Team:Pasteur Paris/Silver

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HUMAN PRACTICES

Our Project In Society W

One of the main concern we had while developing our project was to determine in which way our Biofilm could be used and who would be using it in order to evaluate its impact on society. The field which would benefit the most of a nerves redirection while reducing the risk of infection was medicine, targeting patients suffering amputation.

Investigating Infection During Surgery

In medicine, surgery is a very common procedure. According to the latest data available, gathered by the Royal College of Surgeons, around 4.7 million surgical procedures were performed in 2014 in England, meaning 7% of the total population is impacted by surgery. In the United States of America, according again to the latest data available gathered by the 2010 Ambulatory Medical Care Survey (NHAMCD), 48.23 million surgical procedures were performed in 2010. That’s around 14,8% of the total population. 5% of patients undergoing surgery develop surgical site infections (SSIs), which may cause substantial morbidity that can endanger a patient’s life, increase the number of days in the hospital and increase healthcare costs. SSIs are defined as infections that occur within 1 year if an implant is being placed.

We wanted to understand what goes on during a surgical procedure, what types of precautions were taken and what were the impacts of an infection for the patient. Thus we began contacting surgeons and patients to learn more.

European Hospital Georges-Pompidou (HEGP)

The European Hospital Georges-Pompidou is the latest biggest Parisian hospital. It opened in 2001, receiving the name of one of the French President, Georges-Pompidou. It’s one of the most efficient hospital in Europe, illustrating itself with the first cardiac transplant.

At the HEGP, we learned about the methods used to minimize the risks of infection, as well as how the surgeon was approaching those risks to the patients. We also had the chance to be observe a team of doctors during a spine implant operation. It became clear to us that even though every step was taken to eliminate the risk of infection, it could be useful to develop a system to minimize one step further this risk in the case of an implant.

Interview with Dr. Benjamin Bouyer

Dr. Benjamin Bouyer is a surgeon at the HEGP specialized in lumbar rachis surgeries. He is currently clinic head assistant at the hospital and is also part of “Société Française de Chirurgie du Rachis” or in english the “French Society of Rachis Surgeries”.

Dr. Benjamin Bouyer’s main concern with our project was how we would be incorporating the biofilm inside the patient. Indeed, every implant is given to the surgeon in a sterile way, inside a bag the doctor would not open until the very last moment. He also brought the issue of our system being 3 in 1. Indeed, our biofilm would be capable of reducing the risk of infection by S. aureus but would also be modified to induce the growth of nerves when needed while conducting a signal. Indeed our project is focusing on amputee’s patients, meaning only them would need all three branches of our system. We reassured him by explaining that our system could also be used only for its inhibiting virulence properties, and that it could be open to every type of patient. He did, however, believe that our project could be useful to many branches of medicine. We also asked him if he would, as a surgeon, use our device if the laws changed about the use of GMO, and his response was very positive. Indeed, in his opinion, no doctor would reject a system proven to reduce infections.

Interview with Dr. Jean-Marc Ghigo

Dr. Jean-Marc Ghigo is microbiologist inside the Institut Pasteur. His project is focusing on the genetics of biofilm. He is interested in the mechanisms involved in infections independent of a materiel and infection linked to an implanted materiel.

Dr. Jean-Marc Ghigo was the first professional to talk to us about the formation of biofilms. In addition to his help with biofilm formation protocols, he also gave us great advice concerning our device and the confinement of our biofilm. Indeed, biofilms have a tendency to colonize the system and we needed to think of a way to confine them so they don’t disperse in the patient’s body or contaminate other material during the integration of the implant. By confining the biofilm, we would also reduce the chances of bacterial conjugation between possible pathogenic bacteria and ours.

Investigating Prosthesis

ADEPA

ADEPA stands for “Association de Défense et d’Etude des Personnes Amputés », which translates to « Association for the Defense and Study of Amputated People ». This national association was created in 1996 and aims to unite forces between handicapped people. They are representing the community during ministerial commissions and try to help people in their day to day live with the handicap by giving support and finding solutions.

Interview with Jean-Pascal Hons-Olivier

Jean-Pascal Hons-Olivier is a country security Manager and member of the board of directors of ADEPA. As a leg amputee who underwent multiple corrective surgeries on his leg, Mr. Hons-Olivier is very involved in ADEPA.

Mr. Jean-Pascal Hons-Olivier gave us great input on the different causes of amputation and the relationship between a patient and his prosthetist. He also allowed us to understand what was the process of getting an implant in France, how someone is living with an amputate limb and also gave his opinion on the different type of prosthesis in the market. He also talked about the type of prosthesis our system would integrate in: osteo-integrated prosthesis. The type of surgery is currently not taken in charge by the French health care system due to the high risk of infection, and breaking of the bone and the prosthesis, and only one surgeon is doing this type of operation in the country: Dr. Marion Bernard. Mr Hons-Olivier did raise up some concerns about our project being too innovative, since only a few industries in the USA are working on bionic prosthesis and this type of surgery costs more around 100 000 euros at the moment.

I-CERAM

I-CERAM was founded in 2005 and is designing, manufacturing and marketing high-tech implants for various joints of the human body. The marriage of different ceramic materials and processes is one of the main features of the company. Thus, the clinical experience, combined with compressive strength qualities, osteo-compatibility or decrease friction ceramics are exploited in the design of new implants of the company. The top sell of the company is the marketing of ceramic implant charged in antibiotic.

Interview with Dr. Eric DENES, Dr. Evelyn Poli and Dr. Christelle Arico

Dr. Eric Denes is an infectious diseases specialist at the University Hospital of Limoges and is the scientific director of I-CERAM. Dr. Evelyn Poli is a chemistry research and development engineer and Dr. Christelle Arico is a project manager at I-CERAM.

Dr. Eric Denes as well as Dr. Evelyn Poli and Dr. Christelle were very interested in our project. They are currently designing new materials in ceramic, titane, stainless-steel to test the bacterial adhesion on their prosthesis. They did warn us about the use of metals for the prosthesis since S. aureus and P. aeruginosa have a tendency to form biofilms easily on metals rather than ceramic. They are also using Gentamicine and Vancomycine charged implants to avoid the development of a biofilm. Their system does have a half-life time and our biofilm could be a longer-term solution.