mortality was higher for HA-MRSA and infections like bacteremia. The presence of certain genes was associated with increased severity and pathology.
Many doctors in many hospitals in many countries do not use proper hospital attire, and do not follow basic hygiene routines. Doctors use their private clothes, or other inappropriate attire in the hospitas,l and carry home the dirty clothes contaminated with resistant bacteria and spores. By this way they spread infection from patient to patient, from clinics to clinics, and from hospitals to the homes and communities. This must stop.
This document discusses predicting patient risk of acquiring Klebsiella pneumoniae carbapenemase producing organisms (KCPO) and linking environmental exposure to patient acquisition. It describes developing a patient risk model using a case-control approach and clinical and demographic data. A naïve Bayesian model was created and validated, showing an AUC of 0.746. It then analyzes the impact of positive room environments on patient infection using a treatment effects model, controlling for patient risk and length of stay. The results show room positivity is significantly associated with acquisition of infection, with an odds ratio of 22.25. Ultimately, interventions like hopper covers and heater traps reduced environmental transmission.
This document discusses predicting patient risk of acquiring Klebsiella pneumoniae carbapenemase producing organisms (KCPO) and linking environmental exposure to patient acquisition. It describes developing a patient risk model using a case-control approach and clinical and demographic data. A naïve Bayesian model was built and validated, showing an AUC of 0.746. It then analyzes the impact of positive room environments on patient infection using a treatment effects model, controlling for patient risk and length of stay. The results show room positivity is significantly associated with acquisition of infection, with an odds ratio of 22.25. Ultimately, interventions like hopper covers and heater traps reduced environmental transmission.
Surgical site infections are a major source of postoperative illness and can increase costs and mortality; Staphylococcus aureus and Staphylococcus epidermidis are the most common pathogens causing SSIs. Using ETHICON Plus antiseptic sutures, which contain triclosan and have been shown to create a zone of inhibition against bacteria, can help control wound contamination during a procedure and continue protecting the patient after leaving the operating room.
An audit was conducted of ward nurses' knowledge of sepsis definitions and management guidelines. A questionnaire was administered to 73 ward nurses which assessed their understanding of the signs and symptoms of sepsis, as well as case studies depicting potential sepsis patients. The results showed that some nurses had a poor understanding of the standard definitions of sepsis, severe sepsis/septic shock and recommended initial management. In response, targeted educational initiatives were implemented to improve nurses' knowledge of sepsis definitions and management guidelines put forth by the Surviving Sepsis Campaign. The study concluded that focused education for ward nurses is needed if the goal of reducing sepsis mortality by 25% is to be achieved.
Nosocomial infections, also known as hospital-acquired infections, are infections that patients acquire during the course of receiving treatment for other conditions within a healthcare setting. The document discusses the epidemiology, sources, common microorganisms, types of infections, diagnosis, treatment and prevention of nosocomial infections. It notes that approximately 2 million patients suffer from hospital-acquired infections annually worldwide, with around 100,000 deaths. Common types of nosocomial infections mentioned include urinary tract infections, respiratory infections, surgical site infections, ventilator-associated pneumonia, and septicemia. Prevention strategies focus on proper hand hygiene, limiting unnecessary procedures and devices, and following infection control protocols.
This document discusses community-acquired pneumonia (CAP). It defines CAP and outlines its epidemiology, noting risk factors like increasing age and winter season. Diagnosis involves clinical evaluation, chest imaging, and ruling out other causes if imaging is abnormal but symptoms aren't. Severity is assessed using scores like CURB-65 to determine appropriate treatment setting. Most ambulatory patients receive 5 days of antibiotics while hospitalized patients get broader empiric coverage. Adjunctive steroids may benefit severe cases. Proper follow up and prevention through vaccination and smoking cessation are also discussed.
Current Controversies in Managing HIV-Infected Patients.2014Hivlife Info
This document discusses controversies in managing HIV-infected patients. It begins with a discussion on whether all naive patients should be started on an integrase inhibitor regimen. It reviews key trials demonstrating the efficacy of integrase inhibitors in treatment-naive patients. Expert panel discussion notes some integrase inhibitors have advantages like high barriers to resistance but others have drawbacks like twice-daily dosing. The next section examines the controversy around performing anal Pap smears routinely on all HIV+ MSM, reviewing guidelines and suggested screening paradigms. The final section discusses the controversy around evaluating all HIV+ patients over 50 with DXA scans. It reviews data on bone disease prevalence and recommendations, including evaluating risk factors before obtaining scans.
Current Controversies in Managing HIV-Infected Patients.2014hivlifeinfo
This document discusses controversies around bone density screening in HIV-positive patients. It presents recommendations from guidelines that baseline bone density screening with DXA scans should be performed for all HIV-positive postmenopausal women and men aged 50 years or older. Studies show both osteopenia and osteoporosis are more common in the HIV-positive population compared to HIV-negative controls. The odds of osteoporosis are approximately 3-4 times higher for HIV patients.
Examine the rise in Antibiotic Resistant Organisms and review the Chain of Transmission with emphasis on the portal of entry, and how a focused patient hand hygiene program may be what’s missing in our goal of lower healthcare associated infections and colorizations.
Patient safety involves preventing medical errors and adverse events for patients during healthcare. Some key points covered in the document include:
- Medical errors kill 48,000-98,000 patients per year in the US, costing $18-30 billion annually. Medical error is the third leading cause of death.
- Common causes of errors include poor communication, look-alike medications, improper identification of patients, and failure to follow safety protocols.
- The World Health Organization advocates for practices like explaining procedures during handoffs, checking patient IDs, and improving hand hygiene to prevent infections.
- Hospitals should have safety policies for areas like surgery, laboratories, blood transfusions, and the environment to minimize
1. ICU care bundles are structured ways to improve care through implementing small, evidence-based practices together. Common bundles include ventilator, central line, sepsis resuscitation, and catheter-associated urinary tract infection bundles.
2. The ventilator bundle aims to prevent ventilator-associated pneumonia through practices like elevating the head of the bed, daily oral care with chlorhexidine, and peptic ulcer disease prophylaxis.
3. The central line bundle seeks to reduce central line-associated bloodstream infections through practices such as proper hand hygiene, skin antisepsis with chlorhexidine, and daily review of line necessity.
Webinar: Defeating Superbugs: Hospitals on the Front Lines Modern Healthcare
About the Webinar: Defeating Superbugs: Hospitals on the Front Lines
http://www.modernhealthcare.com/article/20140917/INFO/309179926
Hospitals across the country are facing a grim reality in which some of the most deadly healthcare-associated infections they encounter are untreatable with first- or even second-line antibiotics. These “superbugs” affect at least 2 million Americans each year and lead to 23,000 deaths. And their threat is growing, public health officials warn. This editorial webinar and “Defeating Superbugs” white paper will explore the steps providers must take to ramp up surveillance efforts, promote appropriate antibiotic use and control outbreaks. Our panel of experts will share their organizations' experiences as well as proven strategies for success.
Registration for this webinar includes Modern Healthcare's “Defeating Superbugs” white paper, with proven tips and strategies for promoting appropriate antibiotic use, improving infection surveillance, identifying drug-resistant infections and dealing with outbreaks.
KEY TAKEAWAYS
- Best practices for effective antimicrobial stewardship
- Real-world examples of effective interventions, including universal rapid testing for drug-resistant MRSA
- Tips for engaging senior leadership
- Aggressive strategies for controlling outbreaks
PANELISTS
Lance Peterson
Director of the Clinical Microbiology and Infectious Disease Research Division
NorthShore University HealthSystem, Evanston, Ill.
Anurag Malani
Medical Director for the Infection Prevention and Antimicrobial Stewardship Programs
St. Joseph Mercy Hospital, Ann Arbor, Mich.
Robert Weinstein
Chief Medical Officer for Population Health
Chairman of the Department of Medicine, Cook County Health and Hospitals System; Professor, Rush University Medical Center, Chicago
MODERATOR
Maureen McKinney
Editorial Programs Manager
Modern Healthcare
Environmental Cleaning and Disinfection: Principles of Infection Transmission...Michael Keever
1. Describes the significance of microbial contamination
of the healthcare environment.
2. Identifying the role that environmental cleaning and
disinfection play in patient safety.
3. Factors that should be considered when
implementing an environmental cleaning and
disinfection program.
This document provides an overview of environmental cleaning and disinfection in healthcare settings. It discusses how commonly pathogens contaminate the healthcare environment, including rates as high as 73% for MRSA and 25% for VRE. Pathogens can survive on surfaces for long periods, and contamination of a prior room can put the next patient at risk of acquiring the same pathogen. Improved cleaning and disinfection can reduce this risk and prevent transmission. However, over half of high-touch surfaces are often missed during routine cleaning. Proper cleaning and disinfection of the healthcare environment is crucial for patient safety.
Similar to Clothing and infection control (nj talk) (20)
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
1. It’s Time to Hang Up the White Coat!
Michael Edmond, MD, MPH, MPA
Richard P. Wenzel Professor of Internal Medicine │ Hospital Epidemiologist
2. Goals
• To raise awareness of
the role of clothing in
the transmission of
pathogens in the
healthcare setting
• To examine the conflict
between optimal
infection prevention
and professional
values with regard to
clothing
4. Contact precautions
• Patients with epidemiologically important organisms:
– Placed in a private room or cohorted with another
patient infected or colonized with the same organism
– All persons don gowns & gloves on entry to the room
• Based on the evidence that
clothing can become
contaminated & the
assumption that pathogens on
contaminated clothing can be
transmitted to patients
5. Bare below the elbows:
How it began
• In January 2008, the UK’s NHS mandated
measures to decrease MRSA & C. difficile in the
healthcare setting
– Public reporting by hospitals on:
• compliance with infection control & cleanliness standards
• all MRSA BSIs & C. difficile cases
– Greater use of single rooms, cohort nursing & better
management of isolated patients
– Extension of the hand hygiene campaign to the outpatient
setting
– Bare below the elbows
6. Bare below the elbows
• Short sleeves
• No wrist watch
• No jewelry except
wedding band
• No neck ties
• No white coats
• Intent: allow good hand/wrist washing, &
avoid contamination of sleeve cuffs
7. Postulated role of white coats in the
transmission of pathogens
Patients’ skin & environment are
contaminated with pathogens
White coat becomes contaminated
via contact with patient or
environment + infrequent laundering
Pathogens are transmitted from
the white coat to a subsequent
patient
8. Contamination in the clinical setting:
Neckties
Study
Ditchburn I
2006
Nurkin S
2005
Lopez PJ
2009
Pathogen
N
% positive
S. aureus
40
20
S. aureus
Gram-negative rod
Aspergillus spp
42
42
42
29
12
2
S. aureus
50
26
9. Contamination in the clinical setting:
White coats
Study
Pathogen
N
% positive
Wong D
S. aureus
100
29
Loh W
S. aureus
Acinetobacter
100
5
7
Osawa K
MRSA
14
79
Treakle AM
S. aureus
149
23
Uneke CJ
S. aureus
Ps. aeruginosa
103
19
10
22
32
32
5
1991
2000
2003
2008
2010
S. aureus
Munoz-Price LS Acinetobacter
2012
Enterococcus
10. Contamination in the clinical setting:
Scrubs & Uniforms
Study
Pathogen
N
% positive
Perry C
2001
MRSA
VRE
57
14
38
Munoz-Price LS
2012
S. aureus
Acinetobacter
Enterococcus
97
11
11
3
Krueger CA
2012
S. aureus
268
33
11. Survival of Pathogens on Fabric
Length of survival (days)
Organism
Cotton
Polyester
S. aureus (methicillin S)
4, 5, 19
10, 12, 56
S. aureus (methicillin R)
4, 5, 21
1, 16, 40
E. faecalis (vancomycin S)
11, 33
>90, >90
E. faecalis (vancomycin R)
18, 22
73, 80
E. faecium (vancomycin S)
22, 90
43, >90
E. faecium (vancomycin R)
62, >90
>80, >80
C. albicans
1, 3
1, 1
C. parapsilosis
9, 27
27, >30
1, 10, >30
1, 7, 30
A. fumigatus
Neely AN, Orloff MM. J Clin Microbiol 2001; 39:3360-3361.
Neely AN, Maley MP. J Clin Microbiol 2000;38:724-726.
12. White coats & scrubs:
Frequency of laundering
Mean frequency (days)
N=160
Munoz-Price LS et al. Am J Infect Control 2013;41:565-7.
13. White coat:
Frequency of laundering
Survey of 183 attending
physicians, housestaff
and medical students
Pellerin J, Edmond MB et al. Unpublished data, 2013.
14. Transfer of pathogens from white coat to skin
Number of organisms inoculated onto lab coat
Time
(min)
103
102
+
+
–
–
–
5
+
+
–
–
–
+
+
–
–
–
1
+
+
–
–
–
5
+
+
–
–
–
30
+
+
–
–
–
1
+
+
–
–
–
5
+
+
–
–
–
30
PRA
104
30
VRE
105
1
MRSA
106
+
+
+
–
–
+ = organism transferred from coat to skin
Butler D, Edmond M. J Hosp Infect 2010;75:137-138.
15. Experimental transmission of bacteria
to patients
•
•
•
Clothing was inoculated with Micrococcus (distal tie or
corresponding area on shirt, cuffs of long and short sleeves)
Standardized 2.5 minute exam was performed on a mannequin
Mannequin cultured
Mannequins contaminated
With tie
Without tie
Long sleeve
4/5
1/5
Short sleeve
2/5
0/5
Tie vs. no tie: p = 0.036
Long sleeve vs short sleeve: p > 0.05
Weber RL et al. J Hosp Infection 2012:80:252-254.
16. Summary of evidence:
White coats & the cycle of transmission
Component
Strength of evidence
Pathogens contaminate patients’ skin &
the environment
Conclusive
White coats become contaminated with
pathogens
Conclusive
White coats can transmit pathogens
Some in vitro evidence
Removal of white coats reduces
infection rates
No evidence to date
Biologic plausibility
17. When is biologic plausibility enough to
support a change in practice?
• Potential for benefit
• No risk for harm
• Minimal cost
But without strong evidence for benefit,
we should recommend, not mandate,
the new practice
18. The action threshold
• The action threshold is the probability
of an outcome at which it makes
sense to undertake an intervention
OR how sure to you need to be?
• AT = harm / improvement
Antibiotics for
strep pharyngitis
0%
Gross R. Making Medical Decisions, 1999:45-51.
Cancer
chemotherapy
100%
19. Parachute use to prevent death and major
trauma related to skydiving
•
•
•
•
•
Objective: To determine whether parachutes are effective
in preventing major trauma related to gravitational challenge.
Design: Systematic review of randomized controlled trials (RCTs).
Main outcome measure: Death or major trauma.
Results: We were unable to identify any randomized controlled trials
of parachute intervention.
Conclusions: As with many interventions intended to prevent
ill health, the effectiveness of parachutes has not been subjected to
rigorous evaluation by using RCTs. Advocates of evidence based
medicine have criticized the adoption of interventions evaluated by
using only observational data. We think that everyone might benefit if
the most radical protagonists of evidence based medicine organized
and participated in a double blind, randomized, placebo controlled,
crossover trial of the parachute.
Smith GCS, Pell JP. BMJ 2003;327:1459-1461.
20.
21. Conventional wisdom:
The paradox
• On the basis of the same evidence:
– We are willing to wrap ourselves in plastic &
restrict patients to their hospital room (contact
precautions)
– We are not willing to eliminate white coats &
ties
22. Origin of the white coat
Late 1800s:
Earliest use was in the
operating room
Instruction in Surgery: Scene in the
Operating Room Amphitheater of the
Massachusetts General Hospital,
Boston, 1888.
Early 1900s:
Physicians began to wear
white coats outside the OR
to reinforce the stereotype of
physicians as scientists
Howard Kelly, MD Professor
of Gynecology, Johns
Hopkins Hospital, 1920
23. Functions of the white Coat
•
•
•
•
•
Storage
Protects clothing
Identification
Warmth
Symbolism
24. The White Coat as Symbol
•
•
•
•
•
•
•
Purity
Cleanliness
Superhuman power
Candor
Trust
Integrity
Goodness
Blumhagen DW. Ann Intern Med 1979;91:111-6.
Wear D. Ann Intern Med 1998;129:734-7.
Flannery MC. Thyroid 2001;11:947-51.
Russell PC. Teach Learn Med 2002;14:56-9.
• Hierarchy & authority
• Control
• Social & economic
privilege
• Inclusion in an elite
community
• Separation from the
mass of society
because of superior
knowledge & thinking
skills
25. Reasons for wearing a white coat
Warmth
12%
N = 160
Munoz-Price LS et al. Am J Infect Control 2013;41:565-7.
26. White coat
as vector?
Percentage of
respondents who
believe the white
coat can transmit
pathogens
Pellerin J, Edmond MB et al. Unpublished data, 2013.
28. Which doctor would you prefer?
• Graduated near the bottom
of his class
• Failed board certification
exam on first attempt
• Has difficulties with
communication
• Several nurses & medical
students have filed
complaints against him for
dehumanizing comments
• Graduated near the top of
his class
• Scored at the 95th percentile
on board certification exam
• Numerous patients have
written letters to hospital
administration regarding his
kind demeanor & exceptional
availability
29. Patient preference studies
Site
Setting
N
Findings
UK
ENT clinic
93
• 49% preferred shirt & tie
• 40% preferred scrubs
• 11% preferred open collared shirt, sleeves
UK
ENT clinic 100 • 76% preferred no tie
• 63% preferred no white coat
Virginia OB-GYN
clinic
328 • 61% preferred scrubs
• 86% preferred no white coat or didn’t matter
UK
75
Inpatients
• 82% felt doctors should not be expected to
wear ties
• 75% felt doctors should not wear white coats
• 83% felt scrubs acceptable
Hathorn IF et al. Clinical Otolaryngology 2008;33:505-506.
Pothier DD et al. British Medical Journal 2007;335:684-b.
Neiderhauser A et al. Military Medicine 2009;174:817-820.
Palazzo S, Hocken DB. J Hosp Infect 2010;74:30-34.
30. Flaws in many studies of patient
attitudes regarding physician attire
• Lack external validity
– Mostly small, single center studies
• Confounding
– Age
– Geography/culture
– Socioeconomic factors
• Bias
– Infer professionalism on the basis of attire
– Underestimate how patients choose their doctors
– Ignore context
31. Patient preferences for physician attire:
Impact of education
Before & after survey of 50 randomly selected
surgical inpatients in a British hospital
Intervention: patients were given evidence-based
information on contamination of clothing
Initial Response (%) After intervention (%)
Traditional (tie, white coat)
52
22
Scrubs
24
62
No preference
24
8
Unsure
0
8
Monkhouse SJW. J Hosp Infect 2008;69:408-409.
32. Patient preferences for physician attire:
Randomized studies of actual encounters
Method
Findings
Conclusion
596 patients
Emergency Dept.
Half of patients cared for by
MD in white coat + shirt/tie or
blouse/slacks vs. half cared for
by MD in white coat + scrubs
No significant difference
between the groups on 6
questions assessing
satisfaction with care
Post-visit interview: 70%
110 patients
disapproved of jeans, 67%
tennis shoes; no significant
Pre-op visit by anesthesiologist
difference b/w 2 groups with
regard to selection of
Half seen by MD in suit & tie
descriptors denoting
vs. half seen by MD in jeans,
open collar shirt & tennis shoes professionalism or
approachability
Baevsky RH et al. Acad Emerg Med 1998;5:82-84.
Hennessy N. Anaesthesia 1993; 48:219-222.
No relationship
between
appearance &
satisfaction
33. “I have had the good fortune to encounter a wide and
rich spectrum of opinions from patients, friends,
and colleagues on the matter of proper physician
Matt Bianchi, MD, PhD
attire, perhaps encouraged by my absent white coat,
absent necktie, shaved head, bilateral black hoop earrings,
and tattoos covering approximately 17% of my skin (according to the
Lund-Browder burn chart). With only one exception (a mildly demented
man in heart failure), every one of the uncommon suggestions to
upgrade my appearance for the sake of patient care has come from a
physician colleague. In contrast, there have been countless moments of
connection with patients who confided that some aspect of my
appearance made them feel more comfortable… One can only hope
that each doctor-patient interaction affords the participants the chance
to transcend the cursory impressions of attire and engage in the “real”
work of medicine, the alleviation of suffering and the healing potential of
a positive, productive relationship.”
Bianchi MT. J Gen Int Med 2008;23:641-3.
34. Differences between humanism &
professionalism
Characteristic
Humanism
Professionalism
Types of problems
Universal
Local
Sources of learning
Human experience
Socialization into profession
Motivation
Human welfare
Strengthening of professional
identity
Primary duty
To other humans;
to society
To the professional group
Cognitive basis
Postconventional
thinking: judging
behavior through
deliberation about
universal values
Conventional thinking:
judging behavior by
comparison with the accepted
social norms of a specific
group
Outcome
Links physicians to
patients
Separates physicians from
patients
Modified from: Goldberg JL. Academic Medicine 2008;83:715-722.
36. The White Coat Ceremony
“We do not need to teach students how
to put on their white coats, but how to
take them off. Rather than cloak the students in the coats
of the elite, I would borrow a scene from the 1991 film
The Doctor and dress students in the common garb of
human frailty: a hospital gown. Vulnerable and slightly
exposed, they could stand in front of a crowd that only
slightly outnumbers the daily census of an average
hospital room and pledge never to forget how unforgiving
medical care can be stripping patients down to their bare
humanity. Perhaps students would thus embark on their
medical education with a reminder of what they share
with their patients rather than what sets them apart.”
Goldberg JL. Acad Med 2008; 83:715-722.
37. What do patients want from their doctors?
Observations from both ends of the stethoscope
• Competency
• Access
– Undivided attention & active listening
during the encounter
– Ability to contact the doctor readily & to
be seen quickly when necessary
• Interest in them as patients and
people
41. Scaling back contact precautions
• Patients colonized or infected with
MRSA or VRE are placed on contact
precautions only under the following
conditions:
– Outbreak situation
– Wound drainage that is not contained within a
dressing
– Uncontained respiratory secretions
42. Preliminary findings 6 months after
discontinuing contact precautions for
MRSA & VRE
• Institution-wide surveillance (~850 beds)
for all device associated infections:
MRSA
VRE
Device days
CLABSI
1
2*
19,160
CAUTI
0
0
11,807
Possible/probable VAP
0
0
3,431
TOTAL
1
2*
34,848
*both VRE infections were met criteria for mucosal barrier injury BSI
43. Summary:
Clothing & pathogen transmission
• Clothing has the potential to transmit pathogens
• The white coat serves the doctor & the profession
to a much greater extent than the patient
– Vestigial article of clothing that is neither necessary
nor sufficient for good patient care
• Maximizing patient safety should trump concerns
for “professional” appearance
• SHEA guidance document on healthcare worker
attire is in press
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@mike_edmond