Hand hygiene is a critical component of infection prevention in hospitals, but the unintended consequences include water splashing out of a sink to spread contaminants from dirty taps according to new research. Researchers at the University of Michigan Health System assessed eight different designs across four intensive care units to determine how dirty sinks and taps really are. They found that a shallow depth of the sink bowl enabled potentially contaminated water to splash onto patient care items, healthcare worker hands, and into patient care spaces – at times at a distance of more than four feet (1.2 meter) from the sink itself. “The inside of taps where you can’t clean were much dirtier than expected,” said study author Kristen VanderElzen, MPH, CIC. “Potentially hazardous germs in and around sinks present a quandary for infection preventionists, since having accessible sinks for hand washing is so integral to everything we promote. Acting on the information we found, we have undertaken a comprehensive tap replacement program across our hospital.” To identify the grime level of the sinks, the researchers used adenosine triphosphate (ATP) monitoring to measure the cleanliness. Visible biofilm was associated with higher ATP readings, and cultures tested over the course of the study grew Pseudomonas aeruginosa, mould, and other environmental organisms. The research team also found aerators on sinks where they had previously been removed, pointing to an overall inconsistency of equipment protocols across the facility. Included in the design improvement program were sink guards, which were shown to limit splash significantly. “As we learn more about the often stealthy ways in which germs can spread inside healthcare facilities, infection preventionists play an increasingly important role in healthcare facility design – including in the selection of sink and tap fixtures – as this study illustrates,” said 2019 APIC President Karen Hoffmann, RN, MS, CIC, FSHEA, FAPIC. “Because the healthcare environment can serve as a source of resistant organisms capable of causing dangerous infections, an organization’s infection prevention and control program must ensure that measures are in place to reduce the risk of transmission from environmental sources and monitor compliance with those measures.”
APIChttps://tinyurl.com/yysdlvsb
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Scientists at Sanford Burnham Prebys Medical Discovery Institute, the University of Hong Kong, Scripps Research, UC San Diego School of Medicine, the Icahn School of Medicine at Mount Sinai and UCLA have identified 30 existing drugs that stop the replication of SARS-CoV-2, the virus that causes Covid-19. Almost all of the drugs are entirely different from those currently being tested in clinical trials, and weren’t previously known to hold promise for Covid-19 treatment. The new candidates expand the number of “shots on goal” for a potential Covid-19 treatment and could reach patients faster than drugs that are created from scratch. The study was placed on bioRxiv – https://www.biorxiv.org/content/10.1101/2020.04.16.044016v1 – an open-access distribution service for preprints of life science research.
“We believe this is one of the first comprehensive drug screens using the live SARS-CoV-2 virus, and our hope is that one or more of these drugs will save lives while we wait for a vaccine for Covid-19,” said Sumit Chanda, Ph.D., director of the Immunity and Pathogenesis Program at Sanford Burnham Prebys and senior author of the study. “Many drugs identified in this study – most of which are new to the Covid-19 research community – can begin clinical trials immediately or in a few months after additional testing.”
The drugs were identified by screening more than 12,000 drugs from the ReFRAME drug repurposing collection – a library of existing drugs that have been approved by the FDA for other diseases or have been tested extensively for human safety. ReFRAME was created by Scripps Research with support from the Bill & Melinda Gates Foundation to accelerate efforts to fight deadly diseases. Every compound was tested against the live SARS-CoV-2 virus, isolated from patients in Washington State and China, and the final 30 drugs were selected based on their ability to stop the virus’s growth.
“For us, the starting point for finding any new antiviral drug is to measure its ability to block viral replication in the lab,” says Chanda. “Since the drugs we identified in this study have already been tested in humans and proven safe, we can leapfrog over the more than half decade of studies normally required to get approval for human use.”
Highlights of the scientists’ discoveries follow. Each drug or experimental compound requires further evaluation in clinical trials to prove its effectiveness in treating people with Covid-19 before it can be used broadly.
27 drugs that are not currently under evaluation for Covid-19 were effective at halting viral replication. 17 of these drugs have an extensive record of human safety from clinical studies in non-Covid-19 diseases, including four—clofazimine, acitretin, tretinoin and astemizole—that were previously approved by the FDA for other indications.
Thus far, six of the 17 were shown to be effective at concentrations, or doses, likely to be effective and tolerable in humans. Four of these six drugs – apilimod, MLN-3897, VBY-828 and ONO 5334 – have been tested clinically for diseases including rheumatoid arthritis, Crohn’s disease, osteoporosis and cancer.
In addition to the 27 drug candidates, three drugs currently in clinical trials for Covid-19, including remdesivir and chloroquine derivatives, were also shown to be effective at stopping the growth of SARS-CoV-2. These results reaffirm their promise as potential Covid-19 treatments and support the continuation of ongoing clinical trials to prove their effectiveness in patients.
Depending on regulatory guidance, the newly identified drug candidates may proceed directly to Covid-19 clinical trials or undergo further testing for efficacy in animal models.
“Based on the extensive data in this study, we believe the four drugs described above—apilimod, MLN-3897, VBY-825 and ONO 5334 – represent the best new approaches for a near-term Covid-19 treatment,” says Chanda. “However, we believe that all 30 drug candidates should be fully explored, as they were clearly active and effective at halting viral replication in our tests.”
“We have chosen to release these findings to the scientific and medical community now to help address the current global health emergency,” Chanda continues. “The data from this drug screen is a treasure trove; and we will continue to mine the data from this analysis, with a goal to find additional candidate therapies – and combinations of drugs – as they are identified.”
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Starna, established 1964, has a worldwide reputation for quality, service and innovation in the production and supply of spectrophotometer cells, optical components and Certified Reference Materials (CRMs). World-leader with over 50 years’ experience in the production of Certified Reference Materials for UV-Vis-NIR & Fluorescence spectroscopy; it is the only company to achieve both ISO/IEC 17025 and ISO 17034 for this range of products. A highly regarded manufacturer of high precision quartz and glass Cells/Cuvettes for Photometers and Fluorimeters. Starna sells worldwide to instrument manufacturers, pharmaceuti- cals, life-biosciences, R&D laboratories, medical companies and universities.
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Scientists at the Center for Cardiology of the Mainz University Medical Center have examined the success of more than 13,575 minimally invasive procedures on the mitral valve in the largest study of their kind to date. Key findings: Although patients grew older during the period from 2011 to 2015 and the number of procedures increased from year to year, mortality and complication rates remained consistently low. Mitral valve insufficiency is the most common heart valve disease in Europe and the USA. About ten percent of people over the age of 75 are affected. The patients suffer from a weak closure and thus a leaky mitral valve. Until a few years ago, there was often only the possibility of a drug therapy, because for an open operation, the patients are usually too old, have too many comorbidities or the function of the left ventricle is too bad. There is now a new option to treat this leaky heart valve minimally invasive with a Mitraclip implantation. Germany is one of the leading nations in this innovative, new process. "Several studies with small groups of patients have already been published for the evaluation of the procedure with regard to frequency of inserting the clip or the safety of the procedure, however, so far there have been no large data collections", explain the first and last authors of the study Dr. Ralph Stephan von Bardeleben, Dr. Lukas Hobohm and Dr. Karsten Keller. "That’s why it was a good idea to examine the implantation numbers and the complication rates in Germany on a larger scale." Their results show: The annual implantation numbers in Germany increased more than fivefold from 815 in 2011 to 4,432 in 2015. In total, the study included 13,575 patients who had been treated with Mitraclip. Earlier studies referred to a maximum of 1,064 procedures. The patients were usually between 70 and 89 years old and on average they got older and older. Another important result is that the complication rate or mortality did not change significantly during the period studied. Important prognostic factors related to hospital death were cardiac insufficiency, blood transfusion due to bleeding complications, stroke, pulmonary embolism, or pericardial effusion. The authors conclude from their findings that despite the dramatic fivefold increase in the implantation rate of the clip, the procedure has very low early-stage complication rates during hospitalization. "Catheter-assisted valvular heart valve therapy has evolved from a niche treatment of inoperable patients into a relevant and safe treatment option in only ten years, as our new study emphasizes once again", underlines Dr. von Bardeleben. The Mainz University Medical Center occupies a leading position in the field of gentle heart valve therapy, both nationally and internationally. "In 2018, we implanted more than 700 heart valves, making us one of the largest university centers for minimally invasive heart valve therapy," explains Professor Dr. Thomas Münzel, Director of Cardiology I at the Center for Cardiology of the Mainz University Medical Center. "There were more than 200 Mitraclips. This number is unique in the world.” Cardiologists have also taken the opportunity to establish a new Heart Valve Unit in Mainz because of a striking increase in demand for such interventions in recent years. The advantage of the new heart valve unit: All relevant steps in the course of a heart valve implantation – from patient admission to planning and aftercare on the intensive care unit until to the discharge of patients – take place at one ward. Mainz University Medical Centerhttps://tinyurl.com/y4y75dvs
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Intensive care units (ICUs) can be extremely stressful for patients and families. Changes in the way ICUs are run may help mitigate that stress, two new studies suggest.
Researchers looking at the impact of making ICU visiting hours more flexible, and the keeping of ICU diaries by staff and family members, found some interventions could, at the very least, lessen stress for families, according to the two reports published.
“The efforts made by the researchers are admirable,” said Dr. Albert Wu, an internist and professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health who was not involved in either study. “But I think this is just a drop in the ocean. The ICU experience is so profoundly disorienting, especially for patients, but also for family members and even, to some extent, the people providing the care.”
The visitation study was originally designed to see if longer visiting hours might help prevent delirium in ICU patients. They didn’t – but they did appear to lower anxiety and depression in relatives. In that study, the number of visitation hours in 36 adult ICUs in Brazil was expanded from a maximum of 4.5 hours a day to 12 hours a day. From June 2017 to June 2018, 1,685 patients were randomly assigned to the shorter or more flexible visitation schedules.
Average duration of visits was longer in the group with a 12-hour window for visitation: 4.8 hours versus 1.4. And while patient delirium wasn’t reduced with the longer hours, anxiety and depression levels in the family members declined significantly.
“Although a flexible visiting policy for ICUs has been recommended by professional society guidelines, the evidence suggests most ICUs adopt restrictive visitation models, possibly motivated by risks . . . such as disorganization of care, infections and staff burnout,” said the study’s lead author, Dr. Regis Goulart Rosa of Hospital Moinhos de Vento, Porto Alegre, Brazil. “Interestingly these risks were not confirmed in the ICU visits study.”
The longer, flexible, visiting hours offer a host of benefits: “for patients, the benefits of reassurance, emotional support and comfort, for family members the opportunity to help a loved one,” Rosa said in an email.
Reutershttps://tinyurl.com/y4cupw8m
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Washing contaminated hospital bedsheets in a commercial washing machine with industrial detergent at high disinfecting temperatures failed to remove all traces of Clostridium difficile (C. difficile), a bacteria that causes infectious diarrhoea, suggesting that linens could be a source of infection among patients and even other hospitals, according to a study published.
"The findings of this study may explain some sporadic outbreaks of C. difficile infections in hospitals from unknown sources, however, further research is required in order to establish the true burden of hospital bedsheets in such outbreaks," said Katie Laird, PhD, Head of the Infectious Disease Research Group, School of Pharmacy, De Montfort University, Leicester, United Kingdom and lead author of the study. "Future research will assess the parameters required to remove C. difficile spores from textiles during the laundry process."
Researchers inoculated swatches of cotton sheets with C. difficile. The swatches were then laundered with sterile uncontaminated pieces of fabric using one of two different methods — either in a simulated industrial washing cycle using a washer extractor with and without detergent or naturally contaminated linens from the beds of patients with C. difficile infection were put through a full commercial laundry where they were washed in a washer extractor (infected linen wash) with industrial detergent, pressed, dried, and finished according to current the National Health Service in the United Kingdom’s healthcare laundry policy (Health Technical Memorandum 01-04 Decontamination of Linen for Health and Social Care (2016). Researchers measured the levels of contamination before and after washing.
Both the simulated and the commercial laundering via a washer extractor process failed to meet microbiological standards of containing no disease-causing bacteria, the study found. The full process reduced C. difficile spore count by only 40 percent, and this process resulted in bacteria from the contaminated sheets being transferred to the uncontaminated sheets after washing.
Researchers concluded that thermal disinfection conditions currently required by the UK National Health System are inadequate for the decontamination of C. difficile spores. There may be potential to spread C. difficile back into the hospital environment as linens could be a source for outbreaks at other healthcare facilities through businesses that collect, launder and redistribute rented linens to multiple hospitals and care facilities, as is the case at NHS facilities.
SHEA
https://tinyurl.com/yxh9aa8j
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Thirona, a Dutch start-up company specialising in AI to analyse medical images, is offering one of their products for free to medical imaging specialists in an effort to combat the COVID-19 pandemic. International Hospital speaks to Dr Eva van Rikxoort, the Managing Director and founder of Thirona, about the company and its products. International Hospital: Thirona is a Dutch company established in 2014. Can you give our readers a bit of background about the company? Eva van Rikxoort: Thirona started in 2014 as a spin-off from the Radboud University in Nijmegen. We started with two full-time employees and we have built our company to 25 full-time employees and 20 part-time medical analysists. Together, we developed artificial intelligence software to analyse chest CT scans, chest X-ray images and retina images. Healthcare specialists around the world use our AI software for diseases like asthma, COPD, tuberculosis and diabetic retinopathy. IH: What led you to set it up? EVR: I was doing research on chest CT analysis at the Radboud University with my co-founder Prof. Bram van Ginneken. We saw that there was a gap between research that was being done on potential clinical solutions and putting those into clinical practice; Thirona was founded with the vision to bridge that gap. IH: What products did you have at that time? EVR: We started with two launching customers for one solution – our AI solution for chest CT analysis. IH: Where does the name Thirona come from? EVR: The name Thirona comes from the Celtic goddess named Thirona, worshipped for healing. Although more commonly spelled as ‘Sirona’ in the Latin alphabet, the spelling Thirona was chosen to reflect our roots in thoracic image analysis. IH: Delft Imaging appears to be part of Thirona. Can you tell us a bit more about Delft Imaging and the relationship between Thirona and Delft Imaging? EVR: Technically, Thirona and Delft Imaging are separate companies, although we collaborate extensively and practically work together as sister companies. Where Thirona specialises in artificial intelligence software for medical imaging, Delft Imaging specialises in diagnostic innovations that can be used in developing countries. For example, our AI solution for chest X-ray analysis (CAD4TB) is developed by Thirona and distributed by Delft Imaging. IH: Can you tell us briefly about your key products and where they are being used? EVR: We essentially offer three categories of products. AI software for chest CT analysis focusing on COPD and asthma, called LungQ; AI software for X-ray analysis – focusing on tuberculosis, called CAD4TB; and AI software for the analysis of retinal images – focusing on DR, AMD and Glaucoma, called RetCAD. LungQ allows for the quantification of chest CTs and is used for patient monitoring, treatment planning and clinical trial analysis.It is mostly used across the United States and European Union. CAD4TB is used in 40 countries around the world and has screened more than 6 million people for tuberculosis. RetCAD is being rolled out across Europe and Asia. IH: If we look at how the company has grown over the past 5-6 years — can you explain what has been the driving force behind the growth? EVR: As a spin-off of the Radboud University, our company (and our solutions) is rooted in science. Every software product we develop is thoroughly validated (through 150+ publications to date) and that level of validation drives our growth, I believe; our customers know the type of quality we aim to offer. IH: What guided your research and development? In other words, why did you take the product development route you have taken? EVR: We are a demand-driven organisation. Meaning, we develop and work on where our customers and partners have needs to be supported. That has led us on the route we have been on for the past sevearl years. IH: What are the main challenges have you faced and how have you overcome them? EVR: One of the main challenges was keeping the same culture in the company during the growth from a small team of a few people with similar backgrounds to a larger more diverse team. We did this by installing a management team structure. By making it a focus for each team allowed us to overcome any difficulties. IH: Most recently, you are offering a free AI-powered COVID-19 tool – the CAD4COVID-Xray. I understand it has been developed on the back of your successful TB-screening AI tool, CAD4TB. Can you explain how the CAD4TB tool works and how you adapted it for COVID-19 screening. EVR: Yes, we developed two AI-powered COVID-19 tools actually: one for chest X-ray analysis and one for chest CT. Both have been built on the technical foundation of our existing and proven CAD4TB and LungQ solutions. Because there were underlying algorithms already in place, we were able to rapidly pivot these for the detection of COVID-19. IH: How will this tool help healthcare facilities and COVID-19 patients? EVR: CAD4COVID-XRay and CAD4COVID-CT automatically detect COVID-19 related abnormalities and thereby help with triage before any follow-up testing, like RT-PCR. This helps to reduce the workload of healthcare personnel and alleviate the burden on RT-PCR tests. Furthermore, both solutions show the percentage of affected lung tissue, thereby helping to track disease progress and recovery. IH: How has the AI tool been validated? Has it been approved for use in Europe? In which other countries / regions has it been approved? EVR: We have done several studies for both solutions (a publication on CAD4COVID-XRay was recently published in Radiology), through which we were able to prove that the software performs on par with expert human readers. For both solutions we have applied for class IIa CE certification, which we expect to receive soon. IH: Are the CAD4COVID tools specific to certain platforms? EVR: Both solutions are system agnostic. They process DICOM images which can be from any type of system. IH: Are you receiving many requests for the CAD4COVID-Xray AI tool? EVR: The response has been tremendous, which is probably also because we made the software available free-of-charge. CAD4COVIDXRay was launched first (March 31st) and has since been made available to 30+ healthcare facilities across more than 20 countries. We are especially focusing on resource-constrained settings (mostly in developing countries) because in those settings CT often has limited availability, making X-ray all the more important. CAD4COVID-CT was launched a month later and is available at 15+ facilities across 10 countries. We are also integrating it in several platforms through collaborations with partner companies like Smart Reporting. IH: Why are you offering it for free? EVR: We knew that for CAD4COVID to have the biggest impact during the pandemic and provide the most support to healthcare specialists globally, we needed to roll it out rapidly. In order to do that, we wanted to avoid as many hurdles as possible that could cause a delay in facilities being able to use the software. We believe cost is a big factor in that. That’s why we, supported by several organisations, have made it available to use free-of-charge. IH: Can it be shared easily with healthcare facilities that want to use it? EVR: Yes, people can fill in a form on www.delft.care/cad4covid (for CAD4COVID-XRay) and www.thirona.eu/cad4covid (for CAD4COVID-CT) and our team will reach out to them to help them set it up for their facility. IH: Is any training required to use the CAD4COVID tools? EVR: The tool is designed to be very intuitive, but we have developed an onboarding tool to guide new users on how to use the software effectively. IH: Lastly, what’s in the pipeline for Thirona and how do you envisage development of the field of AI in medical imaging? EVR: We are quickly expanding into other areas like cystic fibrosis on chest CT analysis, silicosis on chest X-ray analysis and cataract on retinal images. I believe that AI still has to prove itself in many settings, for many different use cases, but that it will become more and more accepted over time, and we already see this happening at incredible speed. In time, AI will leverage the efforts of our healthcare specialists, helping them to diagnose and determine treatment planning quicker, more effectively and reduce their workload in the meantime.
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The German Federal Government asked domestic vehicle manufacturers to produce medical equipment, such as masks and ventilators, to help fight Covid-19.
In a statement, the Volkswagen Group announced 20 March it will be providing about 200,000 category FFP-2 and FFP-3 protective face masks for public health protection in the near future. The donation is being made in close cooperation with Federal Minister of Health Jens Spahn.
A spokesperson said the company has more than 125 industrial 3-D printers which could be repurposed to make respirators or other necessary devices, once they receive the required info.
Kathrin Schnurr, spokesperson for Daimler AG Human Resources and External Affairs Communications told International Hospital: “We have inquiries from the medical technology sector. We are currently examining how we can contribute, for example by providing 3D printers or our production expertise.
“In addition, we are in constant communication with the authorities about how and where we can help, for example to sustain the supply infrastructure.”
This follows a trend across Europe as companies unrelated to the medical-device industry offer to retool factories to help make equipment to combat the shortage of devices such as respirators and face masks.
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An observational study conducted in a French hospital showed that human contact was responsible for 90 percent of the spread of one species of antibiotic-resistant bacteria to new patients, but less than 60 percent of the spread of a different species. Audrey Duval of the Versailles Saint Quentin University and Institut Pasteur in Paris, France, and colleagues present these findings. People treated in hospitals and other healthcare settings are increasingly at risk of infection with multidrug-resistant bacteria. Many of these microbes produce enzymes called extended-spectrum β-lactamases (ESBLs), which make them resistant to antibiotics. Understanding how ESBL bacteria spread from person to person is key to developing effective prevention strategies. In the new study, Duval and colleagues distributed wearable sensors to hundreds of patients and healthcare workers in a French hospital. Equipped with RFID tags, the sensors allowed the researchers to track patterns of human contact between patients over an eight-week period. Meanwhile, they systematically screened patients for ESBL-producing Escherichia coli and Klebsiella pneumonia. “By combining digital epidemiology and rapid microbiological diagnostic tools, we may be entering a new era to understand and control the risk of hospital-acquired infection with multidrug-resistant bacteria,” Duval says. An observational study conducted in a French hospital showed that human contact was responsible for 90 percent of the spread of one species of antibiotic-resistant bacteria to new patients, but less than 60 percent of the spread of a different species. Audrey Duval of the Versailles Saint Quentin University and Institut Pasteur in Paris, France, and colleagues present these findings in PLOS Computational Biology. People treated in hospitals and other healthcare settings are increasingly at risk of infection with multidrug-resistant bacteria. Many of these microbes produce enzymes called extended-spectrum β-lactamase (ESBLs), which make them resistant to antibiotics. Understanding how ESBL bacteria spread from person to person is key to developing effective prevention strategies. The scientists found that 90 percent of the spread of ESBL K. pneumonia to new patients could be explained by direct or indirect contact with patients who had the same bacteria within the previous eight weeks; this figure was less than 60 percent for ESBL E. Coli. The findings suggest that contact-prevention strategies — primarily hand hygiene — can be very efficient in limiting transmission of ESBL K. pneumonia. However, additional measures, such as environmental decontamination or using antibiotics more appropriately, may be necessary to prevent spread of ESBL E. Coli. The researchers suggest that the same kind of wearable-sensor analysis could be extended to other multidrug-resistant species. Investigation of more detailed genomic data could further illuminate how ESBL-producing bacteria spread. “By combining digital epidemiology and rapid microbiological diagnostic tools, we may be entering a new era to understand and control the risk of hospital-acquired infection with multidrug-resistant bacteria,” Duval says.
ScienceDailyhttps://tinyurl.com/yxbspjca
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