Impact assessment following implementation of a vascular access team

BACKGROUND

A vascular access team (VAT) was created in 2018 with the aim of improving vascular access and reducing complications associated with catheters. The impact of the introduction of a VAT in the insertion and maintenance of peripheral insertion central catheters (PICCs) was assessed. The cost-benefit associated with the use of a VAT was evaluated and the satisfaction of patients and professionals interacting with the VAT was measured.

METHODS

In a prospective study, 275 PICCs inserted by the VAT were assessed for their impact on complications. PICCs were implanted with maximum barrier measures using an ultrasound with IC-ECG. Also, patient and professional satisfaction have been analysed thought a questionnaire over the phone or online, and hospital financial data was used to assess the cost impact of the insertion methodology followed by the VAT versus Anaesthesia Service.

RESULTS

The thrombosis rate was 2.5% (7) and the bacteraemia rate was 1.1% (3). The use of the IC-ECG was correlated with a lower complication than the RX + IC-ECG (OR = 3.28, p = 0.021). In addition, there was a high level of perceived satisfaction for the patients surveyed and for the healthcare professionals involved in the care and management of these devices. The calculated saving for the implementation of the VAT was 61.81% compared with PICCs implanted in Anaesthesia Service.

CONCLUSION

Low complication rates and high overall satisfaction scores in patients and professionals were observed, showing that a specialist VAT can have a positive impact in the insertion of PICCs and which also has a clear economic benefit.

Iron and sulfur geochemistry in semi-arid mangrove soils (Ceará, Brazil) in relation to seasonal changes and shrimp farming effluents

Iron and sulfur are key elements in the biogeochemistry of estuarine soils, in which Fe and sulfate reduction (SR) pathways are important for organic matter decomposition. In the semi-arid coast of NE Brazil, mangroves are characterized by large seasonal variations in weather and the presence of numerous shrimp farms. The objective was to determine the impacts of shrimp farm effluents on iron and sulfur geochemistry in mangrove soils under the semi-arid climate of NE Brazil. A seasonal study was made of two mangrove forest soils (SF, a mangrove forest that directly receives wastewater from shrimp ponds and CS, a control site). Pyrite Fe, oxyhydroxides Fe, acid volatile sulfide, degree of pyritization (DOP), pH, Eh, total organic carbon (TOC) and total S were determined. There was a clear decrease in pyritic Fe and DOP in the SF soils, which may be related to the anaerobic oxidation of pyrite coupled with nitrate reduction, or to the dominance of denitrification over SR. Lower TOC contents in the SF site suggest that below ground decomposition increased in response to eutrophication. The seasonal variations led to important changes in the semi-arid mangrove soils. During the dry period, both soils experienced oxidizing conditions with remarkable loss of reduced and oxidized forms of Fe, which may have important environmental implications as Fe is biolimiting for marine primary production. The data show that both factors (seasonal weather variations and shrimp effluents) play important roles in the geochemical processes that occur in these soils and, thus, may affect their functioning and maintenance.

Isolation and identification of mycobacteria in New World primates maintained in captivity

The presence of several Mycobacterium species was determined in 68 New World monkeys kept captive in the Cali Zoo. One hundred and thirty-three gastric lavage and blood samples were evaluated for mycobacterial presence by Ziehl-Neelsen (ZN) staining, culture and PCR amplification of the Mycobacterium tuberculosis Mtp40 species-specific gene. Mycobacteria other than tuberculosis (MOTT) were identified by PCR restriction fragment length polymorphism (RFLP). Different species of mycobacteria were detected in 65% of the primate population studied by Alpha Antigen PCR. Eleven percent were positive for Mtp40 PCR amplification, being diagnosed as having M. tuberculosis, and acid-fast bacilli were observed in 23% by ZN staining. MOTT were isolated from samples taken from 37 primates by culturing; according to the RFLP analysis, three strains were classified as belonging to the MAISS complex (Mycobacterium avium-intracellulare-scrofulaceum-simiae) and eight more, isolated from soil inside the cages, were categorized as environmental contaminants. Mycobacterium spp. were detected in 13 different New World primate species showing that PCR amplification of the Mtp40 gene is a better tool than culture for M. tuberculosis detection in captive animals and that RFLP is a useful technique for MOTT identification.

Identification of Mycobacterium bovis in bovine clinical samples by PCR species-specific primers

Tuberculosis, caused by Mycobacterium bovis is emerging as the most important disease affecting cattle. Furthermore, it results in a major public health problem when transmitted to humans. Due to its difficult and non-specific diagnosis, M. bovis has been declared to be one of the etiologic agents causing significant economic loss in the cattle industry. Our group evaluated a more rapid and specific method, based on a new polymerase chain reaction species-specific primers, which amplifies a 470-base pair fragment of the M. bovis genome. A total of 275 milk-producing cows were studied by intradermal tuberculin test (ITT) which gave 184 positive and 91 negative cases. From them, 50 animals were taken from a cattle ranch free of tuberculosis. Three different samples were collected from each animal (blood, nasal mucus, and milk). Positive results were obtained from 26 animals by PCR (11.4%), 1 by bacteriological culturing (0.4%) and 1 by bacilloscopy (0.4%). This finding suggests, as in previous reports, that ITT, normally used for bovine tuberculosis detection, has the inconvenience of having a broad range of specificity and sensitivity, and the PCR technique is a more specific and sensitive test to detect infection associated with M. bovis. Therefore, we propose this PCR assay as a useful tool in the epidemiological characterization of infected animals in areas considered to be at high risk of transmission.

Diagnosis of cutaneous tuberculosis by polymerase chain reaction using a species-specific gene

BACKGROUND

Diagnosis of tuberculosis (TB), especially cutaneous TBC, by conventional microbiologic methods is still a very laborious process and the results are usually inconclusive. Our purpose was to identify M. tuberculosis bacilli in uncultured clinical samples from skin lesions by means of the rapid, specific, and sensitive polymerase chain reaction (PCR).

METHODS

The PCR, using a set of species-specific primers, was performed on biopsies and fluid secretions from lesions.

RESULTS

A positive amplification reaction was observed in three of the four samples studied. For one of the samples, the result was confirmed by a positive culture in Löwenstein-Jensen medium and for the other two, by molecular hybridization and the clinical course of the patients after treatment. Samples obtained from a patient with panniculitis of Christian-Weber and a normal skin biopsy were included as negative controls.

CONCLUSIONS

We propose the PCR method as a tool for the diagnosis of cutaneous TBC. The presence of the M. tuberculosis in an erythema induratum of Bazin suggests a revision of the concept of this disease as a tuberculide reaction.

Evaluation of importance of cystoscopy in staging gynecologic carcinomas

Of 265 patients with gynecologic carcinoma undergoing initial evaluation during a 5-year period 238 were staged prospectively with procedures that included cystoscopy. Endometrial carcinoma was noted in 98 patients, none of whom had evidence of bladder extension nor did the clinical stage of disease change after cystoscopy. Of 120 patients with carcinoma of the cervix 7 were found to have extension of tumor to the bladder. The clinical stage was elevated in 3 of these cases but remained unchanged in 4 because of the cytoscopic findings. Of all 238 patients with gynecologic carcinoma 3 (1 per cent) also were found to have unsuspected low grade transitional cell carcinoma of the bladder.