Hands Of Healthcare Professionals Research Articles

Virulence factors, antifungal susceptibility and molecular profile in Candida species isolated from the hands of health professionals before and after cleaning with 70% ethyl alcohol-based gel

Fungal infections in neonatal intensive care units (NICU) are mainly related to Candida species, with high mortality rates. They are predominantly of endogenous origin, however, cross-infection transmitted by healthcare professionals' hands has occurred. The aim of this study was to identify Candida species isolated from the hands of healthcare professionals in a NICU before and after hygiene with 70% ethanol-based gel and evaluate virulence factors DNase, phospholipase, proteinase, hemolysin, biofilm biomass production, and metabolic activity. In vitro antifungal susceptibility testing and similarity by random amplified polymorphic DNA (RAPD) were also performed. C. parapsilosis complex was the most frequent species (57.1%); all isolates presented at least one virulence factor; three isolates (Candida parapsilosis complex) were resistant to amphotericin B, two (Candida famata [currently Debaryomyces hansenii] and Candida guilliermondii [currently Meyerozyma guilliermondii]) was resistant to micafungin, and six (Candida parapsilosis complex, Candida guilliermondii [=Meyerozyma guilliermondii], Candida viswanathi, Candida catenulata [currently Diutina catenulata] and Candida lusitaniae [currently Clavispora lusitaniae]) were resistant to fluconazole. Molecular analysis by RAPD revealed two clusters of identical strains that were in the hands of distinct professionals. Candida spp. were isolated even after hygiene with 70% ethanol-based gel, highlighting the importance of stricter basic measures for hospital infection control to prevent nosocomial transmission.

A COMPREHENSIVE ANALYSIS OF MICROBIAL CONTAMINATION ON MEDICAL PROFESSIONALS ATTIRE AND DEVICES

This research aimed to evaluate the level of microbiological contamination on the hands, white coats, and cell phones of healthcare workers. The study was conducted as a cross-sectional study at the Pathology Department of Civil Hospital LUMHS Hyderabad between January 2021 and June 2021. A total of 130 participants were selected using convenience sampling and provided samples. Before sample collection, informed consent was obtained from all participants. Samples were randomly collected from the hands of healthcare professionals, white coats, and various cell phones. Data analysis was performed using SPSS 23.0. In our study, 86 (66.2%) were females and 44 (33.8%) were males. There were 46 (35.4%) cases age 20-30 years, 34 (26.2%) cases aged 31-40 years, 28 (21.5%) cases had age 41-50 years, and 22 (16.9%) cases had age >50 years. 62 (47.7%) samples were taken from lab coats, 43 (33.1%) from the hand of healthcare workers, and 25 (19.2%) from cell phones. The results of the lab coat contamination analysis revealed the following: Methicillin-Resistant Staphylococcus aureus MRSA (6%), Escherichia coli (8%), Pseudomonas (2%), Klebsiella (3%), and Staphylococcus aureus (65%). Healthcare workers who were observed had a majority of MRSA (35.4%), Staphylococcus aureus (33.1%), Staphylococcus epidermidis (26.2%), and Pseudomonas (5%) on their hands. The most common bacteria found on mobile phones were MRSA (40%), followed by Staphylococcus aureus (18%), Staphylococcus epidermidis (34%), and pseudomonas (8%). This study demonstrates that a significant portion of the clothing and personal items used by healthcare professionals were tainted with different microorganisms that can cause nosocomial infections.

The Association between Hand Disinfection Techniques and Their Barriers, as Well as the "Bare below the Elbows" Concept, among Healthcare Professionals-A Study Based on a Polish Population.

Hand hygiene is the most effective way to prevent nosocomial infections. Nevertheless, the hands of healthcare professionals are still the primary route of transmission of pathogens responsible for such infections. The aim of this study was to evaluate hand disinfection techniques and investigate the risk factors that may explain the improper hand disinfection techniques among healthcare workers. We selected 7544 hospital workers directly involved in patient care. We recorded data based on the questionnaires, demographic data, and the preparation of hands for disinfection, including risk factors. Correct hand disinfection was verified by COUCOU BOX, with a UV camera. Proper hand disinfection was demonstrated among 4879 (64.7%) subjects, while 2665 (35.3%) subjects disinfected their hands incorrectly. In most places of work, nurses properly disinfected their hands more often than the physicians, particularly in general departments (62.1% vs. 69.2%; p = 0.0019). We observed that long nails and artificial/polished nails were more often observed in the group of nurses than in the group of physicians (7.3% vs. 4.7%, respectively; p = 0.0006 and 19.3% vs. 10.1%; p = 0.0000), while an inverse relationship was found in relation to watches (24.0% vs. 12.0%; p = 0.0000) and long sleeves (24.4% vs. 8.1%; p = 0.0000). Incorrect and less effective hand hygiene among some groups of hospital workers is still present. Therefore, the continuation of education actions concerned with hand hygiene among healthcare workers is needed.

A review on health-care acquired infections of the hospital staff during routine patient’s delivery service

The health-care acquired infections (HCAIs) occur world-wide among persons undergoing medical attention in health institutions and result in unexpected long-term stay, disability and financial loses. The most predominant infections are catheter associated urinary tract, central line associated, surgical site and ventilator associated pneumonia infections. The patients are prone to infections during hospitalization from varied environmental sources, hands of health-care professionals, medical equipment and other infected patients. The frequent factors affecting patients on admission are improper hand hygiene, contact with infected patients, adverse drug events and surgical complications. Patients under health-care delivery can acquire infection disseminated from food, water, aerosols and hospital wastes. The application of personal protective equipment, routine educational interventions are common approaches that can help stop HCAIs and save lives, decrease death rate and health delivery expenses. In buttressing this, the World Health Organization (WHO) enunciated guidelines to enhance hand washing practices, infection prevention and control programme, monitored use of antibiotics and its resistance. The other measures included global adoption of efficient surveillance system and the impact of relevant stakeholders in health sectors needed to prevent and control hospital acquired infections.

Hand hygiene among nurses in pediatric blood and marrow transplantation setting: a best practice implementation project.

The aim of this project was to promote evidence-based best practice regarding hand hygiene among nurses in a pediatric blood and marrow transplantation (BMT) setting. Healthcare-associated infections (HAI) represent important complications of healthcare with potentially major impact on patient outcomes. Most HAI are transmitted through the hands of healthcare professionals (HCP) and therefore hand hygiene is the simplest, most effective and proven method for preventing HAI. However, the overall compliance rate of HCP with hand hygiene remains at a very low level. In this case, it is necessary to implement strategies to improve the compliance with hand hygiene of the HCP with the purpose of reducing HAI rates, mortality and costs, all the more so as it is known that patients with BMT have an increased risk of HAI. This best practice implementation project was based on the JBI methodological approach and included three phases of activity: a baseline audit, implementation of strategies and a follow-up audit. The project was conducted in the pediatric BMT setting of a large university hospital located in Bucharest, Romania, and the sample included 10 nurses and five relatives of pediatric patients from this ward. As a result of the implementation of strategies, improvements were observed across seven audit criteria, given that for two audit criteria out of a total of nine audit criteria compliance was maximum (100%) since the baseline phase. Moreover, the post implementation audit showed a complete compliance (100%) for six audit criteria. However, for the other three audit criteria the compliance in follow-up audit was high: 92, 85 and 80%, respectively. The strategies applied within this evidence implementation project were appropriate, so the project was a success. However, permanent actions are required to sustain changes in practice and improvements made.

Infection Prevention in the ICU

Hospital-acquired infections are among the most significant issues within the healthcare system, both in Greece and abroad. This is because they are associated with severe morbidity and mortality. As a rule, in Intensive Care Units (ICU), hospital-acquired infections are caused by multidrug-resistant bacteria. The spread of infections by multidrug-resistant bacteria occurs in steps. Step one is usually considered to be colonisation of the ICU host-patient via indirect contact. A transmission vehicle in these cases are the hands of healthcare professionals. The main infections in this category are the ones that affect the respiratory system, followed by bloodstream infections, mainly through endovascular catheters, and urinary tract infections. Therefore, some simple measures can limit the spread of infections, improving the clinical outcomes for hospitalised patients. These include following hand hygiene, ensuring that the medical and nursing staff change disposable gloves, keeping the ICU areas extremely clean and keeping together hospitalised patients who are colonised by the same multidrug-resistant bacteria. However, many healthcare professionals fail to consistently comply with these guidelines, which leads to the spread of multidrug-resistant bacteria, and increased morbidity and mortality.

Informisanost i stavovi medicinskih sestara - tehničara o intrahospitalnim infekcijama

Introduction: Intrahospital infections have a great impact on the mortality rate and morbidity of hospitalized patients. The importance of nosocomial infections makes it important for nurses to know and implement preventive measures during provision of nursing care. Objective: To analyze knowledge and attitudes of nurses about nosocomial infections. Material and methods: The research was conducted on a population of nurses and technicians employed at the General Hospital in Subotica. The sample included 44 participants. The research instrument was a questionnaire designed for the purposes of the research. Data were analyzed using descriptive statistics and hi-square test. Results: The definition of nosocomial infections was known to 68% of respondents, but only 50% of respondents knew that the hands of healthcare professionals were the most common way of spreading nosocomial infections. Basic preventive measures against nosocomial infections were familiar to 82% of respondents, and 95% of the respondents thought that nurses have important role in the control and prevention of nosocomial infections. Significantly more respondents who have more than 20 years of work experience thought that nurses do not have contribution in prevention and control of nosocomial infections (p=0.011). Conclusion: Most participants were familiar with the definition of nosocomial infections and basic preventive measures. It is necessary to improve the knowledge about the ways of spreading and the risks for the occurrence of nosocomial infections.

Bacterial invasive infections in a neonatal intensive care unit: a 13 years microbiological report from an Italian tertiary care centre.

SummaryIntroductionTo evaluate the aetiology of neonatal invasive diseases (positive cultures from blood or cerebrospinal fluid, CSF) due to bacteria other than coagulase-negative staphylococci in a large tertiary care centre and compare with results of surveillance cultures.MethodsRetrospective analysis of microbiological data of children admitted in neonatal intensive care unit (NICU) of a large tertiary care centre from 2005 to 2018.Results230 bacterial strains, 223 from blood and 7 from CSF, respectively, were detected as cause of invasive infections, while 152 were detected in surveillance cultures. Methicillin-susceptible Staphylococcus aureus (MSSA) was the most frequently isolated pathogen both in invasive infections (18%) and colonizations (23%) followed by Escherichia coli (16% on invasive disease and 20% of colonizations). Other common bacteria include Enterococcus faecalis and Streptococcus agalactiae for invasive disease and methicillin-resistant Staphylococcus aureus in colonizations. Invasive infection was due to a pathogen detected in surveillance cultures in 33% of cases. In more than 50% of invasive diseases the identified pathogen was not present in surveillance cultures.ConclusionsThe high percentage of invasive infections due to bacteria not previously identified in surveillance cultures raises doubts about the efficiency of this procedure and highlights the need to search for alternative infection sources. This finding and the high prevalence of invasive infections due to nosocomial pathogens such as Staphylococcus aureus could be the result of horizontal transmission between patients through the hands of health care professionals, emphasizing once again the importance of applying stringent hand hygiene procedures and isolation standards.

The Microbiological Analysis of a Rhizobium radiobacter Outbreak After Intravitreal Injection

Rhizobium radiobacter, which is found in nature and causes tumorigenic plant diseases can lead to opportunistic infections, especially in people with underlying diseases. In our study, endophthalmitis that observed in ten patients caused by R.radiobacter bacteria after intravitreal ranibizumab injection in Ophthalmology Clinic were examined microbiologically. Vitreous fluid samples of 13 patients who received intravitreal ranibizumab injection were sent to the Microbiology Laboratory from Van Yuzuncu Yil University Faculty of Medicine's Ophthalmology Clinic for microbiological examination in December 21, 2016. Samples were examined under microscope after staining with Gram and cultured with 5% sheep blood agar and Eosin Methylene Blue (EMB) agar. The culture plates were incubated for 18-24 hours at 37°C in 5% CO2. At the end of this period, catalase, oxidase, and urease tests were performed on the colonies. The identification and antibiotic susceptibility tests of microorganisms growing in vitreous fluid samples were performed using BD Phoenix (Becton Dickinson, USA), Vitek 2 Compact (BioMerieux, France), and Vitek MS (BioMerieux, France) systems. In addition, 16S rDNA sequence analysis was performed and the pulsed field gel electrophoresis (PFGE) method was used to determine the clonal relationship between the isolates. After growing in cultures (one day after the procedure), culture samples were collected from the objects, medical tools and equipment, hands of healthcare staff and a new injection solution in the area where the procedure was performed. R.radiobacter was isolated in 10 of the vitreous fluid samples of 13 patients, and no bacterial growth was detected in 3. The microorganisms were found to be gram-negative bacilli, non-fermenter, motile, catalase/oxidase/urease positive, in compliance with R.radiobacter. All isolates were identified as R.radiobacter by BD Phoenix (Becton Dickinson, USA), Vitek 2 Compact (BioMerieux, France), and Vitek MS (BioMerieux, France) (database v2.0) systems. R.radiobacter isolates were found to be resistant to ampicillin, amoxicillin/clavulanate, trimethoprim/ sulfamethoxazole, cefotaxime and ceftazidime; susceptible to cefuroxime, cefepime, amikacin, gentamicin, imipenem, meropenem, ciprofloxacin, levofloxacin and piperacillin/tazobactam. The isolates were identified as R.radiobacter by 16S rDNA sequence analysis. PFGE showed that all isolates had the same band profile. R.radiobacter isolates with the same band profile likely revealed that the contamination was from the same source. However, the growth of R.radiobacter was not detected in the cultures made from the objects, medical instruments and supplies, the hands of healthcare professionals and the new injection solution in the area where the procedure was performed, and the source of the agent could not be determined. The results have shown that intravitreal injection procedure carries a risk for R.radiobacter infection. Disinfection and antisepsis conditions, before and during the procedure, is important for the prevention of such infections. This study is the first epidemic outbreak report of endophthalmitis caused by the same strain of R.radiobacter and the second article in which R.radiobacter was reported as the cause of endophthalmitis after intravitreal injection.

Bacterial Invasive infections in a neonatal intensive care unit: a 13 years microbiological report from a tertiary referral centre

Introduction: To evaluate the aetiology of neonatal invasive diseases (positive cultures from blood or cerebrospinal fluid) due to bacteria other than coagulase-negative staphylococci in a large third-level centre and compare with results of surveillance cultures. Methods: Retrospective analysis of microbiological data of children admitted in neonatal intensive care unit (NICU) of a large third-level centre from 2005 to 2018. Results: 230 bacterial strains, 223 from blood and 7 from CSF, were detected as cause of invasive infections, while 152 were detected in surveillance cultures. Methicillin-susceptible Staphylococcus aureus (MSSA) was the most frequently isolated pathogen both in invasive infections (18%) and colonizations (23%) followed by Escherichia coli (16% on invasive disease and 20% of colonizations). Other common bacteria include Enterococcus faecalis and Streptococcus agalactiae for invasive disease and Meticillin-resistant Stapylococcus aureus (MRSA) with regard to colonization. Disease was due to a pathogen detected in surveillance cultures flora in 33%. In more than 50% of invasive diseases the identified pathogen was not present in surveillance cultures. Conclusion: The high percentage of invasive infections due to bacteria not previously identified in surveillance cultures raises doubts about the efficiency of this procedure and highlights the need to search for alternative infection sources. This finding and the high prevalence of invasive infections due to nosocomial pathogens such as Staphylococcus aureus could be the result of horizontal transmission between patients through the hands of health care professionals, emphasizing once again the importance of applying stringent hand hygiene procedures and isolation standards.

Assessment of nurses’ knowledge of nosocomial infections transmitted through contact

Abstract Introduction. Due to frequent contact with sick people, the hands of healthcare professionals are the most popular way of transmitting pathogens from patient to patient and from hospital to patient. Hand hygiene is crucial when it comes to reducing HCAI (healthcare-associated infections). Aim. The aim is to analyze the professional knowledge of nurses about nosocomial infections transmitted through contact. Its main assumption is the evaluation of this knowledge in the context of preventing the spread of nosocomial infections. Material and method. A proprietary questionnaire consisting of questions was used to assess the knowledge of medical personnel. The survey contains 25 questions based on the principle of “true/false”. The reliability of the scale was measured and assessed with the Cronbach’s alpha test at the level of 68.4%. Results. Factors adversely affecting the general level of knowledge in the field of hand hygiene turned out to be older age (p=0.012), longer work experience (p=0.023) and the lack of higher education (p=0.048).

1211. Microbiologic Evaluation of Mobile Phones and Hands of Healthcare Professionals in Two Intensive Care Units in a Brazilian University Hospital

BackgroundHealthcare-associated infections (HAIs) are a worldwide concern because of their high morbidity, mortality, and associated costs. Mobile phones (MP) are an important work tool in the healthcare setting, but they can be a reservoir of nosocomial pathogens if not carefully cleaned and cause re-contamination of the healthcare professional’s (HCP) hands. We aimed to evaluate bacterial colonization of HCP’s hands and their respective MPs.MethodsA cross-sectional study was performed in two Intensive Care Units (ICUs), an internal medicine and a burn unit, of a Brazilian tertiary university hospital. These units were chosen because of their different hand hygiene (HH) compliance. We assessed HH and MP handling practices by an electronic inquiry and collected samples from the dominant hand (DH) by the sterile bag technique and of MPs by moistened sterile swab. MALDI-TOF was used for bacterial identification and Dilution Agar (DA) was used to screen Gram-negative bacteria (GNB) susceptibility to carbapenems and colistin.ResultsForty-seven HCPs were evaluated; of whom, 30% were medical residents, 19% nurses, 17% nurse-technicians, 17% physiotherapists, 13% cleaning staff, and 4% radiology technicians.Overall, 85% of HCPs reported use of MP at work, 26% had never cleaned it, and 34% reported optimal HH compliance practices. All of them believed that MPs can have HAIs agents. DH culture showed 94% of colonization and the most common Gram-positive bacteria (GPB) and GNB were S. epidermidis (n = 17∕44) and A. baumannii complex (n = 11∕44), respectively. MP were colonized in 89% of the cases and the most common GPB and GNB were S. epidermidis (n = 16∕42) and Pseudomonas spp (n = 9∕42), respectively. Overall, in the screening 38% of GNB were resistant to meropenem and 22% to colistin. A. baumannii was the most common meropenem (n = 4) and colistin (n = 2) resistant GNB. In the two units, 32% of HCPs had the same microorganism species isolated in the MP and in the DH (Table 1).ConclusionThere was a high rate of bacterial colonization on the MP and DH of HCPs and some of these bacteria were carbapenem or colistin resistant. A policy for MP handling in the healthcare setting should be implemented in order to avoid cross-contamination between the MP and the hand of HCPs. Disclosures All authors: No reported disclosures.

LO78: Point-of-care ultrasound compared with manual palpation for the detection of a carotid pulse in live models: a randomized cross-over study

Introduction: Pulse check by manual palpation (MP) is an unreliable skill even in the hands of healthcare professionals. In the context of cardiac arrest, this may translate into inappropriate chest compressions when a pulse is present, or conversely omitting chest compressions when one is absent. To date, no study has assessed the utility of B-mode ultrasound (US) for the detection of a carotid pulse. The primary objective of this study is to assess the time required to detect a carotid pulse in live subjects using US compared to the standard MP method. Methods: This is a prospective randomized controlled cross-over non-inferiority trial. Health care professionals from various backgrounds were invited to participate. They attended a 15 minute focused US workshop on identification of the carotid pulse. Following a washout period, they were randomized to detect a pulse in live subjects either by MP first or by US first. Both pulse check methods were timed for each participant on 2 different subjects. The primary outcome measure was time to carotid pulse detection in seconds. Secondary outcome measures included comfort levels of carotid pulse detection measured on a 100mm visual analog scale (VAS), and rates of prolonged pulse checks (greater than 5 or 10 seconds) for each technique. Mean pulse detection times were compared using Students t-test. The study was powered to determine whether US was not slower than MP by greater than 2 seconds. Results: A total of 93 participants completed the study. Time to detect pulse was 4.2 (SD=3.4) seconds by US compared with 4.7 (SD=6.5) seconds by MP (P=0.43). Seventeen (18%) participants took >5 seconds to identify the carotid pulse using US compared to 19 (20%) by MP (P=0.74). Eight (9%) candidates took >10 seconds to identify the pulse using US compared to 9 (10%) by MP (P=0.81). Prior to training, participants had a higher comfort level using MP than US pulse checks (67 vs 26 mm, P<0.001). Following the study, participants reported higher comfort levels using US than MP (88 vs 78 mm, P<0.001). Conclusion: Carotid pulse detection in live subjects was not slower using US as compared to MP in this study. A brief teaching session was sufficient to improve confidence of carotid pulse identification even in those with little to no previous US training. The preliminary results from this study provide the groundwork for larger studies to evaluate this pulse check method for patients in actual cardiac arrest.

The bicentennial of the stethoscope: a reappraisal.

Background and aimTwo hundred years ago Laennec, a young French physician discovered the stethoscope, in order to improve the lung auscultation. The stethoscope became the emblematic appendix of the physicians. Nurses use it also to monitor patients and medical students are proud to use it. We critically review the significance of the stethoscope 200 years after its discovery.MethodsPertinent literature was searched on PubMed and Google about the stethoscope, using also other terms: auscultation, Laennec, medical education, clinical diagnosis. Data were collected in a narrative review.ResultsTwo centuries after its invention, the stethoscope still remains a major tool in the hands of healthcare professionals. It is routinely used by medical doctors and has become a mark of their status. Nurses use it also to monitor heart rate and blood pressure. Medical students get familiarized to use it during the medical faculty. Patients perceive the stethoscope as an important symbol of the medical profession.ConclusionsTwo hundred years ago the stethoscope was invented by Laennec. Despite the advent of X rays, CT, ECG, echocardiography and more recently of the electronic stethoscope, the classical stethoscope invented by Laennec still has its major role in the representation of healthcare providers and is a major utility in clinical diagnosis.

Do Longer Surgical Procedures Result in Greater Contamination of Surgeons' Hands?

A surgical site infection is a substantial cause of complications in patients. Different methods are being used to decrease surgical site infections; however, these infections still can cause complications, especially in patients undergoing longer operations (>3hours). There is evidence that the efficacy of the scrubbing material fades after 3hours. However, we do not know the longevity of hand cleanliness after application of scrubbing materials in a long operation. It can be postulated that if the surgeon's scrubbed hands are recolonized after a certain time, they may serve as a progressive source of contamination during surgery. We asked: (1) Is there a correlation between surgical duration and hand contamination at the end of surgery? (2) At what point during surgery does hand contamination reach or exceed prescrub levels? Three spine surgeons using the same scrubbing technique and materials consisting of chlorhexidine gluconate 1% solution and ethyl alcohol 61% w/w were enrolled in our study. Between December 2014 and April 2015, spine procedures of 3hours or more, which were the first case of the day, were selected for this study (20 cases). Cases in which glove changing occurred (perforations, reprepping, and redraping) or cultures obtained after scrubbing were positive (indicative of insufficient hand sanitization) were excluded (0% of cases). Twenty cases (100% enrollment) were analyzed. Surgeons' hands were swabbed with sterile cotton tip applicators and 5 mL sterile phosphate-buffered saline before hand scrubbing (prescrub), immediately after hand scrubbing (postscrub), and immediately after surgery (postoperative). Results were reported in colony-forming units per milliliter. The correlation between duration of surgery and hand recontamination was tested by regression analysis of time versus colony-forming units per milliliter. Receiver-operating characteristic curve tested the cutoff point, where recontamination occurred. With a longer duration of surgery, more colony-forming units are recovered from gloved hands at the end of surgery (R=0.94, R(2)=0.89, p=0.005). The receiver-operating characteristic curve suggested that 5hours is the cutoff point for hand recolonization. At 5hours, contamination reached or exceeded prescrub levels (area under the curve, 0.66; 95% CI, 0.23-1.0), whereas before 5hours, there was no contamination detected at the end of surgery. Our results show that duration of surgery correlates with hand recontamination and at 5hours, recolonization of a surgeon's hands become detectable. Recolonization may have started even earlier than 5hours. However, these levels are not detectable in the laboratory at earlier times. Based on this pilot study, rescrubbing is highly recommended before the fifth hour of an operation, ideally at some point between the fourth and fifth hours. We also recommend the surgical site infection rates in operations using rescrubbing should be compared with those from surgeries with just the conventional single-scrubbing technique, in a randomized controlled trial, to determine the effectiveness of this novel rescrubbing method.

Performance of two updated blood glucose monitoring systems: an evaluation following ISO 15197:2013

Objective For patients with diabetes, regular self-monitoring of blood glucose (SMBG) is essential to ensure adequate glycemic control. Therefore, accurate and reliable blood glucose measurements with SMBG systems are necessary. The international standard ISO 15197 describes requirements for SMBG systems, such as limits within which 95% of glucose results have to fall to reach acceptable system accuracy. The 2013 version of this standard sets higher demands, especially regarding system accuracy, than the currently still valid edition. ISO 15197 can be applied by manufacturers to receive a CE mark for their system.Research design and methods This study was an accuracy evaluation following ISO 15197:2013 section 6.3 of two recently updated SMBG systems (Contour* and Contour TS; Bayer Consumer Care AG, Basel, Switzerland) with an improved algorithm to investigate whether the systems fulfill the requirements of the new standard. For this purpose, capillary blood samples of approximately 100 participants were measured with three test strip lots of both systems and deviations from glucose values obtained with a hexokinase-based comparison method (Cobas Integra† 400 plus; Roche Instrument Center, Rotkreuz, Switzerland) were determined. Percentages of values within the acceptance criteria of ISO 15197:2013 were calculated. This study was registered at clinicaltrials.gov (NCT02358408).Main outcome Both updated systems fulfilled the system accuracy requirements of ISO 15197:2013 as 98.5% to 100% of the results were within the stipulated limits. Furthermore, all results were within the clinically non-critical zones A and B of the consensus error grid for type 1 diabetes.Conclusions The technical improvement of the systems ensured compliance with ISO 15197 in the hands of healthcare professionals even in its more stringent 2013 version. Alternative presentation of system accuracy results in radar plots provides additional information with certain advantages. In addition, the surveillance error grid offers a modern tool to assess a system’s clinical performance.

Parkinsonian Symptoms with Fever

Introduction: West Nile virus (WNV) is the most common arthropod borne virus and is the leading cause of domestically acquired disease in the United States. Case Description: A 75-year-old man presented in August 2015 with sepsis and one day of confusion, fever of 104°F, a white blood cell count (WBC) of 19.80, and blood pressure of 204/91, in the setting of a recent admission for small bowel obstruction. On exam, he was only oriented to self with slurred speech, tongue and bilateral quadriceps fasciculations, cogwheel rigidity and tremor of bilateral upper arms, and dysmetria. He did not have skin changes, no meningeal signs, or visual problems. Initially, he was treated empirically for meningitis. Head computed tomography (CT), magnetic resonance imaging (MRI), abdominal CT, chest X-ray (CXR) were negative. He remained febrile and hypertensive for four days, with worsening Parkinson’s features. Blood and urine cultures were negative and antibiotics were stopped. Neurology started a Sinemet trial. Lumbar puncture (LP) revealed mild pleocytosis and no detectable WNV. On day six, his white blood cell count (WBC) resolved, blood pressures were under control, and defervesced-only with supportive care. All of his Parkinson’s symptoms resolved. On day seven, serum WNV IgM was positively elevated >5.00. One week later, he had seroconverted. Discussion: The first case of WNV was isolated in 1937 in Uganda. This case report reminds us of the necessity to heighten public health awareness for WNV. It also portends the need for WNV surveillance in order to control disease spread. Our priorities need to shift toward early disease identification and implementation of control measures. Reporting databases like ArboNET are effective, however, as it currently stands, the onus of reporting lies in the hands of health care professionals. This leads to an underestimate of the actual disease prevalence and burden. Frequently, WNV cannot be detected in serum because the viremia is short lived and peaks before clinical symptoms are present. Case reports have documented that WNV can present as Parkinsonian symptoms including hypomimia, bradykinesia and postural instability. Persistent fever without a known source should initiate a search for the cause, and merits a thorough review of the patient’s social history. Treatment should be focused on supportive care while pending laboratory confirmation of WNV, and irrespective of imaging studies. Consistent with the literature, our patient did not have significant imaging findings. WNV can be a preventable disease if preventative measures are taken. Thus, the long-term sequelae of WNV, which include depression, fatigue, headaches, cognitive and muscular deficits, can be potentially avoided.

THE IMPORTANCE OF PLAY DURING HOSPITALIZATION OF CHILDREN.

Introduction:Play constitutes an essential parameter of the normal psychosomatic development of children, as well as their statutory right. It is also an important means of communication in childhood.Objective:To review, detect and highlight all data cited regarding the role of play during the hospitalization of children.Methodology:Literature review was achieved by searching the databases Scopus, PubMed, Cinhal in English, using the following key words: therapeutic play, play therapy, hospitalized child, therapist.Results:During hospitalization, play either in the form of therapeutic play, or as in the form of play therapy, is proven to be of high therapeutic value for ill children, thus contributing to both their physical and emotional well-being and to their recovery. It helps to investigate issues related to the child’s experiences in the hospital and reduce the intensity of negative feelings accompanying a child’s admission to hospital and hospitalization. Play is widely used in pre-operative preparation and invasive procedures, while its use among children hospitalized for cancer is beneficial.Conclusion:The use of play in hospital may become a tool in the hands of healthcare professionals, in order to provide substantial assistance to hospitalized children, as long as they have appropriate training, patience, and will to apply it during hospitalization.

Unexpected Consequences of Simulator Use in Medical Education

Reform of medical education in Vienna in the early 19th century led to bodies of patients who had died being used as obstetric simulators. It was unpleasant, but it was thought that learning on a cadaver simulator would be superior to learning on phantoms (artificial simulators). Unfortunately, the change was associated with a significant increase in maternal mortality from puerperal fever and thousands of women died before Ignaz Philipp Semmelweis recognized that the condition was transmitted from the cadaver to the parturient and could be prevented by careful hand washing. A hundred fifty years later, the spread of infection on the hands of health care professionals is still a cause for concern. The apparently simple skill of cleaning hands and adherence to hand hygiene guidelines should be included in scenarios. We also need to make sure that current simulation-based training does not have unwanted consequences.

Supreme Laryngeal Mask Airway achieves faster insertion times than Classic LMA during chest compressions in manikins

BackgroundAccording to the 2010 European Resuscitation Council guidelines on cardiopulmonary resuscitation (CPR), one can appreciate that the classic laryngeal mask airway (CLMA) is acceptable as an alternative airway device to endotracheal intubation for airway management in cardiac arrest victims. ObjectiveTo compare a relatively new supraglottic airway device, the Supreme Laryngeal Mask Airway (SLMA), with the CLMA in a cardiac arrest scenario. MethodsFifty healthcare professionals inexperienced in advanced airway management attempted to insert both airway devices in a manikin in 2 scenarios: in the first, chest compressions were not performed (non-CPR scenario), and in the second, uninterrupted chest compressions were performed (CPR scenario). The primary end points were insertion time and success rate at first attempt. The level of self-confidence of each participant was recorded. ResultsSLMA achieves faster insertion times both in the non-CPR (SLMA: 10.4 ± 2.7 seconds vs CLMA: 13.4 ± 3.2 seconds, P < .05) and in the CPR scenario (SLMA: 9.9 ± 2.0 seconds Vs CLMA: 11.9 ± 2.3 seconds, P < .05). The difference between first attempt success rates was not statistically significant both in the non-CPR (SLMA: 96% vs CLMA: 90%, P = .18) and in the CPR scenario (SLMA: 98% vs CLMA: 94%, P = .32). The participants are more self-confident using SLMA instead of CLMA (P < .001) and 94% of them would prefer SLMA for future use. ConclusionSLMA could be a useful alternative to CLMA during CPR in the hands of healthcare professionals with minimal experience in airway management.