Archive for February 24, 2017

Contamination of Stethoscopes and Physicians’ Hands After a Physical Examination

Mayo Clinic Proceedings February 2014 V.89 N.2  P.291–299

Yves Longtin, Alexis Schneider, Clément Tschopp, Gesuèle Renzi, Angèle Gayet-Ageron, Jacques Schrenzel, Didier Pittet

Abstract

Objectives

To compare the contamination level of physicians’ hands and stethoscopes and to explore the risk of cross-transmission of microorganisms through the use of stethoscopes.

Patients and Methods

We conducted a structured prospective study between January 1, 2009, and May 31, 2009, involving 83 inpatients at a Swiss university teaching hospital. After a standardized physical examination, 4 regions of the physician’s gloved or ungloved dominant hand and 2 sections of the stethoscopes were pressed onto selective and nonselective media; 489 surfaces were sampled. Total aerobic colony counts (ACCs) and total methicillin-resistant Staphylococcus aureus (MRSA) colony-forming unit (CFU) counts were assessed.

Results

Median total ACCs (interquartile range) for fingertips, thenar eminence, hypothenar eminence, hand dorsum, stethoscope diaphragm, and tube were 467, 37, 34, 8, 89, and 18, respectively. The contamination level of the diaphragm was lower than the contamination level of the fingertips (P<.001) but higher than the contamination level of the thenar eminence (P=.004). The MRSA contamination level of the diaphragm was higher than the MRSA contamination level of the thenar eminence (7 CFUs/25 cm2 vs 4 CFUs/25 cm2; P=.004). The correlation analysis for both total ACCs and MRSA CFU counts revealed that the contamination level of the diaphragm was associated with the contamination level of the fingertips (Spearman’s rank correlation coefficient, ρ=0.80; P<.001 and ρ=0.76; P<.001, respectively). Similarly, the contamination level of the stethoscope tube increased with the increase in the contamination level of the fingertips for both total ACCs and MRSA CFU counts (ρ=0.56; P<.001 and ρ=.59; P<.001, respectively).

Conclusion

These results suggest that the contamination level of the stethoscope is substantial after a single physical examination and comparable to the contamination of parts of the physician’s dominant hand.

PDF

http://www.mayoclinicproceedings.org/article/S0025-6196(13)01084-7/pdf

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February 24, 2017 at 3:50 pm

Editorials – Stethoscopes and Health Care–Associated Infection

Mayo Clinic Proceedings March 2014 V.89 N.3 P.277–280

Dennis G. Maki

Divisions of Infectious Disease and Pulmonary/Critical Care Medicine, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI

Over the past 30 years we have come to fully appreciate the enormous potential for person-to-person spread of virulent nosocomial pathogens (eg, methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant enterococcus [VRE], multidrug-resistant [MDR] gram-negative bacilli and Clostridium difficile, viruses such as influenza A, respiratory syncytial virus, and norovirus, and even Candida species) in the health care setting, with devastating infection being the most feared iatrogenic consequence and one of the greatest threats to hospital safety.

It has long been accepted that the major reservoir of nosocomial infection is infected or colonized patients and the major mode of transmission is the transient carriage of nosocomial pathogens on the hands of noncolonized health care workers having direct physical contact with patients.

Hand hygiene before and after direct patient contact—now most often with a waterless alcohol gel or hand rub—has become an uncompromising expectation for modern-day health care workers …

PDF

http://www.mayoclinicproceedings.org/article/S0025-6196(14)00070-6/pdf

February 24, 2017 at 3:49 pm

REVIEW – Middle East Respiratory Syndrome: What Clinicians Need to Know

Mayo Clinic Proceedings August 2014 V.89 N.8 P.1153–1158

Priya Sampathkumar, MD

Division of Infectious Diseases, Mayo Clinic, Rochester, MN

A severe viral illness caused by a newly discovered coronavirus was first reported in the Middle East in 2012. The virus has since been named the Middle East respiratory syndrome coronavirus (MERS-CoV). MERS-CoV cases have been reported in several countries around the world in travelers from the Middle East. The illness has a high mortality rate. Limited human-to-human transmission has occurred including transmission to health care workers. The source of the virus remains unclear, but camels are a possible source. Two unrelated imported cases of MERS-CoV have been reported in the United States. Neither a vaccine nor effective therapy against the virus is available. International cooperation and information sharing will be key to understanding and ending the MERS-CoV outbreak.

PDF

http://www.mayoclinicproceedings.org/article/S0025-6196(14)00527-8/pdf

February 24, 2017 at 3:47 pm

Long-term outcomes of infective encephalitis in children: a systematic review and meta-analysis.

Dev Med Child Neurol. 2016 Nov;58(11):1108-1115.

 doi: 10.1111/dmcn.13197. Epub 2016 Jul 16.

Khandaker G1,2,3, Jung J4, Britton PN4,5,6, King C7, Yin JK7,8, Jones CA4,5,6.

Author information

1Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. gulam.khandaker@health.nsw.gov.au

2National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Sydney, NSW, Australia. gulam.khandaker@health.nsw.gov.au

3Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Sydney, NSW, Australia. gulam.khandaker@health.nsw.gov.au

4Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.

5Marie Bashir Institute for Infectious Diseases and Biosecurity Institute (MBI), University of Sydney, Sydney, NSW, Australia.

6Department of Infectious Diseases and Microbiology, The Children’s Hospital at Westmead, Sydney, NSW, Australia.

7National Centre for Immunisation Research and Surveillance, The Children’s Hospital at Westmead, Sydney, NSW, Australia.

8Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.

Abstract

AIM:

The long-term outcomes of childhood infective encephalitis are variable and not well quantified. We aimed to systematically review the literature and undertake meta-analyses on predetermined outcomes to address this knowledge gap and identify areas for future research.

METHOD:

We searched electronic databases, performed complementary reviews of references of fully extracted articles, and made contact with experts on infective encephalitis. Articles published up until April 2016 were selected for screening.

RESULTS:

We evaluated sequelae of 1018 survivors of childhood infective encephalitis (934 with complete follow-up) from 16 studies. Mean age during acute encephalitis episodes was 5 years 3.6 months (range 1.2mo-17y), 57.6% were male (500/868), and mean follow-up period was 4 years 1.2 months (range 1-12y). Incomplete recovery was reported in 312 children (42.0%; 95% confidence interval [CI] 31.6-53.1% in pooled estimate). Among the other sequelae, developmental delay, abnormal behaviour, motor impairment, and seizures were reported among 35.0% (95% CI 10.0-65.0%), 18.0% (95% CI 8.0-31.0%), 17.0% (95% CI 10.0-26.0%), and 10.0% (95% CI 6.0-14.0%) respectively.

INTERPRETATION:

Almost half of childhood infective encephalitis survivors report incomplete recovery in the long-term; most commonly developmental delay, behavioural abnormality, and neurological impairments (i.e. seizure). Well designed, large-scale prospective studies are needed to better quantify neurodevelopmental sequelae among childhood encephalitis survivors.

PDF

http://onlinelibrary.wiley.com/doi/10.1111/dmcn.13197/epdf

February 24, 2017 at 12:22 pm

The Brief Case: Anaerobiospirillum succiniciproducens Bacteremia and Pyomyositis

Journal of Clinical Microbiology March 2017 V.55 N.3 P.665-669

David J. Epstein, Kristina Ernst, Robert Rogers, Ellie Carmody, and Maria Aguero-Rosenfeld

aDivision of Infectious Diseases and Immunology, Department of Medicine, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA

bDivision of Infectious Diseases, Department of Medicine, NYC Health + Hospitals/Bellevue, New York, New York, USA

cNYU School of Medicine, NYU Langone Medical Center, New York, New York, USA

dDepartment of Pathology, NYU School of Medicine, NYU Langone Medical Center, New York, New York, USA

eDepartment of Pathology, NYC Health + Hospitals/Bellevue, New York, New York, USA

A 39-year-old man presented to the Bellevue Hospital emergency department in November with 1 week of fevers and cough. On the previous day, he had been assaulted, developing right buttock and thigh pain.

His medical history was notable for alcohol use disorder treated with the opioid antagonist naltrexone (depot formulation), injected intramuscularly into the gluteal region monthly.

He received left and right gluteal injections 1 and 6 weeks prior to presentation, respectively. He was homeless and denied travel or animal contact.

He drank up to two dozen beer cans daily and smoked cigarettes but denied drug use….

PDF

http://jcm.asm.org/content/55/3/665.full.pdf+html

 

Closing the Brief Case: Anaerobiospirillum succiniciproducens Bacteremia and Pyomyositis

ANSWERS TO SELF-ASSESSMENT QUESTIONS

PDF

http://jcm.asm.org/content/55/3/986.full.pdf+html

February 24, 2017 at 8:04 am

The Ongoing Genetic Adaptation of Streptococcus pneumoniae

Journal of Clinical Microbiology March 2017 V.55 N.3 P.681-685

Sandra S. Richter and Daniel M. Musher

aDepartment of Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA

bDepartments of Medicine and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, Texas, USA, and the Medical Care Line (Infectious Disease Section), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA

Streptococcus pneumoniae has demonstrated a remarkable ability to adapt during the conjugate vaccine era.

The increasing incidence of serotype 35B disease and emergence of a multidrug-resistant clone reported in this issue of the Journal of Clinical Microbiology (L. Olarte et al., J Clin Microbiol 55:724–734, 2017, https://doi.org/10.1128/JCM.01778-16) underscore the limitations of pneumococcal vaccines that target the polysaccharide capsule.

PDF

http://jcm.asm.org/content/55/3/681.full.pdf+html

February 24, 2017 at 8:02 am

A New Development in Trypanosoma cruzi Detection

Journal of Clinical Microbiology March 2017 V.55 N.3 P.690-692

Herbert B. Tanowitz and Louis M. Weiss

Department of Pathology, Division of Tropical Medicine and Parasitology, and Department of Medicine, Division of Infectious Disease, Albert Einstein College of Medicine, Bronx, New York, USA

Chagas disease is caused by the parasite Trypanosoma cruzi and is an important cause of morbidity and mortality in areas of Latin America where Chagas disease is endemic and among infected individuals who have migrated to nonendemic areas of North America and Europe.

There are many diagnostic tests that are employed in the serological diagnosis of this infection. In this issue of the Journal of Clinical Microbiology, Bautista-López et al. provide characterization of excretory vesicles (EVs) from Vero cells infected with T. cruzi and provide data on the EVs produced by trypomastigotes and amastigotes (N. L. Bautista-López et al., J Clin Microbiol 55:744–758, 2017, https://doi.org/10.1128/JCM.01649-16).

Their proteomic study defines potential targets to evaluate for improved diagnostic tests, effects on host cell biology that contribute to the pathogenesis of infection, and vaccine candidates. If any of the EV-associated proteins identified were to be correlated to cure of infection, this would be a major advance….

PDF

http://jcm.asm.org/content/55/3/690.full.pdf+html

February 24, 2017 at 8:01 am

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