Examination and counseling of gynecological cases during Corona Virus Disease 2019 (COVID-19) pandemic

HIGHLIGHTS1. Clinical gynecology examinations must adapt to pandemic situation.2. It must pay attention to universal precautions, aseptic and sterile technique to minimize infection transmission.3. In terms of reducing contact, the need for examination are divided by priority into "now", "soon", or "later".4. Gynecology examinations can be carried out with direct examinations by medical personnel wearing proper personal protective equipment if needed.5. Patient counseling can be done by remote consultation or telemedicine. ABSTRACTCOVID-19 is a recent pandemic caused by the SARS COV-2 agent with a high incidence and mortality. The disease is transmitted through respiratory droplets and direct contact. Clinically this COVID-19 patient is mainly related to the respiratory tract symptoms. The current clinical classifications are divided into suspected, probable, and confirmed cases. To reduce transmission must pay attention to universal and hierarchical precaution, aseptic standards, and sterile techniques. The types of gynecological examinations during a pandemic are the same as those in general, except that the methods, settings, and priorities are different. The examination begins with screening to assess the risk of transmission so that it can determine the place of examination. The urgency of the examination, history of TOCC, local transmission, provider, and room conditions also need to be considered. Counseling during a pandemic can be done in person or by telemedicine. Counseling is provided for general and case-specific gynecological information. Each gynecological case requires a different focus on counseling.

Effectiveness of a Multidisciplinary Team-Approach on Central-Line–Associated Bloodstream Infections

Background: Although there has been a significant reduction in central-line–associated bloodstream infection (CLABSI) rates in the past decade with the implementation of evidence-based practices, an estimated 30,100 CLABSI occur each year in acute-care facilities. CLABSIs are associated with increased length of stay, cost, morbidity, and mortality, and they are preventable. In this study, we assessed the impact of a multidisciplinary team approach on CLABSI rates at a 319-bed teaching hospital in northwestern Ohio. Methods: In this before-and-after retrospective study, we compared the CLABSI rate per 1,000 central-line days, standardized infection ratio (SIR), and standardized utilization ratio (SUR) in the preintervention period (January 1, 2016, to December 31, 2018) to those of the intervention period (January 1, 2019, to December 31, 2020). Despite hospital-wide nursing education focusing on central-line maintenance in 2017, our SIR and SUR remained above the national benchmark. Starting in August 2018, we began to focus on insertion practices and physician education. An infection preventionist observed resident central-line insertion training and noted that there was no emphasis on infection prevention measures. There was a best practice knowledge gap. Thus, the indications for central-line use were updated, the insertion checklist was standardized, and the vascular access policy was revised to limit femoral and internal jugular vein use. Infection prevention training was provided to all providers involved in central-line insertions. Nurses were tasked with observing insertion of every central line and stopping the procedure if there is was an observed break in sterile technique. A central-line report listing indications and duration was developed and was sent to the nursing directors who assessed daily need with providers and prompted removal of unnecessary lines. The infection prevention medical director provided CLABSI prevention education to providers. Results: The CLABSI rate per 1,000 central-line days decreased from 0.90 in the preintervention period to 0.34 in the postintervention period, resulting in a 62% reduction in CLABSI rate. The SIR decreased from 0.886 to 0.323 (p-value <0.05), yielding a 64% reduction. The SUR also decreased from 1.156 to 0.874 (p-value <0.001) with a 24% reduction. Conclusion: A multidisciplinary team-approach with emphasis on standardized insertion checklist to ensure adherence to sterile technique and prompt removal of unnecessary central lines, and physician insertion training focusing on IP practices may potentially reduce CLABSI rates.Funding: NoDisclosures: None

Supracondylar humerus fracture in children: K wire pinning with minimal sterile technique

<p class="abstract"><span lang="EN-US">A minimal sterile technique to assess the outcome of K wire pinning of Supracondylar fracture of humerus in children. A prospective case series between 2018 to 2020 was conducted on 10 supracondylar fracture of humerus operated at a tertiary care centre. Gartland type 2 and 3 were included and all the patients were treated with minimal sterile K-wire pinning technique. After 18 weeks follow up with mean age of 7.3 years, all patients were found to have excellent results. In our study no patients received antibiotic except in one patient where 5 days of oral antibiotic cefixime was given. Less complications, reduced time of surgery of average 24.3 minutes, reduction in cost factor and patient compliance was better. Supracondylar fracture of humerus can be fixed by K-wire fixation with minimal sterile technique either by cross pinning or lateral pinning which has same outcome as sterile technique and minimal sterile technique is cost effective and time sparing.</span></p>

Pilze: vom „Vitamin“- Überproduzenten zum robusten Alleskönner

Ashbya gosspyii, a fungus overproducing riboflavin, is applied for > 1000 t/a for two decades. Disadvantages of the overproducer are its need of complex nutrients and a weak pH tolerance. An omnipotent anabolism was shown for Phialemonium curvatum isolated from compost by screening for plant oil degradation on mineral salts medium at pH 3. It can be cultivated in plastic vessels > 100 L with minimal sterile technique. Its potential to convert crude palm oil into organic acids is discussed.

ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 update (adults)

Summary statements (1) Peritoneal dialysis (PD) should be considered a suitable modality for treatment of acute kidney injury (AKI) in all settings (1B). Guideline 2: Access and fluid delivery for acute PD in adults (2.1) Flexible peritoneal catheters should be used where resources and expertise exist (1B) (optimal). (2.2) Rigid catheters and improvised catheters using nasogastric tubes and other cavity drainage catheters may be used in resource-poor environments where they may still be life-saving (1C) (minimum standard). (2.3) We recommend catheters should be tunnelled to reduce peritonitis and peri-catheter leak (practice point). (2.4) We recommend that the method of catheter implantation should be based on patient factors and locally available skills (1C). (2.5) PD catheter implantation by appropriately trained nephrologists in patients without contraindications is safe and functional results equate to those inserted surgically (1B). (2.6) Nephrologists should receive training and be permitted to insert PD catheters to ensure timely dialysis in the emergency setting (practice point). (2.7) We recommend, when available, percutaneous catheter insertion by a nephrologist should include assessment with ultrasonography (2C). (2.8) Insertion of PD catheter should take place under complete aseptic conditions using sterile technique (practice point). (2.9) We recommend the use of prophylactic antibiotics prior to PD catheter implantation (1B). (2.10) A closed delivery system with a Y connection should be used (1A) (optimal). In resource poor areas, spiking of bags and makeshift connections may be necessary and can be considered (minimum standard). (2.11) The use of automated or manual PD exchanges are acceptable and this will be dependent on local availability and practices (practice point). Guideline 3: Peritoneal dialysis solutions for acute PD (3.1) In patients who are critically ill, especially those with significant liver dysfunction and marked elevation of lactate levels, bicarbonate containing solutions should be used (1B) (optimal). Where these solutions are not available, the use of lactate containing solutions is an alternative (practice point) (minimum standard). (3.2) Commercially prepared solutions should be used (optimal). However, where resources do not permit this, then locally prepared fluids may be life-saving and with careful observation of sterile preparation procedure, peritonitis rates are not increased (1C) (minimum standard). (3.3) Once potassium levels in the serum fall below 4 mmol/L, potassium should be added to dialysate (using strict sterile technique to prevent infection) or alternatively oral or intravenous potassium should be given to maintain potassium levels at 4 mmol/L or above (1C). (3.4) Potassium levels should be measured daily (optimal). Where these facilities do not exist, we recommend that after 24 h of successful dialysis, one consider adding potassium chloride to achieve a concentration of 4 mmol/L in the dialysate (minimum standard) (practice point). Guideline 4: Prescribing and achieving adequate clearance in acute PD (4.1) Targeting a weekly K t/ V urea of 3.5 provides outcomes comparable to that of daily HD in critically ill patients; targeting higher doses does not improve outcomes (1B). This dose may not be necessary for most patients with AKI and targeting a weekly K t/ V of 2.2 has been shown to be equivalent to higher doses (1B). Tidal automated PD (APD) using 25 L with 70% tidal volume per 24 h shows equivalent survival to continuous venovenous haemodiafiltration with an effluent dose of 23 mL/kg/h (1C). (4.2) Cycle times should be dictated by the clinical circumstances. Short cycle times (1–2 h) are likely to more rapidly correct uraemia, hyperkalaemia, fluid overload and/or metabolic acidosis; however, they may be increased to 4–6 hourly once the above are controlled to reduce costs and facilitate clearance of larger sized solutes (2C). (4.3) The concentration of dextrose should be increased and cycle time reduced to 2 hourly when fluid overload is evident. Once the patient is euvolemic, the dextrose concentration and cycle time should be adjusted to ensure a neutral fluid balance (1C). (4.4) Where resources permit, creatinine, urea, potassium and bicarbonate levels should be measured daily; 24 h K t/ V urea and creatinine clearance measurement is recommended to assess adequacy when clinically indicated (practice point). (4.5) Interruption of dialysis should be considered once the patient is passing >1 L of urine/24 h and there is a spontaneous reduction in creatinine (practice point). The use of peritoneal dialysis (PD) to treat patients with acute kidney injury (AKI) has become more popular among clinicians following evidence of similar outcomes when compared with other extracorporeal therapies. Although it has been extensively used in low-resource environments for many years, there is now a renewed interest in the use of PD to manage patients with AKI (including patients in intensive care units) in higher income countries. Here we present the update of the International Society for Peritoneal Dialysis guidelines for PD in AKI. These guidelines extensively review the available literature and present updated recommendations regarding peritoneal access, dialysis solutions and prescription of dialysis with revised targets of solute clearance.

Incidence of Endophthalmitis after Intravitreal Anti-Vascular Endothelial Growth Factor Injections in an Operating Room in China

Purpose. To evaluate the rate of presumed endophthalmitis (EO) after intravitreal anti-vascular endothelial growth factor (anti-VEGF) injections performed in an operating room (OR) under sterile conditions in mainland China. Methods. Retrospective single-center study between September 2012 and December 2017 at Beijing Tongren Eye Center, Beijing, China. Intravitreal injection database was reviewed. All anti-VEGF injections were performed using a standardized sterile technique in an OR. Injection protocols included antibiotics for 3 days pre-injection, topical 5% povidone-iodine rinsing before the procedure, and post-injection antibiotics for 3 days. Results. A total of 37,830 intravitreal injections were performed at Beijing Tongren Eye Center. Three cases were managed as presumed EO (0.0079%). Positive cultures were documented in 2 of 3 cases. EO incidence following ranibizumab and conbercept administration was 0.0088% (3 in 33,930) and 0% (0 in 3,900), respectively. No significant difference was detected between the two drugs ( P = 0.745 ). Conclusions. Very low EO rates were seen in mainland China using a standardized sterile technique in an OR. However, EO could not be completely avoided.