Laboratory rats show a range of defensive behaviors, including freezing, avoidance, and risk assessment upon exposure to cat odor, an unconditioned but highly effective threat stimulus. This study examined defensive behaviors, and the rapid conditioning to context plus cue, of these behaviors, in 18-, 26-, and 38-day-old male and female rats exposed to cat odor. Rats were placed individually in a runway with a cloth covered (control or saturated with cat fur/skin odor) block for a 10-min trial. On the following day, a similar trial involved an odorless block. On the odor exposure day, rats of all ages showed less contact with the odor block than with the control block. The 26- and 38-day-old rats, but not the 18-day-old rats, also showed locomotor suppression, more avoidance of the area where the odor block was located, and more risk assessment than no-odor controls. On a test of conditioned behavior 24 h following exposure, 26- and 38-day-old rats exhibited defensive behavior including avoidance and reduction of locomotion while 18-day-old pups did not.

Textiles that are capable of harvesting biomechanical energy via triboelectric effects are of interest for self-powered wearable electronics. Fabrication of conformable and durable textiles with high triboelectric outputs remains challenging. Here we propose a washable skin-touch-actuated textile-based triboelectric nanogenerator for harvesting mechanical energy from both voluntary and involuntary body motions. Black phosphorus encapsulated with hydrophobic cellulose oleoyl ester nanoparticles serves as a synergetic electron-trapping coating, rendering a textile nanogenerator with long-term reliability and high triboelectricity regardless of various extreme deformations, severe washing, and extended environmental exposure. Considerably high output (~250-880 V, ~0.48-1.1 µA cm-2) can be attained upon touching by hand with a small force (~5 N) and low frequency (~4 Hz), which can power light-emitting diodes and a digital watch. This conformable all-textile-nanogenerator is incorporable onto cloths/skin to capture the low output of 60 V from subtle involuntary friction with skin, well suited for users' motion or daily operations.

Cotton fibers and various cell wall preparations from grass leaves and from the feces of sheep fed on dried grass were placed in the sheep rumen in bags made from 5-mum-mesh nylon cloth. After periods of from 3 to 48 h, bags were removed, and the contents were fixed, embedded, sectioned, and stained for electron microscopy. Some of the bacteria present were seen to be closely associated with the cell walls, either tunneling within them or making very close contact. Evidence was obtained for differential digestion of cell walls and of the layers within them. Distinct differences were noticed between bacterial populations attacking the more susceptible wall types and those attacking feces cell walls and cotton fibers. Among the latter, the dominant form was a long, thin rod with a typical gramnegative cell wall structure, different from that described for Bacteroides succinogenes S85 or for Butyrivibrio fibrisolvens.

Using a quasi-experimental design, this study was conducted in two maternal & child health centres in Jordan to examine the effects of breast-feeding on pain relief during neonatal immunization injections. Inclusion criteria were first year of age, breast-fed and no concurrent illness. Infants were divided into two groups (of 60 infants for each). One is intervention group: mothers were taken to a private room, seated and reclined on a comfortable chair with their infants awake in their arms, without cloth and with clean diapers. The mothers cradled their infants during breast-feeding to maintain full-body skin-to-skin contact during immunization injections. The other is control group: infants were observed during routine immunization in maternal & child health centres. Pain responses of infants during and after immunization were assessed by using Facial Pain Rating Scale and Neonatal/Infant Pain Scale (NIPS), before, during and after the procedure. Infants' heart rates and duration of crying for both groups were calculated. Findings revealed that the crying time was shorter in intervention (breast-fed) group than in the control group with a statistically significant difference in the duration of crying during and after immunization. We concluded that, breast-feeding and skin-to-skin contact significantly reduced crying in infants receiving immunization.

Exposure to benzene in air is a concern in Thailand, particularly since it was observed that the incidence of blood-related cancers, such as leukemia and lymphoma, has increased in the past few decades. In Bangkok, the mean atmospheric levels of benzene on main roads and in schools were 33.71 and 8.25 ppb, respectively, while in gasoline service stations and petrochemical factories the mean ambient levels were 64.78 and 66.24 ppb, respectively. Cloth vendors (22.61 ppb) and grilled-meat vendors (28.19 ppb) working on the roadsides were exposed to significantly higher levels of benzene than the control group (12.95 ppb; p<0.05). Bangkok school children (5.50 ppb) were exposed to significantly higher levels of benzene than provincial school children (2.54 ppb; p<0.01). Factory workers (73.55 ppb) and gasoline service attendants (121.67 ppb) were exposed to significantly higher levels of benzene than control workers (4.77 ppb; p<0.001). In accordance with the increased benzene exposures, levels of urinary trans,trans-muconic acid (MA) were significantly increased in all benzene-exposed groups. In school children, the levels of MA were relatively high, taking into account the much lower level of exposure. Blood benzene levels were also significantly increased in Bangkok school children (77.97 ppt; p<0.01), gasoline service attendants (641.84 ppt; p<0.05) and factory workers (572.61 ppt; p<0.001), when compared with the respective controls. DNA damage, determined as DNA strand breaks, was found to be elevated in gasoline service attendants, petrochemical factory workers, and Bangkok school children (p<0.001). The cytogenetic challenge assay, which measures DNA repair capacity, showed varying levels of significant increases in the numbers of dicentrics and deletions in gasoline service attendants, petrochemical factory workers and Bangkok school children, indicating a decrease in DNA repair capacity in these subjects.

Traditional fibre-reinforced composite materials with excellent in-plane properties fare poorly when out-of-plane through-thickness properties are important. Composite architectures with fibres designed orthogonal to the two-dimensional (2D) layout in traditional composites could alleviate this weakness in the transverse direction, but all of the efforts so far have only produced limited success. Here, we unveil an approach to the 3D composite challenge, without altering the 2D stack design, on the basis of the concept of interlaminar carbon-nanotube forests that would provide enhanced multifunctional properties along the thickness direction. The carbon-nanotube forests allow the fastening of adjacent plies in the 3D composite. We grow multiwalled carbon nanotubes on the surface of micro-fibre fabric cloth layouts, normal to the fibre lengths, resulting in a 3D effect between plies under loading. These nanotube-coated fabric cloths serve as building blocks for the multilayered 3D composites, with the nanotube forests providing much-needed interlaminar strength and toughness under various loading conditions. For the fabricated 3D composites with nanotube forests, we demonstrate remarkable improvements in the interlaminar fracture toughness, hardness, delamination resistance, in-plane mechanical properties, damping, thermoelastic behaviour, and thermal and electrical conductivities making these structures truly multifunctional.

To assess the Lyme borreliosis vector population density we set up a methodology for sampling the Ixodes ricinus L. population host questing on the vegetation. We focused on the collection of the nymphal stage, which is the principal stage of disease transmission to humans. This study was carried out in Rambouillet forest (Yvelines, France) where seven study areas were demarcated. These areas are maximally homogeneous for plant species using a finer scale than the phytosociological classification as defined by the method of landscape diagnostics. Out of 23 collections performed from March 1997 to May 1998, 2,906 I. ricinus nymphs were collected. The sampling technique chosen was the cloth lure technique. The technical parameters were studied and fixed (cloth type, cloth size, sample size, researcher position). It appeared that toweling was the best cloth type to optimize the number of ticks collected; the position of the researcher had no effect on tick samples. To satisfy the criteria for correct sampling, we studied representativity, randomness, and nonselectivity of our methodology. The spatial distribution of nymphs in a homogeneous area was close to random and thus very few subsamples were needed to obtain a relative density which was representative. No significant differences were found between random samples and following transect samples; and nonselectivity was totally satisfied because we only worked on questing nymphs. We grouped the samples that presented no significant differences to attribute a density index, which varied from 0 to 5. This methodology, applied with the same parameters, offers potential for producing comparable results from studies in different geographical areas and at different times of the years.

OBJECTIVE

This project was aimed at evaluating the impact of combat armor on physiological and cognitive functions during low-intensity exercise in hot-humid conditions (36 degrees C and 60% relative humidity).

METHODS

Nine males participated in three trials (2.5 hours), walking at two speeds and wearing different protective equipment: control (combat uniform and cloth hat); torso armor with uniform and cloth hat; and full armor (uniform, torso armor, and helmet).

RESULTS

As time progressed, core temperatures increased and deviated significantly among trials, rising at 0.37 degrees C h(-1) (control), 0.41 degrees C h(-1) (torso armor), and 0.51 degrees C h(-1) (full armor). Heart rates also progressively diverged, and subjects lost significantly more sweat during the two armored trials. However, cognitive-function tests revealed neither significant main effects nor time by treatment interactions.

CONCLUSIONS

The combat armor and helmet significantly increased thermal and cardiovascular strain, but these were unlikely to lead to either exertional heat illness or impaired cognitive function during uneventful urban, military patrols in hot-humid conditions.

The aim of the functional magnetic resonance imaging (fMRI) study was to investigate brain activation associated with active and passive movements, and tactile stimulation in 17 children with right-sided unilateral cerebral palsy (CP), compared to 19 typically developing children (TD). The active movements consisted of repetitive opening and closing of the hand. For passive movements, an MRI-compatible robot moved the finger up and down. Tactile stimulation was provided by manually stroking the dorsal surface of the hand with a sponge cotton cloth. In both groups, contralateral primary sensorimotor cortex activation (SM1) was seen for all tasks, as well as additional contralateral primary somatosensory cortex (S1) activation for passive movements. Ipsilateral cerebellar activity was observed in TD children during all tasks, but only during active movements in CP children. Of interest was additional ipsilateral SM1 recruitment in CP during active movements as well as ipsilateral S1 activation during passive movements and tactile stimulation. Another interesting new finding was the contralateral cerebellum activation in both groups during different tasks, also in cerebellar areas not primarily linked to the sensorimotor network. Active movements elicited significantly more brain activation in CP compared to TD children. In both groups, active movements displayed significantly more brain activation compared to passive movements and tactile stimulation.

BACKGROUND

Health care workers (HCWs) are at substantial risk of acquiring blood borne infections such as HIV, Hepatitis-B and Hepatitis-C through needle stick injuries (NSIs). This study aimed to assess the proportion of NSIs and their associated factors among HCWs and also to identify the areas in which preventive efforts might be directed to protect against this occupational hazard.

METHODS

A cross-sectional study was conducted in two tertiary care hospitals of Pakistan representing both private and public health sector. A total of 497 HCWs (doctors and nurses) were interviewed using a structured questionnaire. Data was collected from January to May 2008.

RESULTS

Overall, 64% of the HCWs were exposed to at least one NSI during their career; among them 73% reported NSIs for two or more times. Factors found to be highly associated with NSIs were those practicing this occupation for more than five years (p < 0.001: OR = 5.92; 95% CI = 3.45-10.16) and working as nurse than doctor (p 0.001: OR = 2.12; 95% CI = 1.35-3.32). Having received booster dose of hepatitis B vaccine (p 0.02: OR = 1.85; 95% CI = 1.10-3.11), working in surgical specialty (p < 0.01: OR = 1.6; 95% CI = 1.09-2.51) and being a female (p 0.03: OR = 1.52; 95% CI = 1.04-2.22) were also found to be associated with NSIs. Most commonly reported reason for NSIs was injecting medicine and drawing blood (42%) followed by two-handed recapping of needle (37%). Only, 34% of study subjects were vaccinated against hepatitis B infection. Overall, HCWs had inadequate practices regarding standard precautions such as availability of gloves/protective cloths (40%) and infection control guidelines/protocols (10%) respectively in their working places.

CONCLUSIONS

In addition to very high rates of NSIs, low safety practices including inadequate vaccination coverage, unavailability of infection control guidelines and other preventive facilities were reported in this study. Prevention of occupational infections among HCWs should be a priority. Formal training, by health authorities in the local area, about safe practices and availability of preventive facilities should be ensured regarding NSIs among HCWs.

The production of galacto-oligosaccharides (GOS) from lactose by A. oryzae beta-galactosidase immobilized on cotton cloth was studied. The total amounts and types of GOS produced were mainly affected by the initial lactose concentration in the reaction media. In general, more and larger GOS can be produced with higher initial lactose concentrations. A maximum GOS production of 27% (w/w) of initial lactose was achieved at 50% lactose conversion with 500 g/L of initial lactose concentration. Tri-saccharides were the major types of GOS formed, accounting for more than 70% of the total GOS produced in the reactions. Temperature and pH affected the reaction rate, but did not result in any changes in GOS formation. The presence of galactose and glucose at the concentrations encountered near maximum GOS greatly inhibited the reactions and reduced GOS yield by as much as 15%. The cotton cloth as the support matrix for enzyme immobilization did not affect the GOS formation characteristics of the enzyme, suggesting no diffusion limitation in the enzyme carrier. The thermal stability of the enzyme increased approximately 25-fold upon immobilization on cotton cloth. The half-life for the immobilized enzyme on cotton cloth was more than 1 year at 40 degrees C and 48 days at 50 degrees C. Stable, continuous operation in a plugflow reactor was demonstrated for 2 weeks without any apparent problem. A maximum GOS production of 21 and 26% (w/w) of total sugars was attained with a feed solution containing 200 and 400 g/L of lactose, respectively, at pH 4.5 and 40 degrees C. The corresponding reactor productivities were 80 and 106 g/L/h, respectively, which are at least several-fold higher than those previously reported.

Flexible power sources with high energy density are crucial for the realization of next-generation flexible electronics. Theoretically, rechargeable flexible zinc-air (Zn-air) batteries could provide high specific energy, while their large-scale applications are still greatly hindered by high cost and resources scarcity of noble-metal-based oxygen evolution reaction (OER)/oxygen reduction reaction (ORR) electrocatalysts as well as inferior mechanical properties of the air cathode. Combining metallic Co4N with superior OER activity and Co-N-C with perfect ORR activity on a free-standing and flexible electrode could be a good step for flexible Zn-air batteries, while lots of difficulties need to be overcome. Herein, as a proof-of-concept experiment, we first propose a strategy for in situ coupling of strung Co4N and intertwined N-C fibers, by pyrolyzation of the novel pearl-like ZIF-67/polypyrrole nanofibers network rooted on carbon cloth. Originating from the synergistic effect of Co4N and Co-N-C and the stable 3D interconnected conductive network structure, the obtained free-standing and highly flexible bifunctional oxygen electrode exhibits excellent electrocatalytic activity and stability for both OER and ORR in terms of low overpotential (310 mV at 10 mA cm(-2)) for OER, a positive half-wave potential (0.8 V) for ORR, and a stable current density retention for at least 20 h, and especially, the obtained Zn-air batteries exhibit a low discharge-charge voltage gap (1.09 V at 50 mA cm(-2)) and long cycle life (up to 408 cycles). Furthermore, the perfect bendable and twistable and rechargeable properties of the flexible Zn-air battery particularly make it a potentially power portable and wearable electronic device.

The presence of highly heat-resistant spores of Bacillus sporothermodurans in ultrahigh-temperature or sterilized consumer milk has emerged as an important item in the dairy industry. Their presence is considered undesirable since they hamper the achievement of commercial sterility requirements. By using a selective 30-min heat treatment at 100 degrees C, 17 Belgian dairy farms were screened to evaluate the presence, sources, and nature of potentially highly heat-resistant spores in raw milk. High numbers of these spores were detected in the filter cloth of the milking equipment and in green crop and fodder samples. About 700 strains were isolated after the selective heating, of which 635 could be screened by fatty acid methyl ester analysis. Representative strains were subjected to amplified ribosomal DNA restriction analysis, 16S rRNA gene sequencing, percent G+C content, and DNA-DNA reassociations for further identification. The strain collection showed a remarkable diversity, with representatives of seven aerobic spore-forming genera. Bacillus licheniformis and Bacillus pallidus were the most predominant species overall. Twenty-three percent of the 603 spore-forming isolates proved to belong to 18 separate novel species. These findings suggest that the selective heating revealed a pool of unknown organisms with a higher heat-resistant character. This study showed that high spore counts can occur at the dairy farm and that feed and milking equipment can act as reservoirs or entry points for potentially highly heat-resistant spores into raw milk. Lowering this spore load by good hygienic measures could probably further reduce the contamination level of raw milk, in this way minimizing the aerobic spore-forming bacteria that could lead to spoilage of milk and dairy products. Assessment and characterization of this particular flora are of great importance to allow the dairy or food industry to adequately deal with newly arising microbiological problems.

The present study reports the synthesis of silver (Ag) nanoparticles from silver precursor using plant biomaterials, Curcuma longa tuber powder and extract. Water-soluble organics present in the plant materials were mainly responsible for the reduction of silver ions to nano-sized silver particles. pH played a major role in size control of the particles. Silver nanoparticle synthesis was higher in tuber extract compared to powder, which was attributed to the large and easy availability of the reducing agents in the extract. Zeta potential studies showed that the surface charge of the formed nanoparticles was highly negative. The minimum bactericidal concentration (MBC) for Escherichia coli BL-21 strain was found to be 50 mg/L. Immobilization of silver nanoparticles on cotton cloth using sterile water showed better bactericidal activity when compared to polyvinylidene fluoride (PVDF) immobilized cloth, but on consecutive washing the activity reduced drastically in sterile water immobilized cloth.

In this paper we explore the direct transfer via lamination of chemical vapor deposition graphene onto different flexible substrates. The transfer method investigated here is fast, simple, and does not require an intermediate transfer membrane, such as polymethylmethacrylate, which needs to be removed afterward. Various substrates of general interest in research and industry were studied in this work, including polytetrafluoroethylene filter membranes, PVC, cellulose nitrate/cellulose acetate filter membranes, polycarbonate, paraffin, polyethylene terephthalate, paper, and cloth. By comparing the properties of these substrates, two critical factors to ensure a successful transfer on bare substrates were identified: the substrate's hydrophobicity and good contact between the substrate and graphene. For substrates that do not satisfy those requirements, polymethylmethacrylate can be used as a surface modifier or glue to ensure successful transfer. Our results can be applied to facilitate current processes and open up directions for applications of chemical vapor deposition graphene on flexible substrates. A broad range of applications can be envisioned, including fabrication of graphene devices for opto/organic electronics, graphene membranes for gas/liquid separation, and ubiquitous electronics with graphene.

Metal-organic frameworks (MOFs) have received increasing attention as promising electrode materials in supercapacitors (SCs). Yet poor conductivity in most MOFs largely thwarts their capacitance and/or rate performance. In this work, an effective strategy was developed to reduce the bulk electric resistance of MOFs by interweaving MOF crystals with polyaniline (PANI) chains that are electrochemically deposited on MOFs. Specifically we synthesized cobalt-based MOF crystals (ZIF-67) onto carbon cloth (CC) and further electrically deposited PANI to give a flexible conductive porous electrode (noted as PANI-ZIF-67-CC) without altering the underlying structure of the MOF. Electrochemical studies showed that the PANI-ZIF-67-CC exhibits an extraordinary areal capacitance of 2146 mF cm(-2) at 10 mV s(-1). A symmetric flexible solid-state supercapacitor was also assembled and tested. This strategy may shed light on designing new MOF-based supercapacitors and other electrochemical devices.

OBJECTIVE

To investigate whether the direct application of vibratory stimuli inhibits spasticity and improves motor function in the hemiplegic upper limbs of post-stroke patients.

METHODS

Prospective pilot study.

METHODS

University hospital rehabilitation centre.

METHODS

Fourteen post-stroke patients (mean age = 57.3 years; SD = 19.1 years).

METHODS

A hand and forearm stimulation device and an upper-arm stimulation device, consisting of vibrators, a wooden frame and a cloth strap, applied to the upper limbs of subjects.

METHODS

The modified Ashworth scale (MAS) score, F-wave parameters and motor-function parameters (finger tapping, active range of motion and the simple test for evaluating hand function).

RESULTS

Subjects showed significant and potentially durable improvements in MAS score (p < 0.01), F-wave parameters (p < 0.01) and motor-function parameters (p < 0.05). The MAS score, F-wave parameters and motor-function parameters dropped below the baseline values after vibratory stimulation. The MAS score and F-wave parameters remained significantly below the baseline 30 minutes after stimulation.

CONCLUSIONS

The direct application of vibratory stimuli is an effective non-pharmacological anti-spastic treatment that could facilitate stroke rehabilitation. These results provide good evidence of potential short-term benefits of anti-spastic vibratory therapy in post-stroke patients in terms of decreased muscle tonus and improved motor function.

A simple and facile method for obtaining patterned graphene under ambient conditions on the surface of diverse materials ranging from renewable precursors such as food, cloth, paper, and cardboard to high-performance polymers like Kevlar or even on natural coal would be highly desirable. Here, we report a method of using multiple pulsed-laser scribing to convert a wide range of substrates into laser-induced graphene (LIG). With the increased versatility of the multiple lase process, highly conductive patterns can be achieved on the surface of a diverse number of substrates in ambient atmosphere. The use of a defocus method results in multiple lases in a single pass of the laser, further simplifying the procedure. This method can be implemented without increasing processing times when compared with laser induction of graphene on polyimide (Kapton) substrates as previously reported. In fact, any carbon precursor that can be converted into amorphous carbon can be converted into graphene using this multiple lase method. This may be a generally applicable technique for forming graphene on diverse substrates in applications such as flexible or even biodegradable and edible electronics.

BACKGROUND

Skin asepsis is a sentinel strategy for reducing risk of surgical site infections. In this study, chlorhexidine gluconate (CHG) skin concentrations were determined after preoperative showering/skin cleansing using 4% CHG soap or 2% CHG-impregnated polyester cloth.

METHODS

Subjects were randomized to one of three shower (4% soap)/skin cleansing (2% cloth) groups (n = 20 per group): (group 1 A/B) evening, (group 2 A/B) morning, or (group 3 A/B) evening and morning. After showering or skin cleansing, volunteers returned to the investigator's laboratory where CHG skin surface concentrations were determined at five separate skin sites. CHG concentrations were compared with CHG minimal inhibitory concentration that inhibits 90% (MIC(90)) of staphylococcal skin isolates.

RESULTS

CHG MIC(90) for 61 skin isolates was 4.8 parts per million (ppm). In group 1A, 4% CHG skin concentrations ranged from 17.2 to 31.6 ppm, and CHG concentrations were 361.5 to 589.5 ppm (p < 0.0001) in group 1B (2%). In group 2A (4%), CHG levels ranged from 51.6 to 119.6 ppm and 848.1 to 1,049.6 ppm in group 2B (2%), respectively (p < 0.0001). CHG levels ranged from 101.4 to 149.4 ppm in the 4% CHG group (group 3A) compared with 1,484.6 to 2,031.3 ppm in 2% CHG cloth (group 3B) group (p < 0.0001). Effective CHG levels were not detected in the 4% CHG group in selected sites in seven (35%) subjects in group 1A, three (15%) in group 2A, and five (25%) in group 3A.

CONCLUSIONS

Effective CHG levels were achieved on most skin sites after using 4% CHG; gaps in antiseptic coverage were noted at selective sites even after repeated application. Use of the 2% CHG polyester cloth resulted in considerably higher skin concentrations with no gaps in antiseptic coverage. Effective decolonization of the skin before hospital admission can play an important role in reducing risk of surgical site infections.

Many researchers hypothesize that plant richness declines at high soil fertility (and high productivity) due to light limitation. We tested this hypothesis in an old-field by independently manipulating fertilization and light levels via shade cloth (decreased light), vegetation tie-backs (increased light) and vegetation clipping (increased light). Droughts occurred during two of the four years of the study, and we found that higher light levels were generally associated with decreased plant richness in drought years but increased plant richness in wet years. Most importantly, fertilization decreased richness whether light availability limited richness (wet years) or did not limit richness (drought years), and the effects of fertilization and light manipulation treatments were additive. These results suggest that effects of fertilization on plant richness are at least partly independent of light levels and that competition for resources other than light plays a substantial role in the decline of plant richness after fertilization.

BACKGROUND

A paucity of data exists regarding the effectiveness of daily chlorhexidine gluconate (CHG) bathing in non-intensive care unit (ICU) settings.

OBJECTIVE

To evaluate the effectiveness of daily CHG bathing in a non-ICU setting to reduce methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enteroccocus (VRE) hospital-acquired infections (HAIs), compared with daily bathing with soap and water.

METHODS

Quasi-experimental study design; the primary outcome was the composite incidence of MRSA and VRE HAIs. Clostridium difficile HAI incidence was measured as a nonequivalent dependent variable with which to assess potential confounders.

METHODS

Four general medicine units, with a total of 94 beds, at a 719-bed academic tertiary-care facility in Providence, Rhode Island.

METHODS

A total of 7,102 and 7,699 adult patients were admitted to the medical service in the control and intervention groups, respectively. Patients admitted from January 1 through December 31, 2008, were bathed daily with soap and water (control group), and those admitted from February 1, 2009, through March 31, 2010, were bathed daily with CHG-impregnated cloths (intervention group).

RESULTS

Daily bathing with CHG was associated with a 64% reduced risk of developing the primary outcome, namely, the composite incidence of MRSA and VRE HAIs (hazard ratio, 0.36 [95% CI, 0.2-0.8]; P = .01). There was no change in the incidence of C. difficile HAIs (P = .6). Colonization with MRSA was associated with an increased risk of developing a MRSA HAI (hazard ratio, 8 [95% CI, 3-19]; P < .001).

CONCLUSIONS

Daily CHG bathing was associated with a reduced HAI risk, using a composite endpoint of MRSA and VRE HAIs, in a general medical inpatient population.

BACKGROUND

Chlorhexidine bathing has been associated with reductions in healthcare-associated bloodstream infection. To determine the impact and sustainability of the effect of chlorhexidine bathing on central venous catheter-associated bloodstream infection, we performed a prospective, 3-phase, multiple-hospital study.

METHODS

In the medical intensive care unit and the respiratory care unit of a tertiary care hospital and the medical-surgical intensive care units of 4 community hospitals, rates of central venous catheter-associated bloodstream infection were collected prospectively for each period. Pre-intervention (phase 1) patients were bathed with soap and water or nonmedicated bathing cloths; active intervention (phase 2) patients were bathed with 2% chlorhexidine gluconate cloths with the number of baths administered and skin tolerability assessed; post-intervention (phase 3) chlorhexidine bathing was continued but without oversight by research personnel. Central venous catheter-associated bloodstream infection rates were compared over study periods using Poisson regression.

RESULTS

Compared with pre-intervention, during active intervention there were significantly fewer central venous catheter-associated bloodstream infections (6.4/1000 central venous catheter days vs 2.6/1000 central venous catheter days, relative risk, 0.42; 95% confidence interval, 0.25-0.68; P<.001), and this reduction was sustained during post-intervention (2.9/1000 central venous catheter days; relative risk, 0.46; 95% confidence interval, 0.30-0.70; P<.001). During the active intervention period, compliance with chlorhexidine bathing was 82%. Few adverse events were observed.

CONCLUSIONS

In this multiple-hospital study, chlorhexidine bathing was associated with significant reductions in central venous catheter-associated bloodstream infection, and these reductions were sustained post-intervention when chlorhexidine bathing was unmonitored. Chlorhexidine bathing was well tolerated and is a useful adjunct to reduce central venous catheter-associated bloodstream infection.