Empathy dolls: are they a source of cross-contamination between patients?

Following a cluster of two patients with identical strains of Clostridium perfringens prosthetic joint infections on an ortho-geriatric ward in a teaching hospital in England, investigations were conducted into infection control practices. It emerged that empathy dolls were being used to help alleviate agitation in dementia patients; this had been introduced without consultation with the infection prevention and control team. Environmental testing of the doll pre and post laundry at different temperatures helped to establish the types and numbers of organisms present. This testing enabled our unit to provide guidance on the optimum strategy for decontamination and safe use of these dolls.

Outbreaks of food poisoning in adults due to Escherichia coli O111 and campylobacter associated with coach trips to northern France.

Thirty-seven out of 48 people on a coach excursion to northern France developed gastrointestinal symptoms within 4 days of the trip. Twenty-six had stool samples positive for Escherichia coli O111, 8 were also positive for Campylobacter species, and 1 was positive for campylobacter alone. Strains of E. coli were positive for the effacing and attaching protein (eaeA) gene, but negative for other E. coli virulence genes, and therefore belonged to the enteropathogenic E. coli (EPEC) group. Twenty-two out of 37 people in a second party which followed the same itinerary 2 weeks later also became ill. One had a stool sample positive for E. coli O111. Analytical epidemiology suggested that the source of infections was a restaurant in northern France at which both parties had eaten.

Effect of medium-chain fatty acids in mould ripened cheese on the growth of Listeria monocytogenes.

Listeria monocytogenes and List. innocua were isolated from commercial soft ripened and blue-veined cheeses manufactured in France, mainly from Brie cheese made from unpasteurized milk. Five isolates were List. monocytogenes serotype 1/2 and two were List. innocua. Examination of Bleu d'Auvergne cheese with the cryoscanning electron microscope showed that many conidia spores were present in the blue veins in close contact with the cheese surface. There were few conidia spores in the Brie, mostly on the outside of the cheese but not in contact with the surface. High concentrations of free dodecanoic (lauric) acid (1.77-2.50 g/kg cheese) and tetradecanoic (myristic) acid (2.54-6.38 g/kg cheese) were found in the veins of the blue cheese, but concentrations in the white regions were much lower. Free lauric and myristic acids were not detected in the Brie cheeses. There was no difference in the overall fatty acid composition of the fat in the surface ripened and blue-veined cheeses, although higher concentrations of free medium-chain fatty acids were found in a blue cheese compared with a surface ripened cheese. The pH and fat content were higher in regions with obvious fungal growth, the blue veins of Fourme d'Ambert and the rind of Brie. Free lauric acid dissolved in butteroil inhibited multiplication in broth at pH 7.0 of a test strain of List. monocytogenes isolated from Bleu d'Auvergne. Some inhibition was seen with hexanoic, octanoic, decanoic and tetradecanoic acids. We suggest that the presence of localized concentrations of free medium-chain fatty acids (dissolved in the fat) in the blue veins of blue mould ripened cheese could act as natural preservatives and inhibit the growth of listerias in conditions where (if present), one would otherwise expect them to grow.