Biologically, women are more prone than men to experience a urinary tract infection (UTI), and their lifestyles, marked by carrying heavy purses and donning high heels, may actually increase this risk. Whether it is from fashion, exercise, or heavy lifting, an injured back, either the muscles or nerves or both, may increase the risk of a UTI.

“Back injuries can often disrupt or inhibit urine flow,” says Larrian Gillespie, a retired urogynecologist and author of the book, You Don’t Have to Live with Cystitis, The Groundbreaking Guide to the Prevention and Cure of One of Women’s Most Stubborn Ailments (Quill, An Imprint of HarperCollins Publishers). “As a result, UTI-causing bacteria become trapped in the bladder causing a urinary tract infection.”

These infections are usually related to back problems by just a few factors, says Gillespie. The lower back has many fine nerves that can become strained from lifting something very heavy once, or something mildly heavy all of the time/daily, when exercising, from altered posture, etc.

“The discs in the lower back can also become damaged, which can compress the nerves that signal the bladder to empty, causing disruption to urine flow,” says Gillespie. Improper urine flow, she adds, keeps the bacteria in the bladder from being flushed out, which can result in a UTI.

– by Gene J. Koprowski, Editorial Director

Back injuries related to urinary tract infections?

Posted: September 3rd, 2008 under Diseases, Wound Management.
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 A new clinical trial at the University at Buffalo demonstrates that using antimicrobial sutures to secure a shunt and close a wound significantly reduces the number of shunt infections arising during the first six months after brain surgery. Results of the trial appear online in the Journal of Neurosurgery: Pediatrics. 

Sixty-one children requiring brain shunt surgery were assigned randomly to undergo their surgery with antimicrobial sutures, considered the study group, or with conventional sutures, which served as the control group.  All of the procedures were performed by one of two pediatric neurosurgeons at Women & Children’s Hospital of Kaleida Health in Buffalo. At the end of the trial, the shunt infection rate in the study group was 4.3 percent, compared to 21 percent in the control group.

“Some earlier studies, but not all, found that antibiotic-impregnated shunt systems in particular appear to reduce infection risk,” said Dr. Curtis J.  Rozzelle, MD.  “Unfortunately, none of these studies were prospective, randomized, and double-blinded.” In animal trials, sutures were coated with the antimicrobial triclosan have been shown to reduce the number of bacteria adhering to sutures, but only one study has been published thus far on their effect in preventing surgical site infection, so we decided to conduct our own trial, the doctor said.

“Our results showed that using antimicrobial sutures reduced infection risk by 16 percent,” he added.

Antibiotic-impregnated shunts, which are used in some surgeries, have several limitations, said Rozzelle, “They don’t provide complete protection, they can’t be used in patients who are allergic to the antibiotics, and they are a lot more expensive than non-impregnated shunts.”

“Closing wounds with antimicrobial sutures may reduce infections in procedures implanting other devices, such as pacemakers and neurostimulators, pumps that deliver pharmaceuticals and shunts elsewhere in the body,” he said.

– by Gene J. Koprowski, Editorial Director

New sutures cut infection rates for brain surgeries.

Posted: July 28th, 2008 under Anti-Bacterial Resources, Wound Management.
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At Skyline Medical Center in Nashville, Tenn., nurse Deborah Gray, was given the responsibility of developing a pressure ulcer prevention program. In reviewing the hospital’s experience it became apparent to Gray, who holds a master’s in nursing, and is a wound specialist, that incontinence, specifically bowel incontinence, was a major factor in developing skin infections. Her research told her that the best approach was one of frequent, non-abrasive, hypo-allergenic cleansing combined with the use of a “barrier product”—a medication to protect the skin. “The best outcomes in the literature were obtained when there was a system that combined barrier product application with each clean-up episode,” Gray told Infection Protection.Gray found a product that used 3% dimethicone in disposable hypoallergenic washcloths. Dimethicone is a silicone-based organic polymer, used in everything from contact lenses to Silly Putty. When used in a skin moisturizing and cleansing preparation it forms a protective coating. “The cloth used to deliver the 3% dimethicone was much superior to our reusable product and eliminated the abrasive action the we were causing with cleansing,” she says. The new guidelines stressed proper assessment and prevention, as well as treatment. In the two years since implementing her protocol, nurse Gray has seen the rate of incontinence dermatitis fall from double digits to single digits and the rate of hospital acquired pressure ulcers fall to 2%.Incontinence associated dermatitis – skin dermatitis — has been estimated to be as high as 27% in hospitalized patients by some researchers and is associated with hospital acquired infection and a frequent precursor to “hospital acquired pressure ulcers,” experts say.  With proper care, however, all these conditions are completely preventable. As of October 1, the beginning of the next fiscal year for the government, Medicare will no longer pay the extra-care costs of eight common hospital acquired conditions. Pressure ulcers are on that list and Medicare would like to add many hospital acquired infections. The new policy has infection-control advocates both supportive and worried. In a statement issued by the Infectious Disease Society of America, Dr. Lawrence Marginally, MD, chairman of the Clinical Affairs Committee said, “Philosophically, we agree that there should be zero hospital acquired infections. But in practicality, it sets an impossible standard and creates unrealistic expectations.”Medicare, which insures about 44 million people, expects to save $190 million dollars over five years with the new mandates. Private insurers are likely eager to follow suit and the Medicare news has captured the attention of the nation’s hospitals. Medicare reckons the new policy will motivate hospitals to increase the quality of care and reduce preventable complications. The control of incontinence associated dermatitis is one of the areas where some hospitals are having success.Regarding the new Medicare mandates, nurse Gray has mixed feelings, “I believe that facilities that have wound specialists and aggressive quality control programs will probably be all right but so many facilities do not have strong support departments and those I fear will be hurting. I hope these changes will result in better care for patients, but I fear they may only provide additional hoops we all must jump through.”

–by Dr. Chris Iliades, MD, Boston Correspondent

How incontinence dermatitis causes a skin ulcer. Image courtesy of Sage Products.

Posted: March 3rd, 2008 under Feature Stories, Infection Protection, Wound Management.
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A physician has been suspended from practice, and found guilty of incompetence, after misdiagnosing two internal medical problems as “infections,” according to the provincial College of Physicians and Surgeons. The college ruled last week that a Cape Breton doctor was guilty of both “incompetence and professional misconduct.”

Dr. Stani Osif practiced at Northside General Hospital in North Sydney from 1996 until last June. A college review board spent 14 days last fall probing dozens of complaints involving patients, most of them children.

The college is setting a date for her disciplinary hearing, which could result in the loss of her Canadian license to practice medicine.

“We have found that Dr. Osif failed to exercise the degree of care and skill which could reasonably be expected of a normal, prudent practitioner with the same experience and standing in the number of the charges that have been presented to us,” states the report from the college, released Thursday.

According to the college’s findings, Dr. Osif misdiagnosed two potentially life-threatening illnesses, in 2003 and 2005.

* The first involved a 71-year-old amputee who arrived at Northside General in 2003 complaining of hemorrhoids, garbled speech, and bedsores. She diagnosed the man as having an ear infection and hemorrhoids and sent him home with an antibiotic. But a few days later, he developed breathing difficulties, slurred speech and lower back pain and wasn’t eating.

* In another case, the college says the physician also “failed to conduct a proper exam and tests on an 11-year-old girl who arrived with a parent at emergency in 2005 bent over, holding her hypochondrial region. Dr. Osif concluded the ailment was a throat infection, but the girl came back to the hospital days later with a ruptured appendix, requiring emergency surgery.

If a proper physical examination had been performed, symptoms in keeping with appendicitis ought to have been discovered, the board stated, according to a Canadian press report.

– The Editors

http://thechronicleherald.ca/NovaScotia/1033957.html

Logo of College of Physicians & Surgeons.

Posted: January 31st, 2008 under Hand Hygiene, Infection Protection, Wound Management.
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