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1.
Infect Control Hosp Epidemiol ; 39(5): 571-577, 2018 05.
Article in English | MEDLINE | ID: mdl-29485019

ABSTRACT

OBJECTIVEMultidrug-resistant organisms (MDROs) are increasingly reported in residential care homes for the elderly (RCHEs). We assessed whether implementation of directly observed hand hygiene (DOHH) by hand hygiene ambassadors can reduce environmental contamination with MDROs.METHODSFrom July to August 2017, a cluster-randomized controlled study was conducted at 10 RCHEs (5 intervention versus 5 nonintervention controls), where DOHH was performed at two-hourly intervals during daytime, before meals and medication rounds by a one trained nurse in each intervention RCHE. Environmental contamination by MRDOs, such as methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Acinetobacter species (CRA), and extended-spectrum ß-lactamse (ESBL)-producing Enterobacteriaceae, was evaluated using specimens collected from communal areas at baseline, then twice weekly. The volume of alcohol-based hand rub (ABHR) consumed per resident per week was measured.RESULTSThe overall environmental contamination of communal areas was culture-positive for MRSA in 33 of 100 specimens (33%), CRA in 26 of 100 specimens (26%), and ESBL-producing Enterobacteriaceae in 3 of 100 specimens (3%) in intervention and nonintervention RCHEs at baseline. Serial monitoring of environmental specimens revealed a significant reduction in MRSA (79 of 600 [13.2%] vs 197 of 600 [32.8%]; P<.001) and CRA (56 of 600 [9.3%] vs 94 of 600 [15.7%]; P=.001) contamination in the intervention arm compared with the nonintervention arm during the study period. The volume of ABHR consumed per resident per week was 3 times higher in the intervention arm compared with the baseline (59.3±12.9 mL vs 19.7±12.6 mL; P<.001) and was significantly higher than the nonintervention arm (59.3±12.9 mL vs 23.3±17.2 mL; P=.006).CONCLUSIONSThe direct observation of hand hygiene of residents could reduce environmental contamination by MDROs in RCHEs.Infect Control Hosp Epidemiol 2018;39:571-577.


Subject(s)
Cross Infection/microbiology , Cross Infection/prevention & control , Hand Disinfection/methods , Hand Hygiene/statistics & numerical data , Hand Sanitizers/therapeutic use , Acinetobacter/isolation & purification , Aged , Aged, 80 and over , Carbapenems , Cross Infection/epidemiology , Enterobacteriaceae/isolation & purification , Female , Guideline Adherence , Homes for the Aged , Hong Kong/epidemiology , Humans , Male , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections
2.
Clin Infect Dis ; 64(suppl_2): S98-S104, 2017 May 15.
Article in English | MEDLINE | ID: mdl-28475794

ABSTRACT

The first human H5N1 case was diagnosed in Hong Kong in 1997. Since then, experience in effective preparedness strategies that target novel influenza viruses has expanded. Here, we report on avian influenza preparedness in public hospitals in Hong Kong to illustrate policies and practices associated with control of emerging infectious diseases. The Hong Kong government's risk-based preparedness plan for influenza pandemics includes 3 response levels for command, control, and coordination frameworks for territory-wide responses. The tiered levels of alert, serious, and emergency response enable early detection based on epidemiological exposure followed by initiation of a care bundle. Information technology, laboratory preparedness, clinical and public health management, and infection control preparedness provide a comprehensive and generalizable preparedness plan for emerging infectious diseases.


Subject(s)
Communicable Diseases, Emerging/prevention & control , Disease Outbreaks/prevention & control , Influenza in Birds/prevention & control , Influenza, Human/prevention & control , Severe Acute Respiratory Syndrome/prevention & control , Animals , Chickens/virology , Communicable Diseases, Emerging/epidemiology , Communicable Diseases, Emerging/virology , Hong Kong/epidemiology , Hospitals, Public/legislation & jurisprudence , Humans , Influenza A Virus, H5N1 Subtype/isolation & purification , Influenza in Birds/epidemiology , Influenza, Human/epidemiology , Influenza, Human/virology , Pandemics/prevention & control , Poultry Diseases/prevention & control , Poultry Diseases/virology , Severe Acute Respiratory Syndrome/epidemiology , Severe Acute Respiratory Syndrome/virology
4.
Hum Immunol ; 71(7): 702-7, 2010 Jul.
Article in English | MEDLINE | ID: mdl-20359516

ABSTRACT

CD209 (DC-SIGN) is an important C-type lectin which acts a receptor of many pathogens. The single nucleotide polymorphism (SNP) -336A>G in the CD209 promoter has been demonstrated to regulate promoter activity and to be associated with several important infectious diseases, such as human immunodeficiency virus-1 (HIV-1), Mycobacterium tuberculosis, and Dengue fever. CD209 facilitates severe acute respiratory syndrome (SARS)-coronavirus spike protein-bearing pseudotype driven infection of permissive cells in vitro. In keeping with previously published findings, our in vitro studies confirmed that this SNP modulates gene promoter activity. Genetic association analysis of this SNP with clinico-pathologic outcomes in 824 serologic confirmed SARS patients showed that the -336AG/GG genotype SARS patients was associated with lower standardized lactate-dehydrogenase (LDH) levels compared with the -336AA patients (p = 0.014, odds ratio = 0.40). High LDH levels are known to be an independent predictor for poor clinical outcome, probably related to tissue destruction from immune hyperactivity. Hence, SARS patients with the CD209 -336 AA genotype carry a 60% chance of having a poorer prognosis. This association is in keeping with the role of CD209 in modulating immune response to viral infection. The relevance of these findings for other infectious diseases and inflammatory conditions would be worth investigating.


Subject(s)
Cell Adhesion Molecules/genetics , Lectins, C-Type/genetics , Polymorphism, Single Nucleotide/genetics , Promoter Regions, Genetic/genetics , Receptors, Cell Surface/genetics , Severe Acute Respiratory Syndrome/genetics , Adult , Antigens, CD/genetics , Asian People/genetics , Cell Adhesion Molecules/metabolism , DNA/metabolism , DNA Probes/genetics , Electrophoretic Mobility Shift Assay , Female , Gene Frequency/genetics , Genotype , HeLa Cells , Heterozygote , Homozygote , Hong Kong , Humans , L-Lactate Dehydrogenase/blood , Lectins, C-Type/metabolism , Male , Middle Aged , Nuclear Proteins/metabolism , Protein Binding/genetics , Receptors, Cell Surface/metabolism , Severe Acute Respiratory Syndrome/blood , Sp1 Transcription Factor/genetics , Transcription Factor AP-2/genetics , Transfection
5.
J Infect Dis ; 196(2): 271-80, 2007 Jul 15.
Article in English | MEDLINE | ID: mdl-17570115

ABSTRACT

Genetic polymorphisms have been demonstrated to be associated with vulnerability to human infection. ICAM3, an intercellular adhesion molecule important for T cell activation, and FCER2 (CD23), an immune response gene, both located on chromosome 19p13.3, were investigated for host genetic susceptibility and association with clinical outcome. A case-control study based on 817 patients with confirmed severe acute respiratory syndrome (SARS), 307 health care worker control subjects, 290 outpatient control subjects, and 309 household control subjects unaffected by SARS from Hong Kong was conducted to test for genetic association. No significant association to susceptibility to SARS infection caused by the novel coronavirus (SARS-CoV) was found for the FCER2 and the ICAM3 single nucleotide polymorphisms. However, patients with SARS homozygous for ICAM3 Gly143 showed significant association with higher lactate dehydrogenase levels (P=.0067; odds ratio [OR], 4.31 [95% confidence interval {CI}, 1.37-13.56]) and lower total white blood cell counts (P=.022; OR, 0.30 [95% CI, 0.10-0.89]) on admission. These findings support the role of ICAM3 in the immunopathogenesis of SARS.


Subject(s)
Antigens, CD/genetics , Cell Adhesion Molecules/genetics , Genetic Predisposition to Disease , L-Lactate Dehydrogenase/blood , Polymorphism, Single Nucleotide/genetics , Severe Acute Respiratory Syndrome/genetics , Adolescent , Adult , Aged , Aged, 80 and over , Case-Control Studies , Child , Child, Preschool , Female , Gene Frequency , Genotype , Humans , Leukocyte Count , Male , Middle Aged , Severe Acute Respiratory Syndrome/physiopathology
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