Family caregivers are essential inpatient pediatric care partners, yet their handwashing knowledge and compliance are rarely studied. Through hand hygiene audits and self-administered questionnaires, we observed 9% compliance, significantly lower than self-reported practice. We suggest interventions to improve caregiver handwashing behaviors to decrease infection transmission risk to hospitalized children.

We performed an epidemiological investigation and genome sequencing of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) to define the source and scope of an outbreak in a cluster of hospitalized patients. Lack of appropriate respiratory hygiene led to SARS-CoV-2 transmission to patients and healthcare workers during a single hemodialysis session, highlighting the importance of infection prevention precautions.

Background: Hand hygiene (HH) is the most effective means of preventing healthcare-associated infections (HAI). HH improvement strategies primarily focus on healthcare staff, often overlooking the significant contribution of caregivers to HAI risk. We sought to understand caregivers’ HH knowledge and practices to identify improvement opportunities. Methods: A self-administered survey was developed and distributed to families from June to August 2019; open-ended questions and Likert scales assessed caregivers’ perceptions and practices regarding HH at home and in hospital. HH compliance audits of caregivers entering and exiting inpatient rooms were performed in the same time period. Results: Among 81 caregivers surveyed, median patient age was 4.0 (IQR, 0.9–13.0) years. This was the first admission for 42 patients (53.8%). During this admission, 22 (27.2%) patients had been admitted for ≤1 day and 45 (55.6%) for >3 days. Caregivers reported good knowledge of HH practice, with strongly positive responses to knowledge of HH moments (94%) and proper technique (96%). Caregivers recognized that HH is required of hospital visitors (96%) to protect others (99%) and prevent illness in hospital (93%). Responses were less consistent for performing HH before entering a hospital room (83%), after exiting the room (70%), or after coughing or sneezing (65%). The attitudes of caregivers of children above 2 years were equivocal regarding expectations of their child to wash hands upon entering (40%), or exiting (41%) the hospital room. Multivariable modeling identified higher self-reported HH compliance in caregivers during first admission to hospital, compared to subsequent admissions (OR, 3.15; 95% CI, 1.11–9.65). Reported barriers to HH included hand irritation (27.2%) and perceived HH frequency (18.5%). At the time of survey completion, 62 caregivers (77%) reported not having received HH information during their child’s admission from a healthcare provider or volunteer. Information was most commonly gained from posters (75%) and information in the room (31%). Most caregivers (58.0%) reported that they would prefer to receive HH information in the first 24 hours of admission. Among 200 audits, overall caregiver compliance with HH was 9%; HH before entering the room was 7.2% compared to 11.2% after exiting (P = .33). Conclusions: Reported caregiver knowledge of HH was not reflected in audited practice. Fewer than 1 in 4 had received HH information from healthcare staff. HH education in the hospital environment within the first day of admission provides an opportunity for caregivers to improve compliance as partners in HAI prevention and safer pediatric care.

Funding: None

Disclosures: None

The magnetic resonance imaging (MRI) appearance of the brain and spinal cord in humans with neuroangiostrongyliasis (NA) due to Angiostrongylus cantonensis infection has been well reported. Equivalent studies in animals are lacking. This case series describes clinical and MRI findings in 11 dogs with presumptively or definitively diagnosed NA. MRI of the brain and/or spinal cord was performed using high-field (1.5 T) or low-field (0.25 T) scanners using various combinations of transverse, sagittal, dorsal and three-dimensional (3D) T1-weighted (T1W), transverse, sagittal and dorsal T2-weighted (T2W), T2W fluid-attenuated inversion recovery (FLAIR) and T2*-weighted (T2*W) gradient echo (GRE), dorsal T2W short tau inversion recovery (STIR) and post-gadolinium transverse, sagittal, dorsal and 3D T1W and transverse T2W FLAIR sequences. In 4/6 cases where the brain was imaged, changes consistent with diffuse meningoencephalitis were observed. Evidence of meningeal involvement was evident even when not clinically apparent. The spinal cord was imaged in 9 dogs, with evidence of meningitis and myelitis detected in regions consistent with the observed neuroanatomical localization. Pathognomonic changes of neural larva migrans, as described in some human patients with NA, were not detected. NA should be considered in the differential diagnosis of dogs with MRI evidence of focal or diffuse meningitis, myelitis and/or encephalitis, especially in areas where A. cantonensis is endemic. If not precluded by imaging findings suggestive of brain herniation, cerebrospinal fluid (CSF) collection for cytology, fluid analysis, real-time polymerase chain reaction (qPCR) and enzyme-linked immunosorbent assay (ELISA) testing should be considered mandatory in such cases after the MRI studies.

Background: Continuous EEG monitoring, in the form of amplitude-integrated (aEEG) or conventional EEG (cEEG), is used in the neonatal intensive care unit (NICU) to detect subclinical central nervous system pathologies, inform management, and prognosticate neurodevelopmental outcomes. To learn more about provider attitudes and current practices in Canada, we evaluated neurologist and neonatologist opinions regarding NICU EEG monitoring. Methods: A 15-item electronic questionnaire was distributed to 114 pediatric neurologists and 176 neonatologists working across 25 sites. Results: The survey was completed by 87 of 290 physicians. Continuous EEG monitoring is utilized by 97% of pediatric neurologists and 92% of neonatologists. Neurologists and neonatologists differ in their EEG monitoring preferences. For seizure detection and diagnosis of encephalopathy, significantly more neonatologists favor aEEG alone or in combination with cEEG, whereas most neurologists prefer cEEG (p = 0.047, 0.001). There is a significant difference in the perceived gaps in monitoring patients with cEEG between neonatologists (13% would monitor more) and neurologists (41% would monitor more) (p = 0.007). Half of all respondents (53%) reported that they would be interested in attending an education session on neonatal EEG monitoring. Conclusions: Canadian neurologists and neonatologists do not agree on the best monitoring approach for critically ill neonates. Furthermore, neonatologists perceive a smaller cEEG monitoring gap as compared with neurologists. However, many participants from both specialties would like to increase long-term EEG monitoring in the NICU setting. Facilitating access to EEG monitoring and enhancing education may help to address these needs.

Southern Root-Knot nematode and common cocklebur interfere with cotton growth and yield. A greater understanding of the interaction of these pests with cotton growth and yield is needed for effective integrated pest management (IPM). An additive design was used in outdoor microplots with five common cocklebur densities (0, 1, 2, 4, and 8 plants per plot) growing in competition with cotton, with and without the presence of southern Root-Knot nematode. Differences in cotton height could not be detected among common cocklebur densities or nematode presence at 3 wk after transplanting (WAT); however, differences in crop height were observed at 5 WAT between nematode treatments. In the absence of nematodes, the relationship between cotton yield loss and common cocklebur density was described by a rectangular hyperbolic regression model (P < 0.0001). Maximum yield loss from common cocklebur in the absence of nematodes exceeded 80%. In the presence of nematodes, there was a linear relationship between cotton yield loss and common cocklebur density (P = 0.0506). The presence of nematodes at each common cocklebur density increased cotton yield loss 15 to 35%. Common cocklebur plant biomass was 25% greater in nematode treatments, likely because of the reduced competitiveness of the cotton plants in these plots. This study demonstrates that multiple pests can interact to cause an additive reduction in crop yield.

The potential dispersal of Benghal dayflower seeds by mourning doves was studied in southern Georgia, U.S.A. The gut contents (both crop and gizzard) of mourning doves harvested in the autumn months were investigated to determine if mourning doves fed on Benghal dayflower and whether seeds can survive conditions in the bird gut. Research indicated that mourning doves fed selectively on Benghal dayflower with some harvested birds containing hundreds of Benghal dayflower seeds and capsules in their guts. Further, some seeds recovered remained highly viable. Germination rates in seeds taken from bird crops were similar to controls over the first 4 wk of germination and enhanced over control treatments during the latter 16 wk of a 20-wk germination study. Ultimately, seeds extracted from dove crops had 92% germination as compared to 80% for control seeds. Seeds extracted from dove gizzards had 45% germination, about half that of controls. Benghal dayflower seeds have a structurally reinforced seed coat that probably aids in survival of mechanical damage through bird intestinal tracts. Benghal dayflower seeds exposed to 1.0 M HCl treatment for 2 h had little loss in viability, successfully germinating after such treatment. When evaluating mechanisms for the eradication of Benghal dayflower from agricultural crops, consideration needs to be given to the large number of mourning doves and other bird species that visit cropland and potentially aid in its dispersal.

Adebate is emerging regarding the best way to ensure the timely and efficient return to work (RTW) of workers who have become long term absent (LTA) for health reasons. Elements of this debate center on the roles of the individual, the rehabilitation agent, the employing organisation and the rehabilitation and reintegration system. Recent years have seen the emergence of new approaches to managing LTA, mostly focusing on disability management and on amendments to welfare and rehabilitation systems. This paper discusses these trends in the light of a 6-year research programme carried out in Ireland, involving both national and transnational studies which have sought to identify the key elements of successful LTA policies and practices. It also reviews recent international work in the area in order to assess the relative importance of systemic, organisational and individual factors in ensuring timely and effective LTA policies and practices.