Phytopathogen transmitted from plant to human causing peritoneal dialysis-associated peritonitis

We report the first case of peritoneal dialysis (PD)-associated peritonitis due to Sporothrix schenckii, a thermally dimorphic black fungus transmitted from epiphytotic disease. The patient presented with PD-associated peritonitis and fungal colonisation inside the PD catheter’s lumen after an exposing ‘wet contamination’ event with a phytopathogen 11 days prior to the onset of infection. The human pathogen and phytopathogen were confirmed the same species by nucleotide sequences of the internal transcribed spacer and large subunit regions of the ribosomal RNA gene. A ‘wet contamination’ should be closely monitored for an extended period, and a broader spectrum of organisms might lead to peritonitis, particularly in centres with a high prevalence of fungal infection. PD patients and their caregivers should have periodic retraining of aseptic technique and personnel hygiene. We also recommend a long course of antifungal medication in eradicating peritoneal sporotrichosis to prevent unfavourable outcomes and relapsing peritonitis from this organism.

Evaluation of aseptic technique used in interventional rheumatology: survey among Moroccan and Tunisian rheumatologists

The objective of our study was to evaluate the aseptic technique used in interventional rheumatology by Moroccan and Tunisian rheumatologists. We performed an online survey among rheumatologists from Morocco and Tunisia. The questionnaire included 15 questions with single and multiple-choice answers and three open sections for freetext comments. An online survey was prepared and sent to 380 rheumatologists. One hundred and four rheumatologists (27.36%) replied to the survey. More than half of the participants (56.7%) were from Tunisia and 43.3% were from Morocco. Interventional procedures on superficial joints were performed by all participants. Ultrasonography was used by 41.3% of respondents to guide interventional procedures. Regarding the aseptic precautions taken to avoid infection, the majority of participants used povidone iodine to clean the skin and only 8.7% wore a mask. Hand washing alone without gloves wearing was done by 19.2% of participants. 2.9% of participants reported a history of iatrogenic septic arthritis and the duration of practice was the only factor associated with its occurrence (P=0.007). Our study showed that aseptic technique used during interventional rheumatologic procedures is heterogeneous. However, the majority of participants were aware of its necessity to avoid iatrogenic septic arthritis.

Compounding Parenteral Products in Pediatric Wards—Effect of Environment and Aseptic Technique on Product Sterility

Parenteral products must be compounded using an aseptic technique to ensure sterility of the medicine. We compared the effect of three clinical environments as compounding areas as well as different aseptic techniques on the sterility of the compounded parenteral product. Clinical pharmacists and pediatric nurses compounded 220 samples in total in three clinical environments: a patient room, a medicine room and biological safety cabinet. The study combined four methods: observation, environmental monitoring (settle plates), monitoring of personnel (finger dab plates) and sterility testing (membrane filtration). Of the compounded samples, 99% were sterile and no significant differences emerged between the clinical environments. Based on the settle plates, the biological safety cabinet was the only area that fulfilled the requirements for eliminating microbial contamination. Most of the steps on the observation form for aseptic techniques were followed. All participants disinfected their hands, wore gloves and disinfected the septum of the vial. Non-contaminated finger dab plates were mostly detected after compounding in the biological safety cabinet. Aseptic techniques were followed relatively well in all environments. However, these results emphasize the importance of good aseptic techniques and support the recommendation of compounding parenteral products in biological safety cabinets in clinical environments.

Retention of Sterile Compounding Knowledge Among Pharmacy Technicians

Background: Patient safety is in jeopardy due to a rise in the preparation of adulterated parenteral products with poor technique identified as a significant contributing factor. Pharmacy technicians perform an overwhelming majority of aseptic compounding practices; however, this group’s progressive loss of aseptic technique knowledge has not been documented. Objective: The purpose of this correlational research study was to investigate the association between sterile compounding knowledge and years in the field controlling for formal training in sterile compounding techniques. Methods: An assessment tool of fundamental sterile compounding content was electronically distributed to sterile compounding technician members of pharmacy organizations in the southeastern United States. A multiple regression was conducted to predict sterile compounding knowledge from number of years in the field and prior years of formal compounding training. Results: Sixty-eight assessments were returned complete. The overall model was significant ( P < .0005), explaining 22% of the variance in knowledge retention. Years in the field was the only significant predictor ( P < .001). Each additional year of work experience was associated with a 0.18 drop in the assessment score. Conclusions: The longer pharmacy technicians remain in the field, the more aseptic technique knowledge they will lose. Modeling of poor sterile compounding techniques in the workplace may promote loss of competency of the skill. As a result, a plan to address continuing education for pharmacy technician sterile compounders is necessary to ensure patient safety.

Chemical peritonitis associated with intraperitoneal vancomycin: A case series

Peritonitis is a serious complication in peritoneal dialysis, usually secondary to an infectious cause. Chemical peritonitis is rarer. No case exclusively attributed to vancomycin has been reported in the last 20 years. Data from 4 consecutive patients diagnosed with culture -negative peritonitis following administration of intraperitoneal vancomycin between May and June 2019 were retrospectively recorded. All patients were treated with 2 grams of intraperitoneal vancomycin after a break in aseptic technique and developed a cloudy effluent. No patient was previously known to be allergic to vancomycin. All had a clear dialysate before vancomycin. All developed an elevated leukocyte count in the dialysate. All had sterile cultures. All resumed a clear effluent with less <100 cells/μL after vancomycin cessation, and in two there were no further administrations. In one, a new drug challenge led to recrudescence of abdominal pain and reappearance of a cloudy sterile effluent. In another, vancomycin from a different lot was administrated 3 days after, no symptoms developed and dialysate cell count remained normal. The pathogenic mechanisms underlying chemical peritonitis are not fully known. The clinical course is typically benign. Management seems to be limited to drug withdrawal. If unrecognized, chemical peritonitis may ultimately lead to unnecessary catheter removal.

Conceptual review of asepsis, antisepsis & sterilization in Ayurveda

Sterilization is the process of freeing an article, a surface or a medium of all microorganisms. Asepsis is the state of being free from or keeping away disease-producing microorganisms like bacteria, viruses, etc. For the success of any surgical treatment Sterilization and Aseptic precautions are of prime importance. Lack of sterilization and aseptic precautions leads to complications, infection, delayed wound healing, etc. Now a days in modern era there are various chemical & physical methods of sterilization. But the concept of ancient Sterilization and Asepsis is same, cost effective, having medicinal values also. The ancient Acharyas used Agni (Fire), Kwath (Decoction) & various medicated fumigating yogs to protect Atur (patient) from different organisms. The ancient Acharyas mentioned various Dhoopan with Rkashoghanyadravyas for sterilization of OT rooms with that explain some aseptic precautions. So, an effort is made to establish an Ayurvedic sterilization and Aseptic Technique in this era.

Outcome of Nurse-Led Intervention on Knowledge and Practice of Aseptic Technique Among Surgical Nurses in Two Teaching Hospitals in Lagos State, Nigeria

Aseptic Technique (AT) plays a key role in the management of surgical cases within the hospital including the operating rooms. Surgical Nurse uses AT to alleviate the suffering of patients by protecting them during invasive clinical procedure thereby providing optimal care resulting in positive outcome. Therefore, the goal of this study was to train surgical nurses on knowledge and practice of aseptic technique in two teaching hospitals in Lagos State, Nigeria. A two group pre -test and post-test quasi experimental design was utilized and a sample size of 129 was used by simple random technique. A self- structured questionnaire was used for data collection, which was pilot tested and both were analysed through Cronbach Alpha and result yielded four research questions and six hypotheses were formulated. Data were analysed using SPSS version 22. Questionnaire was analysed using descriptive statistics of percentages, means and standard deviation while inferential statistics of t-test and Analysis of Variance(ANOVA) were used to test the hypotheses. Findings revealed that majority 28 (42.5%) and 17 (38.4%) of the participants were between the ages of 30 to 39 years in experimental and control group. The gender showed majority to be female 54 (74%) and 33 (82.5%) in both groups while most participants had degree in Nursing (53.4%) and (50%) in both groups. Their years of service showed that (34.2%) and (45.0%) have worked between 11 and 15 years, more than half were on grade level 7 and10. The pre-intervention mean scores of knowledge level was 27.009 (54.02%) and 26.511 (53.02%) in both groups, this revealed that the level of knowledge among them was below average. The pre-intervention mean scores level of practice in both groups was 7.432 (53.09%) and 7.507 (53.62%), this signified that the practice level of both group was below average. The post-intervention mean scores of the knowledge level in both groups was 43.807 (87.61%) and 26.461 (52.92%). The difference observed in the mean score of both groups was as a result of the training that only experimental group was exposed to, therefore , there was a significant improvement. The post-intervention mean scores of the practice level of both groups was 13.009 (92.92%) and 7.616 (54.4%). The difference observed in the mean score of both groups was as a result of the training of the experimental group therefore, there was a significant improvement. In conclusion, the influence of nurse-led intervention had a significant outcome on the training of knowledge and practice of aseptic technique that the experimental group was exposed to. It is therefore recommended that nurse clinicians be exposed to periodic training and re-training to facilitate good outcome of all invasive clinical procedures thereby reducing sepsis.