Evaluation of hand hygiene: Is university medical education effective in prevention of hospital-acquired infections?

OBJECTIVE: Hand hygiene (HH) compliance is associated with effective prevention of health care-associated infections (HAI), the topic being very important due to current COVID-19 pandemic. There is a growing debate about the role of educational institutions in the low HH compliance of health workers. This study aimed to assess HH knowledge, self-assessment and attitudes of medical students in relation to provided educational background. METHODS: A cross-sectional survey (mixed methods-approach) combined with the curriculum analysis and questionnaires. Quantitative method: a questionnaire of knowledge of HH issues (QK), and a questionnaire of self-assessment and attitudes (SAQ) towards HH. Qualitative method focused on an analysis of content of the curriculum documents. RESULTS: 250 (KQ) and 238 (SAQ) questionnaires were analysed from students of general medicine (n = 262; average age 22.5 years). Below-average knowledge of HH and a high self-assessment of knowledge and compliance with HH was reported by 72.2% and 76.0% of students, respectively. Significant differences in knowledge and self-assessment of HH were found among study years and gender. The content analysis has revealed gaps in HH-related information in general medicine educational programme. CONCLUSIONS: It is highly expected that there might be some association between low HH knowledge level, false self-assessment and educational programme in medical students.

The Effect of Modified Porcine Surfactant Alone or in Combination with Polymyxin B on Lung Homeostasis in LPS-Challenged and Mechanically Ventilated Adult Rats.

The study aimed to prove the hypothesis that exogenous surfactant and an antibiotic polymyxin B (PxB) can more effectively reduce lipopolysaccharide (LPS)-induced acute lung injury (ALI) than surfactant treatment alone, and to evaluate the effect of this treatment on the gene expression of surfactant proteins (SPs). Anesthetized rats were intratracheally instilled with different doses of LPS to induce ALI. Animals with LPS 500 µg/kg have been treated with exogenous surfactant (poractant alfa, Curosurf®, 50 mg PL/kg b.w.) or surfactant with PxB 1% w.w. (PSUR + PxB) and mechanically ventilated for 5 hrs. LPS at 500 µg/kg increased lung edema, oxidative stress, and the levels of proinflammatory mediators in lung tissue and bronchoalveolar lavage fluid (BALF). PSUR reduced lung edema and oxidative stress in the lungs and IL-6 in BALF. This effect was further potentiated by PxB added to PSUR. Exogenous surfactant enhanced the gene expression of SP-A, SP-B, and SP-C, however, gene expression for all SPs was reduced after treatment with PSUR + PxB. In mechanically ventilated rats with LPS-induced ALI, the positive effect of exogenous surfactant on inflammation and oxidative stress was potentiated with PxB. Due to the tendency for reduced SPs gene expression after surfactant/PxB treatment topical use of PxB should be considered with caution.

Satisfaction of Slovak women with psychosocial aspects of care during childbirth.

OBJECTIVE: The objective of the study is to find out and assess satisfaction of Slovak women with psychosocial aspects of perinatal care. DESIGN AND SETTING: The research was designed as a quantitative cross-sectional study. The research data were collected in five pediatric outpatient clinics in Slovakia. PARTICIPANTS: The research sample consisted of 360 women within 0-1 year after natural delivery (average time in months from childbirth: 6.22 ± 3.64) who visited the selected pediatric outpatient clinic in the period from October 2016 to January 2018. METHODS: To collect the relevant data, the original Czech questionnaire measuring psychosocial climate in maternity hospitals - KLI-P (Cronbach α = 0.95) was used to investigate the satisfaction of women with care during labor and delivery as well as with psychosocial aspects. The following six factors were assessed: (1) helpfulness and empathy of midwives and (2) of physicians, (3) superiority and lack of interest, (4) physical comfort and services, (5) control of a woman in labor and her participation in decision-making, (6) providing information. The received data were analyzed using descriptive statistics, the Shapiro-Wilk test, robust ANOVA, Post-hoc test, the Wilcoxon two-sample test, a G-test of independence and the Cochran-Armitage test of trend. FINDINGS: We found that most women (83.1%) were generally satisfied with their care during labor and delivery as well as with psychosocial support. In terms of psychosocial aspects, the highest level of satisfaction was attributed to the approach of the health professionals and the lowest one (61.5%) to the control and participation of delivering woman in decision-making. Both perception of the course of labor and delivery and skin-to-skin contact immediately after birth were shown to be statistically significant predictors of women's satisfaction. The aspect of age was found to be statistically significant in relation to the factor of control of a woman in labor and her participation in decision-making. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: It can be concluded that it is necessary to pay attention to the psychosocial aspects of health care during labor and delivery, with the emphasis on strengthening interventions in the field of participation of women in decision-making. Simultaneously, it is beneficial to emphasize and support the naturalness of childbirth so that women would associate childbirth with a positive experience. Finally, it is important to promote skin-to-skin contact right after birth.

Recombinant Human Superoxide Dismutase and N-Acetylcysteine Addition to Exogenous Surfactant in the Treatment of Meconium Aspiration Syndrome.

This study aimed to evaluate the molecular background of N-acetylcysteine (NAC) and recombinant human superoxide dismutase (rhSOD) antioxidant action when combined with exogenous surfactant in the treatment of meconium aspiration syndrome (MAS), considering redox signalling a principal part of cell response to meconium. Young New Zealand rabbits were instilled with meconium suspension (Mec) and treated by surfactant alone (Surf) or surfactant in combination with i.v. NAC (Surf + NAC) or i.t. rhSOD (Surf + SOD), and oxygen-ventilated for 5 h. Dynamic lung-thorax compliance, mean airway pressure, PaO2/FiO2 and ventilation efficiency index were evaluated every hour; post mortem, inflammatory and oxidative markers (advanced oxidation protein products, total antioxidant capacity, hydroxynonenal (HNE), p38 mitogen activated protein kinase, caspase 3, thromboxane, endothelin-1 and secretory phospholipase A2) were assessed in pulmonary tissue homogenates. rhSOD addition to surfactant improved significantly, but transiently, gas exchange and reduced levels of inflammatory and oxidative molecules with higher impact; Surf + NAC had stronger effect only on HNE formation, and duration of treatment efficacy in respiratory parameters. In both antioxidants, it seems that targeting reactive oxygen species may be strong supporting factor in surfactant treatment of MAS due to redox sensitivity of many intracellular pathways triggered by meconium.

Modified porcine surfactant enriched by recombinant human superoxide dismutase for experimental meconium aspiration syndrome.

AIMS: Combination of exogenous surfactant with antioxidant enzyme recombinant human superoxide dismutase (rhSOD) was tested in the treatment of experimental meconium aspiration syndrome as oxidative processes play key role in its pathogenesis. MATERIAL AND METHODS: Young New Zealand rabbits were instilled by saline (Sal group) or by meconium suspension (Mec group). Some of meconium-instilled animals were treated by surfactant alone (Surf group) or surfactant in combination with rhSOD (Surf + SOD group) and oxygen-ventilated for 5 h. PaO2/FiO2, oxygenation index, oxygen saturation, PaCO2, ventilation efficiency index and alveolar-arterial gradient were evaluated every hour; post mortem, cells in bronchoalveolar lavage were counted, inflammatory and oxidative markers were assessed using ELISA in lung tissue homogenates. KEY FINDINGS: Exogenous surfactant combined with rhSOD improved oxygenation during the first hour after the treatment more than surfactant alone (p = 0.039 to 0.0001 vs. Mec and Surf group). Amelioration was also seen in CO2 elimination (p = 0.049 to 0.0096 vs. Mec group), alveolar-arterial gradient diminution (p = 0.024 to 0.0019 vs. Mec and Surf group), prevention of oxidative damage and cytokine production (p = 0.049 to 0.002 vs. Mec group). SIGNIFICANCE: It seems that inhibition of oxidative signalization may be strong supporting factor in surfactant treatment of MAS.

Anti-IL-8 antibody potentiates the effect of exogenous surfactant in respiratory failure caused by meconium aspiration.

AIM: Meconium aspiration syndrome (MAS) is life-threatening respiratory failure of newborns which can be treated by exogenous surfactant. In response to meconium, increased levels of chemokine IL-8 (CXCL8) stimulate massive neutrophil infiltration of the lungs. Local accumulation and activation of neutrophils, on-going inflammation, lung edema, and oxidative damage contribute to inactivation of endogenous and therapeutically given surfactants. Therefore, we have hypothesized that addition of monoclonal anti-IL-8 antibody into exogenous surfactant can mitigate the neutrophil-induced local injury and the secondary surfactant inactivation and may finally result in improvement of respiratory functions. METHODS: New Zealand rabbits with intratracheal meconium-induced respiratory failure (meconium 25 mg/ml, 4 ml/kg) were divided into three groups: untreated (M), surfactant-treated (M + S), and treated with combination of surfactant and anti-IL-8 antibody (M + S + anti-IL-8). Surfactant therapy consisted of two lung lavages with diluted porcine surfactant Curosurf (10 ml/kg, 5 mg phospholipids (PL)/ml) followed by undiluted Curosurf (100 mg PL/kg) delivered by means of asymmetric high-frequency jet ventilation (f. 300/min, Ti 20%). In M + S + anti-IL-8 group, anti-IL-8 antibody (100 µg/kg) was added directly to Curosurf dose. Animals were oxygen-ventilated for additional 5 h, respiratory parameters were measured regularly. Subsequently, cell counts in bronchoalveolar lavage fluid (BAL), lung edema formation, oxidative damage, levels of interleukins (IL)-1ß and IL-6 in the lung homogenate were evaluated. RESULTS: Surfactant instillation significantly improved lung function. Addition of anti-IL-8 to surfactant further improved gas exchange and ventilation efficiency and had longer-lasting effect than surfactant-only therapy. Combined treatment showed the trend to reduce neutrophil count in BAL fluid, local oxidative damage, and levels of IL-1ß and IL-6 more effectively than surfactant-alone, however, these differences were not significant. CONCLUSION: Addition of anti-IL-8 antibody to surfactant could potentiate the efficacy of Curosurf on the gas exchange in experimental model of MAS.

Meconium-induced inflammation and surfactant inactivation: specifics of molecular mechanisms.

This review summarizes neonatal meconium aspiration syndrome in light of meconium-induced inflammation and inflammatory surfactant inactivation, related to both endogenous and therapeutic exogenous surfactant. The wide effect of meconium on surfactant properties is divided into three points. Direct effect of meconium on surfactant properties refers mainly to fragmentation of dipalmitoylphosphatidylcholine and other surfactant phospholipids together with cleavage of surfactant proteins. Initiation of inflammatory response due to activation of receptors by yet unspecified compounds involves complement and Toll-like receptor activation. A possible role of lung collectins, surfactant proteins A and D, which can exert both pro- and anti-inflammatory reactions, is discussed. Initiation of inflammatory response by specified compounds in meconium reflects inflammatory functioning of cytokines, bile acids, and phospholipases contained in meconium. Unifying sketch of many interconnections in all these actions aims at providing integrated picture of inflammatory surfactant inactivation.

L-NAME in the cardiovascular system - nitric oxide synthase activator?

L-arginine analogues are widely used inhibitors of nitric oxide synthase (NOS) activity both in vitro and in vivo, with N(ω)-nitro-L-arginine methyl ester (L-NAME) being at the head. On the one hand, acute and chronic L-NAME treatment leads to changes in blood pressure and vascular reactivity due to decreased nitric oxide (NO) bioavailability. However, lower doses of L-NAME may also activate NO production via feedback regulatory mechanisms if administered for longer time. Such L-NAME-induced activation has been observed in both NOS expression and activity and revealed considerable differences in regulatory mechanisms of NO production between particular tissues depending on the amount of L-NAME. Moreover, feedback activation of NO production by L-NAME seems to be regulated diversely under conditions of hypertension. This review summarizes the mechanisms of NOS regulation in order to better understand the apparent discrepancies found in the current literature.

Biochemical aspects of nitric oxide synthase feedback regulation by nitric oxide.

Nitric oxide (NO) is a small gas molecule derived from at least three isoforms of the enzyme termed nitric oxide synthase (NOS). More than 15 years ago, the question of feedback regulation of NOS activity and expression by its own product was raised. Since then, a number of trials have verified the existence of negative feedback loop both in vitro and in vivo. NO, whether released from exogenous donors or applied in authentic NO solution, is able to inhibit NOS activity and also intervenes in NOS expression processes by its effect on transcriptional nuclear factor NF-κB. The existence of negative feedback regulation of NOS may provide a powerful tool for experimental and clinical use, especially in inflammation, when massive NOS expression may be detrimental.

Endothelial dysfunction in spontaneously hypertensive rats: focus on methodological aspects.

Despite the apparent consensus on the existence of endothelial dysfunction in conduit and resistance arteries of spontaneously hypertensive rats (SHR), a commonly employed experimental model of hypertension, there are a number of reports showing that endothelium-dependent vasodilatory responses are similar, or even increased, in SHR compared with their normotensive counterparts. The present paper aims to discuss the rationale for these apparent discrepancies, including the effect of age, type of artery and methodological aspects. Data from the literature indicate that the age of the animal is a contributing factor and that endothelial dysfunction is likely to be a consequence of hypertension. In addition, the use of antioxidant additives, such as ascorbic acid or ethylene diaminetetraacetic acid, and differences in the level of initial arterial stretch, might also be of importance because they may modify the oxidative status of the artery and the levels of vasoactive factors released by the endothelium.

Chronic low-dose L-NAME treatment effect on cardiovascular system of borderline hypertensive rats: feedback regulation?

OBJECTIVES: The effect of 8-week-lasting low-dose treatment of NG-Nitro-L-arginine methyl ester (L-NAME), a nitric oxide (NO) synthase inhibitor, was investigated in borderline hypertensive rats (BHR) to examine, whether dose of 1.5 mg/kg/day affects feedback regulation of NO synthesis. METHODS: Blood pressure (BP) of 12 weeks old Wistar and BHR rats was determined non-invasively by tail-cuff. NO synthase (NOS) activity was determined by conversion of [3H]-L-arginine to [3H]-L-citrulline in the aorta, left ventricle (LV) and hypothalamus. Vascular function of the femoral artery was determined using Mulvany's myograph in isometric conditions. RESULTS: Chronic low-dose L-NAME treatment of BHR induced sustained blood pressure elevation and left ventricular hypertrophy associated with the decrease in NOS activity in left ventricle and unaltered NOS activity in the aorta. By contrast, the improvement of LV and aortic NOS activity was found in Wistar rats. In hypothalamus, no changes in NOS activity were found in both BHR and Wistar. In Wistar, acetylcholine-induced relaxation of the femoral artery was increased and serotonin-induced and noradrenalin-induced constriction were reduced in L-NAME treated group. These effects, however, were not seen in BHR. CONCLUSION: The results indicate that NOS/NO feedback regulation works differently under conditions of normotension and prehypertension. Low-dose L-NAME treatment accentuated NO production in normotensive rats, but it failed to improve NOS activity in BHR.