Archive for December 31, 2018

Molecular analysis of bacterial contamination on stethoscopes in an intensive care unit

Infect Control Hosp Epidemiol. December 12, 2018

Background

Culture-based studies, which focus on individual organisms, have implicated stethoscopes as potential vectors of nosocomial bacterial transmission. However, the full bacterial communities that contaminate in-use stethoscopes have not been investigated.

Methods

We used bacterial 16S rRNA gene deep-sequencing, analysis, and quantification to profile entire bacterial populations on stethoscopes in use in an intensive care unit (ICU), including practitioner stethoscopes, individual-use patient-room stethoscopes, and clean unused individual-use stethoscopes. Two additional sets of practitioner stethoscopes were sampled before and after cleaning using standardized or practitioner-preferred methods.

Results

Bacterial contamination levels were highest on practitioner stethoscopes, followed by patient-room stethoscopes, whereas clean stethoscopes were indistinguishable from background controls. Bacterial communities on stethoscopes were complex, and community analysis by weighted UniFrac showed that physician and patient-room stethoscopes were indistinguishable and significantly different from clean stethoscopes and background controls. Genera relevant to healthcare-associated infections (HAIs) were common on practitioner stethoscopes, among which Staphylococcus was ubiquitous and had the highest relative abundance (6.8%–14% of contaminating bacterial sequences). Other HAI-related genera were also widespread although lower in abundance. Cleaning of practitioner stethoscopes resulted in a significant reduction in bacterial contamination levels, but these levels reached those of clean stethoscopes in only a few cases with either standardized or practitioner-preferred methods, and bacterial community composition did not significantly change.

Conclusions

Stethoscopes used in an ICU carry bacterial DNA reflecting complex microbial communities that include nosocomially important taxa. Commonly used cleaning practices reduce contamination but are only partially successful at modifying or eliminating these communities.

FULL TEXT

https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/molecular-analysis-of-bacterial-contamination-on-stethoscopes-in-an-intensive-care-unit/E5080DEC191CA8114D4CD564258CADE3/core-reader

December 31, 2018 at 1:03 pm

The Complex Interpretation and Management of Zika Virus Test Results.

J Am Board Fam Med. Nov-Dec 2018 V.31 N.6 P.924-930.    

Lin KW1, Kraemer JD2, Piltch-Loeb R2, Stoto MA2.

Author information

1 From the Department of Family Medicine, Georgetown University Medical Center, Washington, DC (KWL); Department of Health Systems Administration, Georgetown University, Washington (JDK, MAS); New York University College of Global Public Health, New York, NY (RP-L). Kenneth.Lin@georgetown.edu

2 From the Department of Family Medicine, Georgetown University Medical Center, Washington, DC (KWL); Department of Health Systems Administration, Georgetown University, Washington (JDK, MAS); New York University College of Global Public Health, New York, NY (RP-L).

Zika virus disease provides the latest example of a critical nexus between public health and clinical practice.

Interpreting Zika virus test results is complicated by the absence of a single testing approach with superior validity across contexts and populations.

Molecular tests are highly specific, variably sensitive, and have a short window period. Serologic tests identify antibodies against Zika virus and are more likely than molecular tests to cross-react with other related viruses, reducing specificity.

The type of test performed and timing relative to possible Zika virus exposure depend on public health guidance, testing algorithms, test availability, and capacity.

Guidance from the Centers for Disease Control and Prevention and local health departments have changed throughout the course of the US epidemic based on prevalence, geography, and clinical concerns. Women with a low pretest probability of infection should be counseled against testing.

Women with a high pretest probability of Zika virus infection should still receive enhanced prenatal monitoring and newborn evaluation, regardless of the test result. An appropriate interpretation of results depends on what tests are used, patient characteristics, and reasons for testing.

Clinicians should take these factors into account in shared decision making discussions with pregnant women about Zika virus testing.

FULL TEXT

https://www.jabfm.org/content/31/6/924.long

PDF

https://www.jabfm.org/content/jabfp/31/6/924.full.pdf

December 31, 2018 at 10:11 am


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