ORIGINAL TEXT:
The Centers for Disease Control and Prevention (CDC) today released new guidelines outlining strategies to prevent the spread of drug-resistant infections in healthcare settings. The new guidelines seek to halt the rising rates of drug-resistant infections by calling on hospitals and other healthcare facilities to make comprehensive infection control programs a priority and to take aggressive steps to reduces rates of drug resistance.
During the past 30 years, the proportion of bacteria that are resistant to antibiotics has steeply risen. Antimicrobial resistance occurs when bacteria change or adapt in a way that allows them to survive in the presence of antibiotics designed to kill them. A good example is the type of bacteria that cause “staph” infections– Staphylococcus aureus. In 1972, only 2 percent of these types of bacteria were drug resistant. By 2004, 63 percent of these types of bacteria had become resistant to the antibiotics commonly used to treat them, and methicillin-resistant “staph” infections, often referred to as MRSA, are a growing problem in hospitals and healthcare facilities such as nursing homes and dialysis centers. In a few cases, bacteria become so resistant that no available antibiotics are effective against them.
“Effective and comprehensive programs to prevent drug-resistant infections are essential to improve patient safety,” said Dr. Denise Cardo, director of CDC’s Division of Healthcare Quality Promotion. “Preventing these types of infections requires a constant and concerted effort on the part of healthcare facilities, but it’s important they make this a priority. We need to reduce the number of these serious and potentially life-threatening infections-doing so helps patients get healthy and, most importantly, saves lives.”
This new guidance, Management of Multidrug-Resistant Organisms in Healthcare Settings, was developed by internationally recognized experts in infection control in conjunction with CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC), a committee comprised of external advisors from academic research institutions, public health and healthcare organizations to advise CDC regarding infection control, strategies for healthcare surveillance and prevention of healthcare-associated infections in the United States.
Staph infections, including MRSA, occur most frequently among persons in hospitals and healthcare facilities who have weakened immune systems, and often result in bloodstream infections, surgical site infections or pneumonia.
The new guidelines illustrate that in order to prevent and control antibiotic-resistant infections, hospitals and healthcare facilities need to take several steps including:
• Ensuring prevention programs are funded and adequately staffed,
• Carefully tracking infection rates and related data to monitor the impact of prevention efforts,
• Ensuring that staff use standard infection control practices and follow guidelines regarding the correct use of antibiotics,
• Promoting best-practices with health education campaigns to increase adherence to established recommendations,
• Designing robust prevention programs customized to specific settings and local needs
If those recommendations don’t improve rates, healthcare facilities must reevaluate and implement more stringent measures, including screening of all patients at high risk for carrying drug-resistant bacteria to make sure the correct precautions are used for the right patients.
“There’s no one size fits all solution,” said Dr. Patrick J. Brennan, chair of CDC’s Healthcare Infection Control Practices Advisory Committee. “Prevention of drug-resistant infections requires a full complement of actions tailored to the local setting.”
CDC continues to work with local and regional partners to evaluate effective strategies to reduce healthcare-associated infections. The full document and more information on CDC and local efforts to reduce healthcare-associated infections can be found at www.cdc.gov/ncidod/dhqp. Read more

The practicing physician, whether an imaging specialist or primary care physician, may never have encountered NMR imaging and may have previously considered NMR as merely a chemical phenomenon useful for sophisticated chemical analysis. The principles of NMR are actually first described in 1946, and NMR imaging has been used since 1973. Although clinical medical applications of these imaging techniques have only recently been reported, NMR imaging has already been shown to be clearly superior to other competitive imaging modalities like CT scanning in certain specific situations. NMR scans are free from the artifacts produced in CT scans by sharp dense bone or metallic surgical clips. NMR is the imaging modality of choice in diagnosing mul¬tiple sclerosis, and by selecting the proper NMR imaging techniques, in determining accurately areas of edema and hemorrhage which are difficult to separate by X-ray or CT.

Whether a nodular density in the lung hilum is a normal pulmonary blood vessel or an abnormal tumor mass is a difficult clinical problem with CT scanning or conventional radiography; however, in NMR imaging no signal is returned from rapidly flowing blood, and a very strong signal is returned from be¬nign or neoplastic masses. Thus, this specific clinical problem is easily resolved using NMR. Gated NMR scans appear to be excellent for imaging the myocardium because the flowing blood in the ventricle (no NMR signal) accurately outlines the cardiac muscle. At first glance NMR scans appear very much like CT scans, but there are very definite differences. A careful examination reveals that the circular high-density region is the bony skull and calvarium on the CT scan with little of the subcutaneous fat and scalp tissue in evidence. However, in the NMR scan the high-density (white) ring structure corresponds to the subcutaneous fat and the bone is seen as a relatively dark or black ring inside the outer white ring of fat. Some white and gray areas within the black ring of the skull indicate the bone marrow, which has a relatively high fat content, and therefore a larger NMR signal than surrounding the bone.

The tempo of change in medical imaging has been accelerating, and it is continuing to accelerate at a bewildering rate even for those whose expertise is primarily in the imaging sciences. If we borrow a bit of imagery from Carl Sagan and create an imaging calendar to relate chronologically the major breakthroughs in imaging as Sagan related the major events in the development of the cosmos on a galactic calendar, spanning the events from the last big bang to the present, we find our “imaging big bang” occurs with the discovery of the roentgen ray by Wilhelm Conrad Rontgen in 1895. We can see that January in this imaging calendar year was truly a big bang with fluoroscopy, X-ray tubes and X-ray films, all developed in those early stages. Everything else through September of this year was really just a variation on a theme, which required a slightly dif¬ferent application of previously well-understood principles. However, in November things began to pick up with CT imaging, and an imaging “mini-bang” really exploded in December with clinical NMR imaging, digital imaging, digital subtraction angiography (DSA), laser imaging, and medical holography.

Nuclear Magnetic Resonance

The NMR phenomenon was originally described at Stanford by Block and at Harvard by Purcell in 1946. They later received the Nobel prize in 1952 for their work. Briefly, NMR imaging, with the use of the hospital lab equipment called an NMR scanner, is a way of making pictures of the body that look somewhat like CT scans. Atoms in the body can act like tiny bar magnets with a north and south pole. When an external magnetic field is applied across a part of the body, each little magnet lines up with the external magnetic field. If a radio wave is then broadcast into the body tissue, some of the magnets absorb some of the energy from the radio wave’s energy and tilt over. The radio wave is then turned off, and subsequently the magnets rebroadcast the signal they absorbed. An antenna can pick up this rebroad¬casted signal, and then a computer can make a picture (scan) from the signal.

In most substances, including living tissues, some of the nuclei within the specimen act as tiny magnets when the specimen is placed in a stable magnetic field. For instance, if you were to place the north and south poles of a bar magnet around your index finger, these nuclear magnets (proton nuclei of hydrogen atoms) would orient themselves either parallel or antiparallel to that magnetic field, with the antiparallel protons having a slightly higher energy level than the parallel atoms. When the antiparallel atoms give up energy and switch to a parallel relationship with the external magnetic field, the energy is lost in the form of radio waves. These radio waves exit from your finger and can be picked up by any suitable antenna similar to the one on an AM-FM radio. In a static magnetic field the energy emitted from a given type of atom or nucleus passing from the high ¬to low-energy level is always the same, thus enabling the examiner to determine the quantity and species of atoms present in the spec¬imen and where they were located.

Biopsy, the examination of a sample of tissue removed from a living patient (in contrast to necropsy, the examination of tissue after death), is a valuable aid in establishing a precise diagnosis using specific hospital lab equipment. Samples of muscle, liver, kidney, lung, and other tissues may be removed safely and simply by passing a needle through the skin and into the target organ or tissue, sometimes using ultrasound, CT scanning, or fluoroscopy to help guide the needle. Tumors and cysts in organs such as the breast, ovary, testis, or thyroid can be sampled in the same way. Once obtained, the tissue sample may be examined under a microscope and subjected to a variety of biochemical tests, thereby yielding a diag¬nosis that is accurate.

Endoscopic investigation

Early endoscopes as, hospital lab equipments, were simply rigid or partially rigid tubes, sometimes with complex lens systems and interior lighting, and were of limited use. In the late 1950s, the introduction of fiberoptics enabled endoscopes to be completely flexible, thereby greatly increasing this hospital lab equipment’s versatility. Today, many specialized endoscopes are available, enabling physicians to view directly virtually any structure in the body, including the digestive tract, nasal sinuses, lungs, bladder, abdominal cavity, and joints. In addition, many endo¬scopes can be fitted with attachments that enable samples of tissue to be taken for biopsy or surgical procedures to be carried out.
Magnetic Resonance Imaging (MRI)

Unlike X-ray radiography, CT scanning, and radionuclide imaging, MRI (magnetic resonance imaging), as hospital lab equipment, does not employ potentially harmful ioniz¬ing radiation. Instead, it exploits the natural behavior of the protons (nuclei) of hydrogen atoms when they are subjected to a very strong magnetic field and radio waves. As a result of this stimulation, the protons emit radio signals, which are detected and computer processed to generate an image. The most abundant sources of protons in the body are the hydrogen atoms in water molecules; an MRI scan therefore reflects differences in the water content of tissues.

Superficially, MRI scans look like CT scans. How¬ever, CT scans usually show little differentiation in soft tissues; MRI scans show more of the detailed structure because of differences in water content within these tissues. For example, white and gray matter in the brain is relatively poorly differentiated in some hospital lab equipments like CT scans, while they are distinct and well defined in MRI scans.

Positron Emission Tomography (PET) scanning

PET (positron emission tomography) scanning is a development of radionuclide scanning and resembles at in many ways. Both techniques use a radioactive substance introduced into the body to produce an image that reflects the level of activity of tissues. How¬ever, radionuclide scanning usually produces an image analogous to a conventional X-ray picture; PET manning gives a cross-sectional image that is analogous to a CT scan.

In PET scanning, a substance that takes part in metabolic biochemical processes is labeled with a radioisotope to make it radioactive; it is then injected into the bloodstream. The most metabolically active areas of tissue take up the substance. In the tissue, the substance emits positrons. The positrons, in turn, release photons, which are then detected by an array of sensors around the patient. The sensors are linked to a computer, which calculates the origins of the photons to construct an image of the distribution of the substance within the tissues.

PET scanning is currently being utilized for investigating brain tumors, locating the origin of epileptic activity, and studying the brain function in various mental illnesses. It is anticipated that PET scanning will be used for other organs.

Net magnetization (M) of the hospital equipment called the nuclear magnetic resonance scanner when at rest is zero. In body tissues, or any specimen for that matter, before the application of a magnetic field, the magnetic moments of the nuclei making up the tissue are ran¬domly aligned, and have zero net magnetization. When an external fixed magnetic field is applied, after an interval, the individual magnetic moments align parallel or antipar¬allel with the applied net magnetic field, B. There is a slight prepon¬derance of nuclei aligned parallel with the magnetic field, and this gives the tissue a net magnetization (M). As an example for H, which has a large magnetic moment in a field of 14 kilogauss (KG), the fractional excess of parallel protons is only about 1 x 10-5 at room temperature. Nevertheless, as small as this slight excess is, it accounts for the small macroscopic net magnetic moment directed parallel with the external magnetic field, and it is this differential that accounts for the nuclear magnetic resonance signal on which the imaging is based.

Another important difference between the parallel and antiparallel protons is that the antiparallel protons are at a slightly higher energy level than the parallel protons. One way to conceptualize this differ¬ence in energy states is to consider the different levels of energy expended by two swimmers both tied to ropes and attempting to swim toward each other with one swimming downstream (with the static magnetic field) and the other expending more energy while swimming upstream (against the static magnetic field).

In NMR imaging, the energy differential between the parallel and antiparallel protons is directly proportional to external field strength of hospital lab equipment. At this point the important thing to note about these different energy levels is that the energy differential approximates the thermal energy exchanged between colliding molecules and thus is quite small, i.e., on the order of a few millicalories. At any given field strength, the two energy levels resonate. The energy exchange is at a very specific level, and the higher the magnetic field strength is, the greater the difference between the energies of the parallel and antiparallel protons.

Magnetic Wobble

The magnetic moment of the ensemble of protons in tissue is in stable alignment with the external static magnetic field. In actuality each one of these magnetic mo¬ments wobbles or rotates around the alignment of the static magnetic field in a process that is called precession. By way of analogy, the interaction between the proton angular magnetic moment and the external magnetic field, and the spinning mass of a top and the earth’s gravitation field are similar interactions, with the exception that the competing forces acting on a wobbling top are the earth’s static gravitational field trying to push the top down versus the top’s angular momentum attempting to keep the top upright. Thus, in a friction-free system, tops spinning on a flat surface possess a res¬onant precession or wobble about the direction of the local gravita¬tional field. In a similar manner, a spinning nucleus also processes or wobbles about an applied magnetic field with a resonant angular frequency, determined by a constant (the magnetogyric ratio) and the strength of the magnetic field. Each nuclear species possesses characteristic value for magnetogyric ratio but frequency and strength are related by the equation. The important relationship in this equation is that the an¬gular frequency for any nuclear species is characteristic and directly proportional to the static magnetic field. Thus, there is an interrela¬tionship between frequency and proton energy, such that both resonant frequency and proton energy are directly proportional to the magnetic field.

Body fluids contain thousands of different chemicals. A healthy body maintains the concentration of each substance within clearly defined normal limits. How¬ever, when the patient has a particular disease, the level of a body chemical may be abnormally high or low; detecting this abnormality by biochemical analysis and through the use of specific hospital lab equipments can help in the diagnosis.

A physician may order biochemical tests on samples of blood, urine, and other body fluids, such as spinal fluid, saliva, or sweat, when confirming a diagnosis. These tests, with the use of hospital lab equipments, may be part of a diagnostic investigation in which the chemical constituents of body fluids are checked primarily to confirm an illness that the physician suspects may exist based on the patient’s description of his or her symptoms. The tests may also be used to assess the function of a particular organ, such as the liver or kidneys.

In recent years, the automation of hospital lab equipments used for analysis has made biochemical testing faster and more accurate. New analytical techniques have been developed that make it possible to measure infinitesi¬mal amounts of substances, such as hormones, in a person’s body fluids.

Diagnostic ultrasound

The diagnostic use of ultrasound is based on the prin¬ciple of sonar, in which sound waves are used to locate underwater objects by their echoes. In diagnos¬tic ultrasound, a device called a transducer is placed on the skin and transmits inaudible high-frequency sound waves into the body, where they are reflected by the internal structures. The transducer detects these echoes, which are converted to numerical data and then displayed directly on a screen or analyzed by computer to produce an image of the structures.

In contrast to some hospital lab equipments like X-rays, which are potentially harmful, ultrasound is thought to be completely safe - a belief based on 30 years of use on hundreds of millions of patients with no evidence of any ill effects. Ultrasound is especially useful in obstetrics because it enables the physician to examine the fetus at no known risk to either the woman or her developing child.

A modification of the basic ultrasound technique makes use of the Doppler effect (the change in pitch that occurs when a sound source is moving relative to the detector) to give information about the rate of blood flow through blood vessels. This procedure, known as angiodynography, enables the physician to detect narrowing of blood vessels or turbulence in the flow of blood.

Another ultrasound procedure, known as echocar¬diography, provides information about the heart including the structure and flexibility of heart valves, the condition of the heart muscle, and the flow of blood within the heart.

Biopsy

Biopsy, the examination of a sample of tissue removed from a living patient (in contrast to necropsy, the examination of tissue after death), is a valuable aid in establishing a precise diagnosis. Samples of muscle, liver, kidney, lung, and other tissues may be removed safely and simply by passing a needle through the skin and into the target organ or tissue, sometimes using certain hospital lab equipments like ultrasound, CT scanning, or fluoroscopy to help guide the needle. Tumors and cysts in organs such as the breast, ovary, testis, or thyroid can be sampled in the same way. Once obtained, the tissue sample may be examined under a microscope and subjected to a variety of biochemical tests, thereby yielding a diag¬nosis that is accurate.

Endoscopic investigation

Early endoscopes are medical tools that were simply rigid or partially rigid tubes, sometimes with complex lens systems and interior lighting, and were of limited use. In the late 1950s, the introduction of fiber optics enabled endoscopes to be completely flexible, thereby greatly increasing their versatility. Today, many specialized endoscopes are available, enabling physicians to view directly virtually any structure in the body, including the digestive tract, nasal sinuses, lungs, bladder, abdominal cavity, and joints. In addition, many endo¬scopes can be fitted with attachments that enable samples of tissue to be taken for biopsy or surgical procedures to be carried out.

Genetic analysis

Recent advances in genetics have allowed the genetic defects responsible for certain inherited disorders to be identified and detected. When there is a family history of an inherited disorder, such as muscular dystrophy or Down’s syndrome, or when a couple has had a child with such a disorder, tests may be performed early in pregnancy to discover whether or not the fetus has the genetic defect. The tests involve removing cells from the membranes or fluid around the fetus, culturing the cells, and then analyzing their gene content by examining the chromosomes under a microscope. As a result of genetic analysis and elective termination of pregnancy, the frequency of some inherited disorders has been reduced. Parents at risk of having a baby with an inherited defect may (with genetic counseling and prenatal testing) be able to reassure themselves about the fetus’s health.

Intensive care

Some patients require continuous monitoring of their body functions-heart rate and rhythm, breathing rate, blood pressure-so that any deterioration in their condition can be detected and treated immedi¬ately using specialized hospital lab equipments. Many patients who are seriously ill also must be given fluids, nutrition, and medication intravenously, and some may require a hospital equipment called a ventilator to help them breathe. Monitoring of a patient’s condition is best provided in an intensive care unit (or, for a patient who has had or is suspected of having a myocardial infarction, a coronary-care unit), which has the neces¬sary equipment and is staffed around the clock by specially trained hospital personnel.

Radiation therapy

The use of X-rays and implants of radium (a naturally radioactive substance) to treat cancers dates from the turn of this century. Today, X-rays are still used as a hospital lab equipment in radiation therapy (also known as radiation oncology), but the range of treatment has been greatly expanded to include other forms or sources of radiation (e.g., neutron beams or radioactive varieties of substances such as iodine or yttrium). It is now also possible to focus radiation beams more accurately using specialized hospital lab equipments for radiation, thereby con¬centrating them on the tumor and minimizing damage to surrounding healthy tissue.

Radiation may be used alone to treat some tumors-such as basal cell carcinoma and certain tumors of the pituitary gland-but it is more often used in combination with surgery, chemotherapy, or both. The choice between radiation and surgery may depend on the stage of the tumor. In some cases, the results of surgery or radiation are the same.

Dialysis

A person whose kidneys fail will die within a few days unless impurities that accumulate in the blood are removed, either by a hospital lab equipment called a kidney dialysis machine or by peritoneal dialysis.

In hemodialysis, a hospital equipment called a dialysis machine removes impurities by filtering the patient’s blood through a semipermeable membrane immersed in a special dialysis solution. The procedure takes a few hours and the patient visits a dialysis unit for each treatment. In peritoneal dialysis, the patient’s abdominal cavity lining is used to filter impurities from the blood into the dialysis solution (which is passed in and out of the abdomen through a tube).

Dialysis may be necessary for only a few days if kidney failure is temporary, but it is also effective as a long-term treatment for permanent kidney failure. In most of the latter cases, the best remedy for the patient’s condition is a kidney transplant.

Lithotripsy

Lithotripsy is a noninvasive procedure in which ultra¬sound is used to pulverize stones in the body. This technique seems likely to replace surgery as the treat¬ment for certain kidney stones and is currently under investigation in the treatment of gallstones that cause symptoms. In lithotripsy, repeated pulses of high-energy ultrasound waves are focused on a stone using a specialized hospital lab equipment to break it down into tiny particles that can be passed out of the body via the urine (with kidney stones) or via the feces (with gallstones).

Incubator

Babies born prematurely are small and have internal organs that have not fully matured. Additionally, many basic reflexes and physiological functions, such as those that regulate body temperature, are not fully developed. For this reason, a newborn weighing less than 3.5 pounds is usually placed in a hospital equipment called an incubator, where the temperature, humidity, oxygen, and the baby’s vital functions can be monitored.

Psychiatric treatment

In earlier days, people with mental disorders were incarcerated in remote mental asylums. Today, most individuals are treated in units within general hospi¬tals or in community settings. In addition, new drugs can sometimes transform the outlook for patients with severe mental disorders such as schizophrenia. Drug therapy-often combined with psychotherapy-now enables many people to resume varying degrees of activity within the community. There have also been developments in psychotherapy; the types now available include traditional, Freudian-based psychoanalysis, group therapy, and counseling.

Three-dimen¬sional reconstruction methods repeatedly excite and measure and then using various computer algorithms, calculate the signal con¬tributed by each point or pixel in the objects. The type of imaging method for this hospital lab equipment used has important consequences for the quality of the ulti¬mate NMR image. One of the difficulties in NMR imaging is the large noise background relative to the NMR signal (signal-to-noise ratio). The signal-to-noise ratio depends on a variety of factors including strength of the magnetic field, total volume of the room temperature magnet bore, the imaging technique used, and the excitation volume. The NMR as a hospital instrument itself determines most of the intrinsic noise in the NMR scanning system, but it is important to realize that the value of signal-to-noise ratio in the instrument is not equivalent to the signal-to-noise ratio in the following image. Since the excitation of larger volumes produces larger NMR signals and the scanner determines the noise level, improvement in signal-to-noise ratio results when the whole volume excitation methods are employed. On the other hand, as the size of the resolution volume increases with respect to the object size, blurring will decrease contrast in the ulti¬mate image. Thus, when a very small object is scanned with a rela¬tively large resolution volume, although signal-to-noise increases for the instrument, blurring will decrease contrast in that ultimate image. As we shall see shortly, the FID signal provides a stronger signal than do pulse echoes in the spin-echo technique, thus yielding an improved signal-to-noise ratio for the instrument. However, in this imaging sequence, T2 information and the contrast it provides are lost. The spin-echo technique may actually provide a higher signal-to-¬noise ratio in the ultimate image by enhancing contrast between ad¬jacent organs with different T2 relaxation times.

Essentially, the imaging techniques used in NMR involve a series of options regarding the sequencing of either 90° RF or 180° RF pulses and the timing or sequencing of the series of sets of pulses (repetition rate). The options are used to spatially encode and determine dif¬ferent characteristics of tissue, i.e., proton density, T1 and T2 relax¬ation times. The strategies are designed primarily to elicit some aspect the NMR signal in preference to others with an eye toward a more accurate diagnosis or better resolution.

Inversion recovery and spin-echo arc the two most commonly em¬ployed Imaging methods in use today. Another method that is com¬monly used in spectroscopy is called the steady-state free precession or continuous ware method. In this NMR technique, the magnetic held is periodically tipped by closely pulsed RF excitations. These pulses are short with respect to the TI of the sample being irradiated, mid in this method the FID from each pulse merges with the previous pulse and forms a continuous NMR signal. A continuous signal has the advantage of providing a steady rather than transient source of energy. However, the nuclei are never allowed to return to equilibrium with the main field, and thus, the NMR signal in this hospital lab equipment is reduced but the signal-to-noise ratio is relatively high because it can have a very long duration.

Improvements to the health system is continued to be supported by World Bank sponsored projects.  It aims to improve maternity and newborn care, emergency medical care and as well as the rural primary healthcare. It is good to know that the government of Romania is giving priority on how to improve their health care system.  In fact, their Ministry of Health announced their plan to change and upgrade their existing medical devices and also acquire new devices to be used for new procedures as promptly as they could if their capital will have enough to allocate in these purchases.   Their government wants likely to have a modernized, standardized and computerized healthcare system just like any other developed country which is the reason why they are acquiring medical devices from the United States and Germany as well because they know that these countries are far more advanced in terms of their health care delivery system. 

Because most of the hospitals in Romania are owned and controlled by the state rather than owned by private sectors, this is one problem faced by U.S. medical device suppliers.  In turn, the government of Romania wants to change their healthcare system from centrally planned system to a more market oriented, social insurance based system.  Another problem faced by the United States although not that alarming is having more aggressive European medical device suppliers.  But because medical devices from the United States have already established a name and reputation of their products to health professionals worldwide, Romania then chose to purchase about 35 percent of the their medical devices from the reputable and respectable United States suppliers.  Some of the major companies of U.S. have representatives and distributors in Romania which are GE Medical Systems, Hewlett Packard, Stryker, Instrumentation Laboratories, Baxter, Medtronic, Helena Laboratories, Denver Instruments, Endosonics, Bard Instruments, Space Lab, Johnson & Johnson, 3M and many others. Read more on this topic

Through these new purchases of Romania in their medical devices, it is expected that their health care delivery system will indeed improve and be globally competitive as well.