Screening for antibiotic-resistant infection.

Cases of carbapenemase-producing enterobacteriaceae (CPEs) are rising in the UK and around the world. Guidelines from Public Heath England outline methods for screening and managing CPEs, although the implementation is costly. Managing CPEs effectively relies on early detection and management of colonised or infected people. This article describes how an acute London trust designed a management programme for CPEs that involved increased screening. It began with a trustwide point-prevalence study to determine the most likely entrance points of the infection. Coupled with yearly reviews, this will enable targeted screening and more efficient use of resources.

How to use personal protective equipment.

This article offers a refresher on what personal protective equipment (PPE) is, how to choose the right PPE and how to wear and remove it safely. PPE aims to improve staff and patient safety, but self-contamination commonly occurs during its removal; failure to remove PPE carefully can lead to contamination of the user's skin, own clothes, uniform or scrubs, hair, face and hands. The importance of correct PPE use has been highlighted by the ebola crisis and NHS preparations to deal with patients who are infected.

Detection of genomic abnormalities in multiple myeloma: the application of FISH analysis in combination with various plasma cell enrichment techniques.

Multiple myeloma (MM) is a hematopoietic neoplasm characterized by malignant plasma cells (PCs) that accumulate in the bone marrow. A number of different genomic abnormalities are associated with MM; however, detection of these by fluorescence in situ hybridization (FISH) can be limited by the percentage of PCs in the specimen. In this study, we tested 20 bone marrow specimens with known MM and a low concentration of monoclonal PCs for the presence of genomic abnormalities using FISH in combination with various PC enrichment techniques: magnetic cell sorting, targeted manual scoring, and automated image analysis. In addition, flow cytometric cell sorting of PCs in combination with FISH analysis was also tested for minimal residual disease applications. Different parameters were evaluated when assessing the detection efficiency of each approach. FISH results are highly dependent on the chosen enrichment method. We describe the evaluation of different techniques applicable for various laboratory settings and specimen parameters.

Behaviors and perceptions regarding seasonal and H1N1 influenza vaccination during pregnancy.

We examined vaccination rates during pregnancy against both seasonal and pandemic H1N1 influenza and reasons for nonadherence to recommended guidelines during the 2009 through 2010 influenza season. Demographic and vaccination data were collected using a cross-sectional approach. Among 813 postpartum women, 520 (64%) reported receiving the seasonal influenza vaccination and 439 (54%) reported receiving the H1N1 influenza vaccination during pregnancy. Most received vaccinations at their obstetrician's office. Major reasons for not receiving vaccination were: not knowledgeable about the vaccine importance (25%), concerns for effects on fetal and maternal health (18% and 9%, respectively), and not knowledgeable about where to obtain vaccination (9%). Reported H1N1 influenza vaccination rates were significantly lower in blacks (37%) compared with non-Hispanic whites, Hispanics, and Asian/other (57%, 59%, and 58%, respectively; P < .0001). Subsequent campaigns for improving vaccination rates in pregnancy should focus on educating patients about vaccine importance and safety.

Infectious enthusiasm. Interview by Sue Learner.

A nurse specaist's dedication and achievements in infection control have earned her a national award.

Postoperative malnutrition in Duchenne muscular dystrophy.

Dysphagia and aspiration seem to be rare in Duchenne muscular dystrophy, but cachexia can be associated with early death. Commonly, weight loss can be attributed to inadequate caloric intake caused by loss of ability to self-feed and/or fatigue. Our objective was to determine whether scoliosis repair is associated with malnutrition. A retrospective chart review was undertaken of patients with Duchenne muscular dystrophy, including those who underwent operative repair of scoliosis. We identified nine boys who lost > 5% body weight within 12 months of surgery. Eight patients who gained weight after surgery and eight patients of comparable age who had no surgery served as control subjects. All patients had no change in biceps strength after surgery, but those who lost weight were unable to self-feed. We found that weight loss after surgery was associated with loss of self-feeding. We conclude that pre- and postoperative management of patients with Duchenne muscular dystrophy should include feeding evaluation and determination of postural changes.