Surgical Helmets Used During Total Joint Arthroplasty Harbor Common Pathogens: A Cautionary Note

BackgroundThe use of personal-protection surgical helmet/hood systems is now a part of the standard surgical attire during arthroplasty in North America. There are no protocols for the disinfection of these helmets.MethodsThis is a prospective, single-center, observational study. Helmets worn by 44 members of the surgical team and foreheads of 44 corresponding surgical personnel were swabbed at three distinct time points. In addition, 16 helmets were treated with hypochlorite spray to determine if pathogens could be eliminated. Swabs obtained were processed for culture and next-generation sequencing (NGS).ResultsOf the 132 helmet samples, 97 (73%) yielded bacteria on culture and 94 (71%) had evidence of bacterial–deoxyribonucleic acid (DNA) on NGS. Of the swabs sent for bacterial identification at the three time points, at least one from each helmet was positive for a pathogen(s). Of the 132 forehead samples, 124 (93%) yielded bacteria on culture and 103 (78%) had evidence of bacterial-DNA on NGS. The most commonly identified organism from helmets was Cutibacterium acnes (86/132) on NGS and Staphylococcus epidermidis (47/132) on culture. The most commonly identified organism from the foreheads of surgical personnel was Cutibacterium acnes (100/132) on NGS and Staphylococcus epidermidis (70/132) on culture. Sanitization of helmets was totally effective; no swabs taken the following morning for culture and NGS identified any bacteria.ConclusionThis study demonstrates that surgical helmets worn during orthopedic procedures are contaminated with common pathogens that can potentially cause surgical site infections. The findings of this study should at the minimum compel us to develop protocols for the disinfection of these helmets.     

Outbreak of Burkholderia cepacia complex bacteremia in a chemotherapy day care unit due to intrinsic contamination of an antiemetic drug

Background: In the end of 2009, a large number of patients with cancer undergoing chemotherapy at the day care unit of a private hospital in Mumbai, India developed Burkholderia cepacia complex (BCC) blood stream infection (BSI). Objective: The objectives were to identify the source of the outbreak and terminate the outbreak as rapidly as possible. Materials and Methods: All infection control protocols and processes were reviewed. Intensive training was started for all nursing staff involved in patient care. Cultures were sent from the environment (surfaces, water, air), intravenous fluids, disinfectants and antiseptics and opened/unopened medication. Results: A total of 13 patients with cancer with tunneled catheters were affected with BCC BSI. The isolates were of similar antimicrobial sensitivity. No significant breach of infection control protocols could be identified. Cultures from the prepared intravenous medication bags grew BCC. Subsequently, culture from unused vials of the antiemetic granisetron grew BCC, whereas those from the unopened IV fluid bag and chemotherapy medication were negative. On review, it was discovered that the outbreak started when a new brand of granisetron was introduced. The result was communicated to the manufacturer and the brand was withdrawn. There were no further cases. Conclusions: This outbreak was thus linked to intrinsic contamination of medication vials. We acknowledge a delay in identifying the source as we were concentrating more on human errors in medication preparation and less on intrinsic contamination. We recommend that in an event of an outbreak, unopened vials be cultured at the outset.     

Disparity in the use of adjuvant radioactive iodine ablation among high-risk papillary thyroid cancer patients

BackgroundWe sought to identify treatment disparities existing prior to publication of the 2015 American Thyroid Association Management Guidelines in order to identify patients with papillary thyroid cancer (PTC) at risk for receiving inadequate treatment.MethodsPatients diagnosed with PTC from 2011 to 2013 were identified using Surveillance, Epidemiology and End Results database. High-risk disease was defined as T4, N1, or M1. Chi-square tests compared characteristics of patients with and without high-risk disease and characteristics of high-risk patients who did and did not receive radioactive iodine ablation (RAI). Likelihoods of having high-risk disease, of receiving RAI, and of cause-specific death were calculated using regression analyses.ResultsSample included 32,229 individuals; 7894 (24.5%) had high-risk disease. Mean age was 50.0 years, 24,815 (77.0%) were female, and 21,318 (66.2%) were white. Odds of high-risk disease were greater among males (OR:2.04; 95% CI:1.92–2.16), Hispanics (OR:1.67; 95% CI:1.56–1.79) and Asians (OR:1.49; 95% CI:1.37–1.62), and uninsured (OR:1.24; 95% CI:1.07–1.43), and lower among patients ages 45–64 (OR:0.57; 95% CI:0.53–0.60), and ≥65 years (OR:0.54; 95% CI:0.50–0.59), and Blacks (OR:0.46; 95% CI:0.40–0.53). Most (69.3%) high-risk patients received RAI. Odds of receiving RAI were lower among patients age ≥65 years (OR:0.67; 95% CI:0.58–0.77), uninsured (OR:0.52; 95% CI:0.41–0.67), or with Medicaid (OR:0.58; 95% CI:0.50–0.69). RAI use reduced the risk of cause-specific mortality (HR:0.29; 95% CI:0.18–0.47).ConclusionKnowledge of these treatment disparities will allow recognition of groups at risk for high-risk disease and receiving inadequate treatment.     

CT导向下~(125)I粒子植入治疗复发性盆腔恶性肿瘤

目的探讨CT导向下125I粒子植入治疗复发性盆腔恶性肿瘤的疗效。方法18例复发性盆腔恶性肿瘤患者采用CT导向下125I放射性粒子植入。粒子植入之前采用TPS模拟布源或遵循Halarism的125I经验公式:mCi=Da×5,Da为靶组织长、宽、高的平均值(L W H)/3,单位为cm,求出术中所需125I粒子的总活度及算出治疗粒子的数量。在螺旋CT导向下将125I放射性粒子植入盆腔肿瘤内。结果全组18例22个病灶治疗后2个月后采用PET-CT评价,完全缓解(CR)6例,部分缓解(PR)8例,稳定(NC)3例,进展(PD)1例。18例随访7~16个月,全部存活,近期平均生存期9.5个月。结论125I放射性粒子植入是治疗复发性盆腔恶性肿瘤的一种有效的方法。     

An XPS and SEM evaluation of six chemical and physical techniques for cleaning of contaminated titanium implants

The purpose of the present study was to analyse clinically failed and retrieved implants prior to and after cleaning by means of scanning electron microscopy (SEM) and X-ray induced photoelectron spectroscopy (XPS) as compared to unused controls. Six different chemical and physical techniques for cleaning of contaminated titanium implants were evaluated: 1) rinsing in absolute ethanol for 10 min, 2) cleaning in ultrasonic baths containing trichloroethylene (TRI) and absolute ethanol, 10 min in each solution, 3) abrasive cleaning for 30 s, 4) cleaning in supersaturated citric acid for 30 s, 5) cleaning with continuous CO2-laser in dry conditions at 5 W for 10 s, 6) cleaning with continuous CO2-laser in wet conditions (saline) at 5 W for 10 s. SEM of failed implants showed the presence of contaminants of varying sizes and XPS showed almost no titanium but high carbon signals. XPS of unused titanium implants showed lower levels of titanium as previously reported, probably due to contamination of carbon which increased with time in room air. Cleaning of used implants in citric acid followed by rinsing with deionized water for 5 min followed by cleaning in ultrasonic baths with TRI and absolute ethanol gave the best results with regard to macroscopical appearance and surface composition. However, as compared to the unused implants the results from an element composition point of view were still unsatisfactory. It is concluded that further development and testing of techniques for cleaning of organically contaminated titanium is needed.     

对一宗入境二级放射货包的监测结果分析

汕头卫生检疫局空港处对汕头航空口岸—宗入境二级货包的监测过程及对有关运输工作人员作了放射知识问卷调查。从中发现。运输单位货物存放设施落后。有关工作人员放射卫生知识欠缺，对放射污染可能造成的危害缺乏正确的认识。为此，笔者提出了自己的看法，以期对放射监测工作的进一步完善提供参考。     

抗莱氏支原体单克隆抗体的研制

通过细胞融合技术，筛选出ＭＡＬ－１和ＭＡＬ－２两株抗莱氏支原体（Ａ．Ｌａｉｄｌａｗｉｉ，Ａ．Ｌ）单克隆抗体（单抗）。通过ＳＤＳ－ＰＡＧＥ和Ｗｅｓｔｅｒｎ印迹法测得单抗相对应的抗原分子量均为６７．４６ｋｕ。用间接免疫荧光法（ＩＦＡ）检测，单抗与细胞培养中另外３种常见污染的支原体和呼吸道肺炎支原体无交叉反应。将单抗用于检测支原体污染的细胞培养物，结果表明，此单抗能特异性地检出莱氏支原体。故可用其推断支原体污染途径，便于制定防治措施。     

Microbial aspects of home enteral nutrition–a discussion

Factors that might contribute to the microbial contamination of enteral feeds prepared and administered in the home are reviewed and the significance of this contamination discussed. Numbers, types and sources of micro-organisms, and possible routes for contamination of home enteral feeds, are outlined and the role of cleaning and disinfection in reducing the microbial load is discussed. Some preliminary guidelines are suggested for the handling of enteral feeds in the home.     

What is the HACCP (hazard analysis critical control point) approach and how can it be applied to enteral tube feeding?

The HACCP (hazard analysis critical control point) concept is now widely applied in the food industry and provides a structured and critical approach to the identification and control of hazards that may affect food safety. It has shifted the emphasis for control from retrospective end-product testing to the effective control of raw materials and key processing operations.
This paper discusses how the HACCP approach can be applied to enteral feeding. This involves each unit assembling a multidisciplinary team of personnel involved in enteral feeding. This team will then carry out a detailed analysis of the process from selection of ingredients and feeding systems through to consumption of the feed by the patient by constructing a flow chart that relates specifically to each unit. They can then identify and assess the hazards associated with the handling of the product at each stage in the process. This will enable them to identify the points where control over an identified hazard can be achieved (critical control points, CCP) such as quality of ingredients, design of administration systems, preparation and distribution of the feeds and the procedures involved in the assembly and manipulation of the systems. Control and monitoring procedures can then be specified and implemented at relevant stages in the process. The major strengths of the HACCP procedure are that it entails a team effort from key personnel involved in the full range of activities associated with the product and each detailed analysis is specific to each unit's practices and resources and can be continually reviewed and modified in response to changing circumstances.     

车载苯胺泄漏事故造成水井污染的监测分析

2003年12月30日一辆装载7.28t苯胺的槽车从宁波开往温州的路上在甬台温高速公路温岭市境内翻车,造成5.3t左右的苯胺泄漏在高速公路旁的环境中,除少量的液体被清除外,绝大部分渗入地下,造成了水井污染.从12月31日开始我们对周围的水井开展了监测,现将监测结果分析如下: