Infectious Disorders - Drug Targets (Formerly Current Drug Targets - Infectious Disorders) - Volume 13, Issue 3, 2013

Surgical wound contamination leading to surgical site infection can result from disruption of the intended airflow in the operating room (OR). When personnel enter and exit the OR, or create unnecessary movement and traffic during the procedure, the intended airflow in the vicinity of the open wound becomes disrupted and does not adequately remove airborne contaminants from the sterile field. An increase in the bacterial counts of airborne microorganisms is noted during increased activity levels within the OR. Researchers have studied OR traffic and door openings as a determinant of air contamination. During a surgical procedure the door to the operating room may be open as long as 20 minutes out of each surgical hour during critical procedures involving implants. Interventions into limiting excessive movement and traffic in the OR may lead to reductions in surgical site infections in select populations.

Hemodialysis (HD) patients are particularly vulnerable to Hepatitis B virus (HBV) and have less sustained and lower antibody response to HBV vaccination. Among blood-borne pathogens, HBV can stay alive on environmental surfaces for over a week. The incidence of HBV was extremely high among HD patients. HBV vaccination, screening of blood products and infection control measures lead to significant decrease of HBV among HD patients. The infection control measures include; Medication safety and injection practices, environmental cleaning and disinfection, reuse of dialyzers for same patients, hand hygiene, isolation and barrier precautions, HBV vaccination and routine serology checking, assuring HBV immune status for HD unit staff, transmission based precautions and outbreak management.

Aim: The aim of this paper is to provide a review of the hand hygiene literature and to give an example of the use of this literature to create a multimodal sustainable hand hygiene program. Background: The literature describes six key ingredients to consider when designing a hand hygiene program. These ingredients include leadership engagement, environmental assessment, education, a tight feedback loop, communication and routine revitalization. Programs tend to be more successful when several of these ingredients are utilized. Program Implementation: The multimodal program created and implemented at one academic medical center is described. This program is an example of using the six key ingredients found in the literature with an interesting marketing and revitalization strategy. Conclusion: The literature offers strategies that have led to successful programs in the past. The multimodal use of these strategies was demonstrated in the creation of a successful hand hygiene program at one academic medical center.

There are approximately 5,700 hospitals in the United States, 3,000-4,000 that are antiquated or obsolescing. To meet increased service demands, remain financially viable; meet needs to upgrade aging infrastructure and incorporate medical and technology advancements, healthcare facilities are in a perpetual state of construction. Outbreaks of nosocomial infections have historically been documented in association with construction and renovation actives within health care facilities. For most healthy individuals, environmental exposures to etiological agents, results in no adverse effects but in immune-compromised patient, they are left susceptible to inadvertent exposures during construction to opportunistic bacteria, fungi and viruses. Evidence scientifically linking construction work and nosocomial infections as well as the efficacy and clinical relevance of infection control precautions is somewhat lacking but the empirical evidence and recommendations to support protective measures is steadily growing. Opening a “Pandora's Box” during construction can unleash unintended consequences therefore; it is imperative that a thorough, multidisciplinary approach towards an infection control plan is put clearly and firmly in place allowing health care construction projects to move forward with confidence that patient safety is the first specification.

Eradication of Legionella species from water distribution systems especially in hospital settings has proven to be challenging. Legionella species causes Legionnaire’s disease that is a potentially fatal respiratory disease often acquired through the aerosolization of contaminated water. Monochloramine has been used successfully in the municipal water systems to eradicate Legionella and there is currently limited data to support its use in the hospital setting. This technology appears to be affordable, safe and effective at penetrating biofilm in water distribution systems.

Ultraviolet (UV) radiation is capable of disinfecting surfaces, water and air. The UV technology was used for many years. However, safer and more effective delivery systems of UV radiation, make it a very useful option for disinfection. Effective disinfection of environmental surfaces is a key step in the prevention of spread of infectious agents. The traditional manual cleaning is essential in assuring adequate elimination of contamination. However, terminal cleaning is frequently suboptimal or unpredictable in many circumstances. UV-C radiation is an adjunctive disinfectant new technology that could kill a wide array of microorganisms including both vegetative and spore forming pathogens. The technology is getting more affordable and has produced consistent reproducible significant reduction of bacterial contamination.

The incidence of end-stage renal disease (ESRD) has almost doubled over past 2 decades. Despite decreasing overall hospital admission rates for ESRD population, the rate of infection-related hospitalizations has steadily increased. Infection remains the second most common cause of mortality in this patient population. Specifically, in the hemodialysis (HD) patients, the vascular access related infections are the most common identifiable source of infection. This concise review provides an update on the bacteremia related to vascular access primarily the catheters (Catheter Related Blood Stream Infection- CRBSI) in HD patients emphasizing on the determinants ranging from the epidemiology to pathogenesis, risk factors, cost implications and prevention. Staphylococcus aureus, coagulase negative Staphylococci, and Enterococci are the most common causative microorganisms implicated in CRBSI. The pathogenesis of CRBSI includes organism entry into the blood stream followed by adherence to catheter, colonization and biofilm formation. Vascular access type, catheter position, and prior bacteremic episodes are strongly associated with blood stream infection. Preventive measures should be multidisciplinary in nature and should include avoidance of central venous catheters, best practices for catheter care, surveillance, antimicrobial catheter lock solutions, and use of antibiotic impregnated catheters.

Over the last two decades, occurrence of bacterial resistance to commonly used antibiotics has necessitated the development of safer and more potent anti-microbial drugs. However, the development of novel antibiotics is severely hampered by adverse side effects, such as drug-induced liver toxicity. Several antibacterial drugs are known to have the potential to cause severe liver damage. The major challenge in developing novel anti-microbial drugs is to predict, with certain amount of probability, the drug–induced toxicity during the pre-clinical stages, thus optimizing and reducing the time and cost of drug development. Toxicogenomics approach is generally used to harness the potential of genomic tools and to understand the physiological basis of drug-induced toxicity based on the in-depth analysis of Metagenomic data sets, i.e., transcriptional, translational or metabolomic profiles. Toxicogenomics, therefore, represents a new paradigm in the drug development process, and is anticipated to play an invaluable role in future to develop safe and efficacious medicines, by predicting the toxic potential of a new chemical entity (NCE) in early stages of drug discovery. This review examines the toxicogenomic approach in predicting the safety/toxicity of novel anti-microbial drugs, and analyses the promises, pitfalls and challenges of applying this powerful technology to the drug development process.