scholarly journals Mycobacterium abscessus Surgical Site Infections Due to Modular Cooler-Heater Units in Cardiac Surgery

2021 ◽  
Vol 1 (S1) ◽  
pp. s25-s25
Author(s):  
Ahmed Abdul Azim ◽  
Sharon Wright ◽  
Bryan Connors ◽  
Patrick Gordon ◽  
Preeti Mehrotra
Keyword(s):  
Cardiac Surgery ◽  
Water Samples ◽  
Surgical Site Infections ◽  
Mycobacterium Abscessus ◽  
Control Measures ◽  
Set Up ◽  
Image Position ◽  
Instructions For Use ◽  
Key Aspects ◽  
Particle Generator

Background: In the spring of 2020, we identified 3 patients with organ-space surgical site infections (SSIs) secondary to Mycobacterium abscessus (Table 1). All 3 patients underwent cardiac surgery in the same operating room (OR) during which the CardioQuip Modular Cooler-Heaters (MCHs) were used. We describe key aspects of our cluster investigation, which ultimately led to release of a national safety alert by the Food and Drug Administration (FDA). Methods: For environmental cultures, we obtained samples from 9 MCHs in circulation; 2 scrub sink samples; ice from the OR ice machine; water samples from sinks in the cardiovascular critical care unit, and water samples from floors above the cardiac ORs. All samples were sent for molecular genotyping. For pathway studies, an external environmental engineering team was consulted who conducted smoke pathway tests in 3 different ORs. The team also conducted a particle generator experiment, simulating the set-up of a cardiac bypass surgery case. To assess disinfection practices, we reviewed the manufacturer instructions for use (IFU) protocol of the MCHs and audited our own policies and procedures to ensure compliance. Results: For environmental cultures, molecular typing from 5 of 9 MCHs and all 3 patient SSI isolates returned positive for the identical hybrid species M. abscessus bolleti. All other samples with mycobacterial growth returned with different species. For pathway studies, the particle-generator experiment demonstrated particle movement from the MCH to the sterile field with facilities-guidelines–compliant OR ventilation and despite MCH manufacturing design. For disinfection practices, despite compliance with the stated IFU, and in consultation with experts, we implemented disinfection of associated Quick-connect devices (otherwise not stated in the IFU), and we also initiated a precleaning step prior to disinfection. Conclusions: Our investigation concluded that 3 patients developed SSIs with Mycobacterium abscessus that was aerosolized from the CardioQuip MCH. This finding led to the national FDA safety report alerting providers to risks associated with the device and the need for continued vigilance around disinfection. In addition, we implemented other control measures including placement of MCHs outside all ORs; creation of a separate MCH fleet for non-OR use; and use of modified disinfection protocols. To date, no additional cases have been identified. Funding: No Disclosures: None Table 1.

Feminist Perspective in Shashi Deshpande's “That Long Silence”

2018 ◽  
Vol 6 (1) ◽  
pp. 8
Author(s):  
Mohammad Ahashan ◽  
Dr. Sapna Tiwari
Keyword(s):  
Gender Equity ◽  
Social Life ◽  
Fundamental Rights ◽  
Feminist Movement ◽  
Human Beings ◽  
Simone De Beauvoir ◽  
Equal Rights ◽  
And Gender ◽  
Set Up ◽  
Key Aspects

Man has always tried  to determine  and tamper the image of woman and especially her identity is manipulated and orchestrated. Whenever a woman is spoken of, it is always in the relation to man; she is presented as a wife , mother, daughter and even as a lover but never as a woman  a human being- a separate entity. Her entire life is idealized and her fundamental rights and especially her behaviour is engineered by the adherents of patriarchal society. Commenting  on the Man-woman relationship in a marital bond Simone de Beauvoir wrote in her epoch-making book entitled The Second Sex(1949): "It has been said that marriage diminishes man,  which is often true , but almost always it annihilates women". Feminist movement advocates the equal rights and equal opportunities for women. The true spirit of feminism is into look at women and men as human beings. There should not be gender bias or discrimination in familial and social life. To secure gender justice and gender equity is the key aspects of feminist movement. In India, women writers have come forward to voice their feminist approach to life and the patriarchal family set up. They believe that the very notion of gender is not only biotic and biologic episode but it has a social construction.

Process design and equipment selection for optimized steam and power concepts – the “zero” process steam sugar factory

2020 ◽  
pp. 40-50
Author(s):  
Boris Morgenroth ◽  
Thomas Stark ◽  
Julian Pelster ◽  
Harjeet Singh Bola
Keyword(s):  
Process Design ◽  
Sugar Industry ◽  
Electrical Power ◽  
Power Requirement ◽  
Equipment Selection ◽  
Good Potential ◽  
Set Up ◽  
The Right ◽  
Key Aspects ◽  
Steam Drying

Optimization of process steam requirement in order to maximize sugar recovery and export power along with manpower optimization is a must for sugar factories to survive under difficult conditions and to earn additional revenues. The process steam demand of greenfield and revamped plants has been reduced to levels of 32–38% from originally more than 50% steam on cane in the case of the brownfield plants. In addition, significant improvement in the power requirement of the plants has been achieved. Bagasse drying offers a good potential to improve the power export. Different available concepts are compared with a focus on bagasse steam drying and low temperature bagasse drying. In order to set up an optimized highly efficient plant or to optimize an existing plant to achieve competitive benchmarks, good process design and the right equipment selection are very important. Experience has been gained with multiple stage or double effect crystallization in the beet sugar industry offering further steam optimization potential. Vapour recompression is also an option to substitute live steam by electrical power. This even provides options to reduce the steam demand from the power plant for the sugar process down to zero. Key aspects concerning the process design and equipment selection are described.

scholarly journals Longitudinal Trends in All Healthcare-Associated Infections through Comprehensive Hospital-wide Surveillance and Infection Control Measures over the Past 12 Years: Substantial Burden of Healthcare-Associated Infections Outside of Intensive Care Units and “Other” Types of Infection

2015 ◽  
Vol 36 (10) ◽  
pp. 1139-1147 ◽  
Author(s):  
Hajime Kanamori ◽  
David J. Weber ◽  
Lauren M. DiBiase ◽  
Emily E. Sickbert-Bennett ◽  
Rebecca Brooks ◽  
...  
Keyword(s):  
Intensive Care ◽  
Tract Infection ◽  
Intensive Care Units ◽  
Linear Models ◽  
Infection Type ◽  
Tertiary Care ◽  
Surgical Site Infections ◽  
Control Measures ◽  
Healthcare Associated Infections ◽  
Healthcare Associated

OBJECTIVETargeted surveillance has focused on device-associated infections and surgical site infections (SSIs) and is often limited to healthcare-associated infections (HAIs) in high-risk areas. Longitudinal trends in all HAIs, including other types of HAIs, and HAIs outside of intensive care units (ICUs) remain unclear. We examined the incidences of all HAIs using comprehensive hospital-wide surveillance over a 12-year period (2001–2012).METHODSThis retrospective observational study was conducted at the University of North Carolina (UNC) Hospitals, a tertiary care academic facility. All HAIs, including 5 major infections with 14 specific infection sites as defined using CDC criteria, were ascertained through comprehensive hospital-wide surveillance. Generalized linear models were used to examine the incidence rate difference by infection type over time.RESULTSA total of 16,579 HAIs included 6,397 cases in ICUs and 10,182 cases outside ICUs. The incidence of overall HAIs decreased significantly hospital-wide (−3.4 infections per 1,000 patient days), in ICUs (−8.4 infections per 1,000 patient days), and in non-ICU settings (−1.9 infections per 1,000 patient days). The incidences of bloodstream infection, urinary tract infection, and pneumonia in hospital-wide settings decreased significantly, but the incidences of SSI and lower respiratory tract infection remained unchanged. The incidence of Clostridium difficile infection (CDI) increased remarkably. The outcomes were estimated to include 700 overall HAIs prevented, 40 lives saved, and cost savings in excess of $10 million.CONCLUSIONSWe demonstrated success in reducing overall HAIs over a 12-year period. Our data underscore the necessity for surveillance and infection prevention interventions outside of the ICUs, for non–device-associated HAIs, and for CDI.Infect Control Hosp Epidemiol 2015;36(10):1139–1147

Effect of pre-operative octenidine nasal ointment and showering on surgical site infections in patients undergoing cardiac surgery

2017 ◽  
Vol 95 (2) ◽  
pp. 137-143 ◽  
Author(s):  
M. Reiser ◽  
A. Scherag ◽  
C. Forstner ◽  
F.M. Brunkhorst ◽  
S. Harbarth ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Surgical Site Infections

scholarly journals Preoperative cigarette smoking and short-term morbidity and mortality after cardiac surgery: a meta-analysis

Heart Asia ◽  
2018 ◽  
Vol 10 (2) ◽  
pp. e011069 ◽  
Author(s):  
Nicholas Gregory Ross Bayfield ◽  
Adrian Pannekoek ◽  
David Hao Tian
Keyword(s):  
Cardiac Surgery ◽  
Smoking Status ◽  
Meta Analysis ◽  
Surgical Site Infections ◽  
Neurological Complications ◽  
Pulmonary Complications ◽  
Morbidity And Mortality ◽  
Surgical Patients ◽  
Short Term ◽  
Increased Risk

Currently, the choice of whether or not to electively operate on current smokers is varied among cardiothoracic surgeons. This meta-analysis aims to determine whether preoperative current versus ex-smoking status is related to short-term postoperative morbidity and mortality in cardiac surgical patients. Systematic literature searches of the PubMed, MEDLINE and Cochrane databases were carried out to identify all studies in cardiac surgery that investigated the relationship between smoking status and postoperative outcomes. Extracted data were analysed by random effects models. Primary outcomes included 30-day or in-hospital all-cause mortality and pulmonary morbidity. Overall, 13 relevant studies were identified, with 34 230 patients in current or ex-smoking subgroups. There was no difference in mortality (p=0.93). Current smokers had significantly higher risk of overall pulmonary complications (OR 1.44; 95% CI 1.27 to 1.64; p<0.001) and postoperative pneumonia (OR 1.62; 95%  CI 1.27 to 2.06; p<0.001) as well as lower risk of postoperative renal complications (OR 0.82; 95%  CI 0.70 to 0.96; p=0.01) compared with ex-smokers. There was a trend towards an increased risk of postoperative MI (OR 1.29; 95%  CI 0.95 to 1.75; p=0.10). No difference in postoperative neurological complications (p=0.15), postoperative sternal surgical site infections (p=0.20) or postoperative length of intensive care unit stay (p=0.86) was seen. Cardiac surgical patients who are current smokers at the time of operation do not have an increased 30-day mortality risk compared with ex-smokers, although they are at significantly increased risk of postoperative pulmonary complications.

scholarly journals Gamma spectrometry technique for the determination of residence time in Submarine Groundwater Discharges

2019 ◽  
Vol 18 ◽  
pp. 155
Author(s):  
G. Eleftheriou ◽  
C. Tsabaris ◽  
D. L. Patiris ◽  
E. Androulakaki ◽  
M. Kokkoris ◽  
...  
Keyword(s):  
Residence Time ◽  
Water Samples ◽  
Gamma Ray ◽  
Measuring System ◽  
Gamma Ray Spectrometry ◽  
Reference Source ◽  
Radium Isotopes ◽  
Time Period ◽  
Submarine Groundwater ◽  
Set Up

The evaluation of time period that meteoric water remains in the ground (residence time) before exiting in the open sea can be a valuable information for the submarine groundwater discharges (SGD) in the costal zones. Coastal waters contain elevated dissolved activities of radium isotopes compared to the open ocean, where excess activities are zero. Lately it has been shown by Moore et al., that residence time can be estimated by a model based on radium radioisotopes ratio reduction throughout the coast. However the standard methods for the estimation of radium isotopes concentration in the water are sophisticated, time consuming or require big amount of sample. Hereby, a method based on the direct gamma ray spectrometry of untreated water samples from coastal areas is applied to determine the residence time of the SGD. Efficiency calibration of the spectrometry set up has been performed for two different volumetric sample geometries, using 152Eu/154Eu solution as reference source. In order to ensure the reliability of the method, the background courting rate magnitude and variance through time have been defined for the radioisotopes of interest. Additionally, the minimum detectible activity (MDA) of the measuring system was determined, in Becquerel per cubic meter, as a function of energy in water samples. The developed method was applied and validated for water samples from the submarine spring in Stoupa Bay, southwestern Peloponnesus. The defined residence time varies from 3 to 6 days, being in good agreement with the results of the standard geological pigment-tracer method.

scholarly journals Outbreak investigation of Cholera in Shantinagar VDC of Ilam District in Eastern Nepal

2013 ◽  
Vol 2 (3) ◽  
pp. 87-90
Author(s):  
RB Rayamajhi ◽  
G Pokharel ◽  
G Sharma ◽  
B Neupane ◽  
VK Khanal ◽  
...  
Keyword(s):  
Vibrio Cholerae ◽  
Causative Agent ◽  
Water Samples ◽  
Group Discussion ◽  
Control Measures ◽  
Water Tank ◽  
District Health ◽  
Source Of Infection ◽  
Local Residents ◽  
Stool Analysis

INTRODUCTION: In 2012 August, suspected cases of Cholera in increased number were reported to the district health office of Ilam by the in charge of Shantinagar health post asking for intervention to stop further occurrences. The aim of the investigation was to identify the possible source of infection, the causative agent and the application of local control measures for prevention of further recurrences. MATERIALS AND METHODS: Focus group discussion and Key informant survey were conducted to assess the sanitary hygiene and practices along with source of drinking water for probable cause of diarrhea. Similarly, face to face interview was done among the sick and healthy local residents to collect the demographic and clinical details. Ten stool and water samples were sent for analysis in Biratnagar, Dharan. RESULTS: 150 local residents had suffered from diarrhea with no deaths. People of all the age group were affected with children being more sufferers. Six of the stool analysis and eight of the water samples were positive for Vibrio Cholerae. It was also observed that sanitary hygiene and practices wasn’t adequate after nose and bottoms cleaning of the children and before preparing the meal. CONCLUSIONS: Lack of adequate cleanliness of the common water tank was found to be the culprit behind the incident and Vibrio Cholerae being the causative agent. Local residents and water management committee were demonstrated the technique of chlorination of water and proper hand washing practices to prevent further recurrences. DOI: http://dx.doi.org/10.3126/ijim.v2i3.8666 Int J Infect Microbiol 2013;2(3):87-90

scholarly journals Autochthonous chikungunya and dengue fever outbreak in Mainland France, 2010-2018

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
F Franke ◽  
S Giron ◽  
A Cochet ◽  
C Jeannin ◽  
I Leparc-Goffart ◽  
...  
Keyword(s):  
Dengue Fever ◽  
Urban Areas ◽  
Control Measures ◽  
Entomological Surveillance ◽  
Awareness Campaigns ◽  
Investigation Methods ◽  
Imported Cases ◽  
Set Up ◽  
And Control ◽  
Autochthonous Transmission

Abstract Background Aedes albopictus, vector of dengue and chikungunya viruses, is implanted in mainland France, exposing to the risk of autochthonous transmission. Since 2006, epidemiological and entomological surveillance activities aim to prevent or limit the occurrence of autochthonous cases. We aimed to describe episodes of transmission and control measures implemented in order to reflect on surveillance activities. Methods We reviewed all publications and documents produced on autochthonous transmission episodes in France and surveillance protocols. We reviewed surveillance activities, investigation methods and control measures implemented. Results Between 2010 and 2018, eight episodes of autochthonous dengue fever transmission and three of chikungunya were recorded in mainland France. All of them occurred in the South east of France, between July and October, when vector density was the highest. Transmission areas were limited to single domestic houses located in discontinuous urban areas. Only two episodes happened in two distinct areas. Chikungunya episodes led to 31 cases and dengue fever episodes to 23 cases. Most cases were identified by door-to-door investigations set-up in transmission areas. We isolated serotypes 1 and 2 for dengue and East Central South Africa lineage for chikungunya in autochthonous cases. Adulticide vector control measures were effective in controlling transmission. Seven episodes of transmission were due to failure in identifying primary imported cases. Four episodes occurred because of the absence or the lack of vector controls measures around primary imported cases. Conclusions Surveillance activities, and autochthonous cases investigations, were effective in limiting the extent of transmission, but were highly demanding for surveillance actors. Identified causes of transmission highlight the need of regular awareness campaigns targeting physicians and biologists. Key messages Effectiveness of the surveillance system of dengue, chikungunya and zika viruses, and autochthonous cases investigations. Needs of awareness and training courses targeting health professionals to the risk represented by these viruses.

Sign in / Sign up

Export Citation Format

Share Document