scholarly journals Antibiotic-Selected Gene Amplification Heightens Metal Resistance

mBio ◽  
2021 ◽  
Vol 12 (1) ◽  
Author(s):  
David A. Hufnagel ◽  
Jacob E. Choby ◽  
Samantha Hao ◽  
Anders F. Johnson ◽  
Eileen M. Burd ◽  
...  
Keyword(s):  
Health Care ◽  
Bacterial Colonization ◽  
Multidrug Resistant ◽  
Metal Resistance ◽  
Health Care Facilities ◽  
Health Care Environment ◽  
Nickel Resistance ◽  
Care Environment ◽  
Content Type ◽  
Implanted Devices

ABSTRACT The increasing frequency of antibiotic resistance poses myriad challenges to modern medicine. Environmental survival of multidrug-resistant bacteria in health care facilities, including hospitals, creates reservoirs for transmission of these difficult to treat pathogens. To prevent bacterial colonization, these facilities deploy an array of infection control measures, including bactericidal metals on surfaces, as well as implanted devices. Although antibiotics are routinely used in these health care environments, it is unknown whether and how antibiotic exposure affects metal resistance. We identified a multidrug-resistant Enterobacter clinical isolate that displayed heteroresistance to the antibiotic colistin, where only a minor fraction of cells within the population resist the drug. When this isolate was grown in the presence of colistin, a 9-kb DNA region was duplicated in the surviving resistant subpopulation, but surprisingly, was not required for colistin heteroresistance. Instead, the amplified region included a three-gene locus (ncrABC) that conferred resistance to the bactericidal metal, nickel. ncrABC expression alone was sufficient to confer nickel resistance to E. coli K-12. Due to its selection for the colistin-resistant subpopulation harboring the duplicated 9-kb region that includes ncrABC, colistin treatment led to enhanced nickel resistance. Taken together, these data suggest that the use of antibiotics may inadvertently promote enhanced resistance to antimicrobial metals, with potentially profound implications for bacterial colonization and transmission in the health care environment. IMPORTANCE To inhibit bacterial transmission and infection, health care facilities use bactericidal metal coatings to prevent colonization of surfaces and implanted devices. In these environments, antibiotics are commonly used, but their effect on metal resistance is unclear. The data described here reveal that exposure of a human isolate of Enterobacter cloacae to a last-line antibiotic, colistin, resulted in a DNA amplification that does not confer antibiotic resistance but instead facilitates resistance to the toxic metal nickel. This highlights a novel aspect of antibiotic and metal interplay. Concerningly, these data suggest the use of antibiotics could in some cases promote bacterial survival and colonization in the health care environment and ultimately increase transmission and infection of patients.

Role of internal service quality in enhancing patient centricity and internal customer satisfaction

2019 ◽  
Vol 13 (1) ◽  
pp. 2-20 ◽  
Author(s):  
Gyan Prakash ◽  
Shefali Srivastava
Keyword(s):  
Health Care ◽  
Customer Satisfaction ◽  
Service Quality ◽  
Coordinated Care ◽  
Health Care Environment ◽  
Care Environment ◽  
Content Type ◽  
Patient Centred Care ◽  
Internal Customer ◽  
Organisational Support

Purpose The purpose of this paper is to identify the antecedents and outcomes of internal service quality (ISQ) in a health-care environment. The relationships among the heterogeneous health-care environment, coordinated care, perceived organisational support (POS), ISQ, internal customer satisfaction and patient-centred care were explored. Design/methodology/approach Based on a review of the literature, a structural model was developed. A 37-item questionnaire was circulated among service providers in the health-care system, including doctors, nurses and system staff, all over India. The random sampling method was adopted to collect data. A total of 238 valid responses were received. The data were analysed using structural equation modelling. Findings The results show that the heterogeneous environment, coordinated care and POS act as antecedents of ISQ, which drives internal customer satisfaction and patient centricity in health care. Research limitations/implications The paper contributes to the health-care literature by identifying the antecedents and consequences of ISQ and developing a structural relationship among ISQ, the heterogeneous health-care environment, coordinated care, POS, internal customer satisfaction and patient-centred care. Practical implications Hospital administrators may use various constructs of POS, ISQ and coordinated care to measure process and employee performance, which may aid the design of appropriate processes and improve employee selection. The constructs of patient centricity and internal customer satisfaction may be used as benchmarking tools to facilitate the formulation of immediate corrective actions and policies for future courses of action. Social implications This paper highlights how patient centricity may be achieved by focussing on ISQ, coordinated care processes and a facilitative internal environment. This understanding may aid the design of processes that in turn deliver health as a social good in an effective manner. Originality/value This paper extends past research on ISQ by showing that ISQ affects internal customer satisfaction and, in turn, the quality of service delivery in the system. In the health-care context, heterogeneity in patient needs, coordinated care and organisational support play crucial roles in determining ISQ, which in turn influences the level of patient-centred care.

Response to a Fire Incident in the Operation Room: A Cautionary Tale

2019 ◽  
Vol 14 (2) ◽  
pp. 284-288
Author(s):  
Raman Sharma ◽  
Ashok Kumar ◽  
Vipin Koushal
Keyword(s):  
Health Care ◽  
Operating Room ◽  
Real Life ◽  
Health Care Facilities ◽  
Health Care Environment ◽  
Continuous Training ◽  
Care Environment ◽  
Fire Incident ◽  
Life Challenges ◽  
Precautionary Measures

ABSTRACTHealth care facilities are always seen as places of haven and protection for managing external incidents, but situations become difficult and challenging when such facilities themselves are affected by internal hazards. Such incidents are arguably more disruptive than external incidents, because patients are dependent on supportive measures and are neither in position to respond to such crisis situation nor do they know how to respond. Operating room fires are rare but potentially catastrophic, involving loss of costly resources and possibly lives. This case report details a true operating room fire incident in an emergency operating room and details the real-life challenges encountered by operating room staff in preserving both life and property. As a result of this work, precautionary measures may be implemented to mitigate such incidents. Careful coordination, continuous training, and fire drill exercises can improve the overall outcomes and minimize the possibility of these potentially fatal problems, thereby making a safer health care environment for every worker and patient.

Not for the faint of heart

2014 ◽  
Vol 9 (1) ◽  
pp. 47-65 ◽  
Author(s):  
Ann-Marie Urban ◽  
Elizabeth Quinlan
Keyword(s):  
Health Care ◽  
Data Collection ◽  
Health Care Organizations ◽  
Institutional Ethnography ◽  
Health Care Environment ◽  
Care Environment ◽  
Collection Method ◽  
Content Type ◽  
Data Collection Method ◽  
Health Care Context

Purpose – The purpose of this paper is to share two researcher's experience about the challenges associated with shadowing within the health care context. Design/methodology/approach – Institutional ethnography and shadowing. Findings – Shadowing is increasingly being used as a data collection method, however, before proceeding to use this approach in today's health care environment, the researcher must give thoughtful consideration to the context. Originality/value – This paper provides a reflexive elaboration of the differences between the insider and outsider perspective when using the shadowing data collection method within health care organizations.

scholarly journals Lean Management: organizational innovations in hematological Day-Hospitals

ABOUTOPEN ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. 62-69
Author(s):  
Caterina Bianciardi ◽  
Jacopo Guercini
Keyword(s):  
Health Care ◽  
Case Studies ◽  
Central Italy ◽  
Health Care Facilities ◽  
Health Care Environment ◽  
Lean Thinking ◽  
Care Environment ◽  
Day Hospitals ◽  
Poor Management

Background. Lean Thinking is a management method which, despite its industrial origins, has spread in the health-care environment too. Objective. To describe the path followed and the results reached implementing Lean Thinking in four case studies.  Methods. Such case studies were conducted in as many hematological Day-Hospitals (DHs), located in Central-Italy. At the beginning of each study, the DH internal processes, activity volumes and patient flows were analyzed and satisfaction questionnaires were administered to both operators and patients. Based on the returned questionnaires, deficiencies were focused on; for each deficiency data was collected and objectives defined. Following such definitions, the analysis of inefficiency causes was performed and countermeasures were identified. In the final meeting the results were assessed and monitoring/maintenance methods were defined. All these steps were supported by Lean Thinking instruments for analysis and solution.         Results. Activity organization and patient satisfaction improved everywhere. Time losses and workloads imbalances were minimized in two DHs, particularly through higher standardization in the management of clinical-administrative documents. In another DH, the output capacity of the hospital pharmacy and the workflows in the DH were aligned with respect to the course of the day, so reducing delays in the delivery of therapies.  Appointment planning was improved in the fourth DH, standardizing time slots (15-minutes) necessary for each therapy, so optimizing the number of stations (beds and chairs) used. Conclusions. Poor management of health care facilities can affect efficiency, security and quality of services provided. Lean Thinking is a valid method to address such problems.

scholarly journals Survival, Persistence, and Isolation of the Emerging Multidrug-Resistant Pathogenic Yeast Candida auris on a Plastic Health Care Surface

2017 ◽  
Vol 55 (10) ◽  
pp. 2996-3005 ◽  
Author(s):  
Rory M. Welsh ◽  
Meghan L. Bentz ◽  
Alicia Shams ◽  
Hollis Houston ◽  
Amanda Lyons ◽  
...  
Keyword(s):  
Health Care ◽  
Multidrug Resistant ◽  
Health Care Facilities ◽  
Candida Auris ◽  
Pathogenic Yeast ◽  
Content Type ◽  
Health Care Settings ◽  
Care Facilities ◽  
Enrichment Protocol ◽  
Plastic Surfaces

ABSTRACTThe emerging multidrug-resistant pathogenic yeastCandida aurisrepresents a serious threat to global health. Unlike most otherCandidaspecies, this organism appears to be commonly transmitted within health care facilities and causes health care-associated outbreaks. To better understand the epidemiology of this emerging pathogen, we investigated the ability ofC. auristo persist on plastic surfaces common in health care settings compared with that ofCandida parapsilosis, a species known to colonize the skin and plastics. Specifically, we compiled comparative and quantitative data essential to understanding the vehicles of spread and the ability of both species to survive and persist on plastic surfaces under controlled conditions (25°C and 57% relative humidity), such as those found in health care settings. When a test suspension of 104cells was applied and dried on plastic surfaces,C. aurisremained viable for at least 14 days andC. parapsilosisfor at least 28 days, as measured by CFU. However, survival measured by esterase activity was higher forC. auristhanC. parapsilosisthroughout the 28-day study. Given the notable length of timeCandidaspecies survive and persist outside their host, we developed methods to more effectively cultureC. aurisfrom patients and their environment. Using our enrichment protocol, public health laboratories and researchers can now readily isolateC. aurisfrom complex microbial communities (such as patient skin, nasopharynx, and stool) as well as environmental biofilms, in order to better understand and preventC. auriscolonization and transmission.

scholarly journals Influenza Vaccinationfor Health Care Workers: A Duty of Care

2000 ◽  
Vol 11 (5) ◽  
pp. 225-226 ◽  
Author(s):  
Pamela Orr
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Workers ◽  
Care Delivery ◽  
Health Care Facilities ◽  
Care Providers ◽  
Health Care Environment ◽  
Care Environment ◽  
Care Workers ◽  
Care Facilities

The medical literature has amply documented the transmission of influenza from patients to health care workers (HCWs) (1,2), from HCWs to patients (3) and between HCWs (4-9). The consequences of influenza transmission within the health care environment include morbidity and mortality among patients, most of who are at high risk for the complications of infection, and illness and absenteeism among health care providers. When outbreaks occur in health care facilities, absenteeism among HCWs may approach 30% to 40%, resulting in severe staff shortages, increased employment costs and the potential endangerment of health care delivery due to the scarcity of replacement workers (10-13).

scholarly journals Candida auris: an Emerging Fungal Pathogen

2017 ◽  
Vol 56 (2) ◽  
Author(s):  
Emily S. Spivak ◽  
Kimberly E. Hanson
Keyword(s):  
Health Care ◽  
Fungal Pathogen ◽  
Multidrug Resistant ◽  
Health Care Facilities ◽  
Candida Auris ◽  
Environmental Persistence ◽  
Content Type ◽  
Antifungal Drug Resistance ◽  
Hospital Infection Control ◽  
Skin Colonization

ABSTRACT Candida auris has emerged globally as a multidrug-resistant health care-associated fungal pathogen. Recent reports highlight ongoing challenges due to organism misidentification, high rates of antifungal drug resistance, and significant patient mortality. The predilection for transmission within and between health care facilities possibly promoted by virulence factors that facilitate skin colonization and environmental persistence is unique among Candida species. This minireview details the global emergence of C. auris and discusses issues relevant to clinical microbiology laboratories, hospital infection control, and antimicrobial stewardship efforts.

Knowledge-based lean six sigma system for enhancing quality management performance in healthcare environment

2019 ◽  
Vol 10 (1) ◽  
pp. 211-233 ◽  
Author(s):  
Yousuf Nasser Al Khamisi ◽  
M. Khurshid Khan ◽  
J. Eduardo Munive-Hernandez
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Quality Management ◽  
Six Sigma ◽  
Best Practice ◽  
Lean Six Sigma ◽  
Health Care Environment ◽  
Care Environment ◽  
Content Type ◽  
Knowledge Based

PurposeThis paper aims to present the development of a knowledge-based system (KBS) to support the implementation of Lean Six Sigma (L6s) principles applied to enhance quality management (QM) performance within a health-care environment. Design/methodology/approachThe process of KBS building has been started by acquiring knowledge from experts in field of L6σ and QM in health care. The acquired knowledge has been represented in a rule-based approach for capturing L6σ practices. These rules are produced in IF […].THEN way where IF is the premise and THEN is the action. The produced rules have been integrated with gauging absence pre-requisites (GAP) technique to facilitate benchmarking of best practice in a health-care environment. A comprehensive review of the structure of the system is given, detailing a typical output of the KBS. FindingsImplementation of L6s principles to enhance QM performance in a health-care environment requires a pre-assessment of the organisation’s competences. The KBS provides an enhanced strategic and operational decision-making hierarchy for achieving a performance benchmark. Research limitations/implicationsThe KBS needs validation in real health-care environment, which will be done in Oman’s hospitals. Practical implicationsThe paper is intended to benefit QM practitioners in the health-care sector during decision-making to achieve performance improvement against a best practice benchmark. Originality/valueThis research presents a novel application of a hybrid KBS with GAP methodology to support the implementation of L6s principles to enhance QM performance in a health-care environment.

scholarly journals Candida auris Biofilm Colonization on Skin Niche Conditions

mSphere ◽  
2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Priya Uppuluri
Keyword(s):  
Health Care ◽  
Ex Vivo ◽  
Multidrug Resistant ◽  
Health Care Facilities ◽  
Candida Auris ◽  
Biofilm Growth ◽  
Content Type ◽  
Care Facilities ◽  
Invasive Infections ◽  
Skin Conditions

ABSTRACT Candida auris, an emerging multidrug-resistant yeast, has recently been associated with outbreaks of invasive infections in health care facilities worldwide. Its success as a nosocomial pathogen lies in its capability to sustain for prolonged periods in the intensive care unit (ICU), adeptly colonize skin, and spread among patients. Little is known of the mechanism behind the predilection of C. auris for skin or the extent of its resilience on it. Now, M. V. Horton, C. J. Johnson, J. F. Kernien, T. D. Patel, et al. (mSphere 5:e00910-19, 2020, https://doi.org/10.1128/mSphere.00910-19) demonstrate that in synthetic sweat medium designed to mimic axillary skin conditions, C. auris can grow into multilayers of cells called biofilms that can resist desiccation. C. auris’ propensity to form biofilms was further elaborated using a novel ex vivo porcine skin model of skin colonization. These studies provide early evidence that C. auris biofilm cells persisting on skin could serve as source of continuing outbreaks in health care facilities. Interventions blocking C. auris biofilm growth on skin will help control the spread of this pathogen.

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