Biofilms in Medicine: New Knowledge, Treatment, Prevention - Recorded Webinar

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Webinar Duration: 90 minutes

RECORDED: Access recorded version only for one participant; unlimited viewing for 6 months (Access information will be emailed 24 hours after the completion of payment)

SPEAKER: Wava Truscott

This course will discuss the role of microbial biofilms in human infections generally,describe their formation on medical devices, surgical implants, and on human tissues. We will also explain how poorly cleaned instruments resulting in resident biofilms have caused notable outbreaks with poor patient outcomes. This course is rich with pictures to help visualize the points covered. Man and microorganism share the same Prime Directive,the instinctual drive to survive as an individual and as a species. A single bacterium is vulnerable to various threats of suboptimal environmental conditions, disinfectants, antibiotics, and the human immune system. One mechanism for survival used by bacteria, and fungi is the formation of a biofilm. A biofilm is a highly organized community of bacteria that attach tenaciously to surfaces and to each other, exude a complex "goo"that forms a very effective protective fortress. The microbial inhabitants are often of mixed species, but freely communicate with each other, harvest food, eject waste, and spread antimicrobial resistance by transferring copies of their DNA with others in the biofilm community. Recent understanding of biofilm formation is changing many strategies for preventing their formation and disrupting those that are already established on inanimate surfaces or in the human body. Practices in the OR, Procedure Suites, Cath Labs, Sterile Processing departments and general patient care environments for make a huge impact on the risk of patient biofilm threats as well as overt infections.

Biofilms associated with surgical implants will be highlighted, as a steeply increasing number of total hip and knee replacements, as well as spinal surgeries will be performed. Although traditionally performed primarily in Acute Care Centers, performing these surgeries is now expanding into Ambulatory Surgery Centers where CMS will also extend the allowable patient-stay time limit. This change can be a boon financially to the healthcare costs, but the procedures, device reprocessing and infection prevention practices required for the patient's extended stay and wound care practices. Will all require serious focus and training. Understanding the altered operative site around the new implant and how it changes through the course of healing normally compared with the same site occupied by biofilm structures will help attendees recognize vulnerabilities, understand why they cycle, and, more importantly understand what preventative practices can be implemented to prevent site and implant contamination and biofilm formation. The often unnoticed tissue encapsulation of biofilm colonies along implants, central line catheters and will be explored and why they bode poorly for reuse of the same position.

This course will also address Medical device reprocessing staff who are in daily battles in the war against biofilms. Post-procedural handling of instruments and devices before they are transported to Sterile Processing (Medical Device Reprocessing Department) are critical in preventing biofilm formation. Once an endoscope, for instance, is in the department, leak-testing, thorough cleaning, sonication, manual scrubbing, inspection, disinfection, rinsing and drying can each impact biofilm formation, or removal. As disinfectants cannot adequately penetrate the biofilm matrix, many outbreaks have occurred due to inadequate reprocessing of medical devices. This is a critical link in the chain of infection prevention. We will discuss practices performed and decisions made that promoted infections and biofilm formation and those that reduced them. The course will explain why biofilms are such a threat now more than ever, identify their most frequent location sites, explore new methods for preventing their formation and reintroduce old methods armed with new discoveries to break down established biofilms. A greater understanding of biofilm processes will lead to more effective control strategies for biofilm removal and prevention, while improving patient management, outcomes and satisfaction.

Why should you Attend: Biofilms are at the core of chronic wounds and, most often of recurring infections. They protect bacteria making it hard for disinfectants, antiseptics and antibiotics to reach the pathogens within. The biofilm matrix also creates an environment and provides protection for resistant bacteria to easily transfer DNA segment copies to naïve bacteria enabling them to be resistant as well.

The elderly population increases, so does the need for "replacement parts"(pacemakers, prosthetic hip and knee replacements, spinal implants, ophthalmic lens insertions, artificial heart valves, stents, etc.).Bacteria love to form biofilms on implanted devices. Everything about the location and the situational environment virtually guarantees their success - if they are not prevented from forming in the first place.

It is now understood that biofilm accumulation on the teeth and gums of our critically ill patients significantly increases their risk for infection. Pathogens from the healthcare environment aggressively take over the oral biofilm structures (plaque) initiating inflammation and periodontitis, dilating the adjacent blood vessels and allowing the pathogens released from the mature biofilms as "pioneer cells (planktonic) to be transported to remote locations via the circulatory system to initiate overt infections or form new biofilms.

It is important to understand how, where, and why biofilms are initiated and what we can do to prevent their formation. Current and future patients' lives depend on our ability to prevent infection and biofilm formation as we enter a post antibiotic era where more and more of the pathogens are becoming resistant to the antibiotics that we have depended upon destroy them. The crisis is ever more critical as our aging population needs more surgical procedures and their bodies grow less capable of defense due to a slowing immune response.

Areas Covered in the Session:
- Biofilm requirements to initiate formation
- Stages to biofilm maturity and attributes
- Impact of biofilms in medicine noting types of cases biofilm rather than overt acute infection occurs
- Address hospital surface biofilms as pathogen reservoirs
- Antibiotic resistance and an aging population highlight the importance of preventing infections and biofilm formation now more than ever
- The sequence of events and pathological progression to infection as a result of neglected oral care, biofilm formation, invasion by pathogens in the healthcare environment and culminating in a preventable patient infection. Focus: Critical care patients
- The local environment of a recently implanted prosthetic and along the healing timeline and explain why this is a critical part of infection, biofilm formation, and reseeding of pathogens after overt infection defeated
- How contamination/biofilm preventative practices must be implemented in always but even more urgently when foreign bodies are present
- Stopping practices that increase the surgical patients vulnerability to biofilm formation
- Staff practices to reduce biofilm in medical device reprocessing
- New Biofilm preventative innovations on the horizon
- New methods of penetrating the biofilm matrix to access the microorganisms within and increasing their vulnerability to antibiotics and disinfectants

Who Will Benefit:
- Critical Care Nurses
- Unit Nurses
- Surgical Staff all Levels
- Sterile processing/Medical Device Reprocessing Staff
- Hospital Risk Managers
- Infection Preventionists
- CMS Risk Reduction Staff
- Healthcare Educators

Wava Truscott, PhD. MBA, is founder and president of Truscott MedSci Associates, a consulting company addressing current concerns in healthcare including infection prevention, improved patient outcomes, and staff risk reduction. Development of accredited educational courses, speaking engagements, topic research, writing articles, and assisting with experimental design are core competencies. She is an international lecturer having presented in 17 countries and has written over 90 articles and 7 book chapters.

Dr. Truscott received her doctorate from the University of California at Davis (UCD) in Comparative Pathology with major emphasis in Microbiology, Immunology, and Pathology. Her dissertation: Demonstration and Partial Characterization of a Cell-bound Leukotoxin Isolated from Pasteurella multocida of Avian Origin, and demonstrated the pathogenic effects on mononuclear phagocytic cell function. Performed preliminary studies to evaluate efficacy as a subunit vaccine. Separately, she isolated and characterized a new P. multocida bacteriophage. Its fowl cholera pathogen-specific receptors were run on a unique potato starch “gel”, renatured and on immunoblots of outer membrane proteins sufficiently to receive viral attachments (I125 labelled detection). Her MBA is from the University of La Verne and her BS from Brigham Young University in Botany and Zoology. (BYU).

Formerly, Truscott was the Director of Medical Sciences and Clinical Education for Kimberly-Clark Health Care. She is the founder of Kimberly-Clark’s Knowledge Network* - a dynamic collection of educational resources designed to provide insight and information to healthcare professionals. Prior to Kimberly-Clark, she was Vice President and co-founder of Safe Life Corporation, an antimicrobial-based technology enterprise; Vice President of Safe Skin Corporation, a glove development and manufacturing company; and Director of Regulatory and Consumer Affairs, as well as Divisional Biological Laboratories’ Manager for the Pharmaseal Division of Baxter Healthcare. Before receiving her doctorate, Wava was a lab technician and then supervisor at Microbiological Development and Control (“MIDECO,” now Nelson Laboratories), Laboratory Instructor at both BYU and UCD. At UC Davis, Wava was a laboratory assistant in laboratory courses on human microbiology, separated enzymes, proteins, and DNA in the veterinary laboratory, and worked on bacteriophage vs. host studies.

Truscott served as a volunteer at the Gardner HIV Clinic at UCD and as a Certified Hospital Aide in several military hospitals as well as and a long term care facility during and after the Vietnam War. She co-authored the Microbiological section of the Association for the Advancement of Medical Instrumentation (AAMI) Sterilization and Recommended Practices. Dr. Truscott co-chaired the Health Industry Manufacturer’s Association (HIMA: now AdvaMed) Latex Sensitivity Task Force, and was appointed the U.S. delegate to the International Standards Organization on Biocompatibility Testing of Medical Devices regarding Systemic Toxicity (ISO 10993-11) for several years as the European Union was forming. Dr Truscott has been very active in the study of biological consequences of allergic reactions to natural rubber latex proteins, the complications of glove powder and lint in surgical wounds, the unrecognized sources of endotoxin introduced during surgery, and in the development of test methods and standards for a number of medical devices through ASTM International. She authored an extensive petition to the FDA presenting in-depth reasoning for the ban of all powdered gloves in healthcare facilities, which has finally become an FDA Ban on all Powdered gloves in all healthcare facilities. As part of her efforts to prevent healthcare-associated infections, Dr. Truscott is currently working on the ASTM task force charged with developing test methods to assess the efficacy of antimicrobial-incorporated medical gloves. Curriculum vitae available on request.

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