Background: Despite rigorous disinfection, fumigation and air treatment, infectious microbial load has been found to circulate and survive for significant duration in health care settings. This raises significant concerns for hospital acquired infections. We have developed a novel, hybrid, trap-and-kill airborne-microbicidal technology called ZeBox which is efficient in clearing 99.999% of airborne microbial load under controlled lab conditions. In this study we evaluate the clinical performance of the ZeBox in reducing airborne and surface microbial load in two independent hospital settings.
Methods: The studies were conducted in single bed and multi bed ICU of two hospitals. Airborne and surface microbial loads were collected at pre-determined sampling sites pre- and post-deployment of the ZeBox enabled device. The Normality of data distribution was determined using the Shapiro-Wilk test. Statistical significance was determined using Students T test and Mann-Whitneys U test. Pathogenic and opportunistic organisms were characterized using 16S rDNA sequencing. Furthermore, the antibiotic sensitivity of the isolated organisms was tested against current treatments of choice across major antibiotic classes.
Results: Post-deployment, we found statistically significant reductions in both airborne and surface microbial load within the operating range of the ZeBox enabled technology . Across the both hospital ICUs, there was 90% reduction of airborne microbial load on average, and 75% reduction of surface microbial load on average, providing a low bioburden zone of roughly 10-15 feet diameter around the unit. These reduced microbial levels were maintained during the entire duration of device operation over several weeks. Many of the clinical isolates recovered from one of the hospitals were drug resistant, which highlighted the potential ability of ZeBox to eliminate drug-resistant microbes and thereby reduce the frequency of hospital acquired infections.
Conclusions: ZeBox enabled technology can significantly reduce a broad spectrum of microbial burden in air and on surfaces in clinical settings. It can thereby serve an unmet need in reducing the incidence of hospital acquired infections.
Background: Obstetric patients in ICU, pose a clinical challenge to intensivists and obstetricians. The objective of our study was to evaluate the incidence, indications and interventions in these patients. Secondly to assess whether clinical scores can help to estimate severity of the condition, predict mortality and morbidity in these patients.Methods: It was a retrospective observational study including all antepartum and postpartum patients admitted to ICU between January 2018 to June 2020.Results: Majority of patients needing ICU care were in the antepartum period (82.8%). Multigravida (55.2%) and unbooked cases (60.4%) constituted a major proportion of patients. Hypertensive disorders of pregnancy followed by sepsis amounted for common etiologies. Transfusions (43.2%), ventilatory support (26%) followed by inotropic support (14.9%) were the interventions required in the majority number of patients. Maternal mortality rate was 2.23%. Out of the clinical scores, OEWS (Obstetric early warning score) was a better modality to assess the severity of the disease and the need for ICU care.Conclusions: A multidisciplinary approach and close coordinated care of obstetric patients can reduce the maternal mortality rate. Early identification of critically ill obstetric patients using clinical scores can help us in triaging patients to high dependency units/ICU. OEWS is a very simple score which helps us in identifying patients needing intensive care.
Background
Operative hysteroscopic intravascular absorption syndrome (OHIA) is the constellation of signs and symptoms due to fluid overload during hysteroscopic procedures. It can present with hyponatremia, deranged coagulation, pulmonary, and cerebral edema which are life-threatening issues. To our knowledge, this is the first reported case of recurrent OHIA syndrome which was managed uneventfully.
Case presentation
A 26-year-old American Society of Anesthesiologist (ASA) patient presented with primary infertility and prolonged, heavy menstruation. The abdominal and transvaginal ultrasound (USG) revealed a large posterior intramural fibroid of size 6.1 cm × 4.2 cm with submucosal intracavitary extension. She was planned for two-step laparoscopic and hysteroscopic evaluation and resection of the myoma under general anesthesia. Severe OHIA syndrome occurred with 1.5% glycine in phase 1 resection and recurred with 0.9% sodium chloride in phase 2 resection of intrauterine myoma at two different surgical settings. The uniqueness of this case is recurrence of OHIA syndrome in the same patient despite the use of normal saline (NS) due to lack of precautionary measures for fluid management.
Conclusions
Normal saline as an irrigating medium may not eliminate the risk of OHIA. Lack of adequate fluid management strategies can be detrimental especially in cases of hysteroscopic myoma resections. Following a standard protocol for vigilant monitoring under general anesthesia is the key in successful management.
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