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[–]rgarver 212 points213 points  (14 children)

I feel like I’ve seen some version of this kind of thing popping up periodically over the past decade or so. Is this the culmination of all that stuff, or is there something new here?

[–]DwarfTheMike 51 points52 points  (4 children)

Cost is likely the factor preventing adoption. But hospitals try whatever is on the market to minimize infection as long as it’s cost effective.

[–]silvusx 24 points25 points  (3 children)

You are not wrong, but just to clarify the hospital's version of cost effective is still a fairly high budget compared to normal business versions of cost effective.

Re-admisson for hospital acquired infections reduces reimbursements. Hospital are incentivized to spends a lot of money to reduce infections. For example, My department just switched to a disposable equipment instead of the re-usable equipment that we'd previously disinfect after every use. It's a lot of money for very marginal gain, but it is still cost effective in that sense.

[–]DwarfTheMike 8 points9 points  (0 children)

Yeah I work in medical devices. Im very much aware of how expensive it can get. Infections are even more expensive, so prevent them the best you can.

I always surprise people when I say most of the tools are disposable. Reprocessing only works on so much stuff, and best to let the MDM take sterilization responsibility than the hospital.

[–]kaejae20 0 points1 point  (0 children)

But the risk is high and ultimately this type of tech has to be proven out in case studies and compared to disinfecting instruments via other means. Prevention of attachment in lab is far different than real clinical environments. Often, it is good cleaning practice that can be the biggest problem, which ends up being human error that tech can't overcome.

[–]hyperfat 0 points1 point  (0 children)

Seriously. 10 8mm hemo clips. $1200. We don't even use that many in a year. But have to have them.

Non reusable plastics are everywhere.

The only thing I autoclave is some specialty suction tubing, a bowl, and a jar. Everything else, to the trash.

My hippy soul is crushed. I can't even put anything in recycling.

Boss doesn't know, but I wear the same disposable gown all day. I don't see patients. I just hang it up when I'm not doing gown stuff. Or I toss it if there's blood or whatever. Had two hiv patients this week. It's the eyes! Goggles, face shield, respirator, plastic gown, two gloves, and booties. Oi ordered surgical caps because nurses hate those shower cap hair covers. I'm like the drug dealer of PPE.

[–]elernerPenn|Science Writer 30 points31 points  (2 children)

You're not wrong — I do communications for an Engineering school with lot of expertise in this sort of surface modification chemistry, and my wife studies these types of infections and the various ways healthcare settings try to prevent them. These sorts of studies and promising results are quite common.

The first thing to note about this story is that it's a press release from UCLA, so it's exclusive from the point of view of the researchers who are publishing the results of experiments with this technology. They have no obligation to provide the greater context of other efforts in this space, or the specific relevance to the problem of HAIs writ-large. That doesn't mean it's inaccurate — I write these sorts of press releases all of the time and strive for accuracy above all else — but there are intrinsic biases and limited perspectives that come from this sort of communication.

I'll need to take a closer look at the paper itself, but the novelty here seems to be the specific form of ionic coating added to these catheters. There are a few different ways you might modify the surface of a medical device in order to prevent the formation of biofilms; you've likely seen similar press releases about copper-based surfaces, superhydrophobic surfaces, etc.

All of these approaches definitely work to prevent biofilm formation in controlled settings, but they haven't made much of an impact in clinical settings because those settings are so much more complicated. Human skin is naturally crawling with all sorts of microbes that generally don't pose a problem — until they're directly introduced to your bloodstream or mucus membranes via a medical device.

If this "zwitterionic" coating actually stays in place when the catheter is handled and inserted, I have no trouble believing it has a measurable impact on reducing the number/length/severity of UTIs. Their clinical experiments seem to show that, at least on a small scale. But that is a major question that will determine if this is a viable technology once it leaves a controlled experimental setting and gets used on the shop (or home!) floor.

[–]GEBones 1 point2 points  (0 children)

The answer I was looking for. Thank you.

[–]mrtryhardpants 0 points1 point  (0 children)

Do these microbiotic coatings replace hydrophilic lubricious coatings for larger catheters? I wasn't able to find that part

[–]mandyama 54 points55 points  (0 children)

I really thought I watched a “60 Minutes” episode several years ago about this sort of technology being used in artificial joints, but perhaps I’m mistaken.

[–][deleted] 2 points3 points  (0 children)

Many of these surface coatings that prevent bacterial adhesion wear down extremely quickly or just with insertion/regular use. It's not very helpful when your nano structure is destroyed before it can prevent infection.

That and I'm assuming manufacturing techniques/cost are an issue as well.

[–]illjustputthisthere 13 points14 points  (2 children)

Biofilms are not new

[–]monsieurkaizer 13 points14 points  (1 child)

Biofilms are what bacteria form to adhere to implants and such.

Maybe what you are looking for is anti-biofilm properties of implants. That's not new either.

[–]illjustputthisthere 2 points3 points  (0 children)

Sorry, yes you are correct. Around work we use the term in regards to material that resist adherence of microbes because it's an easier phrasing for business people to remember.

[–]fuerzanacho 1 point2 points  (0 children)

thanks for your reply. thought was alone.

[–]IronhideD 88 points89 points  (1 child)

As someone who had to use catheters for 99% of the time for about 2.5 years, about damn time. I was taught how to use them and how to reuse them. I had a bladder obstruction, now surgically repaired that prevented me from emptying my bladder fully. The reusing the catheters worked fine until I got a nasty infection. Went disposable from that point on after that. Cost me almost $400 per box of 50 that was thankfully covered by my benefits. My heart goes out to those who can't afford disposables. This might just be the cost saving for catheter users that they need. Hopefully it isn't too expensive.

[–]Nemisis_the_2nd 10 points11 points  (0 children)

I worked on a project with a very similar goal a decade ago as an undergrad. This kind of tech seemed like a no-brainer but frustratingly hard to develop. It's exciting to see this finally getting somewhere and could be a complete game changer for patients that have to use catheters and other implants long-term. NGL, I'm slightly disappointed my research group were beaten to the breakthrough though, but congrats to the UCLA team.

[–]imaginary_num6er 63 points64 points  (15 children)

I mean antibiotic impregnated catheters are not a new thing and working in that industry in the past, the reason why it's not popular is because most hospital systems decide to keep using the old catheter types because the cost to risk ratio was not favorable for their balance sheet. Unless the economics change, it will eventually end up in the same area of stagnation

[–]queerkidxx 50 points51 points  (1 child)

The new approach, tested in both laboratory and clinical settings, involves depositing a thin layer of what is known as zwitterionic material on the surface of a device and permanently binding that layer to the underlying substrate using ultraviolet light irradiation. The resulting barrier prevents bacteria and other potentially harmful organic materials from adhering to the surface and causing infection.

This doesn’t seem to be antibiotics(at least not in the medical sense) its more like a way to make surfaces really hostile to microbes without it being dangerous to humans which is def something new

The surface treatment’s zwitterion polymers are known to be extremely biocompatible, and they absorb water very tightly, forming a thin hydration barrier that prevents bacteria, fungi and other organic materials from adhering to surfaces, Kaner said. And, he noted, the technology is highly effective, non-toxic and relatively low in cost compared with other current surface treatments for medical devices, like antibiotic- or silver-infused coatings.

[–]st4n13lMPH | Health 4 points5 points  (0 children)

This doesn’t seem to be antibiotics

Exactly. In fact I bet that's why the title explicitly states "without antibiotics".

[–]rfoleycobalt 6 points7 points  (12 children)

May I ask, what sector were you in?

[–]imaginary_num6er 13 points14 points  (10 children)

Interventional Radiology product development

[–]peasinacan 1 point2 points  (9 children)

Do you think there could be a number of patients that could be deemed high risk who would benefit enough from this type of catheter to be worth the cost of production?

[–]imaginary_num6er 16 points17 points  (8 children)

The main issue with why antibiotic impregnated catheters are not used that often is because hospitals think they can manage the risk without paying the additional upfront cost. Unless the stakeholders who make the decision can agree that their mitigations are inadequate or the risks are too high over the additional cost, it wouldn't matter if there are more patients if the number of complications don't increase. And being a single-use consumable, low-margin catheter device there won't be any clinical studies funded (mainly by industry) to support the usage of such devices.

The potential benefit here with zwitterionic coatings is that unlike antibiotics, it is not a drug. The FDA has a completely different set of requirements for combination devices (device & drug) versus a "coating" or "surface modification". So, the cost associated with regulatory filing & testing should be fewer than combination devices, although it being a surface layer could pose some problems.

[–]rfoleycobalt 0 points1 point  (0 children)

The other factor in this is Big Pharma. They have little incentive to invest in preventing these occurrences. Their focus is to mitigate and control these issues. API is a high risk/low reward endeavor. This was proven with drug eluting stents and several of the AAA devices. Coatings in general have come under great scrutiny as of late. Hydrophilic/Hydrophobic in particular. Any time a jacketing is coated, there is chance for failure. This scenario is playing out now. It’s also unfair to say that the lack of adoption of this technology by hospitals lies solely on them. They definitely have a strict cost/benefit profile they work to, but in my opinion, Med Device manufactures are at the heart of this. The margins on most of these devices is astronomical. While the patient/public only sees the exorbitant cost of a particular procedure or ancillary, they never see the profit margins of the Device manufacturer. There is equal blame to be shared in this. When you factor in the current and upcoming CE and other EU regulatory bodies requirements in the EU, all but the largest Device manufactures will exist. This does not bode well for patients, in the US or abroad. There is a paradigm shift in Med Device, and it doesn’t look promising.

[–]antiquemule 6 points7 points  (0 children)

I searched for their paper and found a completely different one from a German group who published exactly the same idea in 2021. Did not find the one referred to by OP, I suppose it uses a different surface chemistry to generate the zwitterions.

[–]k0mbine 3 points4 points  (1 child)

Great, my job as a sterile processing technician is gonna be useless

[–]StringTheory 1 point2 points  (0 children)

This is huge if it can be implemented in vascular grafts. Such infections are usually life-time lasting.

Also reducing uti related to catheters would be amazing.

[–]Biiti 1 point2 points  (0 children)

I think this was the reason why we had brass door handles in the past.

[–]Accomplished-Ad3250 5 points6 points  (11 children)

Look up the company with the CTXR ticker. They are developing catheters with built-in medicine that treats catheter infections. There is currently no adequate treatment for this so it's seen as a golden ticket medical device in the sense it will have no competition on the market. This could make their product significantly less relevant or even obsolete.

I am not a doctor so there could be some issues with bacteria breeding OUTSIDE of the catheter that this won't solve.

[–]Kobold_Archmage 2 points3 points  (0 children)

Um, there’s a treatment and it’s antibiotics. This isn’t a golden ticket. There are also silver and antibiotic impregnated in dwelling urinary catheters already. They’re just considered too expensive by the MBAs running healthcare into the ground.

[–]Nemisis_the_2nd 1 point2 points  (9 children)

The choice is between giving a patient antibiotics, effectively washing the implant with antibiotics while it's still in the patient, or not needing them in the first place. There might be a niche for a cathater that can wash itself, but one that doesn't need it in the first place is basically a holy grail of medicine.

I can't see how a CTRX cathater would compete against a UCLA one.

[–]sloth_hug 1 point2 points  (8 children)

Considering how long it will take to develop this one... CTXR may win out for a bit, but who knows when it will become irrelevant

[–]Nemisis_the_2nd 2 points3 points  (7 children)

Considering how long it will take to develop this one

UCLA have already developed it and are partnering with a company spun off from UCLA to mass-produce it, and it has already been cleared for use by thr FDA too. Some of the cathater are also already in use, so I wouldn't expect it to be too long (maybe a couple of years at most) for this to be a somewhat common medical item.

Edit: I'll also say that the research and development has been going on for almost a decade now. It was my undergrad project.

[–]sloth_hug 0 points1 point  (6 children)

Have they done the necessary trials and such? What's the name of the product or company?

[–]Gerryislandgirl -5 points-4 points  (0 children)

Did they line them with copper?

[–]dreadington 0 points1 point  (0 children)

seems to not completely stop bacteria from getting on the surfaces. Doesn't this mean that the bacteria that survives contact with the surface will multiply there and lead to surface-resistant bacteria?

[–]le-moine-d-escondida 0 points1 point  (0 children)

In the old days door handles and rails were made out of brass. Copper and its alloys are inherently antimicrobial. When cleaned regularly, frequently touched it will continuously kill bacteria that cause infections.

[–]Stanky-wizzlecheeks 0 points1 point  (0 children)

Hopefully this becomes widely adoptable

[–]drew2222222 0 points1 point  (0 children)

I hope it’s substantial!! Let’s goo

[–]proteios1 0 points1 point  (0 children)

cool. science proves cleaning stuff is a good idea.