Hand hygiene product use by food employees in casual dining and quick-service restaurants

Hand hygiene product usage characteristics by food employees when hand sanitizers are made available are not well understood. To investigate hand hygiene product usage in casual dining and quick-service restaurants, we placed automated monitoring soap and sanitizer dispensers side-by-side at handwash sinks used by food employees in seven restaurants. Dispenses were monitored, and multiple dispenses that occurred within 60 s of each other were considered a single hand hygiene event. This resulted in 186,998 events during the study (149,779 soap only, 21 985 sanitizer only, and 15,234 regimen [defined as soap followed by sanitizer at the same sink within 60 s]) over 15,447 days of use. Soap was the most frequently used hand hygiene method by food employees in both restaurant types. Regimen use, despite being the preferred hand hygiene method by both restaurant chains, was the least used hand hygiene method. When pooled over restaurant types, the median daily usage for soap was statistically significantly highest of all methods at 23.5 dispenses per sink per day (p < 0.0001), the sanitizer median daily usage was 4.27 dispenses per sink per day, and regimen use was statistically significantly lowest of all methods at 4.02 dispenses per sink per day (p < 0.0001). When hand hygiene event types were pooled, casual dining restaurants had similar median hand hygiene event rates (11.4 dispenses per sink per day) compared to quick-service restaurants (11.9 dispenses per sink per day; p = 0.890). The number of events by sink location varied, with sinks located at a warewash station having the highest number of events (19.3 dispenses per sink per day; p < 0.0001), while sinks located by a ready-to-eat food preparation area had the lowest number of events (6.8 dispenses per sink per day; p < 0.0001). These data provide robust baseline benchmarks for future hand hygiene intervention studies in these settings.

RADT-24. PHASE II STUDY OF PROTON RADIATION THERAPY FOR LOWER GRADE GLIOMAS

PURPOSE

To report preliminary results on outcomes of patients with lower grade gliomas (LGG) treated with proton therapy.

METHODS

Patients with grade II or IDH mutant grade III glioma and indications for radiation therapy were enrolled in a prospective single arm trial of proton therapy (PRT), receiving a dose of 54 Gy(RBE) or 59.4 Gy(RBE), respectively. Comprehensive baseline and regular post-treatment evaluations of neuroendocrine function, neurocognitive functions (NCF), quality of life (QOL), and progression-free survival (PFS) were performed.

RESULTS

Among 60 patients (median age 40.8) who received PRT, 28 (47%) were men, and 39 (65%) were WHO grade II. Eighteen patients (30%) were IDH mutant+1p/19q co-deleted, 36 (60%) were IDH mutant astrocytoma, and 6 (10%) were IDH wildtype. Treatment was at initial diagnosis (41; 68%) or progression (19; 32%). Median follow-up after PRT was 4.1 years. All current data are reported for 3 years from PRT. PFS at 3 years was 86% for all patients, 84% for grade II (n = 39), and 90% for favorable grade III gliomas (n = 21). PFS was 83% for IDH mutant astrocytoma, and 94% for IDH mutant+1p/19q co-deleted oligodendrogliomas. New endocrine dysfunction was detected in 3 patients (5%). There was one grade 4 case of brain necrosis (2%) but no grade 3 toxicities. NCF decline, defined by Z-score drop of &gt;/= 1SD on clinical trials battery composite, occurred in 7% (n = 3/43). QOL assessment by FACT-Brain showed 16% with decline of &gt;/= 10 points (n = 7/43).

CONCLUSIONS

At 3 years post-treatment, LGG patients receiving PRT have a high PFS, similarly to previous reports on photon therapy, few new neuroendocrine deficiencies, modest treatment toxicities, and minimal decline in NCF or QOL. These positive outcomes may be attributable to limited integral dose to the brain by use of PRT, demonstrating its value in treatment of LGG patients with long survival expectations.

Cyprinid herpesvirus 3 as a potential biological control agent for carp (Cyprinus carpio) in Australia: susceptibility of non-target species

Carp (Cyprinus carpio L.) is a pest species in Australian waterways, and cyprinid herpesvirus 3 (CyHV-3) is being considered as a potential biological control (biocontrol) agent. An important consideration for any such agent is its target specificity. In this study, the susceptibility to CyHV-3 of a range of non-target species (NTS) was tested. The NTS were as follows: 13 native Australian, and one introduced, fish species; a lamprey species; a crustacean; two native amphibian species (tadpole and mature stages); two native reptilian species; chickens; and laboratory mice. Animals were exposed to 100-1000 times the approximate minimum amount of CyHV-3 required to cause disease in carp by intraperitoneal and/or bath challenge, and then examined clinically each day over the course of 28 days post-challenge. There were no clinical signs, mortalities or histological evidence consistent with a viral infection in a wide taxonomic range of NTS. Furthermore, there was no molecular evidence of infection with CyHV-3, and, in particular, all RT-PCRs for viral mRNA were negative. As a consequence, the results encourage further investigation of CyHV-3 as a potential biocontrol agent that is specific for carp.

Testicular germ cell tumour presenting as thyrotoxicosis

A case is reported of a patient who presented to his family doctor with a short history of cough with signs and symptoms of thyrotoxicosis. Carbimazole treatment had little effect and his symptoms worsened to include severe shortness of breath. He was investigated further and found to have multiple lung and liver metastases from an unknown primary site. Biopsy and subsequent post-mortem investigations revealed a testicular tumour and a grossly elevated serum human chorionic gonadotrophin (hCG) concentration.

The biochemical and clinical thyrotoxicosis is presumed to be due to the thyrotrophic activity of excess hCG secretion, in a situation analogous to that seen in hydatidiform mole or in hyperemesis gravidarum.

Reduction in interval cancer rates following the introduction of two-view mammography in the UK breast screening programme

BACKGROUND

The introduction of two-view mammography at incident (subsequent) screens in the National Health Service Breast Screening Programme (NHSBSP) has led to an increased number of cancers detected at screen. However, the effect of two-view mammography on interval cancer rates has yet to be assessed.

METHODS

Routine screening and interval cancer data were collated from all screening programmes in the United Kingdom for women aged 50-64, screened between 1 April 2003 and 31 March 2005. Interval cancer rates were compared based on whether two-view mammography was in use at the last routine screen.

RESULTS

The reduction in interval cancers following screening using two-view mammography compared with one view was 0.68 per 1,000 women screened. Overall, this suggests the introduction of two-view mammography at incident screen was accompanied by a 15-20% reduction in interval cancer rates in the NHSBSP.

CONCLUSION

The introduction of two-view mammography at incident screens is associated with a reduction in incidence of interval cancers. This is consistent with previous publications on a contemporaneous increase in screen-detected cancers. The results provide further evidence of the benefit of the use of two-view mammography at incident screens.

Pilot study of cytokine profiles in prostate cancer patients undergoing proton or conventional radiotherapy

The mechanisms responsible for normal tissue late effects following radiotherapy are largely unknown and currently no method for predicting such risks is available. Abnormal levels of cytokine production induced by radiation has been suggested as a contributing factor by multiple investigators. The purpose of the present study was to evaluate plasma levels of transforming growth factor-beta 1 (TGF-beta 1), basic fibroblast growth factor (bFGF), tumor necrosis factor-alpha (TNF-alpha), and interleukin-1 beta (IL-1 beta) in patients with prostate cancer scheduled for radiotherapy (protons, photons, or combination of both). It has been recently shown that ionizing radiation can increase expression of these cytokines and there are indications that they may be associated with morbidity. Blood samples were obtained from 20 subjects (age 51-80) before, during the first week, and immediately after the end of therapy; 3 healthy volunteers served as controls. Significant positive correlations (p<0.05) were obtained between bFGF, IL-1 beta, and TNF-alpha and the integral dose of radiation during the first week of treatment. Correlations approaching significance (p<0.1) were obtained with bFGF and acute treatment-related morbidity. A higher integral dose (due to larger irradiated volumes) was delivered with conventional photon compared to proton irradiation. No significance was obtained with any of the cytokines and pretreatment prostate specific antigen (PSA) levels, patient age, grade or stage of disease, or the integral dose by the end of radiation treatment. These results show that large changes occur in the plasma levels of certain cytokines early after initiation of radiotherapy and that treatment of larger volumes is more likely to induce these changes. Our data support further investigation of the role of cytokines during radiotherapy.

SU-E-T-232: Proton Source Modeling for Geant4 Monte Carlo Simulations

PURPOSE

To investigate the effect of initial proton beam source placement, distribution and angle on the proton dose distribution in a therapeutic nozzle using Geant4.

METHODS

We performed Geant4 Monte Carlo simulations of a passively scattered proton treatment nozzle. Accurate geometry including all elements in the treatment room was used. Protons were generated just inside the vacuum pipe using one of two models. First, a standard two dimensional Gaussian distribution of proton starting position was used with a small random angle added to the initial direction. The size of the Gaussian distribution and the random angle were set to match measured beam spot size and angular spread at the exit window. Second, a point source of protons further back in the vacuum pipe with a small random angle was used. The distance of the point source to exit window and the random angle were set to match the spot size and angular deviation used for the Gaussian distribution. Depth dose curves and orthogonal beam profiles were examined to determine changes between the two models.

RESULTS

Orthogonal beam profiles for large apertures showed changes of up to 6.5% between the two models with the point source showing much better agreement with measured data. Depth dose curves and orthogonal profiles for small apertures were unaffected. For large apertures, the average difference compared to measured data was of 1.9% and 0.7% and the max difference was 5.0% and 1.6% for Gaussian and point sources, respectively.

CONCLUSIONS

The point source more realistically models the proton distribution in the vacuum pipe by correlating the proton position with the direction. For certain scattering setups and large apertures point source modeling is necessary to accurate match measured data with Monte Carlo simulations.

Molecular epidemiology of strangles outbreaks in the UK during 2010

The sequence of the Streptococcus equi subspecies equi (S equi) M-like protein (SeM) gene was determined for 105 isolates of S equi from strangles outbreaks in the UK during 2010 and compared with previous data from 2007 to 2008. Twenty-three distinct alleles were identified, including 11 novel alleles. One allele giving rise to a putative truncated M protein was identified from the guttural pouch of an asymptomatic carrier. Allele 9 was the most prevalent, comprising 57.7 per cent of isolates, followed by allele 6 (10.3 per cent). Significant changes in allele prevalence were found between 2007, 2008 and 2010, with an increasing prevalence in SeM-9-related alleles and a corresponding decreasing prevalence in SeM-6-related alleles observed over the period (P<0.001). Geographical proximity of outbreaks caused by some uncommon alleles was apparent between 2007, 2008 and 2010.

Report of the Second Havemeyer EHV-1 Workshop, Steamboat Springs, Colorado, USA, September 2008

This report summarises the findings of the Second Havemeyer EHV-1 Workshop, which was held in Steamboat Springs, Colorado, USA in September 2008. A total of 38 delegates, consisting of veterinary clinicians and scientists from academia and industry participated in a series of sessions that focused on equine herpesvirus myeloencephalopathy (EHM). Each session consisted of a review, followed by short presentations on current research topics. The sessions included EHM epidemiology, in vivo and in vitro models for studying EHM, EHV-1 virulence determinants, real-time PCR diagnostics, antiviral medications and new vaccination technologies. The report summarises the key advances identified during and since the meeting. Citations are restricted to selected reviews and papers published since the workshop.

A randomised controlled trial comparing Rapid Rhino Mannheim and Netcell series 5000 packs following routine nasal surgery

OBJECTIVES

To determine whether there is a difference in discomfort between Netcell Series 5000 and Rapid Rhino Mannheim 8.0 cm (Cat. No. 800) packs used after routine nasal surgery, whilst in situ and during removal. This was tested in a single blind, randomised controlled trial at the ENT Department, Royal Devon & Exeter Hospital.

PARTICIPANTS

Adults aged 16-65 undergoing nasal septal surgery and trimming of inferior turbinates. Patients were excluded if they were undergoing revision surgery, taking anticoagulants, or had a history of sino-nasal disease or trauma. Thirty nine entered and 32 completed the study. The intervention was a different nasal pack in each side of the nose, removed the morning after surgery.

MAIN OUTCOMES MEASURES

Pain experienced by patients while packs are in situ and on removal as recorded on a standard unmarked 100 mm visual analogue scale.

RESULTS

There was no difference in the pain scores whilst in situ. Rapid Rhino Mannheim was more painful on removal (difference = 10.6 mm, p < 0.001, Wilcoxon signed ranks test).

CONCLUSIONS

Rapid Rhino Mannheim packs do not confer a benefit over Netcell Series 5000 packs after routine nasal surgery.

Socio-demographic and geographic analysis of overweight and obesity in Canadian adults using the Canadian Community Health Survey (2005)

Using the 2005 Canadian Community Health Survey, this study examined how overweight and obesity in Canadian adults are distributed across socio-demographic and geographic groupings. Overweight and obesity prevalence were modeled against socio-demographic indicators using Poisson regression and were assessed geographically using choropleth maps. The Gini coefficient was used to assess the distribution of prevalence across risk groups. The potential impacts of high risk versus population-based prevention approaches on the population prevalence of obesity were also examined. Of adults aged 25 to 64 years, 17% were obese and 53% were overweight or obese, with the highest proportions observed in older age groups, among those who were physically inactive, white or non-immigrant, with low educational levels, and living in the prairie and east coast regions. Recalculation of obesity rates under the different prevention scenarios demonstrated that population-based approaches could achieve a four-fold greater decrease in obesity cases than high risk approaches, highlighting the need for broader population strategies for obesity prevention in Canada.

Implementation of proven interventions in general medical inpatients: development and evaluation of a new quality indicator for drug therapy

BACKGROUND

Among adult general medical inpatients, there are numerous interventions whose benefits outweigh their risks. However, there are no published reports describing the overall use of such proven interventions in this population.

OBJECTIVES

To determine implementation rates of a broad range of interventions while accounting for valid reasons for non-use, predictors of implementation and feasibility of generating new indices to describe quality of care.

METHODS

Based on a review of current practice guidelines and clinical trials related to five common conditions, implementation rates of 17 interventions were assessed retrospectively. Subjects were a complete sample of 150 adults with target medical conditions discharged from general medical units at an urban community hospital.

RESULTS

The Ideal Intervention Index (3I), which described the proportion of ideal intervention opportunities that were implemented, was 0.74 (95% CI 0.70 to 0.78). The Justified Non-Use Index (JNUI), which described the proportion of all the interventions not implemented that were justified by a valid reason for non-use, was 0.49 (95% CI 0.41 to 0.55). Smoking cessation therapy in high-risk patients had the lowest indices (3I 0.30, 95% CI 0.00 to 0.60; JNUI 0.00), and aspirin for secondary stroke prevention had the highest (3I 1.0; JNUI 1.0).

CONCLUSIONS

Overall, proven interventions are underused among the patients studied, and the reasons for non-use are frequently not readily discernible. There is potential for improvement, but research is required to further investigate reasons for non-use. It is feasible to measure implementation rates of proven interventions as an indicator of quality of care using the indices developed.

An unusual cause of interference in a salicylate assay caused by mitochondrial acetoacetyl-CoA thiolase deficiency

Mitochondrial acetoacetyl-CoA thiolase deficiency (or beta-ketothiolase deficiency) is a rare metabolic disorder characterized by acute episodes of severe acidosis and ketosis. A case is presented of an 18-month-old boy who presented with vomiting and diarrhoea and was found to be markedly acidotic. When the acidosis persisted despite saline fluid boluses and bicarbonate correction, further investigations were undertaken. Routine biochemical investigation revealed detectable salicylate concentrations despite the parents denying its administration, which initially caused some diagnostic confusion. The results of urine organic acid analysis, however, confirmed that the diagnosis of mitochondrial acetoacetyl-CoA thiolase deficiency. The high concentrations of acetoacetate present in the patient's sample resulted in a false-positive reaction in the Trinder assay for salicylate.

An observational study of practice during transfer of patients from anaesthetic room to operating theatre

We observed practice during transfer of 80 patients from anaesthetic room to operating theatre, to determine the duration of apnoea and the time without monitoring during the transfer process. Median (IQR [range]) time from disconnection of the breathing system in the anaesthetic room to the first breath in theatre was 54 (44-65 [27-196]) s, and from disconnection of the pulse oximetry probe to the first reading in theatre was 90 (74-103 [44-182]) s. In four patients (5%) arterial oxygen saturation fell to 94%, with the greatest desaturation observed 11%. The transfer process may represent a window of opportunity for the occurrence of harm or the first step in a chain of events leading to harm, and is difficult to justify on patient safety grounds.

Detection of White Spot Syndrome virus and Yellowhead virus in prawns imported into Australia

OBJECTIVE

To determine whether viable White Spot Syndrome virus (WSSV) or Yellowhead virus (YHV) were present in prawn products imported into Australia.

PROCEDURE

A sample of fourteen uncooked prawns was obtained from a consignment imported from southeast Asia. Each of the prawns was examined for WSSV by polymerase chain reaction (PCR), and then a bioassay was conducted in which a 10% homogenate of cuticular epithelium from each of the prawns was inoculated intramuscularly into healthy challenge prawns (Penaeus monodon) from Australia. The latter were then monitored for clinical signs of disease, and tissue samples were processed for electron microscopy, histological examination and for detection of WSSV by in situ hybridization (ISH) using a commercial kit. Limited numbers of haemolymph samples from inoculated challenge prawns were also examined by PCR for the presence of WSSV and YHV. All work was carried out under microbiologically secure conditions.

RESULTS

Results of the initial PCR examination for WSSV on the imported prawns were not definitive. However, in the bioassay, several of the challenge prawns inoculated with homogenates from the imported prawns showed clinical signs of disease (inappetence and lethargy) within 24 h post inoculation (pi) and died at 1 to 4 days pi. Tissue samples from a number of moribund prawns demonstrated lesions typical of White Spot Disease (WSD), and the presence of the virus was confirmed by electron microscopy, ISH and PCR. YHV was also demonstrated by PCR in two challenge prawns inoculated with homogenates.

CONCLUSION

Viable WSSV and YHV were present in frozen prawn products imported into Australia for human consumption from southeast Asia. Importation of frozen infected products may present a risk of transferring virus to wild and farmed populations of crustaceans in this country. To date, WSD and Yellowhead Disease remain exotic to Australia.