Antimicrobial effects and efficacy on habitually hand-washing of strong acidic electrolyzed water--a comparative study of alcoholic antiseptics and soap and tap water

The rate of bacterial elimination for the stamp method was compared with regular hand-washing (using soap and tap water), hygienic hand-washing (using alcoholic antiseptics), and hand-washing using strong acidic electrolyzed water (the SAEW method) in routine work. After routine work, the average number of bacteria remaining on the nurse's hands with using the SAEW-method, rubbing method and tap water method, were: 54 +/- 63, 89 +/- 190, 128 +/- 194 CFU/agar plate, respectively (n = 81). In this study. It was clarified that a much larger number of Bacillus sp. were detected for the rubbing method than for the other methods. After further nurse work, the most number of absorbed bacteria on a nurse's hands were counted after cleaning a patient's body. The rate of bacteria elimination for hand-washing with soap and tap water after taking care of a patient was insufficient, especially when before care was provided the number of bacteria on the nurse's hands were less than 100 CFU/agar plate. From these results, the following manual for sanitary hand washing is recommended: 1. At first, dirty hands should be cleaned and the number of bacteria should be reduced using soap and tap water or by scrubbing with disinfectants. 2. After the number of bacteria has been reduced, use the SAEW method routinely. 3. For care requiring a high level of cleanliness or if no tap water facilities are available, use the rubbing method. Finally, routine use of the SAEW method in ICU could be recommended with conventional disinfectants and soap and tap water on a case by case basis for less than adverse reactions, such as in the case of rough-hands or keeping a low level of bacteria on hands.     

Assessment of the effect of hand dryers used in shopping malls on hand hygiene

BackgroundHand drying is one of the most important factors affect hand hygiene. This study was conducted to investigate the effect of hand dryers used in the restrooms located on the food court floors in shopping malls in Turkey on hand hygiene.MethodsHands were washed for at least 20 seconds by following hygienic hand washing procedures of the World Health Organization. Swab samples were taken from the wet hands after hand washing, then from the dry hands, which were dried under the hand dryers and from the air blowing part of the hand dryers. Samples were cultured on agar plates that were directly exposed to the air-blowing part of the hand dryers.ResultsIt was found that total coliform bacteria were 0.000 colony-forming unit (CFU)/petri in wet and dried hand, 3.437 CFU/petri in blown air and 5.250 CFU/petri in swab samples. Staphylococcus aureus was found to be 0.125, 64.125, 26.375, and 388.750 CFU/petri, respectively. Total bacteria count was found to be 0.687, 48.750, 35.625, and 595.000 CFU/petri, respectively. S. aureus and the total bacterial load were higher in the blower outlet of the hand dryers than washed hand, blown air and dried hand (P < .05). The bacteria count in the unfiltered hand dryers was higher than that in the filtered hand dryers (P < .05).ConclusionsUsing hand dryers would negatively affect hand hygiene even if hands were washed following hygienic hand washing procedures.     

Field trial of a low cost method to evaluate hand cleanliness

OBJECTIVE: To evaluate a simple low cost method for measuring hand contamination as an objective assessment of handwashing practices. METHOD: As part of a larger randomized controlled trial of handwashing promotion with soap conducted in squatter settlements of Karachi, Pakistan, a randomly selected subset of 52 mothers in households receiving soap and handwashing promotion and 28 mothers in control households directly pressed three fingers of their right hand onto MacConkey agar plates on weekly unannounced visits from April to September 2002, and monthly from October 2002 to March 2003. The MacConkey plates were incubated at 44 degrees C for 24 h, and evaluated for growth of thermotolerant coliform bacteria. RESULTS: The proportion of samples that had detectable thermotolerant coliforms (50%) was similar in households that received soap and control households (52%, P = 0.40). In the week after evaluation of the mothers' hands, the proportion of households that reported diarrhoea was similar regardless of whether or not the mother had thermotolerant coliforms detected by direct finger imprint (18.6%vs. 19.1%, Relative Risk 0.99, 95% CI 0.96, 1.03). CONCLUSIONS: A three finger direct imprint test using MacConkey agar for thermotolerant coliforms was not a useful method to assess regular handwashing practices with soap in Karachi. Developing better measures of handwashing behaviour remains an important research priority.     

Hand washing: changes in the skin flora

Frequent hand washing may result in skin damage and increase the number of microorganisms that colonize the skin. The purpose of this study was to evaluate changes in total flora of healthy and damaged hands that were caused by the use of gloves, soap, and antiseptics. Samples were collected from the healthy and damaged hands of 30 health care professionals before and after washing with water and nonmedicated soap for the technique of sterile polyethylene bag. Fifteen additional volunteers (technicians and students) were asked to wash their hands 20 times with water and soap; those with complaints of irritation were evaluated separately. Damaged or healthy hands did not present statistically significant differences (P > .05) in terms of qualitative analysis of epidemiologically important microorganisms; however, washing with water and soap was effective only for healthy hands. In short, the water and soap washing of damaged hands was not effective in reducing their contamination.     

Microbiological Effectiveness of Disinfecting Water by Boiling in Rural Guatemala

Boiling is the most common means of treating water in the home and the benchmark against which alternative point-of-use water treatment options must be compared. In a 5-week study in rural Guatemala among 45 households who claimed they always or almost always boiled their drinking water, boiling was associated with a 86.2% reduction in geometric mean thermotolerant coliforms (TTC) (N = 206, P < 0.0001). Despite consistent levels of fecal contamination in source water, 71.2% of stored water samples from self-reported boilers met the World Health Organization guidelines for safe drinking water (0 TTC/100 mL), and 10.7% fell within the commonly accepted low-risk category of (1–10 TTC/100 mL). As actually practiced in the study community, boiling significantly improved the microbiological quality of drinking water, though boiled and stored drinking water is not always free of fecal contaminations.     

Comparison of the immediate, residual, and cumulative antibacterial effects of Novaderm R, Novascrub R, Betadine Surgical Scrub, Hibiclens, and liquid soap

Background: Triclosan (Irgasan), an antibacterial active against staphylococci and coliform bacteria, has been formulated for use as a handwash. There has been only one previous report of the use of the glove juice test to determine the immediate, residual, and cumulative effects of a 1% triclosan-based handwash product. There have been no previous studies on the use of 1% triclosan combined with povidone-iodine (PI) in a handwash product.Methods: The glove juice technique was used to document and compare the immediate, 3-hour residual, and 5-day cumulative effects on the mean log₁₀ bacterial counts of 1% triclosan—based handwash product and 1% triclosan with 5% PI. A standardized surgical handwashing technique was used before sample collection. These results and the identity and type of the aerobic bacteria cultured from the samples were compared with the results of standardized washing and glove juice sampling with 4% weight/volume chlorhexidine gluconate (CHG), 7.5% PI, and a nonantimicrobial liquid soap.Results: All five tested products showed significant log₁₀ reduction from baseline on day 1, hour 0 (p < 0.05). There was no significant difference between the mean log₁₀ bacterial count when 7.5% PI, 4% CHG, and 1% triclosan with 5% PI were compared with each other immediately after washing (p> 0.05). There was a significant difference between 1% triclosan and the liquid soap when they were each compared with 4% CHG, 7.5% PI, and 1% triclosan with 5% PI. There was no statistically significant difference between the 1% triclosan product and the liquid soap (p> 0.20). All products were effective at reducing the immediate bacterial count from the baseline level. All formulations except the liquid soap showed significant cumulative effect (p < 0.05) after multiple washes, with no significant difference between the cumulative effects of the liquid soap and 1% triclosan (p> 0.05). Both products differed significantly (p < 0.05) from the CHG, PI, and triclosan with PI. CHG, PI, and triclosan with PI showed effects significantly different from each other (p < 0.05).Conclusions: Triclosan combined with PI resulted in the prevention of bacterial regrowth at 3 hours such as occurred when PI alone was used. Triclosan-containing products have a small cumulative effect, although not as great as that produced by CHG. The triclosan-based products did not appear to select for gram-negative bacterial overgrowth, although the study period may have been too short to detect such an effect.     

Comparison of bacterial quantities in left and right colon biopsies and faeces

AIM: To compare quantities of predominant and pathogenic bacteria in mucosal and faecal samples.METHODS: Twenty patients undergoing diagnostic colonoscopy with endoscopically and histologically normal mucosa were recruited to the study, 14 subjects of which also supplied faecal (F) samples between 15 d to 105 d post colonoscopy. Mucosal biopsies were taken from each subject from the midportion of the ascending colon (right side samples, RM) and the sigmoid (left side samples, LM). Predominant intestinal and mucosal bacteria including clostridial 16S rRNA gene clusters IV and XIVab, Bacteroidetes, Enterobacteriaceae, Bifidobacterium spp., Akkermansia muciniphila (A. muciniphila), Veillonella spp., Collinsella spp., Faecalibacterium prausnitzii (F. prausnitzii) and putative pathogens such as Escherichia coli (E. coli), Clostridium difficile (C. difficile), Helicobacter pylori (H. pylori) and Staphylococcus aureus (S. aureus) were analysed by quantitative polymerase chain reaction (qPCR). Host DNA was quantified from the mucosal samples with human glyceraldehyde 3-phosphate dehydrogenase gene targeting qPCR. Paired t tests and the Pearson correlation were applied for statistical analysis.RESULTS: The most prominent bacterial groups were clostridial groups IV and XIVa+b and Bacteroidetes and bacterial species F. prausnitzii in both sample types. H. pylori and S. aureus were not detected and C. difficile was detected in only one mucosal sample and three faecal samples. E. coli was detected in less than half of the mucosal samples at both sites, but was present in all faecal samples. All detected bacteria, except Enterobacteriaceae, were present at higher levels in the faeces than in the mucosa, but the different locations in the colon presented comparable quantities (RM, LM and F followed by P₁ for RM vs F, P₂ for LM vs F and P₃ for RM vs LM: 4.17 ± 0.60 log₁₀/g, 4.16 ± 0.56 log₁₀/g, 5.88 ± 1.92 log₁₀/g, P₁ = 0.011, P₂ = 0.0069, P₃ = 0.9778 for A. muciniphila; 6.25 ± 1.3 log₁₀/g, 6.09 ± 0.81 log₁₀/g, 8.84 ± 1.38 log₁₀/g, P₁ < 0.0001, P₂ = 0.0002, P₃ = 0.6893 for Bacteroidetes; 5.27 ± 1.68 log₁₀/g, 5.38 ± 2.06 log₁₀/g, 8.20 ± 1.14 log₁₀/g, P₁ < 0.0001, P₂ ≤ 0.0001, P₃ = 0.7535 for Bifidobacterium spp.; 6.44 ± 1.15 log₁₀/g, 6.07 ±1.45 log₁₀/g, 9.74 ±1.13 log₁₀/g, P₁ < 0.0001, P₂ ≤ 0.0001, P₃ = 0.637 for Clostridium cluster IV; 6.65 ± 1.23 log₁₀/g, 6.57 ± 1.52 log₁₀/g, 9.13 ± 0.96 log₁₀/g, P₁ < 0.0001, P₂ ≤ 0.0001, P₃ = 0.9317 for Clostridium cluster XIVa; 4.57 ± 1.44 log₁₀/g, 4.63 ± 1.34 log₁₀/g, 7.05 ± 2.48 log₁₀/g, P₁ = 0.012, P₂ = 0.0357, P₃ = 0.7973 for Collinsella spp.; 7.66 ± 1.50 log₁₀/g, 7.60 ± 1.05 log₁₀/g, 10.02 ± 2.02 log₁₀/g, P₁ ≤ 0.0001, P₂ = 0.0013, P₃ = 0.9919 for F. prausnitzsii; 6.17 ± 1.3 log₁₀/g, 5.85 ± 0.93 log₁₀/g, 7.25 ± 1.01 log₁₀/g, P₁ = 0.0243, P₂ = 0.0319, P₃ = 0.6982 for Veillonella spp.; 4.68 ± 1.21 log₁₀/g, 4.71 ± 0.83 log₁₀/g, 5.70 ± 2.00 log₁₀/g, P₁ = 0.1927, P₂ = 0.0605, P₃ = 0.6476 for Enterobacteriaceae). The Bifidobacterium spp. counts correlated significantly between mucosal sites and mucosal and faecal samples (Pearson correlation coefficients 0.62, P = 0.040 and 0.81, P = 0.005 between the right mucosal sample and faeces and the left mucosal sample and faeces, respectively).CONCLUSION: Non-invasive faecal samples do not reflect bacterial counts on the mucosa at the individual level, except for bifidobacteria often analysed in probiotic intervention studies.     

Early viral kinetics during hepatitis C virus genotype 6 treatment according to IL28B polymorphisms

AIM:To investigate the early viral kinetics and interleukin-28B(IL28B)polymorphisms of hepatitis C genotype6 during pegylated interferon and ribavirin therapy.METHODS:Sixty-five patients with chronic hepatitis C virus(HCV)infection treated with pegylated interferon and ribavirin(PEG-IFN/RBV)were included,of whom15(23.1%),16(24.6%)and 34(52.3%)patients were infected with hepatitis C genotype 1(HCV-1),genotype3(HCV-3)and genotype 6(HCV-6),respectively.Serum HCV-RNA levels were measured frequently during the first 4-wk of therapy.DNA extracted from samples was analyzed for the IL28B single nucleotide polymorphism(SNP)rs12979860 by polymerase chain reaction and direct sequencing.RESULTS:During the first 4-wk of therapy,the mean viral decline for patients with HCV-6(5.55±1.82 log10IU/mL)was comparable to that of patients with HCV-3(5.55±1.82 log10IU/mL vs 5.86±1.02 log10IU/mL,P=0.44)and was significantly higher than patients with HCV-1(5.55±1.82 log10IU/mL vs 4.23±1.99 log10IU/mL,P=0.04).In the HCV-6 group,the first phase(days 0-2)viral decline was significantly higher in patients with the favorable rs12979860 CC than non-CC genotypes(2.46±1.01 log10IU/mL/wk vs 1.70±0.67 log10IU/mL,respectively,P=0.045).A statistically insignificant decrease in the second-phase(days 7-28)decline was also found in patients with the CC genotype than those with the non-CC genotype,though not significantly different(1.24±0.64 log10IU/mL/wk vs 0.80±0.65 log10IU/mL/wk,respectively,P=0.172).At baseline,the SNP genotype was an independent predictor of rapid virological response but not of sustained virological response.CONCLUSION:The IL28B genotype was linked to an impact on early viral kinetics in response to PEG-IFN/RBV therapy in HCV-6 infected patients.     

Comparison of cloth, paper, and warm air drying in eliminating viruses and bacteria from washed hands.

We compared the efficiency of paper, cloth, and electric warm air drying in eliminating rotaviruses and Escherichia coli remaining on finger pads washed with 70% isopropanol, a medicated liquid soap, an unmedicated liquid soap, or tap water alone. The contaminated area on the finger pads of a volunteer was exposed to the hand-washing agent for 10 seconds and then rinsed in 40 degrees C tap water. The washed areas were dried for 10 seconds by one of the three methods. Irrespective of the hand-washing agent used, electric air drying produced the highest and cloth drying the lowest reduction in the numbers of both test organisms. These findings indicate the importance of selecting the right means for drying washed hands, particularly when less effective hand-washing agents are used.     

Bacteriological safety of plastic–bagged sachet drinking water sold in Amassoma,Nigeria

ObjectiveTo evaluate the bacteriological safety of sachet water sold in Amassoma, a rural community in Bayelsa State, Nigeria.MethodsSix samples of each of the different sachet drinking water brands were bought at random from shop shelves, markets and street vendors and were studies for microbial indicators of safety and quality. Bacterial counts were analyzed by one-way Analysis of Variance (ANOVA) and significance of differences was tested at 5% probability.ResultsMinimum and maximum counts with regard to the sachet water samples investigated were (4.3±1.1)×10⁶ CFU mL^?1 and (8.2±1.0) ×10⁶ CFU mL^?1 for heterotrophic plate counts; (0.9± 0.3) ×10⁶ CFU mL^?1 and (1.2± 0.4) ×10⁶ CFU mL^?1 for aerobic spore-former counts; (1.3±0.5) ×10³ CFU mL^?1 and (2.5± 0.8)×10³ CFU mL^?1 for total coliforms; (1.6±0.9) ×10³ CFU mL^?1 and (9.5±11.2)×10³ CFU mL^?1 for thermotolerant coliforms. Klebsiella spp but not Escherichia coli was present in all samples of the brands; non-coliform bacteria detected in some samples were Staphylococcus, Pseudomonas and Bacillus species.ConclusionsThe brands of sachet water sold (at the time of this study) in Amassoma did not meet the minimum acceptable standard for microbiologically safe drinking water as recommended by the World Health Organization.     

Association between Moderate-to-Severe Diarrhea in Young Children in the Global Enteric Multicenter Study (GEMS) and Types of Handwashing Materials Used by Caretakers in Mirzapur,Bangladesh

Handwashing practices among caretakers of case and control children < 5 years of age enrolled in the Global Enteric Multicenter Study in Mirzapur, Bangladesh were characterized and analyzed for association with moderate-to-severe diarrhea. Soap or detergent ownership was common, yet 48% of case and 47.7% of control caretakers also kept ashes for handwashing, including 36.8% of the wealthiest households. Soap, detergent, and ash were used for multiple hygiene purposes and were kept together at handwashing areas. Caretakers preferred soap for handwashing, but frequently relied on ash, or a detergent/ash mixture, as a low-cost alternative. Moderate-to-severe diarrhea was equally likely for children of caretakers who kept soap versus those who kept ash (matched OR = 0.91; 0.62–1.32). Contact with ash and water reduced concentrations of bacterial enteropathogens, without mechanical scrubbing. Thus, washing hands with ash is a prevalent behavior in Mirzapur and may help diminish transmission of diarrheal pathogens to children.     

Impact of the immune response modification by lysophosphatidylcholine in the efficacy of antibiotic therapy of experimental models of peritoneal sepsis and pneumonia by Pseudomonas aeruginosa: LPC therapeutic effect in combined therapy

IntroductionImmune response stimulation may be an adjuvant to antimicrobial treatment. Here, we evaluated the impact of immune response modification by lysophosphatidylcholine (LPC), combined with imipenem or ceftazidime, in murine models of peritoneal sepsis (PS) and pneumonia induced by Pseudomonas aeruginosa.MethodsThe imipenem and ceftazidime-susceptible strain (Pa39) and imipenem and ceftazidime-resistant strain (Pa238) were used. Ceftazidime pharmacokinetic and pharmacodynamic parameters were determined. The therapeutic efficacy and TNF-α and IL-10 levels were determined in murine models of PS and pneumonia induced by Pa39 and Pa238 and treated with LPC, imipenem or ceftazidime, alone or in combination.ResultsIn the PS model, LPC+ceftazidime reduced spleen and lung Pa238 concentrations (?3.45 and ?3.56 log₁₀ CFU/g; P < 0.05) to a greater extent than ceftazidime monotherapy, while LPC + imipenem maintained the imipenem efficacy (?1.66 and ?1.45 log₁₀ CFU/g; P > 0.05). In the pneumonia model, LPC + ceftazidime or LPC + imipenem reduced the lung Pa238 concentrations (?2.37 log₁₀ CFU/g, P = 0.1, or ?1.35 log₁₀ CFU/g, P = 0.75). For Pa39, no statistically significant difference was observed in the PS and pneumonia models between combined therapy and monotherapy. Moreover, LPC + imipenem and LPC+ceftazidime significantly decreased and increased the TNF-α and IL-10 levels, respectively, in comparison with the untreated controls and monotherapies.ConclusionsThese results demonstrate the impact of immune response modification by LPC plus antibiotics on the prognosis of infections induced by ceftazidime-resistant P. aeruginosa.     

Difference in exercise heart rate,oxygen uptake and ratings of perceived exertion relationships in male post myocardial infarction patients with and without beta blockade therapy

The purpose of the study was to examine the relationships between heart rate (HR), oxygen uptake (V·O₂) and ratings of perceived exertion (RPE) in post myocardial infarction patients (PMIP). This will enable prediction equations to be established for V·O₂and percentage peak V·O₂. Two groups were examined so it was possible to establish whether these relationships were different between those using and not using beta blockade drugs. Thirty-six male recent PMIP performed a graded exercise test (modified Bruce protocol) during which time HR, V·O₂and RPE were recorded at intervals of 30 seconds, 30 seconds and 3 minutes respectively. The subjects were sub-divided into a group on a drug regime including beta blockers (blockade;n = 17; aged 61.5±6.3 years) and a control group using no drugs likely to affect HR (non-blockade;n = 19; aged 62.1±6.0 years). The results showed that although HR related to V·O₂with an r = 0.71, P<0.01 for blockade, and an r = 0.68, P< 0.01 for non-blockade, a significant difference (P< 0.01) existed between groups for the intercept of the regression lines. The relationship between RPE and HR had a similar trend. If HR was replaced by RPE to predict V·O₂, the correlation coefficients increased and also the difference between groups in the intercept disappeared. The multiple regression equations were V·O₂= 0.14 HR + 1.30 RPE-4.37 (r =0.80 , P< 0.01) for blockade, and V·O₂= 0.16 HR + 1.31 RPE-10.80 (r = 0.77,P < 0.01) for non-blockade. The multiple regression improved the linear regression based on HR alone by 14% for blockade and 13% for non-blockade. The same improvements based on RPE alone were by 8% for both blockade and non-blockade.     

Efficacy of Waterless Hand Hygiene Compared with Handwashing with Soap: A Field Study in Dar es Salaam, Tanzania

Effective handwashing with soap requires reliable access to water supplies. However, more than three billion persons do not have household-level access to piped water. This research addresses the challenge of improving hand hygiene within water-constrained environments. The antimicrobial efficacy of alcohol-based hand sanitizer, a waterless hand hygiene product, was evaluated and compared with handwashing with soap and water in field conditions in Dar es Salaam, Tanzania. Hand sanitizer use by mothers resulted in 0.66 and 0.64 log reductions per hand of Escherichia coli and fecal streptococci, respectively. In comparison, handwashing with soap resulted in 0.50 and 0.25 log reductions per hand of E. coli and fecal streptococci, respectively. Hand sanitizer was significantly better than handwashing with respect to reduction in levels of fecal streptococci (P = 0.01). The feasibility and health impacts of promoting hand sanitizer as an alternative hand hygiene option for water-constrained environments should be assessed.     

Baseline HBsAg predicts response to pegylated interferon-α2b in HBeAg-positive chronic hepatitis B patients

AIM: To evaluate the predictive effect of baseline hepatitis B surface antigen (HBsAg) on response to pegylated interferon (PEG-IFN)-α2b in hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) patients.METHODS: This retrospective analysis compared the treatment efficacy of PEG-IFN-α2b alone in 55 HBeAg-positive CHB patients with different baseline HBsAg levels. Serum HBV DNA load was measured at baseline, and at 12, 24 and 48 wk of therapy. Virological response was defined as HBV DNA < 1000 IU/mL. Serum HBsAg titers were quantitatively assayed at baseline, and at 12 and 24 wk.RESULTS: Eighteen patients had baseline HBsAg > 20 000 IU/mL, 26 patients had 1500-20000 IU/mL, and 11 patients had < 1500 IU/mL. Three (16.7%), 11 (42.3%) and seven (63.6%) patients in each group achieved a virological response at week 48, with a significant difference between groups with baseline HBsAg levels > 20000 or < 20000 IU/mL (P = 0.02). Thirteen patients had an HBsAg decline > 0.5 log₁₀ and 30 patients < 0.5 log₁₀ at week 12; and 6 (46.2%) and 10 (33.3%) in each group achieved virological response at week 48, with no significant difference between the two groups (P = 0.502). Eighteen patients had an HBsAg decline > 1.0 log₁₀ and 30 patients < 1.0 log₁₀ at week 24, and 8 (44.4%) and 11 (36.7%) achieved a virological response at week 48, with no significant difference between the two groups (P = 0.762). None of the 16 patients with HBsAg > 20000 IU/mL at week 24 achieved a virological response at week 48.CONCLUSION: Baseline HBsAg level in combination with HBV DNA may become an effective predictor for guiding optimal therapy with PEG-IFN-α2b against HBeAg-positive CHB.     

The effect of disinfecting procedure on the glucose concentration using a personal glucose meter

BackgroundPersonal glucose meters, primarily designed for self-control of glucose concentration in patients with diabetes, are frequently used in clinical practice as point-of-care equipment. The procedure of washing hands with water and soap before testing, as recommended by the manufacturer of personal glucose meters, in hospital wards is often difficult to fulfil and is replaced by disinfecting the place of blood sampling with isopropyl alcohol.AimThe purpose of the research was to evaluate the effect of different disinfecting procedures on glycemia measurement in capillary blood using personal glucose meters.Materials and methodsFour measurements of glycemia were taken in each of 50-volunteer group using Accu-Check Performa (Roche, Swiss) glucose meter using different procedures: washing hands with soap and drying them (1), disinfection with isopropyl alcohol and waiting for the disinfectant to evaporate (2) and the immediate puncture after disinfection. In the latter case two kind of single-use lancets were use – typical for adult (3) and smaller preferred by diabetics or children (4).ResultsPaired T-student test showed no statistically significant difference between measurements 1st and 2nd 95% CI (−4.282 to 0.322), p = 0.09. However, the comparison between 1st/3rd and 1st/4th showed statistically significant difference, 95% CI (−4.964 to −0.796), p = 0,0077 (p < 0,01) and 95% CI (−7.842 to −2.917), p = 0.00006 (p < 0.001).ConclusionsThe procedure of disinfection when fluid completely evaporates has no effect on glucose measurements. Sampling the wet finger influences results of glucose measurement but observed changes were clinically irrelevant.     

Association Between Stool Enteropathogen Quantity and Disease in Tanzanian Children Using TaqMan Array Cards: A Nested Case-Control Study

Etiologic studies of diarrhea are limited by uneven diagnostic methods and frequent asymptomatic detection of enteropathogens. Polymerase chain reaction-based stool pathogen quantification may help distinguish clinically significant infections. We performed a nested case-control study of diarrhea in infants from a community-based birth cohort in Tanzania. We tested 71 diarrheal samples and pre-diarrheal matched controls with a laboratory-developed TaqMan Array Card for 19 enteropathogens. With qualitative detection, no pathogens were significantly associated with diarrhea. When pathogen quantity was considered, rotavirus (odds ratio [OR] = 2.70 per log₁₀ increase, P < 0.001), astrovirus (OR = 1.49, P = 0.01), and Shigella/enteroinvasive Escherichia coli (OR = 1.47, P = 0.04) were associated with diarrhea. Enterotoxigenic E. coli (0.15 SD decline in length-for-age z score after 3 months per log₁₀ increase, P < 0.001) and Campylobacter jejuni/C. coli (0.11 SD decline, P = 0.003) in pre-diarrheal stools were associated with poor linear growth. Quantitative analysis can help refine the association between enteropathogens and disease in endemic settings.     

Hepatitis B surface antigen levels during natural history of chronic hepatitis B: A Chinese perspective study

AIM: To determine the baseline hepatitis B surface antigen (HBsAg) levels during the different phases of chronic hepatitis B (CHB) patients in China.METHODS: Six hundred and twenty-three hepatitis B virus or un-infected patients not receiving antiviral therapy were analyzed in a cross-sectional study. The CHB patients were classified into five phases: immune-tolerant (IT, n = 108), immune-clearance (IC, n = 161), hepatitis B e antigen negative hepatitis (ENH, n = 149), low-replicative (LR, n = 135), and liver cirrhosis (LC, n = 70). HBsAg was quantified (Abbott ARCHITECT assay) and correlated with hepatitis B virus (HBV) DNA, and serum alanine aminotransferase/aspartate aminotransferase (ALT/AST) in each phase of CHB was also determined.RESULTS: Median HBsAg titers were different in each phase of CHB (P < 0.001): IT (4.85 log₁₀ IU/mL), IC (4.36 log₁₀ IU/mL), ENH (2.95 log₁₀ IU/mL), LR (3.18 log₁₀ IU/mL) and LC (2.69 log₁₀ IU/mL). HBsAg titers were highest in the IT phase and lowest in the LC phase. Serum HBsAg titers showed a strong correlation with HBV viral load in the IC phase (r = 0.683, P < 0.001). No correlation between serum HBsAg level and ALT/AST was observed.CONCLUSION: The mean baseline HBsAg levels differ significantly during the five phases of CHB, providing evidence on the natural history of HBV infection. HBsAg quantification may predict the effects of immune-modulator or oral nucleos(t)ide analogue therapy.     

Alcohol-impregnated wipes as an alternative in hand hygiene

The antimicrobial effectiveness of four hand-wash products for health care personnel included three liquid soaps that contained 4% chlorhexidine gluconate, 1% triclosan, or no antiseptic ingredient, respectively, and a 30% w/w ethyl alcohol-impregnated hand wipe. These products were evaluated for reduction in bacterial counts on hands after extended use of 15 handwashes per day for 5 consecutive days. The order of greatest to least log reduction among products at the end of the 5-day test period was chlorhexidine gluconate (2.01), triclosan (1.52), alcohol wipe (0.04), and control soap (0.03). Skin condition before and after handwash was assessed for each treatment group. Subjects reported less skin irritation with alcohol wipes than with the two antiseptic products. Repeated washing with alcohol wipes results in reductions in bacterial colony counts comparable with nonmedicated soap, sufficient to prevent transmission of pathogens by the hands in most situations that arise in nonacute health care settings. This evidence, in addition to increased user acceptability reported by the subjects who used alcohol wipes, suggests that alcohol wipes are an acceptable alternative to soap-and-water handwashing in nonacute health care settings.     

HBsAg levels in HBeAg-positive chronic hepatitis B patients with different immune conditions

AIM:To investigate hepatitis B surface antigen(HBsAg)levels in patients with HBeAg-positive chronic hepatitis B(CHB)and different immune conditions.METHODS:HBeAg-positive CHB patients with different immune conditions were enrolled in this cross-sectional study.These patients were grouped according to the following criteria:immune-tolerant patients,IT group;patients with a mild immune response in the immune clearance phase,IC-Mild group;and patients with a dramatic immune response in the immune clearance phase and exhibiting acute on chronic liver failure(ACLF),ACLF group.All these patients had not previously received antiviral therapy and were enrolled at a pre-settled ratio of2:2:1.Serum HBsAg levels and the correlation between serum HBsAg level and serum hepatitis B virus(HBV)DNA level were evaluated in these groups.RESULTS:In total,180 HBeAg-positive CHB patients[IT group(n=72),IC-Mild group(n=72),and ACLF group(n=36)]were enrolled in this study.The median serum HBsAg levels varied among the groups(P<0.001):IT,4.86 log10IU/mL;IC-Mild,3.97 log10IU/mL;and ACLF,3.57 log10IU/mL.Serum HBsAg level showed a moderate positive correlation with serum HBV-DNA level in the IC-Mild group(r=0.60,P<0.001),but exhibited a weaker correlation in the IT(r=0.52,P<0.001)and ACLF groups(r=0.51,P=0.001).The ratio of HBsAg/HBV DNA did not differ significantly among the IT,IC-Mild,and ACLF groups(medians:0.56,0.55,and 0.56,respectively;P=0.179).CONCLUSION:Serum HBsAg levels varied significantly in HBeAg-positive patients with different immune conditions.These findings may have important implications for understanding the immune clearance of HBV in HBeAg-positive CHB patients.