Reduce Contamination Rates Research Articles

Unveiling 8 years of duodenoscope contamination: insights from a retrospective analysis in a large tertiary care hospital

ObjectiveContaminated duodenoscopes caused several hospital outbreaks. Despite efforts to reduce contamination rates, 15% of patient-ready duodenoscopes are still contaminated with gastrointestinal microorganisms. This study aimed to provide an overview of...

Effectiveness of multidisciplinary interventions to improve blood culture efficiency and optimize antimicrobial utilization.

The low positive rate of blood cultures often leads to downstream consequences. We present a summary of multidisciplinary interventions implemented by a tertiary referral hospital to improve blood culture efficiency and optimize antimicrobial usage. We evaluated the knowledge, attitude, and practice (KAP) of healthcare workers in a tertiary care hospital before and after intervention using a questionnaire. A multidisciplinary team was formed to implement the intervention, defining roles, standardizing procedures, continually improving education and feedback, and establishing incentive mechanisms. Regular quality control assessments are conducted on the responsible departments. Following the intervention, the median submission time for blood culture specimens was reduced from 2.2 h to 1.3 h (p < 0.001). Additionally, the intervention group showed significant (p < 0.05) increases in rates of positivity (9.9% vs. 8.6%), correct timing (98.7% vs. 89.6%), correct processing (98.1% vs. 92.3%), reduced contamination rates (0.9% vs. 1.4%), and disqualification rates (1.3% vs. 1.7%). The delivery rate of therapeutic antibacterial increased (16.1% vs. 15.2%), and the consumption of restrictive grade antimicrobial also significantly increased (26.7% vs. 22.9%). The intervention measures led to a substantial improvement in awareness and compliance with KAP of blood culture collection in the hospital. Hospital-wide antimicrobial usage deceased by 10.7% after intervention. A multidisciplinary collaborative model proves effective in improving blood culture efficiency and optimizing antimicrobial usage.

Review of Blood Cultures Taken From Arterial Lines in James Cook University Hospital: Contamination Analysis And Comparison With Venous Samples

BACKGROUND: Blood cultures are crucial diagnostic tools for identifying and treating bloodstream infections. Traditionally, venous blood is the preferred source for sample acquisition, but arterial lines offer an alternative. However, concerns regarding contamination and diagnostic accuracy have been raised, questioning the reliability of arterial line blood cultures. This study aimed to evaluate the contamination rates of arterial line blood cultures at James-Cook University Hospital (JCUH), UK and compare them with venous samples to understand their clinical utility better. METHODS: A comprehensive retrospective review analysed 17,643 blood culture samples collected between September 2022 and March 2023 at JCUH. Among these, 109 arterial line blood cultures and 785 venous peripheral adult samples were included for data analysis. Contamination rates were calculated as the number of positive blood cultures with contaminants per total positive samples (arterial or venous). The incidence of contamination was defined as the number of total blood cultures reported with contaminants per total samples (arterial or venous). No discrimination was made based on the number of contaminants found. Clinical information accompanying the blood cultures, such as the specification of arterial lines as 'new' samples, was also considered. RESULTS: The overall contamination rate at JCUH was found to be 4.99%. Specifically, the contamination rate for venous samples was 49.26%, while arterial samples had a higher contamination rate of 56.52%. The incidence of contamination from arterial samples was 11.92%, significantly higher than the incidence rate for venous samples at 3.18%. Most arterial samples were requested from intensive care units (ICUs) and highly dependent wards (HDUs), indicating potential areas for targeted interventions to improve blood culture collection practices. CONCLUSION: Arterial blood cultures demonstrated higher contamination rates compared to venous samples, raising concerns about their reliability. Contamination in arterial samples, particularly when collected from critically ill patients in ICUs and HDUs, can lead to inappropriate use of antibiotics, delayed, or missed diagnosis, and suboptimal patient outcomes. The study recommends targeted interventions to improve arterial blood culture collection practices and further training for healthcare workers involved in arterial line care. Encouraging the use of only 'new' arterial lines and implementing standardized protocols can help reduce contamination rates. Furthermore, the study identified certain limitations, such as potential human errors in data analysis and the need for a larger dataset of arterial line cultures. Extending the analysis to compare different sample sources like CVCs, Hickman lines, and central lines could provide a more comprehensive understanding of contamination rates across various culture collection methods. In conclusion, venous samples showed higher clinical favourability with a lower contamination rate, providing increased dependability for accurate diagnosis and management. Although some studies have not shown clear superiority of arterial samples over venous samples, this analysis highlights considerable differences in contamination rates, suggesting a potential inferiority of arterial blood culture samples. While efforts can be made to optimize the consistency of arterial samples and reduce contamination rates, their use should be approached with caution. Implementing the recommended measures is essential for accurate diagnosis, improved patient outcomes, and effective antibiotic management in clinical practice.

Comparative Performance of Cobas 6800, 8800 with Cobas Ampliprep/TaqMan for HIV Viral Load Quantification

Human immunodeficiency virus (HIV) remains a serious public health challenge, especially in Africa. Viral load (VL) is the major marker in monitoring disease prognosis. With the increased demand for HIV VL, countries are equipping fewer laboratories with higher throughput machines based on real-time polymerase chain reaction (PCR) technology. They are fully automated, faster, possess improved assay sensitivity/specificity, higher throughput, more dynamic ranges and reduced contamination rates. This study sought to verify the analytical performance of two new Cobas instruments against the Cobas Ampliprep/TaqMan (CAP/CTM), used in tracking viral suppression in Nigeria. In a cross-sectional study, aliquots of clinical HIV viral load samples were assayed on the three platforms. Values obtained with the CAP/CTM were compared with those from Cobas 6800/8800 in a routine clinical setting. Between June and August 2019, 100 plasma samples collected were analysed in parallel using both techniques. Accuracy, inter-assay precision, linearity and carry-over effect analyses were conducted. The correlation coefficients of 0.997, 0.874, and 0.878 were obtained for C8800/C6800; C8800/CAP/CTM, and C6800/CAP/CTM, respectively. The level of agreement using a Bland–Altman plot was 94.2%. The systems produced good analytical performance, comparable and correlated with CAP/CTM. Therefore, Cobas 6800 and 8800 machines are suitable and acceptable for clinical samples; and recommended for high-volume laboratories.

Abstract 20 Long-Term Follow-Up of Cryopreserved Umbilical Cord Tissue as a Source of Mesenchymal Stem Cells

Abstract Introduction Mesenchymal stem cells (MSCs) can differentiate into various cell types and exhibit immunomodulatory and paracrine effects. The cryopreservation of umbilical cord tissue as a viable source of MSCs has great potential for the field of regenerative medicine. We previously demonstrated that it is feasible to cryopreserve umbilical cord tissue cut into small fragments measuring 2 to 5 mm in length and obtain viable cells by thawing them between 30 and 60 days after freezing. Objectives We aim to assess the condition of previously frozen samples for periods exceeding one year and analyze the data obtained from the cryopreservation of new samples. Methods A total of 834 new samples were frozen with our protocol for umbilical cord tissue cryopreservation. These Samples were thawed after obtaining microbiological contamination results of each sample. Additionally, a group of 100 samples that have been kept frozen for at least one year were selected to be thawed to assess the viability of the tissue frozen for extended periods of time. All cultures were maintained and the days to reach confluence were registered. Results The microbial analysis of the group of 834 new samples showed similar microbial profile and risk factors to those previously reported by us, with higher contamination frequencies associated with vaginal delivery and samples obtained by less experienced personnel in the operating room. Moreover, similar to our previous reports, the most frequent microorganism detected in contaminated samples were Staphylococcus sp, Escherichia Coli, Enterococcus sp and Streptocuccus sp. The group of 100 samples that were kept frozen for a minimum period of one year were thawed to assess if we could obtain viable cells from them. All cell cultures obtained from the thawed tissue were successful, reaching confluence between days 18 and 23, which is consistent with our previously observed timings. Discussion New cryopreserved tissue samples, and samples frozen for more than one year had viable cells that can be expanded as a source of MSCs. Microbial profile of those samples showed association with sample collection conditions at the operating room indicating that proper training of the personnel is the key to reduce contamination rates.

Bacteriological Quality Assessment of Nigerian Indigenous Beverages Consumed in Calabar, Southern Nigeria

Aim: Locally prepared drinks and beverages are gradually replacing the conventional sugary carbonated soft drinks, particularly because of the health effects associated with some of the components in these drinks. This study was aimed at evaluating the bacteriological quality of locally produced drinks/beverages (kunu, zobo, tiger-nut and pineapple drinks), produced and sold in Calabar metropolis.&#x0D; Methodology: Samples (tiger-nut, zobo, kunu and pineapple drink) were collected from five different markets within the study area and evaluated using standard bacteriological techniques. Results: The mean aerobic bacterial ranged from 21.6 ± 0.8 x 105 CFU/mL to 208.8 ± 2.02 x 105 CFU/mL. The coliform counts ranged from 5.8 ± 0.49 x 105 CFU/mL to 187.2 ± 2.10 x 105 CFU/mL. The staphylococcal counts ranged from 29.8 ± 0.92 x 105 CFU/mL to 194.4 ± 1.64 x 105 CFU/mL. Coagulase-negative Staphylococci was the most predominant isolates (27.0%), followed by Escherichia coli (12.2%) and Enterobacter sp (10.4%). Other bacteria genera detected include Bacillus sp, Lactobacillus sp, Pseudomonas sp, Proteus sp, Micrococcus sp, Klebsiella sp, Serratia sp, Citrobacter sp, and Streptococcus sp and Listeria sp.&#x0D; Conclusion: This study revealed that the bacteriological quality of the analyzed samples was above the acceptable standards and as such a potential risk to public health. Therefore, education for vendors on food safety and hygienic practices is essential to reduce contamination rate. Furthermore, regular inspection on food vending practices and safety of ready-to-eat foods is required to improve the health standards of consumers.

A multi-pronged approach to improve blood culture diagnostics in different clinical departments: a single-centre experience

PurposeBlood culture (BC) diagnostics are influenced by many factors. We performed a targeted interdisciplinary analysis to analyse effects of various measures on BC diagnostics performance.MethodsA diagnostic stewardship initiative was conducted at two intervention and two control wards in a German tertiary level hospital. The initiative comprised staff training on the correct indications and sampling for BC, implementation of information cards, labels to identify the collection site, regular BC bottle feedback including the number of bottles, filling volumes and identified pathogens; and the use of a specific sampling device (BD Vacutainer®). Before and after the interventions, two three-month measurement periods were performed, as well as a one-month follow-up period to assess the sustainability of the conducted measures.ResultsIn total, 9362 BC bottles from 787 patients were included in the analysis. The number of BCs obtained from peripheral venous puncture could be increased at both intervention wards (44.0 vs. 22.2%, 58.3 vs. 34.4%), while arterial sampling could be reduced (30.6 vs. 4.9%). A total of 134 staff members were fully trained. The intervention led to a considerable increase in BC knowledge (from 62.4 to 79.8% correct answers) with differences between the individual professional groups. Relevant reduced contamination rates could be detected at both intervention wards.ConclusionsAs knowledge on the correct BC sampling and strategies to reduce contamination varies considerably between clinical departments and healthcare professionals, a targeted training should be adapted to the specific needs of the individual professional groups. An additional filling device is not necessary.

Diagnostic Stewardship: A Systematic Review and Meta-analysis of Blood Collection Diversion Devices Used to Reduce Blood Culture Contamination and Improve the Accuracy of Diagnosis in Clinical Settings.

Blood culture contamination may lead to misdiagnosis, overutilization of antibiotics, and prolonged length of stay. Blood specimen diversion devices can reduce contamination rates during blood culture collection procedures. We performed a systematic literature review and meta-analysis evaluating the influence of blood specimen diversion devices in blood culture contamination rates. We searched Medline, Cumulative Index to Nursing and Allied Health Literature, Embase, Cochrane, Scopus, and Web of Science, from database inception to 1 March 2023, for studies evaluating the impact of a diversion device on blood culture contamination. Blood culture contamination was a positive blood culture with microorganisms not representative of true bacteremia, but rather introduced during collection or processing the blood sample. Random-effects models were used to obtain pooled mean differences, and heterogeneity was assessed using the I2 test. Of 1768 screened studies, 12 met inclusion criteria for this systematic literature review. Of them, 9 studies were included in the meta-analysis. Studies were substantially heterogeneous, but stratified analyses considering only high-quality studies revealed that venipuncture using a diversion device was associated with a significant reduction in blood culture contamination in comparison to the standard procedure of collection (pooled odds ratio [OR], 0.26 [95% confidence interval {CI}, .13-.54]; I2 = 19%). Furthermore, the stratified analysis showed that the adoption of a diversion device did not reduce the detection of true infection (pooled OR, 0.85 [95% CI, .65-1.11]; I2 = 0%). Blood culture diversion devices was associated with decreased contamination rates and could improve quality of care, reduce costs, and avoid unnecessary antibiotic use.

Guidelines for improvement of the procedural aspects of devices and surgical instruments in the operating theatre.

Surgical site infections are a major complication for patients undergoing surgical treatment and a significant cause of mortality and morbidity. Many international guidelines suggest measures for the prevention of surgical site infections (SSI) in perioperative processes and the decontamination of surgical devices and instruments. This document proposes guidelines for improving the perioperative setting in view of the devices and instrumentation required for surgical procedures, aiming to reduce contamination rates and improve clinical performance and management for patients undergoing surgical treatment. This document is intended for doctors, nurses and other practitioners involved in operating theatre procedures, resource management and clinical risk assessment processes, and the procurement, organisation, sterilisation and reprocessing of surgical instruments.

Is it Possible to Reduce Contamination Rates in Urine Cultures?

Is it Possible to Reduce Contamination Rates in Urine Cultures?

188. Opportunities for antimicrobial stewardship: Time to optimal therapy and vancomycin use in gram-positive and contaminated blood cultures before and after implementation of rapid blood culture diagnostic testing

Abstract Background Rapid molecular diagnostic tests improve time to organism identification and may expedite antimicrobial de-escalation. Through faster detection of contaminated samples, rapid blood culture identification (BCID) should also reduce unnecessary antibiotic use. BioFire FilmArray BCID was implemented in July 2019 at a community hospital. This study compared antimicrobial use for gram-positive blood cultures before and after BCID implementation to identify areas for further antimicrobial stewardship intervention. Methods This retrospective cohort study evaluated adult patients at a 450-bed community hospital with gram-positive blood culture results between February and June 2018 and 2019 (pre-and post-BCID). Patients were excluded for polymicrobial bacteremia, pregnancy, or expiration/hospice status before blood culture positivity. The primary outcome was time to optimal therapy (TTOT) for bacteremia, defined as time to antimicrobial de-escalation, discontinuation, or result for untreated contaminated cultures. Time to organism identification, receipt of optimal therapy, and vancomycin duration were also evaluated, in addition to subgroup analysis of contaminated cultures (identified by microbiology comment or physician note). Results Of the 232 patients, median age was 70 years and 54.3% were male. Coagulase-negative staphylococci was most commonly isolated (n=104, 45%) and contamination rate was 53.4%. Median TTOT improved from 53.3 vs 28 hours, p&amp;lt; 0.001 in pre- vs post-groups, respectively, and optimal therapy selection increased from 83% to 93%, p=0.028. Median time to organism identification was 60.2 vs 23.5 hours, p&amp;lt; 0.001. Median duration for vancomycin (35.1 vs 25.2 hours, p=0.231) and overall antimicrobial duration did not differ between groups. Among contaminated blood cultures, TTOT improved (54 vs 27.3 hours, p&amp;lt; 0.001) and vancomycin median duration decreased (27.5 vs 16.6 hours, p=0.253). Conclusion Rapid BCID significantly improved TTOT, resulting in improved rates of optimal therapy and an observed reduced vancomycin duration. High rates of contaminated blood cultures identified opportunities for coordination with antimicrobial stewardship to reduce contamination rates and improve antimicrobial use. Disclosures All Authors: No reported disclosures.

Analysis of the presence of enteroparasites in Lactuca sativa (LETTUCE) sold at fairs and supermarkets in the municipality of Grajaú-Maranhão

Among the vegetables, lettuce (Lactuca sativa) stands out as one of the most popular leafy vegetables and consumed fresh. Due to the lack of structural and hygiene conditions, the commercialization of raw products in open markets causes greater exposure to contaminating pathogens. Thus, this study aimed to analyze the presence of enteroparasites in lettuce sold in supermarkets and open markets in the municipality of Grajaú-MA. Samples were collected at two fair stands and four supermarket shelves. The lettuces were separated into leaves, washed manually with distilled water and 5 drops of Tween 80 and left to stand for 3 hours. The resulting liquid was stored in conical cups for sedimentation for 24 hours. The sediment was separated and analyzed under an optical microscope. All investigated samples presented some type of enteroparasites. The results obtained indicated that all samples studied contained some parasitic structure, Entamoeba coli and the nematode eggs, for example, were present in all samples. In addition to protozoa, Ascaris and Trichuris eggs, fungi, yeasts, dirt and other types of single-celled life were found on the observed slides. The most common intestinal parasites were protozoa such as Giárdia lamblia (63.3%) nematode egg (27.3%), and Entamoeba coli. (23.8%). As lettuce (L. sativa) is eaten raw, it is necessary to apply a health education program for farmers to start reducing contamination rates. And for consumers there is a need to wash the leaves correctly before consuming them. Using the recommended hygiene standards, they can avoid ingesting enteroparasites.

Identification of the main contributors to blood culture contamination at a tertiary care academic medical center

SummaryBackgroundBlood culture contamination poses an issue to all hospital systems worldwide because of the associated costs of extended length of stays, unnecessary antibiotic therapy, and additional laboratory testing that are preventable with proper handling and collection techniques.MethodsIn our study, multiple units, staff, and collection methods were compared to determine the primary culprits of contamination from a tertiary care academic medical center, which includes a pediatric hospital and both adult and pediatric emergency departments.ResultsOver 33 months, 2,083 out of 88,322 total blood cultures collected were contaminated, with an overall contamination rate of 2.4%. A moderate positive correlation was found between the monthly total number of cultures and monthly contamination rate (r = 0.411 P < .01). The most notable factors associated with contamination were found to be phlebotomy teams (2.7%) (P < .01), peripheral draws (2.3%) (P <.01), adult emergency departments (2.6%) (P < .01), and pediatric intensive care units (2.7%) (P < .01). A positive correlation was present between the number of hospital beds per unit and unit contamination rates (r = 0.429 P < .01).ConclusionOur results were used to make recommendations for decreasing the rate of blood culture contamination in this institution, which includes acknowledgement of an overwhelmed staff and mandatory periodic training on acceptable aseptic technique and contamination awareness. Understanding the factors contributing to blood culture contamination can aid efforts to reduce contamination rates.

Exposure to SARS-CoV-2 in Hospital Environment: Working in a COVID-19 Ward Is a Risk Factor for Infection.

Aims. Health care workers (HCWs) are at risk of acquiring the Severe Acute Respiratory Syndrome Coronavirus 2 Infection (SARS-CoV-2). The aim of the study is to determine the SARS-CoV-2 positivity rates during the first epidemiologic peak among HCWs of a south Belgian hospital and to identify risks factors for infection. Methods. All hospital staff who worked during the first epidemiological peak were asked to answer a questionnaire regarding demographical data, function, type of working unit, type of contact with patients, eventual symptomatology, and the positivity of reverse transcription-polymerase chain reaction (RT-PCR) testing or immunoassay. Results. A total of 235 questionnaires were collected; 90 (38%) HCWs tested positive for SARS-CoV-2 from either RT-PCR or immunoassay testing. The positivity rate of HCWs between wards was statistically different (p = 0.004) and was higher in COVID-19 wards than Intensive Care Unit (ICU) and Emergency Department (ED). A total of 114 (49%) HCWs presented SARS-CoV-2-compatible symptomatology; 79 (88%) were positive on either RT-PCR or immunoassay testing; 74 (37%) HCWs were unable to work during the studied period; 5 were hospitalized. No deaths were reported. Multivariate logistic regression modeling showed that having symptoms was highly associated with test positivity (OR 23.3, CI 11.1, 53.1, p-value < 0.001). Working in a COVID-19 ward against working in ICU or ED was also predictive of positivity among HCWs (OR 3.25, CI 1.50, 7.28, p-value = 0.003). Discussion and Conclusions. This study shows a higher positivity rate compared to already reported positivity rates among HCWs. Reported differences in positivity rates depend on many factors, such as local crisis intensity, screening strategy, training in use of self-protective equipment, and study selection bias. HCWs working in COVID-19 wards, in comparison to ED and ICU, seemed at greater risk of being infected in this study. This could be explained by the disparity of HCWs’ experience in handling self-protective equipment and knowledge in infection prevention. Hence, care should be taken in proper training for less-experienced HCWs during hospital epidemics. The latter could increase HCWs’ protection and consequently decrease work absenteeism, ensuring enhanced continuity of patient care during hospital crisis. Rapid quarantine of symptomatic HCWs could reduce contamination rates, as having symptoms was highly associated with test positivity in this study.

Prevalence and Antibiograms of Salmonella in Commercially Produced Crocodile meat in Zimbabwe

The presence of Salmonella in food products and emergence of antibiotic resistance are the major challenges facing public health policies. A total of 2749 crocodile meat samples obtained from the Central Veterinary Laboratories in Zimbabwe were screened for Salmonella specieswere collected from three Zimbabwean commercial farms between the year 2012 and 2019 for a retrospective observational study to determine the prevalence and magnitude of antibiotics resistant Salmonella species in crocodile meat. The isolation of Salmonella was in accordance with the ISO 6579:2002 and the antibiotic susceptibility testing was carried out based on Clinical and Laboratory Standard Institute’s recommendations by means of the Kirby-Bauer disk diffusion method. SILAB Database was used to determine the prevalence of Salmonella species. Prevalence was stratified by year and farms. Twenty Salmonella isolates were identified using biochemical tests, and 15 were confirmed by polymerase chain reaction (PCR). Antimicrobial susceptibility profiles of the confirmed Salmonella isolates were examined using 14 antibiotics. The overall prevalence of Salmonella species in crocodile meat samples was 0.5%. The prevalence of Salmonella species ranged from 0.04% to 0.44% in the crocodile meat samples and annual prevalence ranged from 0.01% to 1%. The highest prevalence of Salmonella (4.4%) was recorded in the year 2012. Salmonella isolates from one of the three tested farms were resistant to Erythromycin (73.33%), Ampicillin (80%), and Penicillin G (100%). Generally, Salmonella isolates displayed lower resistance to Cefepime, Ceftriaxone, Amikacin, Tetracycline, Ertapenem, Florfenicol, and Erythromycin (0-53.33%) whereas all Salmonella isolates showed susceptibility to Cefepime, Ceftriaxone, Ertapenem, and Florfenicol. Although the study indicates low prevalence of Salmonella species in crocodile meat, there is a need for strict implementation of Hazard Analysis Critical Control Point (HACCP) to reduce contamination rates in meat and its products

‘’Evaluation of Flora Bacteria Grown in Blood Cultures: Are They Etiologic Agent of Infection or Only Contaminants?’’

Objective: In this study, it was aimed to determine whether the flora bacteria growing in blood cultures were infectious agents or only contaminants, for this purpose the hemogram parameters and other demographic characteristics of the patients were evaluated.&#x0D; Materials and Methods: We evaluated 11.579 blood culture results using the BacT/ALERT® microbial detection system. The skin flora bacteria was detected in the blood cultures during one year and the rates of infectious agents among these bacteria were investigated retrospectively. The blood culture results, which were accepted as true bacteremia and contamination were compared in terms of positive blood culture flask count and inflammation markers (white blood cell count, neutrophil ratio, lymphocyte ratio and C-reactive protein levels).&#x0D; Results: The total number of blood culture test was 11.579. Out of this number, 8205 (70.87%) was free of microbial growth and there was 3374 (29.13%) with microbial growth. 2609 (77.3%) of the positive cultures represented skin flora bacteria, 2510 (96.2%) of them were coagulase negative staphylococci. Only 50 (1.9%) of the flora bacteria were considered as infectious agents in terms of clinical and laboratory findings in addition to culture. A statistically significant correlation was found between true bacteremia and white blood cell (WBC) count and C-reactive protein (C-RP) levels (p &lt;0.05).&#x0D; Conclusion: Peripheral blood collection instead of catheter and using special phlebotomy teams should be taken into consideration in order to reduce contamination rates precautions such as adequate skin preparation, preparation of blood culture bottles and using single needle instead of double needle.&#x0D; Bangladesh Journal of Medical Science Vol.20(2) 2021 p.288-292

The Disinfection Method Recommended in the Guideline Reduced Contamination Rate in Blood Cultures from the Groin Area - Evaluation using Blood Culture Performed by One Skillful Physician

目的：血液培養のガイドラインでは，陽性率5～15%，汚染率2～3%以下が適切とされる．鼠径部からの採血はコンタミネーションが増えると言われているが，当院では圧倒的に鼠径部からの採血で行う事が多い．2016年よりガイドラインに準じた消毒方法を遵守し，それにより鼠径部からのコンタミネーションが軽減できるかどうかを検証した．個人間の手技の違いを排除するため，検証にあたり特定の1名の医師が採血した検体のみを取り上げた．

Blood Culture Collection Teams Reduce Contamination Rates and Reduce Central Line Associated Blood Stream Infections

<h3>Background</h3> Blood culture contaminations increase hospital costs and generate inappropriate identification of central line-associated blood stream infections. A 300+ bed hospital in the Midwest had contamination rates higher than the national average of < 2% and 68% percent of the central line-associated blood stream infections that occurred were related to blood culture contaminations. Trial objectives are to review evidence-based practice related to blood culture collection practices, create a specialized team to collect blood cultures, and monitor the blood culture contamination rates as well as central line-associated blood stream infections. <h3>Methods</h3> Blood culture team members were educated from July 2018 through December 2018 and initiation began January 2019. Infection Prevention reviewed contaminations and shared opportunities for improvement. During the trial period, directors focused on central line removal and the blood culture team was not consistently utilized potentially impacting the study outcome. The facility's goal was to reduce contaminations and central line-associated blood stream infections. Chi-Square test of independence was performed to examine the relation between blood culture team and the ability to reduce contaminations (p-value < .05). Correlation coefficient was calculated to determine correlation between blood culture contaminations and central line-associated blood stream infections. <h3>Results</h3> When comparing the nonintervention period (January 2017-October 2017) to the study period (January 2019-October 2019), blood culture contaminations were reduced by 81 contaminations. The relation between these variables was significant, X2 (1, N=13867) = 24.55, p < .001. Central line-associated blood stream infections were reduced by 11. Number of contaminations and central line-associated blood stream infections were found to be moderately positively correlated, r (32), p = .034. <h3>Conclusions</h3> Blood culture collection teams significantly reduce blood culture contamination rates (p < .001) as well as central line-associated blood stream infections (p = .034). Reducing contamination rates reduced hospital costs and improved quality of care.

Mobile app-aided risks, attitudes, norms, abilities and self-regulation (RANAS) approach for recycling behavioral change in Singapore

Given the need to conserve energy, natural resources and landfill space, the necessity to recycle has never been more pressing. However, efforts to improve recycling rates and to reduce contamination rates have seen limited success. This study proposes a new mobile app-aided RANAS approach for recycling behavioral change in Singapore with the goal to increase household recycling rates while reducing the proportion of contaminants in recyclables. The recycling program was developed according to the RANAS model which is a behavioral change model that connects behavioral factors with behavioral interventions through designing and evaluating behavioral change strategies that target and change the behavioral factors influencing a specific behavior in a specific population. The program, with the use of a mobile app platform, was based on tracking each user's recyclable contribution by issuing personal QR code stickers. Two experimental campaigns were launched to evaluate the effectiveness of the mobile app-aided RANAS approach for recycling behavioral change. Results show that the mobile app-aided RANAS approach to incorporate sense of ownership greatly encourages recycling rates to above 40% (vs. 20% for the current household recycling rate in Singapore) and significantly reduces contamination rates to below 2% (vs. 40% for the national average contamination rate). Incentives and rewards program can strongly influence mix of recyclables collected. Furthermore, the mobile app-aided RANAS approach is able to achieve intervention of recycling behavioral changes and has the potential to be used as an action-based training tool to educate individuals about the environmental impacts of recycling.

Microbial Cross-contamination in Multidose Eyedrops: The Impact of Instillation Angle and Bottle Geometry.

PurposeTo evaluate the impact of instillation angle and nozzle tip geometry on cross-contamination risk of multidose ocular solution bottles.Methods Pseudomonas aeruginosa solution was passed exclusively on the outside of the nozzle to simulate contamination on the exterior of topical agents. Three drops were administered from angles of 90° and 45° from bottles with either a round or sharp tip geometry, and the cultures were examined for growth. Two-hundred sixteen cultures from nine lubricant eyedrop brands currently existing in the Brazilian market were assessed for bacterial growth.ResultsAfter seven days, bacterial contamination was detected in 53.7% of cultures when drops were administered at 90° and in 70.4% of cultures at 45°. Eyedrops collected from a rounded nozzle tip and an instillation angle of 90° transmitted bacteria in 69.4% of cases, whereas those administered from a sharp tip transmitted bacteria in only 22.2% of cases (P = 0.001). At an instillation angle of 45°, contamination was identified in 83.3% of bottles with a rounded tip geometry and in only eight of 18 bottles (44.4%) from those with a sharp nozzle geometry (P = 0.005).ConclusionsAdjusting the instillation angle of eyedrop solutions to 90°, as well as using a nozzle geometry that prevents flow of the solution to the side of the bottle, significantly reduced contamination rates.Translational RelevanceStandardizing drop bottles and adjusting delivery angle shows promise in reducing contamination rates and may critically impact the quality of care for patients requiring topical therapeutic agents.