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Bacteriology and Infection Prevention for Orthopaedic Postgraduate Exams
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Bacteriology and Infection Prevention for Orthopaedic Postgraduate Exams
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Language: EN.
Segment:0 .
I'll take the recording. Good evening, everybody. I hope you're all keeping yourself safe during this COVID 19 emergency. I appreciate that. It's busy time and I really do appreciate our mentors. We are still finding the time to come on and prepare presentations and vivo questions.
We've got a good showing from our mentor group 10 mentors today. But more importantly, we also have kind of today who's going to give a presentation on bacteria, infection and infection control. So without further ado, said please share your swing. Go ahead. Yeah can I just I'm sorry, can I just say just setting up?
I just remind you, remind everyone, see, country could feel the feedback from which we shared in the chat area. Yes, sorry about that. There is. If you look at the chat section, there is a Google document form there.
We would like you to fill out feedback. There is no rush, but I would advise you to click on it now or you put it into the browser now so that it's there later on before we close. We'll also post it on the telegram group, of course, but we'd like early feedback as soon as possible. Thank you. It's a very important part of our service delivery. We want to make sure that we are improving as we go along and try and listen to what you as the candidates are saying.
Thank you. OK, so do you're ready? Yeah good evening, everybody. So today's topic of discussion is about bacteria infection control. This is basically a basics of all these three things, which can be applied for a common Viber questions. I can't see the presentation. Yeah, so we've got a blank screen.
All right. And you see now, please. No and now. No, sorry. Take your time and just stop and start again. Let's see. Yeah, so probably it is OK. And then we added, sorry guys, just to.
If anyone's been watching the politics, politicians are doing these conferences and meetings on Zoom and their equivalents. They have trouble even with the best IT technicians in the country, supposedly. Axilo tenodesis is.
Tenotomy, can you see some screen, please? Yeah, Yeah. So I thank you. Yeah, so good evening, everybody. This is a topic on bacteria infection and control basics of which can be applied to various viral questions on in the air forces like infected, total knee replacement, necrotizing fasciitis and so on. So it's short and really focused topic attended by me today.
So if you see bacteria, the name derived from bacterial meaning rots bacteria or small microorganisms roughly around 0.5 to five microns, and they are of phylogenetically called prokaryotes sites. The first person who saw the bacteria under a microscope was Anthony living a lie. I mean, it's like it's a Polish name.
I cannot really pronounce it, but he's the one who saw the bacteria under the skin and is designed for primitive microscope and has drawn some rocks on the right sort of thing, which is his illustration on the bacteria. So bacteria is a organism like this. It has. It is called the cell body. And it Dale called flagella no cell has a central genetic material, DNA with some ribosomes is surrounded by a plasma membrane and then cell wall, and on top of it is a capsule.
Some some the genetic material also can exist in a small plasmids through which it transmits and transferred to genetic organism, the genetic material to other organisms. So these are bacteria that are various types of bacteria like cocaine, which is just spherical or bacilli, which are rod shaped or Coco bacilli. They can be solitary or can be in a cluster like staphylococcus, which forms a big cluster like grapes.
And most people would classify them into a gram positive or negative. So it's very important to know how this gram standing is done when we are strict and need and send it to microbiology. We need to answer. So you take an organism like this and on the top of this organism, you put Crystal violet and it strains the organism, a purplish color. And again, you put iodine in the proper color remains and the organism then is washed with the alcohol or acetone.
You will see some organisms maintain the purple color and they're called gram positive. But other ones which do not maintain the color they are called gram negative. So gram negative are further subjected to a dye called saffron and they get a pink color. It's not very pink here, but it's pinkish. So the compost 1 gram negative, so gram positive and gram negative are again divided into Coca and basal like rots and disappears.
So the various ways you can actually diagnose bacteria other than gram stands by culture, culture, you know, blood agar, et cetera. And for slow going bacteria, we have to do it for a long time, like tuberculosis. There is a polymeric and logistics reaction, which can detect pretty quickly. This is up to microbes, but I think mRNA is detected by this technique, and that is a blot analysis can be Western blot, northern blot, Eastern blot, which is basically to see the DNA, RNA or proteins and antigen test, which is not really commonly done in this part of the world.
But many people in the Asian communities that you see that we don't want to test commonly to see whether the disease is active or not. So all the bacteria we commonly and encounter are these staph aureus staph epidermidis streptococci, gram negative Clostridium and not so much. But in Middle East or countries, you can get a tropical disease of brucellosis.
So staph aureus is quite common. Steph epidermidis is also quite common in the race between these two to know what is the number one. So and as MRSA, because mRNA is one of the most important organism which everybody is focused with screen for them and do some things to prevent infection with MRSA. So what do the bacteria actually do to humans they can colonize?
They can just be sitting on the skin like staph epidermidis, or they can be sitting in the tummy like gram negative bacilli. They can cause symbiosis. Like a typical example is like lactobacillus, which helps digestion and the absorption process. They can cause the disease infection. Or they can release toxins which can cause problems somewhere else, like a typical example is tetanus, which can list at most puzzling and cause spasm of muscles and further on.
So these are four basic ways the bacterium can interact with human beings. And this is very important because it will frame what the bacteria actually does. Next question is if the infection or disease, how does it cause disease? What are the types of infections? There can be various types of infections, but roughly what examiner is asking is whether it's biogenic infection or granulomatous infection.
Biogenic infection is a acute infection and there is a chronic infection, biogenic egawa, innate immunity, working granulomatous. What cell mediated and hormonal immunity working and biogenic inflammation generally causes pus. Granulomatous in infection caused granulomas to pathogenic can be something like a boiler for Uncle or abscess.
Granulomatous can be something like a tuberculosis to light is too close to activities, et cetera for example, you might be asked this one, and there might be. It can be anything. But these are two far communist topics which can be asked. One is this will be shown is a related or rapidly spreading like link with some areas of necrosis and/or to talk about it. And this presentation, I plan to just make a work when you can get the points together and work towards this, or you might be asked something like this, which is also common in total.
Joint replacement. These are two common scenarios. As for their first questions. So next question and this is very important is when we have bacteria and we know the cycle and metabolism of bacteria, whether antibiotics actually work. So we'll have our beta lactam antibiotics like penicillin or vancomycin, which inhibits cell wall synthesis.
Then we got the sulfonamides commonly uses trimethoprim, which blocks of folic acid synthesis, and then we have quinolones, which is like ciprofloxacin, which works on DNA guidice. And then we have other side poly mixing, which works on cell membrane. There are some which works on the ribosome, like a monocular and tetracyclines, which work on a subunit, whereas a macrolides work on the 50th erythromycin through Mason acid to rifampicin is not that commonly used for leprosy and tuberculosis, and sometimes for resistant organisms like immodesty, which works on RNA polymerase.
All right. So well, when you get the resistance and we often guess, how do they get resistance, what are the means? And there are various ways the bacteria can get resistant. One is the formation of a glycolipid. I'll come to this again. So this is a 1.4m snake like complex and it's embedded and that prevents the antibiotic actually reaching the organism and the resistance.
Second is it can quote substances that bind antibiotics. A typical example is a penciling binding protein two, which is made by MRSA, which goes in by sponsoring the mecha gene codes. For this and this, this is quite important point to know, actually, then it gene it can metabolize the antibiotics like beta lactam is can disintegrate the penicillin.
Or it can alter the permeability. It might not allow the antibiotic to enter the organism to kill it, or it can once enter the organism. It can pump them out. And last but not least, it can alter the metabolic pathways, so from outside in. These are all causes of resistance against antibiotics. Also, roughly, we have antibiotics, which are bactericidal, which can kill organisms like penicillin or electrostatic, like sulfonamides.
So coming to glycol, which is also called biofilm, it's a very important concept. And it's one concept, which is important for us, especially the second slide, which I showed you where there's a prosthetic joint implants replacement is infected or when there's infected metal work. Why is it important? So basically, what is a biofilm is a matrix formed by protein, fat and protein glycans, so they have stages of forming the biofilm.
So first, the microorganism just attach and attach to surface without any biological attachment. They secrete lipids, proteins, collections to form a matrix. In this matrix, they can release chemicals to communicate with themselves. And this gives 1,000 fold resistance to antibiotics later on the pill. There are small, small finger like projections on bacteria which can hold onto the surface, and that it is really difficult to remove it without removing them.
And that's the reason when there's an infection, the implant in situ, usually we have to remove the implant. So no common way about that topics during the basic science, why what can be MRSA, which is quite important and how to prevent infection during joint replacement? The question can come in several ways like you might be showing a picture of infected joint replacement or you might be asked that you are a new Consultant who has joined just now and your two joints have got infected and what you'll do now, or it can be a design of data, but it all basically is asking the same question.
So even MRSA, when they show you the rest of the previous slides, are one which gives an impression about MRSA also. So MRSA mRNA is methicillin resistant Staphylococcus aureus. It's common in crowded places, more common with open wounds, indwelling catheters, people who got chronic illnesses or immune deficiency, et cetera it's quite a common organism organism actually normally around.
Sorry for that. The reason it is notorious because of its resistance to many antibiotics. Is it resistant? It's because of this gene called gene, which encodes penicillin binding protein that binds penicillin. And they'll further recognize that there is not just a single gene, but a locus of genes, which also codes for other proteins, which which gives resistance to other antibiotics.
So sorry for that. So it is around 1 to 3% of population, and if it's health care workers, it can go up to 10% to 20% What am I to see? Does mRNA can cause a soft tissue infection like cellulitis, abscess, deep infection like osteomyelitis, it can cause chest infection or generalized sepsis. So there are four things MRSA causes.
So how do really we work on MRC, how do we prevent? So first of all, is prevention, fatigue, general hygiene is important. So that's why it will tell people to have baths before they come for elective surgery. Then if a patient has got catheter or wound, you have to cover the wound. Take care of catheter. Effective screening is a important part.
This is commonly done for the people who come for elective surgery and preoperative clinic, as well as the trauma patient. The swaps swapped on the admission swaps are taken from the nose, axilo and groin and doesn't take the site for the testing. And I don't think they do culture on it. They don't do grandstand either. They go for PCR and isolate the organism.
Another very important factor in preventing infections, hand washing before and after isolation of patient and protective equipment. If there is infection, so you are to keep the patient in separate Bay or separate room, use protective equipment like masks, gloves and the aprons and treatment of infection. If it's causing infection, then you treat infection. There are certain antibiotics which are directed towards the mRNA.
Now MRSA, if it's just to colonize it like you will see its pre-op mission complete and patient doesn't have any problem, but you find the positive in the swaps. Then if the patient is given an ointment and blow by it, and if it's going for elective surgeries to get at least three weekly swaps negative till he's ready for surgery, or if it's a disease that is when it's infected and got problems can be cellulitis or whatever things so.
So the drugs which are usually given are vancomycin, typekit, planning and linezolid. Microbiology studies prefer typekit planning because then given once away so medics are happy. It's got a good soft tissue and want a good penetration bone and soft tissues. Then the second line drug, but the second line drug. But it does effect it as it is effective because it can be given oral as well as it got a very good penetration in bone and soft tissues.
Right so next coming is next. Third slide, the third topic, which is rotating around infections, how to prevent infection. So how to prevent infection? It's very common question. And unless you have a framework, you cannot really tell all the points which are required. Most people will say all four, but you have to also say that I would go strategically.
I will see preoperative operative and post-operative practice of preoperative factors can be optimization of medical conditions which might be having diabetes or some COPD or cardiac failure, which can. We can either make room for infection or prolong his stay in hospital and make a point for infection. The second thing is, addition of medication adjustment can be maybe to control a political control diabetic or for orthopedics.
It can be adjustment stopping biological agents for treatment of rheumatoid arthritis, et cetera and I talk about screening. Screening is important for MRSA. That's the common screening and treatment of any other infection, like if a patient might be coming for a total hip replacement and you might have the. I don't know there are any strict guidelines about whether to operate or not.
Some construction depends on consultant wise, but I know a couple of cases where it pretty well, but it isn't adequate infection. So these are preoperative things intraoperatively so improperly to the point the bullet points are appropriate data, which is you've got several factors which you can mention about later that it should be away from the main stream, should be close to surgical.
And what's an intensive unit? It should have adequate and proper flooring, proper ventilation and proper lighting and proper ventilation. When you say when we're talking about. And because. Is known to reduce the airborne infection, and you can quote a little paper on this, but also important is to keep the sterile chain, which is the proper prep shaving, proper preparation, proper draping of both of patients as well as surgeons.
One of the things it's not really important is take the discipline. You see many times for an important procedure. There is a lot of ground and they don't want people to really go in and out, causing entrenchment of airfields and turbulence of elephants and antibiotics. This is very important. Antibiotics for preoperative antibiotics are known to reduce the infection.
Detroit infection, as well as you can. Some consultant use antibiotic impregnated cement. So these are two factors. Then there are surgical factors like meticulous hamish, disease prevention of hematoma, et cetera and what are the post-operative factors? Post-operative factors can be a dedicated elective Ward like in our hospital as a ward, which is basically for elective patients.
And they think the other cases might not be coming because they're not screened for MRSA and so on, et cetera antibiotics. Most people will ask you to do this post-operative, but generally some people also wait 24 hours. I don't think there is a consensus on that. Then good appropriate medical care, which means control of redistricting factors like diabetes treatment of other ailments which can postpone its hospital stay.
And then wound care. Most people wouldn't change the dressing of the wound, but have a look at it. So wound care that most post-operative care and then a regular follow up to see what chain of chain of health professional which you look at the wound and patient otherwise. So these are the factors. So we talk about bacteria, the antibiotic resistance and Mrs.
and the prevention of infection in general. That's the end of the presentation. Thanks for listening. Thank you said that's not an easy topic to cover. There's you're bringing in both bacteria and infection prevention into one. It's quite well, well covered. There was one question on the chat.
Obviously, I read it out for you when there is a prosthetic infection, can you have a scenario where a biofilm does not form, or is it always assumed that a biofilm has formed? Oh, well, most people will say that I don't have what biofilm is formal or not, but most people, if it is less than 4 to six weeks, would just change the space and then and then wash it out and do antibiotic slap lesion.
Yeah absolutely correct, so I agree, but the bacteria that causes us problems as orthopedic surgeons from biofilm, if they didn't form biofilm, then the body's own immune system and the antibiotics, if you're giving it would be effective in most scenarios. So biofilm is presumed as such that it will form within four weeks of acute infection.
And so that's when you can provide a dare as an option, then that brings the next question what? What does d'air mean? Practically what does their mean? What does didn't get it again, so dirty air? Here are I don't know the needs and implant retention procedure done for patients in the acute early phase.
Essentially, it's a wash out and change of any processes that can be changed on any part of the modular prostheses that can be changed. It's quite. Yeah, it's something I know. You know it. I know it's just probably the microphone is not coming across. Well, that's why the so it's something that will come up in the exam day versus one stage versus two stage revision.
It's something I would strongly recommend that you get a grip on it. There's not necessarily a right or wrong answer for this. There are things which include patient factor, acuity of the onset of the infection and the time and onset of intervention when you can get the case done. So there's no right or wrong answer here, but you should read and understand when each when each is recommended or not.
So there will be surgeons that will tell you straight off that they'll always do a two stage. There are some centers that will preferably try and do at one stage as an example. And there would only be reserved for the acute phase of an infection, not for chronic infection. And any other questions and any comments from our mentors?
I think from the exact purpose, it still would be a two stage if you are talking about the revision, because for the single state, you need to the strict criteria they have got for it. And one of them is, as you should know, what bacteria is causing the problem. So that is one of the indications to do one stage invasion. But I think you should.
The candidates should be aware that the one stage region has got his own benefits, especially it has got less morbidity. So and more recently, there are papers coming out, especially from London, which are showing results. But again, it is something which you can't do it in your hospital without having a proper setup. Absolutely there is. We've definitely covered this topic before, and I believe there was a YouTube video.
And if I see a mental page, which is talking about prosthetic joint infections and the specifically discussing these options, so we won't spend too much time on it, only here today. Any other comments? Questions so I have a comment. I'd like you guys to think about one of the potential questions, which I have a feeling will come up at some stage is how does bacteria develop resistance?
And I strongly recommend you do try to read this up. It is something that as auto parts surgeons, we can try and minimize this scenario because, for example, liberal use of antibiotics GPs are, for example, being told now to decrease the amount of time they're giving their antibiotics for a decrease instead of traditional used to give for a week of antibiotics.
Now and then it went down to five. And now some indications are only three days for routine soft tissue infections, specifically because what they don't want to do is encourage the resistant bacteria. But these are things that's worth reading, and I can give you some hints. There's a vertical transmission of the DNA. There's horizontal transmission of the DNA.
And then there's also a combination of bacteria phagocytosis of viral viruses that cause DNA to be incorporated into the bacteria itself and the use of plasmids. So this is a coming area of research, and I suspect if not in the next year or two, it will come up soon after that.
OK any other comments questions? OK excellent. We are looking for volunteers for our vyver session coming up straight after this. Naturally, we don't record these. Thank you so much, Sid, and we had a great participation to list today, over 35 participants today and a good showing from our mentor mentors as well for us.
Amjad Muhammad, Fahad chowdhury, Kashif Mahmood, Ranjit isaca, Muhammad Ali. If I've missed any one, please forgive me. And I just urge all the candidates or the viewer, the audience just to fill the form, the assessment form that have been sent to them as a link, please. Yes feedback is quite important to us. It helps us improve our work. But also it's a way of keeping track of how well we are doing.
Them we're giving our time freely here. It's the least we can ask is if you guys can give us feedback on this form. Thank you very much. We'll stop. Sorry, there was just one more question. Our guest has been sent. The form has been sent to you at the link earlier on. Yeah so it's in the chat section.
And did you did you put it in the telegram group? Amjad, I'll put it right now. Thank you very much. OK, we'll stop recording here.
Segment:0 .
I'll take the recording. Good evening, everybody. I hope you're all keeping yourself safe during this COVID 19 emergency. I appreciate that. It's busy time and I really do appreciate our mentors. We are still finding the time to come on and prepare presentations and vivo questions.
We've got a good showing from our mentor group 10 mentors today. But more importantly, we also have kind of today who's going to give a presentation on bacteria, infection and infection control. So without further ado, said please share your swing. Go ahead. Yeah can I just I'm sorry, can I just say just setting up?
I just remind you, remind everyone, see, country could feel the feedback from which we shared in the chat area. Yes, sorry about that. There is. If you look at the chat section, there is a Google document form there.
We would like you to fill out feedback. There is no rush, but I would advise you to click on it now or you put it into the browser now so that it's there later on before we close. We'll also post it on the telegram group, of course, but we'd like early feedback as soon as possible. Thank you. It's a very important part of our service delivery. We want to make sure that we are improving as we go along and try and listen to what you as the candidates are saying.
Thank you. OK, so do you're ready? Yeah good evening, everybody. So today's topic of discussion is about bacteria infection control. This is basically a basics of all these three things, which can be applied for a common Viber questions. I can't see the presentation. Yeah, so we've got a blank screen.
All right. And you see now, please. No and now. No, sorry. Take your time and just stop and start again. Let's see. Yeah, so probably it is OK. And then we added, sorry guys, just to.
If anyone's been watching the politics, politicians are doing these conferences and meetings on Zoom and their equivalents. They have trouble even with the best IT technicians in the country, supposedly. Axilo tenodesis is.
Tenotomy, can you see some screen, please? Yeah, Yeah. So I thank you. Yeah, so good evening, everybody. This is a topic on bacteria infection and control basics of which can be applied to various viral questions on in the air forces like infected, total knee replacement, necrotizing fasciitis and so on. So it's short and really focused topic attended by me today.
So if you see bacteria, the name derived from bacterial meaning rots bacteria or small microorganisms roughly around 0.5 to five microns, and they are of phylogenetically called prokaryotes sites. The first person who saw the bacteria under a microscope was Anthony living a lie. I mean, it's like it's a Polish name.
I cannot really pronounce it, but he's the one who saw the bacteria under the skin and is designed for primitive microscope and has drawn some rocks on the right sort of thing, which is his illustration on the bacteria. So bacteria is a organism like this. It has. It is called the cell body. And it Dale called flagella no cell has a central genetic material, DNA with some ribosomes is surrounded by a plasma membrane and then cell wall, and on top of it is a capsule.
Some some the genetic material also can exist in a small plasmids through which it transmits and transferred to genetic organism, the genetic material to other organisms. So these are bacteria that are various types of bacteria like cocaine, which is just spherical or bacilli, which are rod shaped or Coco bacilli. They can be solitary or can be in a cluster like staphylococcus, which forms a big cluster like grapes.
And most people would classify them into a gram positive or negative. So it's very important to know how this gram standing is done when we are strict and need and send it to microbiology. We need to answer. So you take an organism like this and on the top of this organism, you put Crystal violet and it strains the organism, a purplish color. And again, you put iodine in the proper color remains and the organism then is washed with the alcohol or acetone.
You will see some organisms maintain the purple color and they're called gram positive. But other ones which do not maintain the color they are called gram negative. So gram negative are further subjected to a dye called saffron and they get a pink color. It's not very pink here, but it's pinkish. So the compost 1 gram negative, so gram positive and gram negative are again divided into Coca and basal like rots and disappears.
So the various ways you can actually diagnose bacteria other than gram stands by culture, culture, you know, blood agar, et cetera. And for slow going bacteria, we have to do it for a long time, like tuberculosis. There is a polymeric and logistics reaction, which can detect pretty quickly. This is up to microbes, but I think mRNA is detected by this technique, and that is a blot analysis can be Western blot, northern blot, Eastern blot, which is basically to see the DNA, RNA or proteins and antigen test, which is not really commonly done in this part of the world.
But many people in the Asian communities that you see that we don't want to test commonly to see whether the disease is active or not. So all the bacteria we commonly and encounter are these staph aureus staph epidermidis streptococci, gram negative Clostridium and not so much. But in Middle East or countries, you can get a tropical disease of brucellosis.
So staph aureus is quite common. Steph epidermidis is also quite common in the race between these two to know what is the number one. So and as MRSA, because mRNA is one of the most important organism which everybody is focused with screen for them and do some things to prevent infection with MRSA. So what do the bacteria actually do to humans they can colonize?
They can just be sitting on the skin like staph epidermidis, or they can be sitting in the tummy like gram negative bacilli. They can cause symbiosis. Like a typical example is like lactobacillus, which helps digestion and the absorption process. They can cause the disease infection. Or they can release toxins which can cause problems somewhere else, like a typical example is tetanus, which can list at most puzzling and cause spasm of muscles and further on.
So these are four basic ways the bacterium can interact with human beings. And this is very important because it will frame what the bacteria actually does. Next question is if the infection or disease, how does it cause disease? What are the types of infections? There can be various types of infections, but roughly what examiner is asking is whether it's biogenic infection or granulomatous infection.
Biogenic infection is a acute infection and there is a chronic infection, biogenic egawa, innate immunity, working granulomatous. What cell mediated and hormonal immunity working and biogenic inflammation generally causes pus. Granulomatous in infection caused granulomas to pathogenic can be something like a boiler for Uncle or abscess.
Granulomatous can be something like a tuberculosis to light is too close to activities, et cetera for example, you might be asked this one, and there might be. It can be anything. But these are two far communist topics which can be asked. One is this will be shown is a related or rapidly spreading like link with some areas of necrosis and/or to talk about it. And this presentation, I plan to just make a work when you can get the points together and work towards this, or you might be asked something like this, which is also common in total.
Joint replacement. These are two common scenarios. As for their first questions. So next question and this is very important is when we have bacteria and we know the cycle and metabolism of bacteria, whether antibiotics actually work. So we'll have our beta lactam antibiotics like penicillin or vancomycin, which inhibits cell wall synthesis.
Then we got the sulfonamides commonly uses trimethoprim, which blocks of folic acid synthesis, and then we have quinolones, which is like ciprofloxacin, which works on DNA guidice. And then we have other side poly mixing, which works on cell membrane. There are some which works on the ribosome, like a monocular and tetracyclines, which work on a subunit, whereas a macrolides work on the 50th erythromycin through Mason acid to rifampicin is not that commonly used for leprosy and tuberculosis, and sometimes for resistant organisms like immodesty, which works on RNA polymerase.
All right. So well, when you get the resistance and we often guess, how do they get resistance, what are the means? And there are various ways the bacteria can get resistant. One is the formation of a glycolipid. I'll come to this again. So this is a 1.4m snake like complex and it's embedded and that prevents the antibiotic actually reaching the organism and the resistance.
Second is it can quote substances that bind antibiotics. A typical example is a penciling binding protein two, which is made by MRSA, which goes in by sponsoring the mecha gene codes. For this and this, this is quite important point to know, actually, then it gene it can metabolize the antibiotics like beta lactam is can disintegrate the penicillin.
Or it can alter the permeability. It might not allow the antibiotic to enter the organism to kill it, or it can once enter the organism. It can pump them out. And last but not least, it can alter the metabolic pathways, so from outside in. These are all causes of resistance against antibiotics. Also, roughly, we have antibiotics, which are bactericidal, which can kill organisms like penicillin or electrostatic, like sulfonamides.
So coming to glycol, which is also called biofilm, it's a very important concept. And it's one concept, which is important for us, especially the second slide, which I showed you where there's a prosthetic joint implants replacement is infected or when there's infected metal work. Why is it important? So basically, what is a biofilm is a matrix formed by protein, fat and protein glycans, so they have stages of forming the biofilm.
So first, the microorganism just attach and attach to surface without any biological attachment. They secrete lipids, proteins, collections to form a matrix. In this matrix, they can release chemicals to communicate with themselves. And this gives 1,000 fold resistance to antibiotics later on the pill. There are small, small finger like projections on bacteria which can hold onto the surface, and that it is really difficult to remove it without removing them.
And that's the reason when there's an infection, the implant in situ, usually we have to remove the implant. So no common way about that topics during the basic science, why what can be MRSA, which is quite important and how to prevent infection during joint replacement? The question can come in several ways like you might be showing a picture of infected joint replacement or you might be asked that you are a new Consultant who has joined just now and your two joints have got infected and what you'll do now, or it can be a design of data, but it all basically is asking the same question.
So even MRSA, when they show you the rest of the previous slides, are one which gives an impression about MRSA also. So MRSA mRNA is methicillin resistant Staphylococcus aureus. It's common in crowded places, more common with open wounds, indwelling catheters, people who got chronic illnesses or immune deficiency, et cetera it's quite a common organism organism actually normally around.
Sorry for that. The reason it is notorious because of its resistance to many antibiotics. Is it resistant? It's because of this gene called gene, which encodes penicillin binding protein that binds penicillin. And they'll further recognize that there is not just a single gene, but a locus of genes, which also codes for other proteins, which which gives resistance to other antibiotics.
So sorry for that. So it is around 1 to 3% of population, and if it's health care workers, it can go up to 10% to 20% What am I to see? Does mRNA can cause a soft tissue infection like cellulitis, abscess, deep infection like osteomyelitis, it can cause chest infection or generalized sepsis. So there are four things MRSA causes.
So how do really we work on MRC, how do we prevent? So first of all, is prevention, fatigue, general hygiene is important. So that's why it will tell people to have baths before they come for elective surgery. Then if a patient has got catheter or wound, you have to cover the wound. Take care of catheter. Effective screening is a important part.
This is commonly done for the people who come for elective surgery and preoperative clinic, as well as the trauma patient. The swaps swapped on the admission swaps are taken from the nose, axilo and groin and doesn't take the site for the testing. And I don't think they do culture on it. They don't do grandstand either. They go for PCR and isolate the organism.
Another very important factor in preventing infections, hand washing before and after isolation of patient and protective equipment. If there is infection, so you are to keep the patient in separate Bay or separate room, use protective equipment like masks, gloves and the aprons and treatment of infection. If it's causing infection, then you treat infection. There are certain antibiotics which are directed towards the mRNA.
Now MRSA, if it's just to colonize it like you will see its pre-op mission complete and patient doesn't have any problem, but you find the positive in the swaps. Then if the patient is given an ointment and blow by it, and if it's going for elective surgeries to get at least three weekly swaps negative till he's ready for surgery, or if it's a disease that is when it's infected and got problems can be cellulitis or whatever things so.
So the drugs which are usually given are vancomycin, typekit, planning and linezolid. Microbiology studies prefer typekit planning because then given once away so medics are happy. It's got a good soft tissue and want a good penetration bone and soft tissues. Then the second line drug, but the second line drug. But it does effect it as it is effective because it can be given oral as well as it got a very good penetration in bone and soft tissues.
Right so next coming is next. Third slide, the third topic, which is rotating around infections, how to prevent infection. So how to prevent infection? It's very common question. And unless you have a framework, you cannot really tell all the points which are required. Most people will say all four, but you have to also say that I would go strategically.
I will see preoperative operative and post-operative practice of preoperative factors can be optimization of medical conditions which might be having diabetes or some COPD or cardiac failure, which can. We can either make room for infection or prolong his stay in hospital and make a point for infection. The second thing is, addition of medication adjustment can be maybe to control a political control diabetic or for orthopedics.
It can be adjustment stopping biological agents for treatment of rheumatoid arthritis, et cetera and I talk about screening. Screening is important for MRSA. That's the common screening and treatment of any other infection, like if a patient might be coming for a total hip replacement and you might have the. I don't know there are any strict guidelines about whether to operate or not.
Some construction depends on consultant wise, but I know a couple of cases where it pretty well, but it isn't adequate infection. So these are preoperative things intraoperatively so improperly to the point the bullet points are appropriate data, which is you've got several factors which you can mention about later that it should be away from the main stream, should be close to surgical.
And what's an intensive unit? It should have adequate and proper flooring, proper ventilation and proper lighting and proper ventilation. When you say when we're talking about. And because. Is known to reduce the airborne infection, and you can quote a little paper on this, but also important is to keep the sterile chain, which is the proper prep shaving, proper preparation, proper draping of both of patients as well as surgeons.
One of the things it's not really important is take the discipline. You see many times for an important procedure. There is a lot of ground and they don't want people to really go in and out, causing entrenchment of airfields and turbulence of elephants and antibiotics. This is very important. Antibiotics for preoperative antibiotics are known to reduce the infection.
Detroit infection, as well as you can. Some consultant use antibiotic impregnated cement. So these are two factors. Then there are surgical factors like meticulous hamish, disease prevention of hematoma, et cetera and what are the post-operative factors? Post-operative factors can be a dedicated elective Ward like in our hospital as a ward, which is basically for elective patients.
And they think the other cases might not be coming because they're not screened for MRSA and so on, et cetera antibiotics. Most people will ask you to do this post-operative, but generally some people also wait 24 hours. I don't think there is a consensus on that. Then good appropriate medical care, which means control of redistricting factors like diabetes treatment of other ailments which can postpone its hospital stay.
And then wound care. Most people wouldn't change the dressing of the wound, but have a look at it. So wound care that most post-operative care and then a regular follow up to see what chain of chain of health professional which you look at the wound and patient otherwise. So these are the factors. So we talk about bacteria, the antibiotic resistance and Mrs.
and the prevention of infection in general. That's the end of the presentation. Thanks for listening. Thank you said that's not an easy topic to cover. There's you're bringing in both bacteria and infection prevention into one. It's quite well, well covered. There was one question on the chat.
Obviously, I read it out for you when there is a prosthetic infection, can you have a scenario where a biofilm does not form, or is it always assumed that a biofilm has formed? Oh, well, most people will say that I don't have what biofilm is formal or not, but most people, if it is less than 4 to six weeks, would just change the space and then and then wash it out and do antibiotic slap lesion.
Yeah absolutely correct, so I agree, but the bacteria that causes us problems as orthopedic surgeons from biofilm, if they didn't form biofilm, then the body's own immune system and the antibiotics, if you're giving it would be effective in most scenarios. So biofilm is presumed as such that it will form within four weeks of acute infection.
And so that's when you can provide a dare as an option, then that brings the next question what? What does d'air mean? Practically what does their mean? What does didn't get it again, so dirty air? Here are I don't know the needs and implant retention procedure done for patients in the acute early phase.
Essentially, it's a wash out and change of any processes that can be changed on any part of the modular prostheses that can be changed. It's quite. Yeah, it's something I know. You know it. I know it's just probably the microphone is not coming across. Well, that's why the so it's something that will come up in the exam day versus one stage versus two stage revision.
It's something I would strongly recommend that you get a grip on it. There's not necessarily a right or wrong answer for this. There are things which include patient factor, acuity of the onset of the infection and the time and onset of intervention when you can get the case done. So there's no right or wrong answer here, but you should read and understand when each when each is recommended or not.
So there will be surgeons that will tell you straight off that they'll always do a two stage. There are some centers that will preferably try and do at one stage as an example. And there would only be reserved for the acute phase of an infection, not for chronic infection. And any other questions and any comments from our mentors?
I think from the exact purpose, it still would be a two stage if you are talking about the revision, because for the single state, you need to the strict criteria they have got for it. And one of them is, as you should know, what bacteria is causing the problem. So that is one of the indications to do one stage invasion. But I think you should.
The candidates should be aware that the one stage region has got his own benefits, especially it has got less morbidity. So and more recently, there are papers coming out, especially from London, which are showing results. But again, it is something which you can't do it in your hospital without having a proper setup. Absolutely there is. We've definitely covered this topic before, and I believe there was a YouTube video.
And if I see a mental page, which is talking about prosthetic joint infections and the specifically discussing these options, so we won't spend too much time on it, only here today. Any other comments? Questions so I have a comment. I'd like you guys to think about one of the potential questions, which I have a feeling will come up at some stage is how does bacteria develop resistance?
And I strongly recommend you do try to read this up. It is something that as auto parts surgeons, we can try and minimize this scenario because, for example, liberal use of antibiotics GPs are, for example, being told now to decrease the amount of time they're giving their antibiotics for a decrease instead of traditional used to give for a week of antibiotics.
Now and then it went down to five. And now some indications are only three days for routine soft tissue infections, specifically because what they don't want to do is encourage the resistant bacteria. But these are things that's worth reading, and I can give you some hints. There's a vertical transmission of the DNA. There's horizontal transmission of the DNA.
And then there's also a combination of bacteria phagocytosis of viral viruses that cause DNA to be incorporated into the bacteria itself and the use of plasmids. So this is a coming area of research, and I suspect if not in the next year or two, it will come up soon after that.
OK any other comments questions? OK excellent. We are looking for volunteers for our vyver session coming up straight after this. Naturally, we don't record these. Thank you so much, Sid, and we had a great participation to list today, over 35 participants today and a good showing from our mentor mentors as well for us.
Amjad Muhammad, Fahad chowdhury, Kashif Mahmood, Ranjit isaca, Muhammad Ali. If I've missed any one, please forgive me. And I just urge all the candidates or the viewer, the audience just to fill the form, the assessment form that have been sent to them as a link, please. Yes feedback is quite important to us. It helps us improve our work. But also it's a way of keeping track of how well we are doing.
Them we're giving our time freely here. It's the least we can ask is if you guys can give us feedback on this form. Thank you very much. We'll stop. Sorry, there was just one more question. Our guest has been sent. The form has been sent to you at the link earlier on. Yeah so it's in the chat section.
And did you did you put it in the telegram group? Amjad, I'll put it right now. Thank you very much. OK, we'll stop recording here.
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