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Rationale, Aims and Objectives: Cleaning smartphones of healthcare workers (HCWs) is generally recommended; however, most previous studies on bacterial contamination of smartphones assessed touchscreens alone. This study compared the prevalence of bacterial contamination on touchscreens and posterior surfaces of smartphones owned by HCWs. Method: A cross‐sectional study of smartphones used by HCWs working at an emergency department (ED) at a Japanese tertiary care hospital was conducted. Bacteria on each surface of the smartphones were isolated separately. Descriptive statistics were used to describe the prevalence of microbial contamination on each surface of the smartphones and the types of associated bacterial species. Fisher's exact test was used to compare dichotomous outcomes. Results: The smartphones of 40 HCWs working in the ED of a Japanese tertiary care hospital were examined. The touchscreens and posterior surfaces were contaminated in 26 (65.0%) and 36 (90.0%) smartphones, respectively, indicating the posterior surface was more frequently contaminated (p = 0.014). Bacillus species and coagulase‐negative staphylococci were most frequently isolated from each surface of the smartphones. Conclusions: The posterior surface of a smartphone was more significantly contaminated with bacteria than the touchscreen. Both surfaces of smartphones need to be cleaned to prevent bacterial contamination in healthcare environments. [ABSTRACT FROM AUTHOR]

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BackgroundIn 2015, an international outbreak of Mycobacterium chimaera infections among patients undergoing cardiothoracic surgeries was associated with exposure to contaminated LivaNova 3T heater-cooler devices (HCDs). From June 2017 to October 2020, the Centers for Disease Control and Prevention was notified of 18 patients with M. chimaera infections who had undergone cardiothoracic surgeries at 2 hospitals in Kansas (14 patients) and California (4 patients); 17 had exposure to 3T HCDs. Whole-genome sequencing of the clinical and environmental isolates matched the global outbreak strain identified in 2015.MethodsInvestigations were conducted at each hospital to determine the cause of ongoing infections. Investigative methods included query of microbiologic records to identify additional cases, medical chart review, observations of operating room setup, HCD use and maintenance practices, and collection of HCD and environmental samples.ResultsOnsite observations identified deviations in the positioning and maintenance of the 3T HCDs from the US Food and Drug Administration (FDA) recommendations and the manufacturer's updated cleaning and disinfection protocols. Additionally, most 3T HCDs had not undergone the recommended vacuum and sealing upgrades by the manufacturer to decrease the dispersal of M. chimaera-containing aerosols into the operating room, despite hospital requests to the manufacturer.ConclusionsThese findings highlight the need for continued awareness of the risk of M. chimaera infections associated with 3T HCDs, even if the devices are newly manufactured. Hospitals should maintain vigilance in adhering to FDA recommendations and the manufacturer's protocols and in identifying patients with potential M. chimaera infections with exposure to these devices.

ABSTRACT BACKGROUND: Contamination of the breathing circuit and medication preparation surface of an anesthesia machine can increase the risk of cross-infection. OBJECTIVE: To evaluate the contamination of the anesthetic medication preparation surface, respiratory circuits, and devices used in general anesthesia with assisted mechanical ventilation. DESIGN AND SETTING: Cross-sectional, quantitative study conducted at the surgical center of a philanthropic hospital, of medium complexity located in the municipality of Três Lagoas, in the eastern region of the State of Mato Grosso do Sul. METHODS: Eighty-two microbiological samples were collected from the breathing circuits. After repeating the samples in different culture media, 328 analyses were performed. RESULTS: A higher occurrence of E. coli, Enterobacter spp., Pseudomonas spp., Staphylococcus aureus, and Streptococcus pneumoniae (P < 0.001) were observed. Variations were observed depending on the culture medium and sample collection site. CONCLUSION: The study findings underscore the inadequate disinfection of the inspiratory and expiratory branches, highlighting the importance of stringent cleaning and disinfection of high-touch surfaces.

SUMMARY: Background: Cloth privacy curtains represent a potentially overlooked high touch surface. Inconsistent cleaning schedules paired with frequent contact allow curtains to provide a surface for the transmission of healthcare associated pathogens. Privacy curtains integrated with antimicrobial and sporicidal agents are shown to reduce the number of bacteria found on the surface of the curtains. The purpose of this initiative is to utilize antimicrobial and sporicidal privacy curtains to mitigate the transmission of healthcare associated pathogens from curtains to patients. Methods: The pre/post-test study design compared the bacterial and sporicidal burden of cloth curtains to the bacterial and sporicidal burden of Endurocide curtains following 20-weeks of use within the inpatient setting of a large military medical hospital. The Endurocide curtains were installed on two inpatient units in the organization. We also compared the overall costs associated with the two different types of curtains. Results: The antimicrobial and sporicidal curtains had a significant reduction in bacterial contamination (32.6 CFUs vs 0.56 CFUs, P < 0.05) after instillation on both units. There were no additional hospital associated infections during the study period. In addition, the direct cost savings of replacing the antimicrobial and sporicidal curtains is estimated to be $20,079.38 annually with a reduction of 66.95 hours in environmental services workload. Conclusion: These curtains represent a cost-effective intervention effective at reducing CFUs with the potential to mitigate the transmission of hospital associated pathogens to patients.

AIM: The aim of this study is to evaluate highly touched clinical surfaces using visual inspection methods and adenosine triphosphate by bioluminescence to identify soiling in intensive care units. METHOD: Descriptive, cross-sectional study carried out in three intensive care units located in Belo Horizonte, MG, Brazil. Data collection included 142 assessments of environmental surfaces. For data analysis, the Pareto diagram and descriptive statistics were used through measures of central tendency. RESULTS: The visual inspection identified dirtiness in the infusion pump, alcohol dispenser, and telephone. The surface that showed a high level of contamination by organic matter identified by the adenosine triphosphate bioluminescence test was the telephone, with a median of 1012 RLU/cm2 (±348.8). CONCLUSION: The surface evaluation methods used in the intensive care units made it possible to identify dirt on surfaces highly touched by hands, reinforcing the need for investments in training and audits in the process of cleaning and disinfecting surfaces. [ABSTRACT FROM AUTHOR]

Background & Aim: Hand disinfection methods are not germ-free, and infected hands transmit the infection. One of the personal protective equipment of the operating room is the mask, which will probably be contaminated by the hands when removing the mask. The aim of this study is to determine the effect of using automatic mask dispenser on the contamination of surgical masks in the operating room. Methods & Materials: The present study is a field experiment that was conducted on 120 hospital staff in Isfahan in 2021. The subjects were randomly divided into two groups of 60; automatic device and manual mask removal. The effect of contact of hands impregnated with fluorescent powder was measured during the removal of the mask in each group. The contamination area of ​​the removed mask and the lower mask on the back and front surfaces were compared in the two groups. Results: The Mann-Whitney test showed that there was a significant difference in the area impregnated with fluorescent powder from hand contact with the mask surface between the two methods (P

Many academics and researchers have responded to the COVID-19 pandemic by forming on-line national and international collaborative groups to rapidly investigate issues of prevention and treatment. This commentary describes the spontaneous formation of an international team of 115 researchers who summarized the literature on safe methods for decontaminating N95 filtering facepiece respirators in response to the supply crisis. The summary reports and fact sheets on the (www.n95decon.org) website have had more than 200 000 unique visits and the organization's webinars have reached health care professionals from more than 50 countries. The team is extending its mission to cover other personal protective equipment. The success of these collaborations may alter how scientific questions are tackled in the future.

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]

Although disinfection is key to infection control, the colonization patterns and resistomes of hospital-environment microbes remain underexplored. We report the first extensive genomic characterization of microbiomes, pathogens and antibiotic resistance cassettes in a tertiary-care hospital, from repeated sampling (up to 1.5 years apart) of 179 sites associated with 45 beds. Deep shotgun metagenomics unveiled distinct ecological niches of microbes and antibiotic resistance genes characterized by biofilm-forming and human-microbiome-influenced environments with corresponding patterns of spatiotemporal divergence. Quasi-metagenomics with nanopore sequencing provided thousands of high-contiguity genomes, phage and plasmid sequences (>60% novel), enabling characterization of resistome and mobilome diversity and dynamic architectures in hospital environments. Phylogenetics identified multidrug-resistant strains as being widely distributed and stably colonizing across sites. Comparisons with clinical isolates indicated that such microbes can persist in hospitals for extended periods (>8 years), to opportunistically infect patients. These findings highlight the importance of characterizing antibiotic resistance reservoirs in hospitals and establish the feasibility of systematic surveys to target resources for preventing infections.

AbstractBacterial attachment on surfaces is an important biological and industrial concern. Many parameters affect cell attachment behavior, including surface roughness and other topographical features. An understanding of these relationships is critical in the light of recent outbreaks caused by foodborne bacteria. Postharvest packing lines have been identified as a potential source of cross-contamination with pathogens, which can cause subsequent foodborne illness. The objective of this article is to evaluate the influence of surface topographical features on bacterial attachment at various processing temperatures to determine the extent of bacterial colonization. Type 304 stainless steel surfaces and pathogenic Listeria monocytogenes Scott A were used for a detailed investigation. Two commonly used surface types, extruded and ground, were evaluated to determine differences in bacterial attachment on the same type of material. Fifteen surface topography parameters at three processing temperatures were studied to evaluate possible correlations with microbial attachment on these surfaces. Scanning electron microscopy, energy-dispersive X-ray spectroscopy, and confocal microscopy were used for both qualitative and quantitative analyses of surfaces. An analysis of variance and multivariate regression analysis were used to predict the attachment behavior of L. monocytogenes Scott A on stainless steel surfaces. Surface isotropy, average surface roughness, surface spacing, and processing temperatures were strongly correlated with bacterial attachment on 304 stainless steel material.Highlights

PurposeTo report a diffuse lamellar keratitis (DLK) cluster attributed to autoclave reservoir biofilm and to review the risk and prevention of DLK and toxic anterior segment syndrome (TASS) caused by such biofilms.SettingRefractive Surgery Center, University of California, Berkeley.DesignObservational case-control study and review of literature.MethodsEyes were evaluated for DLK following laser in situ keratomileusis (LASIK) over a 5-year period. Multiple changes in surgical and operating room protocols were prompted by a cluster of DLK cases. The autoclave reservoir chamber wall was cultured for microbial contamination. The MEDLINE database was used to identify relevant past publications.ResultsFrom January 7, 2010, to December 18, 2014, 1115 eyes received LASIK. Between September 2, 2010, and June 11, 2012, 147 eyes of 395 LASIK cases developed DLK (37.2%). Systematic modifications in surgical protocols were unsuccessful in ending the prolonged cluster of DLK cases until the STATIM 2000 autoclave was replaced with a new STATIM autoclave and a reservoir sterilization and surveillance protocol implemented. Over the subsequent 30 months, DLK incidence was reduced to 2.2% (14 DLK cases from 632 total LASIK cases, P < .0001). The retired autoclave reservoir chamber wall cultures grew Pseudomonas aeruginosa and the Burkholderia cepacia complex.ConclusionsFluid reservoirs of tabletop steam autoclaves can readily develop polymicrobial biofilms harboring microbial pathogens, whose inert molecular byproducts can cause DLK and TASS when introduced to the eye by surgical instruments. Stringent reservoir cleaning and maintenance may significantly reduce this risk by preventing and removing these biofilms.

Most medical centers are postponing elective procedures and deferring non-urgent clinic visits to conserve hospital resources and prevent spread of COVID-19. The pandemic crisis presents some unique challenges for patients currently being treated with deep brain stimulation (DBS). Movement disorder (Parkinson's disease, essential tremor, dystonia), neuropsychiatric disorder (obsessive compulsive disorder, Tourette syndrome, depression), and epilepsy patients can develop varying degrees of symptom worsening from interruption of therapy due to neurostimulator battery reaching end of life, device malfunction or infection. Urgent intervention to maintain or restore stimulation may be required for patients with Parkinson's disease who can develop a rare but potentially life-threatening complication known as DBS-withdrawal syndrome. Similarly, patients with generalized dystonia can develop status dystonicus, patients with obsessive compulsive disorder can become suicidal, and epilepsy patients can experience potentially life-threatening worsening of seizures as a result of therapy cessation. DBS system infection can require urgent, and rarely emergent surgery. Elective interventions including new implantations and initial programming should be postponed. For patients with existing DBS systems, the battery status and electrical integrity interrogation can now be performed using patient programmers, and employed through telemedicine visits or by phone consultations. The decision for replacement of the implantable pulse generator to prevent interruption of DBS therapy should be made on a case-by-case basis taking into consideration battery status and a patient's tolerance to potential therapy disruption. Scheduling of the procedures, however, depends heavily on the hospital system regulations and on triage procedures with respect to safety and resource utilization during the health crisis.

This work aims at addressing whether a catastrophic failure of an entry, descent, and landing event of a Multimission Radioisotope Thermoelectric Generator-based lander could embed the heat sources into the martian subsurface and create a local environment that (1) would temporarily satisfy the conditions for a martian Special Region and (2) could establish a transport mechanism through which introduced terrestrial organisms could be mobilized to naturally occurring Special Regions elsewhere on Mars. Two models were run, a primary model by researchers at the Lawrence Berkeley National Laboratory and a secondary model by researchers at the Jet Propulsion Laboratory, both of which were based on selected starting conditions for various surface composition cases that establish the worst-case scenario, including geological data collected by the Mars Science Laboratory at Gale Crater. The summary outputs of both modeling efforts showed similar results: that the introduction of the modeled heat source could temporarily create the conditions established for a Special Region, but that there would be no transport mechanism by which an introduced terrestrial microbe, even if it was active during the temporarily induced Special Region conditions, could be transported to a naturally occurring Special Region of Mars.

Mucormycosis outbreaks have been linked to contaminated linen. We performed fungal cultures on freshly-laundered linens at 15 transplant and cancer hospitals. At 33% of hospitals, the linens were visibly unclean. At 20%, Mucorales were recovered from >10% of linens. Studies are needed to understand the clinical significance of our findings.

Abstract Background Some institutions reuse cuff syringes and do not periodically sterilize cuff pressure gauges. Pathogenic bacterial contamination of such equipment may increase the probability of pathogen transmission to patients during anesthetic procedures. Therefore, microbial contamination on cuff syringes, cuff pressure gauges, and their surroundings was assessed in the operating rooms of a university-affiliated tertiary care hospital in Japan. Methods This study was conducted between April and May 2019 in 14 operating suites at a hospital. The following sites in each operating suite were sampled: cuff syringe (inner/outer components), outer components of cuff pressure gauge, cuff syringe and cuff pressure gauge storage drawers, and computer mice. The swabs were directly streaked onto agar plates and incubated. Then, the bacterial species were identified using mass spectrometry. Results The highest bacterial isolation was observed in computer mice, followed by the outside of cuff pressure gauges and the drawers of cuff pressure gauges (92.9, 78.6, and 64.3%, respectively). Most of the identified bacteria belonged to the Bacillus species, with colonization rates of 85.7, 57.1, and 57.1% on computer mice, cuff pressure gauges, and cuff pressure gauge storage drawers, respectively. Coagulase-negative Staphylococcus was found in 35.7% of the specimens and was more prevalent on computer mice (71.4%), followed by on cuff pressure gauges (64.3%). Conclusion Anesthesiologists should be aware of the possible pathogen contamination risk from cuff syringes, cuff pressure gauges, or associated equipment and take appropriate infection control measures to minimize the risk of pathogenic transmission.

We evaluated the ability of a novel lithium niobate (LN) thickness-mode device to atomize disinfectants and reduce microbial burden on model surface materials. A small-scale plastic model housed the LN thickness-mode device and circular coupon surface materials including polycarbonate, polyethylene terephthalate, stainless steel, borosilicate glass, and natural rubber. Coupon surfaces were coated with methicillin-resistant Staphylococcus aureus (MRSA) or multidrug-resistant (MDR) strains of Gram-negative bacterial pathogens (Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii), atomized with disinfectant solutions of varying viscosity (including 10% bleach, 70% ethanol (EtOH), or 25% triethylene glycol (TEG)) using the LN thickness-mode device, and assessed for surviving bacteria. The LN thickness-mode device effectively atomized disinfectants ranging from low viscosity 10% bleach solution or 70% EtOH to highly viscous 25% TEG. Coupons harboring MDR bacteria and atomized with 10% bleach solution or 70% EtOH were effectively decontaminated with ~ 100% bacterial elimination. Atomized 25% TEG effectively eliminated 100% of K. pneumoniae (CRE) from contaminated coupon surfaces but not MRSA. The enclosed small-scale plastic model established proof-of-principle that the LN thickness-mode device could atomize disinfectants of varying viscosities and decontaminate coupon surface materials harboring MDR organisms. Future studies evaluating scaled devices for patient rooms are warranted to determine their utility in hospital environmental decontamination.

Objectives: To determine the incidence of infectious complications following ultrasound-guided musculoskeletal interventions performed with a disinfected uncovered ultrasound transducer footprint.Methods: Electronic medical records of all patients who underwent an ultrasound-guided musculoskeletal procedure (including injection, calcific lavage, or ganglion cyst aspiration) performed by any of the 14 interventional musculoskeletal radiologists at our institution between January 2013 and December 2018 were retrospectively reviewed to identify procedure site infections. Biopsies and joint aspirations were excluded. The procedures were performed using a disinfected uncovered transducer footprint. First, an automated chart review identified cases with (1) positive answers to the nurse's post-procedure call, (2) an International Classification of Diseases (ICD) diagnostic code related to a musculoskeletal infection, or (3) an antibiotic prescription within 30 days post-procedure. Then, these cases were manually reviewed for evidence of procedure site infection.Results: In total, 6511 procedures were included. The automated chart review identified 3 procedures (2 patients) in which post-procedural fever was reported during the nurse's post-procedure call, 33 procedures (28 patients) with an ICD code for a musculoskeletal infection, and 220 procedures (216 patients) with an antibiotic prescription within 30 post-procedural days. The manual chart review of these patients revealed no cases of confirmed infection and 1 case (0.015%) of possible site infection.Conclusions: The incidence of infectious complications after an ultrasound-guided musculoskeletal procedure performed with an uncovered transducer footprint is extremely low. This information allows radiologists to counsel their patients more precisely when obtaining informed consent.Key Points: • Infectious complications after ultrasound-guided musculoskeletal procedures performed with a disinfected uncovered transducer footprint are extremely rare. [ABSTRACT FROM AUTHOR]

Objective: to describe the microbiological profile of inanimate surfaces in contact with the patient in a social security level III hospital in Chiclayo, Peru. Material and methods: An observational, descriptive, transversal study was carried out with the data from the reports of the Microbiological Qualitative Control of Physical Environments of 5 services of a Chiclayo Hospital level III in Peru. The method for the identification of microorganisms was the automated system VITEK MS. Descriptive analyses such as frequencies and percentages are presented. Results: A total of 177 isolations were reported, from which 97.74% (173) were positive, of these, 50.87% (88) were composed by gram-negative bacilli, being the most isolated microorganism Acinetobacter baumannii (17 samples) followed by Rhizobium radiobacter (16) and Sphingomonas paucimobilis13. Conclusions: The hospital environment is highly contaminated, being most of them pathogenic microorganisms. These results would be related to the long life of microorganisms on inert surfaces and the process of cleaning and disinfection of the hospital environment, so the evaluation of its effectiveness and the possible development of new and better cleaning techniques should be investigated.

Abstract Background Mobile phones used by healthcare workers (HCWs) are contaminated with bacteria, but the posterior surface of smartphones has rarely been studied. The aim of this study was to compare the prevalence of microbial contamination of touchscreens and posterior surfaces of smartphones owned by HCWs. Methods A cross-sectional study of smartphones used by HCWs employed at two intensive care units at a Japanese tertiary care hospital was performed. Bacteria on each surface of the smartphones were isolated separately. The primary outcomes were the prevalence of microbial contamination on each surface of smartphones and associated bacterial species. Fisher’s exact test was used to compare dichotomous outcomes. Results Eighty-four HCWs participated in this study. The touchscreen and posterior surface were contaminated in 27 (32.1%) and 39 (46.4%) smartphones, respectively, indicating that the posterior surface was more frequently contaminated (p = 0.041). Bacillus species and coagulase-negative staphylococci were isolated from each surface of the smartphones. Conclusions The posterior surface of a smartphone was more significantly contaminated with bacteria than the touchscreen, regardless of having a cover. Therefore, routine cleaning of the posterior surface of a smartphone is recommended.

BackgroundPercutaneous neurostimulation of the peripheral nervous system involves the insertion of a wire "lead" through an introducing needle to target a nerve/plexus or a motor point within a muscle. Electrical current may then be passed from an external generator through the skin via the lead for various therapeutic goals, including providing analgesia. With extended use of percutaneous leads sometimes greater than a month, infection is a concern. It was hypothesized that the infection rate of leads with a coiled design is lower than for leads with a noncoiled cylindrical design.MethodsThe literature was retrospectively reviewed for clinical studies of percutaneous neurostimulation of the peripheral nervous system of greater than 2 days that included explicit information on adverse events. The primary endpoint was the number of infections per 1,000 indwelling days.ResultsForty-three studies were identified that met inclusion criteria involving coiled (n = 21) and noncoiled (n = 25) leads (3 studies involved both). The risk of infection with noncoiled leads was estimated to be 25 times greater than with coiled leads (95% confidence interval [CI] 2 to 407, P = 0.006). The infection rates were estimated to be 0.03 (95% CI 0.01 to 0.13) infections per 1,000 indwelling days for coiled leads and 0.83 (95% CI 0.16 to 4.33) infections per 1,000 indwelling days for noncoiled leads (P = 0.006).ConclusionsPercutaneous leads used for neurostimulation of the peripheral nervous system have a much lower risk of infection with a coiled design compared with noncoiled leads: approximately 1 infection for every 30,000 vs. 1,200 indwelling days, respectively.

Background: Needleless connectors (NCs) can be disinfected using antiseptic barrier caps (ABCs) to reduce the risk of catheter-related bloodstream infections. However, recent evidence suggests that isopropanol can leak from the ABC into the NC, posing concern about their safe use. We sought to determine in vitro which ABC and NC parameters influence the leakage of isopropanol through the infusion circuit., Methods: We assessed 13 NCs and 4 ABCs available in the European market. In vitro circuits consisting of an isopropanol cap, a NC, and an 11-cm catheter line were created. The circuits were left in place for 1 to 7 days at room temperature to assess the kinetics of isopropanol leakage. Isopropanol content in ABC and in circuit flushing solutions (5 mL NaCl 0.9%) after exposure to the cap were measured using gas chromatography with a flame ionization detector., Results: The leakage of isopropanol from the cap to the NC was dependent on the NC, but not the cap. The NC mechanism did not predict the leakage of isopropanol. The Q-Syte NC exhibited the most isopropanol leakage (7.01±1.03 mg and 28.32±2.62 mg at 24 hours and 7 days, respectively), whereas the Caresite NC had the lowest isopropanol leakage at 7 days (1.69±0.01 mg)., Conclusion: The use of isopropanol ABCs can cause isopropanol leakage into the catheter circuit according to NC parameters. Caution should be exercised when using these devices, especially in the pediatric and neonatal population.

Introduction and Aims: Adequate drying and proper storage of flexible endoscopes are essential for maintaining quality in their reprocessing. The aim of the present study was to evaluate the drying stages, storage, and channel conditions of endoscopes through borescope inspection., Material and Methods: The personnel responsible for endoscope reprocessing were interviewed. Storage conditions at 10 endoscopy facilities were inspected and an internal examination of the channels and ports of the stored equipment was carried out, utilizing a borescope. A total of 74 stored endoscope channels were evaluated., Results: Only 10% of the facilities inspected utilized transport cases for storage and only 10% had rooms exclusively used for storage. Sixty percent of the facilities did not perform any shelf-life control. All the channels evaluated were scratched and fluids were present on 69% of them., Conclusions: Endoscope reprocessing can be improved through the implementation of drying and storage control and validation tools, as well as the use of borescopes and periodic clinical audits., (Copyright © 2024 Asociación Mexicana de Gastroenterología. Published by Masson Doyma México S.A. All rights reserved.)

Objective: To identify and report the pathogens and sources of contamination associated with bronchoscopy-related outbreaks and pseudo-outbreaks., Design: Systematic review., Setting: Inpatient and outpatient outbreaks and pseudo-outbreaks after bronchoscopy., Methods: PubMed/Medline databases were searched according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, using the search terms "bronchoscopy," "outbreak," and "pseudo-outbreak" from inception until December 31, 2022. From eligible publications, data were extracted regarding the type of event, pathogen involved, and source of contamination. Pearson correlation was used to identify correlations between variables., Results: In total, 74 studies describing 23 outbreaks and 52 pseudo-outbreaks were included in this review. The major pathogens identified in these studies were Pseudomonas aeruginosa , Mycobacterium tuberculosis , nontuberculous mycobacteria (NTM), Klebsiella pneumoniae , Serratia marcescens , Stenotrophomonas maltophilia , Legionella pneumophila , and fungi. The primary sources of contamination were the use of contaminated water or contaminated topical anesthetics, dysfunction and contamination of bronchoscopes or automatic endoscope reprocessors, and inadequate disinfection of the bronchoscopes following procedures. Correlations were identified between primary bronchoscope defects and the identification of P. aeruginosa (r = 0.351; P = .002) and K. pneumoniae (r = 0.346; P = .002), and between the presence of a contaminated water source and NTM (r = 0.331; P = .004) or L. pneumophila (r = 0.280; P = .015)., Conclusions: Continued vigilance in bronchoscopy disinfection practices remains essential because outbreaks and pseudo-outbreaks continue to pose a significant risk to patient care, emphasizing the importance of stringent disinfection and quality control measures.

Background: Medical equipment can become scarce in disaster scenarios. Prior work has reported that four sheep could be ventilated together on a single ventilator. Others found that this maneuver is possible when needed, but no one has yet investigated whether cross-contamination occurs in co-ventilated individuals., Objective: Our goal was to investigate whether an infection could spread between co-ventilated individuals., Methods: Four 2-L anesthesia bags were connected to a sterilized ventilator circuit that used heat and moisture exchange filters and bacterial and viral filters, as would be expected in this dire scenario. Serratia marcescens was inoculated into "lung" no. 1. After running for 24 h, each lung and three additional points in the circuit were cultured to see whether S. marcescens had spread. These cultures were examined at 24 and 48 h to assess for cross-contamination. This entire procedure was performed three times., Results: S. marcescens was not found in lung no. 2, 3, or 4 or the three additional sites on the expiratory limb at 24 and 48 h in all three trials., Conclusions: Cross-contamination does not occur within 24 h using the described ventilator circuit configuration., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Reprocessing of gastrointestinal (GI) endoscopes and accessories is an essential part of patient safety and quality control in GI endoscopy centers. However, current endoscopic reprocessing guidelines or procedures are not adequate to ensure patient-safe endoscopy. Approximately 5.4 % of the clinically used duodenoscopes remain contaminated with high-concern microorganisms. Thus, the Digestive Endoscopy Society of Taiwan (DEST) sets standards for the reprocessing of GI endoscopes and accessories in endoscopy centers. DEST organized a task force working group using the guideline-revision process. These guidelines contain principles and instructions of step-by-step for endoscope reprocessing. The updated guidelines were established after a thorough review of the existing global and local guidelines, systematic reviews, and health technology assessments of clinical effectiveness. This guideline aims to provide detailed recommendations for endoscope reprocessing to ensure adequate quality control in endoscopy centers., Competing Interests: Conflicts of interest All authors declare that they have no relevant conflicts of interest related to this article., (Copyright © 2023. Published by Elsevier B.V.)

Over the past decade, infections linked to duodenoscopes have become a significant concern, primarily due to the intricate design of the elevator mechanism. Currently, there is limited evidence regarding the bacterial contamination level of the elevator mechanism after clinical use and throughout its various reprocessing stages. This study utilized the swab culture technique to examine the bacterial contamination on the duodenoscope elevator mechanism after clinical use and after 3 reprocessing stages at a Center of tertiary hospital. Our findings revealed severe bacterial contamination after clinical usage, emphasizing that the effectiveness of manual cleaning greatly influences the subsequent high-level disinfection quality., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Several factors in glass slide (GS) preparation affect the quality and data volume of a digitized histological slide. In particular, reducing contamination and selecting the appropriate coverslip have the potential to significantly reduce scan time and data volume., Goals: To objectify observations from our institute's digitization process to determine the impact of laboratory processes on the quality of digital histology slides., Materials and Methods: Experiment 1: Scanning the GS before and after installation of a central console in the microtomy area to reduce dirt and statistical analysis of the determined parameters. Experiment 2: Re-coverslipping the GS (post diagnostics) with glass and film. Scanning the GS and statistical analysis of the collected parameters., Conclusion: The targeted restructuring in the laboratory process leads to a reduction of GS contamination. This causes a significant reduction in the amount of data generated and scanning time required for the digitized sections. Film as a coverslip material minimizes processing errors in contrast to glass. According to our estimation, all the above-mentioned points lead to considerable cost savings., (© 2024. The Author(s).)

Background: A recent study confirmed significant contamination of syringe tips following routine anaesthesia practice of at least 6 h in duration., Aim: We assessed the relative efficacy of clinically relevant syringe tip disinfection techniques following contamination with the hyper transmissible and more pathogenic Staphylococcus aureus sequence type 5 (S. aureus ST5) strain characteristic associated with increased strength of biofilm formation and greater desiccation tolerance., Methods: Syringe tips (N=40) contaminated with S. aureus ST5 were randomized to 70% isopropyl pads with 10 or 60 s of drying time, scrubbing alcohol disinfection caps with 10 or 60 s of dwell time, or to non-scrubbing alcohol disinfection caps with 60 s of dwell time. The primary outcome was residual 24-h colony forming units (cfu) >10., Results: Scrubbing disinfection caps were more effective than alcohol pads (25% (12/48) <10 cfu for scrubbing caps (10- or 60-s dwell times) vs 0% (0/48) <10 cfu for alcohol pads (10 or 60 s of drying time), Holm-Sidak adjusted P=0.0016). Scrubbing disinfection caps were more effective than non-scrubbing alcohol disinfection caps (25% (12/48) <10 cfu for scrubbing alcohol caps (10- or 60-s dwell times) vs 2% (1/48) for non-scrubbing alcohol caps (60-s dwell time), adjusted P=0.0087)., Conclusions: Scrubbing alcohol caps are more effective than alcohol pads or non-scrubbing disinfecting caps for microbial reduction of syringe tips contaminated with the more pathogenic S. aureus ST5., (Copyright © 2024 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Background & Aim: Hand disinfection methods are not germ-free, and infected hands transmit the infection. One of the personal protective equipment of the operating room is the mask, which will probably be contaminated by the hands when removing the mask. The aim of this study is to determine the effect of using automatic mask dispenser on the contamination of surgical masks in the operating room. Methods & Materials: The present study is a field experiment that was conducted on 120 hospital staff in Isfahan in 2021. The subjects were randomly divided into two groups of 60; automatic device and manual mask removal. The effect of contact of hands impregnated with fluorescent powder was measured during the removal of the mask in each group. The contamination area of the removed mask and the lower mask on the back and front surfaces were compared in the two groups. Results: The Mann-Whitney test showed that there was a significant difference in the area impregnated with fluorescent powder from hand contact with the mask surface between the two methods (P<0.05). Only 125.6±77.8 mm2 of from the front surface and 30.6±26.0 mm2 from the back surface of the mask removed with the automatic mask dispenser were contaminated, while the ratio in the hand-removed mask was respectively 961.6±612.9 and 440.4±315.6 mm2 . Conclusion: The study showed that eliminating hand contact with the body of the mask using an automatic mask dispenser, can reduce its contamination. Therefore, mechanization of services is effective in ensuring the safety of individuals’ health and reducing costs. Background & Aim: Hand disinfection methods are not germ-free, and infected hands transmit the infection. One of the personal protective equipment of the operating room is the mask, which will probably be contaminated by the hands when removing the mask. The aim of this study is to determine the effect of using automatic mask dispenser on the contamination of surgical masks in the operating room. Methods & Materials: The present study is a field experiment that was conducted on 120 hospital staff in Isfahan in 2021. The subjects were randomly divided into two groups of 60; automatic device and manual mask removal. The effect of contact of hands impregnated with fluorescent powder was measured during the removal of the mask in each group. The contamination area of the removed mask and the lower mask on the back and front surfaces were compared in the two groups. Results: The Mann-Whitney test showed that there was a significant difference in the area impregnated with fluorescent powder from hand contact with the mask surface between the two methods (P<0.05). Only 125.6±77.8 mm2 of from the front surface and 30.6±26.0 mm2 from the back surface of the mask removed with the automatic mask dispenser were contaminated, while the ratio in the hand-removed mask was respectively 961.6±612.9 and 440.4±315.6 mm2 . Conclusion: The study showed that eliminating hand contact with the body of the mask using an automatic mask dispenser, can reduce its contamination. Therefore, mechanization of services is effective in ensuring the safety of individuals’ health and reducing costs. [ABSTRACT FROM AUTHOR]

Background and Aims: The coronavirus disease 2019 (COVID-19) pandemic has initiated modified protocols for aerosol-generating procedures. A simulation study using dye was conducted to highlight contamination at intubation and extubation and to encourage adherence to the new COVID-19 protocol among anaesthesia personnel in our institution. Methods: A video demonstrating the new COVID-19 protocols was circulated in the Department of Anaesthesiology a week prior to the study. Thirty teams, each comprising an anaesthesia resident and a staff technician, were enroled. Each team was asked to demonstrate the steps of preparation, intubation and extubation on a mannequin in a COVID-19 scenario. Checklists were used to assess points of contamination and adherence to the protocols. Following debriefing, a repeat simulation was conducted. The use of a dye highlighted the points of contamination. The study subjects provided feedback on the usefulness of the session and practical difficulties encountered in adapting to the new protocols. Results: The average contamination scores decreased by 3.4 (95% confidence interval (CI): 2.4–4.4, P < 0.001) in the post-debrief session. Adherence to the steps of the modified protocol improved by a score of 2.7 (CI: 3.6–1.83) among anaesthesiologists and by 4.3 (CI: 5.3–3.3) among technicians. Further, 93% felt that the use of the colour indicator reinforced awareness of the possible points of contamination. Conclusion: Simulation with a low-fidelity mannequin by using colour indicator for secretions is an effective teaching tool to reduce health hazards during airway management in COVID-19 times.

A recent report from the Faroe Islands suggested mild iodine deficiency among women aged 40 years and older. New preliminary results showed an average urinary iodine concentration of 457 µg/L. This spurious finding encouraged the present report. A subset of 17 consecutive pregnant women from an ongoing study provided an additional morning spot urine sample; one part was tested for a few seconds with a test strip for glucose, protein, and erythrocytes, and the other was left untouched. The women recorded the previous week's intake of iodine-rich foods. Additionally, 12 tap water samples were collected such that three samples were sealed immediately, the remaining were strip tested for 10, 30 and 60 s, respectively. Urine and water samples were analysed using the ceri/arsen method after alkaline ashing. Median urinary iodine concentration (UIC) in pristine urine samples was 116 µg/L (IQR 79–204 µg/L; range 26–475 µg/L), and positively associated with iodine-rich food intake. UIC increase with test-strip dip varied from 10 to 94 times the non-dip value. In tap water, the pristine samples had an iodine concentration of 2–4 µg/L, which increased to 10,000 µg/L after 60 s. Urine samples exposed to test strips can be contaminated within a few seconds leading to unreliable iodine results. Therefore, it is crucial that the study protocol clearly states the procedure for urine sample collection and handling, strict adherence to protocol, and that utensils used are dedicated to collecting urine to measure iodine. [ABSTRACT FROM AUTHOR]

BackgroundPeriprosthetic joint infection (PJI) is one of the most common causes of revision total hip arthroplasty (THA) and associated with higher costs, prolonged pain, and worse clinical outcomes. Many factors have been linked to increased infection rates, one being the operative equipment and instrumentation used during the surgical procedure. With few arthroplasty instruments designed for complete disassembly and increasingly complex instrument designs, this study seeks to understand the effect that instrument disassembly plays on infection using disassembled and assembled standard femoral broach handles (BHs).MethodsTwo BHs, not designed for disassembly, were modified and then contaminated in the disassembled state with Geobacillus stearothermophilus vegetative-form bacteria and spores. Using both flash and standard sterilization cycles, the BHs were steam sterilized in the disassembled or assembled state and then analyzed for remaining bacteria and spores.ResultsAt all target locations after either a flash sterilization cycle or a standard sterilization cycle, complete eradication of both the vegetative-form and spore-form of G stearothermophilus was achieved.ConclusionThis study demonstrates that adequate decontamination of the tested BHs can be achieved after steam sterilization in either the disassembled or assembled state, without an increased risk of infection transmission.

Background and aimsThe duodenoscopes used to perform ERCP have been implicated in several outbreaks of carbapenem-resistant Enterobacteriaceae (CRE) infection. The risk factors for CRE transmission via contaminated duodenoscopes remain unclear.MethodsIn this retrospective, single-center, case-control study, all patients who underwent ERCP with either 1 of 2 contaminated duodenoscopes were evaluated. We compared the patients who acquired CRE (active infection or colonization) with those who did not.ResultsBetween October 3, 2014, and January 28, 2015, a total of 125 procedures were performed on 115 patients by using either of the contaminated duodenoscopes. Culture data were available for 104 of the 115 exposed patients (90.4%). Among these patients, 15 (14.4%) became actively infected (n = 8, 7.7%) or colonized (n = 7, 6.7%) with CRE. On univariate analysis, recent antibiotic exposure (66.7% vs 37.1%; P = .046), active inpatient status (60.0% vs 28.1%; P = .034), and a history of cholangiocarcinoma (26.7% vs 3.4%; P = .008) were patient characteristics associated with an increased risk of CRE infection. Biliary stent placement (53.3% vs 22.5%; P = .024) during ERCP was a significant procedure-related risk factor. After adjusting for cholangiocarcinoma, biliary stent placement (odds ratio 3.62; 95% confidence interval, 1.12-11.67), and active inpatient status (odds ratio 3.74; 95% confidence interval, 1.15-12.12) remained independent risk factors for CRE transmission.ConclusionsIn patients undergoing ERCP with a contaminated duodenoscope, biliary stent placement, a diagnosis of cholangiocarcinoma, and active inpatient status are associated with an increased risk of CRE transmission.

Introduction: Transmission of COVID-19 through close contact and droplets is well established, but the influence of aerosol and surface contamination remains to be determined. Literature is scarce and inconsistent about the viable virus particles free-distance from infected patients, as well as about different swabbing methods for surface contamination evaluation. The aim of this study was to evaluate the most sensitive method for the assessment of surface contamination, classify the likelihood of environmental contamination in risk zones and compare the environmental contamination between oxygenation and ventilatory support. Material and Methods: Swabs from potentially contaminated surfaces in a COVID-19 ward, with patients treated with different types of oxygen and ventilatory support, were collected. Three types of swabs were compared in order to evaluate the most sensitive collection method. For risk zone categorization, areas were divided according to the distance from the patient. Results: Of the 63 swabs collected, 17 (27%) tested positive for the presence of SARS-CoV-2. The highest positivity rate was observed with the sterile premoistened swab with saline (n = 8; 38%), but without statistically significant differences. The highest number of positive samples were collected from the high-risk zones, specifically those located one meter from the patient (n = 13; 48%), with statistically significant differences. Only the rooms of patients supported with non-invasive ventilation or high-flow nasal cannula had evidence of bedroom contamination, with 45% and 27% of swab positivity, with statistically significant differences. Discussion: Our findings favour the premoistened swab without transport medium for surface contamination assessment, even though without statistical differences. A statistically significant trend supporting the division in risk zones, according to the distance from the patient, was also identified. The higher positivity rate from the non-invasive ventilation and high-flow nasal cannula bedrooms suggests a significant association between ventilatory strategies and surface contamination, probably due to higher particle dispersion. Conclusion: Our findings support the use of the sterile premoistened swab without preservation medium, the classification of risk areas considering the distance from the patient, and the variability of RNA dispersion between oxygenation and ventilatory support.

Background: In April 2018, Ottawa Public Health identified a large-scale infection prevention and control (IPAC) lapse spanning 15 years related to inadequate reprocessing of reusable critical medical equipment used in a family medicine clinic. Objectives: To describe the public health response to, and estimate the risk of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) transmission from, this IPAC lapse. Methods: Patients who underwent a procedure of concern (during which reusable equipment may have been used) at this clinic were identified using Ontario Health Insurance Plan data and individually notified. Testing for HBV, HCV and HIV at the Public Health Ontario Laboratory was recommended, and the odds of infection were estimated. Results: Of 4,495 patients possibly exposed to improperly reprocessed equipment, 1,496 (33.3%) underwent testing within six months of notification. The prevalence of HBV, HCV and HIV infection in this group was lower than in the general Canadian population. Among patients first diagnosed with HBV after a procedure of concern, the odds of HBV transmission were not increased when the procedure occurred within seven or 28 days of another patient with a positive HBV test result (OR7 days, age-adjusted=0.59, 95% CI: 0.14–2.51; OR28 days, age-adjusted=1.35, 95% CI: 0.62–2.93). The odds of HCV and HIV transmission could not be estimated because no patient was diagnosed with HCV or HIV after having a procedure of concern within 28 days of another patient with a positive HCV or HIV test result. Conclusion: We found no evidence of HBV, HCV or HIV transmission associated with this IPAC lapse. However, transmission cannot be ruled out conclusively because only a third of possibly exposed patients underwent testing.

Biofilm formation has been linked to ventilator-associated pneumonia, which is a prevalent infection in hospital intensive care units. Currently, there is no rapid diagnostic tool to assess the degree of biofilm formation or cellular biofilm composition. Optical coherence tomography (OCT) is a minimally invasive, nonionizing imaging modality that can be used to provide high-resolution cross-sectional images. Biofilm deposited in critical care patients’ endotracheal tubes was analyzed in vitro. This study demonstrates that OCT could potentially be used as a diagnostic tool to analyze and assess the degree of biofilm formation and extent of airway obstruction caused by biofilm in endotracheal tubes.

ABSTRACT Objectives: to evaluate the microbial load and adherence of Escherichia coli in different areas of the surgical instrument surface exposed to experimental contamination over time. Methods: experimental study in which fragments of crile forceps (serrated, rod and rack) were contaminated by immersion in Tryptic Soy Broth, containing 106 CFU/mL of E. coli, for 1, 2, 4, 6, 8, 12 and 24 hours. Microbial load and bacterial adherence were evaluated using microbiological culture and scanning electron microscopy, respectively. Results: there was an increase in the microbial load on the surgical instrument, proportional to the contamination interval, ranging from 102 after 1 hour to 105 CFU/cm2 in 24 hours. The presence of exopolysaccharide was detected after two hours of contamination. Conclusions: microbial load and adhesion of E. coli increased over time, reaching 105 CFU/cm2 after 24 hours of contamination, starting biofilm formation after two hours.

Background and Aim: Bacterial contamination of clinical surfaces of dental units that have been touched or been exposed to patients’ blood or saliva can be a reservoir for infections, leading to cross-contamination. This study aimed to evaluate bacterial contamination in the clinical environment of Sari Dental School in 2018. Materials and Methods: In this cross-sectional (descriptive-analytical) study, samples were randomly collected from 15 active dental units of five departments of Sari Dental School, including surgical, pediatrics, prosthodontics, endodontics, and restorative dentistry departments. Samples were collected from headrests, light handles, and dental seats using moist sterile swabs, and air samples were collected using agar plates. Sampling was carried out before and after dental practice. The samples were transferred to the microbiology laboratory to determine the number of various microorganism colonies. Data were analyzed using Chi-square, McNemar, and Kruskal-Wallis tests. P-values lower than 0.05 were considered significant. Results: A significant difference was found between the frequency of contamination before and after clinical practice based on McNemar test results. Staphylococci were more prevalent on the surfaces. Kruskal-Wallis test revealed no significant difference in the total number of microorganisms between different departments after dental practice. Bacterial contamination of air was greater than other parts, followed by dental seats. Conclusion: Microbial contamination of dental units considerably increases after treatment of each patient. Therefore, disinfection of dental unit surfaces and seats between each patient is essential. Also, methods of infection control must be supervised to prevent cross-infection.

Purpose: To determine and compare the frequency of contamination on different sites of healing abutments (HAs) after sterilization with Phloxine B dye on unused and used HAs after sterilization., Materials and Methods: A total of 60 HAs were divided into two test groups: (1) used and sterilized and (2) a control group (unused). The test group was evaluated for contamination after sterilization; the control group did not undergo any procedure. Data were analyzed using SPSS version 22 (IBM). Descriptive statistics were used to determine the frequency of contamination in the different groups and at the different HA sites. Chi-square test was used to evaluate the association of frequency of contamination with the HA site and design. The level of significance was kept at P ≤ .01., Results: The test group showed more contamination compared to the control group. The most contaminated sites were the screw thread and the screwdriver engagement location., Conclusions: HA reuse is cost-effective, but cleaning and sterilization was not effective for these components; thus, HAs need to be reused with caution because they were heavily contaminated when compared to new HAs. Among the different sites, the screw thread and screwdriver engagement sites were more prone to contamination. HA type did not influence the frequency of contamination.

Background: A significant reduction in bacterial growth on stethoscope membranes has been noticed after performing daily disinfection. Nevertheless, disinfection is rarely performed. We aimed to assess self-reported stethoscope disinfection practices among medical doctors, detect bacterial contamination on personal stethoscopes, and estimate the effectiveness of 70% ethanol as a stethoscope disinfecting agent., Methods: To determine stethoscope disinfection practices, participants filled out a questionnaire (N = 47), followed by providing stethoscopes for bacterial analysis. Differences in bacterial contamination were observed through the self-reported frequency and method of stethoscope disinfection. The effect of disinfecting with 70% ethanol was evaluated by comparing the presence of bacterial growth before and after disinfection., Results: The presence of bacterial growth was found in 78.7% of the stethoscope samples, with the median (interquartile range) number of colony-forming units at 25 (10-105). The frequency of disinfection greatly impacted the number of colony-forming units, and the method affected the presence of bacterial growth. Disinfection of stethoscope membranes using 70% ethanol resulted in a compelling 97.3% reduction of bacterial growth., Conclusions: Adequate stethoscope disinfection is highly efficient in reducing bacterial contamination and as such should be considered a critical step in hygienic practices., (Copyright © 2023 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: To identify all published data on the chemical, micro-organism and malignant cell contents of ultrasonic scalpel plume, if any, and on any clinical implications of the contents on patients and operating staff., Methods: Searches were conducted aiming to identify all published evidence on the chemical constituents, presence/absence of viable micro-organisms and malignant cells in ultrasonic scalpel plume. Attempts were made to source unpublished industry data., Results: There is evidence from human and in vitro studies of the presence of a range of harmful, and some human carcinogenic, chemicals within ultrasonic plume, mostly at very low concentrations. Any clinical relevance of this has not been studied. There is evidence from experimental studies of the presence of hepatitis virus, human coronavirus and human papillomavirus material within ultrasonic plume. Any clinical effect of this has not been studied. There is conflicting evidence from combined in vitro and mouse model studies of the presence of viable malignant cells within ultrasonic plume. Any clinical relevance of this has also not been studied., Conclusion: Overall, relatively little research into the plume has been published, and further study is required to more clearly delineate any potential risk to patients, surgeons and other theatre staff. Current safety recommendations are discussed., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Background and Aims: The coronavirus disease 2019 (COVID-19) pandemic has initiated modified protocols for aerosol-generating procedures. A simulation study using dye was conducted to highlight contamination at intubation and extubation and to encourage adherence to the new COVID-19 protocol among anaesthesia personnel in our institution. Methods: A video demonstrating the new COVID-19 protocols was circulated in the Department of Anaesthesiology a week prior to the study. Thirty teams, each comprising an anaesthesia resident and a staff technician, were enroled. Each team was asked to demonstrate the steps of preparation, intubation and extubation on a mannequin in a COVID-19 scenario. Checklists were used to assess points of contamination and adherence to the protocols. Following debriefing, a repeat simulation was conducted. The use of a dye highlighted the points of contamination. The study subjects provided feedback on the usefulness of the session and practical difficulties encountered in adapting to the new protocols. Results: The average contamination scores decreased by 3.4 (95% confidence interval (CI): 2.4–4.4, P < 0.001) in the post-debrief session. Adherence to the steps of the modified protocol improved by a score of 2.7 (CI: 3.6–1.83) among anaesthesiologists and by 4.3 (CI: 5.3–3.3) among technicians. Further, 93% felt that the use of the colour indicator reinforced awareness of the possible points of contamination. Conclusion: Simulation with a low-fidelity mannequin by using colour indicator for secretions is an effective teaching tool to reduce health hazards during airway management in COVID-19 times. [ABSTRACT FROM AUTHOR]

Microorganisms are ubiquitously distributed in nature and usually appear as biofilms attached to a variety of surfaces. Here, we report the development of a thick biofilm in the drain pipe of several standard laboratory ice machines, and we describe and characterise, through culture-dependent and -independent techniques, the composition of this oligotrophic microbial community. By using culturomics, 25 different microbial strains were isolated and taxonomically identified. The 16S rRNA high-throughput sequencing analysis revealed that Bacteroidota and Proteobacteria were the most abundant bacterial phyla in the sample, followed by Acidobacteriota and Planctomycetota, while ITS high-throughput sequencing uncovered the fungal community was clearly dominated by the presence of a yet-unidentified genus from the Didymellaceae family. Alpha and beta diversity comparisons of the ice machine microbial community against that of other similar cold oligotrophic and/or artificial environments revealed a low similarity between samples, highlighting the ice machine could be considered a cold and oligotrophic niche with a unique selective pressure for colonisation of particular microorganisms. The recovery and analysis of high-quality metagenome-assembled genomes (MAGs) yielded a strikingly high rate of new species. The functional profiling of the metagenome sequences uncovered the presence of proteins involved in extracellular polymeric substance (EPS) and fimbriae biosynthesis and also allowed us to detect the key proteins involved in the cold adaptation mechanisms and oligotrophic metabolic pathways. The metabolic functions in the recovered MAGs confirmed that all MAGs have the genes involved in psychrophilic protein biosynthesis. In addition, the highest number of genes for EPS biosynthesis was presented in MAGs associated with the genus Sphingomonas, which was also recovered by culture-based method. Further, the MAGs with the highest potential gene number for oligotrophic protein production were closely affiliated with the genera Chryseoglobus and Mycobacterium. Our results reveal the surprising potential of a cold oligotrophic microecosystem within a machine as a source of new microbial taxa and provide the scientific community with clues about which microorganisms are able to colonise this ecological niche and what physiological mechanisms they develop. These results pave the way to understand how and why certain microorganisms can colonise similar anthropogenic environments., (© 2023. The Author(s).)

Competing Interests: M. Dinis-Ribeiro has received consultancy fees from Roche and Medtronic. J.A. Cunha Neves declares that he has no conflict of interest.

Introduction: The handling of antineoplastic drugs should follow strict supervision and safety rules to minimize the occupational exposure risks to professionals involved. The external surface contamination of drug vials is recognized as a health risk. So, our goal was to determine if there is residual contamination on the vials and containers surface of the antineoplastic drugs doxorubicin (DOX) and cyclophosphamide (CP)., Methods: A cross-sectional study was conducted. Samples were collected using a uniform sampling procedure on the inner surfaces of the packages/boxes and the outer surfaces of the vials. The analyzes were executed by high-performance liquid chromatography/mass spectrometry (UHPLC-MS/MS)., Results: A total of 209 samples were analyzed, 66 of CP and 143 of DOX. CP levels were detected in nine samples (13.63%), three were below the lower limit of quantification (LLQ) and the other six had contamination levels ranging from 1.24 to 28.04 ng/filter. DOX levels were detected in 36 samples (25.17%), two were below the LLQ and the others had levels between 1.32 and 664.84 ng/filter. The majority of samples with residual contamination were in vials (80.0%), however, boxes also showed contamination., Conclusions: The results revealed the presence of residual contamination in the vials and packages of CP and DOX drugs. Although the residues found in each sample are small, special care should be taken in the handling and disposal of the antineoplastic drugs. The use of personal protective equipment is fundamental while handling the vials and packaging of cytotoxic drugs., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: to analyze the practice of disinfection of finger oximeters by nursing professionals. Methods: a quantitative, descriptive, and cross-sectional study with nine professionals in a hospital clinical unit. Eighteen swab samples were collected, internally and externally from each equipment, isolating 51 bacterial colonies for antimicrobial susceptibility testing. Results: the professionals were not trained to disinfect the equipment. Eight carried the oximeters in their lab coats, and one carried them on a tray. They rarely disinfected the inside of the device fearing the 70% ethyl alcohol would damage the sensor. In 17 samples, different bacterial genera grew. 17.7% were multidrug-resistant to antimicrobials. Conclusion: it was observed that Nursing professionals don’t disinfect finger oximeters correctly. The use of 70% isopropyl alcohol is recommended to disinfect the sensors, since it doesn’t damage the equipment, and 70% ethyl alcohol to sanitize the patients’ fingers before and after the tests.