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Zaraa I, Dehavay F, Richert B. Onychomycosis. Hand Surg Rehabil 2024:101638. [PMID: 38218374 DOI: 10.1016/j.hansur.2024.101638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/11/2023] [Indexed: 01/15/2024]
Abstract
Onychomycosis is a fungal infection of the nail, and the most common nail infection worldwide, causing discoloration and thickening of the nail plate. It is predominantly caused by dermatophytes. Clinical presentation is polymorphous. Diagnosis must be confirmed by mycological examination before initiating any therapy. Management is an ongoing challenge, often requiring several months' treatment, with a high risk of recurrence. Treatment must be adapted to clinical presentation and severity and to the patient's history and wishes. Debridement of all infected keratin is the first step, reducing fungal load. Systemic treatments are more effective than topical treatments, and combining the two increases the cure rate. Terbinafine is the drug of choice for dermatophyte onychomycosis, due to low drug interaction and good cost-effectiveness. Itraconazole and fluconazole are broad-spectrum antifungals that are effective against dermatophytes, yeasts, and some non-dermatophytic molds. Recurrence rates for onychomycosis are high. Prophylactic application of topicals and avoiding walking barefoot in public places may help prevent recurence.
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Affiliation(s)
- Inès Zaraa
- Dermatology Department, Saint Joseph Hospital, Paris, France.
| | - Florence Dehavay
- Dermatology Department, Université Libre de Bruxelles, University Hospital Brugmann and Saint-Pierre, Brussels, Belgium.
| | - Bertrand Richert
- Dermatology Department, Université Libre de Bruxelles, University Hospital Brugmann and Saint-Pierre, Brussels, Belgium.
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Donskey CJ. Update on potential interventions to reduce the risk for transmission of health care-associated pathogens from floors and sinks. Am J Infect Control 2023; 51:A120-A125. [PMID: 37890941 DOI: 10.1016/j.ajic.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/09/2023] [Indexed: 10/29/2023]
Abstract
Health care facility floors and sink drains and other wastewater drainage sites are universally contaminated with potential pathogens and there are plausible mechanisms by which organisms can be disseminated from these sites. However, floors and sink drains are not addressed as potential sources of pathogen transmission in most health care facilities. One factor that has hindered progress in addressing floors and sinks has been the lack of practical and effective measures to reduce the risk for dissemination of organisms from these sites. This article provides an update on some of the potential interventions being used to reduce the risk for transmission of health care-associated pathogens from floors and sinks. Practical approaches to address these sites of contamination are emphasized.
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Affiliation(s)
- Curtis J Donskey
- Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH.
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3
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Torres-Teran MM, Bennett CTP, Osborne AO, Cadnum JL, Wilson BM, Donskey CJ. Effectiveness of ultraviolet-C light treatment of shoes in reducing the transfer of pathogens into patient rooms by shoes of healthcare personnel. Infect Control Hosp Epidemiol 2023; 44:1361-1364. [PMID: 36177872 DOI: 10.1017/ice.2022.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Contaminated shoes are a potential vector for dissemination of healthcare-associated pathogens. We demonstrated that healthcare personnel walking into patient rooms frequently transferred pathogens from their shoes to the floor. An 8-second treatment of shoes with a UV-C decontamination device significantly reduced the frequency of transfer of vegetative bacterial pathogens.
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Affiliation(s)
| | | | - Andrew O Osborne
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jennifer L Cadnum
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Brigid M Wilson
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Curtis J Donskey
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
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Rangel K, Cabral FO, Lechuga GC, Villas-Bôas MHS, Midlej V, De-Simone SG. Effectiveness Evaluation of a UV-C-Photoinactivator against Selected ESKAPE-E Pathogens. Int J Environ Res Public Health 2022; 19:16559. [PMID: 36554438 PMCID: PMC9778679 DOI: 10.3390/ijerph192416559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/23/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Healthcare-associated infections (HAI) worldwide includes infections by ESKAPE-E pathogens. Environmental surfaces and fomites are important components in HAI transmission dynamics, and shoe soles are vectors of HAI. Ultraviolet (UV) disinfection is an effective method to inactivate pathogenic microorganisms. In this study, we investigated whether the SANITECH UV-C shoe sole decontaminator equipment that provides germicidal UV-C radiation could effectively reduce this risk of different pathogens. Six standard strains and four clinical MDR strains in liquid and solid medium were exposed to a UV-C System at specific concentrations at other times. Bacterial inactivation (growth and cultivability) was investigated using colony counts and resazurin as metabolic indicators. SEM was performed to assess the membrane damage. Statistically significant reduction in cell viability for all ATCCs strains occurred after 10 s of exposure to the UV-C system, except for S. enterica, which only occurred at 20 s. The cell viability of P. aeruginosa (90.9%), E. faecalis and A. baumannii (85.3%), S. enterica (82.9%), E. coli (79.2%) and S. aureus (71.9%) was reduced considerably at 20 s. In colony count, after 12 s of UV-C exposure, all ATCC strains showed a 100% reduction in CFU counts, except for A. baumannii, which reduced by 97.7%. A substantial reduction of colonies above 3 log10 was observed at 12 and 20 s in all bacterial strains tested, except for A. baumannii ATCC 19606 (12 s). The exposure of ATCCs bacterial strains to the UV-C system for only 2 s was able to reduce 100% in the colony forming units (CFU) count in all ATCCs strains, S. aureus, P. aeruginosa, E. coli, A. baumannii, E. faecalis, except the S. enterica strain which had a statistically significant reduction of 99.7%. In ATCC strains, there was a substantial decrease in colonies after 4 s (sec) of exposure to the UV-C system, with a reduction ranging from 3.78-4.15 log10 CFU/mL. This reduction was observed in MDR/ESKAPE-E strains within 10 s, showing that UV-C could eliminate above 3.84 log10 CFU/mL. SEM showed a reduction of pili-like appendages after UV-C treatment in all strains except for E. coli (ATCC 25922). The Sanitech UV-C shoe sole decontaminator equipment from Astech Serv. and Fabrication Ltd. (Petrópolis, Brazil), effectively killed in vitro a series of ATCCs and MDR/ESKAPE-E bacteria of sanitary interest, commonly found in the hospital environment.
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Affiliation(s)
- Karyne Rangel
- Center for Technological Development in Health (CDTS)/National Institute of Science and Technology for Innovation in Neglected Population Diseases (INCT-IDPN), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, RJ, Brazil
- Laboratory of Epidemiology and Molecular Systematics (LESM), Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, RJ, Brazil
| | - Fellipe O. Cabral
- Health Sciences Center, Institute of Microbiology Paulo de Góes, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-853, RJ, Brazil
| | - Guilherme C. Lechuga
- Center for Technological Development in Health (CDTS)/National Institute of Science and Technology for Innovation in Neglected Population Diseases (INCT-IDPN), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, RJ, Brazil
- Laboratory of Epidemiology and Molecular Systematics (LESM), Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, RJ, Brazil
| | - Maria H. S. Villas-Bôas
- Microbiology Department, National Institute for Quality Control in Health (INCQS), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, RJ, Brazil
| | - Victor Midlej
- Structural Biology Laboratory (LBE), Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, RJ, Brazil
| | - Salvatore G. De-Simone
- Center for Technological Development in Health (CDTS)/National Institute of Science and Technology for Innovation in Neglected Population Diseases (INCT-IDPN), Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, RJ, Brazil
- Laboratory of Epidemiology and Molecular Systematics (LESM), Oswaldo Cruz Institute, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro 21040-900, RJ, Brazil
- Post-Graduation Program in Science and Biotechnology, Department of Molecular and Cellular Biology, Biology Institute, Federal Fluminense University (UFF), Niterói 22040-036, RJ, Brazil
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Torres-Teran MM, Alhmidi H, Koganti S, Jencson AL, Cadnum JL, Wilson BM, Donskey CJ. Dissemination of methicillin-resistant Staphylococcus aureus and bacteriophage MS2 from floors in long-term care facility resident rooms. Am J Infect Control 2022; 51:714-717. [PMID: 36195154 DOI: 10.1016/j.ajic.2022.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 11/29/2022]
Abstract
We demonstrated that methicillin-resistant Staphylococcus aureus (MRSA) contamination on floors in the rooms of colonized long-term care facility residents was frequently transferred by shoes to adjacent patient rooms. A benign virus inoculated onto the floor was transferred to floors and high-touch surfaces in adjacent rooms and the nursing station. These results suggest that shoes may serve as a vector for dissemination of healthcare-associated pathogens from rooms of MRSA-colonized patients.
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Affiliation(s)
| | - Heba Alhmidi
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Sreelatha Koganti
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Annette L Jencson
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Jennifer L Cadnum
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Brigid M Wilson
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Curtis J Donskey
- Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio.
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Büchler AC, Wicki M, Frei R, Hinic V, Seth-Smith HMB, Egli A, Widmer AF. Matching Clostridioides difficile strains obtained from shoe soles of healthcare workers epidemiologically linked to patients and confirmed by whole genome sequencing. J Hosp Infect 2022; 126:10-15. [PMID: 35562075 DOI: 10.1016/j.jhin.2022.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/27/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The source of transmission of Clostridioides difficile in healthcare institutions is frequently unknown. The aim of this prospective cohort study was to assess the association between strains cultured from patients and shoe soles of healthcare workers (HCW), as already shown in the operation theatre, but not on general hospital wards in an acute care institution. METHODS We conducted a study at a university tertiary care center in Switzerland. From October 2019 to July 2020, shoe soles of HCW were cultured for C. difficile twice per shift while taking care of a patient infected with toxigenic C. difficile. Additional risk factors were assessed by interviewing involved HCW. Patients' fecal samples were processed by routine microbiological methods. Similarity of the HCWs' and patients' strains was determined by whole genome sequencing (WGS). RESULTS 103 HCW exposed to 42 hospitalized patients participated in the study, providing 206 samples. Contamination of shoe soles with C. difficile was detected in 37 samples (17.8%) of HCW taking care of patients infected with C. difficile. Overall, transmission was suspected by epidemiological link and matching strains demonstrated by WGS in 74%. CONCLUSIONS HCW' shoe soles were positive in 17.8% with C. difficile strains linked epidemiologically and confirmed by WGS to infected patients suggesting potential transmission by HCWs' shoe soles. This pilot study provides sufficient evidence to further evaluate this potential mode of healthcare-associated transmission of C. difficile by a larger clinical trial.
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Affiliation(s)
- A C Büchler
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - M Wicki
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - R Frei
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - V Hinic
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland; Clinical Bacteriology and Mycology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - H M B Seth-Smith
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland; Clinical Bacteriology and Mycology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - A Egli
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland; Clinical Bacteriology and Mycology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - A F Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.
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Thomas RE, Thomas BC, Conly J, Lorenzetti D. Hospital and Long-Term Care Facility Environmental Service Workers' Training, Skills, Activities, and Effectiveness in Cleaning and Disinfection: A Systematic Review. J Hosp Infect 2022. [DOI: 10.1016/j.jhin.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/19/2022]
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Jo J, Gonzales-Luna AJ, Lancaster CK, McPherson JK, Begum K, Jahangir Alam M, Garey KW. Multi-country surveillance of Clostridioides difficile demonstrates high prevalence of spores in non-healthcare environmental settings. Anaerobe 2022; 75:102543. [DOI: 10.1016/j.anaerobe.2022.102543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 01/05/2023]
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Zhang J, Wang X, Sun Z, Zhu B. How dirty are the pens in health-care environment? An easily overlooked detail of hand hygiene. Am J Infect Control 2022; 50:108-110. [PMID: 34320408 DOI: 10.1016/j.ajic.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/21/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022]
Abstract
Pens, common in hospitals, may be a potential vehicle for cross-infection. In this study, the number of pathogens on different pens and the positive rates of several common multi-drug-resistant bacteria were calculated and compared according to the nature of use and material. In addition, the effect of pens on bacterial transmission was explored through simulation experiments. High levels of bacteria were found on pens and the simulations demonstrated transmission of bacteria.
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Affiliation(s)
- Jianlu Zhang
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University/ Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Xin Wang
- Department of Clinical Medicine, Medical College of Qinghai University, Xining, China
| | - Zhipeng Sun
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University/ Peking University Ninth School of Clinical Medicine, Beijing, China.
| | - Bin Zhu
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University/ Peking University Ninth School of Clinical Medicine, Beijing, China.
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Thomas RE, Thomas BC. Reducing Biofilm Infections in Burn Patients' Wounds and Biofilms on Surfaces in Hospitals, Medical Facilities and Medical Equipment to Improve Burn Care: A Systematic Review. Int J Environ Res Public Health 2021; 18:13195. [PMID: 34948803 PMCID: PMC8702030 DOI: 10.3390/ijerph182413195] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 11/21/2022]
Abstract
Biofilms in burns are major problems: bacterial communities rapidly develop antibiotic resistance, and 60% of burn mortality is attributed to biofilms. Key pathogens are Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and multidrug-resistant Acinetobacter baumanii. Purpose: identify current and novel interventions to reduce biofilms on patients' burns and hospital surfaces and equipment. Medline and Embase were searched without date or language limits, and 31 possible interventions were prioritised: phages, nano-silver, AgSD-NLs@Cur, Acticoat and Mepilex silver, acetic acid, graphene-metal combinations, CuCo2SO4 nanoparticles, Chlorhexidene acetate nanoemulsion, a hydrogel with moxifloxacin, carbomer, Chitosan and Boswellia, LED light therapy with nano-emodin or antimicrobial blue light + Carvacrol to release reactive oxygen species, mannosidase + trypsin, NCK-10 (a napthalene compound with a decyl chain), antimicrobial peptide PV3 (includes two snake venoms), and polypeptides P03 and PL2. Most interventions aimed to penetrate cell membranes and reported significant reductions in biofilms in cfu/mL or biofilm mass or antibiotic minimal inhibitory concentrations or bacterial expression of virulence or quorum sensing genes. Scanning electron microscopy identified important changes in bacterial surfaces. Patients with biofilms need isolating and treating before full admission to hospital. Cleaning and disinfecting needs to include identifying biofilms on keyboards, tablets, cell phones, medical equipment (especially endoscopes), sinks, drains, and kitchens.
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Affiliation(s)
- Roger E. Thomas
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
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Redmond SN, Pearlmutter BS, Ng-Wong YK, Alhmidi H, Cadnum JL, Silva SY, Wilson BM, Donskey CJ. Timing and route of contamination of hospitalized patient rooms with healthcare-associated pathogens. Infect Control Hosp Epidemiol 2021;:1-6. [PMID: 33431099 DOI: 10.1017/ice.2020.1367] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To investigate the timing and routes of contamination of the rooms of patients newly admitted to the hospital. DESIGN Observational cohort study and simulations of pathogen transfer. SETTING A Veterans' Affairs hospital. PARTICIPANTS Patients newly admitted to the hospital with no known carriage of healthcare-associated pathogens. METHODS Interactions between the participants and personnel or portable equipment were observed, and cultures of high-touch surfaces, floors, bedding, and patients' socks and skin were collected for up to 4 days. Cultures were processed for Clostridioides difficile, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE). Simulations were conducted with bacteriophage MS2 to assess plausibility of transfer from contaminated floors to high-touch surfaces and to assess the effectiveness of wearing slippers in reducing transfer. RESULTS Environmental cultures became positive for at least 1 pathogen in 10 (59%) of the 17 rooms, with cultures positive for MRSA, C. difficile, and VRE in the rooms of 10 (59%), 2 (12%), and 2 (12%) participants, respectively. For all 14 instances of pathogen detection, the initial site of recovery was the floor followed in a subset of patients by detection on sock bottoms, bedding, and high-touch surfaces. In simulations, wearing slippers over hospital socks dramatically reduced transfer of bacteriophage MS2 from the floor to hands and to high-touch surfaces. CONCLUSIONS Floors may be an underappreciated source of pathogen dissemination in healthcare facilities. Simple interventions such as having patients wear slippers could potentially reduce the risk for transfer of pathogens from floors to hands and high-touch surfaces.
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Vos SJ, Wijnker JJ, Overgaauw PAM. A Pilot Study on the Contamination of Assistance Dogs' Paws and Their Users' Shoe Soles in Relation to Admittance to Hospitals and (In)Visible Disability. Int J Environ Res Public Health 2021; 18:E513. [PMID: 33435167 PMCID: PMC7827110 DOI: 10.3390/ijerph18020513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: People with disabilities may benefit from an assistance dog (AD). Despite regulations that prohibit the denial of ADs to public places, this still occurs on a regular basis. The main argument for denial of access is that dogs compromise hygiene with their presence, which could cause a health hazard. Meanwhile, people are allowed to walk into and out of public places freely. (2) Objective: As a pilot study, to investigate the number of Enterobacteriaceae and the presence of Clostridium difficile bacteria on the paws of ADs and pet dogs (PDs) as well as the shoe soles of their users and owners. With the results, an assessment can be made as to whether measures are required to reduce environmental contamination (e.g., in hospitals). (3) Methods: In total, 25 ADs, 25 PDs, and their 50 users/owners participated in the study. Each participant walked their dog for 15-30 min prior to the sampling of the front paws. Each PD owner or AD user filled out a general questionnaire about the care of their dogs, and AD users were asked to fill out an additional questionnaire on their experiences regarding the admittance of their ADs to public places (in particular, hospitals). Dutch hospitals were questioned on their protocols regarding the admittance of ADs and their visitor numbers, including the percentage of AD users, to put these numbers into perspective. (4) Results: Dog paws were more often negative for Enterobacteriaceae compared to shoe soles (72% and 42%, respectively) and also had significantly lower bacterial counts (mean of 3.54log10 and 5.03log10 colony-forming units (CFUs), respectively; p < 0.05). This was most distinct in the comparison between PDs and their owners (3.75log10 and 5.25log10 CFUs; p < 0.05); the numbers were similar between ADs and their users (3.09log10 and 4.58log10 CFUs; p = 0.2). C. difficile was found on one (4%) AD user's shoe soles. Moreover, 81% of AD users had been denied access with their current AD once or several times, the main reason being hygiene. The results of the visibly and invisibly disabled were significantly different. The number of AD users as opposed to the total number of hospital visitors was 0.03% in one hospital and is estimated to be 0.02% in the Netherlands. (5) Conclusions: The general hygiene of dogs' paws is far better than that of shoe soles, mostly demonstrated by the better general hygiene of PD paws compared with their owners' shoe soles; ADs and their users had comparable levels of general hygiene. In addition, the number of AD users amongst the total number of hospital visitors in the Netherlands is very limited. Thus, hygiene measures to reduce any contamination due to dog paws do not seem necessary.
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Affiliation(s)
| | - Joris J. Wijnker
- Department of Population Health Sciences, Institute for Risk Assessment Sciences, Faculty of Veterinary Medicine, Utrecht University, P.O. Box 80178, 3508 TD Utrecht, The Netherlands; (S.J.V.)
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Saeki M, Sato T, Furuya D, Yakuwa Y, Sato Y, Kobayashi R, Ono M, Nirasawa S, Tanaka M, Nakafuri H, Nakae M, Shinagawa M, Asanuma K, Yanagihara N, Yokota SI, Takahashi S. Clonality investigation of clinical Escherichia coli isolates by polymerase chain reaction-based open-reading frame typing method. J Infect Chemother 2020; 26:38-42. [DOI: 10.1016/j.jiac.2019.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 05/14/2019] [Accepted: 06/30/2019] [Indexed: 11/28/2022]
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Perumalsamy S, Putsathit P, Riley TV. High prevalence of Clostridium difficile in soil, mulch and lawn samples from the grounds of Western Australian hospitals. Anaerobe 2019; 60:102065. [PMID: 31260739 DOI: 10.1016/j.anaerobe.2019.06.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 12/11/2022]
Abstract
Despite being considered a major hospital-associated pathogen for many years, Clostridium difficile has been isolated increasingly from people without hospital contact. In this study, we investigated the prevalence of C. difficile in the immediate outdoor environment of several hospitals in Perth, Western Australia, to provide further insight into potential sources of community-acquired C. difficile infection. Over 6 months, a total of 159 samples consisting of soil, mulch, lawn and sand were collected from outdoor surroundings of four different old (age>50 years) and new (age<10 years) hospitals. Samples were cultured in a C. difficile selective enrichment broth. Toxin gene profiling using PCR, and PCR ribotyping, was performed on all C. difficile recovered. C. difficile was isolated from 96 of the 159 samples (60.4%). Of the 112 isolates, 33 (29.5%) were toxigenic and 49 (43.8%) were identified as novel strains. Ribotypes (RTs) 014/020 (14.3%) and 010 (13.4%) constituted the highest proportion of isolates. Interestingly, RT 017, a strain endemic to the Asia-Pacific region (but not Australia), was found in a newly laid lawn. This study adds to existing knowledge of potential sources of C. difficile in Western Australia. More research is required to determine the route of transmission of C. difficile from community sources into the hospital.
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Alam MJ, McPherson J, Miranda J, Thrall A, Ngo V, Kessinger R, Begum K, Marin M, Garey KW. Molecular epidemiology of Clostridioides difficile in domestic dogs and zoo animals. Anaerobe 2019; 59:107-111. [PMID: 31207298 DOI: 10.1016/j.anaerobe.2019.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/31/2019] [Accepted: 06/14/2019] [Indexed: 02/08/2023]
Abstract
Animals such as domestic dogs and zoo animals reside in close proximity to humans and could contribute to the dissemination of Clostridioides difficile spores which are common in the community environment. The purpose of this study was to assess C. difficile colonization in domestic dogs attending a day boarding facility and zoo animals receiving systemic antibiotics. Stool samples and paw swabs were collected from dogs who attended a day boarding facility. Stool samples were also collected from zoo animals starting systemic antibiotics. Finally, environmental samples were collected from nearby public parks. Stool samples and swabs were incubated anaerobically in enrichment broth for C. difficile growth, PCR was done to confirm presence of toxin genes, and PCR ribotyping was performed for strain characterization. During the study period, 136 dog stool samples were obtained, the paws of 16 dogs were swabbed, and 250 environmental swabs from surrounding public parks were obtained. Twenty-three of 136 dog stool samples (17%) and 9 of 16 dog paws sampled (56%) grew toxigenic C. difficile. One hundred and four stool samples from 49 zoo animals were collected of which 19 (18%) grew toxigenic C. difficile. Rates of toxigenic C. difficile colonization increased significantly during antibiotic therapy (33%) and then returned to baseline during the follow-up (11%) period (p = 0.019). Fifty-five of 250 environmental swabs from public parks (22%) grew toxigenic C. difficile. Ribotypes associated with human disease including 106 and 014-020 were isolated from all sources. This study demonstrated a high rate of toxigenic C. difficile colonization in domestic dogs and zoo animals with ribotypes similar to those causing human disease. These results demonstrate the relationship between humans, animals, and the environment in the dissemination of spores.
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Affiliation(s)
| | | | - Julie Miranda
- University of Houston College of Pharmacy, Houston, TX, USA
| | - Allyson Thrall
- University of Houston College of Pharmacy, Houston, TX, USA
| | - Van Ngo
- University of Houston College of Pharmacy, Houston, TX, USA
| | | | | | | | - Kevin W Garey
- University of Houston College of Pharmacy, Houston, TX, USA.
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16
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Abstract
Efforts to improve environmental cleaning and disinfection typically focus primarily on high-touch surfaces in patient rooms. This review highlights evidence that portable equipment and other shared devices and floors may be underappreciated as sources of dissemination of health care-associated pathogens. Practical approaches to address these sites of contamination are emphasized.
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Affiliation(s)
- Curtis J Donskey
- Geriatric Research, Education and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, and Case Western Reserve University School of Medicine, Cleveland, OH.
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17
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Islam MA, Kabir ND, Moniruzzaman M, Begum K, Ahmed D, Faruque ASG, Garey KW, Alam MJ. Clostridioides difficile ribotypes isolated from domestic environment and from patients in Bangladesh. Anaerobe 2019; 56:88-90. [PMID: 30794875 DOI: 10.1016/j.anaerobe.2019.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 02/10/2019] [Accepted: 02/12/2019] [Indexed: 01/03/2023]
Abstract
Clostridioides difficile infection (CDI) is an emerging but often understudied infectious disease in developing countries. This study was aimed to isolate and characterize C. difficile from shoe sole swabs and diarrheal patient's stool samples in Bangladesh. We collected 94 shoe sole swabs samples from urban communities in Dhaka and 208 diarrheal stool samples from hospitalized patients over a period of 4 months. Samples were incubated anaerobically for C. difficile growth, confirmed toxigenic, and PCR-ribotyped. Eleven of 94 (11.7%) shoe sole swabs and 4 of 208 (1.9%) stool samples were culture positive of which 9 shoe sole isolates were toxigenic. Six PCR ribotypes from the 9 toxigenic isolates were identified with ribotype F014-020 being the most common (n = 4; 44%). The recently identified ribotype 106 strain was also identified. To the best of our knowledge, this is the first report of C. difficile culture, isolation and characterization from environmental sources in Bangladesh.
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