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Background: Contaminated surfaces within patient rooms and on shared equipment is a major driver of healthcare-acquired infections (HAIs). The emergence of Candida auris in the New York City metropolitan area, a multidrug-resistant fungus with extended environmental viability, has made a standardized assessment of cleaning protocols even more urgent for our multihospital academic health system. We therefore sought to create an environmental surveillance protocol to detect C. auris and to assess patient room contamination after discharge cleaning by different chemicals and methods, including touch-free application using an electrostatic sprayer. Surfaces disinfected using touch-free methods may not appear disinfected when assessed by fluorescent tracer dye or ATP bioluminescent assay. Methods: We focused on surfaces within the patient zone which are touched by the patient or healthcare personnel prior to contact with the patient. Our protocol sampled the over-bed table, call button, oxygen meter, privacy curtain, and bed frame using nylon-flocked swabs dipped in nonbacteriostatic sterile saline. We swabbed a 36-cm2 surface area on each sample location shortly after the room was disinfected, immediately inoculated the swab on a blood agar 5% TSA plate, and then incubated the plate for 24 hours at 36°C. The contamination with common environmental bacteria was calculated as CFU per plate over swabbed surface area and a cutoff of 2.5 CFU/cm2 was used to determine whether a surface passed inspection. Limited data exist on acceptable microbial limits for healthcare settings, but the aforementioned cutoff has been used in food preparation. Results: Over a year-long period, terminal cleaning had an overall fail rate of 6.5% for 413 surfaces swabbed. We used the protocol to compare the normal application of either peracetic acid/hydrogen peroxide or bleach using microfiber cloths to a new method using sodium dichloroisocyanurate (NaDCC) applied with microfiber cloths and electrostatic sprayers. The normal protocol had a fail rate of 9%, and NaDCC had a failure rate of 2.5%. The oxygen meter had the highest normal method failure rate (18.2%), whereas the curtain had the highest NaDCC method failure rate (11%). In addition, we swabbed 7 rooms previously occupied by C. auris–colonized patients for C. auris contamination of environmental surfaces, including the mobile medical equipment of the 4 patient care units that contained these rooms. We did not find any C. auris, and we continue data collection. Conclusions: A systematic environmental surveillance system is critical for healthcare systems to assess touch-free disinfection and identify MDRO contamination of surfaces.
Although romance QUA romance is often seen as leading to the grim finality of the Victorian marriage plot, Charlotte Brontë's second novel, Shirley (1849), thwarts readerly expectations. Brontë cautions the reader that “if you think, from this prelude, that anything like a romance is preparing for you, reader, you never were more mistaken,” but also teases that “it is not positively affirmed that you shall not have a taste of the exciting” (39; ch. 1). This disavowal, coupled with contradicting hints of romance, appears in the second paragraph of Shirley and establishes the vexed dynamic surrounding the marriage plot present throughout the novel.
The Maqarin site, Jordan is being studied as a natural analogue of a cementitious radioactive waste repository. The microbiology has been studied and diverse microbial populations capable of tolerating alkaline pH were detected at all sampling localities. Dissolved organic carbon was identified as the potentially most important reductant with sulphate identified as the main oxidant, both supplying energy for microbial life. Calculations on upper limits of microbial numbers were made with a microbiology code (MGSE) using existing information but the results are overestimates when compared with field observations. This indicates that the model is very conservative and that more information on, for example, carbon sources is required.
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