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In March 2017, the New Jersey Department of Health received reports of 3 patients who developed septic arthritis after receiving intra-articular injections for osteoarthritis knee pain at the same private outpatient facility in New Jersey. The risk of septic arthritis resulting from intra-articular injection is low. However, outbreaks of septic arthritis associated with unsafe injection practices in outpatient settings have been reported.
An infection prevention assessment of the implicated facility’s practices was conducted because of the ongoing risk to public health. The assessment included an environmental inspection of the facility, staff interviews, infection prevention practice observations, and a medical record and office document review. A call for cases was disseminated to healthcare providers in New Jersey to identify patients treated at the facility who developed septic arthritis after receiving intra-articular injections.
We identified 41 patients with septic arthritis associated with intra-articular injections. Cultures of synovial fluid or tissue from 15 of these 41 case patients (37%) recovered bacteria consistent with oral flora. The infection prevention assessment of facility practices identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, unsafe injection practices, and poor cleaning and disinfection practices. No additional cases were identified after infection prevention recommendations were implemented by the facility.
Aseptic technique is imperative when handling, preparing, and administering injectable medications to prevent microbial contamination.
This investigation highlights the importance of adhering to infection prevention recommendations. All healthcare personnel who prepare, handle, and administer injectable medications should be trained in infection prevention and safe injection practices.
Tactile sensors and ultrasonic transducers based on the piezoelectric properties of polyvinyledene difluoride, PVF2, usually take the form of thin 10 - 110 μm polymer films coated on one or both sides with a metallic film. Electrode patterns are usually fabricated by photolithography that requires a 90 °C baking process which may harm the piezoelectric properties of the PVF2 film. We have developed an alternate method, based on direct patterning with a XeCl laser, yielding complex patterns of lines as narrow as 20 μm which are better than those fabricated by photolithography. The metallic film is ablated on both sides of the polymer while maintaining the intrinsic properties of the PVF2. The ablation mechanism is investigated using transmission optical, scanning electron, and scanning acoustic microscope images. The performance of an ultrasonic transducer fabricated with this technique is described.
Twelve patients with neuroleptic-induced akathisia were treated in a randomised, double-blind, cross-over design with propranolol and matching placebo. Propranolol caused significant decrements in both subjective and objective ratings of akathisia, but not in anxiety scores. This confirms prior findings of the efficacy of propranolol in akathisia induced by neuroleptic treatment.
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