The Use of a Droplet Collar Accessory Attached to a Portable near Infrared Instrument to Identify Methanol Contamination in Whisky

The aim of this study was to evaluate the ability of a droplet collar accessory attached to a portable near-infrared (NIR) instrument to characterize the artificial contamination of methanol in commercial whisky samples. Unadulterated samples (n = 12) were purchased from local bottle shops where adulterated samples were created by adding methanol (99% pure methanol) at six levels (0.5%, 1%, 2%, 3%, 4% and 5% v/v) to the commercial whisky samples (controls). Samples were analyzed using a drop collar accessory attached to a MicroNIR Onsite instrument (900-1650 nm). Partial least squares (PLS) cross-validation statistics obtained for the prediction of all levels of methanol (from 0 to 5%) addition were considered adequate when the whole adulteration range was used, coefficient of determination in cross-validation (R2cv: 0.95) and standard error in cross of validation (SECV: 0.35% v/v). The cross-validation statistics were R2cv: 0.97, SECV: 0.28% v/v after the 0.5% and 1% v/v methanol addition was removed. These results showed the ability of using a new sample presentation attachment to a portable NIR instrument to analyze the adulteration of whisky with methanol. However, the low levels of methanol adulteration (0.5 and 1%) were not well predicted using the NIR method evaluated.

Compliance with universal precautions among emergency department personnel caring for trauma patients

STUDY OBJECTIVE

Emergency department personnel are at high risk of occupational infection with bloodborne pathogens. The objective of this study was to observe and analyze the use of barrier precautions among ED personnel caring for trauma patients.

METHODS

This observational study used videotapes of trauma cases seen at an urban Level I trauma center. Study participants were ED and trauma team personnel. Trained observers scored breaks in the use of barrier precautions during the first 15 minutes of 88 videotaped Level I trauma cases. "Major" breaks were scored when ED personnel performed invasive procedures without gloves, mask, gown, and adequate eye protection. "Minor" breaks were scored when ED personnel were adjacent to a trauma patient (within 1 m) without wearing these items.

RESULTS

We observed 1 or more major breaks in 33.6% of 304 invasive procedures. The most common major break was failure to wear a mask (32.2% of procedures), followed by inadequate eyewear (22.2%), no gown (5.6%), and no gloves (3.0%). We observed minor breaks during 55.5% of 752 patient encounters. Large and statistically significant variations were seen in use rates of barrier precautions among different groups of personnel; surgery residents were most likely to use precautions, whereas attending surgeons were least likely.

CONCLUSION

Compliance with universal precautions is poor in this high-risk clinical setting. These data provide a baseline for measuring the effectiveness of interventions to improve compliance. Videotaped observations are a novel and effective tool in this setting.

Costs of implementing a tuberculosis control plan: a complete education module that uses a train-the-trainer concept

BACKGROUND

Tuberculosis once was thought to be nearly eradicated, but there was a 14% increase in cases of tuberculosis between 1985 and 1993, although decreases were observed in both 1994 and 1995. To reduce spread of this disease, health care workers must be familiar with tuberculosis, its signs, symptoms, and modes of transmission. In October 1994 the Centers for Disease Control and Prevention issued "Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health Care Facilities." The combination of persistently high tuberculosis case rates, the development of multidrug-resistant tuberculosis, the new Centers for Disease Control and Prevention recommendations, and Occupational Safety and Health Administration enforcement has mandated large-scale training in health care facilities.

METHODS

A tuberculosis control plan was developed and the train-the-trainer concept was selected after review of the hospital's tuberculosis risk assessment, staff members requiring training, and available teaching staff. The training program that was developed included tuberculosis pathology and transmission, national and local epidemiology, placement and evaluation of skin tests, and an algorithm to assist in determining when isolation is indicated.

RESULTS

One hundred forty-six trainers were trained in 4 days. During the next quarter, 66% (1989/3000) of staff members requiring instruction were trained. The total cost involved in development and training was approximately $26,000 and involved 1600 person-hours.

CONCLUSION

Tuberculosis training should be directed toward high-risk areas, including intensive care units, emergency departments, and acute medicine wards. Large-scale training is time-consuming and expensive. Evaluation remains difficult. To facilitate compliance, pretest and posttest results should be provided, linked to Occupational Safety and Health Administration compliance and quality indicators for the hospital.

Scheduled change of antibiotic classes: a strategy to decrease the incidence of ventilator-associated pneumonia

The purpose of this study was to determine the impact of a scheduled change of antibiotic classes, used for the empiric treatment of suspected gram-negative bacterial infections, on the incidence of ventilator-associated pneumonia and nosocomial bacteremia. Six hundred eighty patients undergoing cardiac surgery were evaluated. During a 6-mo period (i.e., the before-period), our traditional practice of prescribing a third generation cephalosporin (ceftazidime) for the empiric treatment of suspected gram-negative bacterial infections was continued. This was followed by a 6-mo period (i.e., the after-period) during which a quinolone (ciprofloxacin) was used in place of the third-generation cephalosporin. The incidence of ventilator-associated pneumonia was significantly decreased in the after-period (n = 327) compared with the before-period (n = 353) (6.7 versus 11.6%; p = 0.028). This was primarily due to a significant reduction in the incidence of ventilator-associated pneumonia attributed to antibiotic-resistant gram-negative bacteria (0.9 versus 4.0%; p = 0.013). Similarly, we observed a lower incidence of bacteremia attributed to antibiotic-resistant gram-negative bacteria in the after-period compared with the before-period (0.3 versus 1.7%; p = 0.125). These data suggest that a scheduled change of antibiotic classes can reduce the incidence of ventilator-associated pneumonia attributed to antibiotic-resistant gram-negative bacteria.

A survey of women with HIV about their expectations for care

As an increasing number of women become infected with the human immunodeficiency virus (HIV), it is important to understand their expectations regarding the health care services they receive. In 1995 a new centre was opened at an academic centre in St Louis, Missouri, to provide comprehensive care to women with HIV. To assist in the Centre's development, we interviewed 50 of 119 enrolled clients (42%) using a survey instrument focusing on what they consider important in their care. In response to open-ended questions, clients most often mentioned wanting a sense of personalized caring and respect by medical staff (n = 28, [56%]), having someone to talk to about problems (n = 28, [56%]), honest answers about their condition (n = 23, [46%]), medical follow-up (n = 21, [42%]), reduced barriers to care (n = 20, [40%]), and education about their condition (n = 15, [30%]). The highest-ranked aspects of care were seeing the doctor, learning about their condition, and being seen in a pleasant environment (92% [n = 46%]). Significant differences were found in some responses when analysed according to race, educational level, and severity of disease. It is important that programmes delivering health care services to women with HIV provide services that take into account their individualized needs. Ideally, this requires incorporation of a multidisciplinary team to provide psychological and social support, patient education, and medical management.

High frequency of pseudobacteremia at a university hospital

A prospective survey of all positive blood cultures was performed during a 6-month period at a 390-bed, tertiary-care teaching hospital in St Louis, Missouri. Data were collected from the clinical microbiology laboratory, medical records, and physicians caring for patients with positive blood cultures. Of 5,732 blood cultures, 261 (4.6%) were positive, and approximately half of these (51.3%) were categorized as false positive. Positive cultures were significantly more likely to be true positives if obtained from patients with malignancies or if they became positive within the first 48 hours of incubation.

Rapid development of resistance to clarithromycin following monotherapy for disseminated Mycobacterium chelonae infection in a heart transplant patient

Mycobacterium chelonae (formerly known as M. chelonae subspecies chelonae) is a rapidly growing mycobacterium that can cause disseminated infections, especially in immunocompromised hosts. The bacterium is typically resistant to antimicrobial agents; less than 20% of M. chelonae isolates are susceptible to trimethoprim-sulfamethoxazole, doxycycline, erythromycin, or ciprofloxacin. Findings in a recent study suggested that clarithromycin may be the drug of choice for the treatment of cutaneous (disseminated) disease due to M. chelonae. We describe a 60-year-old heart transplant patient with disseminated M. chelonae infection for whom monotherapy with clarithromycin failed because of the rapid development of resistance to the drug.

Results of a rubella screening program for hospital employees: a five-year review (1986-1990)

The Barnes Hospital Employee Health Service (St. Louis, Missouri) rubella screening program was evaluated over the 5-year period between January 1, 1986, and December 31, 1990. A total of 6,969 new employees were hired, and 6,115 (87.7%) were screened for evidence of rubella immunity by the Employee Health Service. Rubella serology was performed on 5,893 (96.4%) of the screened employees, while 222 (3.6%) had documentation of prior rubella vaccination or rubella infection. The absence of immunity was identified in 325 employees or 5.3% of all those screened. Women were more frequently screened by the Employee Health Service than were men (p < 0.0001), and blacks were more frequently screened than were non-Hispanic Caucasians (p < 0.0001). Physicians were less frequently screened than were other departmental groups (p < 0.0001). The rate of seronegativity for each year of hire varied from 4.45 to 6.76%, but these differences were not significant. Logistic regression analysis demonstrated that 5-year birth cohorts correlated significantly with serologic status. Employees born in 1960-1964 were least likely to be seronegative, and employees born in 1970 or later were most likely to be seronegative. Sex, race, and department group were not predictive of serologic status, although significant differences in results from different rubella assays were detected. Only 13.8% of seronegative employees were subsequently vaccinated by the Employee Health Service. This study demonstrates a lower seronegativity rate than did previous studies. It identifies groups of employees likely to escape rubella screening and low vaccination rates. It finds increasing seronegativity among employees born after 1964 that correlates with the reported increasing rates of rubella in the United States.

DNA large restriction fragment patterns of sporadic and epidemic nosocomial strains of Mycobacterium chelonae and Mycobacterium abscessus

Large restriction fragment (LRF) pattern analysis of genomic DNA using pulsed-field gel electrophoresis was performed on three reference strains, 32 sporadic isolates, and 92 nosocomial isolates from 12 epidemics of Mycobacterium chelonae and Mycobacterium abscessus. Only 17 of 30 (57%) unrelated strains of M. abscessus, compared with 10 of 11 (91%) of M. chelonae strains, gave satisfactory DNA extractions, with the remainder resulting in highly fragmented DNA. DraI, AsnI, XbaI, and SpeI gave satisfactory LRF patterns. Sporadic isolates of the two species had highly variable LRF patterns, except for one reference strain and one sporadic isolate of M. chelonae that differed by only two to five bands. Evaluation of repeat isolates from five patients monitored for 8 months to 13 years (mean, 5.8 years) revealed LRF patterns to be stable, with changes of not more than two bands. LRF analysis of the seven nosocomial outbreaks with evaluable DNA revealed identical patterns in most or all of the patient isolates and in three outbreaks revealed identity with environmental isolates. These outbreaks included endoscope contamination, postinjection abscesses, and surgical wound infections. LRF analysis of genomic DNA is a useful technique for epidemiologic studies of M. abscessus and M. chelonae, although improved technology is needed for the approximately 50% of strains of M. abscessus with unsatisfactory DNA extractions.

Bacterial infections and AIDS

HIV-positive patients are at risk for a number of serious bacterial infections. The author presents on overview of some common bacterial infections these patients are susceptible to and stresses the importance of early diagnosis for appropriate treatment.

Major dog attack injuries in children

Children are frequently admitted to a hospital with injuries sustained as a result of being attacked by a dog. Over a 5-year period (1977 to 1981), 57 such patients have been treated at the Winnipeg Children's Hospital. Half of the dog attack victims were 5 years or younger with injuries occurring more often in boys (55%). The majority of patients (95%) sustained puncture wounds and lacerations to the face (77%) and extremities (23%). In three of the cases, the dog attack victims presented with peritonitis secondary to bowel perforation and were treated successfully. A fourth child died as a result of his injuries prior to reaching the hospital. In the past, much attention has been focused on soft tissue injuries and their cosmetic repair. It is also important to recognize that the small child is particularly vulnerable to dog maulings from which the injuries sustained may be life threatening or lethal. Prevention seems to be the only rational approach to solving this problem.

A family study of craniosynostosis, with probable recognition of a distinct syndrome

A family study was based on 184 consecutive patients who had undergone surgery for craniosynostosis at The Hospital for Sick Children, London, between 1953 and 1976. Of these, 127 were traced and visited and are the probands for this study. Crouzon syndrome was recognised in 16, Apert in 11, Saethre-Chotzen in nine, and Pfeiffer in two. In addition, two probands had Saethre-Chotzen-like facies and bilaterally broad big toes owing to partial or complete duplication of the distal phalanx. This syndrome is distinct from Pfeiffer syndrome, in which the facies more closely resembles that in Crouzon syndrome and in which it is the proximal phalanx of the big toe (and often of the thumb) which is abnormal. It is suggested that this newly recognised syndrome be called after Robinow and Sorauf, who appear to be the first to have described a family with the condition. One proband with coronal stenosis had a mother and brother affected, but no syndrome was recognised in them. Excluding this last case, no non-syndromic proband had an affected parent. The 58 probands with predominantly sagittal synostosis had 106 sibs, none of whom was affected. The 21 probands with predominantly coronal synostosis included one sib pair both affected; the remaining 17 sibs were unaffected. The four probands with predominantly metopic stenosis had 13 unaffected sibs and the four with multiple sutures involved had eight unaffected sibs. One sagittal proband had an unaffected monozygotic twin and another an unaffected dizygotic twin.