Assessment of core capacities for antimicrobial stewardship practices in indian hospitals: Report from a multicentric initiative of global health security agenda

Introduction: Antimicrobial-resistant HAI (Healthcare associated infection) are a global challenge due to their impact on patient outcome. Implementation of antimicrobial stewardship programmes (AMSP) is needed at institutional and national levels. Assessment of core capacities for AMSP is an important starting point to initiate nationwide AMSP. We conducted an assessment of the core capacities for AMSP in a network of Indian hospitals, which are part of the Global Health Security Agenda-funded work on capacity building for AMR-HAIs. Subjects and Methods: The Centers for Disease Control and Prevention's core assessment checklist was modified as per inputs received from the Indian network. The assessment tool was filled by twenty hospitals as a self-administered questionnaire. The results were entered into a database. The cumulative score for each question was generated as average percentage. The scores generated by the database were then used for analysis. Results and Conclusion: The hospitals included a mix of public and private sector hospitals. The network average of positive responses for leadership support was 45%, for accountability; the score was 53% and for key support for AMSP, 58%. Policies to support optimal antibiotic use were present in 59% of respondents, policies for procurement were present in 79% and broad interventions to improve antibiotic use were scored as 33%. A score of 52% was generated for prescription-specific interventions to improve antibiotic use. Written policies for antibiotic use for hospitalised patients and outpatients were present on an average in 72% and 48% conditions, respectively. Presence of process measures and outcome measures was scored at 40% and 49%, respectively, and feedback and education got a score of 53% and 40%, respectively. Thus, Indian hospitals can start with low-hanging fruits such as developing prescription policies, restricting the usage of high antibiotics, enforcing education and ultimately providing the much-needed leadership support.

Effects of clinical use and sterilization on surface topography and surface roughness of three commonly used types of orthodontic archwires.

Aim: To evaluate the changes in surface topography and roughness of stainless steel (SS), nickel‑titanium and beta‑titanium (β‑Ti) archwires after clinical use and sterilization. Settings and Design: Thirty wires each of SS, nitinol, and β‑Ti (3M Unitek) were tested in as received, as received and autoclaved, and clinically retrieved then autoclaved conditions. Materials and Methods: A sterilization protocol of 134°C for 18 min was performed using an autoclave. Surface topography of specimens from each subgroup was examined using an environmental scanning electron microscope (ESEM model Quanta 200, The Netherlands) at ×100, ×1000, and ×2500 magnifications. Surface roughness was measured using arithmetic mean roughness (Ra) values obtained from optical profilometric scanning (Taylor Hobson, Leicester, UK). Statistical Analysis: Data were analyzed by one‑way analysis of variance and Tukey’s post‑hoc procedures. Results: Scanning electron microscope images revealed an increase in surface irregularities in SS and nitinol wires after clinical use. There was a significant increase in Ra values of SS orthodontic wires after intra‑oral exposure (P = 0.0002). Conclusion: Surface roughness of SS wires increased significantly after clinical use. Autoclave sterilization did not affect considerably on surface characteristics of any archwire.

Pain Control In Orthodontics - Causes And Management.

Orthodontic patients experience pain and discomfort to a varying degree during the course of treatment. Since pain is one of the important reasons for not seeking the orthodontic treatment, pain control is important both for patient and clinician. In the present article we made an attempt to highlight the various orthodontic procedures which cause pain and discomfort, mechanism of pain and the methods of evaluating the pain. There are various methods of managing pain but analgesics are still the main treatment modality to reduce orthodontic pain despite their side effects. There are some reports suggesting the use of Tens (transcutaneous electrical nerve stimulation) and low level lasers for the control of pain, further convincing research is required to use them as a main treatment modality.