Acceptability and tolerability of liquid versus gel and standard versus virucidal alcohol-based hand rub formulations among dental students.

BACKGROUND: Hand hygiene is effective to prevent the transmission of microorganisms in health care settings, but compliance remains low, even when easy access to hand cleaning agents is provided. OBJECTIVE: Formulation of alcohol-based hand rub (ABHRs) may influence staff compliance to hand hygiene. The aim of this prospective longitudinal study (1 week) was to investigate possible differences of 4 different gel or liquid ABHR formulations, with or without virucidal claim among dental students. METHODS: Participants were randomly assigned to dental treatment cubicles, equipped with either a gel or a liquid based ABHRs, with our without a virucidal claim. Participants assessed the subjective acceptability and the tolerability of test formulations on their hands over a period of 1 week using the 14 item, 7-point Lickert scale World Health Organization questionnaire. RESULTS: All tested ABHRs passed the subjective acceptability criteria of ≥50% above 4 for the items "color and fragrance" and for all other items of >75% above 4 and may be regarded as "good." Significant differences were observed between the 2 gels but not between the 2 liquid ABHRs. For subjective skin tolerability, no significant difference was observed between the liquid formulations after 1 consecutive week of application. However, the difference between the 2 gels was highly significant. CONCLUSION: Virucidal ABHR formulations may be better accepted and tolerated over prolonged periods by dental students than anticipated. The user acceptability of ABHRs depend more on the specific product's formula than its general category.

Testing for aerobic heterotrophic bacteria allows no prediction of contamination with potentially pathogenic bacteria in the output water of dental chair units.

BACKGROUND: Currently, to our knowledge, quality of output water of dental chair units is not covered by specific regulations in the European Union, and national recommendations are heterogeneous. In Germany, water used in dental chair units must follow drinking water quality. In the United States of America, testing for aerobic heterotrophic bacteria is recommended. The present study was performed to evaluate whether the counts of aerobic heterotrophic bacteria correlate with the presence of potentially pathogenic bacteria such as Legionella spp. or Pseudomonas aeruginosa. METHODS: 71 samples were collected from 26 dental chair units with integrated disinfection device and 31 samples from 15 outlets of the water distribution pipework within the department were examined. Samples were tested for aerobic heterotrophic bacteria at 35°C and 22°C using different culture media and for Legionella spp. and for Pseudomonas aeruginosa. Additionally, strains of Legionella pneumophila serogroup 1 were typed with monoclonal antibodies and representative samples of Legionella pneumophila serogroup 1 were typed by sequence based typing. RESULTS: Our results showed a correlation between different agars for aerobic heterotrophic bacteria but no correlation for the count of aerobic heterotrophic bacteria and the presence of Legionella spp. or Pseudomonas aeruginosa. CONCLUSION: Testing for aerobic heterotrophic bacteria in output water or water distribution pipework within the departments alone is without any value for predicting whether the water is contaminated with potentially pathogenic bacteria like Legionella spp. or Pseudomonas aeruginosa.

Reprocessing of dental instruments in washer-disinfectors: does a representative test soil exist in dentistry?

BACKGROUND: Reprocessing of medical devices, being classified as semi-critical B is recommended to be performed in a washer-disinfector. In order to estimate, whether the expected contaminants of the various medical disciplines can be effectively removed by this washer-disinfector, different so called "test soils" have been proposed to be tested as a marker of cleaning efficacy of the disinfector. Todays described test soils are optimised for the testing of contaminations occurring in surgical procedures, but not for dental procedures. METHODS: In this study the test soils being proposed in the EN 15883-5 (e.g. KMNE soil, recipe by Koller and coagulated sheep's blood) were compared with 8 reference substances used in the conservative-prosthetic dental practice. The success of the cleaning efficacy in the washer-disinfector was checked visually and by determining the residual protein concentration on the contaminated instruments after the cleaning procedure. RESULTS: It could be shown that in contrast to the proposed test soils of the EN 15883-5, the used reference substances of the dental practice could not be removed by the washer-disinfector. Removal of these reference substances was only possible after manual or ultrasonic cleaning. CONCLUSIONS: Since blood plays a subordinate role as a contaminant of instruments during conservative-prosthetic dental treatments, testing of the cleaning efficacy of the washer-disinfector with test soils according to the proposals of the EN 15883-5 is not representative in this discipline of dentistry. Most of the materials used in dental practice can only be removed manually or with the help of the ultrasound bath.

A comparison study of two different control criteria for the real-time management of urban groundwater works.

We present the comparison of two control criteria for the real-time management of a water well field. The criteria were used to simulate the operation of the Hardhof well field in the city of Zurich, Switzerland. This well field is threatened by diffuse pollution in the subsurface of the surrounding city area. The risk of attracting pollutants is higher if the pumping rates in four horizontal wells are increased, and can be reduced by increasing artificial recharge in several recharge basins and infiltration wells or by modifying the artificial recharge distribution. A three-dimensional finite elements flow model was built for the Hardhof site. The first control criterion used hydraulic head differences (Δh-criterion) to control the management of the well field and the second criterion used a path line method (%s-criterion) to control the percentage of inflowing water from the city area. Both control methods adapt the allocation of artificial recharge (AR) for given pumping rates in time. The simulation results show that (1) historical management decisions were less effective compared to the optimal control according to the two different criteria and (2) the distribution of artificial recharge calculated with the two control criteria also differ from each other with the %s-criterion giving better results compared to the Δh-criterion. The recharge management with the %s-criterion requires a smaller amount of water to be recharged. The ratio between average artificial recharge and average abstraction is 1.7 for the Δh-criterion and 1.5 for the %s-criterion. Both criteria were tested online. The methodologies were extended to a real-time control method using the Ensemble Kalman Filter method for assimilating 87 online available groundwater head measurements to update the model in real-time. The results of the operational implementation are also satisfying in regard of a reduced risk of well contamination.

Real-time management of an urban groundwater well field threatened by pollution.

We present an optimal real-time control approach for the management of drinking water well fields. The methodology is applied to the Hardhof field in the city of Zurich, Switzerland, which is threatened by diffuse pollution. The risk of attracting pollutants is higher if the pumping rate is increased and can be reduced by increasing artificial recharge (AR) or by adaptive allocation of the AR. The method was first tested in offline simulations with a three-dimensional finite element variably saturated subsurface flow model for the period January 2004-August 2005. The simulations revealed that (1) optimal control results were more effective than the historical control results and (2) the spatial distribution of AR should be different from the historical one. Next, the methodology was extended to a real-time control method based on the Ensemble Kalman Filter method, using 87 online groundwater head measurements, and tested at the site. The real-time control of the well field resulted in a decrease of the electrical conductivity of the water at critical measurement points which indicates a reduced inflow of water originating from contaminated sites. It can be concluded that the simulation and the application confirm the feasibility of the real-time control concept.

Uncertainty estimation of pathlines in ground water models.

A method is proposed to estimate the uncertainty of the location of pathlines in two-dimensional, steady-state confined or unconfined flow in aquifers due to the uncertainty of the spatially variable unconditional hydraulic conductivity or transmissivity field. The method is based on concepts of the semianalytical first-order theory given in Stauffer et al. (2002, 2004), which allows estimates of the lateral second moment (variance) of the location of a moving particle. However, this method is reformulated in order to account for nonuniform recharge and nonuniform aquifer thickness. One prominent application is the uncertainty estimation of the catchment of a pumping well by considering the boundary pathlines starting at a stagnation point. In this method, the advective transport of particles is considered, based on the velocity field. In the case of a well catchment, backtracking is applied by using the reversed velocity field. Spatial variability of hydraulic conductivity or transmissivity is considered by taking into account an isotropic exponential covariance function of log-transformed values with parameters describing the variance and correlation length. The method allows postprocessing of results from ground water models with respect to uncertainty estimation. The code PPPath, which was developed for this purpose, provides a postprocessing of pathline computations under PMWIN, which is based on MODFLOW. In order to test the methodology, it was applied to results from Monte Carlo simulations for catchments of pumping wells. The results correspond well. Practical applications illustrate the use of the method in aquifers.

Snapshot of moving and expanding clones of Mycobacterium tuberculosis and their global distribution assessed by spoligotyping in an international study.

The present update on the global distribution of Mycobacterium tuberculosis complex spoligotypes provides both the octal and binary descriptions of the spoligotypes for M. tuberculosis complex, including Mycobacterium bovis, from >90 countries (13,008 patterns grouped into 813 shared types containing 11,708 isolates and 1,300 orphan patterns). A number of potential indices were developed to summarize the information on the biogeographical specificity of a given shared type, as well as its geographical spreading (matching code and spreading index, respectively). To facilitate the analysis of hundreds of spoligotypes each made up of a binary succession of 43 bits of information, a number of major and minor visual rules were also defined. A total of six major rules (A to F) with the precise description of the extra missing spacers (minor rules) were used to define 36 major clades (or families) of M. tuberculosis. Some major clades identified were the East African-Indian (EAI) clade, the Beijing clade, the Haarlem clade, the Latin American and Mediterranean (LAM) clade, the Central Asian (CAS) clade, a European clade of IS6110 low banders (X; highly prevalent in the United States and United Kingdom), and a widespread yet poorly defined clade (T). When the visual rules defined above were used for an automated labeling of the 813 shared types to define nine superfamilies of strains (Mycobacterium africanum, Beijing, M. bovis, EAI, CAS, T, Haarlem, X, and LAM), 96.9% of the shared types received a label, showing the potential for automated labeling of M. tuberculosis families in well-defined phylogeographical families. Intercontinental matches of shared types among eight continents and subcontinents (Africa, North America, Central America, South America, Europe, the Middle East and Central Asia, and the Far East) are analyzed and discussed.

Global distribution of Mycobacterium tuberculosis spoligotypes.

We present a short summary of recent observations on the global distribution of the major clades of the Mycobacterium tuberculosis complex, the causative agent of tuberculosis. This global distribution was defined by data-mining of an international spoligotyping database, SpolDB3. This database contains 11708 patterns from as many clinical isolates originating from more than 90 countries. The 11708 spoligotypes were clustered into 813 shared types. A total of 1300 orphan patterns (clinical isolates showing a unique spoligotype) were also detected.