The issue of whether low-level tolerance to germicides selects for antibiotic-resistant strains is unsettled but might depend on the mechanism by which tolerance is attained. For example, changes in the permeability barrier or efflux mechanisms might affect susceptibility to both antibiotics and germicides, but specific changes to a target site might not. Some researchers have suggested that use of disinfectants or antiseptics (e.g., triclosan) could facilitate development of antibiotic-resistant microorganisms 334, 335, . Although evidence in laboratory studies indicates low-level resistance to triclosan, the concentrations of triclosan in these studies were low (generally <1 μg/mL) and dissimilar from the higher levels used in antimicrobial products (2,000–20,000 μg/mL) 364, . Thus, researchers can create laboratory-derived mutants that demonstrate reduced susceptibility to antiseptics or disinfectants. In some experiments, such bacteria have demonstrated reduced susceptibility to certain antibiotics . There is no evidence that using antiseptics or disinfectants selects for antibiotic-resistant organisms in nature or that such mutants survive in nature. ). In addition, the action of antibiotics and the action of disinfectants differ fundamentally. Antibiotics are selectively toxic and generally have a single target site in bacteria, thereby inhibiting a specific biosynthetic process. Germicides generally are considered nonspecific antimicrobials because of a multiplicity of toxic-effect mechanisms or target sites and are broader spectrum in the types of microorganisms against which they are effective 344, .

/pdf/guideline-for-disinfection-and-sterilization-in-healthcare-1gzqhqy6ow.pdf

Guideline for disinfection and sterilization in healthcare facilities, 2008

ESCMID∗ guideline for the diagnosis and treatment of biofilm infections 2014

Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection. A Meta-analysis

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion. 1. Burden of CAUTIs a. Urinary tract infection is the most common hospital-acquired infection; 80% of these infections are attributable to an indwelling urethral catheter. b. Twelve to sixteen percent of hospital inpatients will have a urinary catheter at some time during their hospital stay. c. The daily risk of acquisition of urinary infection varies from 3% to 7% when an indwelling urethral catheter remains in situ. 2. Outcomes associated with CAUTI a. Urinary tract infection is the most important adverse outcome of urinary catheter use. Bacteremia and sepsis may occur in a small proportion of infected patients. b. Morbidity attributable to any single episode of catheterization is limited, but the high frequency of catheter use in hospitalized patients means that the cumulative burden of CAUTI is substantial. c. Catheter use is also associated with negative outcomes other than infection, including nonbacterial urethral inflammation, urethral strictures, and mechanical trauma.

/pdf/strategies-to-prevent-catheter-associated-urinary-tract-41xpa0bd52.pdf

Strategies to Prevent Catheter‐Associated Urinary Tract Infections in Acute Care Hospitals

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs) The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their catheter-associated urinary tract infection (CAUTI) prevention efforts This document updates “Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals,” published in 2008 This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates

/pdf/strategies-to-prevent-catheter-associated-urinary-tract-2vchxi2jbu.pdf

Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update

http://gavecelt.it/nuovo/sites/default/files/uploads/epic_guidelines_2013.pdf

epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England

Association between healthcare water systems and Pseudomonas aeruginosa infections: a rapid systematic review.

Background: Tokophobia, a deep‐seated fear of childbirth, causes women emotional anguish and affects the mother‐baby relationship. It can result in women avoiding future pregnancies or requesting caesarean section. This review examines evidence for the effectiveness of planned interventions in women with okophobia in both reducing requests for caesarean section and in ameliorating maternal distress.

Objectives: 1) To synthesise the best available quantitative evidence for the effectiveness of planned interventions in reducing: a) fear/anxiety in tokophobic women, b) planned caesarean sections

2) To synthesise the best available qualitative evidence relating to the experiences of tokophobic women who request a caesarean section, particularly satisfaction with interventions and the childbirth experience.

Inclusion criteria: This review considered studies that included pregnant women requesting a caesarean section for tokophobia in the absence of medical (or obstetric) indications who were offered a planned intervention.

Search strategy: The literature search focused on published and unpublished studies in English distributed between January 1990 and April 2012. An initial limited database search was undertaken to identify keywords, followed by an extensive search of relevant databases and potential grey material.

Methodological quality: Assessment for methodological quality was carried out independently by two reviewers using the standardised appraisal tools from the Joanna Briggs Institute.

Data extraction: Data were extracted from papers included in the review using the standardised data extraction tool from the Joanna Briggs Institute.

Data synthesis: Statistical meta‐analysis was not possible due to heterogeneity. Therefore, a narrative summary of the data was undertaken.

Results: Nine quantitative papers (comprising eight studies: one randomised controlled trial, five case control studies and two descriptive case series) were included; two of these papers appertained to the same study. No qualitative papers were found.

Definitions for tokophobia varied. Samples were confounded by the inclusion of women with complex obstetric histories or with mental health issues. Comparison groups were sometimes non‐tokophobic women. Interventions were complex and descriptions sometimes lacked clarity. Although the randomised controlled trial found no difference in birth choices between samples, a group therapy intervention predisposed women to vaginal birth. One study measured whether interventions reduced fear, finding that they did. Four studies explored satisfaction with the intervention. In three cases interventions were evaluated positively. These involved midwifery input and birth planning.

Conclusion: More research is needed to identify how tokophobic women might be helped. Current guidelines should be upheld for the time being, in the absence of further evidence.

Implications for practice: Due to the heterogeneous nature of the research it is impossible at this stage to draw conclusions for practice.

Implications for research: Due to ethical concerns about randomising tokophobic women to non‐treatment groups, innovative research designs should be considered.

More research is needed on the effectiveness of group interventions and the role of midwives in administering interventions.

A standard, measurable definition for tokophobia is needed and careful documentation and differential analysis of women's parity, mental health and obstetric status should be made.

Outcomes should include fear reduction. Satisfaction and birth outcome should be measured on more than one occasion.

/pdf/a-comprehensive-systematic-review-of-the-impact-of-planned-3trl0ge1sa.pdf

A comprehensive systematic review of the impact of planned interventions offered to pregnant women who have requested a caesarean section as a result of tokophobia (fear of childbirth)

Review question/objective 
Are nutritional interventions effective in reducing the risk of acquiring healthcare-associated infection (HCAI) in the undernourished elderly? 
The objective of this review is to identify and synthesise the best available evidence relating to how effective various nutritional interventions are in reducing the incidence and prevalence of HCAI in this high-risk group. 
More specifically, the objectives are to identify: 
• Whether undernourishment and old age are risk factors for HCAI (scoping phase), and 
• How effective nutritional interventions are in reducing the risk of HCAI in this population. 
Inclusion criteria 

Types of participants 

This review will consider studies that include undernourished (including those 'at risk' of under-nutrition) participants aged 60 years old or over in acute and tertiary healthcare settings. 

As there is no gold standard for the measurement of under-nutrition, participants will be considered as undernourished if any of the following definitions apply: 
BMI ≤ 20 or ≤ the 15th percentile for age 

· Serum albumin ≤ 3.5gm/dl; albuminaemia, mean albumin or plasma albumin level ≤ 35 g/l; prealbumin ≤ 150 mg/l ; thyroxin-binding prealbumin (TBPA) ≤ 0.10 

· Serum transthyretin concentration ≤ 150 mg/l 

· Insulin-like growth factor 1 (S-IGF-1) ≤ 69 ug/l 
TRUNCATED AT 350 WORDS

The effectiveness of nutritional interventions to reduce the risk of healthcare-associated infection in the undernourished elderly: a systematic review

Jessica Browne

Papers

epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections in NHS Hospitals in England

Association between healthcare water systems and Pseudomonas aeruginosa infections: a rapid systematic review.

A comprehensive systematic review of the impact of planned interventions offered to pregnant women who have requested a caesarean section as a result of tokophobia (fear of childbirth)

The effectiveness of nutritional interventions to reduce the risk of healthcare-associated infection in the undernourished elderly: a systematic review

Systematic review of nutritional interventions to prevent healthcare-associated infections in undernourished elderly