scholarly journals Perioperative Microbial Contamination From Patients on Contact Precaution in Operating Room Environment

2020 ◽  
Vol 41 (S1) ◽  
pp. s348-s349
Author(s):  
Hajime Kanamori ◽  
William Rutala ◽  
Maria Gergen ◽  
David Jay Weber
Keyword(s):  
Small Computer ◽  
Contact Precaution ◽  
Time Points ◽  
Contact Precautions ◽  
Surgery Patient ◽  
Patient Arrival ◽  
The Mean ◽  
Healthcare Associated ◽  
Cleaning And Disinfection ◽  
The Impact

Background: The contaminated healthcare environment, including operating rooms (ORs), can serve as an important role in transmission of healthcare-associated pathogens. Studies are very limited regarding the level of contamination of ORs during the surgery of a patient on contact precautions and the risk to the next surgery patient after standard room cleaning and disinfection. Objective: Here, we investigated the microbial burden on the OR environment when patients on contact precautions receive surgery, and we assessed the impact of cleaning and disinfection on the contamination of OR environmental sites. Methods: This investigation was conducted in the ORs of an academic facility during an 8-month period. It involved 10 patients on contact precautions for multidrug-resistant pathogens, including methicillin-resistant Staphylococcus aureus (MRSA; n = 7); carbapenem-resistant Enterobacteriaceae (CRE) plus MRSA (n = 2); and vancomycin-resistant Enterococcus (VRE) plus MRSA (n = 1), who underwent surgery. Environmental sampling was performed at the following time points: (1) immediately before the surgical patient’s arrival in the OR, (2) after surgery but before the OR cleaning and disinfection, and (3) after the OR cleaning and disinfection. In total, 1,520 environmental samples collected from 15 OR sites for 10 surgical patients at 3 time points were analyzed. Relatedness among environmental MRSA isolates was determined by pulsed-field gel electrophoresis. Results: Overall, the mean CFUs of aerobes per Rodac plate (CFU/25 cm2) were 10.1 before patient arrival, 14.7 before cleaning and disinfection, and 6.3 after cleaning and disinfection (P < .0001, after cleaning and disinfection vs before cleaning and disinfection). Moreover, 7 environmental sites (46.7%) after cleaning and disinfection, including bed, arm rest, pyxis counter, floor (near, door side), floor (far, by door), steel counter (small, near bed), and small computer desk, had significantly lower mean counts of aerobes than before patient arrival or before cleaning and disinfection (Fig. 1). The mean CFUs of MRSA per Rodac plate (CFU/25 cm2) were 0.04 before patient arrival, 0.66 before cleaning and disinfection, and 0.08 after cleaning and disinfection (P = .0006, after cleaning and disinfection vs before cleaning and disinfection). Of environmental sites where MRSA was identified, 87.2% were on floors (41 of 47) and 19.1% were after cleaning and disinfection (9 of 47, 8 from floors and 1 from pyxis touchscreen). The A2/B2 MRSA strain was identified on different environmental sites (eg, floor, computer desk, counter) in various rooms (eg, OR2, OR10, and OR16), even after cleaning and disinfection (Fig. 2). Conclusions: Our study has demonstrated that the OR environment was contaminated with aerobic bacteria and MRSA after surgery and that MRSA persisted in the environment even after cleaning and disinfection. Enhanced environmental cleaning in the perioperative environment used for patients on isolation is necessary to prevent transmission of healthcare-associated pathogens in ORs.Funding: NoneDisclosures: Drs. Rutala and Weber are consultants to PDI (Professional Disposable International)

Electronic Clostridium difficile Infection Bundle Reduces Time to Initiation of Contact Precautions

2016 ◽  
Vol 38 (2) ◽  
pp. 242-244 ◽  
Author(s):  
Courtney M. Dewart ◽  
Natalia Blanco ◽  
Betsy Foxman ◽  
Anurag N. Malani
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Infect Control Hosp ◽  
Contact Precaution ◽  
Order Entry ◽  
Contact Precautions ◽  
Computerized Order Entry ◽  
Time To Initiation ◽  
The Impact ◽  
Reduced Time

The impact of computerized order-entry bundles on timing of contact precaution initiation for C. difficile infection (CDI) remains largely unexplored. Implementation of an electronic CDI prevention and management bundle that included an automatic isolation component significantly reduced time to initiation of contact precautions from 33.7 to 22.4 hours.Infect Control Hosp Epidemiol 2016;242–244

scholarly journals A Bundled Approach to Reduce Delayed Testing and Hospital-Acquired Cases of Clostridioides difficile Infection

2020 ◽  
Vol 41 (S1) ◽  
pp. s92-s92
Author(s):  
Ioana Chirca ◽  
Alan Sun ◽  
Adrienne Wright Albrecht ◽  
Kelly Henry
Keyword(s):  
Developed Countries ◽  
Nucleic Acid Amplification ◽  
University Hospital ◽  
National Standard ◽  
Contact Precautions ◽  
The Third ◽  
Clostridioides Difficile ◽  
Clostridioides Difficile Infection ◽  
Healthcare Associated ◽  
The Impact

Background:Clostridioides difficile is a leading cause of nosocomial infectious diarrhea in developed countries, and it has a significant economic impact throughout the world. Early detection of the pathogen and its toxins is critical because early treatment significantly reduces infection-related morbidity, mortality, and medical cost. Surveillance of healthcare-associated infections (HAIs) is conducted using the NHSN standardized infection ratio (SIR). This metric allows comparison of a facility’s observed infection rate to a national benchmark. The SIR can be elevated due to both a lack of institutional criteria for stool submission and the use of highly sensitive but poorly specific testing as a standalone test for diagnosis. The SIR can be artificially elevated by inclusion of C difficile carriers rather than infected patients due to inappropriate testing and overly sensitive methods. We aimed to determine the impact of an institutional nursing-driven protocol for stool submission as well as 2-step testing on the SIR. Methods: Starting from the fourth quarter of 2018, we instituted a nursing protocol for initiation of C. difficile testing. If the patient had ≥3 soft, loose, or liquid stools in 24 hours within the first 3 days of admission, they were placed on contact precautions and an unformed stool sample was submitted for C. difficile nucleic acid amplification testing (NAAT). A positive result prompted further evaluation with a stool enzyme immunoassay toxin test for confirmation of active infection. From hospital day 4 onward, stricter criteria were implemented for testing for C. difficile infection. Data were extrapolated for calculation of a quarterly SIR. This value was then compared to retrospective SIR data from the first quarter of 2016 to the third quarter of 2018. Results: The quarterly total of hospital-onset C. difficile infections from the first quarter of 2016 to the third quarter of 2018 ranged from 24 to 39 incidents per quarter. After implementing the nursing-driven protocol and 2-step testing, the quarterly total of hospital onset C. difficile infections decreased to 5–6 per quarter. The SIR prior to initiation ranged from 0.66 to 1.37 and decreased to 0.306–0.386 after the nursing-driven protocol and 2-step testing were implemented. Conclusions: Implementation of both an institutional nursing-driven protocol for stool submission and a 2-step testing protocol reduced the number of quarterly hospital-onset C. difficile events as well as our facility’s quarterly SIR to below the national standard.Funding: NoneDisclosures: Ioana Chirca, University Hospital

scholarly journals Spatial Process of Surface Urban Heat Island in Rapidly Growing Seoul Metropolitan Area for Sustainable Urban Planning Using Landsat Data (1996–2017)

Climate ◽  
2019 ◽  
Vol 7 (9) ◽  
pp. 110 ◽  
Author(s):  
Prabath Priyankara ◽  
Manjula Ranagalage ◽  
DMSLB Dissanayake ◽  
Takehiro Morimoto ◽  
Yuji Murayama
Keyword(s):  
Urban Heat Island ◽  
Metropolitan Area ◽  
Heat Island ◽  
Landsat Data ◽  
Time Points ◽  
Seoul Metropolitan Area ◽  
Urban Heat ◽  
The Mean ◽  
The Impact ◽  
The City

The urban heat island (UHI) phenomenon is an important research topic in the scholarly community. There are only few research studies related to the UHI in the Seoul metropolitan area (SMA). Therefore, this study examined the impact of urbanization on the formation of UHI in the SMA as a geospatial study by using Landsat data from 1996, 2006, and 2017. For this purpose, we analyzed the relative variation of land surface temperature (LST) with changes of land use/land cover (LULC) rather than absolute values of LST using gradient, intensity, and directional analyses. It was observed that the impervious surface (IS) has expanded, and the UHI effect was more penetrating in the study area, with considerable loss of other LULC including green surfaces along with the rapid urbanization of the study area. In this study, we divided the IS into persistent IS (PIS) and newly added IS (NAIS). The spatial distribution of the IS, forest surface (FS), PIS, and NAIS was observed based on gradient zones (GZs). The results show that GZ1 recorded a difference of 6.0 °C when compared with the GZ109 in 2017. The results also show that the city center was warmer than the surrounding areas during the period of study. Results reveal that the mean LST has a strong significant positive relationship with a fraction of IS and PIS in 2006 and 2017. On other hand, the mean LST has a strong negative relationship with a fraction of FS and NAIS in the same time points. Relatively low temperatures were recorded in FS and NAIS in both time points. Further, it was proved that the local climate of the SMA and its surroundings had been affected by the UHI effect. Therefore, urban planners of the SMA should seriously consider the issue and plan to mitigate the effect by improving the green surfaces of the city. More greening-oriented concepts are recommended in both horizontal and vertical directions of the SMA, that can be used to control the negative impact associated with UHI. The overall outputs of the study could be used as a proxy indicator for the sustainability of the SMA and its surroundings.

Influence of State Laws Mandating Reporting of Healthcare-Associated Infections: The Case of Central Line–Associated Bloodstream Infections

2013 ◽  
Vol 34 (8) ◽  
pp. 780-784 ◽  
Author(s):  
Amy L. Pakyz ◽  
Michael B. Edmond
Keyword(s):  
Central Line ◽  
Healthcare Associated Infections ◽  
Probit Regression ◽  
Legal Requirements ◽  
State Legislation ◽  
State Laws ◽  
The Mean ◽  
Healthcare Associated ◽  
The Impact ◽  
Mean State

Objective.To evaluate the impact of state laws on reporting of healthcare-associated infections on central line-associated bloodstream infection (CLABSI) rates.Design.Retrospective, cross-sectional study.Methods.Hospital-level administrative and Hospital Compare data were collected on University HealthSystem Consortium hospitals. An ordered probit regression model assessed the association between state legislation and CLABSI standardized infection ratio (SIR). The main independent variable was a state legislation variable concerning 3 legal requirements (data submission, reporting of data to the public, inclusion of facility identifiers in public reports) and was coded for hospitals accordingly located in a state that did not have CLABSI reporting, located in a state that had CLABSI reporting legislation and met 3 legal requirements, or located in a state that had CLABSI reporting but did not meet the 3 legal requirements. A secondary analysis ascertained whether the mean state SIR values differed among the 3 legislation groups.Results.There were 159 hospitals included; 92 were located in states that had CLABSI reporting and met 3 requirements, 33 were located in states that had reporting but did not meet the 3 requirements, and 34 were in states that had no legislation. There was no effect of state legislation group on CLABSI SIR. There were no significant differences in the mean state CLABSI SIRs among the legislation groups.Conclusions.In this sample of academic medical centers, there was no evidence of an effect of state HAI laws on CLABSI occurrence. The impact of state legislation may be lessened by other CLABSI prevention initiatives.

Asteroid and Comet Impact Speeds upon Mars: Significance for Panspermia and the Supply of Organics

1997 ◽  
Vol 161 ◽  
pp. 197-201 ◽  
Author(s):  
Duncan Steel
Keyword(s):  
Probability Distributions ◽  
Regions Of Interest ◽  
Significant Fraction ◽  
Organic Chemicals ◽  
Impact Speed ◽  
The Mean ◽  
The Impact

AbstractWhilst lithopanspermia depends upon massive impacts occurring at a speed above some limit, the intact delivery of organic chemicals or other volatiles to a planet requires the impact speed to be below some other limit such that a significant fraction of that material escapes destruction. Thus the two opposite ends of the impact speed distributions are the regions of interest in the bioastronomical context, whereas much modelling work on impacts delivers, or makes use of, only the mean speed. Here the probability distributions of impact speeds upon Mars are calculated for (i) the orbital distribution of known asteroids; and (ii) the expected distribution of near-parabolic cometary orbits. It is found that cometary impacts are far more likely to eject rocks from Mars (over 99 percent of the cometary impacts are at speeds above 20 km/sec, but at most 5 percent of the asteroidal impacts); paradoxically, the objects impacting at speeds low enough to make organic/volatile survival possible (the asteroids) are those which are depleted in such species.

Sound Production Treatment for Acquired Apraxia of Speech: An Examination of Dosage in Relation to Probe Performance

2020 ◽  
pp. 1-16
Author(s):  
Julie L. Wambaugh ◽  
Lydia Kallhoff ◽  
Christina Nessler
Keyword(s):  
Retrospective Analysis ◽  
Sound Production ◽  
Apraxia Of Speech ◽  
Practice Schedule ◽  
Practice Schedules ◽  
Baseline Performance ◽  
The Mean ◽  
Number Of Treatment ◽  
The Impact

Purpose This study was designed to examine the association of dosage and effects of Sound Production Treatment (SPT) for acquired apraxia of speech. Method Treatment logs and probe data from 20 speakers with apraxia of speech and aphasia were submitted to a retrospective analysis. The number of treatment sessions and teaching episodes was examined relative to (a) change in articulation accuracy above baseline performance, (b) mastery of production, and (c) maintenance. The impact of practice schedule (SPT-Blocked vs. SPT-Random) was also examined. Results The average number of treatment sessions conducted prior to change was 5.4 for SPT-Blocked and 3.9 for SPT-Random. The mean number of teaching episodes preceding change was 334 for SPT-Blocked and 179 for SPT-Random. Mastery occurred within an average of 13.7 sessions (1,252 teaching episodes) and 12.4 sessions (1,082 teaching episodes) for SPT-Blocked and SPT-Random, respectively. Comparisons of dosage metric values across practice schedules did not reveal substantial differences. Significant negative correlations were found between follow-up probe performance and the dosage metrics. Conclusions Only a few treatment sessions were needed to achieve initial positive changes in articulation, with mastery occurring within 12–14 sessions for the majority of participants. Earlier occurrence of change or mastery was associated with better follow-up performance. Supplemental Material https://doi.org/10.23641/asha.12592190

Contact precautions for colonisation with multidrug-resistant organisms and haemodialysis patient quality of life and mood: a pilot case-control study

2019 ◽  
pp. 19-25 ◽  
Author(s):  
Rathika Krishnasamy
Keyword(s):  
Quality Of Life ◽  
Qualitative Interviews ◽  
Social Function ◽  
Multidrug Resistant ◽  
Contact Precautions ◽  
Dialysis Vintage ◽  
Multidrug Resistant Organisms ◽  
And Gender ◽  
The Impact

Background: The rate of multidrug-resistant organisms (MDRO) colonisation in dialysis populations has increased over time. This study aimed to assess the effect of contact precautions and isolation on quality of life and mood for haemodialysis (HD) patients colonised with MDRO. Methods: Patients undergoing facility HD completed the Kidney Disease Quality of Life (KDQOL–SFTM), Beck Depression Inventory (BDI) and Personal Wellbeing-Index Adult (PWI-A). Patients colonised with MDRO were case-matched by age and gender with patients not colonised. Results: A total of 16 MDRO-colonised patients were matched with 16 controls. Groups were well matched for demographics and co-morbidities, other than a trend for older dialysis vintage in the MDRO group [7.2 years (interquartile range 4.6–10.0) compared to 3.2 (1.4–7.6) years, p=0.05]. Comparing MDRO-positive with negative patients, physical (30.5±10.7 vs. 34.6±7.3; p=0.2) and mental (46.5±11.2 vs. 48.5±12.5; p = 0.6) composite scores were not different between groups. The MDRO group reported poorer sleep quality (p=0.01) and sleep patterns (p=0.05), and lower social function (p=0.02). BDI scores were similar (MDRO-positive 10(3.5–21.0) vs. MDRO-negative 12(6.5–16.0), p=0.6). PWI-A scores were also similar in both groups; however, MDRO patients reported lower scores for “feeling safe”, p=0.03. Conclusion: While overall scores of quality of life and depression were similar between groups, the MDRO group reported poorer outcomes in sleep and social function. A larger cohort and qualitative interviews may give more detail of the impact of contact precautions and isolation on HD patients. The necessity for contact precautions for different MDRO needs consideration.

Impact of changing rainfall conditions on surface and groundwater resources in an experimental watershed in Greece

2013 ◽  
Vol 12 (2) ◽  
pp. 119-125
Keyword(s):  
Groundwater Resources ◽  
Annual Runoff ◽  
Annual Rainfall ◽  
Rainfall Regime ◽  
Winter Rainfall ◽  
Rainfall Depth ◽  
Rainfall Volume ◽  
The Mean ◽  
Groundwater Reserves ◽  
The Impact

The present study concerns the impact of a change in the rainfall regime on surface and groundwater resources in an experimental watershed. The research is conducted in a gauged mountainous watershed (15.18 km2) that is located on the eastern side of Penteli Mountain, in the prefecture of Attica, Greece and the study period concerns the years from 2003 to 2008. The decrease in the annual rainfall depth during the last two hydrological years 2006-2007, 2007-2008 is 10% and 35%, respectively, in relation to the average of the previous years. In addition, the monthly distribution of rainfall is characterized by a distinct decrease in winter rainfall volume. The field measurements show that this change in rainfall conditions has a direct impact on the surface runoff of the watershed, as well as on the groundwater reserves. The mean annual runoff in the last two hydrological years has decreased by 56% and 75% in relation to the average of the previous years. Moreover, the groundwater level follows a declining trend and has dropped significantly in the last two years.

(Preprint)

2018 ◽  
Author(s):  
Natalia Banasik ◽  
Dariusz Jemielniak ◽  
Wojciech P?dzich
Keyword(s):  
Medical Condition ◽  
Extended Period ◽  
Well Being ◽  
Marginal Effect ◽  
Life Duration ◽  
Significant Difference ◽  
The Mean ◽  
Academic Teachers ◽  
Length Of Life ◽  
The Impact

BACKGROUND There have been mixed results of the studies checking whether prayers do actually extend the life duration of the people prayed for. Most studies on the topic included a small number of prayers and most of them focused on people already struggling with a medical condition. Intercessory prayer’s influence on health is of scholarly interest, yet it is unclear if its effect may be dependent on the number of prayers for a named individual received per annum. OBJECTIVE We sought to examine if there is a noticeable increased longevity effect of intercessory prayer for a named individual’s well-being, if he receives a very high number of prayers per annum for an extended period. METHODS We retrieved and conducted a statistical analysis of the data about the length of life for 857 Roman Catholic bishops, 500 Catholic priests, and 3038 male academics from the US, France, Italy, Poland, Brazil, and Mexico. We obtained information for these individuals who died between 1988 and 2018 from Wikidata, and conducted an observational cohort study. Bishops were chosen for the study, as they receive millions of individual prayers for well being, according to conservative estimates. RESULTS There was a main effect for occupation F(2, 4391) = 4.07, p = .017, ηp 2 = .002, with pairwise comparisons indicating significant differences between the mean life duration of bishops (M=30489) and of priests (M=29894), but none between the academic teachers (M=30147) and either of the other groups. A comparison analysis between bishops from the largest and the smallest dioceses showed no significant difference t(67.31)=1.61, p = .11. Our main outcome measure is covariance of the mean length of life in each of the categories: bishops, priests, academic teachers, controlled for nationality. CONCLUSIONS The first analysis proved that bishops live longer than priests, but due to a marginal effect size this result should be treated with caution. No difference was found between the mean length of life of bishops from the largest and the smallest dioceses. We found no difference between bishops and male academics. These results show that the impact of intercessory prayers on longevity is not observable.

scholarly journals Mean Empirical Likelihood Inference for Response Mean with Data Missing at Random

2020 ◽  
Vol 2020 ◽  
pp. 1-12
Author(s):  
Hanji He ◽  
Guangming Deng
Keyword(s):  
Empirical Likelihood ◽  
Missing At Random ◽  
Confidence Regions ◽  
Likelihood Inference ◽  
High Dimensional ◽  
Finite Sample ◽  
The Mean ◽  
Data Missing ◽  
Consistency And Asymptotic Normality ◽  
The Impact

We extend the mean empirical likelihood inference for response mean with data missing at random. The empirical likelihood ratio confidence regions are poor when the response is missing at random, especially when the covariate is high-dimensional and the sample size is small. Hence, we develop three bias-corrected mean empirical likelihood approaches to obtain efficient inference for response mean. As to three bias-corrected estimating equations, we get a new set by producing a pairwise-mean dataset. The method can increase the size of the sample for estimation and reduce the impact of the dimensional curse. Consistency and asymptotic normality of the maximum mean empirical likelihood estimators are established. The finite sample performance of the proposed estimators is presented through simulation, and an application to the Boston Housing dataset is shown.

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