Alcohol Wipes Research Articles

Rapid Capture and Extraction of Sweat for Regional Rate and Cytokine Composition Analysis Using a Wearable Soft Microfluidic System

Rapid Capture and Extraction of Sweat for Regional Rate and Cytokine Composition Analysis Using a Wearable Soft Microfluidic System

Corona VIII – strange dreams

Corona VIII – strange dreams

Speech Processor Care in the SARS-CoV-2 Era

Speech Processor Care in the SARS-CoV-2 Era

Pachymeter Use and Disinfection Practice in the United Kingdom: A National Survey.

Pachymetry plays a crucial role in the diagnosis and management of glaucoma and corneal diseases. There have been several outbreaks of epidemic ocular infections in ophthalmology clinics worldwide with reports of viral, parasitic, and prion disease. Contact pachymetry is a possible vehicle of transmission due to its risk of contamination. We aim to identify the types of pachymetry used and methods employed for cleaning and disinfection in eye units throughout the United Kingdom. A telephone survey was carried out, and a senior nurse or sister questioned based on the proforma created. A follow-up email was sent to units that did not respond with the questionnaire attached. Of 109 responses, 10 eye units were unaware of the device name and 4 were unaware of the cleaning method used. Overall, 69/105 (66%) were cleaned with some form of alcohol wipe between patients, 12/105 (11%) used presept solution to soak the pachymetry head mainly 5 to 10 minutes, with 2 units soaking for 20 to 30 minutes. Milton solution was used by 4 units (4%) (10 s to 10 min). Three used a hydrogen peroxide solution for 10 minutes (3%). Three (3%) used an alcohol solution. Fifteen (14%) units used some chlorine-based solution (actichlor/chloraprep) for 5 to 10 minutes. Two (2%) units combined an alcohol-based wipe with solution to soak afterward. There is a large variation in methods and duration of tip disinfection with only a few units following the Royal College of Ophthalmologists (RCOphth) guidelines on pachymeter disinfection. The majority of eye units use alcohol/chlorine-based wipes for cleaning the pachymetry heads which is against the current recommended guidelines. The average immersion time when solutions were used was 5 to 10 minutes.

Methods of Disinfecting Stethoscopes: Systematic Review.

The aim of this systematic review was to investigate the effectiveness of various disinfection methods available for stethoscopes. In March 2019, we performed a search in PubMed and Scopus using the search terms: “reducing stethoscopes contamination” and “disinfection stethoscopes”; the Mesh terms used in PubMed were “Decontamination/methods” or “Disinfection/methods” and “Stethoscopes/microbiology”. Selection criteria were: English language; at least one disinfection method tested. A total of 253 publications were screened. After title, abstract, and full-text analysis, 17 papers were included in the systematic review. Ethanol at 90%, Ethanol-Based Hands Sanitizer (EBHS), triclosan, chlorhexidine, isopropyl alcohol, 66% ethyl alcohol, sodium hypochlorite, and benzalkonium chloride have been proven to lower the presence of bacteria on stethoscopes’ surfaces. In addition, alcohol wipes show effective results. A wearable device emitting ultraviolet C by Light-Emitting Diode (LED) resulted efficacious against common microorganisms involved in Healthcare Associated Infections. The cover impregnated with silver ions seemed to be associated with significantly higher colony counts. Instead, copper stethoscopes surface reduced bacterial load. The disinfection of stethoscopes appears to be essential. There are many valid methods available; the choice depends on various factors, such as the cost, availability, and practicality.

Improving patients’ hand hygiene in the acute care setting: Is staff education enough?

Patients' hand hygiene (PHH) has been associated with reduction of healthcare-associated infections. We compared staff education about the importance of PHH versus providing patients with alcohol wipes for PHH. Our study found that staff education increased the percentage of patients reporting that they had been educated/encouraged to perform PHH but this intervention alone did not resulted in a statistically significant increase of the average frequency of PHH per day.

Commentary: Preferred practice pattern for primary eye care in the context of COVID-19 in L V Prasad Eye Institute network in India.

Commentary: Preferred practice pattern for primary eye care in the context of COVID-19 in L V Prasad Eye Institute network in India.

Therapeutic Hypothermia Improves Hind Limb Motor Outcome and Attenuates Oxidative Stress and Neuronal Damage in the Lumbar Spinal Cord Following Cardiac Arrest.

Hypothermia enhances outcomes of patients after resuscitation after cardiac arrest (CA). However, the underlying mechanism is not fully understood. In this study, we investigated effects of hypothermic therapy on neuronal damage/death, microglial activation, and changes of endogenous antioxidants in the anterior horn in the lumbar spinal cord in a rat model of asphyxial CA (ACA). A total of 77 adult male Sprague–Dawley rats were randomized into five groups: normal, sham ACA plus (+) normothermia, ACA + normothermia, sham ACA + hypothermia, and ACA + hypothermia. ACA was induced for 5 min by injecting vecuronium bromide. Therapeutic hypothermia was applied after return of spontaneous circulation (ROSC) via rapid cooling with isopropyl alcohol wipes, which was maintained at 33 ± 0.5 °C for 4 h. Normothermia groups were maintained at 37 ± 0.2 °C for 4 h. Neuronal protection, microgliosis, oxidative stress, and changes of endogenous antioxidants were evaluated at 12 h, 1 day, and 2 days after ROSC following ACA. ACA resulted in neuronal damage from 12 h after ROSC and evoked obvious degeneration/loss of spinal neurons in the ventral horn at 1 day after ACA, showing motor deficit of the hind limb. In addition, ACA resulted in a gradual increase in microgliosis with time after ACA. Therapeutic hypothermia significantly reduced neuronal loss and attenuated hind limb dysfunction, showing that hypothermia significantly attenuated microgliosis. Furthermore, hypothermia significantly suppressed ACA-induced increases of superoxide anion production and 8-hydroxyguanine expression, and significantly increased superoxide dismutase 1 (SOD1), SOD2, catalase, and glutathione peroxidase. Taken together, hypothermic therapy was found to have a substantial impact on changes in ACA-induced microglia activation, oxidative stress factors, and antioxidant enzymes in the ventral horn of the lumbar spinal cord, which closely correlate with neuronal protection and neurological performance after ACA.

2427. A Laboratory Simulation and Field Study of Simplified Qualitative and Quantitative Environmental Cultures for Clostridioides difficile

BackgroundReliable, simple methods to assess environmental contamination with Clostridioides difficile are needed for studies of terminal disinfection effectiveness and transmission of C. difficile from fomites. We compared two novel sampling methods for assessment of C. difficile contamination: (1) isopropanol wipe sampling with broth enrichment (IW), where alcohol wipes are used to sample surfaces followed by immersion in CDBB-TC broth and (2) ethanol-shock hand imprint sampling (HI), where surfaces are sampled by gloved hands moistened with ethanol hand sanitizer followed by imprinting hands on selective agar (CDBA-TC). Both methods allow for sampling of complex surfaces common in hospital environments.MethodsWe performed a laboratory simulation study using six 10-fold dilutions (101–106) of C. difficile spores from two strains sampled from fiberglass surfaces by IW and HI. We then performed a field study of 10 sites in 11 hospital rooms of patients with C. difficile infection (CDI) diagnosed < 48 hours prior to sampling. Results for the HI and IW method were quantitative and qualitative, respectively. We compared room contamination prevalence (total CFU per room by HI and sites positive/total sites per room) to the cycle crossing threshold (CT) from the diagnostic C. difficile PCR test (Cepheid) from the room occupant.ResultsThe IW laboratory limit of detection was 101 spores compared with 104 spores for HI. In the field study, IW and HI detected C. difficile contamination in 9/11 (82%) rooms at 22/110 (20%) sites and 5/11 (45%) rooms at 22/110 (20%) sites, respectively (Table 1). Six rooms with no detection by the HI method had a lower median number of sites positive per room compared with the 5 rooms with ≥1 cfu (1 vs 6, P < 0.05) (Table 1). The most commonly contaminated sites were linens (53%), call bells (43%), toilets (40%), blood pressure cuffs (40%), over-bed tables (38%), and bedrails (30%) (Table 2). Higher tcdB CT was associated with a lower total room contamination prevalence (Figures 1 and 2).ConclusionOur data suggest that the IW method is more sensitive for detection of C. difficile in the hospital environment, but the HI method offers quantitation. The prevalence of hospital room contamination for CDI patients appears to correspond with their toxin burden as estimated by PCR. Disclosures All authors: No reported disclosures.

566. Reduction of Hospital-Onset Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia in an Acute Care Hospital: Impact of Bundles and Universal Decolonization

BackgroundMRSA is a major concern for hospitalized patients in the United States. Hospital-Onset (HO) MRSA bacteremia is used as a proxy measurement of MRSA healthcare acquisition, exposure, and infection burden. HO MRSA bacteremia standardized infection ratio (SIR) is used by several national agencies as a quality report metric. Our institution had more than expected HO MRSA bacteremia cases despite several interventions. We describe the impact of a bundle of interventions aimed to decrease HO MRSA bacteremia in an acute care facility.MethodsThis quality improvement project was implemented in a 380-bed community hospital in Miami, FL from January 2015 to March 2019. HO MRSA bacteremia was defined as non-duplicate MRSA isolated from a blood culture collected >3 days after admission. SIR was calculated dividing the number of observed events by the number of predicted events; predicted events were obtained from the NHSN report. During baseline period (Figure1 Phase 1 January 2015–August 2016) all adult patients in the intensive care unit (ICU) were screened for MRSA nasal colonization on admission and weekly thereafter, ICU patients received daily Chlorhexidine (CHG) bathing, and colonized/infected patients with MRSA were placed in contact precautions. In Phase 2 (September 2016–June 2017)daily CHG bathing was switched from 2% wipes to 4% soap foam and expanded to all adult patients; ICU patients also received nasal decolonization with mupirocin. Nasal mupirocin in ICU was replaced with alcohol-based nasal sanitizer for all adult units in July 2017 (Phase 3). In April 2017 we discontinued using contact precautions for MRSA patients; nasal surveillance cultures were discontinued in October 2017. In May 2018 (Phase 4) we introduced alcohol-based wipes for patient hand hygiene at the bedside. SIR were compared by exact binomial test.ResultsWe observed 48 HO MRSA bacteremia cases during the study period. The SIR decreased from 3.66 to 0.97 from baseline to postintervention periods (P = 0.003). The largest decrease in cases and SIR was attained using combined hospital-wide daily CHG bathing, alcohol-based nasal sanitizer, and alcohol wipes for patient hand hygiene during Phase 4 (Table 1).ConclusionOur bundle of interventions for universal decolonization was successful in decreasing HO MRSA bacteremia. Disclosures All authors: No reported disclosures.

Erratum to: Surgical Loupes Worn by Orthopaedic Surgeons Are a Reservoir for Microorganisms

We would like to correct errors found in our published study, “Surgical Loupes Worn by Orthopaedic Surgeons Are a Reservoir for Microorganisms”. In the Statistical Analysis section, we wrote: “Additionally, we used the Student’s t-test and the Wilcoxon signed-rank test to detect differences in categorical bacterial growth between paired samples.” Using a Student’s t-test or Wilcoxon tests is not adequate for the analysis given that these were not continuous but rather categorical variables. After a statistical consultation, we determined that the better statistical test in this setting is the Mann-Whitney U test. Given that the data does not change, the medians and 95% confidence intervals for the comparisons (before and after surgical day, before and after alcohol wipe) do not change. The statistical results of the Mann-Whitney U test are as follows: For the before and after surgical day comparison, analysis of the data sets with the Mann-Whitney U test yields a U-value of 20 and given that the critical value of U at p < 0.05 is 20, the result remains significant at p < 0.05. The z-score is - 1.77604, yielding a p = 0.038. For the before and after alcohol wipe comparison, analysis of the data sets with the Mann-Whitney U test yields a U-value of 2.5 and given that the critical value of U at p < 0.05 is 5, the result remains significant at p < 0.05. The z-score is 2.40192, yielding a p = 0.02. As a result, our differences between these groups for both comparisons remain statistically different, although the p values change. Additionally, in the Discussion section, we wrote: “Lastly, we did not conduct clinical followup on the patients included in this study, and we describe a potential association of pathogen colonization with SSIs without demonstrating causation.” We intended to remove this sentence in the course of editing the paper but did not do so. The correct sentence should be: “Lastly, although particulate shedding from the loupes into the surgical field containing microorganisms could increase the risk of SSI, we did not assess SSI in the current study. Future studies should seek to evaluate the degree to which shedding of this sort might be clinically important, and if it is, to identify the best ways to mitigate it.” Finally, there was a typographical error in Table 1. Loupes of 2.5 magnification were used by 15 surgeons and those of 3.5 magnification were used by six surgeons, for a total of 21 surgeons. The authors apologize for the errors.

Safer Crack Kits and Smoking Practices: Effectiveness of a Harm Reduction Intervention among Active Crack Users in Mexico City

Background: Crack cocaine use has increased rapidly throughout Mexico, coinciding with rising HIV and HCV infections among vulnerable groups. Due to the increased risk of infection among crack users, harm reduction approaches have been identified to reduce the spread of disease. However, Mexico has yet to adopt these techniques for crack users. Objectives: To evaluate the impact of a pilot crack kit distribution program on risky smoking behaviors of active crack users in an impoverished colonia of Mexico City, Mexico. Methods: Fifty crack kits, containing safer smoking paraphernalia and related health items (i.e., condoms, alcohol wipes, etc.), were distributed to active crack users. A sample of 58 crack users were surveyed prior to the intervention and 35 were successfully relocated and surveyed three months after the intervention. Surveys assessed drug use, crack kit utilization, and smoking practices. Results: Findings indicate that crack kit utilization was high throughout the sample. Use of risky or unsafe paraphernalia decreased, specifically the use of cans as pipes (Z = −2.653, p = .008). Similarly, Pyrex pipe use increased significantly (Z = −3.132, p = .002). Sharing of paraphernalia also decreased throughout the sample. Conclusion: These findings identify the potential benefits in reducing risky smoking behaviors of crack kit distribution programs in Mexico City. This evidence supports expansion of crack kit programs in Mexico and similar impoverished regions.

Dark Smoke Rose

Dark Smoke Rose Zachary Frank (bio) I came back warm from a long winter run to find my daughter on the couch, feet raised, arm wrapped in a wet towel, a glass of chocolate milk on the end table where her father's ashes used to be. Part of our arrangement for her return, the mason jar of Frick's remains had been moved to my nightstand. Norah had turned off the TV when I entered and now tossed the remote onto the couch. She was wearing the pink sleepshirt and white linen shorts I'd handed down to her years before. "You can watch what you want," she said, then stood, holding the towel in place, and slid into her sandals. "Can you set me up?" she asked. "Can't you wait till after we eat?" "Set me up now and I'll be good when dinner's done." "It just needs reheating." She sighed at me. "Do you want me to withdraw? 'Cause that would not be good for you." Everything I wanted to say dissolved into dumb silence. My mind would fog back then at any hint of an argument, which made it impossible to form a clear thought. I didn't reply, just tried to look upset. It always bothered me not to eat the second dinner was ready. Knowing she'd won, that it had never been a contest, Norah finished her chocolate milk in one long sip then brought the empty cup to the kitchen, squeaking the soles of her sandals against the tile floor as I headed upstairs. I passed her room, which no longer had a lock, and pushed open the door. It almost upset me more, how clean it was, though there wasn't much to make a mess of. A year earlier, Norah had spent hours helping me search for the camera she'd pawned. On her return, I'd boxed away most of the things she could sell and drove them to self-storage. With such obvious, unfilled space, our house had the look of a family moving in or out. My bedroom had a reinforced lock on the door and a safe on my dresser where I kept Norah's dope kit, a black leather toiletry bag [End Page 525] with a gold zipper. I input the code and removed it, along with a fresh needle and a red balloon of white powder, all but weightless in my hand. I pinched it delicately at the stem, letting it dangle, and thought of Frick walking a used condom to the wicker wastebasket in our bathroom. From the nightstand, his ashes stared a jar-shaped hole into the small of my back. ________ Downstairs, I opened a bag of lettuce and fixed myself a bowl of leftover ziti. It was early for dinner but already dark. The glass of the sliding back door shone black, reflecting me in the kitchen as I waited at the microwave and recalculated my night. I'd take my food to the couch instead of the kitchen table and play games on my phone, with the TV for background noise and my daughter set up beside me. I wasn't sweating on my run, the temperature below freezing, but could feel the sweat running down my face now that I'd stopped and stepped inside. I removed my outer layer, would wait to shower till her high wore off. With two seconds remaining, I stopped the microwave so I wouldn't have to hear it beep. As I entered the living room, a bowl in each hand, Norah was preparing herself on the couch. She'd taken the towel off her arm and was tying the green tube of her tourniquet around her bicep. She used her mouth to pull it tight. I took the recliner. She'd placed her Narcan on the coffee table, another part of our agreement, and I slid it closer to me. "Fucking calm down," she said through her teeth. "The fuck's with those noodles?" "They're whole wheat," I said. She swabbed her arm with an alcohol wipe then unwrapped the needle. She mixed her heroin in...

Wiping out MRSA: effect of introducing a universal disinfection wipe in a large UK teaching hospital

BackgroundContamination of the inanimate environment around patients constitutes an important reservoir of MRSA. Here we describe the effect of introducing a universal disinfection wipe in all wards on the rates of MRSA acquisitions and bacteraemias across a large UK teaching hospital.MethodsA segmented Poisson regression model was used to detect any significant changes in the monthly numbers per 100,000 bed days of MRSA acquisitions and bacteraemias from April 2013 - December 2017 across QEHB.ResultsFrom April 2013 to April 2016, cleaning of ward areas and multi-use patient equipment by nursing staff consisted of a two-wipe system. Firstly, a detergent wipe was used, which was followed by a disinfection step using an alcohol wipe. In May 2016, QEHB discontinued the use of a two-wipe system for cleaning and changed to a one wipe system utilising a combined cleaning and disinfection wipe containing a quaternary ammonium compound. The segmented Poisson regression model demonstrated that the rate of MRSA acquisition/100,000 patient bed days was affected by the introduction of the new wiping regime (20.7 to 9.4 per 100,000 patient bed days; p <0.005).DiscussionUsing a Poisson model we demonstrated that the average hospital acquisition rate of MRSA/100,000 patient bed days reduced by 6.3% per month after the introduction of the new universal wipe.ConclusionWe suggest that using a simple one wipe system for nurse cleaning is an effective strategy to reduce the spread and incidence of healthcare associated MRSA.

Are the Hands of Veterinary Staff a Reservoir for Antimicrobial-Resistant Bacteria? A Randomized Study to Evaluate Two Hand Hygiene Rubs in a Veterinary Hospital.

Hand hygiene (HH) is the most successful intervention for hospital infection control. HH rubs with residual action are desired. This study aimed to compare the efficacy of alcohol (A-HH) and lactic acid (LA-HH) rubs, with the latter being marketed as having residual activity. We investigated reductions in bacterial colony-forming units (CFUs), prevalence of antimicrobial-resistant (AMR) organisms, and risk factors for increased counts on the hands of veterinary staff. A randomized, crossover study (53 individuals) was performed in a referral veterinary teaching hospital. Hand plates were taken before, immediately after, and 6 hours after HH. A blinded investigator counted CFUs per plate. Methicillin-resistant Staphylococcus aureus/pseudintermedius (MRSA/MRSP), Enterobacteriaceae, and Pseudomonas species (spp.) were characterized. Gender, profession, time point, and HH product were included as variables within multivariable analyses. A significant reduction in bacterial CFU was seen immediately after A-HH rub application (p < 0.001); however, neither product showed any significant residual action. Veterinarians had higher bacterial CFUs than nurses (p = 0.005); contact with patients, rather than the environment, was also associated with higher counts (p < 0.001). MRSA, MRSP, Enterobacteriaceae spp., and Pseudomonas spp. were detected on 7%, 2%, 14%, and 2% of study participant's hands (n = 208 samples), respectively. Frequent HH administration using an A-HH rub was effective at reducing bacterial CFU on hands in vivo in this veterinary hospital setting, but its use needs further encouragement in veterinary staff. The high prevalence of antimicrobial bacteria on hands is of concern; they might act as reservoirs for patients, the environment, and in-contact people.

Metabolism and Biodegradation of Spacecraft Cleaning Reagents by Strains of Spacecraft-Associated Acinetobacter.

Spacecraft assembly facilities are oligotrophic and low-humidity environments, which are routinely cleaned using alcohol wipes for benchtops and spacecraft materials, and alkaline detergents for floors. Despite these cleaning protocols, spacecraft assembly facilities possess a persistent, diverse, dynamic, and low abundant core microbiome, where the Acinetobacter are among the dominant members of the community. In this report, we show that several spacecraft-associated Acinetobacter metabolize or biodegrade the spacecraft cleaning reagents of ethanol (ethyl alcohol), 2-propanol (isopropyl alcohol), and Kleenol 30 (floor detergent) under ultraminimal conditions. Using cultivation and stable isotope labeling studies, we show that ethanol is a sole carbon source when cultivating in 0.2 × M9 minimal medium containing 26 μM Fe(NH4)2(SO4)2. Although cultures expectedly did not grow solely on 2-propanol, cultivations on mixtures of ethanol and 2-propanol exhibited enhanced plate counts at mole ratios of ≤0.50. In support, enzymology experiments on cellular extracts were consistent with oxidation of ethanol and 2-propanol by a membrane-bound alcohol dehydrogenase. In the presence of Kleenol 30, untargeted metabolite profiling on ultraminimal cultures of Acinetobacter radioresistens 50v1 indicated (1) biodegradation of Kleenol 30 into products including ethylene glycols, (2) the potential metabolism of decanoate (formed during incubation of Kleenol 30 in 0.2 × M9), and (3) decreases in the abundances of several hydroxy- and ketoacids in the extracellular metabolome. In ultraminimal medium (when using ethanol as a sole carbon source), A. radioresistens 50v1 also exhibits a remarkable survival against hydrogen peroxide (∼1.5-log loss, ∼108 colony forming units (cfu)/mL, 10 mM H2O2), indicating a considerable tolerance toward oxidative stress under nutrient-restricted conditions. Together, these results suggest that the spacecraft cleaning reagents may (1) serve as nutrient sources under oligotrophic conditions and (2) sustain extremotolerances against the oxidative stresses associated with low-humidity environments. In perspective, this study provides a plausible biochemical rationale to the observed microbial ecology dynamics of spacecraft-associated environments.

680. “There’s More to This Than Meets the Eye”: Opportunities for Infection Prevention in Optometry Clinics

BackgroundLos Angeles County Department of Public Health (LAC-DPH) investigated an outbreak of epidemic keratoconjunctivitis secondary to adenovirus between June and July 2017, and all cases were linked to a single optometry clinic. The LAC-DPH aimed to determine whether sub-optimal infection prevention practices used in the implicated clinic were commonplace within other local optometry clinics. The objective of this study was to understand infection prevention practices in optometry clinics within Los Angeles County.MethodsLAC-DPH conducted a survey consisting of 17 questions related to infection prevention practices among a sample of optometry providers in the county. The survey was administered online (SurveyMonkey) via emails sent to a local optometric society’s listserv and in-person at a local continuing education event for optometrists. The results were analyzed and are represented as percentages.ResultsThere were 42 responses, 20 via the online survey (response rate 15%) and 22 via the in-person survey (response rate 22%). The majority worked in an optometry clinic: 77.5% (n = 31). More than half had no written hand-hygiene policy (58.5%, n = 24), 46.2% (n = 18) did not wear gloves while examining patients with eye drainage and about half (48.7%, n = 18) did not use droplet precautions for patients with respiratory symptoms. The vast majority used multi-dose eye-drop vials (92.5%, n = 37) but more than 40% (n = 21) did not discard the vial if the tip came into contact with conjunctiva. The majority (68.4%, n = 26) used alcohol wipes with 70% isopropyl alcohol to disinfect tonometers, while 47.4% (n = 18) used noncontact tonometers and 23.6% (n = 9) used disposable tips (options for this question were not mutually exclusive).ConclusionInfection prevention practices in optometry clinics are sub-optimal and must be improved. All optometry clinics must have a hand-hygiene policy and discard multi-dose vials which come into contact with conjunctivae. While the evidence on the best disinfectant for tonometers is limited, commonly used disinfectants like 70% alcohol wipes or 3% hydrogen peroxide have been associated with adenovirus outbreaks. Current evidence suggests that infectious spread via tonometers can be prevented by using disposable covers or by disinfection with 1:10 diluted bleach.Disclosures All authors: No reported disclosures.

How do basic hand hygiene and aqueous scrub solutions compare with alcohol rubs, for the prevention of surgical site infections?

How do basic hand hygiene and aqueous scrub solutions compare with alcohol rubs, for the prevention of surgical site infections?

The risk of microbial contamination associated with six different needle-free connectors.

needle-free connectors are widely used in clinical practice. The aim of this study was to identify any differences between microbial ingress into six different connectors (three neutral-displacement, one negative-displacement and two anti-reflux connectors). each connector underwent a 7-day clinical simulation involving repeated microbial contamination of the connector's injection ports with Staphylococcus aureus followed by decontamination and then saline flushes through each connector. The simulation was designed to be a surrogate marker for the potential risk of contamination in clinical practice. increasing numbers of S. aureus were detected in the flushes over the 7 days of sampling despite adherence to a rigorous decontamination programme. Significant differences in the number of S. aureus recovered from the saline flush of some types of connectors were also detected. Two different durations (5- and 15-second) of decontamination of the injection ports with 70% isopropyl alcohol (IPA) wipes were also investigated. There was no significant difference between the median number of S. aureus recovered in the saline flushes following a 5-second (165.5, 95% CI=93-260) or a 15-second decontamination regimen (75, 10-190). The findings suggest that there may be differences in the risk of internal microbial contamination with different types of connectors and that even 15 seconds of decontamination may not fully eradicate microorganisms from the injection ports of some devices.

Persistence of Healthcare-Associated (Nosocomial) Infections Due to Inadequate Hand Hygiene: Part 2—Human Factors

A healthcare-associated infection (defined as an infection acquired within a healthcare facility), such as due to transmission via medical equipment or by healthcare providers is the most frequent adverse event in the healthcare delivery system. But why does the problem persist, when infection control measures are known, simple, and low-cost? We reviewed some biological- and treatment-factors in Part 1, and we now review some human-factors. Healthcare-associated infections are a major public health problem even in advanced healthcare systems. They affect hundreds of millions of patients each year, and are responsible for increased morbidity, mortality, and financial burden. This is perplexing, since good-hygiene practices are known and promoted. Disinfection, sterilization, handwashing, and alcohol rubs should be more effective, but human-factors interfere. The persistent high prevalence of nosocomial infections, despite known hygienic practices, is attributable to two categories of factors: biological and inherent shortcomings of some practices (considered in Part 1), and human factors (considered here). A new approach is considered in Part 3.