Showing papers in "Journal of Patient Safety and Infection Control in 2013"
TL;DR: A strategic approach based upon addressing factors influencing resistance would considerably lessen the burden on healthcare resulting in a substantial effect on the economy over a period of time.
Abstract: Antimicrobial resistance is one of the biggest challenges being faced by healthcare professionals. Facing this challenge requires a strategic and rationalized approach towards containment of resistance. In South-East Asia, multi-drug-resistant tuberculosis (MDR-TB) continues to plague our community. There have been reports of antiretroviral therapy (ART) resistance as well as resistant malaria. The incidence of multidrug resistant Salmonella typhi (MDRST) is also on the increase. Majority of the healthcare associated infections are caused by multi-drug resistant organisms. Increased resistance has led to increased morbidity and mortality and thus, an increased burden on healthcare resulting in a substantial effect on the economy. Rationalized use of antimicrobials is the need of the hour. A strategic approach based upon addressing factors influencing resistance would considerably lessen the burden over a period of time.
3 citations
TL;DR: Evaluation of risk-factors for food-borne infections and their mitigation in healthcare settings was the objective ofThis review found that bacteria are the commonest causative agents ofFood-borne illnesses followed by viruses.
Abstract: Many illnesses and deaths annually are attributed to intake of contaminated food. Evaluation of risk-factors for food-borne infections and their mitigation in healthcare settings was the objective of this review. Bacteria are the commonest causative agents of food-borne illnesses followed by viruses. Preventive aspects are aimed at holding food (including liquid and other enteral feeds) at proper temperature and storing food in a hygienic manner. Also of paramount importance is the upkeep of personal hygiene of the F & B staff. Such preventive measures have proven beneficial in minimizing food-borne illnesses. Active periodic surveillance shall be a part of any infection control program. Comprehensive food safety program, in keeping with the local laws and regulations, should form an essential component of all healthcare set-ups.
1 citations
TL;DR: There is a need for formulation of guidelines for initiating antifungal therapy as well as setting the dose and duration of therapy for approved indications and de-escalating including review and stoppage of antIFungals if not required.
Abstract: Antifungal agents are being clinically misused, especially in intensive care units (ICUs). The objective of this review is to explore the reasons and to formulate the strategy for their use. Various reasons cited for misuse were the generally increasing incidence of resistant fungi as well as also the risk factors in critically-ill patients like indwelling lines and catheters, broad-spectrum antibiotic cover, hemodialysis, total parenteral nutrition, steroids, and mechanical ventilation. Newer antifungal agents recently available are the echinocandins such as caspofungin, micanozole, anidulafungin and posaconazole. These have approved indications for their use which should be strictly adhered to. There is a need for formulation of guidelines for initiating antifungal therapy as well as setting the dose and duration of therapy for approved indications and de-escalating including review and stoppage of antifungals if not required. Not much choice is available besides amphotericin B, itraconazole and posaconazole with fungi like mucor. Abuse of these should be totally abolished.
1 citations
TL;DR: This study showed that indigenized measures for implementing the Bundle approach can work out as a fruitful strategy for decreasing CR-BSI.
Abstract: Background/Objectives: Catheter-related bloodstream infection (CR-BSI) is one of the common causes of healthcare-associated infections. Minimizing CR-BSI by implementing the various components of the indigenized Bundle was our main objective. Methods: Measurement of CR-BSI was done using the Centers for Disease Control (CDC) criteria. The strategy for re-enforcement of the Bundle aimed at intensifying hand-hygiene, increased awareness drives, creating in-house video training programs and creation of an individualized complete central-line insertion kit. Results: The CR-BSI decreased from 5.4 in 2006 to 1.41 in 2010 per 1000 central line days. Certain challenges like reforming the behavioral attitude required to be tackled. Further measures like use of ATP-based hand-hygiene monitor, chlorohexidine patches and 'scrub the hub' drive were implemented. Conclusion: The CR-BSI decreased to 0.92 per 1000 central line days in 2011. This study showed that indigenized measures for implementing the Bundle approach can work out as a fruitful strategy for decreasing CR-BSI.
1 citations
TL;DR: The role of infection prevention aspects in burns, plastic and cosmetic surgery, and the importance of hand-hygiene with use of gloves, masks and caps is essential while handling burns patients are reviewed.
Abstract: Infections in burns and cosmetic surgery patients are a leading cause of morbidity and mortality. This review dwells into the role of infection prevention aspects in burns, plastic and cosmetic surgery. Standard precautions should be followed by all healthcare workers caring for all patients with burn injuries. Hand-hygiene forms an integral component of these preventive aspects. For patients with larger burn injuries (> 30% total body surface area [TBSA] burn) it is recommended that they be placed in separate isolated rooms as their wounds may be at higher risk of colonization of multi-drug resistant organisms. Special attention should be focused on appropriate asepsis while handling the patients during burns dressing and also on appropriate disinfection and sterilization of all items being used for such patients. Such measures lead to decreased antimicrobial use and also prevention of catheter-related infections and pneumonia. Surface swab cultures from wounds may lead to misleading interpretation of infective episodes. The importance of hand-hygiene with use of gloves, masks and caps is essential while handling burns patients. Unnecessary antimicrobials should not be encouraged in burn patients as many wounds would have colonizers rather than infective pathogens. However, more studies are required for the most effective combination of aspects of infection control precautions in burn patients.
TL;DR: In this paper, a review of the adoption of certain novel lab techniques for early and accurate diagnosis of sepsis is presented, where a semi-automated blood culture system such as BacT-alert is used.
Abstract: Sepsis and septic shock can prove fatal if not diagnosed and appropriately managed. A peep into adoption of certain novel lab techniques for early and accurate diagnosis of sepsis is the main objective of this review. A semi-automated blood culture system such as BacT-alert is advantageous as it is a continuous monitoring system. Rapid methods for identification like immunological methods (latex agglutination, immunochromatography methods), use of chromogenic agar media, and molecular methods were evaluated. Detection assays for biomarkers of sepsis (C-reactive protein [CRP], procalitonin and bacterial endotoxins) were also analyzed. The turn-around time for detection of sepsis was significantly reduced from about 48 hours as seen in the conventional methods to as little as an hour as observed in the above described methods. The microbiology lab plays a pivotal role by making use of these described techniques and hence guiding towards accurate diagnosis and management of sepsis.
TL;DR: In this paper, the authors examined existing guidelines upon prevention of surgical site infections (SSI) in pre-operative, operative, and post-operative phase and evaluated the effectiveness of these guidelines.
Abstract: The incidence of surgical site infections (SSI) depends upon the patient risk-factors, surgical procedure, and practices observed by the operating team. This review aims at examining existing guidelines upon prevention of SSI. Various recommendations pertaining to pre-operative, operative and postoperative phase were evaluated. Implementation of measures like meticulous surgical scrubbing, and surgical site preparation, appropriate antimicrobial prophylaxis (right antimicrobial, dose, timing, and duration), right operative environment, observing strict antisepsis, and glucose control have majorly contributed towards reducing infections. Surveillance strategies towards SSI are essential as they help in guiding towards appropriate implementation of various measures.
TL;DR: Cautious usage of newer antifungals based on standardized susceptibility testing methods would avoid development of resistance rationalizing antIFungal therapy and unnecessary usage.
Abstract: Fungal infections and resistance are becoming a cause of concern in immunosuppressed as well as immunocompromised individuals. The main objective of this review is to elucidate the common mechanisms of antifungal resistance and the means to counter it. Multidrug resistance has been observed to be the principal cause of failure in the treatment of fungal infections. Incidence of resistant Candida glabrata isolates as well as Candida albicans is on the rise. There have been reports of resistance to antifungal drugs like amphotericin B, azoles, and 5-flucytosine. Newer antifungals such as echinocandins maybe alternatives to the resistance but they are costly and have their limitations. Cautious usage of newer antifungals based on standardized susceptibility testing methods would avoid development of resistance rationalizing antifungal therapy and unnecessary usage.
TL;DR: There is a need to change prescribing patterns of clinicians, promote research in anti-Parasitic drugs, and increase awareness of infection prevention and control in order to minimize the spread of parasitic diseases especially as newer anti-parasitic agents are scarce on the horizon.
Abstract: Development of drug resistance, insecticide resistance and appearance of newer antiparasitic strains are some of the current challenges being faced by healthcare professionals in the field of parasitology. Highlighting the opportunities for antiparasitic drug discovered and the progress in recent years is the main objective of this review. Very few antiparasitic drugs have been discovered in the recent past, as compared to the other drugs of the pharmaceutical industry. Public-private partnerships have proven beneficial in providing funds to some parasite-focused projects. Some countries, especially the poor, undeveloped still have a problem due to the neglect of certain parasitic diseases which are unique to their epidemiology. There is a need to change prescribing patterns of clinicians, promote research in anti-parasitic drugs, and increase awareness of infection prevention and control in order to minimize the spread of parasitic diseases especially as newer anti-parasitic agents are scarce on the horizon.