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International audience; In the field of clustering techniques, little attention has been paid to the recovery of a set of clusters from the structure of an additive tree. To bridge this gap, this work presents an original partitioning technique which aims to reveal clusters from an additive tree that represents a large set of objects. Specifically, an algorithm that splits a tree into successive subtrees was developed, based on a ratio of the lengths of edges. The stability of the clusters obtained with this technique was then evaluated using measurements of cohesion and isolation that were generated using a bootstrapping strategy. Finally, the degree of association of each object to clusters was analyzed to gain insight into their internal structure. This analysis was performed on the results of a sorting task conducted by 156 subjects, who were asked to sort 96 terms associated with the odor of wine. The methodology developed in this paper represents an innovative way to highlight groups of terms within a large set of wine odor attributes, with the ultimate goal being to improve the structure of the lexicon.

Background The antibody primarily responsible for fetal anemia may influence treatment and prognosis. The primary objective was to compare ante- and postnatal management and the outcomes of maternal red blood cell (RBC) alloimmunizations according to the antibody involved. The secondary objective was to compare anti-D alloimmunizations according to associated number of antibodies. Study design and methods A single-center study from 1999 to 2015 including maternal RBC alloimmunizations requiring intrauterine transfusion (IUT) was conducted. Patients were classified according to the antibody involved: anti-D, other Rh (anti-c and anti-E), and anti-K1. Obstetric data, IUT characteristics, and neonatal outcome were compared. A specific study on the anti-D, when isolated or associated, was then conducted. Results There were 106 pregnancies included, with 77.4% having anti-D, 9.4% having another anti-Rh (Rh group), and 13.2% having anti-K1. No significant difference between the anti-D and Rh groups was found for management and prognosis. The hemoglobin level in the first IUT was higher in the anti-D group than in the Kell group (6.8 vs. 4.7 g/dL, p = 0.008). Newborns in the anti-D group had significantly higher bilirubin levels and phototherapy duration than those in the Kell group. The mean estimated daily decrease in hemoglobin and that between the first two IUTs were lower with an isolated anti-D, compared with anti-D associated with two antibodies (p = 0.04). Conclusion Anti-K1 alloimmunizations seem to cause more severe fetal anemia than anti-D alloimmunizations. Moreover, a decrease in hemoglobin appears to be more rapid when anti-D is associated with other antibodies.

Background Almost 20% of parvovirus B19 foetal infections require intrauterine transfusions. In addition, myocardial dysfunction has been observed in severe parvovirus B19 infections. One objective of an intrauterine exchange transfusion (IUET) is to avoid an overload during the transfusion. Our aim was to study the obstetrical and neonatal outcomes in cases of IUETs performed for foetal parvovirus infections and to compare our survival rate to those studies in which simple in utero transfusions were chosen. Study design and methods This was a retrospective monocentre study of all patients followed up for parvovirus B19 infections in which IUETs were performed. An IUET was indicated when foetal hydrops was observed and/or when severe foetal anaemia was diagnosed though an elevation in the middle cerebral artery peak systolic velocity. The characteristics of each pregnancy and the neonatal outcomes were studied until hospital discharge. Results Thirty-five IUETs were performed in 26 foetuses. The median gestational age of the first IUET was 22.6 weeks. Only one foetal bradycardia incidence was recorded during the procedure. Three medical pregnancy terminations were observed in our series, secondary to severe cerebral anomalies confirmed in the magnetic resonance imaging. Five in utero deaths occurred, in which 2 of the foetuses underwent multiple IUETs. All the neonates had normal haemoglobin levels at birth, and none were transferred to the neonatal intensive care unit. The overall survival rate was 70%. Conclusion IUETs exhibit a survival rate similar to that of simple intrauterine transfusions in foetal parvovirus infection cases.

Resume But La decouverte d’une hyperechogenicite intestinale fœtale (HEI) entraine souvent la realisation d’un bilan etiologique invasif. Notre objectif est d’etudier les etiologies et le pronostic des HEI selon les constatations echographiques antenatales afin d’evaluer la pertinence de ce bilan. Materiels et methodes Etude retrospective monocentrique, menee de 2008 a 2012, incluant toutes les patientes adressees pour une suspicion d’HEI. Nous avons analyse les resultats des donnees antenatales et neonatales selon 4 groupes definis en echographie : HEI isolee, associee a des signes digestifs, des signes vasculaires ou d’autres signes echographiques. Resultats Cent quarante-neuf patientes ont ete suivies pour une HEI : 69 HEI isolees, 24 associees a des signes digestifs, 16 a des signes vasculaires, 40 a d’autres signes. Les issues etaient differentes entre ces groupes avec respectivement 92,8, 41,7, 0 et 45,0 % d’enfants sains. En cas d’HEI isolee, nous avons note 2,9 % de mucoviscidose, 2,9 % d’infection congenitale et aucune dyschromosomie. Conclusion L’HEI isolee semble avoir un meilleur pronostic que les formes associees. Toutefois, un bilan pour eliminer une mucoviscidose ou une infection congenitale doit etre propose et pourrait etre initialement non invasif, si l’absence de dyschromosomie etait verifiee sur une plus grande serie.

During pregnancy, the occurrence of aortic dissection is a rare event immediately threatening fetal and maternal prognosis. Its occurrence is more common in cases of connective tissue disease. But the absence risk factor shall not exclude or delay diagnosis. We must learn to think about it, because the prognosis is highly dependent on time management. The clinical presentation of this medical and surgical emergency varies, and pregnancy adds its own symptoms. We have to ask without hesitation that echocardiography or chest CT be performed since these diagnostic methods are both reliable and available.

Intrauterine transfusion (IUT) has changed fetal anemia prognosis. However, long-term neurodevelopmental outcome is altered in 5% of children. Our objective was to study the contribution of fetal MRI to diagnosis brain lesions in case of fetal anemia.Retrospective monocentric descriptive study from 2005 to 2016, including all patients followed for fetal anemia requiring IUT. The indications for MRI were: hydrops fetalis and / or hemoglobin5 g / dL and / or more than 3 IUTs and / or acute severe anemia and / or ultrasound abnormality. Fetal and neonatal outcome and pediatric neurological monitoring were studied.89 patients were followed for fetal anemia with IUT and 28 (29.1%) had fetal MRI, 12 of which were abnormal. Two out of twelve had abnormal ultrasound. Seven out of twelve had poor neurological prognosis: 2 medical terminations of pregnancy were performed; 2 children had severe developmental delay and 3 children had schooling difficulties. Five out of twelve children had favorable neurological prognosis.MRI of the fetal brain makes it possible to better detect brain lesions than ultrasound does in the management of severe fetal anemia and seems particularly appropriate in cases of acute anemia.

Esophageal atresia (EA) is prenatally diagnosed in less than one third of the cases and is usually only suspected. Recently, magnetic resonance imaging (MRI) with dynamic sequence and biochemistry of the amniotic fluid have been proposed to enhance prenatal diagnosis of EA. We report the case of a triple negative screening (ultrasound, MRI with dynamic sequence and biochemistry of the amniotic fluid) with a postnatal diagnosis of EA type III with a small defect. Even using second line tests, prenatal diagnosis of EA remains a challenge.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 43 - N° 6 - p. 424-430

Resume Objectifs Repertorier les signes echographiques mis en evidence lors de la suspicion d’un placenta accreta. Les objectifs secondaires sont d’analyser la pertinence du diagnostic en echographie et en imagerie par resonance magnetique (IRM), et de connaitre les circonstances diagnostiques afin d’identifier une population a risque. Patientes et methodes Il s’agit d’une etude retrospective monocentrique. Les cas de placentas accreta pris en charge au centre hospitalo-universitaire de Lille entre 2005 et 2010, suspectes en antenatal ou decouverts per-partum, ont ete recenses. Resultats Vingt-sept patientes ont presente un placenta accreta sur cette periode. 22 cas etaient suspectes en antenatal, dont 21 confirmes a la naissance. Six cas etaient decouverts per-partum. Le diagnostic etait suspecte dans 41 % des cas suite a un episode de metrorragies. Cent pourcent des patientes suivies au diagnostic antenatal avaient un uterus au moins unicicatriciel et un placenta anterieur insere bas. Cinquante pourcent des patientes non depistees avaient un placenta posterieur non insere bas. Les signes echographiques les plus frequents etaient « lacune placentaire » (85,7 %), « vascularisation anormale » (71,4 %), « perte du lisere hypoechogene du myometre » (66,7 %), « irregularite de la paroi vesicale » (57,1 %). La sensibilite de l’echographie de depistage est de 78 %. Vingt et une IRM, realisees en deuxieme intention confirmaient le diagnostic dans 66,7 % des cas. Discussion et conclusion L’echographie est un examen pertinent pour le diagnostic de placenta accreta. Les placentas posterieurs, plus difficiles d’acces, ne doivent pas etre negliges. Les placentas anterieurs praevia chez les patientes multipares ayant un uterus cicatriciel doivent requerir toute l’attention de l’examinateur.

Objective Prenatal diagnosis of esophageal atresia (EA) remains a challenge. Our objective was to evaluate the combination of sonography, magnetic resonance imaging (MRI), and amniotic fluid biochemical markers in prenatal diagnosis of EA. Study design A retrospective study of all cases with prenatal suspicion of EA from January 2008 to May 2013 in our regional reference center was carried out. Patients were included if all the three tests were performed. For each test, sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) were evaluated. Each test was compared using Fisher's exact test. Results Fifteen patients were referred at a median gestational age of 28+5 weeks (24–36) for suspicion of EA on the basis of small or non-visualized fetal stomach bubble and/or polyhydramnios. Se, Sp, PPV, and NPV for sonographic pouch sign/MRI/biochemical amniotic fluid were respectively 40/100/100/45.5%, 80/100/100/71.4%, and 90/60/81.8/75%. MRI was the best predictive test (p = 0.007). Conclusion In case of ultrasound prenatal suspicion of EA (with or without visualization of the pouch sign), an MRI at 30–32 weeks using fast imaging employing steady-state acquisition should be proposed. Biochemical amniotic fluid may be helpful and should be evaluated in a larger study. © 2014 John Wiley & Sons, Ltd.

“Mixed Profiling” (MP) is a descriptive profiling combining a pre-established list of descriptors scored by all tasters and the possibility for each panellist to add free descriptors. All the descriptors, free or not, are rated on an intensity scale. The aim is to improve the reliability of wine characterisation in a professional context. Quantitative Descriptive Analysis® provides a fine characterisation while free-choice profiling is a more holistic method that is easier to implement with professionals. In general, professionals are not trained together and evaluate wines using pre-defined descriptors. MP aims to combine the power of the two methods. It is compared to a classical profiling (CP) largely performed in a wine professional context that uses a pre-defined list of descriptors. Ten red wines were evaluated by two distinct panels of wine professionals without prior common training. Performances of the panel were verified using variance analysis and the results of both sensory methodologies were compared using a multi-block method. The results reveal that MP avoids the omission of a specific sensory characteristic and provides a complete sensory characterisation of products in a short time.

BACKGROUND To best predict the recurrence of fetal anemia after intrauterine transfusion (IUT), the measurement of middle cerebral artery peak systolic velocity (PSV) and the estimation of hemoglobin (Hb) daily decrease are compared. STUDY DESIGN AND METHODS A retrospective study including 38 patients who had at least two IUTs in a context of red blood cell alloimmunization was conducted. PSV values before first, second, and third IUTs were collected and expected Hb level was calculated according to various Hb daily decrease formulas as proposed in the literature. RESULTS Comparison of PSV receiver operating characteristic curves with the various Hb levels did not find any significant difference between first and second IUTs. On the other hand, we found a significant difference between the second and third IUTs, with better prediction of fetal anemia through Hb decrease calculation, whatever the formula. Between the second and third IUTs, no formula was significantly better than the others. CONCLUSION The timing of a second transfusion can be difficult to determine with certainty, but PSV can give an accurate assessment of when to resample the fetus with probably a higher recommended threshold for the diagnosis of fetal anemia. Subsequent to a second transfusion, the intertransfusion interval should be based on estimated Hb decrease rather than PSV thresholds, whatever the chosen formula proposed in the literature. Larger numbers are needed to definitely make this recommendation and it will be interesting to evaluate correlation between different antibodies.

International audience; No abstract available

L’atresie de l’oesophage (AO) est une malformation congenitale rare (1 cas pour 2500 a 3500 naissances). Plusieurs formes anatomiques existent mais l’interruption de l’oesophage est le plus souvent associee a une fistule oesotracheale (90 %). Le diagnostic antenatal (DAN) de cette anomalie est particulierement interessant car il permet de realiser un bilan complementaire a la recherche de formes associees de plus mauvais pronostic (echographie de reference, IRM et amniocentese). Il prepare de plus les parents a la prise en charge postnatale et permet d’optimiser celle ci. L’hydramnios et/ou un estomac absent ou de petite taille sont les deux signes echographiques d’appel les plus frequents mais ils ne sont pas specifiques de l’AO. La visualisation en echographie ou en IRM d’une image liquidienne cervicale ou thoracique lors des mouvements de deglutition (pouch sign des anglosaxons), correspondant a la dilatation du cul-de-sac oesophagien superieur borgne, permet d’augmenter la specificite du diagnostic. Le DAN reste cependant difficile et moins de 50 % des AO sont reperees en antenatal. L’analyse biochimique du liquide amniotique pourrait ameliorer ces resultats.

Haemophagocytic syndrome (HPS) results from an inappropriate stimulation of macrophages in bone marrow and lymphoid organs, leading to haemophagocytosis and hypercytokinemia. HPS may be primitive, essentially in pediatric population, or secondary to malignancy, infection or autoimmune disease. This disease is rare and prognosis is poor. A small number of cases during pregnancy have been described in literature. We report one HPS case in a pregnant patient at 21 week's gestation with systemic lupus erythematosus. We discuss diagnostic difficulties, obstetrical complications and therapeutic options.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 37 - N° 8S1 - p. 398-404

Objective Doppler measurement of peak velocity of systolic blood flow in the middle cerebral artery (PVS-MCA) can safely replace invasive testing in the diagnosis of fetal anemia in Rh-alloimmunized pregnancies and PSV-MCA is now the reference technique. However, no study has evaluated its impact in antenatal care and in survival rate. Our objective was to evaluate the impact of the measurement of PVS-MCA in antenatal management and neonatal outcome in maternal red cell alloimmunization requiring in utero transfusion (IUT). Study design Retrospective study between January 1999 and January 2013. We excluded all cases of hydrops without follow-up before first IUT. From 1999 to 2006, an IUT was indicated on the optical index at 450 nm (Period 1) and was then replaced by the use of PVS-MCA (Period 2). Results 77 patients were included, 39 in Period 1 (104 IUT) and 38 in Period 2 (89 IUT). 5 cases of hydrops fetalis (12.8%) were diagnosed during the follow up in Period 1 and none during Period 2. The average number of IUT, the delays between 2 IUT and between last IUET and birth were comparable. The total rate of complication per IUT during the first period was 9.6% vs 1.1% during the second one ( p = 0.01). The overall survival rate in our population was 34/39 (86.8%) during Period 1 vs 38/38 (100%) during Period 2. Conclusion PSV-ACM allowed an improved monitoring with fewer occurrences of hydrops. Conversely, it did not modify antenatal management and timing of delivery.

Telemonitoring in dialysis, either in hospital centers or at home, poses a challenge for physicians due to the necessity of monitoring and centralizing various patients and equipment parameters. In the near future however, this technique should allow a decrease in the number of patients in medical centers. It should also allow physicians to keep track of the sessions of outpatients who have a consultation every two months only. The study presented here, carried out in the Centre Hospitalier de Saint-Brieuc during the spring and summer of 1998, reviews some of the aspects of this new technology. We first report on the results of a survey performed in 60 dialysis centers in order to confirm the interest of telemonitoring for physicians of nephrology. We then tested and evaluated one of the commercial software programmes during several months. We finally point out some legal linked to such devices use.

Objective To assess the efficacy of moxibustion (heating of the acupuncture needle with an igniting charcoal moxa stick) with acupuncture for version of breech presentations after 33 4/7 weeks of gestation to reduce their rate at 37 weeks of gestation and at delivery. Methods This was a randomized placebo-controlled single-blind trial including 328 pregnant women recruited in a university hospital center between 33 4/7 and 35 4/7 weeks of gestation. Moxibustion with acupuncture or inactivated laser (placebo) treatment was applied to point BL 67 for six sessions. The principal endpoint was the percentage of fetuses in breech presentation at 37 2/7 weeks of gestation. Results The study included 328 women randomized into two groups: moxibustion with acupuncture (n=164) or placebo (n=164). The percentage of fetuses in breech presentation at 37 2/7 weeks of gestation was not significantly different in both groups (72.0 in the moxibustion with acupuncture group compared with 63.4% in the placebo group, relative risk 1.13, 95% confidence interval 0.98-1.32, P=.10). Conclusion Treatment by moxibustion with acupuncture was not effective in correcting breech presentation in the third trimester of pregnancy. Clinical trial registration ClinicalTrials.gov, www.clinicaltrials.gov, NCT01487590.

It has been shown that lyotropic lamellar phases under shear flow form structures corresponding to a close packed assembly of monodisperse multilamellar vesicles (onions). The size, which is fixed by the shear rate, can vary from a few microns to a tenth of a micron. In this study, we investigate for the first time the transient behaviour of size changes of onions under shear flow by means of small angle light scattering, direct microscopic observations, and conductivity measurements. We evidence two regimes: continuous and discontinuous. The nature of which (continuous or discontinuous) depends on the initial and final shear rate, and can be described by a dynamic phase diagram.

Objectifs La diffusion des bacilles a gram negatif (BGN) multiresistants est une menace grandissante en France en particulier chez Escherichia coli. L’objectif de cette etude etait d’evaluer le profil de resistance des E. coli uropathogenes isoles en laboratoires d’analyse de biologie medicale (LABM) en Languedoc. Methodes Cette etude retrospective multicentrique incluait tous les patients ayant eu un ECBU positif a E. coli diagnostique par un LABM du Gard et de l’Herault durant l’annee 2013. Tous les doublons ont ete elimines. Pour chaque inclusion, un recueil epidemiologique (âge, sexe, origine communautaire ou etablissement de sante) etait effectue. Les donnees de la resistance (R) des souches d’E. coli aux principaux antibiotiques testes etait effectue selon les recommandations du CA-SFM. Resultats Un total de 50 287 souches d’E. coli ont ete incluses isoles chez 83 % de femmes d’âge median 62 ans (0–105). Quatre-vingt-neuf pour cent des prelevements etaient communautaires et 11 % en ES. Aucune souche n’etait resistante a l’imipeneme mais 0,3 % (n = 164) etaient resistantes a l’ertapeneme, provenant patients en institution. Aucune carbapenemase n’a ete detectee. 46,4 % des souches etaient resistantes a l’amoxicilline, 31,7 % a l’association amoxicilline/acide clavulanique, 7,2 % au cefixime, 4 % a la gentamicine, 0,6 % a l’amikacine et 1,3 % aux furanes. Les souches isolees des hommes etaient plus resistantes que celles des femmes. Les souches isolees en ES ou en maison de retraites etaient les plus resistantes. Plus l’âge etait eleve, plus les E. coli etaient resistantes aux antibiotiques en particulier aux quinolones et aux C3G. En revanche, la fosfomycine reste particulierement active quel que soit l’âge. Conclusion La diffusion des E. coli multiresistants est importante dans notre region (4,3 % de toutes les souches et 21,4 % chez les hommes en maison de retraite). Nos resultats confirment que les fluoroquinolones et le cotrimoxazole ne peuvent plus etre des antibiotiques de premier choix dans les infections urinaires. Ces donnees locales sont essentielles pour adapter les referentiels locaux.

(1995). Improve Student Teaching Experiences: Develop a Statewide Communication Network. Journal of Physical Education, Recreation & Dance: Vol. 66, No. 2, pp. 51-55.

The purpose of this study was to compare the instructional behaviors of a group of preservice teachers across two teaching conditions, one planned and one unplanned. Twelve physical education teacher education (PETE) majors each taught two 25-minute lessons to elementary-age learners. Lesson plans were developed for the first lesson (planned condition) but not the second (unplanned condition). All lessons were videotaped and employed in the data analyses. Three data collection instruments were used for the analysis of selected teaching behaviors: (a) the Academic Learning Time-Physical Education (ALT-PE) system, (b) an event recording instrument for coding teacher verbal feedback statements, and (c) the Qualitative Dimensions of Lesson Introduction, Task Presentation, and Lesson Closure (QDITC) system. The results suggest that planning has a positive effect on some preservice teachers’ instructional behaviors. For teachers in training, it seems that planning is important to the employment of “effective” teaching behaviors in the interactive teaching environment.

In recent years, consumers have become more health conscious in their food choices but they also have less time to prepare healthy meals. As a result, minimally processed (MP) products have become an important sector of the food industry because of their ‘fresh-like’ qualities, convenience and speed of meal preparation. In this study, the physical qualities of MP potatoes (‘Desiree’ variety) stored for 7 days in vacuum packaging were evaluated. The shelf life of MP potatoes was effectively extended to nearly 1 week under refrigerated storage by using vacuum packaging systems. The main quality parameters were constant during storage.

s, 7th International Conference of the Hospital Infection Society, 10–13 October 2010, Liverpool, UK / Journal of Hospital Infection 76S1 (2010) S1–S90 S33 Poster Session 11 – Environmental Issues: Water, Air, Cleaning P11.01 Resistance of Acanthamoeba spp. cysts to disinfection treatments C. Coulon, A. Collignon, G. McDonnell, V. Thomas. STERIS, France; Paris 11 University, France; STERIS, United Kingdom Amoebae are known to potentially harbour bacteria that can present a threat to humans and particularly hospitalized patients. These bacteria potentially survive in amoebal cysts, as demonstrated for mycobacteria. It is thus important to evaluate the effectiveness of chemical disinfectants used for surface disinfection against amoebal cysts and trophozoites. Nine different Acanthamoeba spp. strains were grown in PYG medium before encystment. Cysts were diluted in each disinfectant tested (see below), and incubated for 10 min at appropriate temperature. After neutralization cysts were serial-diluted on E. coli lawns on NNA agar to observe re-growth, and log reductions were calculated. Actively growing trophozoites directly taken from PYG medium were evaluated using the same method. The most effective treatments were bleach 2.5%, ethanol 70% and a peracetic acid-based formulation (STERIS-20), with a minimum 4-log10 reduction, except for one strain presenting limited resistance to ethanol. Ortho-phthalaldehyde (OPA) alone at 0.55%, peracetic acid alone at 0.2% and a hydrogen peroxidebased product (SporKlenz) presented good activity on all strains (4-log10 reduction) except for 1 of 9 strains with OPA (1-log10 reduction), and for 2 of 9 strains for PAA (0.2 and 0.9-log10 reduction) and SporKlenz (1.7 and 3.6-log10 reduction). Bleach 0.25%, a commercial OPA-based product and glutaraldehyde 2% presented a moderate to low activity. Products with the lowest activity were hydrogen peroxide alone at 7.5% and a commercial, 2% glutaraldehyde-based product. Importantly, glutaraldehyde had also limited efficacy against trophozoites whereas all other tested products were efficient. This study demonstrates that biocides efficacy against amoebae can vary, with known high level disinfectants that may be taken for granted as being effective presenting only limited efficacy. Further investigations are needed to better understand the activity of biocides against amoebal cysts. P11.02 Ingress and egress of pathogens from single isolation rooms M. Muzslay, G. Moore, A.P.R. Wilson. University College London Hospitals, United Kingdom Background: Source isolation can protect the isolated patient (or their roommates) against infection. Some institutions have reduced infection rates by using single isolation rooms. However, others have failed to demonstrate similar benefit. Aims: To investigate the spread of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) to and from single isolation rooms. Methods: Conventional microbiological methods were used to recover MRSA and enterococci from the air (n = 132) and from high contact sites (n = 4257) within isolation rooms and open bay areas. The similarity between clinical and environmental isolates was determined via PFGE. Results: MRSA was recovered from 83 environmental surfaces; 49 were within isolation rooms. The environment of one isolated patient accounted for 43% of all MRSA-positive sites, yet the infective strain was not recovered from outside the room. No patient was colonized with EMRSA-15 B1 yet this strain was recovered from the environment of non-isolated patients, staff communal areas and from an isolation room occupied by an MRSA-negative patient, (previous occupant had different MRSA strain). VRE was recovered from 63 surfaces; 52 were within an isolation room. Large numbers of VR E. faecalis were recovered from the near-patient environment and, despite immobility of the patient, the ensuite toilet area. The same clone was isolated from the inner and outer door handles but not from outside the room. VS E. faecium was recovered from surfaces and the air (120CFU/m) of a 4-bedded open bay. The same clone was recovered from surfaces and the air (5 CFU/m) of an adjacent isolation room. Conclusion: Source isolation contained the infective organism(s). However, heavy airborne contamination and the persistence of MRSA within the ward environment enabled potential pathogens to spread from open bay areas to single isolation rooms via the air and the hands of healthcare workers. P11.03 Identifying opportunities to improve environmental hygiene in multiple healthcare venues P. Carling, J. Po, J. Bartley, L. Herwalt. Boston University School of Medicine, United States; Banner Estrella Medical Center, United States; ESCI, United States; University of Iowa School of Medicine, United States Background: Despite improved hand hygiene compliance and the use of active surveillance cultures to facilitate isolation practice, the impact of such interventions in various types of healthcare settings has been incomplete. Over the past several years 8 studies have documented increased risk of acquisition MRSA, VRE, C. difficile and A. baumannii from prior room occupants. In the context of recent prospective studies which have shown decreased transmission of bacterial pathogens as a direct result of improved hygienic cleaning, a broader evaluation of thoroughness of hygienic cleaning was undertaken by Environmental Hygiene Study Group hospitals. Objective: To evaluate the thoroughness of hygienic cleaning of surfaces that have a significant potential for transmitting hospitalassociated pathogens in a range of healthcare facilities and venues. Methods: A novel fluorescent targeting system was covertly used to objectively evaluate if disinfection cleaning of standardized sets of high risk objects was being performed in a manner consistent with institutional policies in a range of healthcare settings. Results: Terminal thoroughness of disinfection cleaning (TDC) in 82 hospitals was 54% and was significantly better than 16 hospital’s ORs (32%), 7 hospital’s neonatal intensive care units (36%) and 7 EMS vehicles (28%). Daily TDC in ICU isolation rooms in 7 hospitals (31%), in 4 ambulatory chemotherapy suites (26%), in 4 MD clinics (24%), in 5 dialysis units (33%) and in 5 long-term care facilities (34%) was also suboptimal (Figure). Overall the mean TDC for all sites/settings was 34% (Range = 3 to 88, 95% CI 25.2–43.0). Conclusions: Nine studies of TDC, which included >65,400 hightouch surfaces in 106 institutions and 145 venues, identified substantial opportunities for improvement in all venues, suggesting that TDC needs to be improved across a broad range of U.S. healthcare venues as part of efforts to prevent transmission of pathogens. P11.04 Optimising the recovery of methicillin resistant Staphylococcus aureus from surfaces using direct contact plates P. Wolyniec, D.J. Malik, G. Shama. Loughborough University, United Kingdom The presence in health care environments of Methicillin Resistant Staphylococcus aureus (MRSA) continues virtually unabated and has attracted concern from a number of quarters. Reliable methods of assessing the extent of contamination of such environments by MRSA constitute the first step in mobilizing resources to manage and contain potential threats of infection. Among the different techniques available for contamination assessment, Replicate Organism Detection and Counting (RODAC) direct contact plates