Foot lesions and forelimb skin abrasions in suckling piglets: development and risk factors

BACKGROUND

Foot lesions in suckling piglets have been associated with poor flooring in several studies and were recently proposed to be indicative of swine inflammatory and necrosis syndrome. However, identical findings are also the typical outcome of various non-infectious causes; thus, further risk analysis is needed. The objective of this study was to describe the development of heel bruising, coronary band lesions and forelimb skin abrasion in suckling pigs up to 5 days of age. Furthermore, the effects of various intrinsic and extrinsic factors were examined. On each of four commercial piglet-producing farms, piglets from two or three batches of eight sows were studied. The piglets were included within 18 h after birth. Each piglet was individually scored four times. The score for the heels differentiated six (0-5) and for the coronary band and forelimb skin abrasion three stages (0-2). The body weight was measured two times. The effect of the floor was estimated by allocating the sows randomly to farrowing pens equipped with either soft rubber mats covered with litter or fully slatted plastic floors.

RESULTS

The final analysis comprised data from 1045 piglets. Foot lesions were not found at birth but started to develop on day 1. On day 5, heel bruising was found in 94%, main claw coronary band lesions in 49% and forelimb skin abrasion in 73% of the piglets. In a multifactorial logistic regression analysis, it was shown that a slatted plastic floor significantly increased the odds of heel bruising and coronary band lesions, while a rubber floor with litter increased the odds of forelimb skin abrasions.

CONCLUSION

Foot and forelimb lesions in new-born piglets are mainly induced by the floor. The effect of slatted plastic floors on heel bruising showed an overwhelming OR of 52.89 (CI 26.29-106.43). Notably, coronary band lesions in young suckling piglets occur on slatted as well as non-slatted floors, indicating that the piglets incur these injuries not only from the wedging of their feet into the gaps between slats but also from contact with the floor while suckling. Based on these findings, preventive measures should be redirected to the improvement of the floor in the farrowing pen, particularly in the area under the sow's udder.

Empowering patients to prevent healthcare-associated infections

In recent years there has been increasing interest in the empowerment of patients to serve as partners in efforts to prevent healthcare-associated infections. However, patients often have limited awareness of the risk for acquisition and dissemination of healthcare-associated pathogens and have received limited information on how they might participate in infection prevention efforts. This review highlights some of the areas where patient empowerment initiatives in infection control and antimicrobial stewardship may be useful and reviews available evidence that such initiatives can be beneficial. Although patients are the primary focus of these initiatives, inclusion of family members should be considered in many situations because they often play a major role in healthcare decision-making.

First indoor radon mapping and assessment excess lifetime cancer risk in Iran

Radon (222Rn) is believed to be the main contributor to lung cancer second to smoking. The first national indoor radon map derived from some scattered regional radon surveys in Iran. The arithmetic mean of indoor radon concentration was calculated to 117.4 ± 97.7 Bq/m3. The mean excess life time cancer risk (ELCR) values were found to be in the range of 0.1%-4.26%, with an overall average value of 1.01%. The mean radon-induced lung cancer risk was 46.8 per million persons. Absence of sufficient indoor radon data showed that national wide monitoring programs should be activated in uncovered areas. Meanwhile, in order to provide further baseline values for radon mapping, we attempted to survey the radon levels inside 50 dwellings of Shabestar County in northwest of Iran. The investigation was also focused on the effects of some buildings related variables. The radon levels recorded varied from 3.92 to 520.12 Bq/m3, with a mean value of 56.19 ± 45.96 Bq/m3. In 9% of dwellings radon concentration exceeded 100 Bq/m3, the limit recommended by the World Health Organization. The average annual effective dose received by the residents of studied area was calculated to be 1.4 mSv. The ELCR was estimated to be 0.54%.

Potential transmission pathways of clinically relevant fungi in indoor swimming pool facilities

Possible transmission pathways of fungi in indoor swimming pool facilities were assessed through fungal counting in different areas of the facilities and typing of the collected fungal isolates. Air, water and surface samples were collected from seven different indoor swimming pool facilities. Fungal species were identified based on their internal transcribed spacer (ITS) sequences. Maximum fungal concentrations of 6.2 CFU/cm², 1.39 CFU/100 mL, and 202 CFU/m³ were found on surfaces, in water and air, respectively. In total, 458 isolates were obtained, belonging to 111 fungal species, of which 50 species were clinically relevant. Phialophora oxyspora (13.3%) and Trichosporon dohaense (5.0%) were the most frequently isolated species and were merely detected on floors, as were the dermatophytes, Trichophyton interdigitale and T. rubrum. Penicillium spp. and Aspergillus spp. were the dominant fungi in water and air. No typical patterns of fungal concentrations along the preferential pathways of pool visitors were observed, however, sites where pool visitors converge while moving from one room (e.g. dressing room) to another (e.g. shower room) and walking barefoot displayed the highest fungal concentrations thus posing the highest risk of contamination. The dispersal of fungi on floors is most likely facilitated by the pool visitors and cleaning tools. Clinically relevant fungi, including the ones rarely identified in nature, were widely detected on floors, in water and in air, as well as on cleaning tools and flexibeams. Preventive measures such as cleaning should minimize the prevalence of clinically relevant fungi in swimming pool facilities since these potentially pose health risks to those vulnerable for infections.

The Oxford knee score and its subscales do not exhibit a ceiling or a floor effect in knee arthroplasty patients: an analysis of the National Health Service PROMs data set

PURPOSE

In this study, we examined whether the OKS demonstrated a floor or a ceiling effect when used to measure the outcome of knee replacement surgery in a large national cohort.

METHODS

NHS PROMs database, containing pre- to 6 month post-operative OKS on 72,154 patients, mean age 69 (SD 9.4), undergoing knee replacement surgery, was examined to establish the proportion of patients achieving top or bottom OKS values pre- and post-operatively.

RESULTS

Pre-operatively, none of patients achieved the maximum/'best' (48) and minimum (0) scores. Post-operatively, no patients (0 %) achieved the minimum/'worst' score, but the percentage achieving the maximum score increased to 2.7 %. Subgroup analyses demonstrated that the highest post-operative overall ceiling percentage was 3 %, in a subgroup of patients between 60 and 79 years of age and 13.7 % in a group of patients who had a pre-operative OKS above 41. Furthermore, 10.8 % of patients achieved the top post-operative OKS-PCS and 4.7 % top post-operative OKS-FCS.

CONCLUSION

Based on NHS PROMs data, the OKS does not exhibit a ceiling or floor effect overall, or for both its pain and function subscales, and remains a valid measure of outcomes for patients undergoing TKA.

LEVEL OF EVIDENCE

Large-scale retrospective observations study, Level II.

Work-related floors as injury hazards - a nationwide pilot project analyzing floors in theatres and education establishments in Germany

BACKGROUND

An adequate dance floor is said to prevent injuries. On the basis of scientific research, numerous recommendations regarding an adequate dance floor have been developed. Up to the present, however, studies have still been lacking into how far these recommendations have already been implemented in theatres with regular dance productions and/or in-house dance ensembles. The aim of this study is to analyze a nationwide survey on dance floors of theatres and education establishments in Germany.

METHODS

A questionnaire-based survey on existence and type of floors in the various dance-related working areas was carried out at theatres and education establishments institutions (n = 86 institutions (n = 76 theatres, n = 10 education establishments). References as to region, size of dance ensembles and dance styles performed were created.

RESULTS

Of all education establishments, 75.3% were equipped with a sprung sub-floor in the ballet studios. In contrast, sprung sub-floors were only found in 29.7% of the working areas, the stage AND ballet studios in theatres. The percentage of theatres providing sprung sub-floors in all rooms used by dancers is even lower. Considering all dance-related work areas, larger ensembles (>30 dancers) were offered better conditions regarding floors than smaller ensembles (p > 0.001). No significant tendencies were found regarding regions or dance styles.

CONCLUSION

Recommendations concerning an appropriate dance floor have only partly been realized. Besides secured finances for reinstallation, further education of responsible officials and artists is essential. However, accrediting dance as own genre in theatres is the indispensable prerequisite.

Hospital Clostridium difficile outbreak linked to laundry machine malfunction

Clostridium difficile is a gram-positive, spore-forming anaerobic bacillus that is associated with diarrheal disease. C difficile is shed in the feces of affected individuals and its spores can survive on surfaces for prolonged periods of time. These spores can contaminate a hospital environment by spread through health care workers and suboptimal environmental cleaning practices. We report an outbreak of health care facility-onset C difficile infection that was eventually linked to contaminated mop pads after a laundry machine malfunction.