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Despite adherence to reprocessing protocols, duodenoscopes frequently remain contaminated, highlighting significant knowledge gaps in reprocessing efficiency. To identify risk factors in duodenoscope reprocessing procedures affecting contamination rates. Cultures from Pentax ED34-i10T2 duodenoscopes collected between February 2022 and December 2023 were included. Contamination was determined by the presence of micro-organisms of gut or oral origin (MGO). Data on duodenoscope use, reprocessing lead times and personnel were retrieved from electronic medical records. Risk factors were derived from reprocessing guidelines and literature. These included a delay >30 min in initiating manual cleaning, manual cleaning duration of ≤5 min, drying time <90 min, personnel reprocessing frequency, and storage exceeding seven days. A logistic mixed-effects model evaluated these factors' impact on duodenoscope contamination. Out of 307 duodenoscope cultures, 58 (18.9%) were contaminated with MGO. Throughout the study period, the duodenoscopes underwent 1296 reprocessing cycles. Manual cleaning times of ≤5 min significantly increased contamination odds (adjusted odds ratio (aOR): 1.61; 95% confidence interval (CI): 1.10–2.34; P = 0.01). Increased usage of a duodenoscope was associated with reduced odds of contamination (aOR: 0.80; 95% CI: 0.64–0.995; P = 0.045). Other studied risks showed no clear association with contamination rates. Manual cleaning times of ≤5 min increased the odds of contamination with MGO. Delays in reprocessing initiation and incomplete drying, traditionally considered as risk factors, were not associated with an increased risk of contamination in this study. Future research should explore whether enhanced surveillance of reprocessing times can mitigate duodenoscope contamination. [ABSTRACT FROM AUTHOR]

Several single-center studies have suggested that eliminating isolation for vancomycin-resistant enterococci (VRE) control in the context of endemic or nonoutbreak settings, has no impact on infection rates. We performed a systematic review and meta-analysis on the impact of discontinuing isolation. We searched PubMed, Embase, the Cochrane Library, and Web of Science through April 10, 2024 for studies evaluating discontinuation of isolation for VRE. Subgroup analyses assessed sources of heterogeneity. Nine studies were included in the final review. Four reported the incidence of hospital-acquired VRE (HA-VRE) infections and 5 reported the incidence of hospital-acquired VRE bloodstream infections (HA-VRE BSI). No significant difference between the rates of HA-VRE infection before and after stopping isolation was observed (risk ratios, 0.93; 95% confidence interval, 0.68-1.26; P =.62), as well as no significant difference on the incidence of HA-VRE BSI (risk ratios, 0.68; 95% confidence interval, 0.44-1.07, P =.09). Furthermore, we conducted 2 subgroup analyses: one stratified by whether the studies were conducted during Coronavirus Disease 19 (COVID-19), and the other stratified by whether clinicians continued to use personal protective equipment. Both analyses revealed no significant differences in the incidence of HA-VRE BSI and termination of isolation between the subgroups. In the context of endemic or nonoutbreak settings, discontinuation of isolation for VRE patients has not been associated with an increased rate of HA-VRE infections. • Examined VRE isolation discontinuation impact in endemic/non-outbreak settings. • Latest evidence on VRE isolation discontinuation. • Discontinuation not linked to higher VRE infections in endemic/non-outbreak. [ABSTRACT FROM AUTHOR]

Data on multiple consecutive health care-associated infections (HAIs) in patients undergoing extracorporeal membrane oxygenation (ECMO) are limited. We aim to identify the characteristics and outcomes of multiple, consecutive HAIs. This retrospective study included adult patients who underwent ECMO in a single cardiac ICU in China from May 2015 to December 2022. The incidence, clinical characteristics, risk factors, and impact on in-hospital mortality among patients with non-HAI, single HAI, and multiple HAIs were analyzed. Pathogens and infection sites for each new episode were compared. Of 192 patients, 92 (47.92%) developed 141 separate infections, with 41 (21.35%) experiencing multiple infections during a single ECMO period. Respiratory tract infections (RTIs) constituted the majority (75.89%), and gram-negative bacteria were the predominant pathogens (71.63%). RTIs decreased from 86.9% in the first infection to 14.3% in the third (P <.001), while bloodstream infections increased from 10.9 % to 57.1% (P <.001). The proportion of gram-positive bacteria increased from 9.8% to 42.9% (P =.032). Prolonged ECMO duration was the only independent risk factor for multiple consecutive HAIs (odds ratio (OR) = 1.220, P <.001). Multiple consecutive HAIs during ECMO were frequent, with distinct microbiological changes between initial and subsequent HAIs. • Infection episodes during ECMO present significant challenges to patients. • One-quarter of patients had multiple consecutive infections during ECMO support. • The microbiology of the first infection differed from subsequent ones during ECMO. • Predictors for consecutive multiple infections during ECMO were identified. [ABSTRACT FROM AUTHOR]

Simple Summary: This research represents the first analysis of the population genetics of the diplectanid monogenean Lamellodiscus echeneis, sampled from wild and cage-reared gilthead seabream Sparus aurata across fifteen locations in the Southern (Tunisia) and Northern (Italy and Spain) regions of the Mediterranean Sea. The comparison of the newly obtained dataset to previously published sequences of L. echeneis, and the phylogenetic trees based on the analysis of ITS rDNA, confirmed the presence of only one species in the Mediterranean Sea. The star-like haplotype network inferred by COI sequences suggested a recent population expansion of L. echeneis. This study provides insights into the genetic variation among L. echeneis populations and did not reveal a clear genetic structure throughout Tunisian, Italian, and Spanish localities, possibly due to significant gene flow between the populations facilitated by the dispersion potential of hosts. The diplectanid monogenean Lamellodiscus echeneis (Wagener, 1857) is a specific and common gill parasite of the gilthead seabream Sparus aurata Linnaeus, 1758, in the Mediterranean Sea. Few isolated molecular studies of this monogenean have been conducted, and its population structure and genetic diversity are poorly understood. This study represents the first analysis of the population genetics of L. echeneis, isolated from wild and cage-reared gilthead seabream from fifteen localities in both the Southern (Tunisia) and Northern (Italy and Spain) regions of the Mediterranean Sea, using nuclear ITS rDNA markers and a partial fragment of the mitochondrial gene cytochrome oxidase subunit I (COI). The phylogenetic trees based on the newly obtained dataset and the previously published sequences of L. echeneis corroborated the spread of only a single species throughout the Mediterranean Sea. The star-like haplotypes network, inferred by COI sequences, suggested a recent population expansion of L. echeneis. This is supported by the observed high haplotype diversity (Hd = 0.918) and low nucleotide diversity (Pi = 0.01595). Population structure-based AMOVA for two groups (the Adriatic Sea and the rest of the Mediterranean Sea) attributed 35.39% of the total variation to differences within populations, 16.63% to differences among populations within groups, and 47.99% to differences among groups. Fixation indices were significant, with a high FST value (0.64612), likely related to the divergence of the parasite populations from the Adriatic Sea and other Mediterranean regions. Phylogenetic analyses grouped all samples into the main clade corresponding to L. echeneis from several localities. This study provides insight into the genetic variation between L. echeneis populations, and did not show a clear genetic structure between populations of L. echeneis throughout Tunisian, Italian, and Spanish localities, which can be attributed to the considerable gene flow between the populations favoured by the potential for host dispersion within the Mediterranean Sea. Finally, haplotypes shared between wild and cage-reared hosts provided evidence for the potential for cross-infection between wild and farmed hosts in the Mediterranean Sea. [ABSTRACT FROM AUTHOR]

Anthracnose caused by Colletotrichum species is a serious disease of loquat (Eriobotrya japonica), but the species of Colletotrichum that are associated with the disease in Japan have not been adequately surveyed. In this study, 46 isolates were isolated from diseased leaves and fruits of loquat in Kagawa and Tokushima prefectures in 2017 and 2018. On the basis of morphological features and molecular approaches, seven Colletotrichum species were identified: C. fioriniae, C. nymphaeae, C. karsti, C. aenigma, C. fructicola, C. gloeosporioides s. s., and C. siamense. The most prevalent species was C. karsti (43.5% of total species), followed by C. fioriniae (21.7%) and C. gloeosporioides s. s. (13.0%). All identified species were confirmed to cause loquat anthracnose by fulfilling Koch's postulates. The loquat isolates of C. fioriniae, C. fructicola, and C. siamense also caused symptoms on all tested plants of kiwifruit, satsuma mandarin, persimmon, and peach. This report is the first on C. karsti and C. aenigma associated with loquat anthracnose and the first record of C. fructicola in Japan. [ABSTRACT FROM AUTHOR]

Medical waste bins are a potential source of microbial contamination in the hospital environment, while there is no clear guidance for the management of them. We aimed to assess the impact of medical waste bins on patient's environment. This experimental study simulated microbial contamination by performing medical procedures on a patient model with fluorescent lotion. The waste bin was set as initially empty or two-thirds filled with waste, open or with a lid. The percentage of fluorescent-contaminated area in designated patient's environments was analyzed by 2 independent observers. Among a total of 120 experiments, the sides of the bins were more contaminated in open-occupied bins compared to open-empty bins and in open-occupied bins compared to lid-occupied bins (median 1.9175% vs 0.0916% [ P =.001] and 1.9175% vs 0.0899% [ P =.003], respectively). The top of the bedside equipment trolley for preparing medical procedures was more contaminated in lid-occupied bins than open-occupied bins (median 0.0080% vs 0.0040%, P =.013). In addition to reducing contamination of the bin itself, the manually operated lid had a potential risk of contributing to microbial transmission by contaminating the equipment trolley. Medical waste bins should be kept no more than two-thirds full, and caution should be taken when using the manually operated lid, to avoid cross-contamination. • The guidance on medical waste bins, potential source of pathogen, is needed. • Two-thirds filled waste bins were more contaminated than empty bins. • Open waste bins were more contaminated than lidded bins. • Equipment trolley was more contaminated in bins with manually operated lids. • Occupied waste bin and manually operated lid may be sources of contact transmission. [ABSTRACT FROM AUTHOR]

Duodenoscope-associated infections (DAIs) are exogenous infections resulting from the use of contaminated duodenoscopes. Though numerous outbreaks of DAI have involved multidrug-resistant micro-organisms (MDROs), outbreaks involving non-MDROs are also likely to occur. Detection challenges arise as these infections often resolve before culture or because causative strains are not retained for comparison with duodenoscope strains. To identify and analyse DAIs spanning a seven-year period in a tertiary care medical centre. This was a retrospective observational study. Duodenoscope cultures positive for gastrointestinal flora between March 2015 and September 2022 were paired with duodenoscope usage data to identify patients exposed to contaminated duodenoscopes. Analysis encompassed patients treated after a positive duodenoscope culture and those treated within the interval from a negative to a positive culture. Patient identification numbers were cross-referenced with a clinical culture database to identify patients developing infections with matching micro-organisms within one year of their procedure. A 'pair' was established upon a species-level match between duodenoscope and patient cultures. Pairs were further analysed via antibiogram comparison, and by whole-genome sequencing (WGS) to determine genetic relatedness. Sixty-eight pairs were identified; of these, 21 exhibited matching antibiograms which underwent WGS, uncovering two genetically closely related pairs categorized as DAIs. Infection onset occurred up to two months post procedure. Both causative agents were non-MDROs. This study provides crucial insights into DAIs caused by non-MDROs and it highlights the challenge of DAI recognition in daily practice. Importantly, the delayed manifestation of the described DAIs suggests a current underestimation of DAI risk. [ABSTRACT FROM AUTHOR]

Summary: Patients undergoing cataract surgery are at risk of post-cataract surgery endophthalmitis (PCSE), a sight-threatening complication. Cataract surgery is a relatively straightforward and quick procedure often performed under local anaesthetic. It is therefore simple to scale up to reduce the currently long waiting times, but it is important to maintain patient safety when considering high throughput surgery. This literature review aimed to identify appropriate infection prevention and control (IPC) measures to support increased throughput of cataract surgery in Scotland. Database searches were conducted using Medline and Embase from 2010 to 2023. Further hand-searching was also performed. The organisms associated with PCSE and IPC factors relevant to PCSE were analyzed. A range of microorganisms was associated with PCSE, where outbreak reports were most associated with Gram-negative bacteria and fungi, whereas retrospective chart reviews were most associated with Gram-positive bacteria. IPC risk factors identified were related to the built environment and issues with sterilization. Specifically, the sources of outbreaks included failures in the ventilation system, as well as contaminated ophthalmic solutions, surgical instruments, and medications. The factors identified in this review should be considered when implementing high throughput cataract surgery to ensure that patient safety is maintained.

Immunocompromised patients account for an increasing proportion of the typical intensive care unit (ICU) case-mix. Because of the increased availability of new drugs for cancer and auto-immune diseases, and improvement in the care of the most severely immunocompromised ICU patients (including those with hematologic malignancies), critically ill immunocompromised patients form a highly heterogeneous patient population. Furthermore, a large number of ICU patients with no apparent immunosuppression also harbor underlying conditions altering their immune response, or develop ICU-acquired immune deficiencies as a result of sepsis, trauma or major surgery. While infections are associated with significant morbidity and mortality in immunocompromised critically ill patients, little specific data are available on the incidence, microbiology, management and outcomes of ICU-acquired infections in this population. As a result, immunocompromised patients are usually excluded from trials and guidelines on the management of ICU-acquired infections. The most common ICU-acquired infections in immunocompromised patients are ventilator-associated lower respiratory tract infections (which include ventilator-associated pneumonia and tracheobronchitis) and bloodstream infections. Recently, several large observational studies have shed light on some of the epidemiological specificities of these infections—as well as on the dynamics of colonization and infection with multidrug-resistant bacteria—in these patients, and these will be discussed in this review. Immunocompromised patients are also at higher risk than non-immunocompromised hosts of fungal and viral infections, and the diagnostic and therapeutic management of these infections will be covered. Finally, we will suggest some important areas of future investigation. [ABSTRACT FROM AUTHOR]

Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Non-fermenting Gram-negative bacilli (NFGNB) were initially considered non-pathogenic contaminants but now have emerged as major pathogens because of increased isolation from clinical samples and emerging resistance to common antibacterial agents. Objectives: The study aims to determine the magnitude of NFGNB in clinical samples received at the Department of Microbiology, Nil Ratan Sircar Medical College, Kolkata, for a period of one year. Material and Methods: The samples were processed according to standard procedures; for identification and antibiotic susceptibility test, Vitek 2 Compact (Biomerieux©) was used. Results: Out of 725 bacterial isolates, 169 (23.31%) NFGNB were identified during the entire study period. Pseudomonas spp. (n = 84) was isolated most frequently, followed by Acinetobacter spp. (n = 73), Burkholderia cepacia (n = 7), and Stenotrophomonas maltophilia (n = 5). Both Pseudomonas spp. and Acinetobacter spp. showed greater susceptibility to piperacillin-tazobactam and poor susceptibility against cefepime. Conclusion: It is necessary to identify these drug resistant pathogens in healthcare setup. The antibiotic susceptibility pattern of these pathogens needs to be monitored to guide clinicians in better patient care and management by initiating proper antibiotic therapy. [ABSTRACT FROM AUTHOR]

Introduction: After cardiac surgery, patients on venoarterial extracorporeal membrane oxygenation (VA-ECMO) have a higher risk of nosocomial infection in the intensive care unit (ICU). We aimed to establish an intuitive nomogram to predict the probability of nosocomial infection in patients on VA-ECMO after cardiac surgery. Methods: We included patients on VA-ECMO after cardiac surgery between January 2011 and December 2020 at a single center. We developed a nomogram based on independent predictors identified using univariate and multivariate logistic regression analyses. We selected the optimal model and assessed its performance through internal validation and decision-curve analyses. Results: Overall, 503 patients were included; 363 and 140 patients were randomly divided into development and validation sets, respectively. Independent predictors derived from the development set to predict nosocomial infection included older age, white blood cell (WBC) count abnormality, ECMO environment in the ICU, and mechanical ventilation (MV) duration, which were entered into the model to create the nomogram. The model showed good discrimination, with areas under the curve (95% confidence interval) of 0.743 (0.692–0.794) in the development set and 0.732 (0.643–0.820) in the validation set. The optimal cutoff probability of the model was 0.457 in the development set (sensitivity, 0.683; specificity, 0.719). The model showed qualified calibration in both the development and validation sets (Hosmer–Lemeshow test, p >.05). The threshold probabilities ranged from 0.20 to 0.70. Conclusions: For adult patients receiving VA-ECMO treatment after cardiac surgery, a nomogram-monitoring tool could be used in clinical practice to identify patients with high-risk nosocomial infections and provide an early warning. [ABSTRACT FROM AUTHOR]

Hospital populations are vulnerable to COVID-19, but the relative severity of hospital acquisition compared to community is unknown. We investigated differences in mortality between hospital and community acquired cases in Wales. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) polymerase chain reaction tests from February 2020 to March 2022 were linked with hospital admissions to identify likely hospital-acquired cases. All-cause mortality within 28 days of a positive SARS-CoV-2 were measured by source of acquisition. Multi-variable logistic regression was used to compare mortality by source of acquisition, adjusting for confounders, computing adjusted odds ratios (aOR) with 95% confidence intervals (CI). There were 25,263 hospital-acquired cases of COVID-19 and 5490 (22%) deaths in the study period. Although significant on univariate analysis, adjustment for confounding showed no association with increased mortality for hospital-acquired cases compared with cases admitted with COVID-19 (aOR 0.8, 95% CI 0.7-0.8). Vaccination (aOR 0.6, 95% CI 0.5-0.7) and infection in later pandemic waves (aOR 0.5, 95% CI 0.4-0.6) were associated with lower mortality; older age (≥85 vs <25 years: aOR 76.4, 95% CI 41.8-160.5) and male sex (aOR 1.5, 95% CI 1.4-1.6) were associated with higher mortality. One in five hospitalised COVID-19 cases died within a month of infection. Mortality in nosocomial cases was not worse than those admitted with COVID-19, possibly reflecting early identification of nosocomial cases through screening. [ABSTRACT FROM AUTHOR]

Urinary tract infections are among the most prevalent types of healthcare-associated infections (HAIs) in hospitals and nursing homes, and they are primarily a result of unnecessary catheter usage and inadequate care. In Portugal, epidemiological data indicate that catheter-associated urinary tract infections (CAUTIs) remain widespread in clinical settings, resulting in increased morbidity and mortality rates among vulnerable populations. This study aimed to assess urinary catheter use in an oncology ward in Portugal and to evaluate nurses’ adherence to the government-endorsed standards for preventing CAUTIs. An observational study was conducted over a four-month period with daily assessments of nurses’ practices during urinary catheter insertion and maintenance using a government-endorsed auditing tool. Data were collected through on-site observations and nurses’ feedback. The findings revealed a urinary catheter utilization rate of 17.99%. However, there was a lack of complete adherence to government-endorsed standards among oncology nurses (0%). These results indicate that current practices lack evidence-based standardization. Therefore, there is a need to develop and implement quality improvement initiatives to enhance patient safety and experiences.

Abstract Infection transmission in healthcare is multifaceted and by in large involves the complex interplay between a pathogen, a host and their environment. To prevent transmission, infection prevention strategies must also consider these complexities and incorporate targeted interventions aimed at all possible transmission pathways. One strategy to prevent and control infection is environmental cleaning. There are many aspects to an environmental cleaning strategy. We believe the key to successfully reducing the risk of healthcare-associated infections through the environment, is to design and implement a multimodal intervention. This paper aims to provide an overview of important considerations for designing a meaningful and sustainable environmental program for healthcare facilities.

Background: The emergence of coronavirus disease 2019 (COVID-19), a highly contagious disease that causes viral respiratory illness, has changed the lifestyle of humans worldwide. Dental practitioners and patients are at high risk of infection during their routine practice due to their exposure to saliva, blood, and droplet production. Aim: To gain insight into the patient’s viewpoint regarding the practice, altitude, and knowledge of COVID-19 and its transmission and cross-infection in dental clinics. Methods: This was cross–sectional analytic survey in dentistry during the COVID-19 pandemic. A self-administered close-ended questionnaire consisting of 32 variables was distributed among the study participants. The data were analysed using the Statistical Package for the Social Sciences (SPSS) version 25. The level of significance was p ≤ 0.05. Results: The age of the participants varied from 20 - 58 years, with a mean age of 34.6 ±5. The majority (89.3%) felt COVID-19 was a highly contagious disease, while 50.0% of the respondents believed that the most common route of COVID-19 transmission in dentistry is through aerosols. The majority, 78.6%, recorded good knowledge of infection control following the COVID-19 outbreak. The number of married patients who had good knowledge of cross-infection control was 118, which was statistically significant. Conclusion: From the study, it is evident that the patients possess a good range of knowledge in both preventive and cross-infection protocols to follow during the COVID-19 pandemic. However, the same cannot be said about the practice.

Urinary tract infections are among the most prevalent types of healthcare-associated infections (HAIs) in hospitals and nursing homes, and they are primarily a result of unnecessary catheter usage and inadequate care. In Portugal, epidemiological data indicate that catheter-associated urinary tract infections (CAUTIs) remain widespread in clinical settings, resulting in increased morbidity and mortality rates among vulnerable populations. This study aimed to assess urinary catheter use in an oncology ward in Portugal and to evaluate nurses' adherence to the government-endorsed standards for preventing CAUTIs. An observational study was conducted over a four-month period with daily assessments of nurses' practices during urinary catheter insertion and maintenance using a government-endorsed auditing tool. Data were collected through on-site observations and nurses' feedback. The findings revealed a urinary catheter utilization rate of 17.99%. However, there was a lack of complete adherence to government-endorsed standards among oncology nurses (0%). These results indicate that current practices lack evidence-based standardization. Therefore, there is a need to develop and implement quality improvement initiatives to enhance patient safety and experiences. [ABSTRACT FROM AUTHOR]

Marine viruses are a major driver of phytoplankton mortality and thereby influence biogeochemical cycling of carbon and other nutrients. Phytoplankton-targeting viruses are important components of ecosystem dynamics, but broad-scale experimental investigations of host-virus interactions remain scarce. Here, we investigated in detail a picophytoplankton (size 1 µm) host's responses to infections by species-specific viruses from distinct geographical regions and different sampling seasons. Specifically, we used Ostreococcus tauri and O. mediterraneus and their viruses (size ca. 100 nm). Ostreococcus sp. is globally distributed and, like other picoplankton species, play an important role in coastal ecosystems at certain times of the year. Further, Ostreococcus sp. is a model organism, and the Ostreococcus-virus system is well-known in marine biology. However, only few studies have researched its evolutionary biology and the implications thereof for ecosystem dynamics. The Ostreococcus strains used here stem from different regions of the Southwestern Baltic Sea that vary in salinity and temperature and were obtained during several cruises spanning different sampling seasons. Using an experimental cross-infection set-up, we explicitly confirm species and strain specificity in Ostreococcus sp. from the Baltic Sea. Moreover, we found that the timing of virus-host co-existence was a driver of infection patterns as well. In combination, these findings prove that host-virus co-evolution can be rapid in natural systems. [ABSTRACT FROM AUTHOR]

Introduction: Fear and anxiety toward dentists, syringes, and white coats are significant issues affecting the treatment of pediatric patients. According to D.C.I guidelines for the COVID-19 pandemic, it was made mandatory to wear personal protective equipment (PPE) for dental professionals, adding one more cause of fear and anxiety, which made it more challenging to treat pediatric patients. Friendly dentist attire can make a positive impact on a patient's behavior. Aim: This study aimed to assessment of choice for dentist's attire and their effect on anxiety of 5-12-year-old children. Materials and Methods: The present study was conducted in the Department of Pediatric and Preventive Dentistry, IDS, Bareilly. To assess the choice of dentist's attire, a questionnaire consisting of 15 closed and open-ended questions was formulated and was asked to be filled by 182 patients with the help of their parents, who reported in our operatory. To assess the pre- and postanxiety levels among patients, vitals (blood pressure and pulse rate) and facial image scores were recorded. Data obtained were subjected to statistical analysis. Results: Majority of the children, i.e., 58.8%, showed preference for modified PPE with cartoon characters. Facial Image Scale: Score 2, i.e., sad face, was scored by 7% of children at baseline, and was reduced to only 1% after attire selection. Significant differences were seen in physiological parameters. Conclusion: Clinician's attire and appearance play a major role in behavior modification of anxious children. Modified PPE with cartoon characters was the attire of choice for the majority of children. [ABSTRACT FROM AUTHOR]

Healthcare-associated infections (HAI), also referred to as nosocomial infections, is defined as an infection acquired in a hospital setting. This infection is considered a HAI if it was not present or incubating at the time of admission. This includes infections acquired in the hospital but appearing after discharge, and also occupational infections among staff of the facility. HAI are a major patient safety measure to be considered in hospitals.

• Pseudomonas aeruginosa UK strain prevalence assessed. • 51% of patients harboured either common clusters or transmissible strains. • LES prevalence remains stable (9.5%) on comparison with 2013 data. • Cross-infection with hospital-specific strains was found, but was mainly historical. We aimed to describe the UK Pseudomonas aeruginosa population structure amongst people with cystic fibrosis (PWCF), and to examine evidence for cross-infection. Variable Number Tandem Repeat (VNTR) typing was performed on 4640 isolates from 2619 PWCF received from 55 hospital laboratories between 2017 and 2019. A combination of whole genome sequence (WGS)-based analysis of four clusters from one hospital, and epidemiological analysis of shared strains in twelve hospitals evaluated cross-infection. Of 2619 PWCF, 1324 (51%) harboured common clusters or known transmissible strains, while 1295 carried unique strains/those shared among small numbers of patients. Of the former, 9.5% (250 patients) harboured the Liverpool epidemic strain (LES), followed in prevalence by clone C (7.8%; 205 patients), cluster A (5%;130 patients), and cluster D (3.6%; 94 patients). WGS analysis of 10 LES isolates, 9 of cluster D and 6 isolates each of cluster A and clone C from one hospital revealed LES formed the tightest cluster (between 7 and 205 SNPs), and cluster D the loosest (between 53 and 1531 SNPs). Hospital-specific shared strains were found in some centres, although cross-infection was largely historical, with few new acquisitions. Fifty-nine PWCF (2.3%) harboured "high-risk" clones; one ST235 isolate carried a bla IMP-1 allele. Of 2619 PWCF who had P. aeruginosa isolates submitted for VNTR, 51% harboured either common clusters or known transmissible strains, of which LES was the most common. Limited evidence of recent patient-to-patient strain transmission was found, suggesting cross-infection prevention measures and surveillance effectively reduce transmission. [ABSTRACT FROM AUTHOR]

A large proportion of ICU-acquired infections are related to multidrug-resistant bacteria (MDR). Infections caused by these bacteria are associated with increased mortality, and prolonged duration of mechanical ventilation and ICU stay. The aim of this narrative review is to report on the association between COVID-19 and ICU-acquired colonization or infection related to MDR bacteria. Although a huge amount of literature is available on COVID-19 and MDR bacteria, only a few clinical trials have properly evaluated the association between them using a non-COVID-19 control group and accurate design and statistical methods. The results of these studies suggest that COVID-19 patients are at a similar risk of ICU-acquired MDR colonization compared to non-COVID-19 controls. However, a higher risk of ICU-acquired infection related to MDR bacteria has been reported in several studies, mainly ventilator-associated pneumonia and bloodstream infection. Several potential explanations could be provided for the high incidence of ICU-acquired infections related to MDR. Immunomodulatory treatments, such as corticosteroids, JAK2 inhibitors, and IL-6 receptor antagonist, might play a role in the pathogenesis of these infections. Additionally, a longer stay in the ICU was reported in COVID-19 patients, resulting in higher exposure to well-known risk factors for ICU-acquired MDR infections, such as invasive procedures and antimicrobial treatment. Another possible explanation is the surge during successive COVID-19 waves, with excessive workload and low compliance with preventive measures. Further studies should evaluate the evolution of the incidence of ICU-acquired infections related to MDR bacteria, given the change in COVID-19 patient profiles. A better understanding of the immune status of critically ill COVID-19 patients is required to move to personalized treatment and reduce the risk of ICU-acquired infections. The role of specific preventive measures, such as targeted immunomodulation, should be investigated. [ABSTRACT FROM AUTHOR]

Infection transmission in healthcare is multifaceted and by in large involves the complex interplay between a pathogen, a host and their environment. To prevent transmission, infection prevention strategies must also consider these complexities and incorporate targeted interventions aimed at all possible transmission pathways. One strategy to prevent and control infection is environmental cleaning. There are many aspects to an environmental cleaning strategy. We believe the key to successfully reducing the risk of healthcare-associated infections through the environment, is to design and implement a multimodal intervention. This paper aims to provide an overview of important considerations for designing a meaningful and sustainable environmental program for healthcare facilities. [ABSTRACT FROM AUTHOR]

Background: A number of infection control interventions were implemented during the COVID-19 pandemic in order to reduce the spread of this virus. Objective: The purpose of this study was to determine if these interventions were associated with reduced nosocomial bacterial infections in Victoria, Australia. Methods: Observational data were obtained from the Victorian Healthcare Associated Infection Surveillance System (VICNISS) based on admitted hospital patients in two 6-month timeframes representing pandemic and pre-pandemic hospital practices. Data were collected for surgical site infections, Staphylococcus aureus bacteraemia, Clostridioides difficile infection, and central line-associated bloodstream infections. Results: There was a significant reduction in the rates of S. aureus bacteraemia (0.74 infections/10, 000 bed days pre-pandemic vs. 0.53/10,000 bed days in the pandemic period [rate ratio 0.72, 95% CI 0.57–0.90]; p =.003) and in C. difficile infections (2.2 infections/10,000 bed days pre-pandemic vs. 0.86/10 000 bed days in the pandemic era [rate ratio 0.76, 95% C.I. 0.67–0.86]; p <.001). There was no change in the overall rate of surgical site infections or central line-associated infections however. Discussion: The increased emphasis on infection control and prevention strategies during the pandemic period was associated with reduced transmission of S. aureus and C. difficile infections within hospitals. [ABSTRACT FROM AUTHOR]

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Abstract Background Healthcare-associated infections (HAIs) are a common, costly, yet largely preventable complication impacting patients in healthcare settings globally. Improving routine cleaning and disinfection of the hospital environment has been shown to reduce the risk of HAI. Contaminated shared medical equipment presents a primary transmission route for infectious pathogens, yet is rarely studied. The CLEEN study will assess how enhanced cleaning and disinfection of shared medical equipment affects the rate of HAIs in a tertiary hospital setting. The initiative is an evidence-based approach combining staff training, auditing and feedback to environmental services staff to enhance cleaning and disinfection practices. Methods The CLEEN study will use a stepped wedge randomised controlled design in 10 wards of one large Australian hospital over 36 weeks. The intervention will consist of 3 additional hours per weekday for the dedicated cleaning and disinfection of shared medical equipment on each ward. The primary outcome is to demonstrate the effectiveness of improving the quality and frequency of cleaning shared medical equipment in reducing HAIs, as measured by a HAI point prevalence study (PPS). The secondary outcomes include the thoroughness of equipment cleaning assessed using fluorescent marker technology and the cost-effectiveness of the intervention. Discussion Evidence from the CLEEN study will contribute to future policy and practice guidelines about the cleaning and disinfection of shared medical equipment. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in healthcare facilities. Trial registration Australia New Zealand Clinical Trial Registry ACTRN12622001143718.

Introduction: Fear and anxiety toward dentists, syringes, and white coats are significant issues affecting the treatment of pediatric patients. According to D.C.I guidelines for the COVID-19 pandemic, it was made mandatory to wear personal protective equipment (PPE) for dental professionals, adding one more cause of fear and anxiety, which made it more challenging to treat pediatric patients. Friendly dentist attire can make a positive impact on a patient's behavior. Aim: This study aimed to assessment of choice for dentist's attire and their effect on anxiety of 5–12-year-old children. Materials and Methods: The present study was conducted in the Department of Pediatric and Preventive Dentistry, IDS, Bareilly. To assess the choice of dentist's attire, a questionnaire consisting of 15 closed and open-ended questions was formulated and was asked to be filled by 182 patients with the help of their parents, who reported in our operatory. To assess the pre- and postanxiety levels among patients, vitals (blood pressure and pulse rate) and facial image scores were recorded. Data obtained were subjected to statistical analysis. Results: Majority of the children, i.e., 58.8%, showed preference for modified PPE with cartoon characters. Facial Image Scale: Score 2, i.e., sad face, was scored by 7% of children at baseline, and was reduced to only 1% after attire selection. Significant differences were seen in physiological parameters. Conclusion: Clinician's attire and appearance play a major role in behavior modification of anxious children. Modified PPE with cartoon characters was the attire of choice for the majority of children.

The pathogenicity of five isolates of Colletotrichum acutatum species complex (CASC) was tested on artificially injured apple fruits of the cultivar 'Golden Delicious' under laboratory conditions. Then, ten apple cultivars were tested for their relative susceptibility to CASC. Differences in the pathogenicity of the CASC isolates were confirmed in the test. The highest degree of pathogenicity was showed by the isolates from the strawberry and DCSBPM J1 from the apple. No cultivars were resistant to the pathogen. The disease incidence ranged from 57.5% to 100%. The individual cultivars showed different susceptibility to the tested isolates. The cultivars 'Braeburn', 'Jonagold' and 'Rubinola' showed the least susceptibility to the pathogen, while the cultivars 'Jonagored' and 'Otava' were recorded as the most susceptible to CASC. All the tested isolates were confirmed, by the conventional PCR method, to belong to CASC. The sequences of isolates DCSBPM J1 and DCSBPM 1209 were deposited in the GenBank.

Introduction: Teledentistry has provided a glimmer of hope for patients who require treatment, but are limited to their homes owing to Coronavirus Disease-2019 (COVID-19) restrictions. Like any other professional careers, dentistry also had to switch to a new normal mode of consultation and teledentistry came to its aid. With the support of advanced technologies dental care was made possible even though face to face interactions were to be refrained due to the curfew restrictions. Aim: To assess the scope of teledentistry from a patient's perspective. Materials and Methods: The survey was designed as a descriptive cross-sectional study conducted in the Department of Periodontics, Karpaga Vinayaga Institute of Dental Sciences, Chengelpet, Tamil Nadu, on dental patients of Chennai, India, from April 2021 to May 2021 who made use of Telemedicine for dental consultation. The study population included those who sought teledentistry and the study included 100 participants. A computer aided self-administered questionnaire was designed and validated. Practicing dentists were requested to circulate a questionnaire containing 10 questions that assessed scope of teledentistry from patient's perspective, to their patients at the end of their teleconsultation after obtaining consent. A total of 94 responses were obtained successfully out of 100 participants. Descriptive analysis of the obtained data was done using International Business Machines Statistical Package for the Social Sciences (IBM SPSS) software version 22.0. Results: The mean±Standard Deviation (SD) age of the study participants was 33±2.5 years, there were 51 males and 43 females. A 57.5% (n=54) of individuals made the best use of teledentistry during the lockdown and 59.6% (n=56) of the respondents felt that teledentistry was safe as it prevented the risk of unnecessary exposure and cross-infection. Of all, 79 (84.04%) respondents answered that they support teledentistry in the future. Suggestions were received requesting reduction in consultation fee and to increase consultation timings. Conclusion: Teledentistry proved to be an excellent alternate mode of dental service during the COVID-19 pandemic crisis. Moreover, it helped to bring down the cross-infection and made health services available to people caught up in inaccessible areas thus, making teledentistry a valuable tool that can be used on a day to day basis. [ABSTRACT FROM AUTHOR]

Introduction: SARS-CoV-2 is a highly contagious virus, and despite professionals' best efforts, nosocomial COVID-19 (NC) infections have been reported. This work aimed to describe differences in symptoms and outcomes between patients with NC and community-acquired COVID-19 (CAC) and to identify risk factors for severe outcomes among NC patients. Methods: This is a nationwide, retrospective, multicenter, observational study that analyzed patients hospitalized with confirmed COVID-19 in 150 Spanish hospitals (SEMI-COVID-19 Registry) from March 1, 2020, to April 30, 2021. NC was defined as patients admitted for non-COVID-19 diseases with a positive SARS-CoV-2 test on the fifth day of hospitalization or later. The primary outcome was 30-day in-hospital mortality (IHM). The secondary outcome was other COVID-19-related complications. A multivariable logistic regression analysis was performed. Results: Of the 23,219 patients hospitalized with COVID-19, 1,104 (4.8%) were NC. Compared to CAC patients, NC patients were older (median 76 vs. 69 years; p < 0.001), had more comorbidities (median Charlson Comorbidity Index 5 vs. 3; p < 0.001), were less symptomatic (p < 0.001), and had normal chest X-rays more frequently (30.8% vs. 12.5%, p < 0.001). After adjusting for sex, age, dependence, COVID-19 wave, and comorbidities, NC was associated with lower risk of moderate/severe acute respiratory distress syndrome (ARDS) (adjusted odds ratio [aOR]: 0.72; 95% confidence interval [CI]: 0.59–0.87; p < 0.001) and higher risk of acute heart failure (aOR: 1.40; 1.12–1.72; p = 0.003), sepsis (aOR: 1.73; 1.33–2.54; p < 0.001), and readmission (aOR: 1.35; 1.03–1.83; p = 0.028). NC was associated with a higher case fatality rate (39.1% vs. 19.2%) in all age groups. IHM was significantly higher among NC patients (aOR: 2.07; 1.81–2.68; p < 0.001). Risk factors for increased IHM in NC patients were age, moderate/severe dependence, malignancy, dyspnea, moderate/severe ARDS, multiple organ dysfunction syndrome, and shock; odynophagia was associated with lower IHM. Conclusions: NC is associated with greater mortality and complications compared to CAC. Hospital strategies to prevent NC must be strengthened. [ABSTRACT FROM AUTHOR]

The article discusses the tasks of emergency nurses in infection prevention and control in emergency departments (ED) in the U.K. Topics covered include the main pathogens linked to infection, and the importance of reducing their transmission risk to lessen the hospital stay, mortality and morbidity of patients and improving their experience. Also noted are the antimicrobial stewardship responsibility of all clinicians, and the emergency nurse's role in implementing them.

Background: Bronchoscopy is generally a safe and efficient procedure. However, the risk of cross-contamination with reusable flexible bronchoscopes (RFB) has been detected in several outbreaks worldwide. Aim: To estimate the average cross-contamination rate of patient-ready RFBs based on available published data. Methods: We performed a systematic literature review in PubMed and Embase to investigate the cross-contamination rate of RFB. Included studies identified indicator organisms or colony forming units (CFU) levels, and total number of samples >10. The Contamination threshold was defined according to the European Society of Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy Nurse and Associates (ESGE-ESGENA) guidelines. To calculate the total contamination rate, a random effects model was applied. Heterogeneity was analysed via a Q-test and illustrated in a forest plot. Publication bias was analysed via the Egger's regression test and illustrated in a funnel plot. Results: Eight studies fulfilled our inclusion criteria. The random effects model included 2169 samples and 149 events (positive tests). The total RFB cross-contamination rate was 8.69% ± 1.86 (standard division [SD]) (95% confidence interval [CI]: 5.06–12.33%). The result showed significant heterogeneity of 90% and publication bias. Discussion: Significant heterogeneity and publication bias is likely associated with varying methodology and aversion towards publishing negative findings, respectively. Based on the cross-contamination rate an infection control paradigm shift is needed to ensure patient safety. We recommend to follow the Spaulding classification and classify RFBs as critical items. Accordingly, infection control measures such as obligatory surveillance, and implementing single-use alternatives must be considered where feasible. [ABSTRACT FROM AUTHOR]

Introduction: Teledentistry has provided a glimmer of hope for patients who require treatment, but are limited to their homes owing to Coronavirus Disease-2019 (COVID-19) restrictions. Like any other professional careers, dentistry also had to switch to a new normal mode of consultation and teledentistry came to its aid. With the support of advanced technologies dental care was made possible even though face to face interactions were to be refrained due to the curfew restrictions. Aim: To assess the scope of teledentistry from a patient’s perspective. Materials and Methods: The survey was designed as a descriptive cross-sectional study conducted in the Department of Periodontics, Karpaga Vinayaga Institute of Dental Sciences, Chengelpet, Tamil Nadu, on dental patients of Chennai, India, from April 2021 to May 2021 who made use of Telemedicine for dental consultation. The study population included those who sought teledentistry and the study included 100 participants. A computer aided self-administered questionnaire was designed and validated. Practicing dentists were requested to circulate a questionnaire containing 10 questions that assessed scope of teledentistry from patient’s perspective, to their patients at the end of their teleconsultation after obtaining consent. A total of 94 responses were obtained successfully out of 100 participants. Descriptive analysis of the obtained data was done using International Business Machines Statistical Package for the Social Sciences (IBM SPSS) software version 22.0. Results: The mean±Standard Deviation (SD) age of the study participants was 33±2.5 years, there were 51 males and 43 females. A 57.5% (n=54) of individuals made the best use of teledentistry during the lockdown and 59.6% (n=56) of the respondents felt that teledentistry was safe as it prevented the risk of unnecessary exposure and cross-infection. Of all, 79 (84.04%) respondents answered that they support teledentistry in the future. Suggestions were received requesting reduction in consultation fee and to increase consultation timings. Conclusion: Teledentistry proved to be an excellent alternate mode of dental service during the COVID-19 pandemic crisis. Moreover, it helped to bring down the cross-infection and made health services available to people caught up in inaccessible areas thus, making teledentistry a valuable tool that can be used on a day to day basis.

Drinking water in hospitals is often tested for Pseudomonas aeruginosa because of its virulence potential. This article describes a case where, based on EN ISO 16266, seven of 11 (64%) samples taken simultaneously from the drinking water system at a single hospital tested positive for P. aeruginosa. This resulted in extensive investigations and interventions, and a number of measures were implemented. However, supplementary analyses with more discriminatory power (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, 16S-rRNA sequencing) ruled out P. aeruginosa completely. The authors wish to raise awareness of this problem, and suggest that diagnostic uncertainty of results obtained by EN ISO 16266 should be indicated on laboratory reports. Wrongly assuming the presence of P. aeruginosa in hospital water supply systems can lead to unnecessary control measures, as analytical uncertainty massively influences the health risk assessment and the remediation measures initiated in medical environments. [ABSTRACT FROM AUTHOR]

Background: Healthcare-associated infections (HAIs) are a common, costly, yet largely preventable complication impacting patients in healthcare settings globally. Improving routine cleaning and disinfection of the hospital environment has been shown to reduce the risk of HAI. Contaminated shared medical equipment presents a primary transmission route for infectious pathogens, yet is rarely studied. The CLEEN study will assess how enhanced cleaning and disinfection of shared medical equipment affects the rate of HAIs in a tertiary hospital setting. The initiative is an evidence-based approach combining staff training, auditing and feedback to environmental services staff to enhance cleaning and disinfection practices. Methods: The CLEEN study will use a stepped wedge randomised controlled design in 10 wards of one large Australian hospital over 36 weeks. The intervention will consist of 3 additional hours per weekday for the dedicated cleaning and disinfection of shared medical equipment on each ward. The primary outcome is to demonstrate the effectiveness of improving the quality and frequency of cleaning shared medical equipment in reducing HAIs, as measured by a HAI point prevalence study (PPS). The secondary outcomes include the thoroughness of equipment cleaning assessed using fluorescent marker technology and the cost-effectiveness of the intervention. Discussion: Evidence from the CLEEN study will contribute to future policy and practice guidelines about the cleaning and disinfection of shared medical equipment. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in healthcare facilities. Trial registration: Australia New Zealand Clinical Trial Registry ACTRN12622001143718. [ABSTRACT FROM AUTHOR]

Polymeric materials are widely used at present as auxiliary materials in the preservation of tangible cultural heritage in museums, galleries, or libraries. The desired properties of such materials include chemical inertness and long lifetime, which are verified by accelerated aging tests. This work has tested three color types of PE foam Plastazote® LD45 (white, grey, and black), which is recommended for use in the field of cultural heritage preservation. The volatile organic compounds released from the foams after artificial aging and their influence on lignocellulosic materials were investigated. The cellulosic materials were artificially aged in close contact with the foams. All foams released organic acids ranging from acetic acid to hexanoic acid. White foam released organic acids to an extent higher by an order of magnitude compared to the grey and black types. A great influence of white foam on the properties of cellulosic materials was observed. There were large differences in the rate of degradation between the types of foams tested, indicating the need to develop a test method in order to determine the suitability for use in the preservation of culture heritage objects. [ABSTRACT FROM AUTHOR]

During impressions, bacteria, viruses, and fungi remain on the impression material, representing a significant risk for the medical team (dentists, dental assistants, and laboratory technicians). Impression disinfectants have been introduced into dentistry to reduce the risk of cross-infection. This study was performed by examining the surface disinfection of five commonly used impression materials in prosthodontics: alginate-Tropicalgin (Zhermack®), condensation silicone-Zetaplus (Zhermack®), Oranwash L (Zhermack®); and addition silicone-Elite HD + Putty Soft (Zhermack®), Elite + Light Body (Zhermack®) after the disinfection with three disinfectants: Zeta 3 Soft (Zhermack®), Zeta 7 Spray (Zhermack®) and Zeta 7 Solution (Zhermack®). Before disinfection, the impression materials were contaminated with Staphylococcus aureus ATCC 25923, Pseudomonas aeruginosa ATCC 27853, and Candida albicans ATCC 10213. Our results demonstrate the efficacy of the two examined specific disinfectants in reducing cross-infection risk. The surface disinfectant-spray is not adequate for impression disinfection. A high number of bacterial colonies were found on the surface of all impressions disinfected with this spray. The immersion-disinfection method effectively eliminates the risk of cross-infections (Kruskal–Wallis test showed a p < 0.001). [ABSTRACT FROM AUTHOR]

This paper introduced an innovative mode of whole-process non-contact single-person sample collection of nucleic acid testing. This aim of implementing this whole-process non-contact single-person sample collection mode is to reduce cross-infection, workload of sample collection and related health care costs. (本文介绍一种全程无接触式单人核酸检测样本采集创新模式, 旨在减轻减少交叉感染, 减轻医护人员核酸检测工作压力, 降低医疗成本。)

Rana A Alamoudi,1 Shahad Basudan,2 Mona Mahboub,2 Khlood Baghlaf1 1Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 2General Dentist, Private Sector, Jeddah, Saudi ArabiaCorrespondence: Rana A Alamoudi, Pediatric Dentistry Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, 21589, Saudi Arabia, Tel +966-50-459-9971, Email rasalamoudi@kau.edu.saBackground/Purpose: The novel coronavirus disease (COVID-19) outbreak has affected individuals worldwide. Considering the nature of dental treatments and direct exposure to saliva, blood, aerosols, or droplets from infected individuals, dentists are at significant risk of COVID-19 infection. Therefore, to decrease aerosol-generating procedures, minimally invasive dentistry (MID) is recommended during this pandemic. The goal of this research was to compare the flow of patients during a pandemic at a single university hospital in Jeddah City, Saudi Arabia, and to retrospectively assess the impact of the COVID-19 pandemic on pediatric dental treatments including MID.Materials and Methods: This study was a retrospective cross-sectional analysis of pediatric patient records, dental procedures performed, and minimally invasive techniques using the database of the King Abdul-Aziz University Dental Hospital (R4) system during the period of COVID 19 pandemic compared to the same period in the previous year.Results: During the COVID-19 pandemic, pediatric dental patient flow included only 699 patients compared to 1151 patients during the same period in the previous year. The most common pediatric dental procedures performed during the pandemic period were simple restorative treatments, including fissure sealants, followed by dental extractions, and fluoride varnish applications. During the pandemic period, more minimally invasive treatments were performed, including the Hall technique, silver diamine fluoride, resin infiltration, and atraumatic restorative techniques.Conclusion: Based on this data, the COVID-19 pandemic had an impact on dental patient flow and the type of dental procedures performed on children. Minimally invasive treatments that minimize air generation are recommended; however, to establish the long-term effectiveness of minimally invasive treatments in pediatric dentistry, more follow-up studies with bigger sample sizes are required. More recommendations regarding conservative pediatric dental management after the COVID-19 era are suggested.Keywords: coronavirus, cross-infection, aerosol, minimally invasive dentistry, MID, pediatric dentists

ABSTRACT: Objectives: To describe the characteristics of nosocomial cases of Ebola virus disease (EVD) in the Democratic Republic of the Congo between July 2018 and May 2020 in order to inform future interventions. Methods: Nosocomial cases of EVD were identified during outbreak response surveillance, and a retrospective analysis of cases was conducted according to demographic characteristics and type of health facility (HF). Results: Of 3481 cases of EVD, 579 (16.6%) were nosocomial. Of these, 332 cases occurred in women (57.3%). Patients and visitors accounted for 419 cases (72.4%), of which 79 (18.9%) were aged 6–≤18 years and 108 (25.8%) were aged ≤5 years. Health workers (HWs) accounted for the remaining 160 (27.6%) nosocomial cases. The case fatality rate (CFR) for HWs (66/160, 41.3%) was significantly lower than the CFR for patients and visitors (292/419, 69.7%) (P39 beds) had the highest prevalence of nosocomial EVD (148/579, 25.6%). Among HFs with at least one case of nosocomial infection, 50.0% (98/196) were privately owned. Conclusions: Nurses and traditional healers should be targeted for infection prevention and control training, and supportive supervision should be provided to HFs to mitigate EVD transmission.

Recent decades have witnessed the emergence of many airborne diseases such as severe acute respiratory syndrome, Middle East respiratory syndrome, and COVID-19, which have highlighted the importance of effective ventilation in residential, work, or hospital premises. Ventilation which plays an essential role in reducing or diluting the airborne contaminants. However, it is not always easy to achieve by natural ventilation as it depends on many other factors such as temperature and climatic conditions. (wind velocity, wind direction, and housing pattern/design). Horizontal unidirectional airflow (HUAF) is one such method that can be achieved at low cost and can reduce cross-infection of COVID-19 to much extent. Hence, this narrative review aims to bring some insight into what is HUAF, how it can be achieved, and what are its possible implications in preventing COVID-19 transmission.

Background: Ventilator-associated pneumonia (VAP) is a serious nosocomial infection that threatens pediatric patients who have undergone cardiac surgery. The aim of this study is to analyze the bacteriological profile and antibiotic resistance pattern of the organisms grown from pediatric patients diagnosed as VAP after cardiac surgery and also to study the bacteriological and clinical outcomes of the patients. Patients and Methods: This prospective observational study was conducted in a tertiary care teaching institution in children aged younger than 14 years who had undergone cardiac surgery and were diagnosed to have VAP and on mechanical ventilation (MV). The clinical and the bacteriological profile of patients with VAP, the systemic antibiotics used, the resistance pattern to the antibiotics, and, finally, the bacteriological and clinical outcomes were analyzed. Results: Among the 98 patients with VAP, 55% were early onset (4 days of MV) VAP. Among the most common pathogens causing VAP, Klebsiella and Escherichia coli contributed to 18% each of the total VAP. Twenty percent of VAP were polymicrobial in origin. About 63% of organisms were resistant to Augmentin, and 11% of the organisms were multidrug resistant (MDR). Conclusion: This study not only showed the pattern of early and late onset VAP but also revealed the bacteriological profile and the resistance pattern of the local microbial flora causing VAP, guiding us in a more efficient management of VAP in children.

Xenotransplantation is one of the potential approaches to mitigate the shortage of donor kidneys. With the progress of gene modification techniques and the development of immunosuppressant, significant progress has been made in the preclinical research of genetically modified pig to non-human primate (NHP) xenotransplantation. The longest survival time of recipients exceeds 500 d. However, the number of recipients surviving for over 1 year is extremely low, and most recipients die within postoperative 1-2 months. Therefore, several problems remain to be clarified and resolved. In this article, rejection, refractory coagulation dysfunction, persistent inflammation, the selection of immunosuppressant, the selection of clinical recipients and the risk of cross-infection in genetically modified pig to NHP xenotransplantation were reviewed, and current problems and potential solutions of genetically modified pig to NHP xenotransplantation were summarized, aiming to provide reference for promoting xenotransplantation in clinical settings. [ABSTRACT FROM AUTHOR]

Viroids are the smallest known infectious agents that are thought to only infect plants. Here, we reveal that several species of plant pathogenic fungi that were isolated from apple trees infected with apple scar skin viroid (ASSVd) carried ASSVd naturally. This finding indicates the spread of viroids to fungi under natural conditions and further suggests the possible existence of mycoviroids in nature. A total of 117 fungal isolates were isolated from ASSVd-infected apple trees, with the majority (85.5%) being an ascomycete Alternaria alternata and the remaining isolates being other plant-pathogenic or -endophytic fungi. Out of the examined samples, viroids were detected in 81 isolates (69.2%) including A. alternata as well as other fungal species. The phenotypic comparison of ASSVd-free specimens developed by single-spore isolation and ASSVd-infected fungal isogenic lines showed that ASSVd affected the growth and pathogenicity of certain fungal species. ASSVd confers hypovirulence on ascomycete Epicoccum nigrum. The mycobiome analysis of apple tree-associated fungi showed that ASSVd infection did not generally affect the diversity and structure of fungal communities but specifically increased the abundance of Alternaria species. Taken together, these data reveal the occurrence of the natural spread of viroids to plants; additionally, as an integral component of the ecosystem, viroids may affect the abundance of certain fungal species in plants. Moreover, this study provides further evidence that viroid infection could induce symptoms in certain filamentous fungi. [ABSTRACT FROM AUTHOR]

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of the coronavirus disease (COVID-19), is found primarily in the respiratory tract secretions of infected individuals with one of the main routes of transmission being direct or indirect contact. In this study, using fluorescent paint, we evaluated the spread of contaminants while playing catch with a baseball. Fluorescent paint was applied to the right hand of a right-handed baseball player who then engaged in playing catch with 10 other right-handed players (partners) for 5 min each. The fluorescent paint was detected on the right hands (inside) and gloves (inside) of all the 10 partners as well as on the ball; in some partners it was also detected on the back of the right hands or the back of the gloves. However, except for their right hands, fluorescent paint was not detected on the surface of the bodies of the partners. These observations indicated that the fluorescent paint (mimicking virus-containing contaminants) on the hand spreads very efficiently from person to person during the throwing and catching of a baseball, suggesting that a thorough and frequent disinfection of the hands and equipment is important in the prevention of infections that may occur while playing baseball. [ABSTRACT FROM AUTHOR]

The pathogenicity of five isolates of Colletotrichum acutatum species complex (CASC) was tested on artificially injured apple fruits of the cultivar ‘Golden Delicious’ under laboratory conditions. Then, ten apple cultivars were tested for their relative susceptibility to CASC. Differences in the pathogenicity of the CASC isolates were confirmed in the test. The highest degree of pathogenicity was showed by the isolates from the strawberry and DCSBPM J1 from the apple. No cultivars were resistant to the pathogen. The disease incidence ranged from 57.5% to 100%. The individual cultivars showed different susceptibility to the tested isolates. The cultivars ‘Braeburn’, ‘Jonagold’ and ‘Rubinola’ showed the least susceptibility to the pathogen, while the cultivars ‘Jonagored’ and ‘Otava’ were recorded as the most susceptible to CASC. All the tested isolates were confirmed, by the conventional PCR method, to belong to CASC. The sequences of isolates DCSBPM J1 and DCSBPM 1209 were deposited in the GenBank. [ABSTRACT FROM AUTHOR]

Investigating a virus's host range and cross-infection is important for better understanding the epidemiology and emergence of viruses. Previously, our research group discovered a natural infection of a plant RNA virus, cumber mosaic virus (genus Cucumovirus, family Bromoviridae), in a plant pathogenic basidiomycetous fungus, Rhizoctonia solani, isolated from a potato plant grown in the field. Here, we further extended the study to investigate whether similar cross-infection of plant viruses occurs widely in plant-associated fungi in natural conditions. Various vegetable plants such as spinach, leaf mustard, radish, celery, and other vegetables that showed typical virus-like diseases were collected from the fields in Shandong Province, China. High-throughput sequencing revealed that at least 11 known RNA viruses belonging to different genera, including Potyvirus, Fabavirus, Polerovirus, Waikavirus, and Cucumovirus, along with novel virus candidates belonging to other virus genera, infected or associated with the collected vegetable plants, and most of the leaf samples contained multiple plant viruses. A large number of filamentous fungal strains were isolated from the vegetable leaf samples and subjected to screening for the presence of plant viruses. RT-PCR and Sanger sequencing of the PCR products revealed that among the 169 fungal strains tested, around 50% were carrying plant viruses, and many of the strains harbored multiple plant viruses. The plant viruses detected in the fungal isolates were diverse (10 virus species) and not limited to particular virus genera. However, after prolonged maintenance of the fungal culture in the laboratory, many of the fungal strains have lost the virus. Sequencing of the fungal DNA indicated that most of the fungal strains harboring plant viruses were related to plant pathogenic and/or endophytic fungi belonging to the genera Alternaria, Lecanicillium, and Sarocladium. These observations suggest that the nonpersistent acquisition of plant viruses by fungi may commonly occur in nature. Our findings highlight a possible role for fungi in the life cycle, spread, and evolution of plant viruses. [ABSTRACT FROM AUTHOR]

Of 1,118 patients with COVID-19 at a university hospital in Switzerland during October 2020-June 2021, we found 83 (7.4%) had probable or definite healthcare-associated COVID-19. After in-hospital exposure, we estimated secondary attack rate at 23.3%. Transmission was associated with longer contact times and with lower cycle threshold values among index patients. [ABSTRACT FROM AUTHOR]