The Journal of hospital infection
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Several studies have shown that rubbing hands with an alcohol/chlorhexidine solution provides equivalent microbial decontamination to a conventional surgical scrub using aqueous chlorhexidine. However, the authors believe that these studies have methodological flaws that limit their applicability to the operating theatre environment. As such, a method was developed to compare products in an everyday operating theatre environment using working operating theatre personnel. ⋯ An alcohol/chlorhexidine hand rub was found to be as efficacious as a traditional scrub after 30 min; this study differs from previous work as it was undertaken in a population of practising anaesthetists in their working environment. The McKenzie method allows baseline and study evaluations to be performed contemporaneously on the same individual. Each subject was his/her own control. This method offers a more clinically relevant way to compare disinfectant solutions than standard methods.
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Although the germicidal properties of ultraviolet (UV) light have long been known, it is only comparatively recently that the antimicrobial properties of visible violet-blue 405 nm light have been discovered and used for environmental disinfection and infection control applications. ⋯ Violet-blue light, particularly 405 nm light, has significant antimicrobial properties against a wide range of bacterial and fungal pathogens and, although germicidal efficacy is lower than UV light, this limitation is offset by its facility for safe, continuous use in occupied environments. Promising results on disinfection efficacy have been obtained in hospital trials but the full impact of this technology on reduction of healthcare-associated infection has yet to be determined.
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Review
From SARS in 2003 to H1N1 in 2009: lessons learned from Taiwan in preparation for the next pandemic.
In anticipation of a future pandemic potentially arising from H5N1, H7N9 avian influenza or Middle East Respiratory Syndrome, and in large part in response to severe acute respiratory syndrome (SARS) in 2003, the city of Taipei, Taiwan, has developed extensive new strategies to manage pandemics. These strategies were tested during the 2009 H1N1 outbreak. This article assesses pandemic preparedness in Taipei in the wake of recent pandemic experiences in order to draw lessons relevant to the broader international public health community. ⋯ These new strategies for pandemic response and control have been largely effective at providing interim pandemic containment and control, while development and implementation of an effective vaccination programme is underway. As Taipei's experiences with these cases illustrate, in mitigating moderate or severe pandemic influenza, a graduated process including Traffic Control Bundles accompanied by hospital and medical interventions, as well as school- and community-focused interventions, provides an effective interim response while awaiting vaccine development. Once a vaccine is developed, to maximize pandemic control effectiveness, it should be allocated with priority given to vulnerable groups, healthcare workers and school children.
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Prevention measures reduce central-line-associated bloodstream infections (CLABSIs) but are not always implemented. ⋯ In total, 508 cases of CLABSI were observed over 266,471 central line (CL)-days. At baseline, the pooled mean CLABSI rate was 2.29 per 1000 CL-days, and this decreased significantly to 1.64 per 1000 CL-days in the follow-up period. Compared with baseline, the relative risk for CLABSI was 0.88 [95% confidence interval (CI) 0.70-1.11] for the intervention period and 0.72 (95% CI 0.58-0.88) for the follow-up period. No changes were observed in either control group. Following successful implementation of the programme, ICUs showed a significant decrease in CLABSI rates. Although rates were already decreasing prior to implementation of the intervention, the invitation to participate in the study, and increased general awareness of CLABSI prevention through use of the comprehensive multi-modal training materials may have had a beneficial effect on practice.
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Comparative Study
Comparison of intensive-care-unit-acquired infections and their outcomes among patients over and under 80 years of age.
Patients aged >80 years represent a growing population admitted to intensive care units (ICUs). However, little is known about ICU-acquired infection (IAI) in this population, and the rate of invasive procedures is increasing. ⋯ The frequency of IAI was similar in elderly and younger patients, as were the associations between IAI and length of ICU stay, nursing workload and ICU mortality in an ICU with a high rate of invasive procedures.