Hand hygiene compliance in the prevention of hospital-acquired infections: a systematic review.

BACKGROUND: The hands of healthcare workers (HCWs) are known to be a primary source of transmission of hospital-acquired infections (HAIs). Thus, both practising hand hygiene (HH) and adhering to HH guidelines are expected to decrease the risk of transmission. However, there is no consensus on the optimal hand hygiene compliance (HHC) rate for HCWs. AIM: To systematically review the published literature to determine an optimal threshold for the HCW HHC rate associated with the lowest HAI incidence rate. METHODS: This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Online databases were searched using comprehensive search criteria for randomized controlled trials and non-randomized controlled studies, investigating the impact of the HCW HHC rate on HAI incidence rates in patients of all ages within healthcare facilities in high-income countries. FINDINGS: Of the 8093 article titles and abstracts screened, 35 articles were included in the review. Most studies reported overall HAIs per 1000 patient-days and device-associated HAIs per 1000 device-days. Most studies reported HHC rates between 60% and 70%. Lower HAI incidence rates seemed to be achieved with HHC rates of approximately 60%. The studies included in this review were not originally designed to assess the impact of HHC on HAI incidence rates, but risk of bias was assessed in accordance with the predetermined exposure and outcome criteria. Eleven (31%) studies were deemed to have low risk of bias. CONCLUSIONS: Although HHC is part of the HCW code of conduct, very high HHC rates are difficult to reach. In observational studies, HHC and HAIs had a negative relationship up to approximately 60% HHC. Due to flaws in the study design, causality could not be inferred; only general trends could be discussed. Given the limitations, there is a need for high-quality evidence to support the implementation of specified targets for HHC rates.

Safety and effectiveness of neuraminidase inhibitors in situations of pandemic and/or novel/variant influenza: a systematic review of the literature, 2009-15.

Objectives: To review systematically the published literature evaluating neuraminidase inhibitor (NI) safety and effectiveness in situations of pandemic and novel/variant influenza. Methods: We searched six online databases using comprehensive search criteria for observational studies and randomized controlled trials investigating the effects of NI treatment, prophylaxis or outbreak control in patients of all ages. Results: Overall, 165 studies were included (95% observational), which were generally of low methodological quality due to lack of adjustment for confounding variables. In studies reporting adjusted estimates in general populations, NI treatment appeared likely to be effective against mortality (primarily if administered within 48 h of symptom onset) and potentially effective in reducing pneumonia. NIs appeared effective in reducing secondary transmission when indicated for prophylaxis. Limited, low-quality data suggest NIs are likely safe in general populations and may be safe in pregnant women and children. Data are scarce regarding safety of NIs in adults and high-risk individuals. Conclusions: Most included studies were observational, statistically underpowered and at high risk of reporting biased and/or confounded effect estimates. NI treatment appeared likely effective in reducing mortality (cause unspecified) and pneumonia in general populations, with increasing benefit when administered with 48 h of symptom onset. NI pre- or post-exposure prophylaxis is likely effective in reducing secondary transmission of influenza in a general population. Our evidence suggests NIs are likely safe to use in the general population; however, data for children and pregnant women are limited. Knowledge gaps persist in specific populations such as Aboriginals, high-risk individuals and the elderly.

Characterization of oxalate oxidase and cell death in Al-sensitive and tolerant wheat roots.

Several genes including oxalate oxidase (Oxo) are up-regulated in Triticum aestivum L. root tips exposed to Al. To better understand the function of Oxo during Al exposure, the protein level and enzyme activity were measured. The data indicate that both Oxo protein and activity are increased proportionally to the level of root growth inhibition (RGI). A high level of Oxo expression may result in excess H(2)O(2) production which could become toxic and induce cell death. However, the timing of H(2)O(2) production (observed after 24 h) indicates that it cannot be the primary cause of cell death first observed after 8 h. Moreover, at Al concentrations resulting in 50% RGI, we did not observe any cell death in the sensitive cultivar while a punctated pattern of death involving small groups of cells was found in the tolerant cultivar. This pattern was maintained for several days in the tolerant cultivar, suggesting the involvement of a cell death mechanism aimed at replacing epidermal cells intoxicated with Al while root growth is maintained. The accelerated epidermal cell turnover may represent a new detoxification mechanism helping to protect deeper cell layers of the meristematic and elongation zone essential for root growth.

Restriction endonuclease analysis and plasmid profiling of Actinobacillus pleuropneumoniae serotype 7 strains.

Seventeen serotype 7 Actinobacillus pleuropneumoniae strains isolated in New Zealand and A. pleuropneumoniae serotypes 1-12 reference strains were typed by restriction endonuclease analysis of chromosomal DNA and plasmid profiling. All serotype 7 strains produced similar DNA cleavage patterns and were significantly different to other reference serotype strains. Minor differences in the cleavage patterns enabled the 17 serotype 7 strains to be grouped into seven profiles. Plasmids were identified in all but three strains but the banding patterns did not account for the differences in the chromosomal profiles. The study showed that restriction endonuclease analysis and plasmid profiling are useful in epidemiological studies of porcine pleuropneumonia.

The responses of Lucilia cuprina to odours from sheep, offal and bacterial cultures.

The responses of gravid female Lucilia cuprina to odours from sheep urine, faeces and gut mucus, and to odours from liver/sodium sulphide mixtures was tested using a bioassay which measured the movement and probing response of walking flies. The same bioassay was used to test the response to odours from cultures of bacteria isolated from liver/sodium sulphide and liver/water mixtures. A significant movement towards odours from faeces, gut mucus and urine was observed. Odours from cultures of the bacteria Proteus mirabilis, Dermatophilus congolensis and Serratia marcescens also elicited significant movement. A probing response was elicited by odours from gut mucus, fresh urine, liver/sodium sulphide mixtures and cultures of P.mirabilis, D.congolensis and gram-positive species. Odours from cultures of Pseudomonas aeruginosa, Enterobacter aerogenes and Citrobacter freundii did not elicit significant movement or probing. The movement and probing responses are discussed with reference to the possible uses of the substances tested as a bait for attracting L.cuprina.

Effectiveness of BCG vaccination in protecting possums against bovine tuberculosis.

Three groups of eight possums were vaccinated with BCG Pasteur by the subcutaneous, intratracheal or intragastric routes, with a fourth group serving as unvaccinated controls. Forty-two days after the start of vaccination, five possums from each group were challenged intratracheally with virulent Mycobacterium bovis. The vaccination by the subcutaneous or intratracheal routes resulted in a marked reduction in the severity of disease compared with the unvaccinated animals or the animals vaccinated intragastrically. The severity of the disease was assessed by changes in bodyweight, pathological changes in the lungs and bronchial nodes and the number of acid-fast bacilli in the lesions. Before the challenge, lymphocyte blastogenic responses to bovine PPD were observed in the eight animals vaccinated subcutaneously and in two of the animals vaccinated intratracheally.

Translational motion compensation in ISAR image processing.

In inverse synthetic aperture radar (ISAR) imaging, the target rotational motion with respect to the radar line of sight contributes to the imaging ability, whereas the translational motion must be compensated out. This paper presents a novel two-step approach to translational motion compensation using an adaptive range tracking method for range bin alignment and a recursive multiple-scatterer algorithm (RMSA) for signal phase compensation. The initial step of RMSA is equivalent to the dominant-scatterer algorithm (DSA). An error-compensating point source is then recursively synthesized from the selected range bins, where each contains a prominent scatterer. Since the clutter-induced phase errors are reduced by phase averaging, the image speckle noise can be reduced significantly. Experimental data processing for a commercial aircraft and computer simulations confirm the validity of the approach.

Lobectomy in the treatment of the scimitar syndrome.

The scimitar syndrome is a congenital anomaly that consists mainly of total or partial anomalous venous drainage of the right lung to the inferior vena cava. We report the case of an 8-year-old girl diagnosed at birth as having a scimitar syndrome and who presented with recurrent right lower lung infections. She underwent resection of the lower half of her right lung without diversion of the anomalous venous drainage of the upper portion of the lung. She improved rapidly postoperatively and the shunt fraction diminished.

Rapid detection of Escherichia coli in urine samples by a new chromogenic beta-glucuronidase assay.

A new compound, indoxyl-beta-D-glucuronide, was assessed as a substrate for the rapid detection of Escherichia coli in urine. Incorporation of this compound into MacConkey agar allowed the direct differentiation of E. coli as deep blue colonies distinct from lactose and nonlactose fermenters. The sensitivity was 88 to 90%, and the specificity was 100%.

[Congestive cardiomyopathies in children. Natural history and studies]. / Les cardiomyopathies congestives chez l'enfant. Histoire naturelle et investigation.

Congestive cardiomyopathies represent a group of diseases having in common an intrinsic abnormality of the myocardial contraction, of which the cause often remains unknown. In children, there is a more marked incidence during the first year of life. At the Cardiology Institute of Quebec, 25 patients have been diagnosed with a congestive cardiomyopathy since January 1967. The mortality remains high at 48 per cent, and the morbidity at 28 per cent. Thus, the chance of total survival at 16 years was 33 percent. The evaluation and the treatment of the cardiac function as well as the search for a specific etiology must be carried out because the etiological treatment is sometimes possible. Biopsy of the skeletal muscle as the study of fatty acids metabolism have become very important since the identification of a carnitine deficiency. On the other hand, biopsy of the endomyocardium remains the only means to make a pathological diagnosis. Since the treatment of persisting myocarditis is feasible, the histological diagnosis is a pre-requisite in children. So, in four patients with congestive cardiomyopathy, biopsy of the endocardium has enabled to demonstrate a chronic inflammation of the myocardium in one patient. In three other cases, two had non specific lesions on histological examination an one had an extensive fibro-elastosis. As the symptomatic treatment is often deceiving, an in-depth investigation is mandatory in a child suffering from a congestive cardiomyopathy in order to identify an etiology. Such an approach will enable to apply a specific treatment, to achieve a better understanding and perhaps modify its natural history.

[Paroxysmal junctional reciprocal tachycardia and fetoplacental anasarca]. / Tachycardie réciproque jonctionnelle paroxystique et anasarque foeto-placentaire.

Foeto-placental anasarca was diagnosed at 34 weeks gestation in a patient with acute hydramnios. Foetal tachycardia at 300 bpm was recorded. This obstetrical problem led to the birth of a premature baby with generalised oedema, for which the only apparent cause was the tachycardia. This was identified as a paroxysmal junctional reciprocating tachycardia, initiating on atrial extrasystolic echos, terminating on R waves, with lengthening of the PR interval at the onset of tachycardia, without acceleration of the sinus rate and P'R = RP'. Paroxysmal junctional reciprocating tachycardia in utero was responsible for congestive cardiac failure and foeto-placental anasarca. The cardiac failure was treated by foetal delivery, artificial respiration and digoxin. The association of digoxin-disopyramide reduces the frequency of attacks of tachycardia and treatment may be stopped after one year's follow-up.

[Geometric and dynamic characteristics of hockey sticks in regard to their performance]. / Caractéristiques géométriques et dynamiques des bâtons de hockey en regard de leur performance.

The hockey stick can be used for numerous tasks such as shooting, dribbling, receiving and executing passes, stick handling, etc. The purpose of this study was to evaluate the geometrical and dynamic characteristics of hockey sticks in order to identify those which contribute most significantly to its longevity and durability. The characteristics of 14 models of hockey sticks were measured according to the procedure describes by Roy and Doré (1975). To evaluate the longevity of the stick, 45 Midget AA were selected. Each one was given two sample sticks selected randomly. They were to use those sticks in practices and in game situations. Fifteen adult players were selected to evaluate the durability of the stick. Each one received four sample sticks. They had to execute as many slap shots as they could until the stick broke. This work confirmed a previous study of Roy and Doré 1975) which demonstrated a high level of homogeneity in the geometrical characteristics, but a high heterogeneity in their dynamic characteristics. This study revealed also that the longevity and durability measures showed a high level of variability. Through a multiple regression analysis, it was shown that the width and thickness of the handle as well as the rupture coefficient and the module of rigidity of the handle (in a plane parallel to the blade) were four variables contributing significantly to the longevity of the stick.

Immunoglobulin A proteases in gram-negative bacteria isolated from human urinary tract infections.

Several strains of gram-negative bacteria (seven genera, eight species) isolated from patients with urinary tract infections were found to hydrolyze myeloma immunoglobulin A (IgA) protein. Human IgG and IgM and colostrum IgA were not degraded by these organisms. Examination of cleavage digests showed two fragments of different electrophoretic mobilities, with antigenic reactivity and sodium dodecyl sulfate polyacrylamide gel electrophoresis profiles consistent with their identification as Fc and Fab components. The immunoelectrophoresis patterns of cleavage digests suggested that the proteases responsible for this hydrolysis may be dissimilar in the specificity of their IgA cleavage sites.

In vitro lymphocyte transformation as a herd survey method for bovine paratuberculosis.

The lymphocyte-transformation (LT) test was evaluated for its potential application as a field test for bovine paratuberculosis. Using a whole blood technique, samples from 3 consecutive collection periods were subjected to 3 mycobacterial antigens and to phytohemagglutinin. The results obtained from LT were compared with conventional serologic and cultural methods. A positive LT response to johnin purified-protein derivative (PPD) or avian PPD (or both) was noted in 40% to 60% of the animals tested. The complement-fixation test yielded 4% to 6.7% positive results, the immunodiffusion test between 1.2% and 1.4%, and the direct fecal culture between 2.4% and 6%. The mean of the stimulation indices of all positively responding animals was highest with johnin PPD. Specific stimulation to mammalian PPD occurred between 2.4% and 6% of the animals. The efficacy of the LT test for determining the incidence of infection with Mycobacterium paratuberculosis is discussed.

Multiple forms of urease in cytoplasmic fractions of Ureaplasma urealyticum.

The urease activity of Ureaplasma urealyticum was found to be located in the cytoplasmic fraction and consisted of multiple stable enzyme forms representing at least four biotypes.

Total anomalous pulmonary venous connection: Report of 93 autopsied cases with emphasis on diagnostic and surgical considerations.

Total anomalous pulmonary venous connection (TAPVC) is failure of development of the common pulmonary vein, with consequent ersistence and enlargement of embryonic collaterals between the lungs and the systemic veins. In the great majority (91 of 93 autopsied cases, 97 per cent, no remnant of the common pulmonary vein was found, supporting the concept of agenesis or involution of the common pulmonary vein. Occasionally, a cordlike strand was found in the location of the common pulmonary vein (in three of 93 cases, 3 per cent), supporting the concept of atresia of the common pulmonry vein. The order of frequency of the various types of TAPVC was: left innominate vein ("snowman"), 26 perent cent; subdiaphragmatic, 24 per cent; coronary sinus, 18 per cent; right superior vena cava, 15 per cent; right atrium, 8 percent; mixed, 5 per cent; azygos, 2 per cent; and left supeior vena cava, 2 per cent...