Surgical site infections (SSIs) account for 20% of nosocomial infections. Approximately 3-5% of surgeries result in an SSI. There are many pre-operative and perioperative factors that influence the risk of developing an SSI, including patient characteristics (age, health status), procedure-related factors, and hospital structure and protocols. Hospitals can influence several modifiable risk factors like surveillance, antimicrobial prophylaxis, normothermia, glucose control, and skin preparation to help reduce SSIs.
Presentation "Give up on VRE" as part of a debate at HIS 2014 (Lyon, France). Clearly not everything in here is my true opinion, but was part of "playing my part".
The document discusses indicators for accrediting infection control units and hospitals. It proposes assessing structure, process, and outcomes, including monitoring incidence of multidrug-resistant organisms, adherence to infection control guidelines, and environmental cleaning. Outcome indicators like infection and colonization rates are prioritized. Risk stratification into categories like low, medium, and high is recommended based on national guidelines and expert opinion. Both resident and ward-level factors should be considered.
In silico reconstruction of viral genomes from small RNAs improves virus-deri...Raunak Shrestha
This document describes a method called Paparazzi that uses small RNA sequencing data to reconstruct viral genomes. Paparazzi aligns small RNA reads to a reference virus sequence, calls a consensus at each position, and iteratively builds contigs to assemble full viral genomes. The method was able to reconstruct genomes of viruses infecting Drosophila cells that differed from reference sequences. However, it had difficulties in regions prone to deletions or with uneven small RNA coverage. Overall, Paparazzi provides an effective tool for viral genome assembly and small RNA profiling.
The document discusses different types of methicillin-resistant Staphylococcus aureus (MRSA) including community-associated MRSA (CA-MRSA), healthcare-associated MRSA (HA-MRSA), and livestock-associated MRSA (LA-MRSA). It notes that CA-MRSA strains are genetically unrelated to HA-MRSA strains and are enriched with genes like SCCmec IV and PVL toxin. The document also discusses transmission of MRSA between livestock animals like pigs and humans with occupational exposure, finding increased risk of MRSA carriage in those with direct contact to live animals. Overall, the document examines epidemiological characteristics and transmission dynamics of different MRSA strains, especially the emergence of LA-MR
The document discusses guidelines for infection control. It notes that guidelines are seen as both too restrictive by some and not restrictive enough by others. It emphasizes that guidelines need to be adapted to the local situation and highlights strategies for developing and implementing guidelines, including obtaining input from various stakeholders and ensuring guidelines are evidence-based. It also presents "The Ten Commandments of Infection Control" as a concise way to summarize key principles.
The document discusses strategies for controlling methicillin-resistant Staphylococcus aureus (MRSA) in healthcare settings. It describes the ideal "search and destroy" strategy of isolating and screening high-risk patients, decolonizing MRSA carriers, and taking consistent action when transmissions occur. However, it notes many healthcare facilities do not fully implement this strategy due to difficulties identifying at-risk patients and constraints like staffing issues. The document advocates for universal precautions like isolating MRSA-positive patients, promoting hand hygiene, and providing feedback to help facilities improve and reduce MRSA rates.
The document discusses the role of the hospital environment in the transmission of pathogens and healthcare-associated infections. It is estimated that 20% of pathogens causing infections in the intensive care unit come from the environment. Surfaces in patient rooms are often contaminated with pathogens, and contact with these surfaces can lead to healthcare worker contamination. Improved cleaning has been shown to reduce transmission of certain pathogens like C. difficile and VRE. The infectious dose may be very low for some environmental pathogens. The document examines various studies on the role of the environment in transmission and potential strategies to reduce environmental contamination.
Presentation "Give up on VRE" as part of a debate at HIS 2014 (Lyon, France). Clearly not everything in here is my true opinion, but was part of "playing my part".
The document discusses indicators for accrediting infection control units and hospitals. It proposes assessing structure, process, and outcomes, including monitoring incidence of multidrug-resistant organisms, adherence to infection control guidelines, and environmental cleaning. Outcome indicators like infection and colonization rates are prioritized. Risk stratification into categories like low, medium, and high is recommended based on national guidelines and expert opinion. Both resident and ward-level factors should be considered.
In silico reconstruction of viral genomes from small RNAs improves virus-deri...Raunak Shrestha
This document describes a method called Paparazzi that uses small RNA sequencing data to reconstruct viral genomes. Paparazzi aligns small RNA reads to a reference virus sequence, calls a consensus at each position, and iteratively builds contigs to assemble full viral genomes. The method was able to reconstruct genomes of viruses infecting Drosophila cells that differed from reference sequences. However, it had difficulties in regions prone to deletions or with uneven small RNA coverage. Overall, Paparazzi provides an effective tool for viral genome assembly and small RNA profiling.
The document discusses different types of methicillin-resistant Staphylococcus aureus (MRSA) including community-associated MRSA (CA-MRSA), healthcare-associated MRSA (HA-MRSA), and livestock-associated MRSA (LA-MRSA). It notes that CA-MRSA strains are genetically unrelated to HA-MRSA strains and are enriched with genes like SCCmec IV and PVL toxin. The document also discusses transmission of MRSA between livestock animals like pigs and humans with occupational exposure, finding increased risk of MRSA carriage in those with direct contact to live animals. Overall, the document examines epidemiological characteristics and transmission dynamics of different MRSA strains, especially the emergence of LA-MR
The document discusses guidelines for infection control. It notes that guidelines are seen as both too restrictive by some and not restrictive enough by others. It emphasizes that guidelines need to be adapted to the local situation and highlights strategies for developing and implementing guidelines, including obtaining input from various stakeholders and ensuring guidelines are evidence-based. It also presents "The Ten Commandments of Infection Control" as a concise way to summarize key principles.
The document discusses strategies for controlling methicillin-resistant Staphylococcus aureus (MRSA) in healthcare settings. It describes the ideal "search and destroy" strategy of isolating and screening high-risk patients, decolonizing MRSA carriers, and taking consistent action when transmissions occur. However, it notes many healthcare facilities do not fully implement this strategy due to difficulties identifying at-risk patients and constraints like staffing issues. The document advocates for universal precautions like isolating MRSA-positive patients, promoting hand hygiene, and providing feedback to help facilities improve and reduce MRSA rates.
The document discusses the role of the hospital environment in the transmission of pathogens and healthcare-associated infections. It is estimated that 20% of pathogens causing infections in the intensive care unit come from the environment. Surfaces in patient rooms are often contaminated with pathogens, and contact with these surfaces can lead to healthcare worker contamination. Improved cleaning has been shown to reduce transmission of certain pathogens like C. difficile and VRE. The infectious dose may be very low for some environmental pathogens. The document examines various studies on the role of the environment in transmission and potential strategies to reduce environmental contamination.
The document discusses the impact of COVID-19 on orthopedic services and recommendations for responding to the pandemic. It outlines how the orthopedic department adapted by implementing social distancing measures, restricting clinic and trauma meeting attendance, planning workforce remotely, and prioritizing urgent surgeries. Recommendations include developing COVID-19 protocols, re-evaluating surgical waitlists, ensuring PPE availability, and collaborating across specialties. The pandemic has challenged healthcare systems but following guidelines can help orthopedics safely deliver critical services during the crisis.
Healthcare-associated infections (HAIs) have a significant impact on hospitals and patients. For patients, HAIs can lead to increased treatment, extended hospital stays, disability and even death. Hospitals experience decreased productivity, litigation costs and damage to their reputation from HAIs. At a national level, HAIs contribute to increased healthcare costs and societal losses from inability to work. The document discusses the difficulties in measuring the full economic burden of HAIs but notes it has been shown to be substantial. Prevention of HAIs should be an important part of patient care due to their associated morbidity, mortality and costs.
Role of negative pressure wound therapy (V.A.C) in orthopaedicsJoydeep Mandal
Negative pressure wound therapy (NPWT), also known as V.A.C. therapy, uses subatmospheric pressure to promote wound healing. It maintains a moist environment, removes excess fluid, and increases blood flow and granulation tissue formation. The document discusses the role of NPWT in treating open and infected wounds in orthopedics, including its mechanisms, indications, benefits, and two case studies showing improved wound healing with its use.
This document discusses endophthalmitis, a potentially devastating eye infection, and its various causes and risk factors. It covers exogenous endophthalmitis resulting from trauma or surgery and endogenous endophthalmitis from bacteremia or fungemia. Specific surgical procedures like cataract extraction, glaucoma filtration, and intravitreal injections are examined in terms of their associated endophthalmitis rates and common causative organisms. Patient symptoms and the importance of differentiating infectious versus sterile postoperative inflammation are also mentioned.
This document presents a case of a 45-year-old male with uncontrolled diabetes who presented with right facial swelling and discharge from his right ear and cheek. CT scan revealed multiple right facial space infections, including in the infratemporal space. The infratemporal space is a rare site for infection that can spread dangerously if not treated immediately. It is difficult to diagnose due to surrounding bones limiting visible symptoms. However, trismus may indicate infratemporal space infection when accompanied by swelling and pain. Aggressive treatment is needed for these serious odontogenic infections.
The document discusses surgical site infections, providing definitions and classifications. It notes that SSIs are the third most common nosocomial infection, occurring in 14-16% of surgical patients. Risk factors include patient characteristics like diabetes, operation factors like duration, and types of surgery. SSIs are classified as superficial, deep, or organ/space. Prevention strategies discussed include proper hair removal before surgery, appropriate use of antibiotic prophylaxis, and careful tissue handling during operations. Treatment involves antibiotics and sometimes reopening surgical sites.
This document summarizes an article about volunteer surgeons providing care to wounded soldiers in Iraq and Afghanistan. It discusses the senior visiting surgeon program established by the American College of Surgeons that allows surgeons to volunteer their time. The volunteer rotation described involved caring for patients at Landstuhl Regional Medical Center in Germany as part of the complex medical evacuation process bringing wounded soldiers from war zones to the United States for further treatment and recovery.
This document outlines a study exploring the use of antibiotic-impregnated cement beads or nails for the control of orthopedic infections. The objectives are to determine the time required for complete infection control, cost-benefit ratio, suitable antibiotics, and complications. A literature review covers the history and properties of bone cement, use of antibiotic-loaded bone cement, and orthopedic infections. The trial design involves surgical debridement and application of cement beads/nails, followed by monitoring time to infection control and functional outcomes. Preliminary results show the beads/nails need removal after 2 months once infection is controlled, avoiding additional surgeries compared to alternative treatments.
STANDARD OPERATING PROCEDURE FOR RADIOTHERAPY IN COVID-19NikhilBathija
The document discusses revisions made to standard operating procedures at a radiation oncology department in India during the COVID-19 pandemic. Key changes included:
1) Screening all new and existing patients for COVID-19 symptoms and testing as needed.
2) Reducing the interval between brachytherapy treatments from 7 to 3 days to minimize hospital stays.
3) Implementing teleconsultations for patients who could not visit.
4) Educating patients and staff on COVID-19 prevention measures like hand hygiene and mask wearing.
5) Sanitizing treatment areas regularly and encouraging social distancing.
This document summarizes an interview with Dr. Ivan Mazzon, head of the Endoscopic Centre "Arbor Vitae" in Rome, about his "cold loop" hysteroscopic myomectomy technique. Dr. Mazzon was the first to use the term "cold loop myomectomy" and his technique involves using mechanical loops instead of electrified loops to detach the intramural component of fibroids, avoiding thermal injury to tissues. The main advantages are preservation of tissues, elimination of perforation risk, reduced bleeding and adhesions. While initially known only in Italy, interest in the technique is growing internationally as Dr. Mazzon publishes on it in medical journals.
This document discusses factors that increase the risk of central venous catheter infection related to exit site selection. It identifies moisture, warmth, hair distribution, and poor dressing adherence as increasing contamination risk. The groin is considered very high risk due to these factors. The neck and chest areas are also relatively high risk, especially higher on the neck. More stable, dry sites like the base of the neck and upper arm are lower risk. Proper skin antisepsis and securement are important to prevent bacterial colonization and infection.
This document discusses perioperative infection control and the role of anesthesiologists. It begins with the epidemiology of healthcare-associated infections and surgical site infections, noting their impact and common causative pathogens. The pathophysiology of the inflammatory response to surgical tissue damage is described. Risk factors for surgical site infections are outlined. The document then reviews the microbiology of surgical site infections and the role of anesthesiologists in controlling various infection prevention measures like hand hygiene, environmental disinfection, and aseptic techniques for procedures. Guidelines for optimizing infection control in the operating room anesthesia work area are also summarized.
This PowerPoint presentation provides tips and guidelines for safely performing surgery on patients with HIV/AIDS. It discusses obtaining informed consent and assessing patient risk. Precautions like using protective equipment and safe sharps handling are emphasized. The presentation also addresses minimizing occupational risk to healthcare workers and variations in surgical techniques for enhanced safety. Key points covered include the low risk of provider-to-patient HIV transmission if precautions and antiretroviral therapy guidelines are followed.
This document discusses perioperative nursing. It covers the three phases of perioperative care: preoperative, intraoperative, and postoperative. It describes goals and assessments for the preoperative phase, including physiologic and psychologic evaluation of the patient and providing education. Surgical procedures are classified based on purpose, urgency, degree of risk, and whether they are performed as ambulatory/same-day surgery. Risks and the patient's fears and concerns are addressed. Informed consent is also discussed.
Corneal opacities in infants and children pose unique
management challenges. Penetrating Keratoplasty (PKP) has been used in order to clear the visual axis and prevent amblyopia, but has been historically associated with high rates of graft failure and other complications
The document discusses surgical site infections (SSIs), including:
1. SSIs are defined as infections occurring within 30 days of surgery or 1 year if an implant is placed. Common types are superficial and deep incisional infections.
2. SSIs are among the most common and costly healthcare-associated infections, with incidence higher following some orthopedic procedures.
3. Risk factors for SSIs include patient characteristics like diabetes as well as surgical factors like prolonged operating time and implant use. Proper prevention techniques can help reduce SSI risk.
4. Diagnosis involves clinical presentation as well as microbiological and histological testing. Treatment depends on infection severity but often involves wound opening, debride
Surgical site infections (SSIs) are infections that occur after an invasive surgical procedure. A study conducted in Bangladesh found that 20.16% of 496 surgical patients developed wound infections. SSIs can be caused by exogenous sources like contaminated air or instruments, or endogenous sources such as the patient's own skin flora. Risk factors include patient characteristics like age, diabetes, and local factors like wound contamination. SSIs are classified as superficial incisional, deep incisional, or organ/space infections. Prevention strategies include proper patient preparation, sterile technique in the operating room, timely administration of prophylactic antibiotics, and postoperative wound management. SSIs significantly increase hospital costs and negatively impact patient outcomes.
This document discusses various complications that can occur with dental implants. It begins by defining implant survival and success. It then discusses the prevalence of implant complications and lists some common risk factors. The document is organized by type of complication, including surgical (e.g. hemorrhage, nerve damage), biologic (e.g. inflammation, bone loss), prosthetic/mechanical (e.g. screw loosening, fracture), and esthetic complications. For each complication, contributing factors and examples are provided. The conclusion reiterates that complications can usually be prevented through careful treatment planning, surgical skill, and maintenance of implant hygiene.
This document discusses arguments for and against universal masking policies to prevent the spread of COVID-19. It notes that the definition of "universal masking" varies between countries and references studies on the effectiveness of masks. While masks may provide some protection, especially in healthcare settings, there is limited evidence on their effectiveness in community settings. Concerns about universal masking include improper use, a false sense of security, risk compensation, and lack of evidence that cloth masks work as well as medical masks. Overall, masks are presented as just one part of a comprehensive strategy, and not a replacement for other measures like distancing and isolating when sick.
The document discusses the risks posed by water sources in healthcare settings. It notes that water sources can be contaminated with pathogens like Legionella, nontuberculous mycobacteria (NTM), and fungi. Heater-cooler devices used in surgery have been linked to outbreaks of M. chimaera infections. Sinks and drains in patient rooms and bathrooms have been found to harbor multidrug-resistant bacteria and have caused outbreaks through aerosolization and contact with healthcare workers' hands. Removing sinks from intensive care unit rooms and implementing water-free patient care was associated with significantly lower gram-negative bacterial colonization rates in patients.
The document discusses the impact of COVID-19 on orthopedic services and recommendations for responding to the pandemic. It outlines how the orthopedic department adapted by implementing social distancing measures, restricting clinic and trauma meeting attendance, planning workforce remotely, and prioritizing urgent surgeries. Recommendations include developing COVID-19 protocols, re-evaluating surgical waitlists, ensuring PPE availability, and collaborating across specialties. The pandemic has challenged healthcare systems but following guidelines can help orthopedics safely deliver critical services during the crisis.
Healthcare-associated infections (HAIs) have a significant impact on hospitals and patients. For patients, HAIs can lead to increased treatment, extended hospital stays, disability and even death. Hospitals experience decreased productivity, litigation costs and damage to their reputation from HAIs. At a national level, HAIs contribute to increased healthcare costs and societal losses from inability to work. The document discusses the difficulties in measuring the full economic burden of HAIs but notes it has been shown to be substantial. Prevention of HAIs should be an important part of patient care due to their associated morbidity, mortality and costs.
Role of negative pressure wound therapy (V.A.C) in orthopaedicsJoydeep Mandal
Negative pressure wound therapy (NPWT), also known as V.A.C. therapy, uses subatmospheric pressure to promote wound healing. It maintains a moist environment, removes excess fluid, and increases blood flow and granulation tissue formation. The document discusses the role of NPWT in treating open and infected wounds in orthopedics, including its mechanisms, indications, benefits, and two case studies showing improved wound healing with its use.
This document discusses endophthalmitis, a potentially devastating eye infection, and its various causes and risk factors. It covers exogenous endophthalmitis resulting from trauma or surgery and endogenous endophthalmitis from bacteremia or fungemia. Specific surgical procedures like cataract extraction, glaucoma filtration, and intravitreal injections are examined in terms of their associated endophthalmitis rates and common causative organisms. Patient symptoms and the importance of differentiating infectious versus sterile postoperative inflammation are also mentioned.
This document presents a case of a 45-year-old male with uncontrolled diabetes who presented with right facial swelling and discharge from his right ear and cheek. CT scan revealed multiple right facial space infections, including in the infratemporal space. The infratemporal space is a rare site for infection that can spread dangerously if not treated immediately. It is difficult to diagnose due to surrounding bones limiting visible symptoms. However, trismus may indicate infratemporal space infection when accompanied by swelling and pain. Aggressive treatment is needed for these serious odontogenic infections.
The document discusses surgical site infections, providing definitions and classifications. It notes that SSIs are the third most common nosocomial infection, occurring in 14-16% of surgical patients. Risk factors include patient characteristics like diabetes, operation factors like duration, and types of surgery. SSIs are classified as superficial, deep, or organ/space. Prevention strategies discussed include proper hair removal before surgery, appropriate use of antibiotic prophylaxis, and careful tissue handling during operations. Treatment involves antibiotics and sometimes reopening surgical sites.
This document summarizes an article about volunteer surgeons providing care to wounded soldiers in Iraq and Afghanistan. It discusses the senior visiting surgeon program established by the American College of Surgeons that allows surgeons to volunteer their time. The volunteer rotation described involved caring for patients at Landstuhl Regional Medical Center in Germany as part of the complex medical evacuation process bringing wounded soldiers from war zones to the United States for further treatment and recovery.
This document outlines a study exploring the use of antibiotic-impregnated cement beads or nails for the control of orthopedic infections. The objectives are to determine the time required for complete infection control, cost-benefit ratio, suitable antibiotics, and complications. A literature review covers the history and properties of bone cement, use of antibiotic-loaded bone cement, and orthopedic infections. The trial design involves surgical debridement and application of cement beads/nails, followed by monitoring time to infection control and functional outcomes. Preliminary results show the beads/nails need removal after 2 months once infection is controlled, avoiding additional surgeries compared to alternative treatments.
STANDARD OPERATING PROCEDURE FOR RADIOTHERAPY IN COVID-19NikhilBathija
The document discusses revisions made to standard operating procedures at a radiation oncology department in India during the COVID-19 pandemic. Key changes included:
1) Screening all new and existing patients for COVID-19 symptoms and testing as needed.
2) Reducing the interval between brachytherapy treatments from 7 to 3 days to minimize hospital stays.
3) Implementing teleconsultations for patients who could not visit.
4) Educating patients and staff on COVID-19 prevention measures like hand hygiene and mask wearing.
5) Sanitizing treatment areas regularly and encouraging social distancing.
This document summarizes an interview with Dr. Ivan Mazzon, head of the Endoscopic Centre "Arbor Vitae" in Rome, about his "cold loop" hysteroscopic myomectomy technique. Dr. Mazzon was the first to use the term "cold loop myomectomy" and his technique involves using mechanical loops instead of electrified loops to detach the intramural component of fibroids, avoiding thermal injury to tissues. The main advantages are preservation of tissues, elimination of perforation risk, reduced bleeding and adhesions. While initially known only in Italy, interest in the technique is growing internationally as Dr. Mazzon publishes on it in medical journals.
This document discusses factors that increase the risk of central venous catheter infection related to exit site selection. It identifies moisture, warmth, hair distribution, and poor dressing adherence as increasing contamination risk. The groin is considered very high risk due to these factors. The neck and chest areas are also relatively high risk, especially higher on the neck. More stable, dry sites like the base of the neck and upper arm are lower risk. Proper skin antisepsis and securement are important to prevent bacterial colonization and infection.
This document discusses perioperative infection control and the role of anesthesiologists. It begins with the epidemiology of healthcare-associated infections and surgical site infections, noting their impact and common causative pathogens. The pathophysiology of the inflammatory response to surgical tissue damage is described. Risk factors for surgical site infections are outlined. The document then reviews the microbiology of surgical site infections and the role of anesthesiologists in controlling various infection prevention measures like hand hygiene, environmental disinfection, and aseptic techniques for procedures. Guidelines for optimizing infection control in the operating room anesthesia work area are also summarized.
This PowerPoint presentation provides tips and guidelines for safely performing surgery on patients with HIV/AIDS. It discusses obtaining informed consent and assessing patient risk. Precautions like using protective equipment and safe sharps handling are emphasized. The presentation also addresses minimizing occupational risk to healthcare workers and variations in surgical techniques for enhanced safety. Key points covered include the low risk of provider-to-patient HIV transmission if precautions and antiretroviral therapy guidelines are followed.
This document discusses perioperative nursing. It covers the three phases of perioperative care: preoperative, intraoperative, and postoperative. It describes goals and assessments for the preoperative phase, including physiologic and psychologic evaluation of the patient and providing education. Surgical procedures are classified based on purpose, urgency, degree of risk, and whether they are performed as ambulatory/same-day surgery. Risks and the patient's fears and concerns are addressed. Informed consent is also discussed.
Corneal opacities in infants and children pose unique
management challenges. Penetrating Keratoplasty (PKP) has been used in order to clear the visual axis and prevent amblyopia, but has been historically associated with high rates of graft failure and other complications
The document discusses surgical site infections (SSIs), including:
1. SSIs are defined as infections occurring within 30 days of surgery or 1 year if an implant is placed. Common types are superficial and deep incisional infections.
2. SSIs are among the most common and costly healthcare-associated infections, with incidence higher following some orthopedic procedures.
3. Risk factors for SSIs include patient characteristics like diabetes as well as surgical factors like prolonged operating time and implant use. Proper prevention techniques can help reduce SSI risk.
4. Diagnosis involves clinical presentation as well as microbiological and histological testing. Treatment depends on infection severity but often involves wound opening, debride
Surgical site infections (SSIs) are infections that occur after an invasive surgical procedure. A study conducted in Bangladesh found that 20.16% of 496 surgical patients developed wound infections. SSIs can be caused by exogenous sources like contaminated air or instruments, or endogenous sources such as the patient's own skin flora. Risk factors include patient characteristics like age, diabetes, and local factors like wound contamination. SSIs are classified as superficial incisional, deep incisional, or organ/space infections. Prevention strategies include proper patient preparation, sterile technique in the operating room, timely administration of prophylactic antibiotics, and postoperative wound management. SSIs significantly increase hospital costs and negatively impact patient outcomes.
This document discusses various complications that can occur with dental implants. It begins by defining implant survival and success. It then discusses the prevalence of implant complications and lists some common risk factors. The document is organized by type of complication, including surgical (e.g. hemorrhage, nerve damage), biologic (e.g. inflammation, bone loss), prosthetic/mechanical (e.g. screw loosening, fracture), and esthetic complications. For each complication, contributing factors and examples are provided. The conclusion reiterates that complications can usually be prevented through careful treatment planning, surgical skill, and maintenance of implant hygiene.
This document discusses arguments for and against universal masking policies to prevent the spread of COVID-19. It notes that the definition of "universal masking" varies between countries and references studies on the effectiveness of masks. While masks may provide some protection, especially in healthcare settings, there is limited evidence on their effectiveness in community settings. Concerns about universal masking include improper use, a false sense of security, risk compensation, and lack of evidence that cloth masks work as well as medical masks. Overall, masks are presented as just one part of a comprehensive strategy, and not a replacement for other measures like distancing and isolating when sick.
The document discusses the risks posed by water sources in healthcare settings. It notes that water sources can be contaminated with pathogens like Legionella, nontuberculous mycobacteria (NTM), and fungi. Heater-cooler devices used in surgery have been linked to outbreaks of M. chimaera infections. Sinks and drains in patient rooms and bathrooms have been found to harbor multidrug-resistant bacteria and have caused outbreaks through aerosolization and contact with healthcare workers' hands. Removing sinks from intensive care unit rooms and implementing water-free patient care was associated with significantly lower gram-negative bacterial colonization rates in patients.
This document summarizes work done to implement antibiotic stewardship (AMS) programs in nursing homes in the Netherlands. It finds that while AMS is established in hospitals, it is unknown in nursing homes. It discusses adapting hospital AMS guidelines for nursing homes and the unique needs of nursing homes, including limited resources and staff training. It also reports on establishing an AMS team, monitoring antibiotic use data, providing education to nurses and families, and finding room for improvement, particularly around urinary tract infections. The overall inappropriate antibiotic use for UTIs in nursing homes was found to be 32%.
This document discusses patient involvement in infection prevention and control efforts. It suggests including patients in decisions about their own care, quality improvement projects, and strategic planning. Examples of how to engage patients include providing them with information via folders, posters and videos. The document also discusses patients' current internet use to research health topics and find support. It notes that while patients may become well-informed, they still need physician guidance. The rest of the document outlines strategies for engaging patients in hand hygiene monitoring and prevention of surgical site infections and UTIs.
1) The document discusses various methods for monitoring hand hygiene (HH) compliance, including direct observation and electronic monitoring systems (EMS).
2) EMS can continuously monitor HH at a larger scale than direct observers, but may not accurately assess the quality of HH episodes.
3) Several challenges exist with EMS including equipment costs, ensuring dispenser coverage in all needed areas, and potential interference with other devices. Proper implementation requires a team effort.
4) Studies show that while EMS can provide prompts to improve HH, rates may fall again without active intervention. Automated monitoring provides more accurate baseline data than human observers alone.
1) Hand hygiene is important for reducing infection rates in hospitals, which average between 8-12% but can be higher in critical care units at 15-40%.
2) Compliance with hand hygiene has increased with the introduction of alcohol-based hand rubs but barriers still exist including a lack of peer pressure and leadership support for hand hygiene practices.
3) There is debate around which specific moments should require hand hygiene and how many moments are realistically feasible for healthcare workers to comply with, though the WHO guidelines of 5 moments provide a clear framework.
This document discusses various preoperative, perioperative, and postoperative factors that can influence the risk of surgical site infections (SSIs). It identifies factors that are not influenceable, not probably influenceable, can be influenced by others, and can and should be influenced by healthcare providers. It emphasizes the importance of implementing basic practices first, such as appropriate hair removal methods, proper skin antisepsis, maintenance of normothermia, and use of antibiotic prophylaxis. Studies are referenced showing the impact of these factors, such as higher SSI rates with hypothermia during surgery. The document advocates a multifaceted approach focusing on modifiable factors to optimize SSI prevention.
This document discusses hand hygiene (HH) compliance among healthcare workers (HCWs) and different approaches to defining moments when HH should occur. It notes that past attempts to define many specific HH moments resulted in guidelines that were too complex to implement. The document advocates for a simpler approach using 5 core moments and acknowledges this still requires many HH actions per shift. It also explores social contact as a potential separate category and questions how to define such contact given microbes don't distinguish between care and social interactions. The document concludes that while the 5 moments approach may not be perfect, no better universally applicable and easy to remember alternative has been identified.
The document discusses a presentation on infection prevention and control given by Andreas Voss. It touches on several topics:
- Human factors engineering to help males aim better in restrooms to reduce spillage and cleaning needs.
- Studies showing priming behaviors like olfactory scents and images of eyes watching can influence honesty and cooperation.
- A study finding removing sinks from ICU rooms and implementing water-free patient care reduced gram-negative bacteria colonization rates in patients.
- The need for clear, unambiguous terminology to build understanding of antimicrobial resistance across different domains to facilitate a global response.
1. The document discusses challenges facing infection prevention and control (IPC) programs, including securing resources from hospital administrators who see IPC as a cost center rather than revenue generator.
2. It provides advice on how to advocate for IPC programs, including demonstrating the impact of healthcare-associated infections on costs and patient safety, using economic analyses to show potential cost savings, and leveraging crises to highlight the value of IPC.
3. The document emphasizes the importance of engaging hospital leadership in supporting a culture of patient safety and outlines a strategic vision for empowering IPC programs through appropriate structure, resources, and education.
The document discusses several studies related to antimicrobial resistance and infection prevention and control in nursing homes. A study from Hong Kong found an overall MDRO colonization rate of 35.1% among nursing home residents, with MRSA and CRAB being the most common. Another study identified risk factors for CRAB and MRSA colonization like being bed-bound or incontinent. Additional studies discussed interventions to reduce MRSA, C. difficile, and infections in nursing homes through improved antimicrobial stewardship, isolation protocols, hand hygiene programs, and screening practices. However, it was noted that nursing homes often lack dedicated infection prevention resources and have difficulty implementing comprehensive control programs.
This document discusses antimicrobial stewardship programs and their impact on antimicrobial resistance and costs. It notes that while some studies have found reductions in antimicrobial use through stewardship programs can reduce costs, the relationship between use and resistance is complex. Randomized trials evaluating stewardship interventions found lower antimicrobial costs but similar patient outcomes compared to standard care. Overall the document examines both sides of the debate around whether antimicrobial stewardship reduces resistance or simply saves money.
The document discusses strategies for improving antibiotic use and reducing healthcare-associated infections (HAIs) in hospitals. It recommends forming an improvement team to select and implement interventions, monitor compliance with interventions, and check outcomes. Specific interventions discussed include controlling use of reserve antibiotics, standardizing empiric treatment, promoting intravenous to oral switching, educating on antibiotic use, and requiring infectious disease consultation for certain high-risk patients. Real-time surveillance of local resistance trends and guidelines on antibiotic use and infection control are also recommended.
This document summarizes strategies for improving physician compliance with hand hygiene recommendations. It begins by noting the typically low rates of compliance in Dutch hospitals and outlines factors that may contribute to non-compliance. These include perceptions that guidelines are too complex, that one's own situation is different, or simply not caring. The document then provides suggestions for addressing non-compliance, such as having repeated face-to-face conversations to emphasize evidence that non-compliance harms patients, limiting guidelines to one or two clear options to avoid decision paralysis, and appealing to peer pressure by emphasizing consistency with other institutions. The goal is to overcome barriers to compliance through effective communication and engagement strategies.
A "con" presentation of something I am really very much "pro". Still, this were the barriers I had to overcome why implementing S. aureus decolonization
The document discusses various challenges related to managing multidrug-resistant organisms (MDROs) such as VRE in healthcare settings. It notes an outbreak of VRE and lists actions requested of healthcare workers, but also acknowledges ongoing issues like hand hygiene compliance and misunderstandings around isolation protocols. While advanced infection control techniques are desirable, the document emphasizes that proper implementation of basics like hand hygiene, isolation, cleaning, and adherence to guidelines are most important. It raises questions around whether all MDROs require equal screening and management efforts. Regional coordination on surveillance, guidelines and personnel is presented as a strategy to improve practices across different care settings.
This document summarizes an outbreak of vancomycin-resistant Enterococcus (VRE) at a hospital. It describes factors that contributed to the outbreak, including poor infection control practices like inadequate hand hygiene and contact isolation. Over 14 months and 450+ cases, efforts were made to control the outbreak through increased cleaning, screening cultures, audits, and feedback. However, challenges with staff fatigue, unit merging, and financial pressures made outbreak control difficult.
1. Surgical
Site
Infec/ons
November
2012
Andreas
Voss
iPrevent
UMCN
&
CWZ
Nijmegen,
The
Netherlands
OCCUR WITHIN 30 DAYS POST SURGERY
UNLESS IMPLANT UP TO 1 YEAR
¤ Surgical
site
infec/ons
account
for
20%
of
all
nosocomial
infec/ons
¤ Approximately
3-‐5%
of
surgical
opera/ons
result
in
an
infec/on
¤ 77%
of
deaths
among
pa/ents
with
SSI
are
directly
aQributable
to
SSI
Your are entering the
There are many pre-and perioperative
factors that determine whether or not
¤ AQributable
cost
of
SSI
vary
-‐
$3,000-‐$29,000
operating theatre
a patient will develop a SSI
¤ Pa/ent-‐related
¤ Pa#ent-‐related
¤ Procedure-‐related
¤ Procedure-‐related
¤ Structure-‐related
¤ Structure-‐related
Andreas
Voss,
MD,
PhD
1
2. Surgical
Site
Infec/ons
November
2012
¤ Pa/ent-‐related
¤ Pa/ent-‐related
¤ Procedure-‐related
¤ Procedure-‐related
¤ Structure-‐related
¤ Structure-‐related
No
influence
possible
Influence by hospital
• Laminar
air-‐flow
¤ Age
¤ Avoid
shaving
opera/ve
site
• Steriliza/on
¤ Underlying
disease
• Pre-op hospitalization
¤ Maintain
Post-‐op
Glucose
Control
for
Major
Cardiac
Surgery
¤ Malignancy
¤ Wound
classifica/on
Can & should be influenced ¤ Maintain
Post-‐op
Normothermia
for
Colorectal
Surgery
¤ Prosthe/c
material
• Surveillance
• S. aureus colonization
¤ Use
Prophylac/c
An/bio/cs
appropriately
Influenced by patient • Normothermia/hyperoxia
¤ Use
Basic
Preven/ve
Strategies
from
CDC
• BMI >30 • Glucose levels
• Hair-removal ² exclude
pa/ents
w/infec/on,
stop
tobacco
use,
keep
OR
doors
closed,
• Nicotine use
wear
masks,
prepare
skin
w/appropriate
agent.
• Antimicrobial prophylaxis
• Malnutrition
• Skin disinfection
• Infection at remote site
hQp://www.ihi.org/IHI/Topics/Pa/entSafety/SurgicalSiteInfec/ons/Changes/
Disinfec/on
and
steriliza/on
not
… or
Andreas
Voss,
MD,
PhD
2
3. Surgical
Site
Infec/ons
November
2012
¤ 63
surgical
departments
par/cipa/ng
in
KISS
¤ >99.000
opera/ons
¤ Turbulent
+
HEPA
versus
laminar
airflow
+
HEPA
¤ Mul/variate
analyis
to
comtrol
fot
other
factors
influencing
outcome
(SSI)
Brandt et al, Ann Surg 2008; 248:695-700.
Significant
ns
ns
ns
ns
ns
Follow-‐up
study
taking
in
account
the
size
of
the
LAF
plenum
shows
no
difference
in
outcome
Brandt et al, Ann Surg 2008; 248:695-700. Brandt et al, Ann Surg 2008; 248:695-700.
¤ S.
aureus
coloniza/on
¤ An/microbial
prophylaxis
¤ Surveillance
¤ Normothermia
¤ Hyperoxia
¤ Glucose
levels
CAN & SHOULD
¤ Hair-‐removal
¤ Skin
disinfec/on
Andreas
Voss,
MD,
PhD
3
5. Surgical
Site
Infec/ons
November
2012
Li>le
things
can
have
great
impact
(on
hygiene)
¤ Reduc/on
of
Nosocomial
Infec/ons
%
SSI
¤ S.
aureus
coloniza/on
¤ An/microbial
prophylaxis
No
significant
risk
reduc#on
was
¤ Surveillance
observed
for
pa#ents
operated
on
during
¤ Normothermia
the
second
and
third
year
surveillance
years
¤ Hyperoxia
¤ Glucose
levels
¤ Hair-‐removal
Geubels et al Intern J Qual Health Care 2006;18:127-133 ¤ Skin
disinfec/on
200
Pa#ents
SSI
rate
(%)
Pa/ents
with
Normothermia
6
%
colorectal
opera/ons
sample
p=0.009
Hypothermia
19
%
Kurz
et
al.
NEJM
1996;
334:1209-‐15
Andreas
Voss,
MD,
PhD
5
6. Surgical
Site
Infec/ons
November
2012
SSI-‐rate
¤ S.
aureus
coloniza/on
¤ An/microbial
prophylaxis
Local
Systemic
5
(4%)
8
(6%)
¤ Surveillance
Control
¤ Normothermia
19
(14%)
*
p
<
0.01
¤ Hyperoxia
¤ Glucose
levels
¤ Hair-‐removal
¤ Skin
disinfec/on
Melling. Lancet. 2001; 358:876.
JAMA 2004; 291:79-87
¤ S.
aureus
coloniza/on
¤ An/microbial
prophylaxis
¤ Surveillance
¤ Normothermia
JAMA 2005; 294:2035-42 ¤ Hyperoxia
•
High
FiO2
(0.80)
during
and
aqer
¤ Glucose
levels
surgery
•
Colorectal
!
•
General
surgery?
¤ Hair-‐removal
¤ Skin
disinfec/on
¤ Postopera/ve
hyperglycemia
is
an
important
¤ S.
aureus
coloniza/on
independent
risk
factor
for
SSI
in
general
¤ An/microbial
prophylaxis
surgery
pa/ents.
¤ Surveillance
¤ Normothermia
¤ Hyperoxia
¤ Glucose
levels
¤ Hair-‐removal
¤ Skin
disinfec/on
Archives of Surgery 2010;145:858-864]
Andreas
Voss,
MD,
PhD
6
7. Surgical
Site
Infec/ons
November
2012
No
Hair
Group
Removal
Depilatory
Shaved
¤ Number
155
153
246
¤ Infec/on
rate
0.6%
0.6%
5.6%
Seropian.
Am
J
Surg.
1971;
121:
251.
¤ Inappropriate:
² Shaving
Rasors vs. OR = 2.02
„Clipping“ (CI95 1.21-3.36) ¤ Appropriate:
Rasors vs. OR = 1.54 ² No
hair
removal
at
all
Depilatory cream (CI95 1.05-2.24)
² Clipping
² Depilatory
use
Tanner
et
al.
Cochrane
Database
Syst
Rev
2006
Jul
19
¤ S.
aureus
coloniza/on
¤ An/microbial
prophylaxis
¤ Surveillance
¤ Normothermia
¤ Hyperoxia
¤ Glucose
levels
¤ Hair-‐removal
¤ Skin
disinfec#on
Andreas
Voss,
MD,
PhD
7
8. Surgical
Site
Infec/ons
November
2012
lt s !
resu
New
NEJM
Darouiche
et
al
NEJM
2010;362:18-‐26
¤ The
overall
rate
SSI
was
significantly
lower
in
¤ Alcoholic
solu/ons
standard
of
care
in
NL
en
the
chlorhexidine–alcohol
group
than
in
the
other
EU
povidone–iodine
group
(9.5%
vs.
16.1%;
P=0.004)
² I
miss
the
comparison
with
povidone–iodine-‐
alcohol!
¤ Chlorhexidine–alcohol
was
significantly
more
protec/ve
against
¤ What
part
of
chlorhexidine–alcohol
works?
¤ How
important
is
the
CHG
concentra/on
² superficial
incisional
infec/ons
(4.2%
vs.
8.6%,
P=0.008)
¤ Landmark
study
that
shows
that
the
choice
of
² deep
incisional
infec/ons
(1%
vs.
3%,
P=0.05)
skin-‐prep
counts
!
Darouiche
et
al
NEJM
2010;362:18-‐26
Darouiche
et
al
NEJM
2010;362:18-‐26
Reasons
why
implementa/on
of
effec/ve
IC
measures
in
the
OR
is
complicated
J
Am
Coll
Surg
2008;
207:810-‐20
Andreas
Voss,
MD,
PhD
8
9. Surgical
Site
Infec/ons
November
2012
What
do
we
need
to
effec/vly
implement
IC
measures
in
the
OR
¤ People,
/me
and
money
¤ Strong
leadership
² To
handle
the
mul/-‐disciplinary
environment
² To
ensure
responsibili/es
are
known
to
individual
HCWs
¤ Pa/ent
safety
culture
² Survey
and
act
on
process
&
outcome
data
¤ “Conformity”
of
all
HCWs
‘opera/ng”
in
and
around
the
OR
² To
increase
compliance
with
basic
IC
measures
in
OR
Andreas
Voss,
MD,
PhD
9