Decolonization and Pathogen Reduction Approaches to Prevent Antimicrobial Resistance and Healthcare-Associated Infections.

Antimicrobial resistance in healthcare-associated bacterial pathogens and the infections they cause are major public health threats affecting nearly all healthcare facilities. Antimicrobial-resistant bacterial infections can occur when colonizing pathogenic bacteria that normally make up a small fraction of the human microbiota increase in number in response to clinical perturbations. Such infections are especially likely when pathogens are resistant to the collateral effects of antimicrobial agents that disrupt the human microbiome, resulting in loss of colonization resistance, a key host defense. Pathogen reduction is an emerging strategy to prevent transmission of, and infection with, antimicrobial-resistant healthcare-associated pathogens. We describe the basis for pathogen reduction as an overall prevention strategy, the evidence for its effectiveness, and the role of the human microbiome in colonization resistance that also reduces the risk for infection once colonized. In addition, we explore ideal attributes of current and future pathogen-reducing approaches.

Antifungal efficacy of natural antiseptic products against Candida auris.

Candida auris is an emerging fungal pathogen responsible for healthcare-associated infections and outbreaks with high mortality around the world. It readily colonizes the skin, nares, respiratory and urinary tract of hospitalized patients, and such colonization may lead to invasive Candida infection in susceptible patients. However, there is no recommended decolonization protocol for C. auris by international health authorities. The aim of this study is to evaluate the susceptibility of C. auris to commonly used synthetic and natural antiseptic products using an in vitro, broth microdilution assay. Synthetic antiseptics including chlorhexidine, povidone-iodine, and nystatin were shown to be fungicidal against C. auris. Among the natural antiseptics tested, tea tree oil and manuka oil were both fungicidal against C. auris at concentrations less than or equal to 1.25% (v/v). Manuka honey inhibited C. auris at 25% (v/v) concentrations. Among the commercial products tested, manuka body wash and mouthwash were fungicidal against C. auris at concentrations less than or equal to 0.39% (w/v) and 6.25% (v/v) of products as supplied for use, respectively, while tea tree body wash and MedihoneyTM wound gel demonstrated fungistatic properties. In conclusion, this study demonstrated good in vitro antifungal efficacy of tea tree oil, manuka oil, manuka honey, and commercially available antiseptic products containing these active ingredients. Future studies are warranted to evaluate the effectiveness of these antiseptic products in clinical settings.

Candida auris is an emerging superbug fungus that poses a serious threat to global public health. The excellent antifungal efficacy of natural antiseptics and their commercial hygiene products provide new insights into the development of an alternative decolonization regimen against C. auris.

Decolonization and antiracism: intersecting pathways to global health equity.

In this paper, as Black scholars, we address ways that interventions designed to promote equity in health can create pathways for coupling decolonization with antiracism by drawing on the intersection of the health of Africans and African Americans. To frame this intersection, we offer the Public Health Critical Race Praxis (PHCRP) and the PEN-3 Cultural Model as antiracism and decolonization tools that can jointly advance research on colonization and racism globally. We argue that racism is a global reality; PHCRP, an antiracism framework, and PEN-3, a decolonizing framework, can guide interventions to promote equity for Africans and African Americans.

The development of moral reasoning in urban, high-social class families from Gujarat, India: A longitudinal study from middle childhood to late adolescence.

The aims of the present study were to quantitatively test hypotheses based on the cultural-developmental approach among children and adolescents in Vadodara, India, and to use qualitative analyses to examine the use of indigenous moral concepts. The study included 72 participants who were interviewed at two different age points, separated by approximately 4.5 years. At Time 1, participants were in middle childhood (Mage = 8.22 years) and in early adolescence (Mage = 11.54 years). At Time 2, the same participants were in early adolescence (Mage = 12.87 years) and late adolescence (Mage = 15.77 years). Three findings stood out: (1) As expected, the degree of use of Autonomy increased over the course of adolescence, as did the types of moral concepts. (2) The degree of use of Community significantly increased from middle childhood to adolescence. Duty, within Community was evoked prominently and consistently across all age points suggesting that aspects of social membership emerge early in Indian children's moral reasoning and remain important through adolescence. (3) The use of Divinity was prominent in middle childhood and its use decreased significantly through early adolescence; with a trend for a decrease in its use from early to late adolescence. While much of the reasoning in middle childhood was dominated by a concern for Punishment Avoidance from God, by adolescence Customary Traditional Authority and God's Authority gained prominence. Findings highlight aspects of adolescent moral reasoning that are largely missing in Western studies and point to the utility of emic, indigenous approaches to study moral development.

A Culturally Humble Approach to Designing a Sports-Based Youth Development Program With African-Australian Community.

This article draws on the concept of cultural humility, to describe and analyze a decolonizing approach to co-designing a primary prevention basketball program for young African-Australian people in Melbourne, Australia. We explore the potential for genuine collaboration and power-sharing with a culturally diverse community through collaboratively developing the co-design process and resultant program design. This article highlights the central role of UBUNTU in the co-design process, prioritizing African ways of knowing, being, and doing within a Westernized social work and design context. Through reporting on the stages of program design, we offer an example of how Indigenous knowledges and philosophies such as UBUNTU might be incorporated into co-design through cultural humility. We suggest this allows for a transformation of design tools and processes in ways that undermine oppressive and marginalizing power imbalances in design and social work.

Decolonially speaking, sensing, and thinking: Racialized tuition-based family therapists learning without teaching.

We address the ethical implications of training and becoming family therapists in the United States when considering the colonial control and management of knowledge by the westernized institutionalized university. We do so decolonially. Through the work of decolonial thinkers, doers, and sensers, we center our discussion on the heteropatriarchal Eurocentric institutionalization of knowledge linked to the development and sustainability of structures of family therapy training through racialization and monetization. We discuss a decolonial understanding of race in relation to the liberalized politics of diversity, equity, and inclusion and upward mobility of family therapy education. Most importantly, we reflect upon the possibilities of reexistence within family therapy, fissuring the colonial structures of training tuition-based family therapists. We locate those possibilities through practices of crack-making, epistemic insurgence, and mischief. Our discussions and reflections are developed throughout by thinking, sensing, and speaking decolonially, storying our racialized incarnated lives from the saberes, ज्ञान, rhythms, vapors, or tastes of our communities, displaced by the European cannon. We embrace a decolonial pedagogy of learning without teaching, positioning family therapy education as a site for sociopolitical struggle and action toward possibilities of reexistence.

Do no harm: A call to action by nurses to dismantle structural violence against LGBTQ+ youth.

This commentary addresses structural violence - an overlooked and unrecognized harm within nursing. Structural violence within nursing practice refers to the violent impacts of racism, classism, homophobia, and transphobia as well as other biases on vulnerable and underprivileged groups. As one of the largest and most trusted health professions, collectively nursing has the power to leverage their influence to mitigate the harmful effects of structural violence when caring for LGBTQ+ youth.

From group mentoring to collective liberation: The imperative to decolonize nursing academia.

BACKGROUND: Four Black early-career faculty members, one Black doctoral student, and a Black senior faculty member, (herein referred to as scholars), previously engaged in cross-cultural mentoring with a White senior researcher to bolster their scholarship. PURPOSE: In the years following the 2020 racial reckoning, the scholars were motivated to reconvene by the realization that traditional scholarship activities of academia ignore historical educational oppression and fail to account for the contemporary effects of racism and discrimination rooted in American colonialism. METHODS: Collaborative autoethnography, a decolonizing qualitative approach to research, was used to explicate our journeys in academia. The tenets of Freire's critical pedagogy (conscientização, scholarship, praxis) framed our collective experiences. DISCUSSION: We describe resisting academic structures of power, discrimination, and disadvantage through reformation, crafting a vision statement, and utilizing positions of influence. CONCLUSION: To decolonize nursing academia, we implore the scholarly community to pursue liberation and contest structures that center Whiteness and marginalize collectivism and collaboration.

Decolonizing nursing for health equity: A scoping review.

BACKGROUND: The recent push to "decolonize nursing" has become a critical movement to address institutional racism, but the term has circulated through nursing circles enough to risk becoming a buzzword. PURPOSE: This article clarifies "decolonizing nursing" by addressing the following questions: (a) How has "decolonizing nursing" been discussed in nursing research? (b) What specific projects have been implemented to decolonize nursing? (c) How has decolonizing nursing been related to health equity? METHODS: We conducted a scoping review and searched CINAHL, PubMed, and PsycINFO databases. A total of N = 56 records were included. DISCUSSION: "Decolonization" has referred to a range of ideas related to resisting Western ideals, legitimizing Indigenous knowledge, and repatriating land and territory especially to Indigenous and dispossessed communities. Few empirical studies have examined the relationship between decolonization or colonialism and specific health outcomes. CONCLUSION: Decolonization differs from other social justice initiatives. To clarify what decolonizing nursing means, researchers can engage with historical, interdisciplinary, and community-based participatory research. In turn, nursing research will understand colonialism's historical context, provide evidence that supports policies that protect Indigenous territory, and design clinical interventions that promote health equity for dispossessed populations.

Decolonizing nursing knowledge: Challenging Eurocentrism centering Global South voices.

BACKGROUND: Exploring decolonization in nursing knowledge, particularly through Latin American nursologists, is crucial. Initially focused on underrecognized thought schools in Latin America and the concept of "Cuidado" versus Eurocentric paradigms, this paper extends the discussion on decolonization as potentially colonizing. PURPOSE: This paper examines the decolonization discourse in nursing reinforcing colonization, arguing that the nursing metaparadigm remains Eurocentric, neglecting Global South contributions. METHODS: The article critically discusses emerging theoretical ideas and situational theories from Latin America relevant to decolonizing nursing knowledge, providing analysis and proposing decolonization paths in nursing. DISCUSSION: The paper calls for genuine decolonization, urging Global North scholars to engage with indigenous, marginalized, and non-Western perspectives. It stresses the importance of acknowledging historical injustices, fostering cultural sensitivity, and revising nursing curricula for inclusivity and equity. CONCLUSION: Ultimately, the paper advocates for a transformative approach to nursing knowledge that challenges colonial legacies, promoting a more inclusive and equitable field.

Nurses You Should Know: The power of online microlearning to decolonize nursing's history.

Black, Hispanic, Indigenous, Native American, Asian, and Pacific Islander nurses have played a critical role in shaping professional nursing and health care. Despite their contributions, the narrative of nursing's origin has predominantly revolved around the legacy of a single white British nurse, Florence Nightingale. This paper presents the development of the Nurses You Should Know (NYSK) project, which sought to decolonize the narrative surrounding nursing's history and highlight the contributions and experiences of past and present-day nurses of color. The NYSK project utilized an Equity-Centered Community Design process, incorporating microlearning strategies, storytelling, and history to develop a digital library of over 100 stories of nurses of color that capture nursing's rich and complex history. Utilized as a resource within nursing curricula, the NYSK project stands as a testament to the power of history in promoting a more inclusive and equitable future for nursing, offering valuable insights for educators, researchers, and practitioners.

Ethical and Equitable Digital Health Research: Ensuring Self-Determination in Data Governance for Racialized Communities.

Recent studies highlight the need for ethical and equitable digital health research that protects the rights and interests of racialized communities. We argue for practices in digital health that promote data self-determination for these communities, especially in data collection and management. We suggest that researchers partner with racialized communities to curate data that reflects their wellness understandings and health priorities, and respects their consent over data use for policy and other outcomes. These data governance approach honors and builds on Indigenous Data Sovereignty (IDS) decolonial scholarship by Indigenous and non-indigenous researchers and its adaptations to health research involving racialized communities from former European colonies in the global South. We discuss strategies to practice equity, diversity, inclusion, accessibility and decolonization (EDIAD) principles in digital health. We draw upon and adapt the concept of Precision Health Equity (PHE) to emphasize models of data sharing that are co-defined by racialized communities and researchers, and stress their shared governance and stewardship of data that is generated from digital health research. This paper contributes to an emerging research on equity issues in digital health and reducing health, institutional, and technological disparities. It also promotes the self-determination of racialized peoples through ethical data management.

Anti-oppression as praxis in the research field: Implementing emancipatory approaches for researchers and community partners.

Equity, diversity, and inclusion (EDI) and anti-oppression (AO) policies are implemented in research to address intersecting systemic barriers for marginalized populations. Grant applications now include questions about EDI to ensure researchers have considered how research designs perpetuate discriminatory practices. However, complying with these measures may not mean that researchers have engaged with AO as praxis. Three central points emerged from our work as a women's research collective committed to embedding AO practices within the research methodology of our community-based study. First, research ideas must be connected to larger pursuits of AO in and across marginalized communities. Secondly, AO as praxis in the research design is an exercise in centering cultural knowledge and pragmatic research preparation and response that honours the collective. Lastly, AO approaches are not prescriptive. They must shift, adapt, and change based on the research project and team, creating space for transformative resistance and emancipation of racialized researchers and community workers.

A decolonized mental health framework for black women and birthing people.

Black perinatal mental health is an area that has received less focus in psychotherapy research in the United States. This area is especially important as recent attacks on Reproductive Justice impact not only birthing people's rights and freedoms but also their mental health and emotional well-being. Current psychotherapy interventions are rooted in evidence-based treatments (EBTs) that may not always align with the values and practices of frameworks like radical healing and liberation psychology that are meant to emphasize collective healing and empower individuals. To date, psychological research involving radical healing and liberation psychology approaches have not had a specific focus on birthing people. Psychotherapeutic interventions have also largely excluded the unique intersectional identities and healing of Black birthing people. In moving toward decolonizing psychotherapy, this conceptual paper will propose a multi-pronged framework for addressing racial stressors and other mental health concerns during the perinatal period. The proposed framework, The Three Cs of Decolonization, includes three components: Community, Creativity, and Connection to Self. These components of the framework are meant to address and highlight culturally relevant ways of healing for Black birthing people. Larger systemic changes are needed and necessary for the desired change across mental health, medical, and other integrated systems of care that have been impacted by racism and discrimination. The current framework is dedicated to healing and empowering Black birthing people with approaches and considerations that are consistent with Reproductive Justice.

Comparison of global decolonization efficacy with mupirocin nasal drop and chlorhexidine mouthwash in acute leukemia patients: randomized clinical trial.

PURPOSE: Neutropenic fever remains a major complication in acute leukemia. Decolonization is assumed as a promising intervention for eradicating causative agents of infection. METHODS: In this randomized clinical trial, 96 patients with acute leukemia were assigned randomly to mupirocin nasal drop 2% (n = 32), chlorhexidine mouthwash 0.2% (n = 33), and control group (n = 31). In control group, patients did not receive any medication for decolonization. All patients received treatment for 5 days (2 days prior to chemotherapy until 3 days after chemotherapy). Pharynx and nasal swabs were taken prior to the intervention and at the end of decolonization period in all groups. Antibiotic susceptibility testing was performed by the disc diffusion method in order to identify bacterial isolates. RESULTS: Bacterial recovery of both nasal and pharynx swabs was observed after global decolonization with mupirocin nasal drop. Decolonization with mupirocin significantly eradicated Coagulase-negative staphylococci (CONS) in both nasal and pharynx swabs (p-value = 0.000). Moreover, mupirocin decreased Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) species. Chlorhexidine mouthwash significantly eradicated CONS in pharynx swabs (p-value = 0.000). In addition, both decolonization strategies decreased both antibiotic use and frequency of fever in leukemic patients. CONCLUSION: Global decolonization with mupirocin nasal drop not only eradicates both nasal and pharynx microorganisms, but also reduces antibiotic requirement and frequency of fever in patients with acute leukemia. The protocol of the present study was approved on December 2016 (registry number: IRCT20160310026998N6).

Decolonizing a Wretched Healthcare System: The African Public Health Practitioner Case.

Introduction: Over the past two years, public health practitioners in African countries have worked actively to combat the Coronavirus Disease 2019 (COVID-19) pandemic with relatively low fatality rates. This pandemic has forced healthcare professionals to re-think and redesign the healthcare system within their own country. Methods: Using the Afrocentric PEN-3 framework and a letter style, the purpose of this commentary was to describe the positive, existential, and negative socio-cultural values associated with African healthcare systems. The commentary also highlights socio-cultural factors affecting public trust in African healthcare systems and their health agencies and how systematically decolonizing them may decrease foreign reliance and empower efficient locally based solutions. Results: We, as African public health practitioners, make three key points in this commentary. First, African public health practitioners have developed resilience within under-resourced healthcare systems. Secondly, oral tradition in African societies and its byproduct (social media) is the means through which people connect and share what they know about any topics (COVID-19). Thirdly, African leaders have particularly contributed to the high level of distrust in their countries' healthcare systems in favor of the healthcare systems of industrialized countries. Conclusion: This commentary concludes with implications for encouraging African public health practitioners to cultivate the resilience that has led to contributing to the wellness of millions of Africans during this COVID-19 pandemic.

Decolonizing global AI governance: assessment of the state of decolonized AI governance in Sub-Saharan Africa.

Global artificial intelligence (AI) governance must prioritize equity, embrace a decolonial mindset, and provide the Global South countries the authority to spearhead solution creation. Decolonization is crucial for dismantling Western-centric cognitive frameworks and mitigating biases. Integrating a decolonial approach to AI governance involves recognizing persistent colonial repercussions, leading to biases in AI solutions and disparities in AI access based on gender, race, geography, income and societal factors. This paradigm shift necessitates deliberate efforts to deconstruct imperial structures governing knowledge production, perpetuating global unequal resource access and biases. This research evaluates Sub-Saharan African progress in AI governance decolonization, focusing on indicators like AI governance institutions, national strategies, sovereignty prioritization, data protection regulations, and adherence to local data usage requirements. Results show limited progress, with only Rwanda notably responsive to decolonization among the ten countries evaluated; 80% are 'decolonization-aware', and one is 'decolonization-blind'. The paper provides a detailed analysis of each nation, offering recommendations for fostering decolonization, including stakeholder involvement, addressing inequalities, promoting ethical AI, supporting local innovation, building regional partnerships, capacity building, public awareness, and inclusive governance. This paper contributes to elucidating the challenges and opportunities associated with decolonization in SSA countries, thereby enriching the ongoing discourse on global AI governance.

Bacterial diversity and specific taxa are associated with decolonization of carbapenemase-producing enterobacterales after fecal microbiota transplantation.

OBJECTIVES: We evaluated the effect of fecal microbiota transplantation (FMT) on the clearance of carbapenemase-producing Enterobacterales (CPE) carriage. METHODS: We performed a prospective, multi-center study, conducted among patients who received a single dose of FMT from one of four healthy donors. The primary endpoint was complete clearance of CPE carriage two weeks after FMT with a secondary endpoint at three months. Shotgun metagenomic sequencing was performed to assess gut microbiota composition of donors and recipients before and after FMT. RESULTS: Twenty CPE-colonized patients were included in the study, where post-FMT 20% (n = 4/20) of patients met the primary endpoint and 40% (n = 8/20) of patients met the secondary endpoint. Kaplan-Meier curves between patients with FMT intervention and the control group (n = 82) revealed a similar rate of decolonization between groups. Microbiota composition analyses revealed that response to FMT was not donor-dependent. Responders had a significantly lower relative abundance of CPE species pre-FMT than non-responders, and 14 days post-FMT responders had significantly higher bacterial species richness and alpha diversity compared to non-responders (p < 0.05). Responder fecal samples were also enriched in specific species, with significantly higher relative abundances of Faecalibacterium prausnitzii, Parabacteroides distasonis, Collinsella aerofaciens, Alistipes finegoldii and Blautia_A sp900066335 (q<0.01) compared to non-responders. CONCLUSION: FMT administration using the proposed regimen did not achieve statistical significance for complete CPE decolonization but was correlated with the relative abundance of specific bacterial taxa, including CPE species.

Cutting Periprosthetic Infection Rate: Staphylococcus aureus Decolonization as a Mandatory Procedure in Preoperative Knee and Hip Replacement Care-Insights from a Systematic Review and Meta-Analysis of More Than 50,000 Patients.

Background: No consensus in the literature has been found about the necessity of implementing a decolonization screening protocol for Staphylococcus aureus in patients who undergo prosthesis implantation of the knee (TKA) or of the hip (THA), with the aim of reducing periprosthetic infections (PJIs). Methods: A systematic literature search was conducted using PubMed, Web of Science, and Embase in April 2024. Studies conducted on patients who underwent a TKA or THA and who followed a screening and decolonization protocol from S. aureus were included. The benefits of implementing this protocol were evaluated through the number of infections overall caused by S. aureus and other pathogens. The risk of bias and quality of evidence were assessed using Cochrane guidelines. Results: A total of 922 articles were evaluated, and of these, 12 were included in the study for a total of 56,930 patients. The results of the meta-analysis showed a reduced risk of overall PJI (p = 0.002), PJI caused by S. aureus (p < 0.0001), and PJI caused by MRSA (p < 0.0001) and highlighted no differences between the two groups in the onset of a PJI caused by other bacteria (p = 0.50). Conclusions: This study showed that the screening and decolonization of S. aureus in patients undergoing THA or THA procedures reduced the risk of a PJI. The screening and decolonization protocol for this kind of patient represents an important procedure for the safety of the patient and in social-economic and medico-legal terms.