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Swall A, Ebbeskog B, Lundh Hagelin C, Fagerberg I.

Stepping out of the shadows of Alzheimer’s disease : a phenomenological hermeneutic study of older people with Alzheimer’s disease caring for a therapy dog.

Int J Qual Stud Health Well-being, 12(1) : 1347, December 2017.

Living with Alzheimer’s disease (AD) can involve a person being unable to recall and convey information in daily life. There are several ways to provide person-centred care to older people with AD, e.g. by empowering them in a situation. The use of animal-assisted therapy (AAT) with a therapy dog in the care of people with dementia is increasing, with the presence of a therapy dog being described as improving, among other things, the well-being and socialization of the person. The aim of this study was to illuminate meanings of care for people with AD in their encounters with a therapy dog.
The study used video-recorded observations of the person with AD and the dog. Data were transcribed and analysed using a phenomenological hermeneutic method..
The main theme was «Using one’s own resources and abilities as a human being», which meant being the person one can be and distancing oneself from the symptoms of AD during the time with the dog.
The feelings evoked in the people with AD included empathy and altruism, which allowed for a sense of joy and tenderness, which may induce a sense of self-worth, of being needed, and of being meaningful.

Friedman E, Krause-Parello CA.

Companion animals and human health : benefits, challenges, and the road ahead for human-animal interaction.

Rev Sci Tech. 37(1) : 71-82, April 2018. 

There is ample evidence that human-animal interaction (HAI) is associated with health. Studies encompass three general categories: those that compare companion animal owners with individuals who do not own companion animals, those examining brief, ‘one-off’ contacts with animals, and those that review animal-assisted interventions. The health benefits demonstrated typically include reductions in depression and loneliness, while enhancing social interaction or social skills, and decreasing anxiety and arousal. Other health benefits associated with companion animals include the promotion of exercise or physical activity. The types of human-animal contact that have been evaluated include visual contact, physical contact, and looking at images of animals. The species used in interventions include dogs, cats, horses, rabbits, goats, hamsters and crickets. Despite these benefits, HAIs are also associated with problems, including allergies, asthma, zoonoses, animal bites and scratches, and human falls. Other problems include grief and negative emotions when a companion animal is injured or dies. Companion animal ownership is also expensive. Inconsistent policies concerning keeping animals in housing and enabling service animals to access public places make it difficult to live with companion animals or keep service animals in some circumstances. Additional research is needed to provide an evidence base to evaluate the efficacy of particular types of HAI using a given type of animal. This will document specific outcomes for an individual with certain characteristics and assist in promoting the future use of HAI to enhance human and animal health and well-being.

Mota Pereira J, Fonte D.

Pets enhance antidepressant pharmacotherapy effects in patients with treatment resistant major depressive disorder.

J Psychiatr Res.,104 : 108-113, September 2018.

Treatment resistant major depressive disorder (TR-MDD) is a severe disease, with very low remission rates. The resistance to pharmacotherapy leads to the search of non-pharmacological alternative approaches. Animal therapy has been used in patients with psychiatric conditions and the results have been promising. However, there have been no studies in TR-MDD patients with pet adoption. This study assessed the impact of TR-MDD patients adopting a pet. Eighty patients were suggested to adopt a pet, and 33 accepted the challenge. Other 33 patients constituted the control group (did not accept the suggestion of pet adoption and did not already have a pet). All patients maintained their usual pharmacotherapy. All participants were evaluated at baseline, 4, 8 and 12 weeks for depressive symptoms using HAMD17 and GAF. Results show that the pet group had an improvement in HAMD17 and GAF scores as well as higher response and remission rates compared to the control group, where no patient responded or remitted. Therefore, pets can be used as an effective adjuvant to pharmacotherapy with regular medical appointments..

Gupta OT, Wiebe DJ, Pyatak EA, Beck AM.

Improving medication adherence in the pediatric population using integrated care of companion animals.

Patient Educ Couns. 101(10) : 1876-1878, October 2018.

Medication non-adherence occurs in more than half of children with chronic conditions. Unfortunately, most strategies for improving adherence have had limited success in the pediatric population highlighting the need for novel interventions that establish healthy self-management habits for children and adolescents. In this paper we discuss innovative strategies to improve adherence by embedding a medical regimen within a pet care routine, thereby capitalizing on the benefits of a structured habit while providing opportunities for development of autonomy in children and fostering collaborative parent interactions.

Cortegiani A, Misseri G, Fasciana T, Giammanco A, Giarratano A, Chowdhary A.

Epidemiology, clinical characteristics, resistance, and treatment of infections by Candida auris.

J Intensive Care. 29 (6) : 69, October 2018. 

Candida spp. infections are a major cause of morbidity and mortality in critically ill patients. Candida auris is an emerging multi-drug-resistant fungus that is rapidly spreading worldwide. Since the first reports in 2009, many isolates across five continents have been identified as agents of hospital-associated infections. Independent and simultaneous outbreaks of C auris are becoming a major concern for healthcare and scientific community. Moreover, laboratory misidentification and multi-drug-resistant profiles, rarely observed for other non-albicans Candida species, result in difficult eradication and frequent therapeutic failures of C auris infections. The aim of this review was to provide an updated and comprehensive report of the global spread of C auris, focusing on clinical and microbiological characteristics, mechanisms of virulence and antifungal resistance, and efficacy of available control, preventive, and therapeutic strategies.

Bentz ML, Sexton DJ, Welsh RM, Litvintseva AP.

Phenotypic switching in newly emerged multidrug-resistant pathogen Candida auris.

Med Mycol.16, October 2018.

Candida auris is an emerging, multidrug-resistant yeast that can spread rapidly in healthcare settings. Phenotypic switching has been observed in other Candida species and can potentially interfere with correct identification. The aim of this study is to address misidentification of C. auris by describing alternate phenotypes after broth enrichment and subculturing on CHROMagar Candida. Each isolate displayed different frequencies of phenotypic switching, suggesting a strain to strain variability. Increased knowledge of the multiple phenotypes of C. auris increases the chance of isolating and identifying C. auris by reducing the risk of discarding false negative alternate colony morphologies.

Dekkerová J, Lopez-Ribot JL, Bujdáková H.

Activity of anti-CR3-RP polyclonal antibody against biofilms formed by Candida auris, a multidrug-resistant emerging fungal pathogen.

BMJ Open. 2017 Nov 8;7(11):e016251. American Journal of Infection Control, 2017, 45(11) : 1249-1253

Fungal biofilm has remained a serious medical problem that complicates treatment of mycoses. In particular, once biofilms are formed, they display high levels of resistance against most common antifungals. Candida auris is currently considered as a serious emerging fungal pathogen frequently exhibiting high levels of resistance to antifungals. Recent studies have confirmed that C. auris shares similarity with Candida albicans in regards to virulence-associated proteins involved in adherence and biofilm development. Complement receptor 3-related protein (CR3-RP) is one of the key surface antigens expressed by Candida species during biofilm formation. Here, we have investigated the presence of this cell surface moiety on the surface of C. auris, as well as the potential of anti-CR3-RP polyclonal antibody (Ab) to inhibit biofilm formation by this emerging fungal pathogen. Using indirect immunofluorescence and ELISA, we were able to confirm the presence of CR3-RP in C. auris cells within biofilms. Further, not only anti-CR3-RP Ab was able to inhibit biofilm formation by multiple C. auris strains when added during the adherence phase, but it also demonstrated activity against C. auris 24-h pre-formed biofilms, which compared favorably to levels of inhibition achieved by treatment with current conventional antifungals fluconazole, amphotericin B, and caspofungin. Overall, our data demonstrate the presence of this antigen on the surface of C. auris and points to the potential of anti-CR3-RP Ab in eradication of biofilms formed by this novel fungal pathogen.

Junker K, Bravo Ruiz G, Lorenz A, Walker L, Gow NAR, Wendland J.

The mycoparasitic yeast Saccharomycopsis schoenii predates and kills multi-drug resistant Candida auris.

Sci Rep., 8(1) : 14959, October 2018.

Candida auris has recently emerged as a multi-drug resistant fungal pathogen that poses a serious global health threat, especially for patients in hospital intensive care units (ICUs). C. auris can colonize human skin and can spread by physical contact or contaminated surfaces and equipment. Here, we show that the mycoparasitic yeast Saccharomycopsis schoenii efficiently kills both sensitive and multi-drug resistant isolates of C. auris belonging to the same clade, as well as clinical isolates of other pathogenic species of the Candida genus suggesting novel approaches for biocontrol.

McCord J, Prewitt M, Dyakova E, Mookerjee S, Otter JA

Reduction in Clostridium difficile infection associated with the introduction of hydrogen peroxide vapour automated room disinfection.

J Hosp Infect.,94(2) : 185-7, October 2016.

The clinical impact of implementing hydrogen peroxide vapour (HPV) disinfection of rooms vacated by patients with Clostridium difficile infection (CDI) was evaluated. Breakpoint time series analysis indicated a significant reduction (P<0.001) in the CDI rate at the time when HPV disinfection was implemented, resulting in a reduction in the CDI rate from 1.0 to 0.4 cases per 1000 patient-days in the 24 months before HPV usage compared with the first 24 months of HPV usage. HPV should be considered to augment the terminal disinfection of rooms vacated by patients with CDI.

Ali S, Muzslay M, Bruce M, Jeanes A, Moore G, Wilson AP.

Efficacy of two hydrogen peroxide vapour aerial decontamination systems for enhanced disinfection of meticillin-resistant Staphylococcus aureus, Klebsiella pneumoniae and Clostridium difficile in single isolation rooms.

J Hosp Infect., 93(1) : 70-7, May 2016.

Hydrogen peroxide vapour (HPV) disinfection systems are being used to reduce patients’ exposure to hospital pathogens in the environment. HPV whole-room aerial disinfection systems may vary in terms of operating concentration and mode of delivery.
To assess the efficacy of two HPV systems (HPS1 and HPS2) for whole-room aerial disinfection of single isolation rooms (SIRs).
Ten SIRs were selected for manual terminal disinfection after patient discharge. Test coupons seeded with biological indicator (BI) organisms [∼10(6) colony-forming units (cfu) of meticillin-resistant Staphylococcus aureus (MRSA) or Klebsiella pneumoniae, or ∼10(5)cfu Clostridium difficile 027 spores] prepared in a soil challenge were placed at five locations per room. For each cycle, 22 high-frequency-touch surfaces in SIRs were sampled with contact plates (∼25cm (2)) before and after HPV decontamination, and BIs were assayed for the persistence of pathogens.
Approximately 95% of 214 sites were contaminated with bacteria after manual terminal disinfection, with high numbers present on the SIR floor (238.0-352.5cfu), bed control panel (24.0-33.5cfu), and nurse call button (21.5-7.0cfu). Enhanced disinfection using HPV reduced surface contamination to low levels: HPS1 [0.25cfu, interquartile range (IQR) 0-1.13] and HPS2 (0.5cfu, IQR 0-2.0). Both systems demonstrated similar turnaround times (∼2-2.5h), and no differences were observed in the efficacy of the two systems against BIs (C. difficile ∼5.1log10 reduction; MRSA/K. pneumoniae ∼6.3log10 reduction). Despite different operating concentrations of hydrogen peroxide, MRSA persisted on 27% of coupons after HPV decontamination.
Enhanced disinfection with HPV reduces surface contamination left by manual terminal cleaning, minimizing the risks of cross-contamination. The starting concentration and mode of delivery of hydrogen peroxide may not improve the efficacy of decontamination in practice, and therefore the choice of HPV system may be based upon other considerations such as cost, convenience and logistics.

David Russell PhD, Dawn W.Dowding PhD, RN, FAAN  Margaret V. McDonald MSW, Victoria Adams BSN, MSN, FNP-BC, Robert J.Rosati PhD, Elaine L.Larson PhD, RN, FAAN, CIC, Jingjing Shang PhD, RN

Factors for compliance with infection control practices in home healthcare: findings from a survey of nurses’ knowledge and attitudes toward infection control.

American Journal of Infection Control, Vol 46 (11) : 1211-121, November 2018.

Infection is a leading cause of hospitalization among home healthcare patients. Nurses play an important role in reducing infection among home healthcare patients by complying with infection control procedures. However, few studies have examined the compliance of home healthcare nurses with infection control practices or the range of sociocultural and organizational factors that may be associated with compliance.
This study analyzed survey responses from nurses at 2 large, certified home healthcare agencies (n = 359), to explore levels of compliance with infection control practices and identify associated demographic, knowledge, and attitudinal correlates.
Nurses reported a high level of infection control compliance (mean = 0.89, standard deviation [SD] = 0.16), correct knowledge (mean = 0.85, SD = 0.09), and favorable attitudes (mean = 0.81, SD = 0.14). Multivariate mixed regression analyses revealed significant positive associations of attitudinal scores with reported level of compliance (P < .001). However, knowledge of inflection control practices was not associated with compliance. Older (P < .05) and non-Hispanic black (P < .001) nurses reported higher compliance with infection control practices than younger and white non-Hispanic nurses.
These findings suggest that efforts to improve compliance with infection control practices in home healthcare should focus on strategies to alter perceptions about infection risk and other attitudinal factors.

Kathryn Lim MIPH, MPH, Claire Kilpatrick MSc, Julie Storr MBA, Holly Seale PhD, MPH

Exploring the use of entertainment-education YouTube videos focused on infection prevention and control.

American Journal of Infection Control, Vol 46 (11) : 1218-1223, November 2018.

As a communications strategy, education entertainment has been used to inform, influence, and shift societal and individual behaviors. Recently, there has been an increasing number of entertainment-education YouTube videos focused on hand hygiene. However, there is currently no understanding about the quality of these videos; therefore, this study aimed to explore the social media content and user engagement with these videos.
The search terms “hand hygiene” and “hand hygiene education” were used to query YouTube. Video content had to be directed at a health care professional audience. Using author designed checklists, each video was systematically evaluated and grouped according to educational usefulness and was subsequently evaluated against the categories of attractiveness, comprehension, and persuasiveness.
A total of 400 videos were screened, with 70 videos retained for analysis. Of these, 55.7% (n = 39) were categorized as educationally useful. Overall, educationally useful videos scored higher than noneducationally useful videos across the categories of attractiveness, comprehension, and persuasiveness. Miscommunication of the concept of My 5 Moments for Hand Hygiene was observed in several of the YouTube videos.
The availability of educationally useful videos in relation to hand hygiene is evident; however, it is clear that there are opportunities for contributors using this medium to strengthen their alignment with social media best practice principles to maximize the effectiveness, reach, and sustainability of their content.

Daryl S.Paulson PhD, Robert Topp RN, PhD, Robert E.Boykin MD, GregoryS chultz PhD, Qingping YangMS,

Efficacy and safety of a novel skin cleansing formulation versus chlorhexidine gluconate

American Journal of Infection Control, Vol. 46 (11) : 1262-1265, November 2018.

This study evaluated whether a multi-ingredient surfactant colloidal silver technology was noninferior to a 4% chlorhexidine gluconate (CHG) antiseptic on immediate and persistent antimicrobial activity.
The inguinal regions of 81 healthy adults were demarcated into 4 quadrants, and 3 were used for testing each product at baseline, 10 minutes, and 6 hours post-application. The log of the number of colony forming units was obtained using a cylinder sampling technique. The 95% confidence interval of the test product to the control product with a margin of 0.65 was established as the upper limit of noninferiority.
A total of 81 individuals were enrolled. The colloidal silver product was found to be noninferior to 4% CHG at both 10 minutes and 6 hours post-application.
The colloidal silver-based product was noninferior to the 4% CHG product at 10 minutes and 6 hours postapplication.

Harsha Siani BSc, Rebecca Wesgate BSc, Jean-Yves Maillard PhD

Impact of antimicrobial wipes compared with hypochlorite solution on environmental surface contamination in a health care setting : A double-crossover study

American Journal of Infection Control, Vol. 46 (10) : 1180-1187, October 2018.

Antimicrobial wipes are increasingly used in health care settings. This study evaluates, in a clinical setting, the efficacy of sporicidal wipes versus a cloth soaked in a 1,000 ppm chlorine solution.
A double-crossover study was performed on 2 different surgical and cardiovascular wards in a 1,000-bed teaching hospital over 29 weeks. The intervention period that consisted of surface decontamination with the pre-impregnated wipe or cloth soaked in chlorine followed a 5-week baseline assessment of microbial bioburden on surfaces. Environmental samples from 11 surfaces were analyzed weekly for their microbial content.
A total of 1,566 environmental samples and 1,591 ATP swabs were analyzed during the trial. Overall, there were significant differences in the recovery of total aerobic bacteria (P < .001), total anaerobic bacteria (P < .001), and ATP measurement (P < .001) between wards and between the different parts of the crossover study. Generally, the use of wipes produced the largest reduction in the total aerobic and anaerobic counts when compared with the baseline data or the use of 1,000 ppm chlorine. Collectively, the introduction of training plus daily wipe disinfection significantly reduced multidrug-resistant organisms recovered from surfaces. Reversion to using 1,000 ppm chlorine resulted in the number of sites positive for multidrug-resistant organisms rising again.
This double-crossover study is the first controlled field trial comparison of using pre-impregnated wipes versus cotton cloth dipped into a bucket of hypochlorite to decrease surface microbial bioburden. The results demonstrate the superiority of the pre-impregnated wipes in significantly decreasing microbial bioburden from high-touch surfaces.

K. Ledwoch, S.J.Dancer, J.A.Otter, K.Kerr, D.Roposte, L.Rushton, R.Weiser, E.Mahenthiralingam, D.D.Muir, J.-Y.Maillard

Beware biofilm ! Dry biofilms containing bacterial pathogens on multiple healthcare surfaces ; a multi-centre study

Journal of Hospital Infection, Vol.100 (3) : e47-e56, November 2018.

Wet biofilms associated with medical devices have been widely studied and their link with healthcare-associated infections (HCAIs) is well recognized. Little attention has been paid to the presence of dry biofilms on environmental surfaces in healthcare settings.
To investigate the occurrence, prevalence, and diversity of dry biofilms on hospital surfaces.
Sixty-one terminally cleaned items were received from three different UK hospitals. The presence of dry biofilm was investigated using culture-based methods and scanning electron microscopy (SEM). Bacterial diversity within biofilms was investigated using ribosomal RNA intergenic spacer analysis (RISA)–polymerase chain reaction and next-generation sequencing.
Multi-species dry biofilms were recovered from 95% of 61 samples. Abundance and complexity of dry biofilms were confirmed by SEM. All biofilms harboured Gram-positive bacteria including pathogens associated with HCAI; 58% of samples grew meticillin-resistant Staphylococcus aureus. Dry biofilms had similar physical composition regardless of the type of items sampled or the ward from which the samples originated. There were differences observed in the dominance of particular species: dry biofilms from two hospitals contained mostly staphylococcal DNA, whereas more Bacillus spp. DNA was found on surfaces from the third hospital.
The presence of dry biofilms harbouring bacterial pathogens is virtually universal on commonly used items in healthcare settings. The role of dry biofilms in spreading HCAIs may be underestimated. The risk may be further exacerbated by inefficient cleaning and disinfection practices for hospital surfaces.


Systematic review and meta-analysis of the effectiveness of antiseptic agents for meatal cleaning in the prevention of catheter-associated urinary tract infections

Journal of Hospital Infection, Vol 95 (3): 233-242, March 2017

Catheter-associated urinary tract infections (CAUTIs) are among the most common healthcare-associated infections. Antiseptic cleaning of the meatal area before and during catheter use may reduce the risk of CAUTIs.
To undertake a systematic review of the literature and meta-analysis of studies investigating the effectiveness of antiseptic cleaning before urinary catheter insertion and during catheter use for prevention of CAUTIs.
Electronic databases were searched to identify randomized controlled trials. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated and compared across intervention and control groups using DerSimonian–Laird random-effects model. Subgroup analyses were performed. Heterogeneity was estimated using the I2 statistic.
In total, 2665 potential papers were identified; of these, 14 studies were eligible for inclusion. There was no difference in the incidence of CAUTIs when comparing antiseptic and non-antiseptic agents (pooled OR 0.90, 95% CI 0.73–1.10; P=0.31), or when comparing different agents: povidone-iodine vs routine care; povidone-iodine vs soap and water; chlorhexidine vs water; povidone-iodine vs saline; povidone-iodine vs water; and green soap and water vs routine care (P>0.05 for all). Comparison of an antibacterial agent with routine care indicated near significance (P=0.06). There was no evidence of heterogeneity (I2=0%; P>0.05). Subgroup analyses showed no difference in the incidence of CAUTIs in terms of country, setting, risk of bias, sex and frequency of administration.
There were no differences in CAUTI rates, although methodological issues hamper generalizability of this finding. Antibacterial agents may prove to be significant in a well-conducted study. The present results provide good evidence to inform infection control guidelines in catheter management.

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