Comparison of low energy and high energy electron beam treatments on sensory and chemical properties of seeds.

Consumption of fresh and minimally processed foods such as seeds as a part of a healthy diet is a trend. Unfortunately, fat-rich seeds are often contaminated with pathogenic microorganisms and face frequent product recalls. Electron beams have been applied as a microbial decontamination measure for decades. Conventionally high energy electron beams (HEEB) are being used, whereas low energy electron beams (LEEB, <300 keV) have only recently been introduced to the food industry and more studies are needed. Electron beam treatment has several advantages over other decontamination technologies. The treatment is non-thermal, chemical-free, water-free, and does not use radioactive substances. The effect of electron beams on the sensory and chemical properties of seeds has not been widely studied. This study assessed LEEB and HEEB treated pumpkin and flax seeds immediately after treatments, and after three months of storage. The seeds' sensory profiles were altered after both treatments when compared with non-treated samples, with a higher dose leading to a greater level of alteration. However, the sensory profile of LEEB treated seeds was similar to the non-treated seeds whereas HEEB treated seeds differed from both. The storage period of three months further increased the observed differences between the samples. LEEB and HEEB treatments seemed to cause lipid degradation as the content of volatile aldehydes was increased. This effect was more profound in HEEB treated samples. The data presented in this study shows that LEEB as a microbial reduction solution has great potential to preserve the chemical and sensory properties of nutritious seeds.

Clinical findings in relation to mortality in non-tuberculous mycobacterial infections: patients with Mycobacterium avium complex have better survival than patients with other mycobacteria.

We compared the clinical findings and survival in patients with Mycobacterium avium complex (MAC) and other non-tuberculous mycobacteria (NTM). A total of 167 adult non-human immunodeficiency virus (HIV) patients with at least one positive culture for NTM were included. Medical records were reviewed. The patients were categorised according to the 2007 American Thoracic Society (ATS) criteria. MAC comprised 59 % of all NTM findings. MAC patients were more often female (70 % vs. 34 %, p < 0.001) and had less fatal underlying diseases (23 % vs. 47 %, p = 0.001) as compared to other NTM patients. Symptoms compatible with NTM infection had lasted for less than a year in 34 % of MAC patients but in 54 % of other NTM patients (p = 0.037). Pulmonary MAC patients had a significantly lower risk of death compared to pulmonary other NTM (hazard ratio [HR] 0.50, 95 % confidence interval [CI] 0.33-0.77, p = 0.002) or subgroup of other slowly growing NTM (HR 0.55, 95 % CI 0.31-0.99, p = 0.048) or as rapidly growing NTM (HR 0.47, 95 % CI 0.25-0.87, p = 0.02). The median survival time was 13.0 years (95 % CI 5.9-20.1) for pulmonary MAC but 4.6 years (95 % CI 3.4-5.9) for pulmonary other NTM. Serious underlying diseases (HR 3.21, 95 % CI 2.05-5.01, p < 0.001) and age (HR 1.07, 95 % CI 1.04-1.09, p < 0.001) were the significant predictors of mortality and female sex was a predictor of survival (HR 0.38, 95 % CI 0.24-0.59, p < 0.001) in the multivariate analysis. Pulmonary MAC patients had better prognosis than pulmonary other NTM patients. The symptom onset suggests a fairly rapid disease course.

Two cases of food-borne botulism in Finland caused by conserved olives, October 2011.

In October 2011 in Finland, two persons fell ill with symptoms compatible with botulism after having eaten conserved olives stuffed with almonds. One of these two died. Clostridium botulinum type B and its neurotoxin were detected in the implicated olives by PCR and mouse bioassay, respectively. The olives were traced back to an Italian manufacturer and withdrawn from the market. The public and other European countries were informed through media and Europe-wide notifications.

A foodborne outbreak due to Cryptosporidium parvum in Helsinki, November 2008.

We report the first foodborne outbreak caused by Cryptosporidium parvum in Finland. The outbreak occurred among personnel of the Public Works Department in Helsinki, who had eaten in the same canteen. 72 persons fell ill with diarrhoea, none was hospitalised. Four faecal samples obtained from 12 ill persons were positive for Cryptosporidium by an antigen identification assay and microscopy. The vehicle of infection could not be identified with certainty but a salad mixture was suspected.

Rehabilitation of the hospital infrastructure in a developing country.

Mongolia is in fact not a developing country at all but a country of transitional economy (since 1990) with a fairly comprehensive health care infrastructure. However, the health care is facing great difficulties comparable to those in a developing country. Hospital infrastructure rehabilitation was a part of a wider health sector development project with 3 remote aimags (provinces) as the target areas. The Mongolian system of health care has been built up over many years as a country-wide network of community-based feldschers and doctors, supported by a hierarchy of hospitals and mobile emergency teams. Health standards are also impacted by many factors (better housing, water supplies, better roads and rail links) outside the control of the Ministry of Health, and of health care providers. The majority of the rural hospitals lack the basic facilities. There are operating theatres without running water, hospitals with electricity only from 8 to 10 in the evening etc. The hygienic standard is unacceptable. Central heating systems do not function. Many of the facilities are underutilised and in poor condition due an ongoing lack of maintenance. The project aimed for a network that would offer services for all people, including nomadic people. The number of rural hospitals was slightly reduced and some of them were upgraded to first referral unit with basic clinical services. Approximately one third of the rural hospitals had to be rebuilt. The project recommended and started multiphased long-term master planning for those 3 aimag hospitals, all of which displayed difficulties similar to the rural hospitals.

Clostridium difficile-associated diarrhea: epidemiology, risk factors, and infection control.

OBJECTIVES: To evaluate the effectiveness of specific infection control measures on the incidence of Clostridium difficile-associated diarrhea (CDAD) and to identify risk factors for its development. SETTING: 370-bed, tertiary-care teaching hospital with approximately 12,000 to 15,000 admissions per year. METHODS: Several infection control measures were implemented in 1991 and 1992, and the attack rates of CDAD were calculated quarterly. Antibiotic use for 1988 through 1993 was analyzed. A case-control study was conducted from January 1992 to December 1992 to identify risk factors for acquisition of CDAD. RESULTS: From 1989 to 1992, the attack rate of CDAD increased from 0.49% to 2.25%. An increase in antibiotic use preceded the rise in the incidence of CDAD in 1991. Despite implementation of various infection control measures, the attack rate decreased to 1.32% in 1993, but did not return to baseline. Ninety-two cases and 78 controls (patients with diarrhea but with negative toxin assay) were studied. By univariate analysis, history of prior respiratory tract infections (odds ratio [OR], 3.6; 95% confidence interval [CI95], 1.2-10.4), the number of antibiotics, and the duration of exposure to second-generation cephalosporins (OR, 3.55; CI95, 1.47-9.41) and to ciprofloxacin (OR, 7.27; CI95, 1.13-166.0) were related significantly to the development of CDAD. By stepwise logistic regression analysis, only exposure to antibiotics and prior respiratory tract infections (P = .0001 and .0203, respectively) were found to be significant. CONCLUSION: Antibiotic pressure might have contributed to failure of infection control measures to reduce the incidence of CDAD to baseline.

Cost analysis and clinical impact of weekly ventilator circuit changes in patients in intensive care unit.

BACKGROUND: The introduction of heated circuits and sealed, single-use humidifiers has prompted some investigators to question the traditional recommendations for changing ventilator circuits. We studied the clinical and cost impact of extending the circuit change interval from 72 hours to 7 days in our two intensive care units with 17 beds. METHODS: With standard surveillance definitions from the Centers for Disease Control and Prevention and the National Nosocomial Infections Surveillance System, baseline pneumonia rates were established for a 3-month period. After the institution of weekly circuit changes, daily surveillance of intubated patients was performed during 18 of 22 weeks from May through September 1993. Standard microbiologic methods were used for the identification of patient and environmental isolates. RESULTS: Ventilator-associated pneumonia for the 72-hour circuit change group was 9.1% or 1.29 per 100 ventilator days. After the institution of weekly changes, pneumonia occurred in 9 of 146 patients (6.2% or 0.74 per 100 ventilator days chi 2 = 0.33, p = 0.44). No common bacterial isolates were recovered as judged by phenotype, biochemical, or antimicrobial susceptibility patterns. Weekly changes reduced the number of circuits used from a predicted 469 to 214. Estimating $26.46 per circuit change, annualized cost savings were $20,246.90. CONCLUSIONS: Weekly circuited changes in patients undergoing ventilation therapy in the intensive care unit are cost-effective and do not contribute to increased rates of nosocomial pneumonia.

A cluster of atypical skin lesions in well-baby nurseries and a neonatal intensive care unit.

We describe an epidemiologic investigation that elucidated the cause of vesicular and bullous skin lesions of the hands and feet that occurred in three otherwise well neonates during a 24-hour period. The investigation encompassed two well-baby nurseries of 28 and 17 beds and one level III neonatal intensive care unit (NICU) of 31 beds located in a 440-bed university-affiliated community hospital. Work-up for infectious causes of the skin lesions in the initial three cases had negative results. Expanded case surveillance disclosed seven additional cases that had occurred within the previous 2 weeks in the NICU. Analysis of risk factors focused attention on the insertion technique for peripheral intravenous catheters. This led to the discovery of a defective transillumination device, the tip of which reached a temperature of 88 degrees C within 20 seconds, causing thermal burns. The cause of the malfunction was the failure to install an infrared filter during the manufacture of the device. No additional cases were observed after the defective unit was removed from service. In summary, a defective transilluminating device caused a cluster of thermal burns in a newborn nursery and NICU. Epidemiologic investigation of the cluster allowed the investigators to focus on techniques of intravenous catheter insertion, which thus led to the identification of the cause of the injuries. With the increasing emphasis on health outcomes measurement, hospital epidemiologists will likely have an expanding role in investigating clusters of noninfectious adverse events.

Environmental effects of nationwide selenium fertilization in Finland.

To study the possible pollution of natural waters by selenium added to agricultural fertilizers, water selenium concentrations were determined in lakes and ground water pools during the year 1992, when the enrichment of fertilizers by selenium had continued for 8 yr. Water samples were preconcentrated by evaporating, and selenium concentrations were analyzed fluorometrically using the dye 2,3-diaminonaphthalene after wet digestion. In lake water samples from 13 lakes, no significant correlations were found between selenium and pH, chlorophyll A, total nitrogen, or phosphorus. Agriculturally affected and nonaffected lakes had no differences in their selenium concentrations. In the lakes that were surrounded by cultivated fields mean water selenium was 83.4 ng/L (range: 75.2-93.4 ng/L, n = 9). Correspondingly, in lakes situated in forests without agricultural surroundings, mean water selenium concentration was 76.5 ng/L (range: 51.2-110 ng/L, n = 3). Only one lake in the close vicinity of a coal power plant had a high water selenium concentration (mean 272 ng/L). In ground water samples, there was a big variation in selenium levels between different pools, the levels varying between 33 and 260 ng/L. This variation may partly be explained by different selenium concentrations of the bedrock and sediments. However, simultaneous increase of total nitrogen, phosphorus, and selenium levels in consecutive samples from some ground water pools indicates leaching of selenium from the fertilizers into the ground water in certain areas.

Study of the definition of nosocomial infections (SDNI). Research Committee of the Association for Practitioners in Infection Control.

If nosocomial infections are to be used as clinical indicators of quality, their definitions must be accurate. To assess validity and reliability of definitions of nosocomial infection, a study was conducted in two groups of U.S. hospitals. Group A consisted of a stratified, random sample of 715 hospitals and excluded those that are part of the National Nosocomial Infections Surveillance System. The 112 NNIS hospitals were surveyed separately in group B. Both groups used the same instrument, consisting of 36 case studies simulating patients' charts. Content and construct validity were formally tested and demonstrated. Six case studies were presented for each of the four major NI sites and for community-acquired or no infection. The pooled hospital response was 48% (396/827). The pooled number of individual responders whose data were used in the analysis was 469. Their overall mean score was 84%, and the score for correctly identifying any NI was 83%. Both groups were best at identifying urinary nosocomial infections (Group A = 92%, Group B = 93%) and poorest for no infection (Group A = 62%, Group B = 75%). Group A responders had significantly higher scores if they were certified, had a baccalaureate or higher degree, had taken a formal infection control course, had worked in infection control for greater than or equal to 2 years, or had worked full time in infection control in a greater than or equal to 200-bed hospital that was affiliated with a medical school (all p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Latex and vinyl nonsterile examination gloves: status report on laboratory evaluation of defects by physical and biological methods.

We have reported previously (H. R. Kotilainen, J. P. Brinker, J. L. Avato, and N. M. Gantz, Arch. Intern. Med. 149:2749-2753, 1989) that the quality of nonsterile examination gloves available for clinical use may be extremely variable. In view of the concern over human immunodeficiency virus and hepatitis B virus transmission to health care workers, the continuing variability of gloves available for use, and the need for a simple and safe test, we have evaluated 2,500 vinyl (five brands) and 2,000 latex (four brands) gloves by the 300-ml and the newly proposed 1,000-ml water tests and for permeability to herpes simplex virus type 1 and poliovirus type 1, respectively. While all 300-ml watertight gloves were unlikely to leak herpes simplex virus type 1 (1.3% vinyl; 0.5% latex), poliovirus was recovered much more frequently (8.9% vinyl, 6.1% latex). In all gloves that passed the 1,000-ml test, herpes simplex virus type 1 was not recovered. Poliovirus was recovered infrequently (1.4% vinyl, 1.5% latex). Preliminary analyses suggest that the 1,000-ml water test has significantly increased sensitivity over the 300-ml water test in the detection of small holes in both vinyl and latex gloves that may allow the passage of viral particles. Gloves that pass a 1,000-ml water challenge are unlikely to allow the passage of a small virus such as poliovirus. Given that human immunodeficiency virus, hepatitis B virus and herpes simplex virus type 1 are larger particles than poliovirus, gloves that pass the 1,000-ml water test theoretically could provide better protection.

Latex and vinyl examination gloves. Quality control procedures and implications for health care workers.

In December 1987, we investigated an increased number of cases of herpetic whitlow in medical intensive care unit nurses who routinely gloved for secretion contact. One particular brand of vinyl examination glove had been used in the medical intensive care unit. Restriction endonuclease mapping established the similarity of employee isolates with one patient isolate of herpes simplex virus type I. When initial viral assay demonstrated 2.5% to 10% penetration of herpes simplex virus type I across unused gloves, an evaluation of glove quality was undertaken. In a 300-mL watertightness test, seven brands of vinyl gloves failed 4% to 28% (average, 11.1%; 132/1200), while seven brands of latex gloves failed 0% to 2.6% (average, 1.4%; 24/1750). The brand of vinyl glove that had been in use in the medical intensive care unit failed 28% of the time. Watertight gloves were then tested for permeability to herpes simplex virus type I. None of the latex gloves failed (n = 1726), while only 10 of the vinyl gloves failed (n = 1068, 0.95%). Extreme variability in glove quality was observed. However, gloves made from intact vinyl may provide similar protectiveness as those made from intact latex. As the demand for gloves increases, emphasis should be placed on the production of plentiful, better quality latex and vinyl gloves.

Nursing assessment program in infection control procedures.

To assess the infection control educational needs of the nursing service while providing a "hands-on" in-service exercise, nurses were invited to test their infection control knowledge as part of a clinical scenario. After a brief review of the "case," participants surveyed for 10 minutes a mock patient's room where a manikin served as the "patient." Through staged breaks in technique, various components of infection control practice were to be identified by the participants. Five basic areas of infection control practice including handwashing and isolation technique, Foley catheter care, intravenous therapy and line maintenance, use of suctioning equipment and fluids, and general sanitation were presented at 12 stations within the room. Immediately after this exercise, members of the infection control staff revealed the errors in the exhibit and demonstrated the correct procedures. The average score among 548 participants was 57% (11.4 out of 20 possible correct answers). Scores were not influenced by the number of years of experience in nursing. However, differences were seen regarding educational degree and nursing units, which served as a basis to recommend specific infection control education.

An evaluation of three biological indicator systems in flash sterilization.

An evaluation of two flash-sterilization-specific biological indicators (BI) and a traditional spore strip indicator was performed to assess sensitivity and reliability as reflected in survive/kill ratios. The BIs tested included: 3M's Attest #1261, Amsco's Proof Flash, and Castle Tec Test. Survival after "come-up" time alone, (0 exposure) and one-, two-, and three-minute exposures at 273 degrees F in a gravity displacement sterilizer was measured by media color change or turbidity after incubation at 55 degrees C. Each cycle was replicated three times on two separate days with six of each BI per run. Positive BIs were subcultured as necessary. Proof Flash presented technical difficulties due to incomplete or impossible crushing of media vials, unexpected media color changes, and evaporation of media. Tec Test was not sufficiently resistant as survivors were not detected at any exposure time. The Attest had 100% survival at zero and one-minute exposures and 94% survival after the two-minute exposure. No survivors were detected after the three-minute exposure. Although each institution should evaluate BIs for their own use independently, the data indicate that Attest #1261 monitored the three-minute flash cycles more satisfactorily than the other BIs tested.

Intracranial pressure monitors. Epidemiologic study of risk factors and infections.

An increase in the number of cases of gram-negative ventriculomeningitis in patients followed with intracranial pressure monitors when compared with patients with craniotomy alone was revealed by routine surveillance data. A study was undertaken at four area institutions to describe the infections, risk factors, and management. Two hundred fifty-five patients with diagnoses of intracerebral hemorrhage (n = 86), closed trauma (n = 66), open trauma (n = 21), tumor (n = 66), and miscellaneous other conditions were compared with their nonmonitored counterparts for type of intracranial pressure monitor used, use of drains, prophylactic antibiotics, and steroids, and remote presence of infection. The presence of intracranial pressure monitor with craniotomy was associated with an 11 percent infection rate whereas craniotomy alone demonstrated a 6 percent rate. Of the intracranial pressure monitors used, the subarachnoid screw was associated with the lowest infection rate (7.5 percent) followed by the subdural cup catheter (14.9 percent) and the ventriculostomy catheter (21.9 percent). Regardless of the monitor used, infection was twice as likely to develop in patients with open trauma or hemorrhage. The use of bacitracin flush solutions for maintenance of lumen patency was more often associated with infections. Use of prophylactic antibiotics did not significantly influence outcome.

Biological sterilization monitors: a four-year in-use evaluation of two systems.

Biological monitors (BI) are considered to be the best monitor of the sterilization process yet false positives may result in recalls and quality assurance difficulties. To assess the frequency, type and reasons for questionable results, we undertook a 4-year in-use study of two commonly used BI types--spore strips (Spordi) and a self-contained crushable ampule (Attest)--for both steam and ethylene oxide (EO). After laboratory verification of time/kill ratios for a portion of each involved lot, 2 BI of each type were placed in test pack within a randomly selected load run at standard time and temperature. All resulting positive BI were subcultured. Steam cycle positives were uncommon (32/1,1710 positive Spordi, 1.9%; 20/1,710 positive Attest, 1.2%) and could be related to chamber temperature or steam quality. All of the 4 BI per load were positive in only three loads; physical monitors indicated gross malfunction. Five positive Spordi were due to either contaminants or a malfunctioning incubator. EO-related positives were more common (53/1,109 positive Spordi, 4.8%; 25/1,109 positive Attest, 2.3%). One-half of the Spordi tests became positive after 48 hours of incubation. Organisms other than B. subtilis were recovered from 49.1% of the positive tests (26/53). The Attest was remarkable for its lack of contamination; 1/25 was positive for Pseudomonas stutzeri only. More positives were observed during the winter months when relative humidity was below 20%. This finding was more commonly observed with the EO Attest. In summary, we found no significant difference in the performance of either BI.(ABSTRACT TRUNCATED AT 250 WORDS)