Multifactor Assessment of Non-Antimicrobial Soap Performance.

A non-antimicrobial soap was benchmarked against 2 reference soaps for microbial removal and skin compatibility, key factors in soap effectiveness and usage. The non-antimicrobial test soap removed more Staphylococcus aureus (P = .024) when applied to nonwetted hands and showed no difference in skin barrier function compared with the reference soaps (P = .736).

Health care worker hand contamination at critical moments in outpatient care settings.

BACKGROUND: The delivery of health care in outpatient settings has steadily increased over the past 40 years. The risk of infection in these settings is considered to be low. However, the increasing severity of illness and complexity of care in outpatient settings creates a need to reexamine the transmission of pathogens in this setting. MATERIALS AND METHODS: Seventeen health care workers from 4 wound care facilities were sampled during 46 patient care encounters to determine the presence of health care-associated pathogens (ie, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, multidrug-resistant Acinetobacter species, and Clostridium difficile) on their hands at key moments of care. RESULTS: Health care workers acquired at least 1 pathogen on their hands during 28.3% of all patient care encounters. Hands sampled before a clean or aseptic procedure and hands sampled after body fluid exposure risk were each contaminated in 17.4% of instances. Hand contamination occurred in 19.6% of instances where health care workers wore gloves during care compared with 14.6% when health care workers were ungloved. CONCLUSIONS: Contamination of health care workers' hands presents a significant risk of pathogen transmission in outpatient settings. Gloving education, hand hygiene solutions at the point of care, and hand hygiene surveillance are important solutions for reducing transmission of pathogenic organisms.

Local impact of 'Antenatal Screening for Down syndrome and other conditions' on diagnosis and outcomes in a fetal medicine centre in New Zealand.

AIM: In 2010, the National Screening Unit of the Ministry of Health launched 'Antenatal Screening for Down syndrome and other conditions'. Our aim was to assess the local impact of the new screening process on the number and outcomes of women attending a south island Fetal Medicine Centre. METHODS: Retrospective audit; two time periods (T1 and T2) were reviewed. Data was prospectively collected in a viewpoint database and combined with data from other hospital databases and laboratories. Outcome measures included invasive procedures done and results and MSS1 results. Statistical analysis was done using Open Epi software. RESULTS: 51% of women who were pregnant in T2 underwent MSS1 screening. There was a statistically significant decrease in the number of invasive procedures carried out 2.9% (175) vs. 4.1% (253), p0.0003 in T2. The proportion of procedures undertaken by Chorionic Villus Sampling and amniocentesis did not change. In both time periods no babies with Down syndrome were born following pregnancies where screening was undertaken and was low risk. CONCLUSIONS: The implementation of the new antenatal screening process in Canterbury has so far proved to be successful in maintaining detection rates of genetic anomalies whilst decreasing the numbers of invasive diagnostic procedures being done.

Patients' potential role in the transmission of health care-associated infections: prevalence of contamination with bacterial pathogens and patient attitudes toward hand hygiene.

BACKGROUND: Transmission of health care-associated infections (HAIs) has been primarily attributed to health care workers, and hand hygiene is considered the most important means to reduce transmission. Whereas hand hygiene research has focused on reducing health care worker hand contamination and improving hand hygiene compliance, contamination of patients' hands and their role in the transmission of HAIs remains unknown. METHODS: Patients' hands were sampled by a "glove juice" recovery method and enumerated for the presence of common health care-associated pathogens. Patient demographics and other covariates were collected to determine their association with patient hand contamination. Patient attitudes and practices toward hand hygiene were also surveyed and analyzed. RESULTS: Of the 100 patients in the study, 39% of hands were contaminated with at least 1 pathogenic organism, and 8% were contaminated with 2 or more pathogens 48 hours after admission. Patient admission from or discharge to an outside institution and self-reported functional limitations were the only covariates that were significantly associated with hand contamination. CONCLUSION: Pathogenic organisms can be frequently detected on hands of acute care patients. Future studies are needed to better understand the relationship between patient hand contamination and the acquisition of HAIs in addition to the role patient hand hygiene can play in reducing HAIs.

Patient-centered hand hygiene: the next step in infection prevention.

Hand hygiene has been recognized as the most important means of preventing the transmission of infection, and great emphasis has been placed on ways to improve hand hygiene compliance by health care workers (HCWs). Despite increasing evidence that patients' flora and the hospital environment are the primary source of many infections, little effort has been directed toward involving patients in their own hand hygiene. Most previous work involving patients has included patients as monitors or auditors of hand hygiene practices by their HCWs. This article reviews the evidence on the benefits of including patients more directly in hand hygiene initiatives, and uses the framework of patient-centered safety initiatives to provide recommendations for the timing and implementation of patient hand hygiene protocols. It also addresses key areas for further research, practice guideline development, and implications for training of HCWs.

An emerging severe leukoencephalopathy: is it due to HIV disease or highly active antiretroviral therapy?

We report an individual who had HIV-associated dementia, but a good clinical response to antiretroviral therapy, with a rising CD4 count and undetectable viral load. A severe leukoencephalopathy was noted at postmortem; however, no HIV immunopositive cells were found in the brain, suggesting that this new severe leukoencephalopathy is associated with immune reconstitution.

Quality assurance processes for designing patient education web sites.

In the future, more nurses and other healthcare professionals will be providing patient education on the Internet. Having knowledge of processes that lead to quality patient education Web site design is essential. These quality assurance processes include determining the site's purpose, selecting the user population, establishing the expected clinical and learning outcomes, providing an educational framework, incorporating specific design principles, and multiple and ongoing site evaluation. Therefore, Web site development processes designed to undergird quality patient education are presented, and an example Web site is used to illustrate them.

Management issues in syphilis.

Syphilis is a sexually transmitted infection which is systemic from the outset and has increased in incidence worldwide over the last decade. There has been concern as to whether or not co-infection with HIV can modify the clinical presentation of syphilis and, as a genital ulcer disease, it can facilitate the transmission of HIV infection. Diagnosis is based on the microscopic identification of the causative treponeme and serological testing. Recommendations for the treatment of syphilis have been based on expert opinion, case series, some clinical trials and 50 years of clinical experience. Penicillin, given intramuscularly, is the mainstay of treatment and the favoured preparations for early infectious syphilis are benzathine penicillin as a single injection or a course of daily procaine penicillin injections for 10 to 14 days. The duration of treatment is longer for late syphilis. There has been concern that benzathine penicillin may not prevent the development of neurosyphilis but that is a rare outcome with this therapy. The main alternative to penicillin is doxycycline, but the place of azithromycin and ceftriaxone is yet to be established. It is not necessary to carry out examination of the cerebrospinal fluid in patients with early infectious syphilis but it should be performed in those with neurological or ocular signs, psychiatric signs or symptoms, when there is evidence of treatment failure and in those who are co-infected with HIV. Follow-up is an essential part of management and should be particularly assiduous, for at least 24 months, in those co-infected with HIV. Partner notification should be mandatory to try to contain the spread of infection.

Services for sexually transmitted infections in the new millennium--some thoughts from the United Kingdom.

Individuals who have acquired sexually transmitted infections (STIs) have been cared for, over time, by a wide variety of practitioners. In western Europe, most care for STIs is delivered in the primary care sector with dermatovereologists providing the specialist care. With a rising incidence of STIs across Europe, it is appropriate to look at different arrangements for the future. The developing plans in the United Kingdom (UK) are described with its national sexual health strategy, targets to be met, plans for greater use of nurses and primary care and possible future developments using the internet.