Evaluating the effectiveness of ultraviolet-C lamps for reducing keyboard contamination in the intensive care unit: A longitudinal analysis.

BACKGROUND: Ultraviolet (UV) spectrum light for decontamination of patient care areas is an effective way to reduce transmission of infectious pathogens. Our purpose was to investigate the efficacy of an automated UV-C device to eliminate bioburden on hospital computer keyboards. METHODS: The study took place at an academic hospital in Chicago, Illinois. Baseline cultures were obtained from keyboards in intensive care units. Automated UV-C lamps were installed over keyboards and mice of those computers. The lamps were tested at varying cycle lengths to determine shortest effective cycles. Delay after use and prior to cycle initiation was varied to minimize cycle interruptions. Finally, 218 postinstallation samples were analyzed. RESULTS: Of 203 baseline samples, 193 (95.1%) were positive for bacteria, with a median of 120 colony forming units (CFU) per keyboard. There were numerous bacteria linked to health care-associated infections (HAIs), including Staphylococcus, Streptococcus, Enterococcus, Pseudomonas, Pasteurella, Klebsiella, Acinetobacter, and Enterobacter. Of the 193 keyboards, 25 (12.3%) had gram-negative species. Of 218 postinstallation samples, 205 (94%) were sterile. Of the 13 that showed bacterial growth, 6 produced a single CFU. Comparison of pre- and post-UV decontamination median CFU values (120 and 0, respectively) revealed a >99% reduction in bacteria. CONCLUSIONS: The UV lamp effectively decontaminates keyboards with minimal interruption and low UV exposure. Further studies are required to determine reduction of HAI transmission with use of these devices.

Longitudinal changes in airway remodeling and air trapping in severe asthma.

RATIONALE AND OBJECTIVES: Previous cross-sectional studies have demonstrated that airway wall thickness and air trapping are greater in subjects with severe asthma than in those with mild-to-moderate asthma. However, a better understanding of how airway remodeling and lung density change over time is needed. This study aimed to evaluate predictors of airway wall remodeling and change in lung function and lung density over time in severe asthma. MATERIALS AND METHODS: Phenotypic characterization and quantitative multidetector-row computed tomography (MDCT) of the chest were performed at baseline and ∼2.6 years later in 38 participants with asthma (severe n = 24 and mild-to-moderate n = 14) and nine normal controls from the Severe Asthma Research Program. RESULTS: Subjects with severe asthma had a significant decline in postbronchodilator forced expiratory volume in 1 second percent (FEV1%) predicted over time (P < .001). Airway wall thickness measured by MDCT was increased at multiple airway generations in severe asthma compared to mild-to-moderate asthma (wall area percent [WA%]: P < .05) and normals (P < .05) at baseline and year 2. Over time, there was an increase in WA% and wall thickness percent (WT%) in all subjects (P = .030 and .009, respectively) with no change in emphysema-like lung or air trapping. Baseline prebronchodilator FEV1% inversely correlated with WA% and WT% (both P < .05). In a multivariable regression model, baseline WA%, race, and health care utilization were predictors of subsequent airway remodeling. CONCLUSIONS: Severe asthma subjects have a greater decline in lung function over time than normal subjects or those with mild-to-moderate asthma. MDCT provides a noninvasive measure of airway wall thickness that may predict subsequent airway remodeling.

Severe asthma: what makes it so hard to manage?

Severe asthma presents significant management challenges. Patients can be difficult to control despite use of current standard-of-care therapy, including inhaled corticosteroids and long-acting beta-agonists. Alternative diagnoses, noncompliance, and comorbidities all can influence asthma control, future risk, and response to currently available therapy. Definitions of severe asthma evaluate and address these confounding variables, and yet patients are still symptomatic despite aggressive, appropriate therapy. Severe asthma has a distinct pathophysiology including airway remodeling that contributes to the decreased effectiveness of standard therapy. Multiple phenotypes exist within severe asthma that likely require distinct therapeutic approaches to achieve control and improve long-term health outcomes. New therapeutic approaches to these distinct phenotypes will improve our understanding and treatment of this difficult-to-manage disease.