The impact of environmental contamination on nosocomial cross-transmission is mostly unresolved and in Danish hospitals assessment of cleaning is based on visible criteria only. The use of premoistened microfibre cloths and the 16-side method have been introduced into Danish hospitals because of economic and ergonomic advantages but they have not been evaluated for applicability in hospital cleaning. Our hypothesis was that this method may spread bacteria. A surface was contaminated with bacteria (4 cfu/bacteria/cm(2)), and cleaned with a premoistened microfibre cloth folded to 16-side use. Each of 15 sterile surfaces was cleaned with a new side of the microfibre cloth; imprints were made and the experiment repeated 12 times. After cleaning, the contaminated surface imprints of microfibre cloths showed a median of 45.5 cfu/plate for E. faecalis and 2.5 cfu/plate for B. cereus. Median values from imprints from cloth sides 2-16 were between 1 and 12 cfu/plate for E. faecalis and 0 cfu/plate for B. cereus. Imprints of the contaminated surfaces were a median of 45.5 cfu/plate for E. faecalis, giving a reduction of 5.6-fold. For B. cereus the median value was 0 cfu/plate. The surface numbers 2-16 had median values between 0.5 and 7.5 for E. faecalis, which was spread to 11-15 of the 15 sterile surfaces (P<0.01). B. cereus was found in six out of 180 imprints on surfaces 2-16, all with 1 cfu/plate (non-significant). The implication is that although there was an overall reduction in bacterial counts on the contaminated surface, bacteria were spread to subsequently cleaned surfaces.

The resurgence of dengue fever and the chikungunya epidemic make the control of Aedes aegypti mosquitoes, the vectors of these diseases, critically important. We developed and evaluated an Ae. aegypti control device that is visually-attractive to mosquitoes. This pyriproxyfen-treated device was evaluated for its impact on Ae. aegypti egg production and population dynamics in dengue-endemic areas in Thailand. The device consists of a "high rise" shaped ovitrap/ resting station covered with black cotton cloth. The device is easily collapsible and transportable. Ae. aegypti are generally drawn towards darker, shadier areas making this device physically attractive as a resting station to mosquitoes of all physiological stages. The results show this device suppressed Ae. aegypti populations after it was introduced into a village. The observed effect was primarily the result of the Ae. aegypti exposure to pyriproxyfen shortly after adult emergence or after taking a blood meal resulting in decreased egg production. We believe the device may be further improved physically and the formulation should be replaced to provide even better efficacy for controlling Ae. aegypti mosquito, populations.

Burkholderia (Pseudomonas) cepacia is an important pathogen amongst persons with cystic fibrosis (CF), and evidence suggests that transmission of strains within CF clinics contributes to pulmonary colonization of some patients. In order to optimize preventive strategies, the survival of B. cepacia on various environmental surfaces, including cotton cloth, stainless steel, latex and polyvinylchloride (PVC) tubing, was investigated. For surface inoculation, bacteria were suspended in phosphate buffered saline, sputum from CF patients, or sputum from persons without CF. The results demonstrate that amongst the strains examined, organisms survived significantly (P < 0.001) longer when suspended in sputum from CF patients than in either non-CF sputum or buffered saline. Significant (P < 0.001) differences in survival on the various surfaces were found; survival was greatest on PVC. Significant (P < 0.001) strain-to-strain differences in survival were also demonstrated; patient isolates representing predominant CF centre ribotypes survived longest. These data demonstrate that (1) B. cepacia can survive for long periods in respiratory droplets on environmental surfaces typically found in CF clinics, (2) undefined factors in sputum from patients with CF may contribute to survival of B. cepacia, and (3) strain-to-strain variation in survival time may affect strain transmissibility.

Day-to-day observations reveal numerous medical and social situations where maintaining physical distancing is either not feasible or not practiced during the time of a viral pandemic, such as, the coronavirus disease 2019 (COVID-19). During these close-up, face-to-face interactions, a common belief is that a susceptible person wearing a face mask is safe, at least to a large extent, from foreign airborne sneeze and cough droplets. This study, for the first time, quantitatively verifies this notion. Droplet flow visualization experiments of a simulated face-to-face interaction with a mask in place were conducted using the particle image velocimetry setup. Five masks were tested in a snug-fit configuration (i.e., with no leakage around the edges): N-95, surgical, cloth PM 2.5, cloth, and wetted cloth PM 2.5. Except for the N-95 mask, the findings showed leakage of airborne droplets through all the face masks in both the configurations of (1) a susceptible person wearing a mask for protection and (2) a virus carrier wearing a mask to prevent the spreading of the virus. When the leakage percentages of these airborne droplets were expressed in terms of the number of virus particles, it was found that masks would not offer complete protection to a susceptible person from a viral infection in close (e.g., <6 ft) face-to-face or frontal human interactions. Therefore, consideration must be given to minimize or avoid such interactions, if possible. This study lends quantitative support to the social distancing and mask-wearing guidelines proposed by the medical research community.

BACKGROUND

The mosquito Aedes aegypti, vector of dengue fever, is a target for control by entomopathogenic fungi. Recent studies by our group have shown the susceptibility of adult A. aegypti to fungal infection by Metarhizium anisopliae. This fungus is currently being tested under field conditions. However, it is unknown whether blood-fed A. aegypti females are equally susceptible to infection by entomopathogenic fungi as sucrose fed females. Insect populations will be composed of females in a range of nutritional states. The fungus should be equally efficient at reducing survival of insects that rest on fungus impregnated surfaces following a blood meal as those coming into contact with fungi before host feeding. This could be an important factor when considering the behavior of A. aegypti females that can blood feed on multiple hosts over a short time period.

METHODS

Female A. aegypti of the Rockefeller strain and a wild strain were infected with two isolates of the entomopathogenic fungus M. anisopliae (LPP 133 and ESALQ 818) using an indirect contact bioassay at different times following blood feeding. Survival rates were monitored on a daily basis and one-way analysis of variance combined with Duncan's post-hoc test or Log-rank survival curve analysis were used for statistical comparisons of susceptibility to infection.

RESULTS

Blood feeding rapidly reduced susceptibility to infection, determined by the difference in survival rates and survival curves, when females were exposed to either of the two M. anisopliae isolates. Following a time lag which probably coincided with digestion of the blood meal (96-120 h post-feeding), host susceptibility to infection returned to pre-blood fed (sucrose fed) levels.

CONCLUSIONS

Reduced susceptibility of A. aegypti to fungi following a blood meal is of concern. Furthermore, engorged females seeking out intra-domicile resting places post-blood feeding, would be predicted to rest for prolonged periods on fungus impregnated black cloths, thus optimizing infection rates. It should be remembered that lowered susceptibility was only a temporary phenomenon and this may not necessarily occur when mosquitoes are infected with other fungal isolates. These results may have implications for field testing of entomopathogenic fungi by our group and further studies should be carried out to better understand the insect-fungus interaction.

BACKGROUND

Central line-associated bloodstream infections (CLABSI) contribute to increased morbidity, mortality, length of stay, and excessive cost of care.

METHODS

This study was an observational cohort study using historical controls in the setting of a 9-bed surgical intensive care unit in a Level I trauma center; all patients admitted or transferred into the unit were enrolled in the study.

OBJECTIVE

A quality improvement intervention protocol was instituted to reduce CLABSI incidence with a 3-month effectiveness study using 2% chlorhexidine gluconate-impregnated cloths for daily patient bathing; education of surgical intensive care unit staff on changes to CLABSI prevention protocol and all existing CLABSI prevention policies and bundles already in place; and compliance monitoring and documentation.

RESULTS

The 3-month effectiveness study showed a decrease in CLABSI rates from 12.07 CLABSIs per 1000 central line-days to 3.17 CLABSIs per 1000 central line-days (73.7% rate reduction; P = .0358).

CONCLUSIONS

CLABSI incidence rates were reduced in a high-risk patient population using evidence-based prevention bundles and implementing daily bathing with 2% chlorhexidine gluconate nonrinse cloths.

Healthcare-associated infections (HCAI/HAI) represent a substantial threat to patient health during hospitalization and incur billions of dollars additional cost for subsequent treatment. One promising method for the detection of bacterial contamination in a clinical setting before an HAI outbreak occurs is to exploit native fluorescence of cellular molecules for a hand-held, rapid-sweep surveillance instrument. Previous studies have shown fluorescence-based detection to be sensitive and effective for food-borne and environmental microorganisms, and even to be able to distinguish between cell types, but this powerful technique has not yet been deployed on the macroscale for the primary surveillance of contamination in healthcare facilities to prevent HAI. Here we report experimental data for the specification and design of such a fluorescence-based detection instrument. We have characterized the complete fluorescence response of eleven clinically-relevant bacteria by generating excitation-emission matrices (EEMs) over broad wavelength ranges. Furthermore, a number of surfaces and items of equipment commonly present on a ward, and potentially responsible for pathogen transfer, have been analyzed for potential issues of background fluorescence masking the signal from contaminant bacteria. These include bedside handrails, nurse call button, blood pressure cuff and ward computer keyboard, as well as disinfectant cleaning products and microfiber cloth. All examined bacterial strains exhibited a distinctive double-peak fluorescence feature associated with tryptophan with no other cellular fluorophore detected. Thus, this fluorescence survey found that an emission peak of 340nm, from an excitation source at 280nm, was the cellular fluorescence signal to target for detection of bacterial contamination. The majority of materials analysed offer a spectral window through which bacterial contamination could indeed be detected. A few instances were found of potential problems of background fluorescence masking that of bacteria, but in the case of the microfiber cleaning cloth, imaging techniques could morphologically distinguish between stray strands and bacterial contamination.

Monitoring the cholesterol level is of great importance, especially for people with high risk of developing heart disease. Here we report on reagentless cholesterol detection in human plasma with a novel single-enzyme, membrane-free, self-powered biosensor, in which both cathodic and anodic bioelectrocatalytic reactions are powered by the same substrate. Cholesterol oxidase was immobilized in a sol-gel matrix on both the cathode and the anode. Hydrogen peroxide, a product of the enzymatic conversion of cholesterol, was electrocatalytically reduced, by the use of Prussian blue, at the cathode. In parallel, cholesterol oxidation catalyzed by mediated cholesterol oxidase occurred at the anode. The analytical performance was assessed for both electrode systems separately. The combination of the two electrodes, formed on high surface-area carbon cloth electrodes, resulted in a self-powered biosensor with enhanced sensitivity (26.0 mA M(-1) cm(-2)), compared to either of the two individual electrodes, and a dynamic range up to 4.1 mM cholesterol. Reagentless cholesterol detection with both electrochemical systems and with the self-powered biosensor was performed and the results were compared with the standard method of colorimetric cholesterol quantification.

Insect-killing fungi such as Beauveria bassiana are being evaluated as possible active ingredients for use in novel biopesticides against mosquito vectors that transmit malaria. Fungal pathogens infect through contact and so applications of spores to surfaces such as walls, nets, or other resting sites provide possible routes to infect mosquitoes in and around domestic dwellings. However, some insects can detect and actively avoid fungal spores to reduce infection risk. If true for mosquitoes, such behavior could render the biopesticide approach ineffective. Here we find that the spores of B. bassiana are highly attractive to females of Anopheles stephensi, a major anopheline mosquito vector of human malaria in Asia. We further find that An. stephensi females are preferentially attracted to dead and dying caterpillars infected with B. bassiana, landing on them and subsequently becoming infected with the fungus. Females are also preferentially attracted to cloth sprayed with oil-formulated B. bassiana spores, with 95% of the attracted females becoming infected after a one-minute visit on the cloth. This is the first report of an insect being attracted to a lethal fungal pathogen. The exact mechanisms involved in this behavior remain unclear. Nonetheless, our results indicate that biopesticidal formulations comprising B. bassiana spores will be conducive to attraction and on-source visitation by malaria vectors.

Cellulose nanocrystals (CNCs) were prepared from waste cotton cloth and degreasing cotton was used as a comparison. The cellulose was first extracted by alkali and bleaching treatments, and then the CNCs were isolated by the mix acid solution hydrolysis of cellulose under the controlled conditions. The CNCs were analyzed by Attenuated total reflectance Fourier transform infrared spectroscopy, Transmission electron microscopy, X-ray diffraction analysis, thermogravimetric and differential scanning calorimetry analysis. The results confirmed that the resultant samples were the cellulose species, and the CNCs obtained from waste cotton cloth exhibited a high crystallinity index of 55.76±7.82%, which had higher thermostability than that from the degreasing cotton. The morphology analysis results showed that the ranges of length and diameter of CNC extracted from waste cotton cloth were from 28 to 470nm and 3 to 35nm. The preparation of CNCs with a high aspect ratio and good thermostability in this work paves the way for an alternative reuse of waste cotton cloth.

Electrochemical reduction of CO2 into liquid fuels is a promising approach to achieve a carbon-neutral energy cycle. However, conventional electrocatalysts usually suffer from low energy efficiency and poor selectivity and stability. A 3D hierarchical structure composed of mesoporous SnO2 nanosheets on carbon cloth is proposed to efficiently and selectively electroreduce CO2 to formate in aqueous media. The electrode is fabricated by a facile combination of hydrothermal reaction and calcination. It exhibits an unprecedented partial current density of about 45 mA cm-2 at a moderate overpotential (0.88 V) with high faradaic efficiency (87±2 %), which is even larger than most gas diffusion electrodes. Additionally, the electrode also demonstrates flexibility and long-term stability. The superior performance is attributed to the robust and highly porous hierarchical structure, which provides a large surface area and facilitates charge and mass transfer.

The main form of COVID-19 transmission is via "oral-respiratory droplet contamination" (droplet: very small drop of liquid) produced when individuals talk, sneeze, or cough. In hospitals, health-care workers wear facemasks as a minimum medical "droplet precaution" to protect themselves. Due to the shortage of masks during the pandemic, priority is given to hospitals for their distribution. As a result, the availability/use of medical masks is discouraged for the public. However, for asymptomatic individuals, not wearing masks in public could easily cause the spread of COVID-19. The prevention of "environmental droplet contamination" (EnvDC) from coughing/sneezing/speech is fundamental to reducing transmission. As an immediate solution to promote "public droplet safety," we assessed household textiles to quantify their potential as effective environmental droplet barriers (EDBs). The synchronized implementation of a universal "community droplet reduction solution" is discussed as a model against COVID-19. Using a bacterial-suspension spray simulation model of droplet ejection (mimicking a sneeze), we quantified the extent by which widely available clothing fabrics reduce the dispersion of droplets onto surfaces within 1.8 m, the minimum distance recommended for COVID-19 "social distancing." All textiles reduced the number of droplets reaching surfaces, restricting their dispersion to <30 cm, when used as single layers. When used as double-layers, textiles were as effective as medical mask/surgical-cloth materials, reducing droplet dispersion to <10 cm, and the area of circumferential contamination to ~0.3%. The synchronized implementation of EDBs as a "community droplet reduction solution" (i.e., face covers/scarfs/masks and surface covers) will reduce COVID-19 EnvDC and thus the risk of transmitting/acquiring COVID-19.

Keywords: COVID-19; SARS-Cov-2; cloth masks; coronavirus; public droplet safety; respiratory pandemic; spray simulation model; textiles.

Management of the global crisis of the coronavirus disease 2019 pandemic requires detailed appraisal of evidence to support clear, actionable, and consistent public health messaging. The use of cloth masks for general public use is being debated, and is in flux. We searched the MEDLINE and EMBASE databases and Google for articles reporting the filtration properties of flat cloth or cloth masks. We reviewed the reference lists of relevant articles to identify further articles and identified articles through social and conventional news media. We found 25 articles. Study of protection for the wearer used healthy volunteers, or used a manikin wearing a mask, with airflow to simulate different breathing rates. Studies of protection of the environment, also known as source control, used convenience samples of healthy volunteers. The design and execution of the studies was generally rigorously described. Many descriptions of cloth lacked the detail required for reproducibility; no study provided all the expected details of material, thread count, weave, and weight. Some of the homemade mask designs were reproducible. Successful masks were made of muslin at 100 threads per inch (TPI) in 3 to 4 layers (4-layer muslin or a muslin-flannel-muslin sandwich), tea towels (also known as dish towels), made using 1 layer (2 layers would be expected to be better), and good-quality cotton T-shirts in 2 layers (with a stitched edge to prevent stretching). In flat-cloth experiments, linen tea towels, 600-TPI cotton in 2 layers, and 600-TPI cotton with 90-TPI flannel performed well but 80-TPI cotton in 2 layers did not. We therefore recommend cotton or flannel at least 100 TPI, at least 2 layers. More layers, 3 or 4, will provide increased filtration but there is a trade-off in that more layers increases the resistance to breathing. Although this is not a systematic review, we included all the articles that we identified in an unbiased way. We did not include gray literature or preprints. A plain language summary of these data and recommendations, as well as information on making, wearing and cleaning cloth masks is available at www.clothmasks.ca.

BACKGROUND

Masks are often worn in healthcare settings to prevent the spread of infection from healthcare workers (HCWs) to patients. Masks are also used to protect the employee from patient-generated infectious organisms but poor compliance can reduce efficacy. The aim of this study was to examine the factors influencing compliance with the use of medical and cloth masks amongst hospital HCWs.

METHODS

HCWs compliance with the use of medical and cloth masks was measured over a 4-week period in a randomized controlled trial in Vietnam. HCWs were instructed to record their daily activities in diary cards. Demographic, clinical, and diary card data were used to determine the predictors of compliance and the relationship of compliance with infection outcomes.

RESULTS

Compliance rates for both medical and cloth masks decreased during the 4 weeks: medical mask use decreased from 77 to 68% (P < 0.001) and cloth masks from 78 to 69% (P < 0.001). The presence of adverse events (adjusted RR 0.90, 95% CI 0.85-0.95), and performing aerosol-generating procedures (adjusted RR 0.78, 95% CI 0.73-0.82) were negatively associated with compliance, while contact with febrile respiratory illness patients was positively associated (adjusted RR 1.14, 95% CI 1.07-1.20). Being compliant with medical or cloth masks use (average use ≥70% of working time) was not associated with clinical respiratory illness, influenza-like illness, and laboratory-confirmed viral infection.

CONCLUSIONS

Understanding the factors that affect compliance is important for the occupational health and safety of HCWs. New strategies and tools should be developed to increase compliance of HCWs. The presence of adverse events such as discomfort and breathing problems may be the main reasons for the low compliance with mask use and further studies should be conducted to improve the design/material of masks to improve comfort for the wearer.

The structure and electrical conductivity of anode play a significant role in the power generation of microbial fuel cells (MFCs). In this study, we developed a three-dimensional (3D) reduced graphene oxide-nickel (denoted as rGO-Ni) foam as an anode for MFC through controlled deposition of rGO sheets onto the nickel foam substrate. The loading amount of rGO sheets and electrode surface area can be controlled by the number of rGO loading cycles. 3D rGO-Ni foam anode provides not only a large accessible surface area for microbial colonization and electron mediators, but also a uniform macro-porous scaffold for effective mass diffusion of the culture medium. Significantly, at a steady state of the power generation, the MFC device with flexible rGO-Ni electrodes produced an optimal volumetric power density of 661 W m(-3) calculated based on the volume of anode material, or 27 W m(-3) based on the volume of the anode chamber. These values are substantially higher than that of plain nickel foam, and other conventional carbon based electrodes (e.g., carbon cloth, carbon felt, and carbon paper) measured in the same conditions. To our knowledge, this is the highest volumetric power density reported for mL-scale MFC device with a pure strain of Shewanella oneidensis MR-1. We also demonstrated that the MFC device can be operated effectively in a batch-mode at least for a week. These new 3D rGO-Ni electrodes show great promise for improving the power generation of MFC devices.

An effecient feather-degrading bacterium was isolated from poultry dumping yard and identified as Bacillus pumilus GRK based on 16S rRNA sequencing. Complete feather degradation (98.3±1.52%) with high keratinase production (373±4 U/ml) was observed in 24h under optimized conditions (substrate 1% (w/w); inoculum size 4% (v/v); pH 10; 200rpm at 37°C) with feathers as sole carbon and nitrogen source in tap water. The fermented broth was enriched with amino acids like tryptophan (221.44µg/ml), isoleucine (15.0µg/ml), lysine (10.81µg/ml) and methionine (7.24µg/ml) suggesting its potential use as feed supplement. The keratinase produced was a detergent stable serine protease and its activity was further enhanced by Ca+2 and Mg+2. Bacillus pumilus GRK keratinase was successfully utilised as bioadditive in detergent formulations for removing the blood stains from cloth without affecting its fiber and texture.

On April 3, 2020, the White House Coronavirus Task Force and CDC announced a new behavioral recommendation to help slow the spread of coronavirus disease 2019 (COVID-19) by encouraging the use of a cloth face covering when out in public (1). Widespread use of cloth face coverings has not been studied among the U.S. population, and therefore, little is known about encouraging the public to adopt this behavior. Immediately following the recommendation, an Internet survey sampled 503 adults during April 7-9 to assess their use of cloth face coverings and the behavioral and sociodemographic factors that might influence adherence to this recommendation. The same survey was administered 1 month later, during May 11-13, to another sample of 502 adults to assess changes in the prevalence estimates of use of cloth face coverings from April to May. Within days of the release of the first national recommendation for use of cloth face coverings, a majority of persons who reported leaving their home in the previous week reported using a cloth face covering (61.9%). Prevalence of use increased to 76.4% 1 month later, primarily associated with increases in use among non-Hispanic white persons (54.3% to 75.1%), persons aged ≥65 years (36.6% to 79.2%), and persons residing in the Midwest (43.7% to 73.8%). High rates were observed in April and by May, increased further among non-Hispanic black persons (74.4% to 82.3%), Hispanic or Latino persons (77.3% to 76.2%), non-Hispanic persons of other race (70.8% to 77.3%), persons aged 18-29 years (70.1% to 74.9%) and 30-39 years (73.9% to 84.4%), and persons residing in the Northeast (76.9% to 87.0%). The use of a cloth face covering was associated with theory-derived constructs that indicate a favorable attitude toward them, intention to use them, ability to use them, social support for using them, and beliefs that they offered protection for self, others, and the community. Research is needed to understand possible barriers to using cloth face coverings and ways to promote their consistent and correct use among those who have yet to adopt this behavior.

Cotton-based waste textiles were explored as alternative feedstock for production of bacterial cellulose (BC) by Gluconacetobacter xylinus. The cellulosic fabrics were treated with the ionic liquid (IL) 1-allyl-3-methylimidazolium chloride ([AMIM]Cl). [AMIM]Cl caused 25% inactivation of cellulase activity at a concentration as low as of 0.02 g/mL and decreased BC production during fermentation when present in concentrations higher than 0.0005 g/mL. Therefore, removal of residual IL by washing with hot water was highly beneficial to enzymatic saccharification as well as BC production. IL-treated fabrics exhibited a 5-7-fold higher enzymatic hydrolysis rate and gave a seven times larger yield of fermentable sugars than untreated fabrics. BC from cotton cloth hydrolysate was obtained at an yield of 10.8 g/L which was 83% higher than that from the culture grown on glucose-based medium. The BC from G. xylinus grown on IL-treated fabric hydrolysate had a 79% higher tensile strength than BC from glucose-based culture medium which suggests that waste cotton pretreated with [AMIM]Cl has potential to serve as a high-quality carbon source for BC production.

Molecular gut-content analysis enables detection of arthropod predation with minimal disruption of ecosystem processes. Mass-collection methods, such as sweep-netting, vacuum sampling and foliage beating, could lead to regurgitation or rupturing of predators along with uneaten prey, thereby contaminating specimens and compromising resultant gut-content data. Proponents of this 'cross-contamination hypothesis' advocate hand-collection as the best way to avoid cross-contamination. However, hand-collection is inefficient when large samples are needed, as with most ecological research. We tested the cross-contamination hypothesis by setting out onto potato plants immature Coleomegilla maculata and Podisus maculiventris that had been fed larvae of either Leptinotarsa decemlineata or Leptinotarsa juncta, or unfed individuals of these predator species along with L. decemlineata larvae. The animals were then immediately re-collected, either by knocking them vigorously off the plants onto a beat cloth and capturing them en masse with an aspirator ('rough' treatment) or by hand-searching and collection with a brush ('best practice'). Collected predators were transferred in the field to individual vials of chilled ethanol and subsequently assayed by PCR for fragments of cytochrome oxidase I of L. decemlineata and L. juncta. Ten to 39 per cent of re-collected fed predators tested positive by PCR for DNA of both Leptinotarsa species, and 14-38% of re-collected unfed predators contained L. decemlineata DNA. Overall levels of cross-contamination in the rough (31%) and best-practice (11%) samples were statistically different and supported the cross-contamination hypothesis. A pilot study on eliminating external DNA contamination with bleach prior to DNA extraction and amplification gave promising results.

BACKGROUND

Research has indicated that the environment may play an important role in the transmission of meticillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile in healthcare facilities. Despite the significance of this finding, few data exist from longitudinal studies investigating MRSA and C. difficile contamination, concurrently, in both patient rooms and the general ward environment. The objectives of this study were to determine the prevalence of MRSA and C. difficile contamination in patient rooms and the ward environment and identify risk factors associated with a surface being contaminated with these pathogens.

METHODS

Environmental surfaces in patient rooms and the general environment in the medical and surgical wards of a community hospital were sampled six times over a 15 week period. Sterile electrostatic cloths were used for sampling and information pertaining to the surface sampled was recorded. MRSA isolates and C. difficile specimens were obtained from hospitalized patients.Enrichment culture was performed and spa typing or ribotyping was conducted for MRSA or C. difficile, respectively. Exact logistic regression models were constructed to examine risk factors associated with MRSA and C. difficile contamination.

RESULTS

Sixteen (41%) patient rooms had ≥ 1 surfaces contaminated with MRSA and/or C. difficile. For 218 surfaces investigated, 3.2% and 6.4% were contaminated with MRSA or C. difficile, respectively. Regression models indicated that surfaces in rooms exposed to a C. difficile patient had significantly increased odds of being contaminated with C. difficile, compared to surfaces in unexposed patient rooms. Additionally, compared to plastic surfaces, cork surfaces had significantly increased odds of being contaminated with C. difficile. For 236 samples collected from the ward environment, MRSA and C. difficile were recovered from 2.5% and 5.9% of samples, respectively. Overall, the majority of MRSA and C. difficile strains were molecularly identified as spa type 2/t002 (84.6%, n = 11) and ribotype 078 (50%, n = 14), respectively.

CONCLUSIONS

In patient rooms and the ward environment, specific materials and locations were identified as being contaminated with MRSA or C. difficile. These sites should be cleaned and disinfected with increased vigilance to help limit the transmission and dissemination of MRSA and C. difficile within the hospital.

A survey (2005-2006) of house fly, Musca dormestica L. (Diptera: Muscidae) populations on four Florida dairy farms demonstrated the presence of flies with acute symptoms of infection with salivary gland hypertrophy (SGH) virus on all farms. Disease incidence varied among farms (farm averages, 0.5-10.1%) throughout the year, and it showed a strong positive correlation with fly density. Infections were most common among flies that were collected in a feed barn on one of the farms, especially among flies feeding on wet brewers grains (maximum 34% SGH). No infections were observed among adult flies reared from larvae collected on the farms, nor among adults reared from larvae that had fed on macerated salivary glands from infected flies. Infected female flies produced either no or small numbers of progeny, none of which displayed SGH when they emerged as adults. Healthy flies became infected after they fed on solid food (a mixture of powdered milk, egg, and sugar) that had been contaminated by infected flies (42%) or after they were held in cages that had previously housed infected flies (38.6%). Healthy flies also became infected after they fed on samples of brewers grains (6.8%) or calf feed (2%) that were collected from areas of high fly visitation on the farms. Infection rates of field-collected flies increased from 6 to 40% when they fed exclusively on air-dried cloth strips soaked in a suspension of powdered egg and whole milk. Rates of virus deposition by infected flies on food were estimated by quantitative polymerase chain reaction at approximately 100 million virus copies per fly per hour. Electron microscopy revealed the presence on enveloped virus particles in the lumen of salivary glands and on the external mouthparts of infected flies.

Televised endoscopy and the concept of the "assisted" endoscopic operation is of great help in teaching surgical endoscopic techniques. The use of training dummies provides a new method of training manual dexterity and surgical skills in special courses or in surgical skill laboratories. We have developed a training system for transanal endoscopic microsurgery. Operations with our technique were performed on 116 patients. Like other microsurgical techniques, our method requires a special introduction and intensive training. This paper presents our multistage, video-supported training course for teaching transanal endoscopic microsurgery. The one-day training session is divided into four steps: (1) becoming acquainted with the technology; (2) training on cloth phantom; (3) training on opened bowel; (4) training on closed bovine bowel distended by gas insufflation. Each step is introduced by a short videotape didactically demonstrating the particular aspects of the method.

Strengths of several upper- and lower-limb muscle groups were measured in an elderly population by using a simple, adaptable dynamometer. The bladder of a sphygmomanometer was modified by folding and surrounding it in a sewn cloth bag. It was then attached to a board for improved stability during the tests. Thirty-seven men and 81 women aged 62 to 102 years were tested. Four muscle groups were statistically determined to best represent strength-two for upper limb and two for lower limb. These strength measures were correlated with anthropometric indices, and a step-wise multiple regression was used to determine the degree of association between the variables. Men were significantly stronger than women in absolute strength, but were not different when strength was expressed relative to body weight. Within each sex, however, age was the most important variable related to loss of strength; body weight was secondary or not significant. These results suggest that age is the most important factor for relating differences in strength in an older elderly population (those aged 75 to 90 or more years). This factor must be accounted for just as body weight or cross-sectional muscle area often are, when comparing strengths in a younger population.