The morphological effects of penicillin on gram-negative nonsporeforming rods, especially E8cherichia coli, have been studied by several authors. Gardner (1940) reported that grotesque forms of E. coli resulted from autolytic swelling when this organism was treated with penicillin and that elongated, swollen cells resulted from incomplete fission. Weiss (1943) showed by electron micrographs that certain bacterial cells, when medicated with penicillin, became enlarged and fission was often incomplete. The effects of penicillin on intestinal bacteria as reported by Thomas and Levine (1945) included long twisting filaments in lower inhibitory concentrations and cells resembling Pasteur flasks, swelled fusiform rods, large globular cells, and irregular masses in higher concentrations. In concentrations just above those with visible growth, globular masses were found upon centrifugation and examination of the sediment. Normal rods were cultivated from the masses in the sediment. In the same year Alture-Werber, Lipschitz, Kashdan, and Rosenblatt (1945)-studied the effect of incompletely inhibitory concentrations of penicillin on Escherichia coli. These authors found organisms resembling budding fungi in the urine of patients treated with penicillin. Culturing for molds was negative, but E. coli was isolated on other media and it was concluded that penicillin was responsible for the funguslike appearance of the cells in urine. This assumption was confirmed by in vitro experiments using MacConkey's agar to which was added varying concentrations of penicillin. Morphological changes noted were diphtheroidlike, bipolar cells at 75 units per ml.; unsegmented filaments with myceliallike appearance at 100 informative review of the action of penicillin and its effect on bacterial morphology was given by Fisher (1946). Morphological variation may be induced by agents or conditions other than by the use of penicillin. Only a few of the more important aspects of the phe-183
H ospitals and health care systems facing capacity strain due to changes in patient volume, patient acuity, or resource allocation may see increases in safety events as teams adapt to new stressors. Organizations need to establish and sustain cultures that support timely and honest reporting of safety events. Nurses are pivotal in promoting patient safety, as they make up the largest health care discipline. Research demonstrates that improved nursing resources in terms of work environment, staffing, and education can be associated with improvement in quality and patient safety outcomes. 1 PROBLEM Starting in 2008, nursing leadership at a large quaternary care, pediatric medical center recognized that expansion in patient census and acuity was posing challenges for safety management
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