Liquid and Dry Swabs for Culture- and PCR-Based Detection of Colonization with Methicillin-Resistant Staphylococcus aureus during Admission Screening

Rapid detection of methicillin-resistant Staphylococcus aureus (MRSA) colonization status facilitates isolation and decolonization and reduces MRSA infections. Liquid but not dry swabs allow fully automated detection methods. However, the accuracy of culture and polymerase chain reaction (PCR) using liquid and dry swabs has not been analyzed. We compared different swab collection systems for routine nasal–throat MRSA screening in patients admitted to a tertiary care trauma center in Germany. Over 3 consecutive months, dry swabs (month 1), ESwabs (month 2), or MSwabs (month 3) were processed using Cepheid GeneXpert, Roche cobas and BD-MAX™ MRSA tests compared to chromogenic culture. Among 1680 subjects, the MRSA detection rate using PCR methods did not differ significantly between dry swabs, ESwab, and MSwab (6.0%, 6.2%, and 5.3%, respectively). Detection rates using chromogenic culture were 2.9%, 3.9%, and 1.9%, using dry, ESwab, and MSwab, respectively. Using chromogenic culture as the “gold standard”, negative predictive values for the PCR tests ranged from 99.2–100%, and positive predictive values from 33.3–54.8%. Thus, efficient and accurate MRSA screening can be achieved using dry, as well as liquid E- or MSwab, collection systems. Specimen collection using ESwab or MSwab facilitates efficient processing for chromogenic culture in full laboratory automation while also allowing molecular testing in automated PCR systems.

Treatment of poultry slaughterhouse wastewater using a static granular bed reactor (SGBR) coupled with ultrafiltration (UF) membrane system

The South African poultry industry has grown exponentially in recent years due to an increased demand for their products. As a result, poultry plants consume large volumes of high quality water to ensure that hygienically safe poultry products are produced. Furthermore, poultry industries generate high strength wastewater, which can be treated successfully at low cost using anaerobic digesters. In this study, the performance of a bench-scale mesophilic static granular bed reactor (SGBR) containing fully anaerobic granules coupled with an ultrafiltration (UF) membrane system, as a post-treatment system, was investigated. The poultry slaughterhouse wastewater was characterized by a chemical oxygen demand (COD) range between 1,223 and 9,695mg/L, average biological oxygen demand of 2,375mg/L and average fats, oil and grease (FOG) of 554mg/L. The SGBR anaerobic reactor was operated for 9 weeks at different hydraulic retention times (HRTs), i.e. 55 and 40 h, with an average organic loading rate (OLR) of 1.01 and 3.14g COD/L.day. The SGBR results showed an average COD, total suspended solids (TSS) and FOG removal of 93%, 95% and 90% respectively, for both OLR. The UF post-treatment results showed an average of COD, TSS and FOG removal of 64%, 88% and 48%, respectively. The overall COD, TSS and FOG removal of the system (SGBR and UF membrane) was 98%, 99.8%, and 92.4%, respectively. The results of the combined SGBR reactor coupled with the UF membrane showed a potential to ensure environmentally friendly treatment of poultry slaughterhouse wastewater.

A systematic review of interventions promoting clinical information retrieval technology (CIRT) adoption by healthcare professionals

PURPOSE

This paper presents the evidence on the effectiveness of interventions promoting the use of clinical information retrieval technologies (CIRTs) by healthcare professionals.

METHODS

We electronically searched articles published between January 1990 and March 2008 using following inclusion criteria: (1) participants were healthcare professionals; (2) specific intervention promoted CIRT adoption; (3) studies were randomised controlled trials, controlled clinical trials, controlled before and after studies or interrupted time series analyses; and (4) they objectively reporting measured outcomes on CIRT use.

RESULTS

We found nine studies focusing on CIRT use. Main outcomes measured were searching skills and/or frequency of use of electronic databases by healthcare professionals. Three studies reported a positive effect of the intervention on CIRT use, one showed a positive impact post-intervention, and four studies failed to demonstrate significant intervention effect. The ninth study examined financial disincentives, and found a significant negative effect of introducing user fees for searching MEDLINE in clinical settings. A meta-analysis showed that educational meetings were the only type of interventions reporting consistent positive effects on CIRT adoption.

CONCLUSION

CIRT is an information and communication technology commonly used in healthcare settings. Interventions promoting CIRT adoption by healthcare professionals have shown some success in improving searching skills and use of electronic databases. However, the effectiveness of these interventions remains uncertain and more rigorous studies are needed.