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On 23 July 2018 the German Constitutional Court decided that mechanical restraint in psychiatric patients with 5 or 7‑point mechanical restraint lasting longer than 30 min requires a judicial authorization. On the same day, the German Association for Psychiatry and Psychotherapy (DGPPN) published guidelines on the prevention of coercion and violence. Together, this can be considered as the strongest intervention to reduce coercion on a national level worldwide. The registry for coercive measures in the Federal State of Baden-Wuerttemberg, available since 2015 and comprising all 32 hospitals licensed to admit involuntary patients, has made it possible to evaluate the effect of the legal change. We analyzed the mean percentage of patients subjected to coercive measures and the mean cumulative duration of these interventions in ICD-10 diagnostic groups in psychiatric hospitals from 2015 to 2017 compared to 2019 among a total of 438,003 admissions. The percentage of patients subjected to any kind of freedom-restricting coercion (restraint or seclusion) decreased from 6.7% (average 2015–2017) to 5.8% in 2019 (p < 0.001). Effects were strongest in patients with organic (F0) and schizophrenic disorders (F2). The percentage of patients subjected to mechanical restraint decreased from 4.8% to 3.6% in 2019, and the percentage of mechanical restraints less than 30 min increased from 1.8% to 10.5%. Vice versa, the percentage of patients subjected to seclusion increased from 2.9% to 3.3%. The median cumulated duration of restraint and seclusion per affected case decreased from 12.7h to 10.9 h (median). The intervention was probably responsible for a reduction of the percentage of cases subjected to coercive measures by about 13% and a reduction of the duration of these measures per affected case by about 14%. [ABSTRACT FROM AUTHOR]

In the present study, three potentially Pb(II)-resistant and biosurfactant-producing bacterial strains were isolated from a total of 23 strains using various screening methods, investigated for their biosorption of Pb(II) and used for the biodegradation of used motor oil. The results show that strain E1 (Bacillus haynesii) has significantly high efficiency in biodegradation of used motor oil, up to 82 % in the first three days. Maximum Pb(II) biosorption capacities of 238.09 mg/g and 99.01 mg/g were determined for strains E1 and F5 (Pseudomonas aeruginosa), respectively. The biosorption process was found to be in good agreement with the Langmuir isotherm for both E1 (R² = 0.9614) and F5 (R2 = 0.9646), suggesting monolayer biosorption. The four common screening methods, namely the haemolytic assay, the determination of surface tension, the emulsifying activity and the foam test, were also correlated with the Pearson correlation method. [ABSTRACT FROM AUTHOR]

Background: Research on measures to prevent or reduce the use of coercive measures is steadily gaining momentum in research. Post-seclusion/post-restraint debriefings with the affected patients are recommended in treatment guidelines but the effectiveness as an intervention has so far only scarcely been studied. Aims and methods: This article briefly outlines the existing literature on post-seclusion/post-restraint debriefings, the legal basis in Germany, recommendations by various treatment guidelines as well as the existing evidence of the effectiveness. Furthermore, challenges pertaining to the implementation of debriefings are discussed. Results: Various treatment guidelines recommend post-seclusion/post-restraint debriefings with patients and the individual Mental Health Laws (PsychKG) of the German federal states provide more or less specific guidance on how to implement the intervention. So far, hardly any scientific studies on the effectiveness of post-seclusion/post-restraint debriefings exist but they are already carried out in a variety of complex treatment concepts. Various parameters, e.g. who participates and when the debriefing is conducted, also vary across implementations. Initial pilot studies have shown indications for positive effects in terms of reducing coercive measures through the implementation of post-seclusion/post-restraint debriefings; however, structured debriefings are not yet part of routine practice. Conclusion: Structured post-seclusion/post-restraint debriefings with patients constitute a possible intervention to reduce coercive measures, but as of now there is little scientific evidence for the efficacy. Incorporating them into complex therapeutic treatment concepts for ward programs appears to be meaningful. [ABSTRACT FROM AUTHOR]

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Copyright of Wiener Klinisches Magazin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Only a few antibiotics are available for treatment of infections with multidrug resistant gram-negative bacteria (MRGN). The management of patients with MRGN colonization or infection is therefore of great importance with respect to postoperative morbidity and mortality. Objective: This article presents a description of the management pathway for patients with MRGN colonization. Results: The prevalence of MRGN colonization is increasing, particularly for persons with contact to the healthcare system in endemic regions. The Robert Koch Institute demands an obligatory MRGN screening and isolation of patients with geographic or contact-related exposure risk for colonization with 4MRGN (carbapenemase producers). For patients with elective visceral interventions a prompt sensitive screening before inpatient admission is wise. Strict basic hygiene measures are essential to prevent transmission. Isolation is indicated for patients with 4MRGN and also for patients with 3MRGN in risk areas. Risk patients with unknown status are preemptively isolated. Perioperative antibiotic prophylaxis should be administered as a single dose and in cases of MRGN colonization substances effective against MRGN should be given if necessary. For treatment of secondary/tertiary peritonitis with a risk of MRGN involvement and in hemodynamically instable patients, effective extended spectrum beta-lactamase (ESBL) substances should primarily be used (e.g. tigecycline, carbapenems, ceftolozane/tazobactam and ceftazidim/avibactam). Ceftazidim/avibactam is also a novel therapy option for infections with carbapenamase-producing enterobacteria. Conclusion: The structured implementation of MRGN screening in patients at risk, stringent basic hygiene, targeted isolation and adequate calculated antibiotic therapy are essential measures in the management of the problem of MRGN in visceral surgery. [ABSTRACT FROM AUTHOR]

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Copyright of Krankenhaus-Hygiene + Infektionsverhutung is the property of Elsevier GmbH, Urban & Fischer Verlag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Krankenhaus-Hygiene + Infektionsverhutung is the property of Elsevier GmbH, Urban & Fischer Verlag and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The prevalence of health-care associated infections caused by multidrug resistant organisms has significantly increased over the past decade. Among these organisms, Methicillin-resistant Staphylococcus aureus (MRSA) plays a prominent and increasing role. Because of consequences for patients and the economic burden in course of prolonged treatment following MRSA infections and additional indirect costs for e.g. isolation or antiseptic treatment, this trend will further damage European health-care systems. In 2006, a workshop was initiated at the 8th International Congress of the German Society of Hospital Hygiene held in Berlin. The aim of this workshop was to give an overview of the current situation of MRSA in selected European countries and to elaborate on potential strategies to prevent MRSA-infections and dissemination. A questionnaire encom-passing 20 questions addressed topics such as epidemiology, current measures and future prospects was distributed to representatives from various European countries and Japan. A variety of widely different answers was obtained. It was shown that in all countries prevalence of MRSA is on a rising tide. This trend is observable in all European countries, albeit less strong in The Netherlands, Slovenia, France, Austria and Scandinavian countries. It was conclude that prevention strategies in a united and expanding European Community will become of utmost importance and that rapid screening strategies, e.g. PCR, might be of assistance in such an approach. A potential strategy to improve infection control measures could be the requirement of health-insurance providers to sign contracts only with hospitals able to proof having an infection control management in place. [ABSTRACT FROM AUTHOR]

The increasingly wide use of antibiotics is responsible for the increasingly frequent development of resistant microorganisms. In trauma and orthopaedic departments the vast majority of postoperative wound infections are caused by Staphylococcus aureus, which means the development and dissemination of methicillin-resistant Staphylococcus aureus (MRSA) is extremely significant. In the treatment of MRSA infections its insensitivity to a large number of conventional antibiotics and the restricted treatment options are importan factors. Extreme significance therefore attaches to prevention of its transmission, and thus to basic hygiene measures. Setting up isolation wards could be one option for this purpose. The isolation ward in the employers' liability insurance association's trauma clinic in Murnau is used as an example to show how a ward of this kind should be designed, what treatment and hygiene methods are required and how the quality of care can be guaranteed. The isolation of potentially infectious patients has led to a reduction in the number of MRSA infections, while at the same time understanding of the problems surrounding MRSA and awareness about the basic hygiene measures have improved. [ABSTRACT FROM AUTHOR]

Summary. The study compared ground red hot pepper agar (GRHP) and Guizotia abyssinica creatinine agar (GACA), a medium routinely used for isolation of Cryptococcus neoformans . In order to confirm the capacity of GRHP to support the Cr. neoformans growth and pigment production, 15 strains were inoculated onto GRHP and GACA. No significant differences in the growth and pigmentation of the tested strains on the two media were noted. As heavily contaminated specimens, 50 samples of pigeon droppings were examined by plating on GRHP and GACA, which resulted in the isolation of 14 and nine Cr. neoformans strains, respectively. The results indicate that GRHP, as a result of its superior selectivity and significant reduction of contaminant growth, provides better conditions than GACA for isolation and presumptive identification of Cr. neoformans from heavily contaminated specimens. [ABSTRACT FROM AUTHOR]

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Einleitung Die Prävention und Kontrolle von nosokomialen Infektionen und multiresistenten Pathogenen ist von größter Wichtigkeit für einen hohen Level an Patientensicherheit. Unterstützt durch jüngst erlassene Rechtsvorschriften wurden in Deutschland vor kurzem besser koordinierte Programme eingeführt. Gut ausgebildetes und hoch motiviertes Personal im Gesundheitsbereich scheint die entscheidende Komponente zu sein, um eine hohe Compliance hinsichtlich der etablierten Prinzipien der Infektionskontrolle zu erreichen. The prevention and control of healthcare-associated infections and multidrug-resistant pathogens is of key importance for a high level of patient safety. Supported by recent legislation, better co-ordinated programs have been introduced recently in Germany. Well educated and highly motivated healthcare workers seem to be the most critical component to achieve a high rate of compliance with the established infection control principles. [ABSTRACT FROM AUTHOR]

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