Efficacy of chlorine-based disinfectants to control Legionella within premise plumbing systems.

Legionella is an opportunistic waterborne pathogen that causes Legionnaires' disease. It poses a significant public health risk, especially to vulnerable populations in health care facilities. It is ubiquitous in manufactured water systems and is transmitted via inhalation or aspiration of aerosols/water droplets generated from water fixtures (e.g., showers and hand basins). As such, the effective management of premise plumbing systems (building water systems) in health care facilities is essential for reducing the risk of Legionnaires' disease. Chemical disinfection is a commonly used control method and chlorine-based disinfectants, including chlorine, chloramine, and chlorine dioxide, have been used for over a century. However, the effectiveness of these disinfectants in premise plumbing systems is affected by various interconnected factors that can make it challenging to maintain effective disinfection. This systematic literature review identifies all studies that have examined the factors impacting the efficacy and decay of chlorine-based disinfectant within premise plumbing systems. A total of 117 field and laboratory-based studies were identified and included in this review. A total of 20 studies directly compared the effectiveness of the different chlorine-based disinfectants. The findings from these studies ranked the typical effectiveness as follows: chloramine > chlorine dioxide > chlorine. A total of 26 factors were identified across 117 studies as influencing the efficacy and decay of disinfectants in premise plumbing systems. These factors were sorted into categories of operational factors that are changed by the operation of water devices and fixtures (such as stagnation, temperature, water velocity), evolving factors which are changed in-directly (such as disinfectant concentration, Legionella disinfectant resistance, Legionella growth, season, biofilm and microbe, protozoa, nitrification, total organic carbon(TOC), pH, dissolved oxygen(DO), hardness, ammonia, and sediment and pipe deposit) and stable factors that are not often changed(such as disinfectant type, pipe material, pipe size, pipe age, water recirculating, softener, corrosion inhibitor, automatic sensor tap, building floor, and construction activity). A factor-effect map of each of these factors and whether they have a positive or negative association with disinfection efficacy against Legionella in premise plumbing systems is presented. It was also found that evaluating the effectiveness of chlorine disinfection as a water risk management strategy is further complicated by varying disinfection resistance of Legionella species and the form of Legionella (culturable/viable but non culturable, free living/biofilm associated, intracellular replication within amoeba hosts). Future research is needed that utilises sensors and other approaches to measure these key factors (such as pH, temperature, stagnation, water age and disinfection residual) in real time throughout premise plumbing systems. This information will support the development of improved models to predict disinfection within premise plumbing systems. The findings from this study will inform the use of chlorine-based disinfection within premise plumbing systems to reduce the risk of Legionnaires disease.

Effects of early warm water sitz bath on urinary retention and pain after haemorrhoidectomy: A randomized controlled trial.

BACKGROUND: Haemorrhoids are a common chronic anorectal disease, and haemorrhoidectomy is the standard treatment for advanced (grade III and IV) haemorrhoids. Warm water sitz has commonly been used to stimulate urination, cleanse wounds, and decrease pain. Although urinary retention and pain usually occur within the first 24 h after surgery, the warm water sitz bath is provided 24 h after haemorrhoidectomy, which might be a missed opportunity to optimize the quality and efficiency of the care provided. OBJECTIVE: To investigate the effect of early warm water sitz bath on the day of haemorrhoidectomy surgery on preventing urinary retention and reducing wound pain. DESIGN: This was a longitudinal double-blind study with a permuted block randomization design. SETTING(S): This study was conducted in a surgical ward of a medical center. An average of 18 patients receiving hemorrhoid surgery in that ward every month. PARTICIPANTS: A total of 64 participants (32 each in the experimental and control groups) were enrolled. (The first recruitment date is January 16, 2020.) METHODS: Patients who received haemorrhoidectomy for grade III or IV haemorrhoids from January to December 2020 were enrolled. The experimental and control groups received the same conventional treatment and care before the haemorrhoidectomy. The experimental group started warm-water sitz bath 6 h after the surgery, and the control group started warm water sitz bath on post-haemorrhoidectomy day 1 as usual. Urinary retention was defined as use of Foley catheter during the hospital stay or remaining urine volume ≧ 300 ml using the bladder scan. A numerical rating scale was used to rate the pain level. Each participant was evaluated 6 times in total until hospital discharge. The data were analysed by descriptive statistics, chi-square test, and independent samples t test. Generalized estimating equations and intention to treat were used to identify changes in urinary retention and pain over time and missing data, respectively. RESULTS: There was no significant difference in the degree of change in the number of people with urinary retention between groups. A change in the wound pain index was noted; the study group had a statistically significant lower pain score than the control group (B = -0.81, 95 % CI: -1.44 to -0.18). CONCLUSIONS: Early warm water sitz bath was a safe and effective strategy to decrease post-haemorrhoidectomy pain, but not urinary retention. Nurses could provide early warm water sitz bath for post-haemorrhoidectomy patients' comfort. REGISTRATION: ClinicalTrials.gov ID: NCT04535765.

Optimized Design of Irrigation Water-Heating System and Its Effect on Lettuce Cultivation in a Chinese Solar Greenhouse.

In cold regions, the low irrigation water temperature is an important factor of low-temperature stress for greenhouse crops. In this paper, an irrigation water-heating system (IWHS) is proposed to increase the water temperature by utilizing the excess heat in the solar greenhouse. The heat-collection capacity of the system was analyzed by screening the IWHS process parameters in a Chinese solar greenhouse, and a warm-water irrigation experiment for lettuce was conducted. The results demonstrated that the water temperature increased with the increase in wind speed, and the increase in daily average water temperature reached the maximum value of 8.6 °C at 4.5 m/s wind speed. When the heat exchanger was installed at a height of 3.0 m, the collector capacity increased by 17.8% and 6.0% compared with the heating capacity at 0 m and 1.5 m, respectively, and the operation termination water temperature was 22.0-32.2 °C and its coefficient of performance (COP) was optimal. Surface darkening of the heat exchanger did not affect the heat-collection capacity of the system. Using the IWHS effectively improved the temperature of lettuce irrigation water in the Chinese solar greenhouse. The increased frequency of warm-water irrigation significantly promoted lettuce growth and increased the average yield per plant by 15.9%. Therefore, IWHS effectively increased the irrigation water temperature in a Chinese solar greenhouse in winter. Improving the system would enhance its economic and application value.

Effects of chronic cold stress on tissue structure, antioxidant response, and key gene expression in the warm-water bivalve Chlamys nobilis.

As ectothermic invertebrates, mollusks are regarded as good environmental indicator species for determining the adverse effects of climate change on marine organisms. In the present study, the effects of cold stress on the tissue structure, antioxidant activity, and expression levels of genes were evaluated in the warm-water noble scallop Chlamys nobilis by simulating natural seawater cooled down during winter from 17 °C to 14 °C, 12 °C, 10 °C, and 9 °C. Firstly, the gill was severely damaged at 10 °C and 9 °C, indicating that it could be used as a visually indicative organ for monitoring cold stress. The methylenedioxyamphetamine (MDA) content significantly increased with the temperatures decreasing, meanwhile, the antioxidant enzyme activities superoxide dismutase (SOD) and catalase (CAT) showed a similar pattern, suggesting that the scallop made a positive response. More importantly, 6179 genes related to low temperatures were constructed in a module-gene clustering heat map including 10 modules. Furthermore, three gene modules about membrane lipid metabolism, amino acid metabolism, and molecular defense were identified. Finally, six key genes were verified, and HEATR1, HSP70B2, PI3K, and ATP6V1B were significantly upregulated, while WNT6 and SHMT were significantly downregulated under cold stress. This study provides a dynamic demonstration of the major gene pathways' response to various low-temperature stresses from a transcriptomic perspective. The findings shed light on how warm-water bivalves can tolerate cold stress and can help in breeding new strains of aquatic organisms with low-temperature resistance.

Water temperature at the time of the catch-and-release event is a better predictor of survival in Atlantic salmon (Salmo salar) than acute water temperature changes before and after.

Despite studies on the effect of catch-and-release on the survival of Atlantic salmon (Salmo salar) being widespread in the literature, studies to date have failed to evaluate the potential role of thermal history. Herein, we show that despite cooler conditions post-release, 4/18 (22%) salmon died when caught-and-released at water temperatures ≥20°C, whereas 1/13 (8%) salmon caught-and-released at water temperatures ≤20°C, but who encountered mean water temperatures ≥20°C post-release, died. We conclude water temperature at time of the catch-and-release event remains the most suitable predictor of post-release survival.

A Case Report of Food Impaction Relieved by Warm Water Drinking Therapy.

BACKGROUND: Emergency department (ED) management of esophageal food impaction without high-grade obstruction is highly variable, without definitive and validated interventions being supported in medical literature. CASE REPORT: We discuss a 34-year-old male patient with diagnosis of eosinophilic esophagitis and history of multiple food impactions presenting to the ED with a food impaction. Based on a known esophageal history with repeated failure of pharmacologic interventions, the patient was submitted to a new conservative treatment of warm water drinking. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report suggests warm water ingestion as a novel, safe, and successful treatment method in the management of esophageal food bolus impaction. As a conservative treatment not deviating greatly from current ED treatment options, it can reduce patient length of stay and decrease exposure to potential morbidity via invasive endoscopic or surgical intervention. It should be further investigated and validated with a large cohort study.

Parasympathetic Dominance Decreases the Choroidal Blood Flow Velocity Measured Using Laser Speckle Flowgraphy.

BACKGROUND: This study aimed to examine the changes to choroidal blood flow velocity using laser speckle flowgraphy (LSFG) in healthy eyes after warm water immersion at 40°C. METHODS: Data regarding the right eyes of 23 healthy volunteers were included. The mean blur rate (MBR) of the macula, which represents the choroidal blood flow velocity, was evaluated using LSFG. Intraocular pressure (IOP), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), ocular perfusion pressure (OPP), and MBR were assessed at baseline, immediately after immersion (0 minutes), and 10, 20, and 30 minutes later. RESULTS: At 0 minutes, SBP, DBP, MBP, and OPP values were lower than those at baseline. The MBR significantly declined immediately after immersion to -6.0 ± 5.2%. However, there were no changes in these parameters after 10, 20, or 30 minutes. A significant positive correlation was observed between the MBR, SBP, DBP, MBP, and OPP values. In healthy individuals, the dominant parasympathetic activity induced by warm stimulation reduced the choroidal hemodynamic rate in the macula and decreased systemic circulatory dynamics, which normalized after 10 minutes. CONCLUSIONS: These findings suggest that the dominant parasympathetic activity induced by warm water immersion at 40°C may lead to a reduction in the systemic circulation rate and choroidal blood flow rate in the macula. These findings may help prevent and treat various retinal choroidal diseases, in which sympathetic hyperactivity is involved in the pathogenesis of the disease.

Drinking Warm Water Promotes Performance by Regulating Ruminal Microbial Composition and Serum Metabolites in Yak Calves.

Yaks live in the harsh environment of the Qinghai-Tibet Plateau, and the cold climate causes lower growth efficiency. The aim of this experiment was to explore the effects of drinking warm water on the growth performance in yak calves and investigate the underlying physiological mechanisms. A total of 24 Datong yak calves were selected and randomly assigned into the cold water group (group C, water temperature around 0-10 °C without any heating; 58.03 ± 3.111 kg) and the warm water group (group W, water constantly heated at 2 °C; 59.62 ± 2.771 kg). After the 60-day experiment, body weight was measured, and rumen fluid and blood serum samples were collected for analysis. The results show that the body weight and average daily gain of yaks that drank warm water were higher compared to those that drank cold water (p < 0.05). The acetic, propionic, isobutyric, valeric, and isovaleric acid concentrations were higher in group W than in group C (p < 0.05). Additionally, warm water changed the ruminal microbes at different levels. At the phylum level, the relative abundance of Tenericutes, Kiritimatiellaeota, and Elusimicrobiota was higher in group C (p < 0.05). At the genus level, three genera were increased by warm water, including Ruminococcoides and Eubacteriales Family XIII. Incertae Sedis, and 12 genera were decreased, including Ruminococcus (p < 0.05). At the species level, unclassified Prevotellaceae and Ruminococcoides bili were increased by warm water compared to cold water (p < 0.05). According to the metabolomics results, metabolites, including valine, isoleucine, PC (15:0/22:2(13Z,16Z)), and LysoPC (18:0/0:0), were increased in the warm water group compared to the cold water group (p < 0.05), and were enriched in glycerophospholipid and amino acid metabolism pathways. This study analyzed the differences in ruminal microbes and metabolomes of yak calves provided with water at different temperatures and revealed the potential mechanism for better performance promoted by warm drinking water.

Prevention and Treatment of Nonfreezing Cold Injuries and Warm Water Immersion Tissue Injuries: Supplement to Wilderness Medical Society Clinical Practice Guidelines for the Prevention and Treatment of Frostbite.

We convened an expert panel to develop evidence-based guidelines for the evaluation, treatment, and prevention of nonfreezing cold injuries (NFCIs; trench foot and immersion foot) and warm water immersion injuries (warm water immersion foot and tropical immersion foot) in prehospital and hospital settings. The panel graded the recommendations based on the quality of supporting evidence and the balance between benefits and risks/burdens according to the criteria published by the American College of Chest Physicians. Treatment is more difficult with NFCIs than with warm water immersion injuries. In contrast to warm water immersion injuries that usually resolve without sequelae, NFCIs may cause prolonged debilitating symptoms, including neuropathic pain and cold sensitivity.

Acute Toxicity Assessment and Prediction Models of Four Heavy Metals.

Water quality criteria (WQC) are developed to protect aquatic organisms. Toxicity data of local fish are essential to improve the applicability of WQC derivatives. However, the paucity of local cold-water fish toxicity data limits the development of WQC in China. Brachymystax lenok is a representative Chinese-endemic cold-water fish, which plays an important role in the characterization of metal toxicity in the water environment. Whereas, the ecotoxicological effects of copper, zinc, lead and cadmium, as well as its potential as a test species for the metal WQC, remain to be investigated. In our study, acute toxicity tests of copper, zinc, lead and cadmium were performed on this fish according to the OECD method and 96 h-LC50 values were calculated. The results showed that the 96 h-LC50 values of Cu2+, Zn2+, Pb2+ and Cd2+ for B. lenok were 134, 222, 514 and 734 µg/L, respectively. Toxicity data for freshwater species and Chinese-native species were collected and screened, and the mean acute values of each metal for each species were ranked. The results showed that the accumulation probability of zinc by B. lenok was the lowest and less than 15%. Thus, B. lenok was sensitive to Zn and can be considered as the test cold-water fish for derivation of Zn WQC. In addition, B. lenok in comparison with warm-water fish, we found that cold-water fish are not always more sensitive to heavy metals than warm-water fish. Finally, the models for toxic effects prediction of different heavy metals on the same species were constructed and evaluated the reliability of the model. We suggest that the alternative toxicity data provided by the simulations can be used to derive WQC for metals.

"Mãos de Conforto" (Hands of Comfort): A novel non-pharmacological intervention to ease agitation in elderly persons with dementia.

Behavioral symptoms associated with dementia, such as agitation, are frequent and associated with well-known negative consequences for patients, their carers, and their environment. Pharmacological treatments for agitation using sedatives and antipsychotics are known to have several undesirable side effects and modest efficacy. Non-pharmacological alternatives are recommended as first-line options for agitation in persons with dementia with few side effects, but there is limited evidence of efficacy. We developed a novel and simple non-pharmacological alternative for agitation in dementia residents based on a Brazilian intervention using warm water surgical gloves used in patients with COVID-19 in intensive care units during the pandemic. We coined it "Mãos de Conforto" - Hands of Comfort. We report a series of 7 cases in 3 residents with dementia who whore Hands of Comfort.

CYX-5, a G-protein biassed MOP receptor agonist, DOP receptor antagonist and KOP receptor agonist, evokes constipation but not respiratory depression relative to morphine in rats.

BACKGROUND: Strong opioid analgesics such as morphine alleviate moderate to severe acute nociceptive pain (e.g. post-surgical or post-trauma pain) as well as chronic cancer pain. However, they evoke many adverse effects and so there is an unmet need for opioid analgesics with improved tolerability. Recently, a prominent hypothesis has been that opioid-related adverse effects are mediated by ß-arrestin2 recruitment at the µ-opioid (MOP) receptor and this stimulated research on discovery of G-protein biassed opioid analgesics. In other efforts, opioids with MOP agonist and δ-opioid (DOP) receptor antagonist profiles are promising for reducing side effects c.f. morphine. Herein, we report on the in vivo pharmacology of a novel opioid peptide (CYX-5) that is a G-protein biassed MOP receptor agonist, DOP receptor antagonist and kappa opioid (KOP) receptor agonist. METHODS: Male Sprague-Dawley received intracerebroventricular bolus doses of CYX-5 (3, 10, 20 nmol), morphine (100 nmol) or vehicle, and antinociception (tail flick) was assessed relative to constipation (charcoal meal and castor oil-induced diarrhoea tests) and respiratory depression (whole body plethysmography). RESULTS: CYX-5 evoked naloxone-sensitive, moderate antinociception, at the highest dose tested. Although CYX-5 did not inhibit gastrointestinal motility, it reduced stool output markedly in the castor oil-induced diarrhoea test. In contrast to morphine that evoked respiratory depression, CYX-5 increased tidal volume, thereby stimulating respiration. CONCLUSION: Despite its lack of recruitment of ß-arrestin2 at MOP, DOP and KOP receptors, CYX-5 evoked constipation, implicating a mechanism other than ß-arrestin2 recruitment at MOP, DOP and KOP receptors, mediating constipation evoked by CYX-5 and potentially other opioid ligands.

A prospective cohort study comparing neonatal outcomes of waterbirth and land birth in an Australian tertiary maternity unit.

BACKGROUND: Maternal preference for warm water immersion (WWI) and waterbirth is increasing, but adoption into obstetric guidelines and clinical practice remains limited. Concerns regarding safety and a paucity of evidence have been cited as reasons for the limited adoption and uptake. AIM: The aim was to investigate maternal and neonatal outcomes after WWI and/or waterbirth compared with land birth. MATERIALS AND METHODS: A prospective cohort study was conducted in an Australian public maternity hospital between 2019 and 2020. Maternal and neonatal outcomes for 1665 women who had a vaginal birth were studied. Primary outcome was admission to the neonatal unit (NNU). Secondary outcomes included neonatal antibiotic administration, maternal intrapartum fever, epidural use and perineal injury. Multivariate logistical regression analyses compared the outcomes between three groups: waterbirth, WWI only and land birth. RESULTS: NNU admissions for a suspected infectious condition were significantly higher in the land birth group (P = 0.035). After accounting for labour duration, epidural use and previous birth mode, no significant difference was detected between groups in the odds of NNU admission (P = 0.167). No babies were admitted to NNU with water inhalation or drowning. Women birthing on land were more likely to be febrile (2 vs 0%; P = 0.007); obstetric anal sphincter injury and postpartum haemorrhage were similar between groups. Regional analgesia use was significantly lower in the WWI group compared to the land birth group (21.02 vs 38.58%; P = <0.001). There was one cord avulsion in the waterbirth group (0.41%). CONCLUSION: Maternal and neonatal outcomes were similar between groups, with no increased risk evident in the waterbirth and WWI groups.

Warm water treatment increased mortality risk in salmon.

Thermal treatment is a controversial method to control sea lice in the Atlantic salmon farming industry. This study aimed to complement the growing evidence base to document the impact of thermal treatments on salmon welfare, behaviour, physiology and health. Here, fish were treated two times (four weeks apart) for 30 s in either 27, 30, or 33 °C warm water, and parameters were compared to a procedural control (exposed to their holding temperature of 14 °C) or a negative control (where no treatments were applied). The fish had a clear behavioural response to the warm water, despite low difference between treatment and holding temperature (Δt = 13, 16 or 19 °C). Eye damages were more prevalent in the warm water treated groups than in the controls. Little difference was recorded between treatment groups in their growth and condition factor, blood plasma values, organ health, and long-term coping ability. There was, however, a significant increase in mortality as a function of temperature after the first treatment (14 °C: 6.5%, 27 °C: 5.3%, 30 °C: 12.4% and 33 °C: 18.9% mortality). The first treatment was performed only two weeks after the fish had been tagged and moved into the experimental holding tanks, while the fish had been allowed to recover for four weeks without any handling before the second treatment. The group of fish that were not subjected to any treatments (the negative control) had no mortality throughout the entire experimental period.

Development and Characterization of Natural-Fiber-Based Composite Panels.

The emphasis on sustainability in materials related to the construction and transportation sectors has renewed interest in the usage of natural fibers. In this manuscript, a different perspective is taken in adopting oil palm fibers (OPF) to develop composite panels and understand their acoustic, mechanical, and water susceptibility (including warm water analysis) properties to provide an insight into the potential of these panels for further exploration. The binder for these composite panels is a water-based acrylic resin, and for reinforcement purposes, fly ash and other metal oxides are used. It is shown that the presence of fibers positively influences the acoustic absorption coefficient in the critical mid-frequency range of 1000-3000 Hz. Even the noise reduction coefficient values highlighting the octave band are higher by more than 50% in the presence of fibers as compared to traditional refractory boards. Quasistatic indentation and drop-weight tests have also highlighted the excellent performance of the composite panels developed in this work. Though the water immersion tests on composite panels and subsequent analysis showed relatively minor changes in their performance, the immersion of the panels in caustic warm water for 56 days has resulted in their severe degradation with a loss of more than 65% in flexural strength.

Evaluation of short-term effects of three passive aquatic interventions on chronic non-specific low back pain: Study protocol for a randomized cross-over clinical trial.

BACKGROUND: Low back pain (LBP) is among the most common physical ailments and its chronic manifestation is a leading cause for disability worldwide. LBP is not attributable to a known diagnosis in 85% of the cases and therefore called chronic non-specific LBP (cnLBP). Passive immersion in warm water is commonly claimed to reduce muscular tension and pain, but not yet sufficiently investigated with regard to cnLBP. The current study compares three passive aquatic interventions regarding their effects on cnLBP: floating (resting in a supine immersed position on flotation devices), WATSU (a passive hands-on treatment, in which a practitioner stands in warm water, gently moving and massaging the client), and a Spa session. METHODS: In this randomized cross-over clinical trial, all 24 adult participants with cnLBP will undergo the three interventions in balanced order with a washout-period of at least two weeks in between. Assessments will take place at baseline and follow-up of study and immediately before and after each intervention. Assessments cover the primary outcome self-reported current pain (Visual Analog Scale, range: 0-100 mm), other self-report questionnaires (addressing, e.g., personality traits or -states), and physiological parameters (e.g., measurement of spinal range of motion). DISCUSSION: The study adds estimates of intervention-specific effect-sizes of widespread passive aquatic interventions to cnLBP. The study also points to potential underlying pain-reducing mechanisms. TRIAL REGISTRATION: The protocol was approved by the Ethics Committee of the Canton Bern (ProjectID: 2018-00461). Trial registration is intended at ClinicalTrials.gov.

A Safe Way to Administer Drugs Through a Nutrition Tube-The Simple Suspension Method.

The simple suspension method (SSM), developed by Kurata in 1997, is a way to suspend tablets and capsules in warm water for decay and suspension prior to their administration. This method is safe and has various advantages such as the avoidance of tube clogging and the loss of the drug. This study aimed to investigate whether a higher percentage of commonly used drugs could pass through nutrition tubes effectively using SSM, relative to that using the conventional crushing method. A tablet or capsule was inserted into a 20 mL syringe with warm water (at 55 °C). After 10 min, it was shaken in the syringe. The suspension liquid was injected into tubes of the following sizes: 8 Fr, 10 Fr, 12 Fr, 14 Fr, 16 Fr, and 18 Fr. A total of 3686 tablets and 432 capsules that are frequently used in Japan were tested. Using SSM, 3377 (91.6%) tablets and 359 (83.1%) capsules disintegrated within 10 min and passed through the tube without clogging it in the tube passage test. With the conventional crushing method, 2117 tablets (57.4%) and 272 capsules (63.0%) could be crushed. SSM reduced the risk of tube clogging and drug loss with more drugs than that with the conventional crushing method. The number of drugs indicated for administration by SSM is greater than that indicated by the conventional crushing method. Further studies are needed to consider its utility compared to conventional methods for dysphagia patients in clinical settings.

The effect of pulsed-xenon ultraviolet disinfection on surfaces contaminated with vancomycin-resistant Enterococci in a Japanese hospital.

INTRODUCTION: Recently, a worldwide outbreak of vancomycin-resistant Enterococci (VRE) was reported. However, due to the low incidence of VRE infection and colonization, VRE contamination of hospital environments has not been fully investigated in Japan. METHODS: Surfaces were swabbed, before and after manual cleaning and after pulsed xenon ultraviolet (PX-UV) disinfection, in five patient rooms that had been occupied by patients colonized with VRE. Difference in the number of VRE-positive samples and VRE colony forming units (CFUs), before and after disinfection, for each cleaning method was estimated. RESULTS: We detected VRE contamination in 22/60 (37%) and 14/60 (23%) samples collected before and after manual cleaning, respectively. In contrast, VRE contamination was not detected in the samples collected after PX-UV disinfection. In addition, 3/5 (60%) spray nozzles of electric warm-water bidet toilet seats were found to be contaminated with VRE before terminal cleaning. Manual cleaning caused a significant decrease in the number of VRE CFUs compared with that before cleaning (P = 0.031). PX-UV disinfection also caused a significant decrease in the number of VRE CFUs compared to that of manual cleaning (P < 0.001). CONCLUSION: We identified hot spots of severe contamination, such as private bathrooms in patient rooms and areas around the bed of patients using diapers and required assistance. VRE contamination persisted even after terminal disinfection; PX-UV disinfection in addition to terminal disinfection was effective at eliminating VRE contamination. These results can be useful in controlling the spread of VRE infections in Japanese hospitals.

Decontamination effect of neutral electrolysed water for spray nozzles of electric warm-water bidet toilet seats in the healthcare setting.

BACKGROUND: There has been an increasing demand for more sanitary bidet seats in many healthcare settings because of concerns regarding potential contamination of the spray nozzles of warm-water bidet toilet seats. This contamination is thought to possibly serve as a reservoir for horizontal transmission of drug-resistant bacteria. AIM: This study was performed to determine the optimal Pseudomonas aeruginosa decontamination conditions and verify the effectiveness of these decontamination conditions. METHODS: An in vitro test of rinsing with neutral electrolysed water was performed using seven strains of P. aeruginosa. The decontamination effect of the neutral electrolysed water was verified by a field test involving an analysis of the number of bacteria isolated from samples collected from the spray nozzles and the sprayed water from 10 toilet seats at the internal medicine ward of Juntendo University Hospital. FINDINGS: The in vitro test results showed that the decontamination effect of neutral electrolysed water tended to be higher with higher free chlorine concentrations in the nozzle-cleaning water and shorter intervals of rinsing. The field test involving the hospital ward toilets showed that routine physical cleaning was satisfactorily effective. CONCLUSION: The study results suggest that the risk of horizontal transmission of drug-resistant bacteria via the use of bidet toilet seats in hospitals can be reduced by general cleaning and appropriate control of the free chlorine concentration in the nozzle-cleaning water.

Acute Effects of Short-Term Warm Water Immersion on Arterial Stiffness and Central Hemodynamics.

Warm water immersion (WWI) has a potentially favorable effect on vascular health. However, the effects of short-term WWI on vascular function and central hemodynamics remain unclear. The present study aimed to determine the acute effects of short-term WWI on arterial stiffness and central hemodynamics in healthy men. Ten healthy men (27-57 years, 44 ± 12 years of mean age) underwent 5-min WWI (40-41°C) at the heart level. Systemic hemodynamics and tympanic temperature were monitored during WWI. Furthermore, pulse wave velocity (PWV) and aortic hemodynamics were measured before and 10 min after WWI. Cardiac output (CO) (via the Modelflow method) increased (P = 0.037), whereas tympanic temperature did not change (P = 0.879) during WWI. After 5-min WWI, heart rate (HR) and brachial diastolic blood pressure (BP) were significantly decreased. Aortic and leg PWV were decreased by 7.5 and 3.1%, respectively (P = 0.006 and P = 0.040). Femoral arterial blood flow was increased by 45.9% (P = 0.002), and leg vascular resistance was decreased by 29.1% (P < 0.001). Regarding central hemodynamic variables (estimated by general transfer function), aortic BP and augmentation index (AIx) did not change significantly, but the subendocardial viability ratio (SEVR), an index of coronary perfusion, was increased (P = 0.049). Our results indicate that a short-term WWI acutely improves aortic and peripheral arterial stiffness and coronary perfusion. Further studies to determine the interaction between the residual effect of a single bout of short-term WWI and chronic change (e.g., adaptation) in arterial stiffness and central hemodynamics are needed.