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BackgroundHospitals are complex and dynamic facilities that house vulnerable people, medical equipment, and hazardous materials, making them susceptible to fires and explosions with potentially catastrophic effects. This study aims to understand and address fire and explosion risks in hospital environments using biomedical engineering, safety, and fire prevention concepts to develop effective mitigation strategies.Materials and MethodsThe study employed a mixed-methods approach, integrating quantitative and qualitative techniques. Data from an insurance and reinsurance company in Peru were analyzed, and surveys, data analysis, and interviews were conducted. The preferred reporting items for systematic review and meta-analysis (PRISMA) methodology was also applied to conduct a thorough literature review.ResultsThe results revealed the most frequent risk factors in hospital settings and identified the most effective mitigation strategies. Implementing these strategies resulted in a considerable decrease in the incidences of fires and explosions.DiscussionThe research provides a comprehensive explanation of hospital fire and explosion risks and proposes evidence-based strategies to improve the safety. These results underscore the relevance of biomedical engineering in managing risks within hospital settings. Despite certain limitations, the study lays a firm foundation for future research aimed at improving hospital safety.

Considered a new stage of human development, driven by a set of technologies developed from the three previous revolutions, the Fourth Industrial Revolution, or Industry 4.0, is based on the fusion of technologies and the interaction between physical, digital, and biological environments. Many sectors are being modified, and in the specific case of everything related to health care, the term Healthcare 4.0 appears. When technologies are created, evolved, and incorporated into healthcare systems, they impact several areas, including the architectural planning of the environment. In this way, this study aims to contextualize the current scenario of Healthcare 4.0, mapping emerging technologies as opportunities for optimizing complex systems, such as those in the health sector, and identifying their relationships and possible impacts on the hospital built environment. To this end, a scoping review was carried out in the Google Scholar, IEEE Xplore, PubMed, SciELO, Scopus, and Web of Science databases, aiming to provide an overview of research on the subject, where the following were identified: Healthcare 4.0, challenges, solutions and opportunities, benefits, technologies and characteristics of the physical environment. It was noticed that literature on the subject is scarce, highlighting the lack of studies and the existence of a field still under construction. [ABSTRACT FROM AUTHOR]

Candida auris, a multidrug-resistant yeast, poses significant challenges in healthcare settings worldwide. Understanding its environmental reservoirs is crucial for effective control strategies. This systematic review aimed to review the literature regarding the natural and environmental reservoirs of C. auris. Following the PRISMA guidelines, published studies until October 2023 were searched in three databases: PubMed, Web of Science, and Scopus. Information regarding the origin, sampling procedure, methods for laboratory identification, and antifungal susceptibility was collected and analyzed. Thirty-three studies published between 2016 and 2023 in 15 countries were included and analyzed. C. auris was detected in various environments, including wastewater treatment plants, hospital patient care surfaces, and natural environments such as salt marshes, sand, seawater, estuaries, apples, and dogs. Detection methods varied, with molecular techniques often used alongside culture. Susceptibility profiles revealed resistance patterns. Phylogenetic studies highlight the potential of environmental strains to influence clinical infections. Despite methodological heterogeneity, this review provides valuable information for future research and highlights the need for standardized sampling and detection protocols to mitigate C. auris transmission. [ABSTRACT FROM AUTHOR]

الملخص: أهداف البحث: سلطت الدراسة الضوء على انتشار أنواع العصيات (بما في ذلك المقاومة للأدوية) في بيئات المستشفيات العامة وتدعو إلى تصميم استراتيجيات مثالية للحد من انتشارها وهو أمر بالغ الأهمية في جميع أنظمة الرعاية الصحية مثل الرعاية لعدد متزايد من المرضى الذين يعانون من ضعف المناعة. طريقة البحث: تم جمع ما مجموعه 528 عينة مسحة من بيئة المستشفيات السعودية المختلفة. تم جمع عينات المسحات عن طريق مسح ما يقرب من 5 سم مربع من السطح في كل موقع باستخدام مسحات قطنية مبللة مسبقا مع محلول معادل بسعة 1 مل (ديفكو ، الولايات المتحدة الأمريكية). تم نقل المسحات في صناديق تبريد مع أكياس ثلج في غضون ساعتين من التجميع. تم إجراء العزل والتعريف وفقا لطرق التوصيف البكتريولوجية التقليدية ، والسمية الآلية ، والجزيئية. تم إجراء تصنيف المضادات الحيوية ضد مجموعات مختلفة من العوامل المضادة للميكروبات. النتائج: أما الأنواع المعزولة فكانت العصوية الشمعية (46,6%) تليها العصوية الرقيقة (38,1%) بينما كانت العصوية القزمة الأقل انتشارا (1.1٪). غالبية عزلات العصيات (25,6%) كانت من قسم الطب الباطني يليه قسم الطوارئ (18.8٪) بينما أظهرت غرف العمليات أقل معدل انتشار (4.5٪). أظهر اختبار الحساسية لمضادات الميكروبات مقاومة عالية لعزلات العصيات للبيتا-لاكتام و تتراسيكلين هيدروكلوريد. العزلات المقاومة للأدوية المتعددة والتي كانت مقاومة ثلاثة أو أكثر من المضادات الحيوية (21.6٪). أظهر تصنيف المضادات الحيوية لـ 176 عزلة وجود 45 نوعا من المضادات وأكثرها شيوعا كانت من النمط 31، والتي اشتملت على 32 عزلة (18.2٪) مقاومة للبنسلين والسيفوكسيتين. الاستنتاجات: كشفت هذه الدراسة عن الانتشار الواسع لأنواع العصيات في بيئات المستشفيات التي في الدراسة ذات المقاومة العالية لمضادات بيتا-لاكتام والتتراسيكلين. أظهر التحليل الجزيئي وجود تنوع وراثي بين عزلات العصيات المدروسة. وبالتالي، فإن مراقبة بيئة المستشفى هي أداة مهمة في الوقاية من العدوى المرتبطة بالمستشفيات بأنواع العصيات. Abstract: Objective: This study highlighted the dissemination of Bacillus species (including drug-resistant species) in public hospital environments and calls for the design of optimal strategies to curb their spread. This a critical consideration for all health care systems such as caring for the increasing number of immune-compromised patient. Methods: A total of 528 swab samples were collected from the environments of different Saudi hospitals. Swab samples were collected by swabbing approximately 5 cm2 of different surfaces at each site using pre-moisturized cotton swabs with 1 mL of neutralizing buffer. The swabs were transported in cool boxes with ice packs within 2 h of collection. Isolation and identification were performed according to conventional bacteriological, semi-automated and molecular characterization methods. Antibiogram typing was carried against different groups of antimicrobial agents. Results: The most prevalent of the isolated Bacillus species were Bacillus cereus (46.6%) followed by Bacillus subtilis (38.1%); the least prevalent was Bacillus pumilus (1.1%). Most Bacillus isolates (25.6%) were isolated from the Department of Internal Medicine followed by the Emergency Department (18.8%), while the operating rooms had the lowest prevalence (4.5%). Antimicrobial susceptibility testing revealed high levels of resistance in Bacillus isolates to β-lactams and tetracycline. Overall, 21.6% of isolates showed multi-drug resistance to three or more antibiotics (21.6%). Antibiogram typing of the 176 isolates revealed 45 antibiotypes; the most common was antibiotype 31, which included 32 isolates (18.2%); this particular antibiotype was resistant to both penicillin and cefoxitin. Conclusions: Analyses identified the high dissemination of Bacillus species in several hospital environments with high resistance to β-lactams and tetracycline antibiotics. Molecular analysis also revealed the existence of genetic diversity among the Bacillus isolates investigated. Thus, monitoring the hospital environment is an important tool in the prevention of hospital-associated infection by Bacillus species.

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Background: Bacillusspecies are widely distributed in all environments including health care settings and represent one of the highly resistant organisms. Objective: This study aimed to find out the prevalence, molecularcharacterization of genetic diversity among studied Bacillus species in Egyptian hospitals environment and their antibiotic susceptibility profile. Methods: A total 528 swab samples were collected from different hospitals environment. Isolation and identification were performed according to conventional bacteriological methods, semi-automated and molecular characterization methods. Antimicrobial susceptibility was carried against different groups of antimicrobial agents. Results: The most isolated microorganism was Bacillus spp. (43.2%), followed by coagulase-negative Staphylococci (19.2%), Staphylococcus aureus (15.2%), Enterococus spp. (10.1%), Gram-negative rods (8.9%), and Micrococcus spp. (3.4 %). The most prevalent species, were Bacillus cereus (46.6%) followed by Bacillus subtilus (38.1%) while, Bacillus pumilus was the least (1.1%). A majority of Bacillus isolates (25.6%) were isolated in Internal medicine department followed by Emergency department (18.8%) while operating rooms showed the lowest prevalence rate (4.5%). Antimicrobial susceptibility testing revealed high resistance of Bacillus isolates to β-lactams and tetracycline antibiotics. Multi-drug resistance (MDR) isolates which resistance to three or more antibiotics was (21.6%). Susceptibility reports of the 176 Bacillus isolates revealed 45 antibitypes and the most common was antibiotype 31, which included 32 isolates (18.2%), that is resistant to both penicillin and cefoxitin. Conclusions: This study revealed that, dissemination of Bacillus species in study hospital environments with high resistance to β-lactams and tetracycline antibiotics. The molecular analysis revealed the existence of genetic diversity among studied Bacillus isolates. Thus, monitoring the hospital environment is an important tool in the prevention of hospital-associated infection by Bacillus species.

This article presents an approach on the theory of innovation in services and aims to propose a set of guidelines to support management during the implementation of innovations in hospital organizations. A case study was carried out with two hospitals in the northeastern region of Brazil to seek an answer to the following research question: What guidelines can be proposed to support management during the process of implementing innovations in hospital organizations? The collected data were treated with content analysis techniques with the aid of the Atlas.ti software. As a result, it was possible to structure a set of guidelines composed of five stages, capable of supporting the management team during the process of implementing innovations in hospital organizations. The proposed guidelines indicate that to implement innovations, the hospital must arouse to the need to innovate, learn to innovate, reconfigure the environment, implement innovations and monitor results. The article adds academic contributions by exploring the theory of innovation and associating it with the service sector. It presents managerial contributions by proposing a set of guidelines for the implementation of innovations in hospital organizations. Finally, the article presents its limitations and recommendations for future research.

Background: Bacillus species are widely distributed in all environments including health care settings and represent one of the highly resistant organisms. Objective: This study aimed to find out the prevalence, molecular characterization of genetic diversity among studied Bacillus species in Egyptian hospitals environment and their antibiotic susceptibility profile. Methods: A total 528 swab samples were collected from different hospitals environment. Isolation and identification were performed according to conventional bacteriological methods, semi-automated and molecular characterization methods. Antimicrobial susceptibility was carried against different groups of antimicrobial agents. Results: The most isolated microorganism was Bacillus spp. (43.2%), followed by coagulase-negative Staphylococci (19.2%), Staphylococcus aureus (15.2%), Enterococus spp. (10.1%), Gram-negative rods (8.9%), and Micrococcus spp. (3.4 %). The most prevalent species, were Bacillus cereus (46.6%) followed by Bacillus subtilus (38.1%) while, Bacillus pumilus was the least (1.1%). A majority of Bacillus isolates (25.6%) were isolated in Internal medicine department followed by Emergency department (18.8%) while operating rooms showed the lowest prevalence rate (4.5%). Antimicrobial susceptibility testing revealed high resistance of Bacillus isolates to ß-lactams and tetracycline antibiotics. Multi-drug resistance (MDR) isolates which resistance to three or more antibiotics was (21.6%). Susceptibility reports of the 176 Bacillus isolates revealed 45 antibitypes and the most common was antibiotype 31, which included 32 isolates (18.2%), that is resistant to both penicillin and cefoxitin. Conclusions: This study revealed that, dissemination of Bacillus species in study hospital environments with high resistance to ß-lactams and tetracycline antibiotics. The molecular analysis revealed the existence of genetic diversity among studied Bacillus isolates. Thus, monitoring the hospital environment is an important tool in the prevention of hospital-associated infection by Bacillus species. [ABSTRACT FROM AUTHOR]

Conventional hospital facility management (FM) focuses on reasonably allocating various resources to support core healthcare services from the perspectives of the FM department and hospital. However, since patients are the main service targets of hospitals, the patients' demographic and hospitalization information can be integrated to support the patient-centric facility management, aiming at a higher level of patient satisfaction with respect to the hospital environment and services. Taking the pharmaceutical services in hospital inpatient departments as the case, forecasting the pharmaceutical demands based on the admitted patients' information contributes to not only better logistics management and cost containment, but also to securing the medical requirements of individual patients. In patient-centric facility management, the pharmacy inventory is regarded as the combination of medical resources that are reserved and allocated to each admitted patient. Two forecasting models are trained to predict the inpatients' total medical requirement at the beginning of the hospitalization and rectify the patients' length of stay after early treatment. Specifically, once a patient is admitted to the hospital, certain amounts of medical resources are reserved, according to the inpatient's gender, age, diagnosis, and their preliminary expected days in the hospital. The allocated inventory is updated after the early treatment by rectifying the inpatient's estimated length of stay. The proposed procedure is validated using medical data from eighteen hospitals in a Chinese city. This study facilitates the integration of patient-related information with the conventional FM processes and demonstrates the potential improvement in patients' satisfaction with better hospital logistics and pharmaceutical services. [ABSTRACT FROM AUTHOR]

Background: The benefits of upright birth positions are well-established in the literature, yet women are persistently challenged to assume the lithotomy or supine birth positions. This study aimed to explore what is known about women's capacity to assume upright birth positions in hospital environments, and its effect on physiological birth. Methods: A structured five-step approach was employed to conduct an integrative review of the literature. The Cumulative Index to Nursing and Allied Health Literature and MEDLINE were searched for articles on women's position during labour and birth in hospital settings. Four articles were selected for inclusion and subjected to thematic analysis to elicit themes and subthemes. Results: Three core themes emerged from this review: 'the biomedical model of care and workplace culture impact the positions women adopt during labour and birth', 'midwives' philosophy and views support physiological birth' and 'clinical settings are not conducive to physiological birth'. Conclusions: Midwives are losing the skills and confidence to support women into upright birth positions. Improved education and training around upright birthing may see a rise in women adopting these positions in hospital environments. [ABSTRACT FROM AUTHOR]

Several challenges to guarantee medical care have been exposed during the current COVID-19 pandemic. Although the literature has shown some robotics applications to overcome the potential hazards and risks in hospital environments, the implementation of those developments is limited, and few studies measure the perception and the acceptance of clinicians. This work presents the design and implementation of several perception questionnaires to assess healthcare provider's level of acceptance and education toward robotics for COVID-19 control in clinic scenarios. Specifically, 41 healthcare professionals satisfactorily accomplished the surveys, exhibiting a low level of knowledge about robotics applications in this scenario. Likewise, the surveys revealed that the fear of being replaced by robots remains in the medical community. In the Colombian context, 82.9% of participants indicated a positive perception concerning the development and implementation of robotics in clinic environments. Finally, in general terms, the participants exhibited a positive attitude toward using robots and recommended them to be used in the current panorama.

Infections associated with Staphylococcus aureus (S.aureus) have high mortality rate and lead to economic loss with a long stay in the hospital. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the major nosocomial pathogens which are acquired in the health care facilities. The objective of the study is to investigate the presence of methicillinresistant Staphylococcus aureus (MRSA) in clinical sources and hospital environments. Samples were collected, cultured and identified morphologically. Likewise, the antibiotic susceptibility profile was done. Identification was also done molecularly using PCR (Polymerase Chain Reaction) method. Sixty-three isolates were positive for S. aureus out of 370 clinical samples (urine, wound, nasal swabs and pus) and 37 positives out of 262 samples from hospital environments. Majority of the isolates were sensitive to cefoxitin, novobiocin and majority were resistant to ceftazidine, cloxacillin and augmentin. Seventy-one to ninety- five percent and 51-72% exhibited multi-drug resistance among clinical samples and hospital environments respectively. Both samples were positive for nuc and mec A genes. The detection of methicillin-resistant S. aureus (MRSA) in hospital environments may pose a great danger to patients especially those of compromised status. [ABSTRACT FROM AUTHOR]

Nowadays, one of the most important and essential aspects of having a healthy and safe life is the air safety and its quality in indoor and outdoor environments. In the air, there are not only chemical pollutants but also biological ones, with specific impacts. Hospital environments are among the most likely to be affected by the microbiological contamination of the air; therefore its quality is particularly important. Pathogenic microorganisms, which may be present in the air, can cause nosocomial infections in hospitalized patients, with compromised immune system or other medical conditions. This paper reflects the evaluation of microbiological air contamination, in different hospital environments and nearby areas, in the city of Tirana. The microbial air quality has been monitored during the period of 2009–2018, performing evaluations every three years, in the same area and the same time of the year. In order to build a database for understanding the impact of developmental changes on the air microbiological loads, results of similar studies conducted earlier, during 2007 and 2008 were also taken into consideration. The above-mentioned period was selected because of the changes in the infrastructure and indoor environments of the monitored area, where many patients have been treated for years. Changes have been made over the years to hospital structures and surroundings, including recreational facilities, clinical service units, as well as main and connecting roads, etc. The obtained results, which were compared over the years, provided a clear view of the changing microbiological air loads, influenced by the improvements of indoor and outdoor areas. The morphological studies of the observed, isolated, purified and identified microorganisms revealed the presence of specific mold loads, with the dominance of the species of Aspergillus genus and those of the group Fungi imperfecti. Over the years, a decrease in the total number was observed (from 103 to 101 ), together with a smaller number of bacteria (1012), in the monitored environments. [ABSTRACT FROM AUTHOR]

Conventional hospital facility management (FM) focuses on reasonably allocating various resources to support core healthcare services from the perspectives of the FM department and hospital. However, since patients are the main service targets of hospitals, the patients’ demographic and hospitalization information can be integrated to support the patient-centric facility management, aiming at a higher level of patient satisfaction with respect to the hospital environment and services. Taking the pharmaceutical services in hospital inpatient departments as the case, forecasting the pharmaceutical demands based on the admitted patients’ information contributes to not only better logistics management and cost containment, but also to securing the medical requirements of individual patients. In patient-centric facility management, the pharmacy inventory is regarded as the combination of medical resources that are reserved and allocated to each admitted patient. Two forecasting models are trained to predict the inpatients’ total medical requirement at the beginning of the hospitalization and rectify the patients’ length of stay after early treatment. Specifically, once a patient is admitted to the hospital, certain amounts of medical resources are reserved, according to the inpatient’s gender, age, diagnosis, and their preliminary expected days in the hospital. The allocated inventory is updated after the early treatment by rectifying the inpatient’s estimated length of stay. The proposed procedure is validated using medical data from eighteen hospitals in a Chinese city. This study facilitates the integration of patient-related information with the conventional FM processes and demonstrates the potential improvement in patients’ satisfaction with better hospital logistics and pharmaceutical services.

Abstract Objective This study aimed at assessing the magnitude, distribution, and the antimicrobial susceptibility of the extended spectrum beta-lactamase producing Entrobacteriaceae in the University of Gondar Referral Hospital environments. Results Out of a total of 384 samples, 14.8% were ESBL producing Entrobacteriaceae, where 42.10% Klebsiella pneumoniae, 35.09% Escherchia coli and 7.01% Proteus mirabilis were the predominant isolates. Most ESBL producing isolates, that is, 24.56, 22.8, and 22.8% were found from waste water, sinks and bedside tables respectively. All ESBL producing Entrobacteriaceae were found to be resistant to ceftriaxone, ceftazidime, cefpirome, cefpodoxime, and amoxicillin with Clavulanic acid. Resistance rate was also high for non-beta-lactam antimicrobials, like chloramphenicol (70.18%), cotrimoxazole (64.91%), norfloxacin (42.10%), ciprofloxacin (43.86%), and gentamicin (19.30%).

Ensuring good indoor air quality is critical in hospitals. An environment free from airborne particles can prevent the spread of various diseases and improve patient health. In this study, the efficiency of a personalised ventilation supply system (PSS) and personalised ventilation extraction system (PES) for diluting and removing contaminants exhaled by a patient in a hospital bed was evaluated. These systems, which were integrated into the head and foot of a hospital bed, were combined with three general ventilation strategies in the room. Fifteen ventilation strategies were analysed experimentally. Two breathing thermal manikins (BTMs) were used to simulate a patient and health worker in a hospital. The breathing of each BTM was controlled by the patient (source) generating particles that can increase the risk of infection in a healthy person (target). Experimental results show that using a PES combined with general ventilation of the room reduces the exposure of the target manikin compared to general ventilation strategies alone. However, no marked improvement was observed when the PSS was activated. The reduction in exposure to the target manikin was considerable when the PES was located at the foot of the hospital bed, which is the preferred option for integrating personalised systems in a hospital bed. [Display omitted] • Assessment of exposure to exhaled contaminants in a hospital room was investigated. • Ventilation systems are used to reduce intake fraction in health worker. • Personalised ventilation extraction at head of the bed reduced intake fraction. • Personalised ventilation supply and extraction systems didn't reduce exposure. [ABSTRACT FROM AUTHOR]

Background: The adenosine triphosphate (ATP) assay is widely used for simple and rapid evaluation of the cleanliness of environmental surfaces. However, there remain concerns regarding the reliability of the ATP assay in hospital settings. This study aimed to assess whether the ATP assay could detect inadequate cleaning within hospital environments as well as monitor the effectiveness of routine cleaning., Methods: The cleanliness of seven types of high-touch surfaces in operating rooms that were routinely cleaned was evaluated by testing the ATP assay and aerobic colony counts (ACC). For pressure redistribution mattresses (Soft-nurse®) that were found to be particularly at risk of infection, cleaning methods were improved, and the effectiveness of these improvements was monitored using the same two methods., Results: The ATP assay quantitatively detected contamination on seven high-touch surfaces but showed no correlation with ACC. However, a significant positive correlation between luminescence and ACC was found on one specific surface, allowing for determining a theoretical cutoff value. Additionally, the ATP assay effectively identified the risk of future infection, which the ACC test could not assess., Conclusions: The ATP assay can monitor the effectiveness of routine cleaning by setting a theoretical cutoff value for each subject. The method provides quantitative and meaningful values when used with an understanding of its limitations., (Copyright © 2023 Australasian College for Infection Prevention and Control. Published by Elsevier B.V. All rights reserved.)

Objective: To determine the prevalence and antimicrobial resistance rates of nosocomial pathogens isolated from cancer patients and hospital environments. Methods: A descriptive cross-sectional study was conducted between December 2010 to May 2013 at Radiation and Isotopes Centre of Khartoum, Sudan. A total of 1503 samples (505 clinical and 998 environmental) were examined. Isolates were identified, and their antimicrobial susceptibility was determined using standard laboratory procedures. Results: Out of 505 clinical samples, nosocomial pathogens were found as 48.1%. Among hospital environment samples, bacterial contaminants were detected in 29.7% of samples. The main microorganisms recovered from cancer patients were Proteus spp. (23.5%), Escherichia coli (22.2%), Pseudomonas aeruginosa (P. aeruginosa) (21.0%) and Staphylococcus aureus (20.2%). The most frequent isolates from hospital environments were Bacillus spp. (50.0%), Staphylococcus aureus (14.2%) and P. aeruginosa (11.5%). The proportions of resistance among Gram-negative pathogens from cancer patients were high for ampicillin, cefotaxime, ceftazidime and ceftriaxone. Moderate resistance rates were recorded to ciprofloxacin, such as 51.0% for P. aeruginosa, 21.7% for Klebsiella pneumoniae and 55.5% for Escherichia coli. Except Klebsiella, there were no significant differences (P ≥ 0.05) of resistance rates between Gram-negative isolates from cancer patients to those from the hospital environments. The proportions of extended-spectrum β-lactamase producing isolates from cancer patients were not differ significantly (P = 0.763) from those collected from the hospital environments (49.2%; 91/185 vs. 47%; 32/68). Conclusions: The prevalence of nosocomial infection among cancer patients was high (48.1%) with the increasing of antimicrobial resistance rates. Hospital environments are potential reservoirs for nosocomial infections, which calls for intervention program to reduce environmental transmission of pathogens.

The resistance of bacteria from hospital environments has been less frequently investigated. Twenty - seven Gram-negative bacterial isolates were isolated and identify from the hospital environment. The isolates were Acinetobacter baumanii (16 isolates), Pseudomonas aeruginosa (4 isolates), Enterobacter cloacae (3 isolates) Klebsiella pneumoniae (3 isolates) and Escherichia coli (one isolate). Antimicrobial susceptibility test was performed by disk diffusion method and polymerase chain reaction was used to detect blaNDM-1 genes among imipenem-resistant MBL positive isolates. The results showed that the all isolates were imipenem-resistant, cefotaxime resistance was seen in 48.14% of isolates, ciprofloxacin resistance rate was 11.11%, and 25 isolates (92.5%) were inferred to be MBLs producers. Among these isolates, 11 isolates had blaNDM-1 genes. The antibacterial effect of ZnO nanoparticles, fullerene (C60) and pyocyanin against various bacterial isolates from hospital environment was investigated. Preliminary growth analysis data suggest that ZnO nanoparticles and pyocyanin have significantly higher antibacterial effects on bacteria than do fullerene (C60). The nanoparticles reduced the growth of A.baumanii and E. cloacae higher than that with P. aeruginosa and K. pneumonia. It was concluded that nanoparticles and pyocyanin have potential as a therapeutic agent against Gram-ve bacteria from the hospital environment. [ABSTRACT FROM AUTHOR]

Healthcare-associated items are a common source of acquired infections, and hospital-acquired infections cause significant mortality and morbidity worldwide. Acinetobacter baumannii is the most prevalent infection-causing organism in the hospital environment. Hospital articles and objects are the main sources of infection with the ability to transmit some of the pathogenic microorganisms such as A. baumannii , which is considered a serious problem in therapeutic treatments. In the current study, we isolated A. baumannii from hospital sources and evaluated its antibiotic resistance, virulence factors and resistance gene determinants. The isolates were identified phenotypically as well as genotypically using PCR. In addition, their capability for biofilm formation and ten other virulence factors were measured. Of 112 samples, 21 showed growth of the target organism. Apart from A. baumannii , isolates of Candida albicans , Staphylococcus sp., Pseudomonas aeruginosa , Escherichia coli and Klebsiella pneumoniae were also grown. Antibiotic susceptibility test results considered all the A. baumannii to be multidrug-resistant isolates with the highest resistance being 100% to gentamycin, ciprofloxacin; the most effective antibiotics with 100% susceptibility was colistin and tigecycline. All A. baumannii isolates had MIC for ceftriaxone >32 mg/L. All A. baumannii isolates from the hospital environment showed multidrug resistance and had many virulence factors. They have long-term resistance to dry conditions and cause a serious public health issue. [ABSTRACT FROM AUTHOR]

The species of Legionella (gram-negative aerobic bacillus) are widely distributed in water environments. The Legionellaceae family comprises a group of fastidious bacteria that requires special isolation techniques, and of which the Legionella pneumophila is the member which is most commonly identified as the cause of human diseases or of the worsening of health conditions. The purpose of this work is to verify conditions in randomly chosen hospitals from the public system for the development of Legionella pneumophila, and, thus, contribute to the debate on legislation and technical standardization in the network, with the purpose of controlling and preventing the presence of this bacillus in the Brazilian hospital system. At the same time, some physicochemical and colimetric parameters (total and thermo-tolerant coliforms) were evaluated aiming at defining the total quality of water used. The results show the presence of coliforms and Legionella sp in the water used in the monitored hospitals. In this way, it is shown that the maintenance of the quality of water used in hospitals is fundamental, as well as the carrying out of biological tests for the detection of Legionella pneumophila so that the necessary safety of the hospital environment can be achieved.

The growth of wireless communications, radio and worldwide basis in clinical and hospital environments stations, create an exposure to non-ionizing electromagnetic radiation of high and low frequencies, that can create interference with medical equipment, which can be detrimental to these. This article discusses the fundamental aspects for the design and implementation of measurement and certification protocols of levels of intensity non-ionizing electromagnetic fields (FEM) of high and low frequency, applicable to clinical hospitable environments consistent with existing national and international standards were studied to this purpose. The most important result was the design and implementation of measurement protocols, considering that they comply with the requirements of technical competence required to perform such measurements. [ABSTRACT FROM AUTHOR]

Objective To determine the prevalence and antimicrobial resistance rates of nosocomial pathogens isolated from cancer patients and hospital environments. Methods A descriptive cross-sectional study was conducted between December 2010 to May 2013 at Radiation and Isotopes Centre of Khartoum, Sudan. A total of 1 503 samples (505 clinical and 998 environmental) were examined. Isolates were identified, and their antimicrobial susceptibility was determined using standard laboratory procedures. Results Out of 505 clinical samples, nosocomial pathogens were found as 48.1%. Among hospital environment samples, bacterial contaminants were detected in 29.7% of samples. The main microorganisms recovered from cancer patients were Proteus spp. (23.5%), Escherichia coli (22.2%), Pseudomonas aeruginosa ( P. aeruginosa ) (21.0%) and Staphylococcus aureus (20.2%). The most frequent isolates from hospital environments were Bacillus spp. (50.0%), Staphylococcus aureus (14.2%) and P. aeruginosa (11.5%). The proportions of resistance among Gram-negative pathogens from cancer patients were high for ampicillin, cefotaxime, ceftazidime and ceftriaxone. Moderate resistance rates were recorded to ciprofloxacin, such as 51.0% for P. aeruginosa , 21.7% for Klebsiella pneumoniae and 55.5% for Escherichia coli . Except Klebsiella, there were no significant differences ( P ≥ 0.05) of resistance rates between Gram-negative isolates from cancer patients to those from the hospital environments. The proportions of extended-spectrum β-lactamase producing isolates from cancer patients were not differ significantly ( P = 0.763) from those collected from the hospital environments (49.2%; 91/185 vs. 47%; 32/68). Conclusions The prevalence of nosocomial infection among cancer patients was high (48.1%) with the increasing of antimicrobial resistance rates. Hospital environments are potential reservoirs for nosocomial infections, which calls for intervention program to reduce environmental transmission of pathogens. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance has been recognized as an important emerging environmental pollutant. 'Last-resort' antibiotics including tigecycline, polymyxin E, daptomycin, vancomycin and linezolid are the 'last line of defence' for antibiotic resistant pathogen infections. Therefore, the presence of 'last-resort' antibiotic resistant pathogens in hospital environments and the nosocomial transmission of 'last-resort' antibiotic resistance poses a grave threat to the well-being of patients. In this work, the extent of resistance to 'last-resort' antibiotics in culturable pathogens in hospital wastewater was investigated. Resistance to 'last-resort' antibiotics were quantified for 1384 culturable Enterobacteriaceae, Enterococcus , Staphylococcus , and Pseudomonas strains. With these investigations, several significant findings were made: (1) a very high level of resistance to 'last-resort' antibiotics was found; (2) multiple resistance to antibiotics, including 'last-resort' antibiotics, was prevalent; (3) a high level of 'last-resort' antibiotic resistance phenotype-genotype inconsistency was found, suggesting knowledge gap for resistance mechanisms; 4) tet(X4) -containing tigecycline-resistant Gram-positive pathogens were found for the first time; 5) wastewater treatment processes are effective in preventing the release of 'last-resort' antibiotic resistant pathogens to the environment. This investigation reveals the severe situation on 'last-resort' resistance in the hospital environment, and implies high risk for nosocomial transmission of 'last-resort' antibiotic resistant pathogens. [Display omitted] • 'Last-resort' antibiotic resistant pathogens were studied in hospital wastewater. • A total of 1384 culturable pathogenic strains were isolated and studied. • Surprising high levels of resistance to 'last-resort' antibiotics were found. • Tet(X4)-containing tigecycline-resistant Gram positive pathogens were discovered. • Nosocomial transmission of "last resort" antibiotic resistance is highly likely. [ABSTRACT FROM AUTHOR]

Candida albicans and, more recently, non- C. albicans Candida spp. are considered the most frequent fungi in hospitals. This study analyzed Candida spp. isolates and compared the frequency of different species, that is, C. albicans and non- C. albicans Candida spp., and the origins of isolates, that is, from hospital environments or infections. Yeast virulence factors were evaluated based on biofilm production and metabolic activity. Hemolysin production and the antifungal susceptibility profiles of isolates were also evaluated. Candida spp. were highly prevalent in samples collected from hospital environments, which may provide a reservoir for continuous infections with these yeasts. There were no differences in the biofilm productivity levels and metabolic activities of the environmental and clinical isolates, although the metabolic activities of non- C. albicans Candida spp. biofilms were greater than those of the C. albicans biofilms ( p < 0.05). Clinical samples had higher hemolysin production ( p < 0.05) and lower susceptibility to fluconazole ( p < 0.05). Non- C. albicans Candida spp. predominated in samples collected from hospital environments and infections ( p < 0.05). These species had a lower susceptibility to fluconazole and amphotericin B, and their biofilms had higher metabolic activities than those produced by C. albicans, which may explain the increased incidence of fungal infections with these yeasts during recent years. [ABSTRACT FROM AUTHOR]

Introduction: The contribution of Clostridioides difficile (formerly Clostridium difficile ) to the burden of hospital-associated infections (HAIs) remains undetermined in many African countries., Aim: This study aimed to identify a sensitive and readily adaptable C. difficile detection assay and to evaluate the C. difficile HAI risk in Kenya., Methodology: Sterile swabs in neutralizing buffer were used to sample equipment or surfaces that patients and clinical staff touched frequently. These swabs were either plated directly on chromogenic agar or cultured in an enrichment broth before plating. The swab suspensions, enrichment broth and plate cultures were screened by quantitative PCR (qPCR) to determine the most efficient detection method. The HAI risk was evaluated by testing the C. difficile -positive samples by qPCR for the A, B and binary toxins., Results: C. difficile was detected on 4/57 (7.0 %) equipment and surfaces by direct culture. The additional enrichment step increased the detection rate 10-fold to 43/57 (75.4 %). In total, 51/57 (89.5 %) environmental samples were positive for C. difficile detected through either culture or qPCR. The genes encoding the primary toxins, tcdA and tcdB , were detected on six surfaces, while the genes encoding the binary toxins, cdtA and cdtB , were detected on 2/57 (3.5 %) and 3/57 (5.3 %) surfaces, respectively. Different C. difficile toxin gene profiles were detected: the tcdA+/tcdB - gene profile on 4/10 (40 %) high-touch surfaces, tcdA-/tcdB + on 3/10 (30 %) surfaces, tcdA+/tcdB+/cdtA+/cdtB+ on 2/10 (20 %) surfaces and tcdA-/tcdB+/cdtB+ on one high-touch surface., Conclusion: The widespread contamination of hospital environments by toxigenic C. difficile gives a strong indication of the high risk of C. difficile infections (CDIs). The two-step culture process described can easily be adapted for monitoring hospital environment contamination by C. difficile ., Competing Interests: The authors declare that there are no conflicts of interest., (© 2020 The Authors.)

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Objective: This study aimed at assessing the magnitude, distribution, and the antimicrobial susceptibility of the extended spectrum beta-lactamase producing Entrobacteriaceae in the University of Gondar Referral Hospital environments. Results: Out of a total of 384 samples, 14.8% were ESBL producing Entrobacteriaceae, where 42.10% Klebsiella pneumoniae, 35.09% Escherchia coli and 7.01% Proteus mirabilis were the predominant isolates. Most ESBL producing isolates, that is, 24.56, 22.8, and 22.8% were found from waste water, sinks and bedside tables respectively. All ESBL producing Entrobacteriaceae were found to be resistant to ceftriaxone, ceftazidime, cefpirome, cefpodoxime, and amoxicillin with Clavulanic acid. Resistance rate was also high for non-beta-lactam antimicrobials, like chloramphenicol (70.18%), cotrimoxazole (64.91%), norfloxacin (42.10%), ciprofloxacin (43.86%), and gentamicin (19.30%). [ABSTRACT FROM AUTHOR]