Management of infection control in dental practice.

This was an observational study in which the management policies and procedures associated with infection control and instrument decontamination were examined in 179 dental surgeries by a team of trained surveyors. Information relating to the management of a wide range of infection control procedures, in particular the decontamination of dental instruments, was collected by interview and by examination of practice documentation. This study found that although the majority of surgeries (70%) claimed to have a management policy on infection control, only 50% of these were documented. For infection control policies, 79% of surgeries had access to the British Dental Association Advice Sheet A12. Infection control policies were claimed to be present in 89% of surgeries, of which 62% were documented. Seventy-seven per cent of staff claimed to have received specific infection control training, but for instrument decontamination this was provided mainly by demonstration (97%) or observed practice (88%). Many dental nurses (74%) and dental practitioners (57%) did not recognise the symbol used to designate a single-use device. Audit of infection control or decontamination activities was undertaken in 11% of surgeries. The majority of surgeries have policies and procedures for the management of infection control in dental practice, but in many instances these are not documented. The training of staff in infection control and its documentation is poorly managed and consideration should be given to development of quality management systems for use in dental practice.

Post-discharge surgical site infection surveillance by automated telephony.

Surgical site infection (SSI) is an important outcome indicator after surgery and is part of a national programme of surveillance in Scotland. Post-discharge surveillance has important cost implications for both primary and acute areas of the NHS and it is therefore important to establish a robust method to obtain these data. This study used an automated telephony system to gain information on SSI developing post-discharge. The patients included were those who had inpatient surveillance carried out following hip and knee replacements, and cardiac surgery. A recorded message was used to ask the patient questions concerning the state of their wound. These questions were answered by pressing numbers on their phone. The study population was 104 and there were 18 patients who thought they had a wound infection but after clarification only nine patients suffered a post-discharge SSI. The number of patients who responded with at least one call to the system was 62. Although this pilot study was carried out with small numbers, it was felt that with certain refinements it should continue to be used for post-discharge surgical site surveillance of infection.

Getting research into practice: developing oral hygiene standards.

In 1997, the then Victoria Infirmary NHS Trust established a nursing research and practice development committee (NRPDC) to implement evidence-based practice in nursing care in response to its nursing strategy for 1998-2000. A survey of nursing projects was undertaken in 1996 and repeated in spring of 1998. Initially, 107 projects were identified which included 58 reviews of the literature. In 1998, 95 projects were identified with 42 reviews of literature. The number of research projects being undertaken by nurses in the trust increased from four to 15 and the number of audits increased from nine to 45. The NRPDC established a link nurse system to assist in developing practice at ward level and they have been offering a series of educational seminars. Oral hygiene was the first topic tackled trustwide, with a mouth care standard developed and staff knowledge subsequently surveyed 6 months after it was put into practice. Results demonstrated a good level of knowledge for general oral hygiene among trained and untrained staff. However, specialist oral care and care of stomatitis require some further updating. This survey has identified the increasing sophistication of the projects being undertaken by the nursing staff across the trust and the support they are receiving. This arrangement has provided the opportunity to demonstrate the impact of having a senior researcher available for advice at trust level. The NRPDC can improve the quality of evidence-based care delivered within the trust and it can provide a model for the implementation of evidence-based practice.

Wound care. Discharged but not forgotten.

A pilot study assessed a methodology for establishing the incidence of post-discharge surgical wound infections. An infection rate of 13% was recorded. The eight patients who developed infections generated 35 clinical episodes. This could have resource implications for early discharge after surgery.

Overexpression of metallothionein in the heart of transgenic mice suppresses doxorubicin cardiotoxicity.

Metallothionein (MT) may provide protection against doxorubicin-induced heart damage. To test this hypothesis, a heart-specific promoter was used to drive the expression of human MT-IIa gene in transgenic mice. Four healthy transgenic mouse lines were produced. Cardiac MT was constitutively overexpressed from 10- to 130-fold higher than normal. The MT concentration was not altered in liver, kidneys, lungs, or skeletal muscles. Other antioxidant components including glutathione, glutathione peroxidase, glutathione reductase, catalase, and superoxide dismutase were not altered in the MT-overexpressing heart. Mice (7-wk-old) from transgenic lines expressing MT activity 10- or 130-fold higher than normal and from nontransgenic controls were treated intraperitoneally with doxorubicin at a single dose of 20 mg/kg, and were killed on the 4th day after treatment. As compared to normal controls, transgenic mice exhibited a significant resistance to in vivo doxorubicin-induced cardiac morphological changes, and the increase in serum creatine phosphokinase activity. Atria isolated from transgenic mice and treated with doxorubicin in tissue bath was also more resistant to functional damage induced by this drug. The results provide direct evidence for the role of MT in cardioprotection against doxorubicin toxicity.

Human trichostrongyliasis in Queensland.

Trichostrongylus infection, an uncommonly reported zoonosis in Australia, is common in parts of the world where there is close human contact with herbivorous animals. We report 5 cases diagnosed in our laboratory since 1992. Over this period the laboratory has conducted over 46,000 parasitological examinations on feces. All 5 cases were investigated for fecal parasites following detection of a blood eosinophilia. Two of the 5 cases complained of mild abdominal discomfort and diarrhea. It is likely that all obtained their infection following ingestion of contaminated unwashed vegetables which had been fertilized with animal manure. Four of the cases acquired their infection in Queensland and the fifth may have become infected in rural Victoria. All were treated with pyrantel embonate with resolution of the eosinophilia. Follow up fecal specimens showed no parasites. Patients were instructed on the mode of transmission and advised to thoroughly wash any uncooked vegetables prior to ingestion. In our cases, goats and horses were possibly implicated. No published reports of Trichostrongylus spp. in humans in Australia have occurred since the 1930s and it may be more common in Australia than is recognized. The infection may be missed because patients are asymptomatic or have mild gastrointestinal symptoms or only a blood eosinophilia. Trichostrongylus eggs may also be mistaken for hookworm eggs. It is important therefore to distinguish these infections from hookworm infection as the modes of transmission, management and advice regarding prevention differ.

Insulin synthesis, secretory competence, and glucose utilization are sensitized by transgenic yeast hexokinase.

Glucokinase regulates insulin secretion by controlling the rate of glucose phosphorylation. In this report we utilize islets transgenic for high affinity yeast hexokinase to examine the role of glucose phosphorylation on other beta cell functions. Normal pancreatic islets responded to culture in low glucose by lowering insulin synthetic rates, becoming depleted of insulin and insulin mRNA, losing competence to respond to glucose with increased insulin secretion, and lowering glucokinase levels by one-half. In transgenic islets, increased high affinity hexokinase activity provided significant protection against reductions in all parameters of insulin synthesis and helped preserve the competence of beta cells to secrete insulin. The transgenic hexokinase also increased the rate of glucose utilization. These results demonstrate that glucose phosphorylation and presumably glucokinase mediate these glucose regulated responses. Of the parameters measured, only the change in glucokinase activity did not show an effect of the yeast hexokinase transgene. We also found that yeast hexokinase transgene expression was regulated 10-fold by glucose. This is the first demonstration of glucose inducibility of the insulin promoter in transgenic mice.

True aneurysm formation in femoropopliteal autogenous vein bypass grafts: two cases.

This paper describes two cases of true atheromatous aneurysm formation within reversed autogenous saphenous vein used for femoropopliteal bypass graft. We note the rarity of this complication and review the literature for true aneurysm formation within vein grafts used for this and other bypass procedures.