Approaches to multidrug-resistant organism prevention and control in long-term care facilities for older people: a systematic review and meta-analysis

Background Despite clear evidence of benefits in acute-care hospitals, controversy over the effectiveness of IPC measures for MDROs is perceptible and evidence-based practice has not been established. Objective To investigate the effects of IPC interventions on MDRO colonization and infections in LTCFs. Data sources Ovid MEDLINE, EMBASE, and CINAHL from inception to September 2020. Eligibility criteria Original and peer-reviewed articles examining the post-intervention effects on MDRO colonization and infections in LTCFs. Interventions (i) Horizontal interventions: administrative engagement, barrier precautions, education, environmental cleaning, hand hygiene, performance improvement, and source control; and (ii) vertical intervention: active surveillance plus decolonization. Study appraisal and synthesis We employed a random-effects meta-analysis to estimate the pooled risk ratios (pRRs) for methicillin-resistant Staphylococcus aureus (MRSA) colonization by intervention duration; and conducted subgroup analyses on different intervention components. Study quality was assessed using Cochrane risk of bias tools. Results Of 3877 studies identified, 19 were eligible for inclusion (eight randomized controlled trials (RCTs)). Studies reported outcomes associated with MRSA (15 studies), vancomycin-resistant Enterococci (VRE) (four studies), Clostridium difficile (two studies), and Gram-negative bacteria (GNB) (two studies). Eleven studies were included in the meta-analysis. The pRRs were close to unity regardless of intervention duration (long: RR 0.81 [95% CI 0.60–1.10]; medium: RR 0.81 [95% CI 0.25–2.68]; short: RR 0.95 [95% CI 0.53–1.69]). Vertical interventions in studies with a small sample size showed significant reductions in MRSA colonization while horizontal interventions did not. All studies involving active administrative engagement reported reductions. The risk of bias was high in all but two studies. Conclusions Our meta-analysis did not show any beneficial effects from IPC interventions on MRSA reductions in LTCFs. Our findings highlight that the effectiveness of interventions in these facilities is likely conditional on resource availability—particularly decolonization and barrier precautions, due to their potential adverse events and uncertain effectiveness. Hence, administrative engagement is crucial for all effective IPC programmes. LTCFs should consider a pragmatic approach to reinforce standard precautions as routine practice and implement barrier precautions and decolonization to outbreak responses only.

Sequential Intravenous-Oral Therapy for Pediatric Streptococcus anginosus Intracranial Infections

Introduction Streptococcus anginosus group is a common cause of pediatric intracranial infections but treatment recommendations, including use of oral therapy, are poorly defined. Methods We performed a retrospective review from 2004-2019 of all patients with Streptococcus anginosus group pyogenic intracranial infections at Children’s Hospital Colorado, highlighting patients transitioned to oral therapy. The primary endpoint was worsening infection necessitating intravenous antibiotics or a source control procedure after transition to oral therapy. Results Of 107 patients with Streptococcus anginosus intracranial infections, 61 were transitioned to exclusive oral therapy after a median intravenous duration of 37 days, overwhelmingly with a levofloxacin-based regimen. Only one failure was noted in a patient who did not fill their prescription. Patients with epidural infections were more likely to be transitioned to oral therapy within the first 28 days of treatment (defined as “early”). Patients with parenchymal infections, bacteremia, co-pathogens, higher inflammatory markers, and requiring >1 source control procedure were less likely to be transitioned early to oral therapy. Complications of a central catheter and/or intravenous medications contributed to 56% of oral transitions. Conclusions Levofloxacin-based oral regimens were effective and well-tolerated. Patients with less severe infections were more likely to be transitioned early to oral therapy. Criteria for transitioning patients to oral antibiotics for intracranial infections should be established to minimize risks inherent with central catheters.

Rapid evidence review to inform safe return to campus in the context of coronavirus disease 2019 (COVID-19)

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted predominantly through the air in crowded and unventilated indoor spaces, especially among unvaccinated people. Universities and colleges are potential settings for its spread. Methods: An interdisciplinary team from public health, virology, and biology used narrative methods to summarise and synthesise evidence on key control measures, taking account of mode of transmission. Results: Evidence from a wide range of primary studies supports six measures. Vaccinate (aim for > 90% coverage and make it easy to get a jab). Require masks indoors, especially in crowded settings. If everyone wears well-fitting cloth masks, source control will be high, but for maximum self-protection, respirator masks should be worn. Masks should not be removed for speaking or singing. Space people out by physical distancing (but there is no “safe” distance because transmission risk varies with factors such as ventilation, activity levels and crowding), reducing class size (including offering blended learning), and cohorting (students remain in small groups with no cross-mixing). Clean indoor air using engineering controls—ventilation (while monitoring CO2 levels), inbuilt filtration systems, or portable air cleaners fitted with high efficiency particulate air [HEPA] filters). Test asymptomatic staff and students using lateral flow tests, with tracing and isolating infectious cases when incidence of coronavirus disease 2019 (COVID-19) is high. Support clinically vulnerable people to work remotely. There is no direct evidence to support hand sanitising, fomite controls or temperature-taking. There was no evidence that freestanding plastic screens, face visors and electronic air-cleaning systems are effective. Conclusions: The above evidence-based measures should be combined into a multi-faceted strategy to maximise both student safety and the continuation of in-person and online education provision. Those seeking to provide a safe working and learning environment should collect data (e.g. CO2 levels, room occupancy) to inform their efforts.

Efficiency of emergency service for COVID-19 patients in Indonesia: management system, public policies, and medical action

Since the implementation of physical distancing and Large-Scale Social Restrictions (PSBB) on March 20, 2020, there was a decrease in patients at Cicendo Eye Hospital as much as 67.9% from March to April 2020. Encouragement to the public to keep their distance, avoid crowds, and the advice to stay at home resulted in a flow the process of health care during the COVID-19 pandemic has changed, such as the implementation of standard precautions for all patients and ensure early identification and source control. The existence of COVID-19 policies in the form of screening, service procedures, and the changing flow of the service process is thought to also affect patient satisfaction and the quality of nursing services. To analyze the quality of nursing services during the COVID-19 pandemic at Cicendo Eye Hospital. Using the Importance Performance Analysis (IPA) method. Data collection is carried out in outpatient and inpatient settings. Cicendo Eye Hospital. Sources of data in the form of primary data through questionnaires Responsiveness, Assurance, Tangible, Empathy and Reliability (RATER) and secondary data in the form of patient satisfaction data and service quality in 2019.

Design of an universal source for semi-automatic ac welding and induction heating

This paper proposes a circuit solution and a power source control algorithm for semi-automatic AC welding with improved energy and weight-size characteristics. A distinctive feature of the designed source is the absence of an input rectifier: welding is carried out with a high-frequency alternating current. That has made it possible to significantly reduce power losses in the source, as well as provide the possibility of implementing induction heating by connecting an inductor to the source output. Another distinctive feature of the designed source is an increased power factor and a reduced level of higher harmonics of the current consumed. The power factor of the described source reaches 0.94 against 0.5÷0.7 for sources equipped with a conventional rectifier with capacitive smoothing. The designed source's composition includes a power supply system for the wire feed drive with speed stabilization due to positive feedback on the motor current. That has made it possible to ensure the stable operation of the drive in a wide range of speeds. A model has also been developed of a flux wire welding torch containing a feed drive and a coil with a wire (up to 100 mm in diameter), placed, in order to reduce the size, in the handle of the torch. In addition to the welding function, the source makes it possible to solve the tasks related to induction heating and/or hardening of small parts; to that end, a compact inductor is connected to its output. Tests of the source showed the feasibility of the proposed ideas and circuit solutions. The dimensions of the source are 190×107×65 mm; weight, 1.4 kg; output current, up to 120 A. The proposed technical solution enables the construction of small-sized, lightweight, universal, easy-to-use power supplies for semi-automatic welding with the option of induction heating

The Case for Early Antibiotic Commencement and Source Control in Paediatric Subdural Empyema: A Single-Centre Retrospective Case Series

<b><i>Background:</i></b> Subdural empyema is a neurosurgical emergency requiring prompt diagnosis and treatment. There is a debate between the benefits and risks of starting early antibiotics prior to surgical drainage as this is purported to reduce the rate of microbiological diagnosis. Here, we describe our experience of treating this potentially life-threatening condition, advocating for the early commencement of antibiotics and importance of source control in its treatment. <b><i>Methods:</i></b> Retrospective review of a prospectively collected electronic departmental database included all patients who were admitted to our unit with a diagnosis of subdural empyema over an 11-year period (2008–2018). Basic demographic data were collected. Further data pertaining to mode of presentation, surgical approach, causative organism, post-operative antibiotic regime, anti-seizure medications, length of hospital stay, further surgery, and neurological outcomes were extracted. <b><i>Results:</i></b> Thirty-six children underwent 44 operations for subdural empyema at our institution during the study period. Median age was 11.0 (range 0.2–15.8); 47.2% (17/36) were female. Over time, there was decreasing use of burr holes and increasing use of craniectomy as the index surgery. Using a combination of extended culture and polymerase chain reaction, a microbiological diagnosis was achieved in all 36 cases; the commonest causative microorganism was of the <i>Streptococcus anginosus</i> group of bacteria. Seven patients underwent repeat surgery, and 4 patients underwent a concurrent ENT procedure. No risk factors were significant in predicting the likelihood of re-operation (location of subdural empyema, age, index surgery type, inflammatory markers, concurrent ENT procedure, and microorganism) although it was notable that none of the patients undergoing a concurrent ENT procedure underwent repeat surgery (<i>p</i> = 0.29). Median length of stay was 12 days (range 3–74), and there were no inpatient or procedure-related mortalities. Clinical outcomes were good with 94.4% (34/36) categorized as modified Rankin Scale 0–3 at discharge and there were 2 cranioplasty-related complications. <b><i>Conclusions:</i></b> We observed an evolution of practice from limited surgical approaches towards more extensive index surgery over the study period. Given that a microorganism was isolated in all cases using a comprehensive approach, initiation of antibiotic therapy should not be delayed on presentation. Concurrent ENT surgery may be an important factor in providing aggressive source control thereby reducing the need for repeat surgery.

Application of Computer Vision and Python Scripts as Educational Mechatronic Platforms for Engineering Development in STEM Technologies

This paper presents the process of designing, fabrication, assembling, programming and optimizing a prototype of a nonlinear mechatronic Ball-Plate System (BPS) as a laboratory platform for STEM engineer education. Due to the nonlinearity and complexity of BPS, task presents challenging issues, such as: 1) difficulties in controlling the stabilization of a given position point known as steady state error, 2) position resolution known as specific distance error and 3) adverse environmental effects - light shadow error, also discussed in this paper. The laboratory BPS prototype for education was designed, manufactured and installed at the Karlovac University of Applied Sciences at the Department of Mechanical Engineering, Study of mechatronics. The low-cost two degrees BPS system uses a USB HD camera for computer vision as feedback and two DC servomotors as actuators. Due to controlling problems, an advanced block diagram of control system is proposed and discussed. An open-source control system based on Python scripts that allows the use of ready-made functions from the library allows changing the color of the ball and the parameters of the PID controller, thus indirectly simplifying control system and directly the mathematical calculation. The authors will continue their research on this BPS mechatronic platform and control algorithms.