scholarly journals Silica Nanoparticles With Encapsulated DNA (SPED) to Trace the Spread of Pathogens in Healthcare

2021 ◽  
Author(s):  
Cinzia Ullrich ◽  
Anne M Luescher ◽  
Julian Koch ◽  
Robert N Grass ◽  
Hugo Sax
Keyword(s):  
Silica Nanoparticles ◽  
Mobile Phones ◽  
Mobile Device ◽  
Real Life ◽  
Hospital Setting ◽  
Pathogen Transmission ◽  
University Hospital ◽  
Patient Room ◽  
Transmission Pathways ◽  
First Time

Abstract Background: To establish effective infection control protocols, understanding pathogen transmission pathways is essential. Non-infectious surrogate tracers may safely explore these pathways and challenge pre-existing assumptions. We used silica nanoparticles with encapsulated DNA (SPED) for the first time in a real-life hospital setting to investigate potential transmission routes of vancomycin-resistant enterococci in the context of a prolonged outbreak.Methods: The two study experiments took place in the 900-bed University Hospital Zurich, Switzerland. A three-run ‘Patient experiment’ investigated pathogen transmission via toilet seats in a two-patient room with shared bathroom. First, various predetermined body and fomite sites in a two-bed patient room were probed at baseline. Then, after the first patient was contaminated with SPED at the subgluteal region, both patients sequentially performed a toilet routine. All sites were consequently swabbed again for SPED contamination. Eight hours later, further spread was tested at predefined sites in the patient room and throughout the ward. A two-run ‘Mobile device experiment’ explored the potential transmission by mobile phones and stethoscopes in a quasi-realistic setting. All SPED contamination statuses and levels were determined by real-time qPCR.Results: Over all three runs, the ‘Patient experiment’ yielded SPED in 59 of 73 (80.8 %) predefined body and environmental sites. Specifically, positivity rates were 100 % on subgluteal skin, toilet seats, tap handles, and entertainment devices, the initially contaminated patients’ hands; 83.3 % on patient phones and bed controls; 80 % on intravenous pumps; 75 % on toilet flush plates and door handles, and 0 % on the initially not contaminated patients’ hands. SPED spread as far as doctor’s keyboards (66.6 %), staff mobile phones (33.3 %) and nurses’ keyboards (33.3 %) after eight hours. The ‘Mobile device experiment’ resulted in 16 of 22 (72.7 %) positive follow-up samples, and transmission to the second patient occurred in one of the two runs. Conclusions: For the first time SPED were used to investigate potential transmission pathways in a real hospital setting. The results suggest that, in the absence of targeted cleaning, toilet seats and mobile devices may result in widespread transmission of pathogens departing from one contaminated patient skin region.

scholarly journals Silica nanoparticles with encapsulated DNA (SPED) to trace the spread of pathogens in healthcare

2022 ◽  
Vol 11 (1) ◽  
Author(s):  
Cinzia Ullrich ◽  
Anne M. Luescher ◽  
Julian Koch ◽  
Robert N. Grass ◽  
Hugo Sax
Keyword(s):  
Silica Nanoparticles ◽  
Mobile Phones ◽  
Mobile Device ◽  
Real Life ◽  
Hospital Setting ◽  
Pathogen Transmission ◽  
University Hospital ◽  
Patient Room ◽  
Transmission Pathways ◽  
First Time

Abstract Background To establish effective infection control protocols, understanding pathogen transmission pathways is essential. Non-infectious surrogate tracers may safely explore these pathways and challenge pre-existing assumptions. We used silica nanoparticles with encapsulated DNA (SPED) for the first time in a real-life hospital setting to investigate potential transmission routes of vancomycin-resistant enterococci in the context of a prolonged outbreak. Methods The two study experiments took place in the 900-bed University Hospital Zurich, Switzerland. A three-run ‘Patient experiment’ investigated pathogen transmission via toilet seats in a two-patient room with shared bathroom. First, various predetermined body and fomite sites in a two-bed patient room were probed at baseline. Then, after the first patient was contaminated with SPED at the subgluteal region, both patients sequentially performed a toilet routine. All sites were consequently swabbed again for SPED contamination. Eight hours later, further spread was tested at predefined sites in the patient room and throughout the ward. A two-run ‘Mobile device experiment’ explored the potential transmission by mobile phones and stethoscopes in a quasi-realistic setting. All SPED contamination statuses and levels were determined by real-time qPCR. Results Over all three runs, the ‘Patient experiment’ yielded SPED in 59 of 73 (80.8%) predefined body and environmental sites. Specifically, positivity rates were 100% on subgluteal skin, toilet seats, tap handles, and entertainment devices, the initially contaminated patients’ hands; 83.3% on patient phones and bed controls; 80% on intravenous pumps; 75% on toilet flush plates and door handles, and 0% on the initially not contaminated patients’ hands. SPED spread as far as doctor’s keyboards (66.6%), staff mobile phones (33.3%) and nurses’ keyboards (33.3%) after eight hours. The ‘Mobile device experiment’ resulted in 16 of 22 (72.7%) positive follow-up samples, and transmission to the second patient occurred in one of the two runs. Conclusions For the first time SPED were used to investigate potential transmission pathways in a real hospital setting. The results suggest that, in the absence of targeted cleaning, toilet seats and mobile devices may result in widespread transmission of pathogens departing from one contaminated patient skin region.

scholarly journals Treatment of COPD in one university hospital setting in Thailand: the real-life prescribing patterns and treatment expenditures

2019 ◽  
Vol 46 (3) ◽  
pp. 175-183
Author(s):  
Thidarat Samarnkongsak ◽  
Montarat Thavorncharoensap ◽  
Theerasuk Kawamatawong ◽  
Oraluck Pattanaprateep ◽  
Farsai Chancharuporn ◽  
...  
Keyword(s):  
Real Life ◽  
Hospital Setting ◽  
University Hospital ◽  
Prescribing Patterns ◽  
The Real

scholarly journals Medication Experience and Adherence to Oral Chemotherapy: A Qualitative Study of Patients’ and Health Professionals’ Perspectives

2021 ◽  
Vol 18 (8) ◽  
pp. 4266
Author(s):  
Amparo Talens ◽  
Mercedes Guilabert ◽  
Blanca Lumbreras ◽  
María Teresa Aznar ◽  
Elsa López-Pintor
Keyword(s):  
Qualitative Study ◽  
Health Professionals ◽  
Real Life ◽  
Positive Influence ◽  
Barriers And Facilitators ◽  
University Hospital ◽  
Nominal Group ◽  
Care Plans ◽  
Individualized Care ◽  
Medication Experience

Lack of adherence constitutes one of the most important challenges in patients undergoing treatment with oral antineoplastic drugs (ANEO). Understanding cancer patients’ experiences with respect to their medication is key for optimizing adherence and therapeutic results. We aimed to assess the medication experience (ME) in patients with cancer in treatment with ANEO, to describe the barriers and facilitators related to the disease and its treatment and to compare them with the healthcare professionals’ perspectives. We carried out an exploratory qualitative study in the University Hospital of San Juan de Alicante, Spain. Three focus groups and two nominal group discussions were conducted with 23 onco-hematological patients treated with ANEO and 18 health professionals, respectively. The data were analyzed using content analyses and were eventually triangulated. The most impactful aspects in patients’ ME were the presence of adverse effects; lack of information about treatment; beliefs, needs and expectations regarding medications; social and family support; and the relationship with the health professionals. Both patients and professionals agreed on considering the negative side effects and the information about treatment as the main barriers and facilitators of adherence, respectively, although the approaches differed between both profiles. The professionals offered a more technical vision while patients prioritized the emotional burden and motivation associated with the disease and medication. This study allowed us to understand the real-life experiences of patients being treated with ANEO and explore the factors which had an impact on adherence to treatment. This understanding enables professionals to have a positive influence on patients’ behavior and provide individualized care plans. Pharmacists’ assistance is relevant to support patients’ adherence and self-management.

scholarly journals COT-13 Current situation and problems of cancer genomic profiling test in Kyoto University Hospital

2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii22-ii22
Author(s):  
Yoshiki Arakawa ◽  
Junko Suga ◽  
Yukinori Terada ◽  
Kohei Nakajima ◽  
Masahiro Tanji ◽  
...  
Keyword(s):  
Treatment Options ◽  
Insurance Coverage ◽  
Germline Mutations ◽  
University Hospital ◽  
Genomic Profiling ◽  
Test Results ◽  
Final Test ◽  
First Time ◽  
To Receive ◽  
Secondary Finding

Abstract Objective: Kyoto University Hospital has introduced the cancer genomic profiling tests, Oncoprime in 2015, Guardant360 in 2018, which are not under insurance coverage, FoundationOne CDx(F1CDx) and OncoGuide NCC Oncopanel system(NCC OP) in 2019, which received approval for insurance coverage for the first time in Japan. We investigated the results of cancer genomic profiling test under insurance coverage in our hospital. Methods: A special facility for the cancer genomic profiling tests was produced. To perform the cancer genomic profiling test, an outpatient must visit the facility three times (learning, ordering of the test, and getting the results). The expert panels decide the final test results and treatment options with the all information of the patients. Results: From November 2019 to March 2020, 51 and 9 patients were tested with F1CDx and NCC OP, respectively. 16 patients (31%) of F1CDX and 2 patients (22%) of NCC OP got treatment recommendations from the expert panels. However, only 5 patients (9.8%) of F1CDX and 1 patient (11%) of NCC OP received the treatments. The secondary finding suspecting germline mutations was found in 8 patients of F1CDX. Conclusion: After the approval the cancer genomic profiling tests with insurance coverage in Japan, it becomes easy for the patients to perform the test and get the genetic information of the tumor. However, it remains not easy to receive the recommended drugs because of several limitations of their usages.

scholarly journals Leadership assumptions on implementation of patient involvement methods

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kathrine Håland Jeppesen ◽  
Kirsten Frederiksen ◽  
Marianne Johansson Joergensen ◽  
Kirsten Beedholm
Keyword(s):  
Health Care ◽  
Organizational Learning ◽  
Health Care Professionals ◽  
Large Scale ◽  
Patient Involvement ◽  
Hospital Setting ◽  
Implementation Process ◽  
University Hospital ◽  
Structured Interviews ◽  
Implementation Processes

Abstract Background From 2014 to 17, a large-scale project, ‘The User-involving Hospital’, was implemented at a Danish university hospital. Research highlights leadership as crucial for the outcome of change processes in general and for implementation processes in particular. According to the theory on organizational learning by Agyris and Schön, successful change requires organizational learning. Argyris and Schön consider that the assumptions of involved participants play an important role in organizational learning and processes. The purpose was to explore leaders’ assumptions concerning implementation of patient involvement methods in a hospital setting. Methods Qualitative explorative interview study with the six top leaders in the implementation project. The semi-structured interviews were conducted and analyzed in accordance with Kvale and Brinkmanns’ seven stages of interview research. Result The main leadership assumptions on what is needed in the implementation process are in line with the perceived elements in organizational learning according to the theory of Argyris and Schön. Hence, they argued that implementation of patient involvement requires a culture change among health care professionals. Two aspects on how to obtain success in the implementation process were identified based on leadership assumptions: “The health care professionals’ roles in the implementation process” and “The leaders’ own roles in the implementation process”. Conclusion The top leaders considered implementation of patient involvement a change process that necessitates a change in culture with health care professionals as crucial actors. Furthermore, the top leaders considered themselves important facilitators of this implementation process.

scholarly journals Mycoplasma pneumoniae may cause dyspnoea and hospitalisations in young healthy adults

2021 ◽  
Author(s):  
Riku Metsälä ◽  
Solja Ala-Korpi ◽  
Juha Rannikko ◽  
Merja Helminen ◽  
Marjo Renko
Keyword(s):  
Respiratory Tract ◽  
Mycoplasma Pneumoniae ◽  
Hospital Setting ◽  
Health Condition ◽  
Clinical Findings ◽  
Antimicrobial Treatment ◽  
University Hospital ◽  
Upper Respiratory Tract ◽  
Beta Lactam ◽  
Beta Lactam Antibiotics

AbstractPolymerase chain reaction (PCR)-based diagnostics for Mycoplasma pneumoniae (M. pneumoniae) from the respiratory tract has become widely available, but the interpretation of the results remains unclear. M. pneumoniae has been suggested to cause mainly mild and self-limiting infections or asymptomatic carriage. However, systematic analyses of the association between PCR results and clinical findings are scarce. This study aimed to clarify the clinical features of PCR-positive M. pneumoniae infections in a hospital setting. We reviewed 103 PCR-positive patients cared for in a university hospital during a 3-year period. Data on age, sex, health condition, acute symptoms, other pathogens found, laboratory and X-ray results and treatments were collected. Over 85% of the patients had a triad of typical symptoms: fever, cough and shortness of breath. Symptoms in the upper respiratory tract were rare. In 91% of the cases, M. pneumoniae was the only pathogen found. The highest incidence was found in the age group of 30–40 years, and 68% of the patients did not have any underlying diseases. Most patients were initially empirically treated with beta-lactam antibiotics and needed 2–4 changes in their treatment. Only 6% were discharged without an antibiotic effective against M. pneumoniae. This study shows that M. pneumoniae often led to hospitalisation and that patients needed appropriate antimicrobial treatment to recover. Mixed infections were rare, and situations that could be interpreted as carriage did not occur.

scholarly journals Challenges and Opportunities Developing Mathematical Models of Shared Pathogens of Domestic and Wild Animals

2018 ◽  
Vol 5 (4) ◽  
pp. 92 ◽  
Author(s):  
Kathryn Huyvaert ◽  
Robin Russell ◽  
Kelly Patyk ◽  
Meggan Craft ◽  
Paul Cross ◽  
...  
Keyword(s):  
Mathematical Models ◽  
Domestic Animals ◽  
Domestic Animal ◽  
Pathogen Transmission ◽  
Management Actions ◽  
Animal Populations ◽  
Challenges And Opportunities ◽  
Conservation Concern ◽  
Transmission Pathways ◽  
And Control

Diseases that affect both wild and domestic animals can be particularly difficult to prevent, predict, mitigate, and control. Such multi-host diseases can have devastating economic impacts on domestic animal producers and can present significant challenges to wildlife populations, particularly for populations of conservation concern. Few mathematical models exist that capture the complexities of these multi-host pathogens, yet the development of such models would allow us to estimate and compare the potential effectiveness of management actions for mitigating or suppressing disease in wildlife and/or livestock host populations. We conducted a workshop in March 2014 to identify the challenges associated with developing models of pathogen transmission across the wildlife-livestock interface. The development of mathematical models of pathogen transmission at this interface is hampered by the difficulties associated with describing the host-pathogen systems, including: (1) the identity of wildlife hosts, their distributions, and movement patterns; (2) the pathogen transmission pathways between wildlife and domestic animals; (3) the effects of the disease and concomitant mitigation efforts on wild and domestic animal populations; and (4) barriers to communication between sectors. To promote the development of mathematical models of transmission at this interface, we recommend further integration of modern quantitative techniques and improvement of communication among wildlife biologists, mathematical modelers, veterinary medicine professionals, producers, and other stakeholders concerned with the consequences of pathogen transmission at this important, yet poorly understood, interface.

scholarly journals Introduction of Criterion-Based Audit of Postpartum Hemorrhage in a University Hospital in Eastern Ethiopia: Implementation and Considerations

2020 ◽  
Vol 17 (24) ◽  
pp. 9281
Author(s):  
Abera Kenay Tura ◽  
Yasmin Aboul-Ela ◽  
Sagni Girma Fage ◽  
Semir Sultan Ahmed ◽  
Sicco Scherjon ◽  
...  
Keyword(s):  
Postpartum Hemorrhage ◽  
Hospital Setting ◽  
Hospital Staff ◽  
University Hospital ◽  
Local Hospital ◽  
Eastern Ethiopia ◽  
Self Reflection ◽  
Intervention Plan ◽  
Cross Matching

With postpartum hemorrhage (PPH) continuing to be the leading cause of maternal mortality in most low-resource settings, an audit of the quality of care in health facilities is essential. The purpose of this study was to identify areas of substandard care and establish recommendations for the management of PPH in Hiwot Fana Specialized University Hospital, eastern Ethiopia. Using standard criteria (n = 8) adapted to the local hospital setting, we audited 45 women with PPH admitted from August 2018 to March 2019. Four criteria were agreed as being low: IV line-setup (32 women, 71.1%), accurate postpartum vital sign monitoring (23 women, 51.1%), performing typing and cross-matching (22 women, 48.9%), and fluid intake/output chart maintenance (6 women, 13.3%). In only 3 out of 45 women (6.7%), all eight standard criteria were met. Deficiencies in the case of note documentation and clinical monitoring, non-availability of medical resources and blood for transfusion, as well as delays in clinical management were identified. The audit created awareness, resulting in self-reflection of current practice and promoted a sense of responsibility to improve care among hospital staff. Locally appropriate recommendations and an intervention plan based on available resources were formulated.

scholarly journals Underlying causes of under-utilization of cardiac resynchronization therapy in real-world heart failure settings

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Choha ◽  
J Henrysson ◽  
E Thunstrom ◽  
M Fu ◽  
C Basic
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Cardiac Resynchronization Therapy ◽  
Real World ◽  
Angiotensin Receptor Blockers ◽  
Real Life ◽  
University Hospital ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Underlying Causes

Abstract Background Despite well-established effectiveness of cardiac resynchronization therapy (CRT) in patients with heart failure (HF), it remained significantly under-utilized. The underlying causes are still not well described. Aim To investigate how many patients with HF were eligible for CRT and determine underlying causes why CRT was abstained for these patients in real life settings. Methods Retrospective review of medical data was carried out in all patients hospitalized for newly diagnosed HF from January 1, 2016 to December 31, 2019. Patients were identified from the local university hospital register with three afiliations by use of international classification of disease (ICD)-10 codes I50.0-I50.9. Medical journals, including electrocardiograms and echocardiograms, were reviewed. The indication for CRT was evaluated three months after mineralocorticoid receptor antagonists (MRA) were initiated as addition to angiotensin converting enzyme inhibitor /angiotensin-receptor blockers and beta-blocker treatment according to European guidelines for heart failure from 2016. Follow-up was minimum one year and up to two years after HF diagnosis. Results In 3456 patients with HF, 642 (18.6%) were patients hospitalized for new onset of HF with ejection fraction (EF) <40%. Out of those, 104 (16.2%) patients were excluded because of incomplete medical record as a result of referral to primary care. Finally, 538 were included in this study. Overall, 163 patients (30.3%) met CRT criteria with 22.5%, 2.6%, 1.9% complying with recommendation IA, IIA, IIB respectively, and 3.9% had more than 50% right ventricular pacing. Only 52 (9.7%) of patients received CRT with mean age 69.3±11.5 years, and 69.2% men and EF 31.9% ± 7.6. In all these patients with HF eligible for CRT, no difference was found in baseline data including hypertension, ischemic heart disease, atrial fibrillation, valvular heart disease, diabetes mellitus, stroke, cancer and renal failure nor medical treatment between those received CRT and those without CRT. Among underlying causes of under-utilization of CRT, 24.3% were due to multiple concomitant comorbidities, 4.5% due to patient's own wish, 12.5% due to other reasons such as socioeconomic problems and 58.6% with unknown reasons. Mortality rates were 20.7% in patients without treatment with CRT compared with 7.7% in those who received CRT (p=0.037). Conclusion In this real world HF cohort, 1/3 patients were eligible for CRT treatment. However only 1/3 received CRT and 58.6% had no contraindication but did not receive CRT, which emphasize urgent need for structured implementation methods for device treatment in patients with HF. FUNDunding Acknowledgement Type of funding sources: None.

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