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C1. You must be able to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to your patients. (GOsC 2018, p.16)

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C1. You must be able to conduct an osteopathic patient evaluation and deliver safe, competent and appropriate osteopathic care to your patients. (GOsC 2018, p.16)

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Reflection Using Jasper's Reflective Model

Experience

A 36 year old female came to see me for neck pain. The clinical history revealed PTSD and previous physical abuse, which affected the patient’s life through ‘flashbacks’ as reported by herself. She suffered with widespread pain sometimes which she could not describe. Physical examination revealed increased sensitivity to light pressure (allodynia) and, because I did not have encountered symptoms like this before, I did not suspect fibromyalgia. The tutor on the day suggested to test the common pain points and the patient had 14 points positive out of 18.

Reflection

I felt discouraged about the fact that I didn’t suspect fibromyalgia from the start, however, I decided to revise the condition again and prepare for the next time the patient came in.

Fibromyalgia is a complex and often misunderstood condition that presents with a range of symptoms, including widespread pain and allodynia. It is commonly associated with psychological conditions such as PTSD, which can complicate diagnosis and treatment. The challenge in recognizing fibromyalgia, particularly in patients with a history of trauma, underscores the importance of thorough clinical assessment and familiarity with its diagnostic criteria (Wolfe et al., 2010).

Action

I revised fibromyalgia again and I gave the patient the correct advice, gave her the required referral letter and she started having the correct investigations.

During a CEX (clinic exam) I had a patient with fibromyalgia and the tutor’s feedback was positive.

Wolfe, F., Clauw, D.J., Fitzcharles, M.A., Goldenberg, D.L., Katz, R.S., Mease, P., Russell, A.S., Russell, I.J., Winfield, J.B. and Yunus, M.B., 2010. The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthritis care & research, 62(5), pp.600-610.

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C2. You must ensure that your patient records are comprehensive, accurate, and legible and completed promptly.(GOsC 2018, p.16)

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C2. You must ensure that your patient records are comprehensive, accurate, and legible and completed promptly.(GOsC 2018, p.16)

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Reflection Using Jasper's Reflective Model

Experience

Being an osteopath involves taking accurate notes during the consultation, form the clinical history taking to examination, to treatment and final reflections.

At the beginning I tried to fight my neurodivergence and tried to write what I thought it was concise notes.

Some tutors are ok to sign the notes even when we write ’NAD’ for cardiovascular questionnaire, or any systemic category.   One day, an intense tutor asked me: what questions did you asked for the systemics? I answered all of them, I just wrote NAD, as patient did not report any palpitations, SOB etc. Then the tutor asked me: if you receive a complaint, how can you prove you asked those questions?

Reflection

I started to understand straight away that I had to find a way to be thorough, short and concise at the same time, but my notes became much elaborated and I could not keep with time anymore. I also understood SOCRATES model does not work for me, as I was taking too many questions and not obtaining the DDX.

Maintaining comprehensive, accurate, and legible patient records is a fundamental aspect of safe and effective osteopathic practice. Proper documentation ensures continuity of care, legal protection, and facilitates communication among healthcare providers. Inadequate or incomplete records can lead to miscommunication, missed diagnoses, and potential legal consequences. Research underscores the importance of thorough documentation, especially in multidisciplinary and high-stress environments, where the risk of errors can be heightened by factors such as neurodivergence or time constraints (Clayton et al., 2017; Jefferies et al., 2018). Implementing strategies that balance thoroughness with efficiency, such as tailoring the use of clinical note templates and abbreviations to individual needs, can improve both the quality and efficiency of record-keeping.

Action

I asked all the tutors to give me advice on how to write good notes and also to read my colleagues’ ones. Slowly I started improving the layout and conciseness, without compromising on the quality of the notes and keeping up the time.

Jefferies, D., Johnson, M. and Griffiths, R., 2010. A meta‐study of the essentials of quality nursing documentation. International journal of nursing practice, 16(2), pp.112-124.

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C3. You must respond effectively and appropriately to requests for the production of written material and data.

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C3. You must respond effectively and appropriately to requests for the production of written material and data.

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Reflection Using Jasper's Reflective Model

Experience

The learning experience is not always smooth and I tried to cut the corners by writing suggestions for the patients to take to their GP, like blood tests etc, on the clinic slip notes.

It worked for a while, but a tutor observed me and he told me to write proper referral letters from now on, which took way longer.

Reflection

Being an osteopath is not about being fast, but thorough and professional, even in writing the notes and any written material. The written material has legal importance and can make a big difference in a legal action. I also found out that, once you wrote the notes, even if they are untidy, you cannot make new ones.

In clinical practice, the importance of thorough and accurate documentation, including referral letters, cannot be overstated. Properly written referral letters are not only a critical aspect of patient care coordination but also serve as a legal document that can protect both the patient and the practitioner in the event of a dispute. The temptation to cut corners in documentation, such as by providing informal notes instead of formal referral letters, can lead to significant risks, including miscommunication and potential legal liabilities. Research highlights that effective referral letters should clearly convey the clinical findings, the rationale for the referral, and any specific recommendations for further investigation or management (Grol et al., 2013). Developing and practicing the skill of writing concise yet comprehensive referral letters is essential for ensuring high standards of care and maintaining legal and professional integrity.

Action

Practicing ow to write referral letters helped me become faster and now I am assured the patients receive the best service and also I am legally covered if any complaint should happen.

Grol, R., Wensing, M., Eccles, M. and Davis, D. eds., 2013. Improving patient care: the implementation of change in health care. John Wiley & Sons.

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C4. You must take action to keep patients from harm. (GOsC 2018, p.17)

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C4. You must take action to keep patients from harm. (GOsC 2018, p.17)

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Reflection Using Jasper's Reflective Model

Experience

During the first academic year I attended the safeguarding course, which was very disturbing and upsetting, as I was taught about female genital mutilation, a horrible practice around the world, that affects young females, as young as 3 years old. My daughter was 3 years old when I started this course, so I felt really affected by this.

Reflection

The consequences of FGM are terrible, including early death of infection or later in childbirth, bleeding etc, but the ones we need to be able to spot are difficulty to urinate, the girl may have difficulty walking, standing, or sitting, being anxious.

Female genital mutilation (FGM) is a deeply traumatic practice with severe physical and psychological consequences. It can lead to immediate complications such as severe pain, bleeding, and infection, as well as long-term issues including chronic pain, childbirth complications, and psychological trauma. The ability of healthcare professionals to recognize the signs and symptoms of FGM, such as difficulty in urination, walking, or sitting, as well as anxiety and behavioral changes, is crucial for early intervention and support. However, prevention remains the most critical aspect, as stopping FGM before it occurs can save countless girls from suffering (Elmamin et al., 2020). Raising awareness and supporting survivors who work towards preventing FGM, as portrayed in the documentary "Desert Flower," is essential in combating this practice.

Action

Being able to see the signs and symptoms of FGM is very important, however, I believe what is more important- is to help with prevention. I watched the ‘Desert Flower’ movie on Youtube and I found out there are strong women that have suffered the procedure that are helping prevent it.

Elamin, W. and Mason-Jones, A.J., 2020. Female genital mutilation/cutting: A systematic review and meta-ethnography exploring women’s views of why it exists and persists. International Journal of Sexual Health, 32(1), pp.1-21.

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Female genital mutilation (FGM) includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons.

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C5. You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation. (GOsC 2018, p.17)

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C5. You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation. (GOsC 2018, p.17)

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C5. You must ensure that your practice is safe, clean and hygienic, and complies with health and safety legislation. (GOsC 2018, p.18)

Reflection Using Jasper's Reflective Model

Experience

Before I joined this course during the COVID pandemic in 2020, I already had a veterinary business open since 2016.

Because of the operative theatre strict hygiene rules, I learned about how easily bacteria and viruses can infiltrate and cause harm, also how to implement strict hygiene rules.

The COVID hygiene rules were also very strict, so hygiene practice at the ESO was very controlled, as well as the clinic.

Reflection

The disinfecting and personal protection material must be widely available, even if COVID rules do not exist anymore. This hard period taught us all a lesson on how fragile the vulnerable patients can really be. This has cemented even more my previous knowledge about cross contamination, but helped me to see patients with different eyes.

Maintaining a safe, clean, and hygienic clinical environment is a critical aspect of healthcare practice, not only for patient safety but also for the protection of healthcare providers. The COVID-19 pandemic has heightened awareness of the importance of stringent hygiene protocols, emphasizing the need for consistent disinfection practices. In osteopathic practice, where hands-on treatment and close physical contact are routine, the risk of cross-contamination is significant. Recent research underscores that even in controlled environments like medical school labs, disinfection practices often fall short, particularly in high-touch areas such as examination tables (Patrizio et al., 2023). This highlights the necessity of ongoing vigilance and adherence to robust disinfection protocols to prevent healthcare-associated infections (HAIs) and ensure a safe practice environment.

Action

I always wear a mask if I have a cold or a virus and I spray the couch and disinfect hands in between patients, I even ask patients to wear a mask if I see them being unwell, because protection needs to be both ways. If I don’t take care of myself and I fall ill, I need to cancel the appointments my patients booked, therefore denying them the care they need.

Patrizio, H.A., Phyu, R., Boyle, T. and Schachter, T., 2023. The effectiveness of disinfection protocols in medical school osteopathic manipulative medicine labs. Journal of Osteopathic Medicine, 123(9), pp.435-441.

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Abstract

Objectives

To analyze the microbiota of the physiotherapist's work environment to understand the existing potential risks and to adopt appropriate preventive measures.

Design

Cross-sectional descriptive observational study.

Setting

Physiotherapist's working environment.

Participants

Physiotherapy and rehabilitation centers (N=19).

Interventions

A microbiological sampling was carried out in the physiotherapy centers. The samples were studied using the usual culture and analysis methodology for characterization and isolation of a range of bacteria.

Main Outcome Measures

Absolute and relative frequency of microorganism isolation.

Results

In the analysis, pathogens normally responsible for nosocomial infections were detected, especially on instruments and equipment used by the physiotherapist such as sponge electrodes, and were significantly more contaminated than the rest of the places studied ( P<.01).

Conclusion

This situation confirms the absence of measures and protocols for the prevention and control of such infections in the physiotherapist's environment, which is why they must be considered to protect both physiotherapy professionals and patients.

Keywords: Cross infection, Infection control, Rehabilitation

According to the data reported for the Study of Prevalence of Nosocomial Infections in Spain for the year 2016, the prevalence of nosocomial infections stood at 5.5% in hospital rehabilitation services, placing it fourth in the ranking, just behind surgical specialties.¹ These particular types of infection often affect geriatric patients, children, and people with chronic diseases, all of whom are susceptible to acquiring infections within the hospital environment. Several factors that may be related to the high prevalence of nosocomial infections have been identified, including the current trend of starting the rehabilitation process at an early stage (even after a stay in an intensive care unit); difficulties in the isolation of patients susceptible to infection; heterogeneity in training among professionals in infection control interacting in these units; and the use of instruments and equipment whose handling, maintenance, and cleaning is frequently not included in the prevention protocols of nosocomial disease transmission. 2, 3, 4, 5, 6, 7, 8, 9, 10

Previous investigations have been conducted to determine the microbiological contamination of the equipment and materials routinely used in physiotherapy, such as ultrasonic devices and therapy machines. 11, 12, 13, 14 However, studies related to microbiological hazards that may occur in the physiotherapeutic environment are scarce both in our country and much of the Western world.⁹,¹⁵

At present, there are no specific recommendations for the management and infection control in the physiotherapist's environment based on objective data, despite calls to do so in the past by various authors.² Therefore, the objective of this study was to discover the bacterial microbiota present in the physiotherapeutic environment in order to detect potential risks of nosocomial infections.

Methods

Design

A cross-sectional descriptive observational study was proposed to analyze the nosocomial bacterial microbiota present in the work environment of the physiotherapist.

Participants

Nineteen physiotherapy centers were selected for this investigation. Permission for the sampling was requested from the management or owners of the centers, and they were instructed not to inform the personnel of the time of the visit for the collection of samples to prevent influencing the behavior of the workers in the center. In each center, samples were collected from the treatment couches, the instruments and equipment being used, from the hands of the physiotherapists, and the ambient air. All samples were classified and numbered as shown in table 1 .

Table 1

Sample Groups

Samples

Treatment table, A

1

Head section

2

Intermediate section

3

Caudal section

Instruments and equipment, B

1

Reusable sponge electrodes

2

Adhesive reusable electrode

3

Single use adhesive electrode

4

Ultrasound probe

5

Ultrasound gel

6

Short-wave electrodes

7

Laser probe

8

Cold packs

Physiotherapist, C

Hands

Ambient air, D

250 liters of ambient air

Intervention

The collection of samples was carried out using 3 methods depending on the characteristics of the study site. With the exception of the samples taken from the ultrasound gel and the ambient air, a sterile swab with Copan Venturi Transystem a transport medium was used. Each swab was handled individually using non-sterile vinyl gloves, the container was opened immediately before the collection of the sample, and the swab applicator was placed immediately and directly into the tube containing the transport medium without touching any external surfaces. For samples of ultrasound gel, a 5 cm ³ sterile syringe was used for the extraction of 1 cm ³ of gel from the container next to the therapeutic ultrasound equipment. Once the sample was taken, the extraction cannula of the syringe was sealed with the needle cap to avoid contamination during transport until the time of culturing. Finally, the collection of environmental air was done by collecting 250 liters of air directly onto a Petri dish with cysteine lactose electrolyte deficient agar, using an impactor device for taking aerial samples on standard 90 mm plates (MAS-100; Merck Millipore b). All samples were labeled for correct follow-up and were transferred to the laboratory under cold conditions in a portable refrigerator for a period not exceeding 24 hours.

Once in the laboratory, the samples were aseptically plated on Difco c prepared plates with the following solid culture media: blood agar, Baird-Parker agar, MacConkey agar, Mossel agar, and King B agar. The semisolid culture medium GI was used for the detection of bacterial motility. The plates were incubated at 37°C±1°C for a period of 24 hours. Thereafter, the plates were checked for the presence of colony-forming units. Identification of colonies was made through observational methods (ie, Gram stain negative and direct microscopic observation), biochemical tests (ie, catalase test and oxidase test), tests using miniaturized selected BBL Enterotube II d galleries for the identification of Enterobacteriaceae and other Gram-negative bacilli with negative oxidase results, and BBL Oxi/Ferm Tube II d for the detection of Gram-negative fermenting bacteria positive for oxidase and non-fermenting Gram-negative bacteria. After characterization of samples using the house commercial systems bioMérieux Vitek e with gallery ATB STAPH 5 was used for the detection of staphylococci, and Vitek 2 Compact (applying the cards ID-GNB, ID-GPC, ID-NH) was used to identify Gram-negative bacilli, Gram-positive coccus, and Neisseria-Haemophilus, respectively.

Data analysis

All data obtained from the samples, respecting the confidentiality of their origin, were used and processed using the statistical analysis software SPSS (version 15.0) f and Statgraphics (version 5.1), g in addition to Microsoft Excel 2007 h for the preparation of graphs and calculation tables.

The relative and absolute frequencies were calculated, and the value of the Spearman correlation coefficient between the grouping categories of the centers was calculated according to (1) their average daily care load, (2) the ownership of the center, and (3) their type of care (ambulatory or integrated into an organization with hospitalization of patients) versus the frequency of contamination of the samples and number of contaminating colonies. Analysis of variance was also performed on the total number of colonies in the 4 groups of samples analyzed. Finally, the differences between the total number of contaminated colonies with group B samples were analyzed using the Student t test to compare the incidence of contamination between certain instruments and equipment.

Results

Not all of the originally proposed samples to be obtained from each center could be collected because of the different characteristics and work modes normally used in the physiotherapy centers. Of the 247 potential samples, a total of 201 were collected. Of these, 83 were positive in growth after cultivation. The presence and distribution in the appearance of the species found was variable. Their absolute and relative frequencies are shown in tables 2 and ​and3 3 .

Table 2

Sample Group C

S.ep

Bac

Mc

Cor

St.m

Physiotherapist's hands

18

5

5

4

1

1

Sample Group D

S.ep

Mc

Bac

Ambient air

19

4

7

2

Table 3

Sample Group C

S.ep

Bac

Mc

Cor

St.m

Phyisiotherapist's hands

18

27.8

27.8

22.2

5.5

5.5

Sample Group D

S.ep

Mc

Bac

Ambient air

19

21.0

36.8

10.5

The Spearman rank correlation coefficient was established by clustering the centers according to their average daily care load (0-50 patients/d, 50-100 patients/d, and 100-200 patients/d) , and the frequency of contamination of the samples. The ownership (privately or publicly owned), character of the center (centers with outpatient admission or centers with inpatients), and the frequency of contamination of the samples was also established. There was no correlation for a P value less than .05 in any of the cases.

The use of analysis of variance ( table 4 ), showed there were significant differences between the different types of samples (differences between groups) with a P value less than .01. The least significant difference test indicated that the differences were proven ( P<.05) between the B samples (instruments), which would be the most contaminated, and the rest of the samples. The result of the Student t test (see table 4 ) on the samples obtained from B1 (sponge electrodes) showed greater contamination than the rest of the group B samples, with a 99% probability ( P<.01) compared with B4, B5, B7, and B8 samples (ultrasound probe, ultrasound gel, laser probe, and cryotherapy bags, respectively), and an 84% probability ( P<.16, not significant) compared with B2 samples (reusable adhesive electrodes).

Table 4

ANOVA

P Value

Differences between groups

P<.01

Intra-group differences

NS

LSD Between Sample Types

D

C

B

A

NS

NS

P<.05

B

P<.05

P<.05

C

NS

Student t Test

B2

B4

B5

B7

B8

B1

P value

NS ( P=.186)

P=5.298×10⁻¹⁰

P=.002

P=4.402×10⁻⁵

P=3.528×10⁻⁴

Discussion

Considering the relative and absolute frequencies of isolation of microorganisms (see tables 2 and ​and3), 3 ), it can be affirmed that there was a greater presence of coagulase-negative staphylococci, and Gram-negative non-Enterobacteriaceae bacteria on treatment couches or tables where patients are treated (A samples), which is in agreement with the studies by Kim et al⁹ and Kim et al,¹⁵ who also found significant contamination by these types of microorganisms. Other authors have studied the treatment tables exclusively in their work and have also found a higher presence of Gram-positive bacteria, especially species of coagulase-negative Staphylococcus.¹⁶ It should be noted that in all of the studies cited, except for that conducted by Burnham et al,¹⁷ the presence of S. aureus was low, which agrees with the findings of this study (see tables 2 and ​and3). 3 ). Regarding the type of contamination between the 3 sections evaluated (head, intermediate, and caudal sections), there were no large differences observed with coagulase-negative S. spp. being predominant in all of them, a fact that is novel as there are no such data in the existing literature.

In the samples from group B, which were taken from various instruments commonly used in the physiotherapy room, a greater presence of Enterobacteriaceae bacteria was found, including species such as Pantoea agglomerans, Citrobacter freundii, Serratia marcescens, Serratia rubidaea, and Providencia stuartii. A significant presence of S. epidermidis was also detected. The samples obtained from group B were significantly more contaminated ( P<.05) than the rest of the group of samples. The samples obtained from the sponge electrode (B1) presented higher and more varied contamination compared with the other samples ( P<.01 for samples B4, B5, B7, and B8) (see table 4 ). These data indicate that the sponge electrode is a major source of microorganisms among the instruments evaluated, with more than 20 different bacterial species identified (see table 2 , fig 1 ), including important pathogens such as S. aureus, Acinetobacter spp., and Escherichia coli. The identification of this type of electrode as the main source of microorganisms is concordant with the study by Kim et al,⁹ although most of the microorganisms identified in their study were non-Enterobacteriaceae Gram-negative bacteria ( Acinetobacter baumannii, Acinetobacter lwoffii, and Acinetobacter junii). On the other hand, in their investigations of sponge electrodes, Lambert et al¹¹ found a predominance of negative coagulase Staphylococcus and other Gram-negative species ( Acinetobacter spp., Pasteurella spp., and Pseudomonas spp.). In this latter case, there was greater agreement with the results of the present study in relation to the high presence of negative coagulase Staphylococcus.

Among the group B samples evaluated in this investigation, other instruments and equipment previously investigated were also studied, such as the probe (sample B4) and the ultrasound gel (sample B5). The study by Schabrun et al¹² found that these devices were contaminated to a greater percentage with negative coagulase Staphylococcus, followed by Micrococcus spp., and certain environmental species of fungi. We found that the ultrasound heads had a lower presence of Gram-positive bacteria ( Bacillus spp. and Micrococcus spp.) but S. epidermidis and S. aureus were also detected in isolation. As for the transduction ultrasound gel, small amounts (<5 colony-forming units/cm ²) isolated from P. agglomerans, Stenotrophomonas maltophilia were found. In contrast, the study by Schabrun et al¹² detected high concentrations of S. maltophilia and A. baumannii in the samples analyzed.

The microorganisms detected on the hands of the physiotherapists (C samples), were mostly Gram-positive bacteria, in keeping with the usual microbiota of the human body.¹⁸ Specifically, S. maltophilia and Corynebacterium spp. were detected. This fact reinforces the necessity of hand washing before touching the patient, and even combining hand washing with the use of gloves. Furthermore, it is necessary to wash properly after touching the patient to avoid cross contamination.

Finally, only S. epidermidis, Micrococcus spp., and Bacillus spp. were detected in the air samples from the centers, as well as fungi that were not isolated or identified as they were not the aim of this work. The presence of fungal spores as the main contaminant is also consistent with normal atmospheric conditions.¹⁹

The absence of Enterobacteriaceae bacteria in the hand and air samples, along with the predominant presence of these microorganisms in B samples (especially the sponge electrodes [B1]), suggest that the transmission routes of these microorganisms are not attributable to the atmosphere or to the clinical staff. These microorganisms appear mainly in wastewater because they are part of the intestinal microbiota of mammals. Thus, fecal-oral transmission is the probable predominant route. Although the contaminant load of these bacteria is low, conditions of humidity, temperature, and the presence of organic remains, combined with poor hygiene practices with the sponge electrode, may favor their growth, which would explain the abundance of microorganisms found. In most of the literature consulted on the use, application, and conservation of sponge electrodes, there are no specific protocols for their disinfection and cleaning.²⁰ The lack of sanitation behavior for this type of electrode is striking, especially when some texts recommend the direct application of the electrode on ulcers and scars, with only the interposition of a saline-moistened pad.²¹

The absence of adequate cleaning and maintenance entails the accumulation and proliferation of nosocomial pathogens detected during this study in several of the fomites analyzed, among which are coagulase-positive staphylococci, Enterobacteriaceae bacteria, and Pseudomonas spp. 22, 23, 24 The pathogenic action of many of these microorganisms has been exacerbated in recent years by the increasing frequency of antibiotic resistance, which affects a greater number of species. 25, 26, 27, 28, 29, 30

The importance of maintaining good hygiene and disinfection measures in physiotherapy areas has recently been highlighted with the coronavirus disease 2019 pandemic that is currently extended worldwide. One of the main routes of contagion of severe acute respiratory syndrome coronavirus 2 occurs through the contact of the hands with contaminated surfaces and fomites, followed by the contact with the mucosa of the nose, mouth, and eyes.³¹ Furthermore, it is known that the survival of severe acute respiratory syndrome coronavirus 2 on materials such as copper, cardboard, stainless steel, and plastic has been reported to be 4, 24, 48, and 72 hours, respectively, when it is maintained at 21 to 23°C and with 40% of relative humidity.³² Disinfection is absolutely essential, not only of the physiotherapist's hands, but also of all instruments, equipment, and other fomites that will be in contact with the patient. Although these habits are widely described in community health hygiene practices, they are not always carried out in daily work and might have been a focus of transmission in the current pandemic.

Study limitations

It will be necessary to develop new studies aimed at determining the antibiotic susceptibility of the microorganisms found, as well as to develop preventive and regular monitoring strategies that control microbiological contamination with the aim of reducing the rate of nosocomial infections in the physiotherapist's work environment. Moreover, in the present study, only the contamination of aerobic bacterial microorganisms has been analyzed. It is necessary to extend the analysis to include anaerobic bacteria, fungi, and viruses as well, especially as the current coronavirus disease 2019 pandemic leads us to consider viruses as a potential threat in the health care work environment.

Conclusions

The microbiota of the physiotherapist's work environment is formed by a heterogeneous group of microorganisms, essentially commensals, coming from the environment, which are common on the surface of the skin and other processes of cross-contamination. What is significant is the presence of microbial contamination found on the everyday working instruments and equipment of the physiotherapist, especially the electrode sponges used in electrotherapy treatments, which seem to concentrate a wide variety of microorganisms, many of them responsible for the most common nosocomial infections. The microorganisms isolated most frequently in the physiotherapist's environment are opportunistic pathogens in immunosuppressed patients, those weakened by chronic diseases, elderly patients, or patients vulnerable owing to their immaturity. Therefore, it is necessary to establish corrective measures to evaluate and control these risks, as well as expanding this research with new studies focused on anaerobic bacteria, fungi, and viruses.

Suppliers

a.

b.

c.

Difco.

d.

e.

f.

g.

Statgraphics Technologies, Inc.

h.

Acknowledgments

We thank the owners, managers, and staff of the physiotherapy centers who participated in this work. We thank Brian Crilly and Paloma Sampayo, PT, for their translation and editing assistance.

References

15. Kim M., Kim L.J., Jo H. High isolation frequency of [ Acinetobacter baumannii from physical therapy departments of geriatric care hospitals and antibiotic resistance patterns of isolated pathogens. J Phys Ther Sci. 2012;24:105-109. Google Scholar]

18. Brooks G.F., Carroll K.C., Butel J.S., Morse S.A., Mietzner T.A. Chapter 10: Normal microflora of the human body. In: Jawetz M., editor. [ Medical microbiology [Spanish] 25th ed. McGraw-Hill-Lange; New York: 2011. pp. 159-164. Google Scholar]

19. Rippon F. 4th ed. McGraw-Hill; Barcelona: 1997. Medical mycology [Spanish] [ Google Scholar]

20. Rodríguez Martín J.M. Mandala DL; Madrid: 1994. Low and medium frequency electrotherapy [Spanish] [ Google Scholar]

21. Maya J., Albornoz M. Elsevier; Barcelona: 2010. Transcutaneous and neuromuscular electrical stimulation [Spanish] [ Google Scholar]

Articles from Archives of Physical Medicine and Rehabilitation are provided here courtesy of Elsevier

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Analysis of the Microbiota of the Physiotherapist's Environment

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To analyze the microbiota of the physiotherapist's work environment to understand the existing potential risks and to adopt appropriate preventive measures.Cross-sectional descriptive observational study.Physiotherapist's working environment.Physiotherapy ...

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C6. You must be aware of your wider role as a healthcare professional to contribute to enhancing the health and wellbeing of your patients. (GOsC 2018, p.18)

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C6. You must be aware of your wider role as a healthcare professional to contribute to enhancing the health and wellbeing of your patients. (GOsC 2018, p.18)

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Reflection Using Jasper's Reflective Model

Experience

The children’s clinic at the ESO has been a great learning environment. Being in contact with new mothers can be a calm experience, but also moving, as some of them can have physical and/or mental difficulties. From sleep patterns to breastfeeding issues, stress caused by other family members etc, osteopaths must identify and try to help with the cause and prevention.

Reflection

Working in the children’s clinic as a mother myself has helped me understand the struggles of new mothers. I have also seen the pattern of some women that get caught up in the situation, and they forget completely they exist, or that their wellbeing is important.

I was that new mother myself once, and having my patients in front of me going through the same situation, has given me the opportunity to give advice on their wellbeing.

The babies are feeling all the energy around, and their connection to their mother makes them feel all their emotions. If the mum is stressed, the baby is stressed too, if the mum is calm, the baby is calm as well.

In reflecting on the holistic approach required in osteopathic practice, I have come to appreciate the significance of viewing both the mother and child as interconnected beings, rather than isolated patients. According to Fahlgren et al. (2015), osteopathic philosophy aligns closely with the biopsychosocial model, emphasizing the importance of addressing the physical, mental, and spiritual aspects of health. This perspective has influenced how I approach treatment, recognizing that supporting a mother’s mental and emotional wellbeing is crucial for the child’s health as well. By adopting a person-centered approach, I am better equipped to provide advice and support that goes beyond mere physical interventions, helping new mothers foster resilience and well-being in both themselves and their children. This holistic perspective has allowed me to develop a deeper connection with my patients, empowering them to achieve a more harmonious balance in their lives, which is reflected in the positive outcomes observed in their infants' behavior.

Action

Although the osteopathic treatment has been proved to help newborn babies and new mothers, I believe that the anxious mothers would benefit from finding ways to unwind and relax, nurturing themselves, even if there is no one around to help much. When the mother is more relaxed, the baby sleeps better and more, so she gets more time for herself. I have given this advice to minimum 3 new mums and they both told me that the babies were more relaxed and content, latching and feeding better.

Fahlgren, E., Nima, A.A., Archer, T. and Garcia, D., 2015. Person-centered osteopathic practice: patients’ personality (body, mind, and soul) and health (ill-being and well-being). PeerJ, 3, p.e1349.

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Parenting stress in the early years - a survey of the impact of breastfeeding and social support for women in Finland and the UK - BMC Pregnancy and Childbirth

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Background Being a new parent can be both joyful and stressful. Parenting stress is associated with poorer health and well-being for parents and infant and increased psychological distress. For new mothers, physical and hormonal changes, expectations of mothering and demands of a new baby may cause additional stress.