Reengineering the patient's environment: Establishment of a "Red Box" to improve communications with patients on isolation precautions.

BACKGROUND: Hospitalized patients on isolation precautions are reported to have less frequent health care provider (HCP) visits owing to time required to don and doff personal protective equipment (PPE). Thus, placement on isolation precautions leads to negative patient perception and affects their care. METHODS: A "Red Box" that extended 3 feet beyond the door was marked in 50 patient rooms of a tertiary care hospital and used for patient communication by HCPs without PPE. HCP and patient perceptions of the Red Box were studied via a survey and personal interviews. Compliance was also observed by "secret shoppers." Rates of health care-associated infections (HAIs) were monitored. RESULTS: Over a 1-year period, HCPs reported improved patient communication, utilization of time, and increased interactions. HCPs used the Red Box to communicate with patients 76% of the time. In 92% of the cases, HCPs remembered not to use PPE while in the Red Box and were observed 80% of the time using PPE when venturing beyond the Red Box. Patients reported improved frequency of HCP contact and satisfaction. HAIs in these units did not show any increase compared with those in prior years. CONCLUSIONS: HCP interaction and communication with patients on isolation precautions improved with the reengineering of the patient environment in the form of the Red Box. HAI rates did not increase with this intervention.

Effectiveness of fecal-derived microbiota transfer using orally administered capsules for recurrent Clostridium difficile infection.

BACKGROUND: Clostridium difficile infection (CDI), a complication of antibiotic-induced injury to the gut microbiome, is a prevalent and dangerous cause of infectious diarrhea. Antimicrobial therapy for CDI is typically effective for acute symptoms, but up to one third of patients later experience recurrent CDI. Fecal-derived microbiota transplantation (FMT) can ameliorate the underlying dysbiosis and is highly effective for recurrent CDI. Traditional methods of FMT are limited by patient discomfort, risk and inefficient procedures. Many individuals with recurrent CDI have extensive comorbidities and advanced age. Widespread use of FMT requires strategies that are non-invasive, scalable and applicable across healthcare settings. METHODS: A method to facilitate microbiota transfer was developed. Fecal samples were collected and screened for potential pathogens. Bacteria were purified, concentrated, cryopreserved and formulated into multi-layered capsules. Capsules were administered to patients with recurrent CDI, who were then monitored for 90 days. RESULTS: Thirteen women and six men with recurrent CDI were provided with microbiota transfer with orally administered capsules. The procedure was well tolerated. Thirteen individuals responded to a single course. Four patients were cured after a second course. There were 2 failures. The cumulative clinical cure rate of 89% is similar to the rates achieved with reported fecal-derived transplantation procedures. CONCLUSIONS: Recurrent CDI represents a profound dysbiosis and a debilitating chronic disease. Stable cure can be achieved by restoring the gut microbiome with an effective, well-tolerated oral capsule treatment. This strategy of microbiota transfer can be widely applied and is particularly appropriate for frail patients.

Infections in alcoholic liver disease.

Alcoholic individuals are at increased risk of infection in general, in part because of immune defects. In addition, associated situations, such as depressed mental status, increase risk to specific syndromes such as lung abscess related to depressed consciousness and aspiration. Social factors related to hygiene and living situations are also linked to specific microorganisms, such as Mycobacteria tuberculosis, Bartonella quintana, Vibrio vulnificus, and Capnocytophaga canimorus..