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To sustainably improve cleaning of high-touch surfaces (HTSs) in acute-care hospitals using a multimodal approach to education, reduction of barriers to cleaning, and culture change for environmental services workers.
The study was conducted in 2 academic acute-care hospitals, 2 community hospitals, and an academic pediatric and women’s hospital.
Frontline environmental services workers.
A 5-module educational program, using principles of adult learning theory, was developed and presented to environmental services workers. Audience response system (ARS), videos, demonstrations, role playing, and graphics were used to illustrate concepts of and the rationale for infection prevention strategies. Topics included hand hygiene, isolation precautions, personal protective equipment (PPE), cleaning protocols, and strategies to overcome barriers. Program evaluation included ARS questions, written evaluations, and objective assessments of occupied patient room cleaning. Changes in hospital-onset C. difficile infection (CDI) and methicillin-resistant S. aureus (MRSA) bacteremia were evaluated.
On average, 357 environmental service workers participated in each module. Most (93%) rated the presentations as ‘excellent’ or ‘very good’ and agreed that they were useful (95%), reported that they were more comfortable donning/doffing PPE (91%) and performing hand hygiene (96%) and better understood the importance of disinfecting HTSs (96%) after the program. The frequency of cleaning individual HTSs in occupied rooms increased from 26% to 62% (P < .001) following the intervention. Improvement was sustained 1-year post intervention (P < .001). A significant decrease in CDI was associated with the program.
A novel program that addressed environmental services workers’ knowledge gaps, challenges, and barriers was well received and appeared to result in learning, behavior change, and sustained improvements in cleaning.
In this study, we used an online survey to assess knowledge, attitudes, and practices related to environmental cleaning and other infection prevention strategies among environmental services workers (ESWs) at 5 hospitals. Our findings suggest that ESWs could benefit from additional education and feedback as well as new strategies to address workflow challenges.
We measured relative positions of the 22 GHz H2O maser components toward the class 0 protostar S106FIR with the VLA. Two clusters of H2O masers were found. The separation between these clusters is approximately 50 AU at position angle = 73° and each cluster is spread over about 10–20 AU The size of the S106FIR maser clusters is unusually compact compared with other known H2O masers associated with outflows of forming stars. The maser emission appears to originate from MHD driven outflow very close to the star.
The VLBA map of the H2O maser IC 1396N, which was obtained during the VSOP pre-launch survey, shows an ordered position of maser spots. The maser spots are located along an almost straight line with the separation between extreme maser spots of 20 mas. The radial velocity varies along the line from by 3 km s−1. In total 9 maser features have been located on the line, all of them unresolved by the VLBA beam. This geometry is consistent with the disk model of masers. The mass of the disk is estimated between 10−7 and 10−4 M⊙, depending on the thickness and density. The disk must be supported by a central star with the mass of about 0.07 M⊙. The H2O maser in IC 1396N may be a proto-planetary disk around a low mass protostar in the process of accretion.
Corynebacterium ulcerans (toxigenic C. ulcerans) produces the diphtheria toxin, which causes pharyngeal and cutaneous diphtheria-like disease in people, and this bacterium is commonly detected in dogs and cats that are reared at home. It is considered dangerous when a carrier animal becomes the source of infection in people. To investigate the carrier situation of toxigenic C. ulcerans of cats bred in Japan, bacteria were isolated from 37 cats with a primary complaint of rhinitis in 16 veterinary hospitals in Osaka. Toxigenic C. ulcerans was detected in two of the cats. By drug sensitivity testing, the detected bacterium was sensitive to all investigated drugs, except clindamycin. It appears necessary to create awareness regarding toxigenic C. ulcerans infection in pet owners because this bacterium is believed to be the causative organism for rhinitis in cats.
Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia cause significant morbidity and mortality in hospitalized patients. Using a nested case-control design, 204 MRSA bacteraemia cases were compared to 301 unmatched methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia controls and were matched 1:2 with non-infected controls. The independent risk factors for MRSA bacteraemia compared to MSSA bacteraemia were older age (P = 0·048), major organ transplant during current hospital stay (P = 0·016) and quinolone use (P = 0·016). Cases were more likely than non-infected controls to have renal failure (P = 0·003), cirrhosis (P = 0·013), and a central venous catheter (P = 0·003) after controlling for other risk factors. This large case-control study made it possible to assess risk factors for MRSA bacteraemia using two sets of controls and showed that risk factors differed greatly depending on the control group chosen. These results confirm the need for careful selection of appropriate control groups and the need to carefully adjust for underlying severity of illness.
We investigated the high-mass star-forming region G28.87+0.07 by means of maser kinematics, including H2O, CH3OH, and OH, and radio to infrared, continuum observations. All observational evidence suggests that these masers are associated with the same young star of 20-30 M⊙, still in the main accretion phase and surrounded by a rich stellar cluster.
Aluminum films containing solid Xe precipitates have been subjected to 1 MeV electron irradiation in a high-voltage electron microscope. High-resolution images have been recorded on videotape in order to monitor the changes to the system resulting from the passage of electrons through the film. Inspection of the video recordings reveals that complex, rapid processes occur under the electron beam. These include shape changes, the creation and movement of extended defects within the Xe lattice, movement of small clusters, coalescence of neighboring clusters and the apparent melting and resolidification of the Xe. An interpretation of many of the observations is presented in terms of the interaction of the nanoclusters with defects created in the aluminum by the high-energy electrons.
The Mn deposited clean Si (111) substrates were examined with UHV-TEM and STM that are part of an UHV-TEM/STM integrated characterization system. The Mn deposition with coverages of 5-20 ML followed by annealing at 673 K formed MnSi islands with Moire fringes. They showed metallic character. Subsequent annealing at 873 K dissipated the islands instead of transforming them into MnSi1.7. The re-deposition of Mn and re-annealing at 473 K succeeded to transform MnSi islands into MnSi1.7. The islands had several orientation relationships with substrate Si, and were semiconducting. The growth mechanism of MnSi1.7 is inferred.
Noble gases are generally very insoluble in solids. For example, Xe implanted into Al at 300 K forms a fine dispersion of crystalline precipitates and, at large enough fluence, fluid precipitates, both of which are stabilized, relative to the gas phase, by the Laplace pressure due to precipitate/matrix interface tensions. High resolution electron microscopy has been performed to determine the largest Xe nanocrystalline precipitate in local equilibrium with fluid Xe precipitates within the Al matrix. From the shape and size of the largest crystal and the Laplace pressure associated with its interface, we show that the interface tensions can be derived by setting the Laplace pressure equal to the pressure for solid/fluid Xe equilibrium derived from bulk Xe compression isotherms at the temperature of equilibration and observation. The Xe/Al interface tensions thus derived are in the range of accepted values of surface tensions for the Al matrix. Furthermore, it is suggested that this same technique may be employed to estimate unknown surface tensions of a solid matrix from the size and shape of maximal nanocrystals of a noble gas element, which have been equilibrated in that matrix at the temperature of observation.
Material properties of of rapidly solidified(RS),Ti5øNi5ø-xCux(X=O-2Oat%) alloys,i.e., thermoelasatic transformation temperature,transformation strain vs. temperature hysteresis, strength.ductility,themal fatigue resistance and corrosion resistance etc. were investigated. Specimens of thin ribbon were prepared by using melt-spinning machine with single Cu rolls at the cooling rate of about 40 m/sec. In the range of Cu content over lOat%,rapidly solidified (RS)ribbons were producible as a very thin plate and showed high ductility(i.e.180° bending). From the measurements of transformation strain vs. temperature hysteresis under small stress a bout 60MPa,transformation strain shows the maximum at Cu=5at%,and its transformtion temperature range nΔ(=Af-Mf) decreased with increasing Cu content to minimum value of 6.5K at Cu=17 at%. Thermal fatigue resistance was improved very much about ten times,futhermore,corrosion resistance was also improved over 100 times as much as conventionally processed(i.e. melting→ mechanically worked) material. It can be concluded that the functional superioity of RS meltspun Ti5øNi5ø-xCux ribbon exists in the range of Cu content over 10 at%. The reason of abovementioned remarkable improvements of material properties of RS TiNiCu alloys is discussed by relating with the observed unique fine columnar microstructures having strong crystal anisotropy and homogeneouss smooth surface.
Recently, shape memory alloy(SMA) is regarded as one promising material element natively with intelligent functions. I introduce the fundamental design concept and several trials for developing intelligent(smart) materials and structures by using shape memory alloy. Moreover, I introduce our recent works and point out the necessity for developing fundamental techniques to realize the intelligent materials using SMA.
In high-level waste repository, a carbon steel overpack will be corroded after closure. This will create a reducing environment in the vicinity of the repository. Reducing conditions are expected to retard the migration of redox-sensitive radionuclides such as uranium.
The apparent diffusion coefficients of uranium were measured in compacted bentonites (Kunigel VI® and Kunipia F®, JAPAN) in contact with carbon steel and its corrosion products under reducing conditions or without carbon steel under oxidizing conditions for comparison. The apparent diffusion coefficients measured were 10-12 to 10-14 m2/s under oxidizing conditions and 10-13 to 10-14 m2/s under reducing conditions. There were significant effects of redox conditions, dry density (0.8 to 2.0 g/cm3) and montmorillonite contents (60% for Kunigel VI or 100% for Kunipia F) on the apparent diffusion coefficients. The sorption of uranium on corrosion products of iron was smaller than that on montmorillonite. Montmorillonite density could be a good index to explain density dependence of the diffusion coefficients under the reducing conditions. Uranium would diffuse in free pore water with diffusion coefficients greater than 10-13 m2/s in low density bentonites under both redox conditions because the diffusion coefficients depended on sorption coefficients. Since diffusion coefficients were independent of sorption coefficients in high density bentonites where free pore water is scarce, surface diffusion might occur with coefficients were of about 10-13 m2/s.
Electro-magnetic nozzleless melt-spinning method was developed by combining the control of the flow down of the molten metals after electromagnetic float-melting(i.e. levitation) with rapid solidification by rotating roll. The metallurgical grain microstructures can be changed by rotating roll speed. It was confinned that the produced, intermetallic TiNi and NiAl system alloy thin plates showed the strong crystal anisotropy, higher shape memory functional properties than those of the conventionally processed melt-worked samples having its same origin. As new SMAs by using this method, ferromagnetic shape memory, FePd alloy having very large magnetostriction and super high temperature shape memory, RuTa alloy having the transformation over 1000°C were developed. Moreover, our recent study on the advanced rapid-solidification machine to produce many kinds of short fibers as well as ribbons is introduced. Finally, harmonic material design for sensor/actuator stacking composite system, namely “Smart Board” for aircraft structures will be introduced.
Static corrosion tests of a powdered simulated waste glass were performed in the presence of magnetite under oxic and anoxic conditions, respectively. The corrosion tests under oxic conditions were performed in air, and those under anoxic conditions were performed in a glove box purged with mixed gas(Ar+5%H2). The experimental results showed that the presence of magnetite can enhance glass corrosion under both oxic and anoxic conditions, and the enhancement under anoxic conditions was small compared to that under oxic conditions. A large portion of the Si and insoluble elements were sorbed onto the magnetite surface, and the sorption under anoxic conditions was small compared to that under oxic conditions.
It was suggested that the enhancement of glass corrosion by magnetite results from the sorption or precipitation of silica on the magnetite surface, which can be greatly affected by redox condition. Under anoxic conditions, it was suggested that precipitation of amorphous silica on the magnetite surface may be the dominant process for enhancement of glass corrosion in addition to sorption.
Since the fatigue life time is a serious problem of the Cu-Al-Ni alloy, it is difficult to apply for practical use. The authors have investigated the influence of the cooling condition of liquid-quenching on fatigue property. The liquid-quenching is performed by a piston-anvil apparatus. It is easy to control the solidification condition. The fatigue life time increases with increasing the cooling rate. The long life time is due to the small grain size, the small volume of γ1' phase, the low density of lattice defects and the low transformation temperature.
In a high-level waste repository, a carbon steel overpack will corrode after the repository is closed. This will create a reducing environment in the vicinity of the repository. Reducing conditions are expected to retard the migration of redox-sensitive radionuclides such as plutonium.
The apparent diffusion coefficients of plutonium were measured in compacted bentonites (Kunigel V1® and Kunipia F®, Japan) in contact with carbon steel and its corrosion products under a reducing condition and, for comparison, without carbon steel under an oxidizing condition. Gas bubbles were observed in some bentonite specimens which had low dry densities after contact with carbon steel for approximately two years. This observation suggests hydrogen generation during corrosion of the carbon steel. The apparent diffusion coefficients measured were approximately 10−14 m2/s under the reducing condition and less than 1015 m2s under the oxidizing condition. There was a significant effect of redox conditions on the apparent diffusion coefficients. The effects of dry density (0.8 to 2.0 Mg/m3) and montmorillonite contents (50% for Kunigel V1 or 100% for Kunipia F), however, were not observed clearly. The chemical species of plutonium were expected to be PuOH2+ for the reducing condition and Pu(OH)4 for the oxidizing condition, respectively.
Self-organization processes in Xe nanocrystals embedded in Al are observed with in-situ high-resolution electron microscopy. Under electron irradiation, stacking fault type defects are produced in Xe nanocrystals. The defects recover in a layer by layer manner. Detailed analysis of the video reveals that the displacement of Xe atoms in the stacking fault was rather small for the Xe atoms at boundary between Xe and Al, suggesting the possibility of the stacking fault in Xe precipitate originating inside of precipitate, not at the Al/Xe interface.