Medicine

The problem

We interviewed medical professions with a range of experience and specialisations. In particular two categories came up as reoccurring problems. This included health, economy and time. Essentially the negative effects caused by colonisation of biofilms, would manifest into problems in economy and time. From what medics have told us that in most cases the human body has the ability to defend against the manifestation of bacteria within the body. However, with medical devices, in particular the urinary catheters – the most common equipment used – presents with bacterial attachment and apparent growth.

A lot of patients with cystic fibrosis are severely affected by gram negative bacteria, which can worsen their condition and decrease mortality rate. The main cause of this is Pseudomonas aeruginosa (P.aeruginosa) which can in fact show antibiotic resistance and thus chronic infection. In fact, microbiologists state biofilm formation is a major factor in antibiotic resistance.

Infection in the airways can cause serious damage to the lungs in patients with cystic fibrosis. It is said to be very difficult to eradicate the infection, however there is treatment to slow down the aggressive manifestations. Therefore, preventative measures are preferred and put into place.

The hospital acquired infections manifest in a wide range of difficulties outside health. For example, a patient who is infected must be treated separately, prolonging their hospital stay. In addition to this, the patient must be seen by only one nurse each time. These precautions take up more facilities – which could have been used for new patients – and manual labour. This in turn requires more funding from the NHS. This can cause an unnecessary loss – as these infecting could have been prevented by following strict hygiene protocols - in the NHS budget. The NHS is already facing a problem with funding medical procedures, hiring work force and medical equipment due to budget cuts.

Prevention

Medics have certain strategies in place to prevent any contamination of the catheter insertion. The national health service (NHS), the public health service has protocols for aseptic catheterisation insertion in order to prevent the common HAI catheter-associated urinary tract infection (CAUTI). The professionals that can carry out catheter insertion are nurses, medics and the students of both disciplines. Aiming to ensure competency, appropriate catheterisation minimising HAIs.

The appropriate catheter insertion – preventing any bacteria adhering to the catheter prior insertion - using the aseptic technique.

Wash hands
The catheter pack is opened aseptically
Wear sterile gloves
The equipment is set up on a sterile field (a table cover)
NaCl is used for cleansing (contained within gallipot)
Perineum is cleaned
Change sterile gloves
The catheter’s wrapper is opened without touching tip and is inserted into the urethra.

Another method is a five-step hand washing routine any one who is in contact with patients, or the hospital environment itself must follow. Having a presentation from the infection control team from the Peterborough city hospital we were informed of the many ways of hand hygiene to prevent bacteria transfer and thus subsequent bacteria adherence and growth. This includes the hygienic hand wash, the alcohol hand rub, surgical hand wash, and five step hand washing routine when in contact with patients. This includes washing hand before seeing patient and after seeing the patient.

Other strategies involves a UV cleaner that eliminates bacteria from wards and private clinic room walls, keeping patients who are infected with HAI in private rooms to prevent spread of infection and chlor wipes.

In regards P.aeruginosa and its manifestations in the airways of patients with cystic fibrosis preventative measures are preferred and put into place. One way is preventing cross infection form taking place. P.aeruginosa spread is within the hospital environment for example in kitchens, wards and private patient rooms. Keeping these areas clean and help reduce the bacteria growth.

Problem with current prevention method

However, cases of UTIs are still apparent. While asking medics a mixed response of why this is the case. Reasons have eluded to the fact that professionals qualified to carry out catheterization are possibly not carry out the aseptic technique according to the protocol. Another interesting reason was that the catheter itself, when inserted into the urethra it allows a means of entry into the sterile environment of the bladder. This bacterium can adhere on the tube, and produce a surface which neutralises antiadhesive properties. This itself allows more bacteria adhere. The biofilm formation is self – perpetuating. Meaning the more bacteria that adheres, the more bacteria is attracted. This bacteria can enter across or through the catheter’s tube. An indirect cause of UTIs is thought to be due to the incorrect insertion of the catheter which causes urine stasis. This is allows the bacteria to adhere, grow and manifest.

The aspects of hand washing and using wipes are all to do with compliance. The infection control unit believes it is due to the lack of awareness because hand hygiene is not only necessary for health professionals. It’s for anyone from hospital visitors to administration. In relation to the UV machine, it is unable to clear corners and is only administrated in wards twice a year.

The effect

Increases mortality
Increase hospital stay
Take up more resources than were necessary
Patient anxiety
Patients have less confidence in the health profession
More time and money used
Causes deaths that could have been prevented – 35%

With P.aeruginosa trying to keep environments constantly sterile in reality is difficult. It requires manual labour, time and money which the NHS unfortunately does not have. What makes it even more difficult is the fact that the reason why P.aeruginosa exist in the above mentioned environments is because they are prone to humidity. P.aeruginosa thrives in humid environments. Therefore, although the up most efforts can go into cleaning the surroundings, it is difficult to always keep a dry environment.

Our project

We went out to finally ask how our project, in the eyes of the health professionals, could help circumvent these obstacles caused by the bacterial communities. If our proof of concept is proven right. Prototypes can be engineered into sprays which could be used on floors, tables, hands and catheters. This would prevent any biofilm formation, therefore survival of bacteria. This could possibly even reduce the number of steps in hand hygiene or steps in the aseptic technique for catherization. This can ideally prevent the problem of having a lack of compliance and possibly have more of a permanent and effective contribution to any bacteria spread and infection. This could be used as a medical application for patients with cystic fibrosis. This can prevent patients contracting P.aeruginosa in the first place and receiving a huge influx of medication. It could also the combat the problem of antibiotic resistance.

Our approach

Identify

A SALIENT DEFINITION OF BIOFILMS OFFERED BY DONLAN AND COSTERTON:

“A microbially derived sessile community characterized by cells that are irreversibly attached to a substratum or interface or to each other, embedded in a matrix of extracellular polymeric substances that they have produced, and exhibit an altered phenotype with respect to growth rate and gene transcription.”

The formation of biofilms on abiotic and biotic surface has a global effect on our society. Two main victims of this can effect; One is medicine and the second is dentistry. For example, biofilms constitute for hospital acquired infections – causing around 300,000 cases of hospital acquired infections- this costs the national health service approximately £1 billion a year. Bacteria constituting biofilms have the ability to be less defensive against host defences than are planktonic forms of the same microorganisms. Subsequent infection with caused by biofilms can manifest in many clinical challenges, such as uncultivable species, chronic inflammation, impaired wound healing, and spread of infection. You may think, why? This is because medical devices such as catheters, pacemakers, vascular prostheses regardless of their sophistication ae susceptible to colonization of bacterial species.

In relation to dentistry biofilms can also increase the risk of HAIs. Biofilms are the main culprit in etiopathogenesis of dental caries and periodontal disease. Though uncalcified biofilms can be removed by professional in the dental discipline, these biofilms can mature within hours and have the potential to calcify into dental calculus making their removal difficult. Hence, these biofilms are a great challenge to the dentist and hygienist in the control and eradication of diseases caused by biofilms adherence to teeth

The is what we know form literature – that bacteria pose a threat the healthy lifestyle in many unique ways. This gives an idea of how our project can contribute positively to society. However, we as a team wanted to go further than this. Rather than relying on only research we got enthused with local communities to gain first-hand knowledge from disciplines from the front line. We went with a simple strategy to achieve this.

Our strategy

We know form literature that dentistry and medicine are highly targeted fields by biofilms. However, we wanted to know the hows, the whens the whats. We as a team agreed that we wanted to keep it simple but constructive. In this way it would allow us to accurately understand different problems of each aspect thoroughly.

How biofilms effect the healthcare community?
What strategies are already in place to reduce effects of biofilms?
How our project will circumvent these issues caused by biofilms?
Any suggestions to facilitate improvement in relation to our project

Team:Westminster UK/HP/Gold Integrated

Medicine