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To determine the effectiveness of ultraviolet (UV) environmental disinfection system on rates of hospital-acquired vancomycin-resistant enterococcus (VRE) and Clostridium difficile.
Using active surveillance and an interrupted time-series design, hospital-acquired acquisition of VRE and C. difficile on a bone marrow transplant (BMT) unit were examined before and after implementation of terminal disinfection with UV on all rooms regardless of isolation status of patients. The main outcomes were hospital-based acquisition measured through (1) active surveillance: admission, weekly, and discharge screening for VRE and toxigenic C. difficile (TCD) and (2) clinical surveillance: incidence of VRE and CDI on the unit.
Bone marrow transplant unit at a tertiary-care cancer center.
Stem cell transplant (SCT) recipients.
Terminal disinfection of all rooms with UV regardless of isolation status of patients.
During the 20-month study period, 579 patients had 704 admissions to the BMT unit, and 2,160 surveillance tests were performed. No change in level or trend in the incidence of VRE (trend incidence rate ratio [IRR], 0.96; 95% confidence interval [CI], 0.81–1.14; level IRR, 1.34; 95% CI, 0.37–1.18) or C. difficile (trend IRR, 1.08; 95% CI, 0.89–1.31; level IRR, 0.51; 95% CI, 0.13–2.11) was observed after the intervention.
Utilization of UV disinfection to supplement routine terminal cleaning of rooms was not effective in reducing hospital-acquired VRE and C. difficile among SCT recipients.
The contribution of mixed infection in recurrent Clostridium difficile infection (CDI) episodes is not known. Among paired isolates from 52 patients, mixed infection due to >1 toxigenic strain of C. difficile was identified in 8% of first episodes. Among recurrences, relapse from 1 or both co-infecting strains was uncommon; it was detected in a single case each.
To determine the role of unit-based transmission that accounts for cases of early Clostridium difficile infection (CDI) during hospitalization for allogeneic stem cell transplant.
Stem cell transplant unit at a tertiary care cancer center.
Serially collected stool from patients admitted for transplant was screened for toxigenic C. difficile through the hospital stay and genotyping was performed by multilocus sequence typing. In addition, isolates retrieved from cases of CDI that occurred in other patients hospitalized on the same unit were similarly characterized. Transmission links were established by time-space clustering of cases and carriers of shared toxigenic C. difficile strains.
During the 27-month period, 1,099 samples from 264 patients were screened, 69 of which had evidence of toxigenic C. difficile; 52 patients developed CDI and 17 were nonsymptomatic carriers. For the 52 cases, 41 had evidence of toxigenic C. difficile on the first study sample obtained within a week of admission, among which 22 were positive within the first 48 hours. A total of 24 sequence types were isolated from this group; 1 patient had infection with the NAP1 strain. A total of 11 patients had microbiologic evidence of acquisition; donor source could be established in half of these cases.
Most cases of CDI after stem cell transplant represent delayed onset disease in nonsymptomatic carriers. Transmission on stem cell transplant unit was confirmed in 19% of early CDI cases in our cohort with a probable donor source established in half of the cases.
Because of its significant potential in controlling key steps of apatite mineralization, recombinant amelogenin has been applied in different in vitro systems for the synthesis of uniquely ordered composite material similar to enamel. Here we summarize the results of a series of experiments, in which mineral deposition took place on the exposed surface of enamel from extracted human third molars soaked in calcium phosphate solution, in the presence of amelogenin and fluoride. Analysis of crystal size and morphology revealed that in the presence of both amelogenin (50-100 μg/mL) and fluoride (1 ppm), bundles of oriented rod- like fluoridated apatite crystals were formed creating a dense coating on the enamel substrate. Such organized bundles were not formed at low concentrations of rP172 (< 30 μg/mL). Preparation of such ordered nanocomposites provides a promising approach for development of new generation of dental restorative materials with improved esthetic and mechanical properties.
It is as yet unclear whether the benefits of early linguistic experiences can be maintained without at least some minimal continued exposure to the language. This study compared 12 adults adopted from Korea to the US as young children (all but one prior to age one year) to 13 participants who had no prior exposure to Korean to examine whether relearning can aid in accessing early childhood language memory. All 25 participants were recruited and tested during the second week of first-semester college Korean language classes. They completed a language background questionnaire and interview, a childhood slang task and a Korean phoneme identification task. Results revealed an advantage for adoptee participants in identifying some Korean phonemes, suggesting that some components of early childhood language memory can remain intact despite many years of disuse, and that relearning a language can help in accessing such a memory.
Pulse-oximetry has proven clinical value in Emergency Departments and Intensive Care Units. In the prehospital environment, oxygen is given routinely in many situations. It was hypothesized that the use of pulse oximeters in the prehospital setting would provide a measurable cost-benefit by reducing the amount of oxygen used.
This was a prospective study conducted at 12 ambulance stations (average transport times >20 minutes). Standard care protocols and paramedic assessments were used to determine which patients received oxygen and the initial flow rate used. Pulse-oximetry measurements (oxygen-saturation measured by pulse oximetry) were then taken. If oxygen-saturation measured by pulse oximetry fell below 92% or rose above 96% (except in patients with chest pain), oxygen (O2) flow rates were adjusted. Costs of oxygen use were calculated: volume that would have been used based on initial flow rate; and volume actually used based on actual flow rates and transport time.
A total of 1,907 patients were recruited. Oximetry and complete data were obtained on 1,787 (94%). Of these, 1,329 (74%) received O2 by standard protocol: 389 (27.5%) had the O2 flow decreased; 52 had it discontinued. Eighty-seven patients (6%) not requiring O2 standard protocol were hypoxemic (oxygen-saturation measured by pulse oximetry < 92%) by oximetry, and 71 patients (5%) receiving oxygen required flow rate increases. Overall, O2 consumption was reduced by 26% resulting in a cost-savings of $0.20 / patient. Prehospital pulse-oximetry allows unncessary or excessive oxygen therapy to be avoided in up to 55% of patients transported by ambulance and can help to identify suboptimally oxygenated patients (11%).
Rationalizing the O2 administration using pulse-oximetry reduced O2 consumption. Other health care savings likely would result from a reduced incidence of suboptimal oxygenation. Oxygen cost-saving justifies oximeter purchase for each ambulance annually where patient volume exceeds 1,750, less frequently for lower call volumes, or in those services where the mean transport time is less than the 23 minute average noted in this study.
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