Staphylococcal decolonization to prevent surgical site infection: Is there a role in colorectal surgery?

Objective: We implemented a preoperative staphylococcal decolonization protocol for colorectal surgeries if efforts to further reduce surgical site infections (SSIs). Design: Retrospective observational study. Setting: Tertiary-care, academic medical center. Patients: Adult patients who underwent colorectal surgery, as defined by National Healthcare Safety Network (NHSN), between July 2015 and June 2020. Emergent cases were excluded. Methods: Simple and multivariable logistic regression were performed to evaluate the relationship between decolonization and subsequent SSI. Other predictive variables included age, sex, body mass index, procedure duration, American Society of Anesthesiology (ASA) score, diabetes, smoking, and surgical oncology service. Results: In total, 1,683 patients underwent nonemergent NHSN-defined colorectal surgery, and 33.7% underwent the staphylococcal decolonization protocol. SSI occurred in 92 (5.5%); 53 were organ-space infections and 39 were superficial wound infections. We detected no difference in overall SSIs between those decolonized and not decolonized (P = .17). However, superficial wound infections were reduced in the group that received decolonization versus those that did not: 7 (1.2%) of 568 versus 32 (2.9%) of 1,115 (P = .04). Conclusions: Staphylococcal decolonization may prevent a subset of SSIs in patients undergoing colorectal surgery.

Management of the COVID-19-Infected Psychiatric Inpatients: Unique Infection Prevention Considerations and Evolving Strategies.

REASON FOR REVIEW: The COVID-19 pandemic has affected the way healthcare services are provided and created challenges to the delivery of behavioral health in the inpatient setting. Here, we present our front-line experience of infection prevention for the psychiatric patient in the COVID era. RECENT FINDINGS: There are unique challenges surrounding COVID-19 precautions within inpatient psychiatric settings. The challenges presented to psychiatric care by COVID-19 begin in the emergency department and follow the patient through the continuum of care once admitted to the facility. Unit infrastructure, patient population, treatment modalities, staffing considerations, and discharge planning are distinct instances where COVID-19 protocols that are well-suited for other hospital settings necessitate revision for psychiatric settings. SUMMARY: The purpose of this communication is to add to the current body of shared experience of infection prevention for the psychiatric patient in the COVID-19 era.

Test stewardship, frequency and fidelity: Impact on reported hospital-onset Clostridioides difficile.

We assessed the impact of an embedded electronic medical record decision-support matrix (Cerner software system) for the reduction of hospital-onset Clostridioides difficile. A critical review of 3,124 patients highlighted excessive testing frequency in an academic medical center and demonstrated the impact of decision support following a testing fidelity algorithm.

Impact of discontinuation of contact precautions on central-line associated bloodstream infections in an academic children's hospital.

We investigated the impact of discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus infected or colonized patients on central-line associated bloodstream infection rates at an academic children's hospital. Discontinuation of contact precautions with a bundled horizontal infection prevention platform resulted in no adverse impact on CLABSI rates.

Infection prevention and enhanced recovery after surgery: A partnership for implementation of an evidence-based bundle to reduce colorectal surgical site infections.

To reduce surgical site infections (SSIs) in colorectal surgeries we introduced a bundle of care elements in partnership with the Enhanced Recovery after Surgery (ERAS) multidisciplinary team. We measured the incidence of National Healthcare Safety Network-defined SSIs, along with adherence to bundle care elements. Despite opportunities for improvement in adherence to some key components, implementation of the ERAS protocol may have facilitated a reduction in the rate of colorectal SSIs at our institution.

Alternative doffing strategies of personal protective equipment to prevent self-contamination in the health care setting.

BACKGROUND: Health care workers routinely contaminate skin and clothing when doffing personal protective equipment (PPE). Alternative doffing strategies, such as hand hygiene on gloved hands and double gloving, have been suggested but not validated by comparison against the standard Centers for Disease Control and Prevention procedures. METHODS: Participants were assigned to doff PPE following 1 of 4 specific strategies. Prior to doffing, PPE was "contaminated" with Glo Germ and fluorescing Staphylococcus epidermidis at the recommended level of 1.5 × 108 colony forming units/mL. After doffing, areas of self-contamination were detected using a black light. Cultures were taken from these areas using cotton swabs, inoculated onto blood agar plates, and incubated for 48hours. Each participant completed a survey regarding usability. The Fisher exact test and the Kruskal-Wallis test were used for data analysis with SAS 9.4. RESULTS: There were 51 participants who completed the study. Breaches in PPE were observed in only 5 of 51 doffs (10%). However, 46 of 51 (90%) had areas of self-contamination that was apparent by transfer of Glo Germ to skin or clothing. A subset (16%) of these sites also grew fluorescing S epidermidis. Assigned doffing strategy was associated with bacterial contamination (P = .0151), but not usability (P = .2372). CONCLUSIONS: Participants experienced self-contamination when doffing PPE with both a surrogate marker and live bacteria. Close attention to doffing technique is necessary for optimal results, and one-step procedures may be more effective.

Munumbicins, wide-spectrum antibiotics produced by Streptomyces NRRL 30562, endophytic on Kennedia nigriscans.

Munumbicins A, B, C and D are newly described antibiotics with a wide spectrum of activity against many human as well as plant pathogenic fungi and bacteria, and a Plasmodium sp. These compounds were obtained from Streptomyces NRRL 3052, which is endophytic in the medicinal plant snakevine (Kennedia nigriscans), native to the Northern Territory of Australia. This endophyte was cultured, the broth was extracted with an organic solvent and the contents of the residue were purified by bioassay-guided HPLC. The major components were four functionalized peptides with masses of 1269.6, 1298.5, 1312.5 and 1326.5 Da. Numerous other related compounds possessing bioactivity, with differing masses, were also present in the culture broth extract in lower quantities. With few exceptions, the peptide portion of each component contained only the common amino acids threonine, aspartic acid (or asparagine), glutamic acid (or glutamine), valine and proline, in varying ratios. The munumbicins possessed widely differing biological activities depending upon the target organism. For instance, munumbicin B had an MIC of 2.5 microg x ml(-1) against a methicillin-resistant strain of Staphylococcus aureus, whereas munumbicin A was not active against this organism. In general, the munumbicins demonstrated activity against Gram-positive bacteria such as Bacillus anthracis and multidrug-resistant Mycobacterium tuberculosis. However, the most impressive biological activity of any of the munumbicins was that of munumbicin D against the malarial parasite Plasmodium falciparum, having an IC(50) of 4.5+/-0.07 ng x ml(-1). This report also describes the potential of the munumbicins in medicine and agriculture.