Trends in late-onset sepsis in a neonatal intensive care unit following implementation of infection control bundle: A 15-year audit.

AIM: Late-onset sepsis (LOS) is a frequent and important cause of morbidity and mortality in newborn infants admitted to neonatal intensive care units (NICUs). The objective of this study is to evaluate the impact of various infection control quality measures introduced as a bundle on the trends of the LOS in a NICU. METHODS: This was a prospective quality improvement study involving all neonates admitted to a NICU over a 15-year period between 2002 and 2016. The main focus areas of the bundle included collaborative team effort, hand hygiene, education, central line insertion and maintenance bundles and parenteral nutrition. The main outcome measures were LOS and central line-associated bloodstream infections. RESULTS: Yearly admissions increased during study period, from 776 in 2002 to 952 in 2016. There was a progressive decrease in LOS rate, from 4.3 to 1.6 per 1000 patient days (B coefficient -0.17, 95% confidence interval -0.25, -0.09; P < 0.001), and the central line-associated bloodstream infection rate dropped from 25 in 2003 to 5 in 2016 per 1000 central line days (B coefficient -1.20, 95% confidence interval -1.84, -0.56; P = 0.001). Hand hygiene compliance rates remained consistent, over 80%. During the study period, coagulase-negative staphylococcus caused 56% and Gram-negative organisms 18% of the total infections. CONCLUSION: Multifaceted infection control bundle practices with a concerted team effort in the implementation, with continuing education, feedback and reinforcement of best infection control practices, can sustain the gains achieved by infection control for a long period of time.

Influence of enzymes and surfactants on the disintegration behavior of cross-linked hard gelatin capsules during dissolution.

Gelatin exhibits cross-linking upon storage at stress conditions. Capsules stored at these conditions fail to show appropriate in vitro dissolution. The aim of this study is to show the effect of surfactants in the medium on the disintegration of the gelatin capsule. This is demonstrated in the presence and absence of the enzymes pancreatin and pepsin, the function of which is to improve the dissolution. Sodium lauryl sulfate (SLS) and Tween 80 are tested as surfactants. When SLS is used in the medium, dissolution is significantly hampered due to the formation of a less soluble precipitate of gelatin. Compared to SLS, Tween 80 shows far better disintegration and solubility results in dissolution media with neutral or low pH. Therefore, it is concluded in this study that Tween 80 is preferred when a surfactant is necessary to comply with sink condition requirements.

Effects of tibolone and continuous combined hormone replacement therapy on parameters in the clotting cascade: a multicenter, double-blind, randomized study.

OBJECTIVE: To determine the effects of tibolone and continuous combined HRT (ccHRT) on parameters in the clotting cascade. DESIGN: Randomized, double-blind study. SETTING: Hemostasis unit of a university hospital clinic in Germany. PATIENT(S): Sixty healthy postmenopausal women. INTERVENTION(S): Twenty-nine subjects were treated with tibolone (2.5 mg/d) and 31 with oral ccHRT containing estradiol (2 mg/d) + estriol (1 mg/d) + norethindrone acetate (1 mg/d). MAIN OUTCOME MEASURE(S): Effects on parameters in the clotting cascade at baseline and after 12 and 24 weeks of treatment. RESULT(S): Tibolone increased fibrinolysis parameters without significantly altering coagulation parameters. Treatment with ccHRT resulted in a stimulating effect on parameters of both fibrinolysis and coagulation. Tibolone showed a stronger reduction of factor VII activity; less reduction of AT-III, protein C activity, and protein S activity; stronger increase of the activated partial thromboplastin time, plasminogen and plasminogen-antiplasminogen complexes; and less increase of D-Dimer than ccHRT. Both preparations similarly reduced climacteric complaints, whereas tibolone showed less breast complaints than ccHRT. CONCLUSION(S): This study confirms that tibolone, and to a lesser extent also ccHRT, changes hemostasis parameters toward a more fibrinolytic profile, which may diminish the risk of venous thrombosis.

[Estrogen replacement in postmenopause, blood coagulation and fibrinolysis: comparison of a new kind of transdermal estradiol treatment with oral therapy with conjugated estrogens]. / Ostrogensubstitution in der Postmenopause, Blutgerinnung und Fibrinolyse: Vergleich einer neuartigen transdermalen Ostradiol-Behandlung mit der oralen Therapie mit konjugierten Ostrogenen.

Estrogen replacement therapy (ERT) appears to markedly reduce the risk of cardiovascular disease in postmenopausal women. There is evidence that estrogen effects on blood coagulation and fibrinolysis are important mediators of this beneficial effect. It is the acute phase reactants such as factor VII (F VII), von Willebrand factor (vWF) and fibrinogen (Fbg) as well as the main inhibitor of the fibrinolytic system, the plasminogen activator inhibitor (PAI 1), which have been shown to be associated with a particular predisposition or poor prognosis of cardiovascular disease. Additionally, the analysis of stabile reaction products of the coagulation cascade allows for an assessment of the loss of endothelial anticoagulant properties, i.e. endothelial injury. We compared the effects of oral versus transdermal ERT on these key parameters of the hemostatic system. 42 postmenopausal women were randomly assigned to receive either a novel transdermal system releasing 50 micrograms 17-beta-estradiol/24 hours or oral therapy with 0.6 mg conjugated estrogens combined with cyclic medrogestone 5 mg on day 11-21 for three treatment cycles. The study was performed according to the criteria of good clinical practise. We observed no adverse effects on the hemostatic system. Particularly, no increase of coagulatory reaction products, i.e. activity was found. Differences between groups were seen with regard to the extent of favourable effects: While the continuous transdermal ERT significantly reduced factor VII activity, oral ERT had no effect. However, oral ERT significantly reduced PAI 1 concentration by 40% suggesting an improved fibrinolytic capacity.(ABSTRACT TRUNCATED AT 250 WORDS)