Microbiological evaluation of MiraFlow

The antimicrobial activity of MiraFlow, an extra-strength cleaner containing 20% isopropyl alcohol, was evaluated using various microorganisms including Acanthamoeba. Other leading cleaners, disinfecting solutions and heat were evaluated for comparison. MiraFlow had greater antimicrobial activity than the other cleaning solutions against all five test microorganisms. When evaluated against Acanthamoeba castellanii, MiraFlow was significantly better than disinfecting solutions containing 3% hydrogen peroxide, with D-values of less than 12 seconds and 1 hour, respectively. Thermal disinfection of Acanthamoeba cysts occurred rapidly at temperatures above 60 degrees C. The data suggest that either thermal disinfection or cleaning lenses for 20 seconds with MiraFlow followed by disinfection in an amoebacidal solution such as 3% hydrogen peroxide, should inactivate Acanthamoeba cysts found as chance contaminants on lenses.     

Ventriculoatrial shunt utilizing the azygos vein.

Long-term ventricular cerebrospinal fluid shunting can prove difficult in the neonatal population, particularly in those neonates who have had previous abdominal and vascular procedures. This article presents a technique of providing vascular access for ventriculoatrial shunting via the azygos vein for patients with limited vascular access and in whom ventriculoperitoneal shunting is not feasible.     

Laser scanning-based tissue autofluorescence/fluorescence imaging (LS-TAFI), a new technique for analysis of microanatomy in whole-mount tissues

Intact organ structure is essential in maintaining tissue specificity and cellular differentiation. Small physiological or genetic variations lead to changes in microanatomy that, if persistent, could have functional consequences and may easily be masked by the heterogeneity of tissue anatomy. Current imaging techniques rely on histological, two-dimensional sections requiring sample manipulation that are essentially two dimensional. We have developed a method for three-dimensional imaging of whole-mount, unsectioned mammalian tissues to elucidate subtle and detailed micro- and macroanatomies in adult organs and embryos. We analyzed intact or dissected organ whole mounts with laser scanning-based tissue autofluorescence/fluorescence imaging (LS-TAFI). We obtained clear visualization of microstructures within murine mammary glands and mammary tumors and other organs without the use of immunostaining and without probes or fluorescent reporter genes. Combining autofluorescence with reflected light signals from chromophore-stained tissues allowed identification of individual cells within three-dimensional structures of whole-mounted organs. This technique could be useful for rapid diagnosis of human clinical samples and possibly the effect of subtle variations such as low dose radiation.     

Direct transport within an organized state trauma system reduces mortality in patients with severe traumatic brain injury

BACKGROUND: Prehospital management of traumatic brain injury (TBI) and trauma system development and organization are aspects of TBI care that have the potential to significantly impact patient outcome. This multi-center study was conducted to explore the effect of prehospital management decisions on early mortality after severe TBI. METHODS: This report is based on 1449 patients with severe TBI (GCS<9) treated at 22 trauma centers enrolled in a New York State quality improvement (QI) program between 2000 and 2004. The prehospital data collected on these patients include time of injury, time of arrival to the trauma center, mode of transport, type of EMS provider, direct or indirect transport, blood pressure and pulse oximetry values, GCS score, pupillary assessment, and airway management procedures. RESULTS: After exclusion criteria were applied, a total of 1,123 patients were eligible for analysis. The majority of patients were male (75%) with a mean age of 36 years. After controlling for arterial hypotension, age, pupillary status, and initial GCS score, direct transport was found to result in significantly lower mortality than indirect transport. Transport mode, time to admission, and prehospital intubation were not found to be related to 2-week mortality. CONCLUSIONS: The present study provides class II evidence that demonstrates a 50% increase in mortality associated with indirect transfer of TBI patients. Patients with severe TBI should be transported directly to a Level I or Level II trauma center with capabilities as delineated in the Guidelines for the Prehospital Management of Traumatic Brain Injury, even if this center may not be the closest hospital.     

Predicting 14-day mortality after severe traumatic brain injury: application of the IMPACT models in the brain trauma foundation TBI-trac® New York State database

Prognostic models for outcome prediction in patients with traumatic brain injury (TBI) are important instruments in both clinical practice and research. To remain current a continuous process of model validation is necessary. We aimed to investigate the performance of the International Mission on Prognosis and Analysis of Clinical Trials in TBI (IMPACT) prognostic models in predicting mortality in a contemporary New York State TBI registry developed and maintained by the Brain Trauma Foundation. The Brain Trauma Foundation (BTF) TBI-trac? database contains data on 3125 patients who sustained severe TBI (Glasgow Coma Scale [GCS] score ≤ 8) in New York State between 2000 and 2009. The outcome measure was 14-day mortality. To predict 14-day mortality with admission data, we adapted the IMPACT Core and Extended models. Performance of the models was assessed by determining calibration (agreement between observed and predicted outcomes), and discrimination (separation of those patients who die from those who survive). Calibration was explored graphically with calibration plots. Discrimination was expressed by the area under the receiver operating characteristic (ROC) curve (AUC). A total of 2513 out of 3125 patients in the BTF database met the inclusion criteria. The 14-day mortality rate was 23%. The models showed excellent calibration. Mean predicted probabilities were 20% for the Core model and 24% for the Extended model. Both models showed good discrimination with AUCs of 0.79 (Core) and 0.83 (Extended). We conclude that the IMPACT models validly predict 14-day mortality in the BTF database, confirming generalizability of these models for outcome prediction in TBI patients.     

Sharps injuries in the operating room

Objectives

We aimed to identify who sustains needlestick and sharps injuries, under what circumstances and what actions are taken to minimize the risk and in response to intraoperative NSSIs.

Methods

The cross-sectional study was conducted in 2013 on 215 operation room personnel in 14 hospitals of the Hormozgan province, Iran.

Results

Two hundred and fifty appropriate responders completed the questionnaire (86 %). Anaesthesia 59 (27.4 %) and operation room technicians 55 (25.6 %) sustained the greatest numbers of NSSIs over the past year. Awareness of local protocols was significantly worse in the residents group. The commonest reasons for noncompliance with NSSIs local protocols were not sure of the local protocols 44 (20.4 %) and prolonged operation so unable to leave operation table 37 (17.3 %).

Conclusions

A revision of the local protocol to reduce the time it takes to complete may improve compliance. Education is of paramount importance in making health care workers aware of this issue. The application of safety devices led to a reduction in NSSIs and reduces the risk of blood borne infection as well.