Preparation and Characterization of Photocatalytically Active Antibacterial Surfaces Covered with Acrylic Matrix Embedded Nano-ZnO and Nano-ZnO/Ag

In the context of healthcare-acquired infections, microbial cross-contamination and the spread of antibiotic resistance, additional passive measures to prevent pathogen carryover are urgently needed. Antimicrobial high-touch surfaces that kill microbes on contact or prevent their adhesion could be considered to mitigate the spread. Here, we demonstrate that photocatalytic nano-ZnO- and nano-ZnO/Ag-based antibacterial surfaces with efficacy of at least a 2.7-log reduction in Escherichia coli and Staphylococcus aureus viability in 2 h can be produced by simple measures using a commercial acrylic topcoat for wood surfaces. We characterize the surfaces taking into account cyclic wear and variable environmental conditions. The light-induced antibacterial and photocatalytic activities of the surfaces are enhanced by short-term cyclic wear, indicating their potential for prolonged effectivity in long-term use. As the produced surfaces are generally more effective at higher relative air humidity and silver-containing surfaces lost their contact-killing properties in dry conditions, it is important to critically evaluate the end-use conditions of materials and surfaces to be tested and select application-appropriate methods for their efficacy assessment.

Evaluation of new polymer-iodine complexes for the fabrication of medical devices.

Povidone-iodine has been a true success story in the fight against infections by harnessing the antimicrobial and antiviral properties of elemental iodine for water-based applications. However, to date there has been little success in implementing iodine attributes in water-insoluble engineering plastics. Here, we describe the first development of biocidal active polyamide- and polyurethane-iodine complexes at laboratory and commercially relevant scales. These polymer-iodine materials are active against a broad range of microorganisms, including bacteria, yeast and fungi, and can be used as base materials for medical devices. The use of new polymer-iodine complexes for infection prevention in medical devices, such as sutures, catheters and drains, or wound care is expected to have significant positive effects at reducing healthcare-acquired infections. In addition, the materials are expected to find significant applications in other fields, such as air handling with the production of biocidal face masks and air filters to control spread of pathogens.

Surgical pathology

This chapter focuses on surgical pathology. Pathology forms the basis for understanding surgical management. The chapter outlines key concepts that are relevant to the surgical patient and highlights key pathogenesis factors and clinical points. It deals with cellular injury; inflammation; hypersensitivity reactions; wound healing; ulcers; cysts, sinuses, and fistulae; atherosclerosis; thromboembolic disease; gangrene and capillary ischaemia; neoplasia; carcinogenesis; tumours; and tumour markers. Moreover, it examines the grading and staging of a tumour, and discusses surgically important bacteria, viruses, surgical site infections, soft tissue and bone infections, bleeding and coagulation, and anaemia and polycythaemia. Other infections in the surgical patient include nosocomial (healthcare acquired) infections, infective diarrhoea, urinary tract infection (UTI), and pelvic inflammatory disease (PID).

EVALUASI PELAKSANAAN SISTEM SURVEILANS HEALTHCARE ACQUIRED INFECTIONS (HAIS) DI RSU HAJI SURABAYA TAHUN 2020

Healthcare Acquired Infections (HAIs) or nosocomial infections are infections that occur in patients during hospitalization. HAIs are classified into 4 namely Catheter-Associated Urinary Tract Infection, Surgical Site Infection, Ventilator-Associated Pneumonia, and Blood Stream Infection. The purpose of this study is to evaluate the implementation of the HAIs surveillance sistem. The research method used is a descriptive evaluation study with an observational research design. The data sources used are the Reports and dissemination of HAIs Surveillance at RSU Haji Surabaya in 2019-2020. The results showed that HAIs cases at RSU Haji Surabaya in 2020 were 0.03%. The problems in the implementation of HAIs surveillance are the accuracy and completeness of data reports, implementation support facilities, and employee participation in training has not been running optimally, application bundle items are under repair, and job rotation for employees. Conclusion : the implementation of HAIs surveillance activities is in accordance the Regulation of the Peraturan Menteri Kesehatan Republik Indonesia Number 27 of 2017 Tentang Pedoman Pencegahan Dan Pengendalian Infeksi di Fasilitas Pelayanan Kesehatan, but the implementation still running unoptimally, researchers recommend the implementation of reward and punishment activities for surveillance officers as a solution to improve the sistem surveillance.

Whole-Genome Sequencing Elucidates the Epidemiology of Multidrug-Resistant Acinetobacter baumannii in an Intensive Care Unit

The nosocomial pathogen Acinetobacter baumannii is a frequent cause of healthcare-acquired infections, particularly in critically ill patients, and is of serious concern due to its potential for acquired multidrug resistance. Whole-genome sequencing (WGS) is increasingly used to obtain a high-resolution view of relationships between isolates, which helps in controlling healthcare-acquired infections. Here, we conducted a retrospective study to identify epidemic situations and assess the percentage of transmission in intensive care units (ICUs). Multidrug-resistant A. baumannii (MDR-AB) were continuously isolated from the lower respiratory tract of different patients (at the first isolation in our ICU). We performed WGS, pulsed-field gel electrophoresis (PFGE), and multilocus-sequence typing (MLST) analyses to elucidate bacterial relatedness and to compare the performance of conventional methods with WGS for typing MDR-AB. From June 2017 to August 2018, A. baumannii complex strains were detected in 124 of 796 patients during their ICU stays, 103 of which were MDR-AB. Then we subjected 70 available MDR-AB strains to typing with WGS, PFGE, and MLST. Among the 70 A. baumannii isolates, 38 (54.29%) were isolated at admission, and 32(45.71%) were acquisition isolates. MLST identified 12 unique sequence types, a novel ST (ST2367) was founded. PFGE revealed 16 different pulsotypes. Finally, 38 genotypes and 23 transmissions were identified by WGS. Transmission was the main mode of MDR-AB acquisition in our ICU. Our results demonstrated that WGS was a discriminatory technique for epidemiological healthcare-infection studies. The technique should greatly benefit the identification of epidemic situations and controlling transmission events in the near future.

COVID-19 and Ventilator-Associated Event Discordance

Background: The COVID-19 pandemic has challenged healthcare facilities since its discovery in late 2019. Notably, the subsequent COVID-19 pandemic has led to an increase in healthcare-acquired infections such as ventilator associated events (VAEs). Many hospitals in the United States perform surveillance for the NHSN for VAEs by monitoring mechanically ventilated patients for metrics that are generally considered to be objective and preventable and that lead to poor patient outcomes. The VAE definition is met in a stepwise manner. Initially, a ventilator-associated condition (VAC) is met when there an increase in ventilator requirements after a period of stability or improvement. An IVAC is then met when there is evidence of an infectious process such as leukocytosis or fever and a new antimicrobial agent is started. Finally, possible ventilator-associated pneumonia (PVAP) is met when there is evidence of microbial growth or viral detection. Since the beginning of the COVID-19 pandemic, our hospital has seen an increase in VAEs, which is, perhaps, not unexpected during a respiratory illness pandemic. However, the NSHN definitions of VAE, and PVAP in particular, do not account for the novelty and nuances of COVID-19. Methods: We performed a chart review of 144 patients who had a VAE reported to the NHSN between March 1 and December 31, 2020. Results: Of the 144 patients with a VAE reported to NHSN, 39 were SARS-CoV-2 positive. Of the 39 patients, 4 patients (10.25%) met the NHSN PVAP definition due to a positive SARS-CoV-2 PCR that was collected in the prolonged viral shedding period of their illness (< 90 days). One of the four patients also had a bacterial infection in addition to their subsequent positive COVID-19 result. All these patients were admitted to the hospital with a COVID-19 diagnosis and their initial PCR swab was performed upon admission. Conclusions: We believe that the PVAP definition was inappropriately triggered by patients who were decompensating on the ventilator due to a novel respiratory virus that was present on admission. Early in the pandemic, frequent swabbing of these patients was performed to try and understand the duration of viral shedding and to determine when it would be safe to transfer patients from isolation after prolonged hospitalization. The NSHN definition should take into consideration the prolonged viral shedding period of COVID-19 and natural history of the illness, and subsequent COVID-19 testing within 90 days of an initial positive should not require classification as a hospital-acquired PVAP.Funding: NoDisclosures: None

Known mechanisms account for less than half of antimicrobial resistance in a diverse collection of non-aureus staphylococci.

Introduction: Non-aureus staphylococci (NAS) are implicated in many healthcare-acquired infections and an understanding of the genetics of antimicrobial resistance in NAS is important in relation to both clinical intervention and the role of NAS as a reservoir of resistance genes. Gap statement: The burden of antimicrobial resistance in NAS, particularly to clinically relevant antimicrobials, is understudied. Methodology: We sourced 394 NAS isolates from clinical samples, healthy human volunteers, animals and type cultures and subjected them to agar dilution susceptibility testing against eight antimicrobials. We performed whole genome sequencing on 316 isolates and analysed these genotypically for the presence of genetic mechanisms responsible for the phenotypic levels of reduced antimicrobial susceptibility. Results: Cefoxitin is used to screen for methicillin resistance in S. aureus, as it stimulates expression of mecA. We observed 174 isolates with an MIC of at least 4 μg/ml to cefoxitin, of which sequencing revealed 47.6% (80/168) did not harbour a known mec homologue. Seven clinical NAS isolates displayed high daptomycin minimum inhibitory concentrations (MICs) (>4 μg/ml), with no known mechanism identified. Differences in MICs against erythromycin were attributable to the presence of different resistance genes (msrA and ermC). In total, 49% (187/394) of isolates displayed reduced susceptibility to three or more of the antimicrobials tested. Conclusions: The widespread presence of reduced antimicrobial susceptibility in NAS is a concern, with an increased likelihood of (1) harder to treat infections caused directly by NAS, and (2) resistance genes being passed on to other bacteria via horizontal gene transfer, both of which have clinical implications for treatment and management of patients.

Stethoscope hygiene: A call to action. Recommendations to update the CDC guidelines

Healthcare-acquired infections are a tremendous challenge to the US medical system. Stethoscopes touch many patients, but current guidance from the Centers for Disease Control and Prevention does not support disinfection between each patient. Stethoscopes are rarely disinfected between patients by healthcare providers. When cultured, even after disinfection, stethoscopes have high rates of pathogen contamination, identical to that of unwashed hands. The consequence of these practices may bode poorly in the coronavirus 2019 disease (COVID-19) pandemic. Alternatively, the CDC recommends the use of disposable stethoscopes. However, these instruments have poor acoustic properties, and misdiagnoses have been documented. They may also serve as pathogen vectors among staff sharing them. Disposable aseptic stethoscope diaphragm barriers can provide increased safety without sacrificing stethoscope function. We recommend that the CDC consider the research regarding stethoscope hygiene and effective solutions to contemporize this guidance and elevate stethoscope hygiene to that of the hands, by requiring stethoscope disinfection or change of disposable barrier between every patient encounter.

The Need for Dedicated Microbiology Leadership in the Clinical Microbiology Laboratory

Clinical microbiology laboratories play a crucial role in patient care using traditional and innovative diagnostics. Challenges faced by laboratories include emerging pathogens, rapidly evolving technologies, healthcare-acquired infections, antibiotic-resistant organisms and diverse patient populations. Despite these challenges, many clinical microbiology laboratories in the United States are not directed by doctoral level microbiology-trained individuals with sufficient time dedicated to laboratory leadership. This manuscript highlights the need for medical microbiology laboratory directors with appropriate training and qualifications.