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Contaminated surfaces may be a source of transmission for the globally emerging pathogen, Candida auris. Because floors may be a source of C. auris contamination on hands, strategies for inactivating or removing C. auris from floors were investigated. A sporicidal disinfectant and UV-C were most effective in inactivating C. auris on floors.
In laboratory testing, a mobile enclosed disinfection cabinet using ultraviolet-C light and aerosolized hydrogen peroxide was effective for disinfection of hard and soft surfaces. The addition of aerosolized hydrogen peroxide to ultraviolet-C light resulted in improved disinfection of soft surfaces and Clostridioides difficile spores.
A wall-mounted, far-ultraviolet-C light technology reduced aerosolized bacteriophage MS2 by >3 log10 plaque-forming units within 30 minutes. Vegetative bacterial pathogens on steel disk carriers in the center of the room were reduced by >3 log10 after 45 minutes of exposure, but Candida auris and Clostridioides difficile spores were not.
We tested the effectiveness of 23 disinfectants used in healthcare facilities against isolates from the 4 major clades of Candida auris. Sporicidal disinfectants were consistently effective, whereas quaternary-ammonium disinfectants had limited activity. Quaternary-ammonium–alcohol and hydrogen-peroxide–based disinfectants varied in effectiveness against C. auris.
We developed a do-it-yourself test protocol using commercial Bacillus atrophaeus spores to assess the efficacy of ultraviolet-C (UV-C) light room-decontamination devices. Overall, 4 UV-C devices reduced B. atrophaeus by ≥3 log10 colony-forming units in 10 minutes, whereas a smaller device required 60 minutes. Of 10 in-use devices, only 1 was ineffective.
During the 4 years after implementation of the 2-step Clostridioides difficile infection (CDI) testing algorithm, 70% to 78% of patients with suspected CDI and a positive nucleic acid amplification test but a negative toxin test (NAAT+/TOX−) received CDI treatment. Overall, 73% of NAAT+/TOX− patients were classified as having probable or possible CDI.
Contaminated shoes are a potential vector for dissemination of healthcare-associated pathogens. We demonstrated that healthcare personnel walking into patient rooms frequently transferred pathogens from their shoes to the floor. An 8-second treatment of shoes with a UV-C decontamination device significantly reduced the frequency of transfer of vegetative bacterial pathogens.
In a randomized trial, patients wearing slippers whenever out of bed transferred bacteriophage MS2 from hospital room floors to patients and surfaces significantly less often than controls not provided with slippers. Wearing slippers could provide a simple means to reduce the risk for acquisition of healthcare-associated pathogens from contaminated floors.
In a randomized trial, adjunctive ultraviolet-C light treatment with a room decontamination device and sodium hypochlorite delivered via an electrostatic sprayer were similarly effective in significantly reducing residual healthcare-associated pathogen contamination on floors and high-touch surfaces after manual cleaning and disinfection. Less time until the room was ready to be occupied by another patient was required for electrostatic spraying.
A novel 1-step anionic surfactant disinfectant was effective against Candida auris isolates from the 4 major phylogenetic clades as well as methicillin-resistant Staphylococcus aureus (MRSA) and the enveloped virus bacteriophage Phi6. This anionic surfactant disinfectant may be a useful addition to the disinfectant products available for use against C. auris.
To investigate a cluster of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in employees working on 1 floor of a hospital administration building.
Contact tracing was performed to identify potential exposures and all employees were tested for SARS-CoV-2. Whole-genome sequencing was performed to determine the relatedness of SARS-CoV-2 samples from infected personnel and from control cases in the healthcare system with coronavirus disease 2019 (COVID-19) during the same period. Carbon dioxide levels were measured during a workday to assess adequacy of ventilation; readings >800 parts per million (ppm) were considered an indication of suboptimal ventilation. To assess the potential for airborne transmission, DNA-barcoded aerosols were released, and real-time polymerase chain reaction was used to quantify particles recovered from air samples in multiple locations.
Between December 22, 2020, and January 8, 2021, 17 coworkers tested positive for SARS-CoV-2, including 13 symptomatic and 4 asymptomatic individuals. Of the 5 cluster SARS-CoV-2 samples sequenced, 3 were genetically related, but these employees denied higher-risk contacts with one another. None of the sequences from the cluster were genetically related to the 17 control sequences of SARS-CoV-2. Carbon dioxide levels increased during a workday but never exceeded 800 ppm. DNA-barcoded aerosol particles were dispersed from the sites of release to locations throughout the floor; 20% of air samples had >1 log10 particles.
In a hospital administration building outbreak, sequencing of SARS-CoV-2 confirmed transmission among coworkers. Transmission occurred despite the absence of higher-risk exposures and in a setting with adequate ventilation based on monitoring of carbon dioxide levels.
In an unventilated room, 2 commercial portable air cleaners with high efficiency particulate air (HEPA) filters and a do-it-yourself box fan air cleaner with minimum efficiency reporting value (MERV)-13 filters significantly reduced aerosolized bacteriophage MS2. Increasing airflow and addition of ultraviolet-C light plus titanium dioxide–generated photocatalytic oxidation enhanced viral clearance.