Feedback of ATP measurement as a tool for reducing environmental contamination in hospitals in the Dutch/Belgian border area.

DESIGN: A two-phase prospective intervention study. OBJECTIVE: The objective of this study was to determine if feedback of adenosine triphosphate (ATP) measurements decreases environmental contamination within hospitals in the Dutch/Belgian border area. METHODS: Standardized ATP measurements were conducted in nine hospitals on pre-defined fomites. Four different fomite groups were defined: medical devices, patient-bound materials, ward-bound materials and sanitary items. ATP results were reported in relative light unit (RLU), RLU >1000 was considered as 'not clean.' Two rounds of ATP measurements were conducted. After the first round of ATP measurements, results were provided to the wards and cleaning staff. The second round of ATP measurements was performed one year later. The amount of surface contamination before and after the feedback was compared. RESULTS: In total 1923 ATP measurements were performed. Before feedback 960 ATP measurements were conducted and after feedback 963 were conducted. The overall median reduction in RLU was 381 (P < 0.001), from 568 before feedback to 187 afterward. In each hospital there was a reduction of the median RLU after feedback. CONCLUSIONS: Substantial reductions in RLU values were found after feedback of ATP measurements. Feedback of ATP measurement in itself was associated with a major reduction of surface contamination in hospitals.

Aspergillus Test Profiles and Mortality in Critically Ill COVID-19 Patients.

The literature regarding COVID-19-associated pulmonary aspergillosis (CAPA) has shown conflicting observations, including survival of CAPA patients not receiving antifungal therapy and discrepancy between CAPA diagnosis and autopsy findings. To gain insight into the pathophysiology of CAPA, we performed a case-control study in which we compared Aspergillus test profiles in CAPA patients and controls in relation to intensive care unit (ICU) mortality. This was a multinational case-control study in which Aspergillus test results, use of antifungal therapy, and mortality were collected from critically ill COVID-19 patients. Patients were classified using the 2020 European Confederation for Medical Mycology and the International Society for Human and Animal Mycology (ECMM/ISHAM) consensus case definitions. We analyzed 219 critically ill COVID-19 cases, including 1 proven, 38 probable, 19 possible CAPA cases, 21 Aspergillus-colonized patients, 7 patients only positive for serum (1,3)-ß-d-glucan (BDG), and 133 cases with no evidence of CAPA. Mortality was 53.8% in CAPA patients compared to 24.1% in patients without CAPA (P = 0.001). Positive serum galactomannan (GM) and BDG were associated with increased mortality compared to serum biomarker-negative CAPA patients (87.5% versus 41.7%, P = 0.046; 90.0% versus 42.1%, P = 0.029, respectively). For each point increase in GM or 10-point BDG serum concentration, the odds of death increased (GM, odds ratio [OR] 10.208, 95% confidence interval [CI], 1.621 to 64.291, P = 0.013; BDG, OR, 1.247, 95% CI, 1.029 to 1.511, P = 0.024). CAPA is a complex disease, probably involving a continuum of respiratory colonization, tissue invasion, and angioinvasion. Serum biomarkers are useful for staging CAPA disease progression and, if positive, indicate angioinvasion and a high probability of mortality. There is need for a biomarker that distinguishes between respiratory tract colonization and tissue-invasive CAPA disease.

The correlation between ATP measurement and microbial contamination of inanimate surfaces.

BACKGROUND: The objective of this study was to determine the correlation between adenosine triphosphate (ATP) measurements and microbial contamination using a standardized method. Secondarily, analyzing reproducibility of ATP measurements and aerobic colony counts (ACC's) on the same surface. METHODS: ATP measurements and ACC's were conducted on 10 pre-defined fomites in a hospital and nursing home setting. Per fomite two ATP measurements and two agar plate measurements were conducted, each measurement was conducted on a 25 cm2 surface. Both measurements were compared and analyzed for correlation. RESULTS: In total 200 paired measurements were conducted, 200 ATP measurements and 200 ACC's. The mean of all ATP measurements tested on the same surface was calculated, as was for all 200 ACC's. There was a strong correlation between the mean of two ATP measurements on two different sites on the same fomite (R = 0.800, p < 0.001) as well as between two ACC measurements on the same fomite (R = 0.667, p < 0.001). A much weaker correlation was found between RLU values and ACC's (R = 0.244, p < 0.001). CONCLUSIONS: Reproducibility of ATP measurements and ACC's on the same fomite was good. However, the correlation between RLU values and ACC's on hospital surfaces was much lower. This may be explained by the wide variety of biological material that is measured with ATP, of which the bacterial load is only one of many components. ATP measurement can be used to give a quantifiable outcome for the rating of cleanliness in health care facilities, however the results cannot be translated into the level of microbial contamination.

ATP measurement as an objective method to measure environmental contamination in 9 hospitals in the Dutch/Belgian border area.

BACKGROUND: The objective of this study was to determine the level of environmental contamination in hospitals in the Dutch/Belgian border area, using ATP measurements. DESIGN: A cross-sectional observational survey. METHODS: Standardized ATP measurements were conducted in 9 hospitals on 32 hospital wards. Thirty pre-defined surfaces per hospital ward were measured with the 3 M Clean Trace NG luminometer. Results are displayed in relative light units (RLU). RLU > 1000 was considered as "not clean." Differences in RLU values were compared between countries, hospitals, fomite groups and medical specialties. RESULTS: A total of 960 ATP measurements were performed, ranging from 60 up to 120 per hospital. The median RLU-value was 568 (range: 3-277,586) and 37.7% of the measurements were rated as not clean (RLU > 1000). There were significant differences between countries, hospitals and fomite groups. CONCLUSION: ATP measurements can be used as a more objective approach to determine the level of environmental contamination in hospitals. Significant differences in ATP levels were found between hospitals and between countries. Also, substantial differences were found between different fomite groups. These findings offer potential targets for improvement of cleanliness in healthcare facilities.

[Meningitis due to infection with Borrelia hispanica]. / Meningitis door een infectie met Borrelia hispanica.

BACKGROUND Tick-borne relapsing fever is a disease that is caused by infection with a Borrelia bacterium, and is transmitted by ticks. This infectious disease is characterised by relapsing episodes of high fever, often accompanied by aspecific symptoms. CASE DESCRIPTION We describe the history of a 20-year-old woman who developed recurrent episodes of fever with headache and vomiting after a holiday in Morocco. Additional examination showed pleiocytosis in the cerebrospinal fluid, which was initially suggestive of viral meningitis. However, Borrelia spp. were isolated from a 16S-rRNA-PCR-test which led to the diagnosis 'tick-borne relapsing fever'. The patient was treated with intravenous ceftriaxone for two weeks, after which time her symptoms gradually improved. CONCLUSION Prompt antibiotic treatment of tick-borne relapsing fever can prevent a serious course of the disease. For this reason, in patients with recurrent episodes of fever, it is important to consider this diagnosis if they have recently made a trip to Africa, America or the Middle East.

Reducing transmission of methicillin-resistant Staphylococcus aureus in a surgical ward of a resource-limited hospital in Indonesia: an intervention study.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in healthcare settings in Indonesia. AIM: To evaluate the effect of a bundle of preventive measures on the transmission and acquisition of MRSA in a surgical ward of a resource-limited hospital in Indonesia. METHODS: The study consisted of a pre-intervention (7 months), intervention (2 months), and post-intervention phase (5 months) and included screening for MRSA among eligible patients, healthcare workers (HCWs), and the hospital environment. In the intervention phase, a bundle of preventive actions was introduced, comprising: a hand hygiene educational program, cohorting of MRSA-positive patients, decolonization therapy for all MRSA-positive patients and HCWs, and cleaning and disinfection of the ward's innate environment. Hand hygiene compliance was assessed throughout the study period. The primary outcome was the acquisition rate of MRSA among patients per 1,000 patient-days at risk. Clonality of MRSA isolates was determined by Raman spectroscopy and multilocus sequence typing. FINDINGS: In total, 1,120 patients were included. Hand hygiene compliance rate rose from 15% pre-intervention to 65% post-intervention (P<0.001). The MRSA acquisition decreased from 9/1,000 patient-days at risk pre-intervention to 3/1,000 patient-days at risk post-intervention, but this difference did not reach statistical significance (P=0.08). Raman type 9 which belonged to ST239 was the single dominant MRSA clone. CONCLUSION: The introduction of a bundle of preventive measures may reduce MRSA transmission and acquisition among surgery patients in a resource-limited hospital in Indonesia, but additional efforts are needed.