by Physicians Weekly | Oct 17, 2016 | Articles, humira-tablet, Infectious Disease, Primary Care, Tablet
Good news for the millions of people who suffer from skin wounds that won’t heal. A team of researchers at The Ohio State University has brought a potentially transformative solution to the problem by creating a portable adhesive patch that drives a continuous, small electrical current to stimulate healing and reduce the risk of infection. Nearly 7 million Americans have chronic wounds – typically a result of diabetes, obesity or other conditions that impact circulation – costing the healthcare system nearly $25 billion each year. The non-healing wounds are painful, can permanently damage nerves, prevent mobility and in extreme cases, cause infection that can lead to death. The patch’s design significantly advances existing FDA-approved wireless electroceutical dressing (WED) that harnesses the body’s innate response to injury to help wounds heal. “A wound naturally produces its own electrical fields that help reduce bacteria and promote cell regeneration; however, this function is likely impaired in chronic wounds,” said Sashwati Roy, PhD, an Associate Professor in the Department of Surgery at Ohio State’s College of Medicine. “The prototype dressing mimics this physiological process, and while it has proven to create an optimal environment where chronic wounds can heal, we are always looking for new ways to keep pathogens under better control.” Roy notes that chronic wounds are particularly susceptible to infection because bacteria, which at times are free floating within a wound – can sometimes mobilize, creating colonies covered by a thick sticky coating called a biofilm. The immune system cannot penetrate the biofilm, and antibiotics can’t get in either – causing constant inflammation and low-level infection that can further dampen the...
by Physicians Weekly | Jan 28, 2014 | Articles, Doctor's Voice, Hospital Medicine, Infectious Disease
Are banning wrist watches and providing hooks for white coats realistic solutions for reducing infections? A new guideline released from the Society for Healthcare Epidemiology of America (SHEA) provides recommendations on reducing transmission of healthcare-associated infections (HAIs) through guidance of healthcare personnel (HCP) attire in non-operating room settings. The recommendations, published in Infection Control and Hospital Epidemiology, are based on limited evidence, theoretical rationale, and practical considerations. Acknowledging that more appropriately designed studies should be funded and performed to better define the relationship between HCP attire and HAIs, the following are based on evidence-based measures to prevent HAIs: 1) “Bare below the elbows”: HCPs should wear short sleeves, no wristwatches or jewelry, and no ties during clinical practice. Even though the prevention impact is unknown, the recommendations rationalize that it is supported by “biological plausibility” and is unlikely to cause harm. 2) White coats: Facilities that mandate or strongly recommend the use of white coats should require that HCPs possess 2 or more white coats in addition to institution-provided on-site laundering at no or low cost. Institutions should also provide coat hooks so that HCPs can remove and hang their white coat before patient contact. 3) Other HCP apparel: Use of other specific apparel items can’t be limited because transmission of pathogens remains undetermined. However, neckties, for example, should be secured. 4) Laundering: Any apparel worn that comes in direct contact with patients or the patient environment should be laundered after daily use, no less frequently than once a week. 5) HCP footwear: All footwear should have closed toes, low heels, and non-skid soles. The article also delves...
by admin | Sep 10, 2013 | Articles, Guidelines, Infectious Disease, Recent Features, Slider, Surgery
Research shows that as many as 20,000 of the nearly 1 million total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures performed in the United States result in a prosthetic joint infection (PJI) over the lifetime of the device. PJIs remain one of the most serious complications of prosthetic joint implantation. According to recent estimates, roughly 4 million THAs and TKAs will be performed each year in the U.S. by 2030, due largely to the rapidly increasing elderly population. Diagnosing PJIs is often challenging for physicians and frequently necessitates multiple modalities. Management of these infections typically requires surgical interventions and lengthy courses of intravenous (IV) and oral antibiotics. Although much research has been conducted in this area, questions about optimal diagnosis and management strategies for PJIs remain. The Infectious Diseases Society of America (IDSA) recently released updated guidelines that are intended to help clinicians by offering optimal strategies to improve the diagnosis and management of these infections. Using a Team Approach A key point that the IDSA guidelines emphasize is that using a multidisciplinary team approach is essential for managing PJIs. “A strong collaboration is required from all medical specialists who are involved in the care of patients with PJIs,” explains Douglas R. Osmon, MD, who served as lead author of the IDSA guidelines. “This team most often includes an orthopedist and an infectious diseases specialist. Other specialists should be involved on a case-by-case basis, such as plastic surgeons, general internists, nurses, mid-level providers, and microbiologists.” Patients requiring THA or TKA procedures tend to be elderly, meaning they are more likely than others to have multiple comorbidities,...
by admin | Jan 9, 2013 | Articles, Emergency Medicine, Hospital Medicine, Opinion Article, Slider
Sepsis and septic shock are leading causes of morbidity and mortality in the United States and represent an increasing problem for patients, providers, and healthcare systems. Studies indicate that these conditions contribute to more than 20,000 deaths per day worldwide. Despite the emergence of newer microbiology technologies, blood cultures continue to be indispensable tests for the microbiology laboratory. Positive blood cultures are often a critical step in diagnosing sepsis and are required for downstream identification and susceptibility testing. Significant advances have been made in automated blood culture systems, including the addition of enriched growth media, enhancements in automated agitation systems, and improved growth algorithms. Despite the progress, obtaining blood cultures before initiating anti-infective therapy and ensuring appropriate fill volumes of 20 mL to 40 mL of blood per venipuncture remain key factors in the successful detection of adult bacteremia. In some healthcare settings, anaerobic bacteremia has reemerged as a significant clinical problem, most likely due to more patients presenting to these institutions with complex underlying diseases. Reaching Clinical Goals Initiation of prompt, appropriate antimicrobial therapy in patients at risk for sepsis is a critical clinical goal, but doing so before culture collection may delay or prevent pathogen recovery. To address this issue, blood culture manufacturers have incorporated blood-broth ratios and/or proprietary antimicrobial removal systems into media to minimize the impact of antimicrobials and facilitate pathogen detection. For example, the BACTEC Plus (Becton Dickinson) and BacT/Alert (bioMérieux) are two frequently used aerobic blood culture media that incorporate the use of proprietary antimicrobial removal systems. The BACTEC medium uses proprietary resin beads, whereas the BacT/Alert medium uses Ecosorb (a blend of...
by TimH | Jan 8, 2013 | Articles, Emergency Medicine, Guidelines, Hospital Medicine, Infectious Disease, Recent Features, Slider, Surgery
Over the past 30 years, many multidrug-resistant organisms have emerged across healthcare settings in the United States. At the same time, there has been a dramatic drop in the development and approval of new antibiotics. “The antimicrobial armamentarium has been depleted,” explains Neil Fishman, MD. “As a result, our ability to treat infectious diseases has been severely compromised. Resistant infections are increasing morbidity and mortality while simultaneously increasing healthcare costs.” Research has shown that a multifaceted approach is required to prevent, detect, and control the emergence of antimicrobial-resistant organisms. This includes ensuring that effective and appropriate therapeutic agents are available and that healthcare settings have the diagnostic capacity to rapidly and reliably detect specific pathogens and their antimicrobial susceptibilities. Promoting better infection prevention and control practices and antimicrobial stewardship programs is important in reducing the burden of infectious diseases, Dr. Fishman says. More healthcare facilities nationwide are launching antimicrobial stewardships because they have the potential to reduce the emergence and transmission of resistant pathogens and decrease antimicrobial resistance. A Joint Position Statement on Antimicrobial Stewardship In the April 2012 issue of Infection Control and Hospital Epidemiology, the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS) published a joint position paper focusing on the need for public policy around the issue of antimicrobial stewardship. SHEA, IDSA, and PIDS have been at the forefront of addressing the need for antimicrobial resistance programs for many years, says Dr. Fishman, co-author of the position paper. “Great efforts are needed to improve prevention and control practices throughout the country.” Key Recommendations...
