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Background: Healthcare-associated infections (HAIs) are a global concern in healthcare facilities, and hand hygiene (HH) using alcohol-based hand rubs (ABHR) is fundamentally crucial for their prevention. While previous studies report improvements in HH compliance amid the COVID-19 pandemic, the real situation in Japanese medical settings remains unclear., Methods: This observational study sought data from the Japanese national surveillance, focusing on ABHR use in hospitals before and after the COVID-19 pandemic. Data were retrieved from facilities certified to receive the Additional Healthcare Reimbursements for Infection Prevention and Control I. The study spanned five years (2019-2023), segmented quarterly, and employed Joinpoint regression analysis to assess the annual percentage change (APC)., Results: Overall, ABHR use per patient per day significantly increased both in critical care units and general wards amid the pandemic. However, the APC in the critical care units demonstrated a downward trend from Q4 of 2021 to Q1 of 2023, and ABHR use in general wards remained below the amount of WHO recommendations., Conclusion: This trend analysis highlighted recent patterns of ABHR use in Japanese hospitals by comparing pre- and post-COVID-19 periods. Although increases in ABHR use were observed over time, sustained efforts to promote HH compliance are necessary, particularly in general wards., (Copyright © 2024 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Background: Hand hygiene (HH) among health care workers (HCWs) is crucial in preventing infections in nursing homes. However, HH compliance (HHC) among HCWs remains low. This study aimed to investigate the effect of feedback lights on HCWs' HHC., Methods: A 5-month interventional study was conducted in 3 wards in a nursing home in Denmark. During the intervention period, a green light with a smiley appeared on the alcohol-based hand rub (ABHR) dispensers when HCWs used the ABHR, acknowledging HCWs for using the ABHR. HHC was monitored using an automatic HH monitoring system (AHHMS)., Results: A total of 64 HCWs were enrolled. The AHHMS collected 23,696 HH opportunities in apartments and dirty utility rooms. Overall, HHC in the apartments increased from 50% at baseline (95% CI: 48, 53) to 56% (95% CI: 54, 58) during the intervention. However, the increased HHC level was not sustained during follow-up., Conclusions: The AHHMS enabled the assessment of the intervention. We found a significant effect of light-guided feedback in the apartments. However, the increased HHC was not sustained after the light was switched off., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Elderly nursing home residents are vulnerable to infection from micro-organisms. Hand hygiene is considered one of the most important measures to prevent transmission., Aim: To determine the effect of increased accessibility to alcohol-based hand rub (ABHR) in nursing home wards by monitoring hand hygiene compliance (HHC) among healthcare workers (HCWs)., Methods: An 11-month intervention study was conducted in a Danish six-ward nursing home. Data were collected using an automatic hand hygiene monitoring system (AHHMS). After a baseline period, one extra ABHR dispenser was placed in each of the 150 apartments. Baseline HHC was compared with the HHC during an immediate intervention period and a long-term intervention period., Findings: A total of 159 HCWs were included. The AHHMS registered 341,078 hand hygiene opportunities. Overall baseline HHC was 31% (95% confidence interval: 30-32). A significant +18% absolute immediate effect (first five months) (95% CI: 17-19; P < 0.0001) and +13 percentage points (95% CI: 11-14; P < 0.0001) long-term effect (another four months) were recorded. HCWs working day shifts and short-term employees had a higher baseline HHC than HCWs working evening/night shifts. However, HCWs working night shifts achieved the greatest long-term effect with a mean +27 percentage point difference (P < 0.0001)., Conclusion: Placing an additional ABHR dispenser strategically within staff workflow significantly increased HHC among HCWs, demonstrating a noteworthy effect. The study is the first to report the effect on nursing home dispenser accessibility as a single intervention and to show a significant unmet potential., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Argania spinosa (L.) plays an important role in the Moroccan agroeconomy, providing both employment and export revenue. Argan oil production generates different by-products with functionalities that are not yet investigated, in particular, the shell fruit. The present study aims, for the first time, at evaluating the acute and subacute toxicity, anti-inflammatory, and antioxidant effects of argan fruit shell ethanol extract (AFSEE). The LD 50 of AFSEE was determined to be greater than the 5000 mg/kg body weight of mice. No significant variation in the body and organ weights was observed after 28 days of AFSEE treatment compared to that of the control group. Biochemical parameters and histopathological examination revealed no toxic effects of AFSEE. The AFSEE produced a significant inhibition of xylene-induced ear edema in mice. AFSEE reduced significantly the paw edema in mice after carrageenan injection. The chemical characterization showed that AFSEE contains a high level of total phenol content, flavonoids, condensed tannins, and flavanols. The obtained IC 50 of DPPH, ABTS, reducing power, and β -carotene demonstrates that AFSEE has a potential antioxidant effect. The results indicate that AFSEE was safe and nontoxic to mice even at higher doses. Furthermore, the present findings demonstrate that AFSEE has potential anti-inflammatory and antioxidant activities., Competing Interests: All co-authors declare no conflict of interest., (Copyright © 2021 Rachida Makbal et al.)

Moderate alcohol consumption is associated with increased plasma high-density lipoprotein (HDL)-cholesterol concentrations and reduced risk for cardiovascular disease. Plasma cholesteryl ester transfer activity (CETA) mediates the exchange of HDL-cholesteryl ester (CE) for the triacylglycerol (TAG) of very-low-density lipoproteins. We compared the effects of oral challenges of Alcohol, saturated fat (SAT), and (Alcohol + SAT) on plasma CETA, cholesterol, nonesterified fatty acids (NEFA), and TAG among normo-triglyceridemic (NTG) and mildly hypertriglyceridemic (HTG) volunteers having a range of plasma TAG concentrations. The major changes were (1) CETA increased more after ingestion of SAT and (Alcohol + SAT) in the HTG group versus the NTG group; (2) after all three challenges, elevation of plasma TAG concentration persisted longer in the HTG versus NTG group. Plasma cholesterol was not affected by the three dietary challenges, while Alcohol increased NEFA more in the HTG group than the NTG group. Plasma TAG best predicted plasma CETA, suggesting that intestinally derived lipoproteins are acceptors of HDL-CE. Unexpectedly, ingestion of (Alcohol + SAT) reduced the strength of the correlation between plasma TAG and CETA, that is the effects of (SAT and Alcohol) on plasma CETA are not synergistic nor additive but rather mutually suppressive. The alcohol-mediated inhibition of CE-transfer to chylomicrons maintains a higher plasma HDL-cholesterol concentration, which is athero-protective, although the suppressive metabolite underlying this correlation could be acetate, the terminal alcohol metabolite, other factors, including CETA inhibitors, are also likely important., (© 2020 AOCS.)

Ingestion of toxic alcohols (TA) typically presents with a high anion gap (AG) metabolic acidosis, and elevated osmolar gap (OG). Hemodialysis (HD) has not been recommended in early phases of intoxication with high OG and normal AG metabolic acidosis. We describe the case of a 40-year-old male who was brought to our emergency department for reported paint thinner ingestion. He was unable to protect his airway and required intubation. Blood gas showed respiratory acidosis, an initial AG, corrected by albumin of 12.75, lactic acid 5.26 mmol/L, and an OG of 170. Patient was treated with bicarbonate drip, fomepizole and emergent HD, which improved his neurologic status. Days after his admission, alcohol levels came positive for a co-ingestion of ethylene glycol, diethylene glycol, and methanol. Most of the TA are metabolized into their toxic byproducts by the enzyme alcohol dehydrogenase (ADH). The kinetics of these alcohols will be altered when there is co-ingestion of multiple substances. Moreover, early ingestions will translate in a high OG without a high AG. False elevation of lactate can occur with the ingestion of ethylene glycol due to a cross-reaction with L-lactate oxidase in the analyzer. In our case, the administration of fomepizole followed by an early HD given the poor clinical improvement, was followed by a fast recovery of the neurological status and potentially prevented renal failure. A high index of suspicion for TA ingestion should be raised when encountering an individual with lactic acidosis, high OG, and normal AG.

Purpose: Preventing CLABSI events in the dialysis inpatient population represents significant challenges. Bacteremia associated with lines or grafts are common health-associated infections that lead to adverse patient outcomes. Dialysis patients represent a much higher infection risk due to health frequency needs, more frequent hospitalizations, multiple comorbidity issues, fistula functionality, and multiple attempts for line access leading to additional complications, costs, morbidity, and mortality., Methods: An observational study was conducted including central line device days, CLABSI events, and possible confounding variables in admitted dialysis patients. All CLABSI data were identified according to the Centers for Disease Control and Prevention's National Healthcare Safety Network's definitions for CLABSIs. The intervention involved the removal of 70% alcohol swabs and alcohol hub disinfecting caps, then replacing with swabs containing 3.15% chlorhexidine gluconate/70% alcohol for central line hub disinfection and vascular graft access skin disinfection., Results: The 5-year preintervention period (2008-2012) involved 7568 central line days, 11 CLABSI events, and a 1.45 per 1000 device day rate. The 6-month trial period involved 1559 central line days and no CLABSI events. The 5-year postimplementation period (2013-2017) involved 9787 central line days, 5 CLABSI events, and a 0.51 per 1000 device day rate. The postimplementation period represented a statistically significant ( P value=0.0493) reduction with 65% fewer CLABSI events compared with the preimplementation period., Limitations: A limitation was variations in scrub time and dry time during central venous catheter hub access. While we were comparing 2 products, behavioral practices using these 2 products were possible influencers and represent a possible confounding variable., Conclusions: This study found that using alcohol with chlorhexidine gluconate prior to accessing central line hubs and vascular grafts allows for reduction in CLABSI events and sustains statistically significant lower CLABSI rates in the inpatient dialysis population. HIGHLIGHTS Using alcohol with chlorhexidine gluconate (CHG) before accessing central line hubs helps reduce central line-associated bloodstream infection (CLABSI) events Using alcohol with CHG before accessing vascular grafts helps reduce CLABSI events A statistically significant reduction (65%) in CLABSI events occurred after use. Statistically significant lower CLABSI rates are sustainable with use of alcohol with CHG.

Cutaneous antisepsis with chlorhexidine or povidone-iodine, usually with alcohol, has been extensively studied. This review of published studies reveals that sequential use of povidone-iodine and chlorhexidine leads to a greater reduction in the bioburden of aerobic and anaerobic bacteria on the skin, lower risk of intravascular catheter colonization, and lower risk of surgical site infection compared to use of either agent alone. As such, sequential use of cutaneous antiseptic agents may further reduce risk of surgical site infections, as well as infections associated with insertion of transdermal devices such as nephrostomy tubes, left-ventricular assistance devices, and intravascular catheters.

Background: Binge drinking, an increasingly common form of alcohol use disorder, is associated with substantial morbidity and mortality; yet, its effects on the immune system's ability to defend against infectious agents are poorly understood. Burkholderia pseudomallei, the causative agent of melioidosis can occur in healthy humans, yet binge alcohol intoxication is increasingly being recognized as a major risk factor. Although our previous studies demonstrated that binge alcohol exposure increased B. pseudomallei near-neighbor virulence in vivo and increased paracellular diffusion and intracellular invasion, no experimental studies have examined the extent to which bacterial and alcohol dosage play a role in disease progression. In addition, the temporal effects of a single binge alcohol dose prior to infection has not been examined in vivo., Principal Findings: In this study, we used B. thailandensis E264 a close genetic relative of B. pseudomallei, as useful BSL-2 model system. Eight-week-old female C57BL/6 mice were utilized in three distinct animal models to address the effects of 1) bacterial dosage, 2) alcohol dosage, and 3) the temporal effects, of a single binge alcohol episode. Alcohol was administered comparable to human binge drinking (≤ 4.4 g/kg) or PBS intraperitoneally before a non-lethal intranasal infection. Bacterial colonization of lung and spleen was increased in mice administered alcohol even after bacterial dose was decreased 10-fold. Lung and not spleen tissue were colonized even after alcohol dosage was decreased 20 times below the U.S legal limit. Temporally, a single binge alcohol episode affected lung bacterial colonization for more than 24 h after alcohol was no longer detected in the blood. Pulmonary and splenic cytokine expression (TNF-α, GM-CSF) remained suppressed, while IL-12/p40 increased in mice administered alcohol 6 or 24 h prior to infection. Increased lung and not intestinal bacterial invasion was observed in human and murine non-phagocytic epithelial cells exposed to 0.2% v/v alcohol in vitro., Conclusions: Our results indicate that the effects of a single binge alcohol episode are tissue specific. A single binge alcohol intoxication event increases bacterial colonization in mouse lung tissue even after very low BACs and decreases the dose required to colonize the lungs with less virulent B. thailandensis. Additionally, the temporal effects of binge alcohol alters lung and spleen cytokine expression for at least 24 h after alcohol is detected in the blood. Delayed recovery in lung and not spleen tissue may provide a means for B. pseudomallei and near-neighbors to successfully colonize lung tissue through increased intracellular invasion of non-phagocytic cells in patients with hazardous alcohol intake., Competing Interests: The authors have declared that no competing interests exist.

Objectives: Surgical site skin preparation is an effective method to prevent wound complications. The optimal agent has not been established, and guidelines contain conflicting recommendations., Methods: The aim of alcoholic chlorhexidine or alcoholic iodine skin antisepsis (ACAISA) was to assess the efficacy of surgical site skin preparation with 0.5% chlorhexidine gluconate (w/v) in 70% ethanol (v/v) to 1% iodine (w/v) in 70% ethanol (v/v). This was a cluster randomized, controlled, single-centre, assessor-blinded, superiority trial in patients undergoing elective hip or knee arthroplasty. Each surgeon had a set operating day and the unit of randomization was the day of surgery. The primary outcome was superficial wound complication, defined as a composite endpoint of superficial incisional surgical site infection and/or clinically significant wound ooze in the 30 days following arthroplasty. The secondary outcome was any surgical site infection, including prosthetic joint infection. Outcome ascertainment was undertaken by an independent verification panel. The primary analysis was intention-to-treat, performed at the individual level. Taking into account the clustering effect, analysis of primary and secondary outcomes was undertaken at the level of the surgeon., Results: A total of 780 participants were included; 390 participants were allocated chlorhexidine-alcohol and 390 participants were allocated iodine-alcohol. There was no difference in superficial wound complications: 19 (4.9%) versus 15 (3.8%) respectively (OR 1.28; 95%CI 0.62, 2.63; p 0.50). There was an increased odds of surgical site infection in the chlorhexidine-alcohol group compared to iodine-alcohol: 12 (3.1%) versus four (1.0%) respectively (OR 3.06; 95%CI 1.26, 7.46; p 0.014). The odds of prosthetic joint infection were also increased in the chlorhexidine-alcohol arm compared with iodine-alcohol: seven (1.8%) versus two (0.5%) respectively (OR 3.55; 95%CI 1.20, 10.44; p 0.022)., Conclusions: No difference was observed in the primary outcome of superficial wound complications when chlorhexidine-alcohol and iodine-alcohol were compared. However, on a secondary analysis, iodine-alcohol had greater efficacy than chlorhexidine-alcohol for preventing surgical site infection., Clinical Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614000177651., (Copyright © 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

A service evaluation was designed to examine the effect of installation of alcohol-releasing Surfaceskins doorplates on routine alcohol hand gel hygiene use by healthcare workers. There was an approximate doubling increase in healthcare worker use of alcohol hand gel dispensers following the installation of Surfaceskins doorplates in two operating theatre suites. No evidence was found that Surfaceskins doorplates replaced routine hand hygiene. It is concluded that these devices represent a useful adjunct to routine hand hygiene practice in healthcare environments, and potentially in other settings (e.g. washrooms, restaurants) where frequent contact with doors could undermine infection prevention practice., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

Background: Hand hygiene plays a vital role in the prevention of transmission of micro-organisms. Ozone (O 3 ) is a highly reactive gas with a broad spectrum of antimicrobial effects on bacteria, viruses, and protozoa. It can easily be produced locally in small generators, and dissolved in tap water, and quickly transmits into ordinary O 2 in the surrounding air., Aim: To compare ozonized tap water and alcohol rub in decontamination of bacterially contaminated hands., Methods: A cross-over study among 30 nursing students. Hands were artificially contaminated with Escherichia coli (ATCC 25922), then sanitized with ozonized tap water (0.8 or 4 ppm) or 3 mL standard alcohol-based rub (Antibac 85%). The transient microbes from fingers were cultivated and colony-forming units (cfu)/mL were counted. The test procedure was modified from European Standard EN 1500:2013., Findings: All contaminated hands before disinfection showed cfu >30,000/mL. The mean (SD) bacterial counts in (cfu/mL) on both hands combined were 1017 (1391) after using ozonized water, and 2337 (4664) after alcohol hand disinfection. The median (range) values were 500 (0-6700) and 250 (0-16,000) respectively (non-significant difference). Twenty per cent of participants reported adverse skin effects (burning/dryness) from alcohol disinfection compared with no adverse sensations with ozone., Conclusion: Ozonized tap water is an effective decontaminant of E. coli, and it could be an alternative to traditional alcohol-fluid hand disinfectants both in healthcare institutions and public places. Ozonized water may be especially valuable for individuals with skin problems., (Copyright © 2019 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Objectives: Compliance with the World Health Organization 'how to handrub' action is suboptimal. Simplifying the hand-hygiene action may improve practice. However, it is crucial to preserve antibacterial efficacy. We tested the non-inferiority of 15 versus 30 seconds handrubbing for Staphylococcus aureus and Escherichia coli contamination at different loads, using hand-size customized alcohol-based handrub (ABHR) volumes., Methods: In an EN1500-based study, 18 health-care workers (HCWs) with extensive experience in hand hygiene rubbed hands with a hand-size customized volume of isopropanol 60% v/v. They repeated the following sequence: hand contamination (E. coli or S. aureus; broth containing 10 8 or 10 6  CFU/mL); baseline fingertips sampling; handrubbing (15 or 30 seconds); re-sampling. The main outcome was log 10  CFU corrected reduction factor (cRF) on HCWs' hands, applying a generalized linear mixed model with a random intercept for subject., Results: The median cRF was 2.1 log 10 (interquartile range 1.50-3.10). After fitting the model, cRF was significantly higher for S. aureus compared with E. coli but there was no significant effect for duration of handrubbing or contamination fluid concentration. Fifteen seconds of handrubbing was non-inferior to 30 (-0.06 log 10 , 95% CI -0.34 to 0.22; EN1500 0.60 log 10 non-inferiority margin). This was confirmed in all pre-specified subgroups., Conclusion: Among experienced HCWs using a hand-size customized volume of ABHR, handrubbing for 15 seconds was non-inferior to 30 seconds in reducing bacterial load, irrespective of type of bacteria or contamination fluid concentration. This provides further support for a shorter, 15-seconds, hand-hygiene action., (Copyright © 2018 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Although substantial improvements in hand hygiene practices have occurred in recent years, many health care facilities continue to encounter challenges in achieving and maintaining high levels of hand hygiene compliance. Issues of current interest include the optimum dose of alcohol-based handrub (ABHR) that should be applied, the impact of hand size and alcohol-based handrub dry times have on efficacy, and ideal hand hygiene technique. There is a need to determine which additional promotional activities can augment improvements in hand hygiene that are achieved by implementing the multimodal improvement strategy recommended by the World Health Organization. Monitoring hand hygiene performance and providing personnel with feedback on their performance are essential elements of successful improvement programs. Further research is needed to establish the most effective methods of providing feedback. Additional studies are needed to optimize strategies for performing direct observation of hand hygiene compliance, and to determine the role of supplementing direct observations using automated monitoring systems., (Copyright © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: The alcohol rub has been proposed as an alternative to the traditional surgical scrub in preparing the hands for surgical procedures. Few reviews have examined critically the evidence that favors or discredits the use of the alcohol rub instead of the traditional scrub., Methods: A review of available published literature was undertaken to define the evidence for the best methods for hand preparation before surgical procedures. The focus of this literature review was to compare the bacteriologic and clinical outcomes of conventional surgical scrubbing of the hands compared with alcohol rubs., Results: The bacteriologic studies of the hands after the conventional scrub versus the alcohol rub demonstrated consistently comparable or superior reductions in bacterial presence on the hand with the alcohol rub. Only four clinical studies were identified that compared the scrub versus the rub in the frequency of surgical site infections. No difference in surgical site infections were identified., Conclusions: The alcohol rub appears to have comparable results to the surgical scrub and is a reasonable alternative in preparation of the hands for surgical procedures.

The perineural administration of alcohol or phenol results in protein denaturation and, consequently, neurolysis. This can produce long-lasting analgesia, with a duration of 3-6 months. Although neurolytic blocks for the brachial plexus have been described in multiple review articles and textbooks, they are rarely performed. As such, little is known about the efficacy and adverse effect profile of this commonly described treatment. In this article, we report the outcomes of a patient who underwent a left brachial plexus neurolytic block for the management of upper limb pain arising from a malignant peripheral nerve sheath tumor.

Background: Surgically-managed fractures, particularly open fractures, are associated with high rates of surgical site infections (SSIs). To reduce the risk of an SSI, orthopaedic surgeons routinely clean open fracture wounds in the emergency department (ED) and then apply a bandage to the open wound. Prior to the surgical incision, it is standard practice to prepare the fracture region with an antiseptic skin solution as an additional SSI prevention strategy. Multiple antiseptic solutions are available., Objectives: To explore the variation in practice patterns among orthopaedic surgeons regarding antiseptic solution use in the ED and antiseptic preparatory techniques for fracture surgery., Methods: We developed a 27-item survey and surveyed members of several orthopaedic associations., Results: Two hundred and-ten surveys were completed. 71.0% of respondents irrigate the open wound and skin in the ED, primarily with saline alone (59.7%) or iodine-based solutions (32.9%). 90.5% of responders indicated that they dress the open wound in the ED, with 41.0% applying a saline-soaked bandage and 33.7% applying an iodine-soaked dressing (33.7%). In their surgical preparation of open fractures, 41.0% of respondents used an iodine-based solution, 26.7% used a chlorhexidine gluconate (CHG)-based solution, and 31.4% used a combination of the two. In closed fractures, 43.8% of respondents used a CHG-based solution, 28.1% used an iodine-based solution, and 27.1% used a combination. Despite theoretical concerns about the use of alcohol in open wounds, 51.4% used alcohol-based solutions or alcohol alone during skin preparation of open fractures., Conclusions: A lack of consensus exists regarding use of antiseptic surgical preparation solutions for fractures. High-quality clinical research is needed to assess the effectiveness of different surgical antiseptic preparation solutions on patient outcomes in fracture populations., Competing Interests: This study was approved by the Hamilton Integrated Research Ethics Board (HiREB #2016–2326). Utilizing SurveyMonkey, the survey was distributed through email which included a link to the online survey and presented information on the survey’s purpose, how their data would be stored and used, and the investigator’s contact information. Completion of the survey was considered as implicit consent, and no monetary incentives or pre-notification emails were used for this survey. Questionnaire completion was voluntary and individual responses were kept confidential, only being accessible through a password protected account.Not Applicable.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

We report a case of serious neurologic injury due to inadvertent epidural injection of 8 ml of the antiseptic 2% chlorhexidine in 70% alcohol during a procedure aimed to relieve the pain of labour. This resulted in immediate severe back pain, progressive tetraparesis and sphincter dysfunction caused by damage to the spinal cord and nerve roots. Subacute hydrocephalus necessitated drainage, but cranial nerve and cognitive function were spared. Magnetic resonance imaging documented marked abnormality of the spinal cord and surrounding leptomeninges. In the ensuing eight years, there has been clinical and electrophysiological evidence of partial recovery, but neurologic deficit remains severe.

Background: Healthcare workers perform hand hygiene much more frequently than workers in other fields. As a result, healthcare workers have a higher exposure to topical antiseptic products., Methods: Five tertiary care facilities were equipped with an electronic hand hygiene compliance monitoring system. Alcohol-based handrub (ABHR) and handwash use was recorded on a worker-specific basis for 6 months. Total hand hygiene product use and total hours worked were calculated for each worker to determine use frequency., Results: A detailed, descriptive analysis of hand hygiene practices was performed. All facilities demonstrated high hand hygiene compliance rates (>85%). ABHR use was more frequent (9.1 uses/hour, 95 th percentile) than handwashing (2.1 uses/hour, 95 th percentile). This study identified a relationship between hand hygiene frequency and job function. Nursing and nonclinical support staff demonstrated higher usage rates than other healthcare workers. For these workers with high hand hygiene frequency, 95 th percentile usage rates for ABHR use and handwashing were 9.6 and 2.2 uses/hour, respectively., Conclusions: This extensive dataset, monitoring nearly 4000 healthcare workers and more than 6 million data points, provides a detailed description of current hand hygiene practices of hospital staff. ABHR was used more frequently than handwashing. Job function was found to affect hand hygiene frequency, with nonclinical staff and nursing staff demonstrating elevated rates of hand hygiene., (Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Objectives: Hand hygiene is considered the most effective way to reduce the transmission of (multidrug-resistant) organisms and to prevent healthcare-associated infections. Hand rubbing with alcohol-based handrub (AHR) has become the reference standard for hand hygiene. Data on AHR consumption are easy to obtain and can serve as an approximation for hand hygiene compliance. As described earlier, AHR consumption varies among European hospitals. In the current study the role of various hospital and country indicators for AHR consumption is analysed., Methods: As part of the European Prevention of Hospital Infections by Intervention and Training (PROHIBIT) project hospital-based data on infection prevention and control (IPC) structure and organization and hospital-wide AHR consumption were obtained from acute care hospitals. National indicators such as income, public health expenditure, national hand hygiene campaigns, IPC training and the six Hofstede dimensions were identified. Univariable and multivariable linear regression analyses using generalized linear models were performed to estimate the association between AHR consumption and indicators at both hospital and country levels., Results: Data from 232 hospitals from 22 European countries were analysed. Multivariate risk factor analysis showed independent associations between AHR consumption and private and university-affiliated hospitals (multiplicative effect, 95% CI: 1.76, 1.21-2.55; and 1.39, 1.17-1.64, respectively), high-income countries (3.61, 2.94-4.43), and countries offering national curricula for the training of IPC nurses (3.77, 2.32-6.13). However, no cultural dimension was independently associated with AHR consumption., Conclusion: Country indicators such as high-income, national training on IPC, and hospital type and status are positively associated with AHR consumption in Europe., (Copyright © 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Chronic kidney disease (CKD) affects 8⁻16% of the population worldwide. In developed countries, the most important risk factors for CKD are diabetes, hypertension, and obesity, calling into question the importance of educating and acting on lifestyles and nutrition. A balanced diet and supplementation can indeed support the maintenance of a general health status, including preservation of renal function, and can help to manage and curb the main risk factors for renal damage. While the concept of protein and salt restriction in nephrology is historically acknowledged, the role of some nutrients in renal health and the importance of nutrition as a preventative measure for renal care are less known. In this narrative review, we provide an overview of the demonstrated and potential actions of some selected nutrients, nutraceuticals, and xenobiotics on renal health and function. The direct and indirect effects of fiber, protein, fatty acids, curcumin, steviol glycosides, green tea, coffee, nitrates, nitrites, and alcohol on kidney health are reviewed here. In view of functional and personalized nutrition, understanding the renal and systemic effects of dietary components is essential since many chronic conditions, including CKD, are related to systemic dysfunctions such as chronic low-grade inflammation.

The Scottish national hand hygiene proxy measure uses the volume of alcohol-based hand rub (ABHR) purchased by NHS Scotland boards as an indicator of the number of hand hygiene moments being performed per patient-bed-day. The proxy measure calculation is based on the assumption that 3 mL of ABHR is used per hand hygiene moment. This study aimed to validate the volume of ABHR being used per hand hygiene moment. It found that the median volume of ABHR being used in practice is approximately 1 mL per hand hygiene moment, and that using this validated volume in the calculation substantially increases the proxy measure of hand hygiene compliance., (Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Among the serious consequences of alcohol abuse is the reduced ability to process visual information. Diminished vision from excessive consumption of alcohol has been implicated in industrial, home, and automobile accidents. Alcohol is also generally recognized as an inhibitor in the brain by potentiating GABA-ergic transmission. In this study, we focused on visual motion processing and explored whether moderate alcohol intoxication induced changes in inhibitory mediated motion repulsion in a center-surround configuration. We conducted a double-blind, placebo-controlled, within-subjects study on the effect of alcohol on visual motion repulsion. Each subject underwent three experimental conditions (no alcohol, placebo and moderate alcohol) on separate days. The order of the placebo and moderate alcohol conditions was counterbalanced. The results showed that the effects of the surround context on the perception of the center motion direction were similar in both the sober (no alcohol) and placebo conditions. However, contextual modulations were significantly stronger during intoxication compared to both the sober and placebo conditions. These results demonstrate that moderate alcohol consumption is associated with altered neural function in visual cortical areas and that motion repulsion deficits might reflect the inhibitory effects of alcohol on the central nervous system.

Background: Optimal hand hygiene may be compromised by contact with contaminated environmental surfaces., Aim: To investigate the in-vitro efficacy of a novel alcohol-release doorplate to reduce surface contamination during hand contact., Methods: Prototype, horizontally held, Surfaceskins, alcohol gel-impregnated and control (aluminium) doorplates were challenged (N = 72 per micro-organism) with Staphylococcus aureus-, Eschericia coli-, Enterococcus faecalis-, or Clostridium difficile-contaminated fingers. S. aureus and E. faecalis were used for challenges (90 per micro-organism) of vertical (modified design) doorplates, on days 0, 3, 4, 6, and 7. Surface contamination was measured pre and immediately post challenges using agar contact plates., Findings: Horizontal test, but not control, doorplates demonstrated bacterial killing of S. aureus, E. faecalis and E. coli, but not of C. difficile; hence, only testing of S. aureus and E. faecalis was continued. Vertical Surfaceskins, but not control, doorplates demonstrated rapid killing of S. aureus over seven days. There were significant reductions (>90% up to day 6; P ≤ 0.01) of surface bacterial colony counts compared with controls immediately post challenge. There were also significant reductions in Surfaceskins doorplate enterococcal colony counts compared with controls on every day of testing (P ≤ 0.004). There was no evidence that bacterial recovery was greater from the tops of Surfaceskins doorplates (i.e. due to pooling of contents)., Conclusion: Surfaceskins doorplates were efficient at reducing surface contamination by S. aureus, E. faecalis, and E. coli. Reducing microbial contamination of frequently touched door surfaces, and so bacterial transfer via hands, could feasibly reduce the risk of healthcare-associated and other infections., (Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Increasing evidence suggest that low-dose alcohol consumption (LAC) reduces the incidence and improves the functional outcome of ischemic stroke. We determined the influence of LAC on post-ischemic inflammation. Male Sprague-Dawley rats were divided into 3 groups, an ethanol (13.5% alcohol) group, a red wine (Castle Rock Pinot Noir, 13.5% alcohol) group, and a control group. The amount of alcohol given to red wine and ethanol groups was 1.4 g/kg/day. After 8 weeks, the animals were subjected to a 2-hour middle cerebral artery occlusion (MCAO) and sacrificed at 24 hours of reperfusion. Cerebral ischemia/reperfusion (I/R) injury, expression of adhesion molecules and pro- and anti-inflammatory cytokines/chemokines, microglial activation and neutrophil infiltration were evaluated. The total infarct volume and neurological deficits were significantly reduced in red wine- and ethanol-fed rats compared to control rats. Both red wine and ethanol suppressed post-ischemic expression of adhesion molecules and microglial activation. In addition, both red wine and ethanol upregulated expression of tissue inhibitor of metalloproteinases 1 (TIMP-1), downregulated expression of proinflammatory cytokines/chemokines, and significantly alleviated post-ischemic expression of inflammatory mediators. Furthermore, red wine significantly reduced post-ischemic neutrophil infiltration. Our findings suggest that LAC may protect the brain against its I/R injury by suppressing post-ischemic inflammation.

Background: Hand hygiene is the cornerstone of infection prevention and control practices, and reduces healthcare-associated infections significantly. However, international evidence suggests that medical doctors demonstrate poor compliance., Aim: To explore and compare practices and attitudes towards hand hygiene, particularly hand rubbing using alcohol-based hand rub (ABHR), among hospital-based physicians in Ireland between 2007 and 2015., Methods: In 2007, a random sample of doctors in a large teaching hospital was invited to complete a postal survey using a validated questionnaire. In 2015, the study was replicated among all doctors employed in a university hospital group, including the setting of the original study, using an online survey. Data were analysed using SPSS and Survey Monkey., Findings: Predominately positive and improving attitudes and practices were found, with 86% of doctors compliant with hand hygiene before patient contact in 2015, compared with 58% in 2007. Ninety-one percent of doctors were compliant after patient contact in 2015, compared with 76% in 2007. In 2015, only 39% of respondents reported that they 'almost always' used ABHR for hand hygiene. However, this represents 13.5% more than in 2007. Stated barriers to use of ABHR included dermatological issues, poor acceptance, tolerance and poor availability of ABHR products., Conclusion: Greater awareness of hand hygiene guidelines and greater governance appear to have had a positive impact on practice. However, despite this, practice remains suboptimal and there is scope for substantial improvement. Continued and sustained efforts are required in order to build on progress achieved since the World Health Organization hand hygiene guidelines were published in 2009., (Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Background: Hand hygiene is one of the most effective attempts to control nosocomial infections, and it is an important measure to avoid the transmission of pathogens. However, the compliance of healthcare workers (HCWs) with hand washing is still poor worldwide. Herein, we aimed to determine the best hand hygiene preference of the infectious diseases and clinical microbiology (IDCM) specialists to prevent transmission of microorganisms from one patient to another., Methods: Expert opinions regarding the criteria that influence the best hand hygiene preference were collected through a questionnaire via face-to-face interviews. Afterwards, these opinions were examined with two widely used multi-criteria decision analysis (MCDA) methods, the Multi-Attribute Utility Theory (MAUT) and the Analytic Hierarchy Process (AHP)., Results: A total of 15 IDCM specialist opinions were collected from diverse private and public hospitals located in İzmir, Turkey. The mean age of the participants was 49.73 ± 8.46, and the mean experience year of the participants in their fields was 17.67 ± 11.98. The findings that we obtained through two distinct decision making methods, the MAUT and the AHP, suggest that alcohol-based antiseptic solution (ABAS) has the highest utility (0.86) and priority (0.69) among the experts' choices., Conclusion: In conclusion, the MAUT and the AHP, decision models developed here indicate that rubbing the hands with ABAS is the most favorable choice for IDCM specialists to prevent nosocomial infection.

Enhancement of alcohol tolerance in microorganisms is an important strategy for improving bioalcohol productivity. Although cyanobacteria can be used as a promising biocatalyst to produce various alcohols directly from CO 2 , low productivity, and low tolerance against alcohols are the main issues to be resolved. Nevertheless, to date, a mutant with increasing alcohol tolerance has rarely been reported. In this study, we attempted to select isopropanol (IPA)-tolerant mutants of Synechococcus elongatus PCC 7942 using UV-C-induced random mutagenesis, followed by enrichment of the tolerant candidates in medium containing 10 g/L IPA and screening of the cells with a high growth rate in the single cell culture system in liquid medium containing 10 g/L IPA. We successfully acquired the most tolerant strain, SY1043, which maintains the ability to grow in medium containing 30 g/L IPA. The photosynthetic oxygen-evolving activities of SY1043 were almost same in cells after 72 h incubation under light with or without 10 g/L IPA, while the activity of the wild-type was remarkably decreased after the incubation with IPA. SY1043 also showed higher tolerance to ethanol, 1-butanol, isobutanol, and 1-pentanol than the wild type. These results suggest that SY1043 would be a promising candidate to improve alcohol production using cyanobacteria. Biotechnol. Bioeng. 2017;114: 1771-1778. © 2017 Wiley Periodicals, Inc., (© 2017 Wiley Periodicals, Inc.)

Background: Burn patients are an especially high-risk population for development of central line associated bloodstream infections (CLABSI) due to open wounds, extended length of intensive care unit stay, frequent use of central venous catheters, and generally immunocompromised state. Implementing evidence-based practices to prevent these infections is a 2014 National Patient Safety Goal per The Joint Commission., Objectives: The purpose of this project was introduction of a commercially available alcohol impregnated central venous line port protector to reduce the incidence of CLABSI in the burn unit., Methods: The Iowa Model for Implementing Evidenced-Based Practice was used to guide this intervention conducted by the Unit Practice Council. A pre- and post-intervention design compared rates of CLABSI before and after introduction of the port protectors., Results: CLABSI infection rates decreased following the intervention from baseline of 7.3 per 1000 line days to an average of 3.04 per 1000 line days during calendar year 2013., Conclusions: Introduction of an alcohol impregnated central venous line port protector can reduce the incidence of CLABSI in a burn unit., (Published by Elsevier Ltd.)

The purpose of this study was to evaluate persistent activity of three alcohol-based antiseptics widely used in the clinical routine containing chlorhexidine, triclosan or mecetronium after hand disinfection. Four tests were used to evaluate the antimicrobial activity of antiseptics on: (i) resident microbiota; (ii) nutrient agar plates (NAP) subsequently inoculated with a test organism; and transient microbiota acquired by contact with dry hands (iii), or (iv) a wet inert surface that had been artificially contaminated. Four reference strains (Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis) and an Acinetobacter baumannii strain responsible for a hospital outbreak were used as transient microbiota. Antimicrobial activity was calculated according to the CFUs reduction by reference to non-disinfected control hands. The antiseptics were applied according to European Standard EN1500. Solutions containing chlorhexidine or triclosan showed some persistent effects on transient microbiota on inert humid surfaces and NAP, but not on contaminated dry hands. Solutions containing mecetronium showed no persistent effect on transient flora in any of the trials. All alcohol-based antiseptics tested were more effective against resident flora than soap. No persistent activity was observed for A. baumannii in any of the trials. Chlorhexidine and triclosan are preferred when an antiseptic with persistent activity is desired, but a moist environment appears to be necessary for that antibacterial activity. Accordingly, relevant conclusions regarding the persistent activity of antiseptics for clinical practice and protection against bacterial contamination cannot be derived from this study for the alcoholic solutions tested.

Alcohol and nicotine are the two most commonly-abused substances and are often used together. Nicotine enhances alcohol-drinking behaviors in humans and in animals, and was suggested to enhance the reinforcing properties of other reinforcers. Here, we show that nicotine-associated environment, rather than nicotine itself, enhances alcohol intake in rats. Adolescent rats received repeated intermittent injections of nicotine (0.4 mg/kg, i.p., 5 injections, every 3 rd day) or saline. The injection was paired with their home cage, or with the subsequent alcohol self-administration context. Rats were then trained to self-administer 20% alcohol. Nicotine given in the home cage did not alter subsequent alcohol intake. However, pairing nicotine with the operant chamber during adolescence led to a long-lasting increased alcohol self-administration in adulthood, compared to nicotine pre-treatment in other contexts. This effect persisted 3 months after nicotine cessation, in a relapse test after abstinence. Furthermore, re-exposure to the nicotine-associated context in adult rats led to a decrease in glial cell line-derived neurotrophic factor (Gdnf) mRNA expression in the ventral tegmental area, an effect that leads to increased alcohol consumption, as we have previously reported. Our findings suggest that retrieval of nicotine-associated contextual memories from adolescence may gate alcohol intake in adulthood, with a possible involvement of GDNF.

Introduction: There is still some uncertainty on cord care practices all around the world, especially in developing countries. The aim of our study was to investigate the effects of six different umbilical cord care practices on the rate of colonization and cord separation time., Methodology: A total of 516 newborns were randomly allocated to the following six umbilical cord care groups: group 1 received dry care; groups 2-4 received a single application of 70% alcohol, 4% chlorhexidine, or povidon-iodine in the delivery room, respectively, which were discontinued thereafter; groups 5 and 6 received a single application of 70% alcohol or 4% chlorhexidine, respectively, starting in the delivery room and continuing every six hours until discharge. Umbilical cords were examined on the second and third days and between the fifth and seventh day for signs of omphalitis. Swab cultures were taken on the second or third day from all cases., Results: Cord separation time (median [interquartile range]) was the shortest for group 1 (7 [6-7] days) and the longest for group 3 (10 [7-12] days) and group 6 (10 [8-12] days) (p < 0.001). The cord colonization in the swab cultures was significantly lower in groups 3 and 6 (p < 0.001). Omphalitis was detected in eight (1.5%) patients among the study population, and there was no significant difference between the groups., Conclusions: Our study showed that chlorhexidine application was the most effective agent in decreasing colonization, though it increased cord separation time significantly in both groups.

Background: Manufacturers' recommended dosages for alcohol-based hand rubs are typically determined by measuring product efficacy using a model protocol such as EN 1500; however, anecdotal reports and informal observation suggests that in many cases users self-titrate to much lower doses in real-world application., Aim: To examine the interdependence of alcohol-based hand-rub volume on in-vivo efficacy using the EN 1500 standard test method, on drying time on users' hands, and on their perceptions of acceptability., Methods: Three formulations were studied using EN 1500 and a modification of this method. The modification used volumes ranging from 0.5 to 3.0 mL and 30 s application. Drying times were recorded and user acceptability was established using a three-point scale (too long, OK, or too short). Dying times were analysed in relation to hand surface area., Findings: The drying time for all three products increased as a function of volume. The drying time displayed a positive association with volume and a negative association with hand surface area. The optimum volume for user acceptability was between 1.5 and 2 mL, yielding a drying time of between 20 and 30 s., Conclusion: Whereas EN 1500 is appropriate for establishing the efficacy of a hygienic hand-rub formulation compared to a benchmark, it does not reflect actual in-use conditions or the likely clinical effectiveness of the product. In particular, it fails to address the need to optimize the volume of application and user acceptability of the product., (Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Background: Major complications of central venous catheter (CVC) use include bloodstream infection and occlusion. We performed a prospective, observational study to determine the rate of central line-associated bloodstream infection (CLABSI) and CVC occlusion using a negative displacement connector with an alcohol disinfecting cap., Methods: Patients were followed from the time of CVC insertion through 2 days after removal, at the time of hospital discharge if there was no documentation of removal, or 90 days after the insertion of the CVC if it was not removed. CLABSI was defined using National Healthcare Safety Network criteria. Data for evidence of lumen occlusions were extracted from the electronic health record. Direct observations were performed to assess adherence to hospital policy regarding CVC insertion practice., Results: A total of 2,512 catheters from 2,264 patients were enrolled for this study. There were 21 CLABSIs (0.84%; 95% confidence interval [CI], 0.48%-1.19%; 0.62 per 1,000 line days) and 378 occlusions (15.05%; 95% CI, 13.65%-16.45%; 11.23 per 1,000 line days). Eighty-five direct observations demonstrated insertion protocol adherence in 881 of 925 (95.24%; 95% CI, 93.87%-96.61%) measured criteria., Conclusions: Lines placed following a standardized protocol using a negative displacement connector with an alcohol cap have low rates of infection compared with historically published findings. We also established that the occlusion rate is >15-fold the CLABSI rate., (Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Germany has established a nationwide surveillance system of alcohol-based hand-rub consumption (AHC) per patient-day in hospital settings as a surrogate parameter for hand hygiene (HH) compliance. Analysis of AHC data in intensive care units (ICUs) shows not only a wide range of consumption between units of different specialties, but also within units of one specialty. This seems to reflect variation in the number of HH opportunities per patient-day between ICUs due to variation in complexity of care., Aim: To investigate whether ventilator utilization ratio (VUR) might be a good surrogate for describing complexity and intensity of care on ICUs and whether stratification by VUR works as a new method of setting benchmarks for AHC data., Methods: Data from 365 ICUs participating in the German national nosocomial infection surveillance system (KISS) were used. VUR was calculated by dividing the number of ventilator-days per unit by the number of patient-days per unit. AHC was stratified according to VUR in quartiles., Findings: The median AHC was 107mL/patient-day [interquartile range (IQR): 86-134] and the median VUR was 33% (IQR: 22-45%). The Spearman rank correlation coefficient was 0.28 (P<0.0001). After stratifying AHC according to VUR, the AHC in quartile I was significantly lower compared to quartile IV. There was also significant difference between quartile I and quartiles II and III., Conclusion: Stratification of AHC data according to VUR is suggested to improve the quality of benchmark parameters based on AHC data as surrogate parameter for HH compliance in ICUs., (Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Iatrogenic ventriculitis is a potential complication of ventriculostomy drain placement. In this study, an alcohol-impregnated external ventricular drain port cap was added to a standardized ventriculostomy placement bundle. Rates of ventriculitis were reduced postintervention, but this finding did not reach statistical significance., (Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

A high-speed handpiece is used in several dental procedures and the official recommendation for safe decontamination consists of rinsing with water, washing with detergent, mechanical friction, and sterilization; however, many professionals only apply 70% w/v alcohol without also cleaning the tool between patients. We performed an analysis of high-speed handpieces reprocessed only with 70% w/v alcohol and found that the methods used in clinical practice are not safe., (Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

This study aimed to investigate the effects of alcohol-based hand hygiene solution (ABHS) use by care providers on point-of-care alcohol breath analyzer interpretation under different clinically relevant conditions. Among each test condition (foam vehicle with immediate testing, gel vehicle with immediate testing, allowing hands to dry after the use of ABHS, and donning gloves after the use of ABHS), alcohol was detected in breath at 1 minute after use of ABHS. Because the use of ABHS by individuals administering breath alcohol detection may result in false-positive detection of alcohol, staff using these devices should consider traditional hand hygiene with soap and water., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Visitors of an infection prevention and control conference performed hand hygiene with 1, 2, or 3 mL ultraviolet light-traced alcohol-based handrub. Coverage of palms, dorsums, and fingertips were measured by digital images. Palms of all hand sizes were sufficiently covered when 2 mL was applied, dorsums of medium and large hands were never sufficiently covered. Palmar fingertips were sufficiently covered when 2  or 3 mL was applied, and dorsal fingertips were never sufficiently covered., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Sepsis is the leading cause of death in intensive care units in the US, and it is known that chronic alcohol use is associated with higher incidence of sepsis, longer ICU stays, and higher mortality from sepsis. Both sepsis and chronic alcohol use are associated with immune deficits such as decreased lymphocyte numbers, impaired innate immunity, delayed-type hypersensitivity reactions, and susceptibility to infections; however, understanding of specific pathways of interaction or synergy between these two states of immune dysregulation is lacking. This study therefore sought to elucidate mechanisms underlying the immune dysregulation observed during sepsis in the setting of chronic alcohol exposure. Using a murine model of chronic ethanol ingestion followed by sepsis induction via cecal ligation and puncture, we determined that while CD4+ and CD8+ T cells isolated from alcohol fed mice eventually expressed the same cellular activation markers (CD44, CD69, and CD43) and effector molecules (IFN-γ, TNF) as their water fed counterparts, there was an overall delay in the acquisition of these phenotypes. This early lag in T cell activation was associated with significantly reduced IL-2 production at a later timepoint in both the CD4+ and CD8+ T cell compartments in alcohol sepsis, as well as with a reduced accumulation of CD8dim activated effectors. Taken together, these data suggest that delayed T cell activation may result in qualitative differences in the immune response to sepsis in the setting of chronic alcohol ingestion., Competing Interests: The authors have declared that no competing interests exist.

Background: Peracetic acid sporicidal wipes have been shown to be an effective disinfectant, but in controlled test environments. Their high cost may restrict use., Aims: This pilot study investigated the efficacy and compared the costs of routine universal use of peracetic acid sporicidal wipes versus sporicidal quaternary ammonium compound and alcohol wipes in the disinfection of a hospital environment., Methods: The routine universal use of peracetic acid wipes (Clinell Sporicidal; GAMA Healthcare Ltd, London, UK) was allocated to a study ward, whereas the control ward continued with the use of quaternary ammonium compound wipes (Tuffie 5; Vernacare, Bolton, UK) and alcohol wipes (PDI Sani-Cloth 70; PDI, Flint, UK). Twenty high-touch areas in the 2 wards were sampled for the presence of indicator organisms. The weekly detection rates of indicator organisms and weekly healthcare associated infection (HCAI) rates in the 2 wards were compared and examined for decreasing trends over the trial period., Results: The detection rates of indicator organisms and HCAI rates were not significantly different in the 2 wards, and did not decrease significantly over the trial period. However, the peracetic acid wipes seem to be more effective against gram-negative organisms but at a significantly higher cost., Conclusions: Further prospective studies are needed to assess the cost-effectiveness of peracetic acid wipes., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Pterocarpus santalinus, a traditional medicinal plant has shown protective mechanisms against various complications. The aim of the present study is to evaluate therapeutic efficacy of P. santalinus heartwood methanolic extract (PSE) against alcohol-induced oxidative/nitrosative stress leading to hepatotoxicity. In-vitro studies revealed that PSE possess strong DPPH (1,1-diphenyl-2-picryl hydrazyl) and nitric oxide radical scavenging activity. For in vivo studies male albino Wistar rats were treated with 20% alcohol (5g/kg b.wt/day) and PSE (250mg/kg b.wt/day) for 60days. Results showed that alcohol administration significantly altered plasma lipid profile with marked increase in the levels of plasma transaminases (ALT and AST), alkaline phosphatase (ALP), lactate dehydrogenase (LDH) and gamma glutamyl transferase (γGT). Moreover, lipid peroxides, nitric oxide (NOx) levels in plasma and liver were increased with increased iNOS protein expression in liver was noticed in alcohol administered rats and these levels were significantly brought back close to normal level by PSE administration except iNOS protein expression. Alcohol administration also decreased the content of reduced glutathione (GSH) and activities of glutathione peroxidase (GPx), glutathione-s transferase (GST), glutathione reductase (GR), superoxide dismutase (SOD) and catalase (CAT) in liver, which were significantly enhanced by administration of PSE. The active compounds pterostilbene, lignan and lupeols present in PSE might have shown protection against alcohol-induced hepatic damage by possibly reducing the rate of lipid peroxidation, NOx levels and increasing the antioxidant defence mechanism in alcohol administered rats. Both biochemical and histopathological results in the alcohol-induced liver damage model emphasize beneficial action of PSE as a hepatoprotective agent., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Chronic alcohol abuse is one of the leading causes of dilated cardiomyopathy (DCM) in the United States. Volume overload (VO) also produces DCM characterized by left ventricular (LV) dilatation and reduced systolic and diastolic function, eventually progressing to congestive heart failure. For this study, we hypothesized that chronic alcohol exposure would exacerbate cardiac dysfunction and remodeling due to VO. Aortocaval fistula surgery was used to induce VO, and compensatory cardiac remodeling was allowed to progress for either 3days (acute) or 8weeks (chronic). Alcohol was administered via chronic intermittent ethanol vapor (EtOH) for 2weeks before the acute study and for the duration of the 8week chronic study. Temporal alterations in LV function were assessed by echocardiography. At the 8week end point, pressure-volume loop analysis was performed by LV catheterization and cardiac tissue collected. EtOH did not exacerbate LV dilatation (end-systolic and diastolic diameter) or systolic dysfunction (fractional shortening, ejection fraction) due to VO. The combined stress of EtOH and VO decreased the eccentric index (posterior wall thickness to end-diastolic diameter ratio), increased end-diastolic pressure (EDP), and elevated diastolic wall stress. VO also led to increases in posterior wall thickness, which was not observed in the VO+EtOH group, and wall thickness significantly correlated with LV BNP expression. VO alone led to increases in interstitial collagen staining (picrosirius red), which while not statistically significant, tended to be decreased by EtOH. VO increased LV collagen I protein expression, whereas in rats with VO+EtOH, LV collagen I was not elevated relative to Sham. The combination of VO and EtOH also led to increases in LV collagen III expression relative to Sham. Rats with VO+EtOH had significantly lower collagen I/III ratio than rats with VO alone. During the acute remodeling phase of VO (3days), VO significantly increased collagen III expression, whereas this effect was not observed in rats with VO+EtOH. In conclusion, chronic EtOH accelerates the development of elevated wall stress and promotes early eccentric remodeling in rats with VO. Our data indicate that these effects may be due to disruptions in compensatory hypertrophy and extracellular matrix remodeling in response to volume overload., Competing Interests: NWG is a consultant for Glauser Life Sciences., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Multiple factors affect compliance with hand hygiene, including conspicuity of alcohol-gel dispensers. Previous studies have shown that flashing lights increase hand hygiene compliance; however, the durability of this effect has not been studied., Methods: We affixed flashing lights to hand sanitizer dispensers for a total of 6 weeks. Regression analysis was used to compare compliance rates between the beginning and end of the intervention. Our secondary objective was to determine whether compliance rates in cold weather could be improved by adding a sign separated in time and space from the dispensers., Results: Flashing lights improved hand hygiene compliance from 11.8% to 20.7%, and this effect was unchanged over the 6-week study period. Fully charged lights resulted in a greater compliance increase. A preemptive sign did not have a significant effect on hand hygiene rates nor did absolute temperatures., Conclusions: Flashing lights are a simple, inexpensive way of improving hand hygiene. Brighter lights appear to have a greater effect; however, this must be balanced with annoyance in specific settings. Temperature did not have a significant effect; however, this may be because the relationship does not fit a linear model. Other interventions, such as signs, may need to be tailored specifically to individual hospital environments., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Although transthyretin (TTR), a negative acute phase protein, is recognized as one of the nutrition assessment proteins, factors affecting serum TTR concentrations than nutritional state in healthy subjects have not been well understood. We investigated the sources of variation of serum TTR concentrations in healthy subjects., Methods: Serum samples of 3511 healthy volunteers (2055 of Japanese subjects and 1456 of other East and Southeast Asian subjects) were collected. We measured serum TTR concentrations in addition to routine blood examinations in each sample, and assessed the relationship between each serum TTR concentrations and the clinical indices such as age, sex, body mass index (BMI), smoking, and level of daily alcohol consumption. We also investigated the direct alcohol effect of TTR expression by assessing TTR mRNA and protein levels in vivo and in vitro experiments., Results: Mean TTR concentrations of males were prominently higher than those of females. Multiple regression analysis revealed that serum TTR concentrations increased with age, BMI, and the level of daily alcohol consumption after adjustment for a slight regional difference. Moreover, TTR expression was up-regulated by alcohol treatment through hepatocyte nuclear factor 4α (HNF-4α) in vitro and in vivo experiments., Conclusions: Sex, aging, BMI, and the level of daily alcohol consumption may be the factors affecting serum TTR concentrations in healthy subjects., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Alcohol-based hand sanitizers are widely used to disinfect hands to prevent the spread of pathogens including noroviruses. Alcohols inactivate norovirus by destruction of the viral capsid, resulting in the leakage of viral RNA (virolysis). Since conflicting results have been reported on the susceptibility of human noroviruses against alcohols, we exposed a panel of 30 human norovirus strains (14 GI and 16 GII strains) to different concentrations (50%, 70%, 90%) of ethanol and isopropanol and tested the viral RNA titer by RT-qPCR. Viral RNA titers of 10 (71.4%), 14 (100%), 3 (21.4%) and 7 (50%) of the 14 GI strains were reduced by > 1 log10 RNA copies/ml after exposure to 70% and 90% ethanol, and 70% and 90% isopropanol, respectively. RNA titers of 6 of the 7 non-GII 4 strains remained unaffected after alcohol exposure. Compared to GII strains, GI strains were more susceptible to ethanol than to isopropanol. At 90%, both alcohols reduced RNA titers of 8 of the 9 GII.4 strains by ≥ 1 log10 RNA copies/ml. After exposure to 70% ethanol, RNA titers of GII.4 Den Haag and Sydney strains decreased by ≥ 1.9 log10, whereas RNA reductions for GII.4 New Orleans strains were < 0.5 log10. To explain these differences, we sequenced the complete capsid gene of the 9 GII.4 strains and identified 17 amino acid substitutions in the P2 region among the 3 GII.4 variant viruses. When comparing with an additional set of 200 GII.4 VP1 sequences, only S310 and P396 were present in all GII.4 New Orleans viruses but not in the ethanol-sensitive GII.4 Sydney and GII.4 Den Haag viruses Our data demonstrate that alcohol susceptibility patterns between different norovirus genotypes vary widely and that virolysis data for a single strain or genotype are not representative for all noroviruses.