Admission screening and cohort care decrease carbapenem resistant enterobacteriaceae in Vietnamese pediatric ICU's.

OBJECTIVES: To assess if admission screening for Carbapenem Resistant Enterobacteriaceae (CRE) and cohort care can reduce CRE acquisition (CRE colonization during hospital stay), Hospital Acquired Infections (HAI), hospital-stay, mortality, and costs in three Intensive Care Units (ICU's) at the Vietnamese National Children's Hospital. METHOD: CRE screening using rectal swabs and ChromIDCarbas elective culture at admission and if CRE negative, once weekly. Patients were treated in cohorts based on CRE colonization status. RESULTS: CRE colonization at baseline point-prevalence screening was 76.9% (103/134). Of 941 CRE screened at admission, 337 (35.8%) were CREpos. 694 patients met inclusion criteria. The 244 patients CRE negative at admission and screened > 2 times were stratified in 8 similar size groups (periods), based on time of admission. CRE acquisition decreased significant (OR - 3.2, p < 0.005) from 90% in period 2 (highest) to 48% in period 8 (last period). Patients with CRE acquisition compared to no CRE acquisition had a significantly higher rate of culture confirmed HAI, n = 20 (14%) vs. n = 2 (2%), longer hospital stays, 3.26 vs. 2.37 weeks, and higher total treatment costs, 2852 vs. 2295 USD. CONCLUSION: Admission CRE screening and cohort care in pediatric ICU's significantly decreased CRE acquisition, cases of HAI and duration of hospital-stay.

Nitric oxide in exhaled and aspirated nasal air as an objective measure of human response to indoor air pollution.

UNLABELLED: The concentration of nitric oxide (NO) in exhaled and aspirated nasal air was used to objectively assess human response to indoor air pollutants in a climate chamber exposure experiment. The concentration of NO was measured before exposure, after 2, and 4.5 h of exposure, using a chemiluminescence NO analyzer. Sixteen healthy female subjects were exposed to two indoor air pollutants and to a clean reference condition for 4.5 h. Subjective assessments of the environment were obtained by questionnaires. After exposure (4.5 h) to the two polluted conditions a small increase in NO concentration in exhaled air was observed. After exposure to the reference condition the mean NO concentration was significantly reduced compared to pre-exposure. Together these changes resulted in significant differences in exhaled NO between exposure to reference and polluted conditions. NO in nasal air was not affected by the exposures. The results may indicate an association between polluted indoor air and subclinical inflammation. PRACTICAL IMPLICATIONS: Measurement of nitric oxide in exhaled air is a possible objective marker of subclinical inflammation in healthy adults.

Passenger evaluation of the optimum balance between fresh air supply and humidity from 7-h exposures in a simulated aircraft cabin.

UNLABELLED: A 21-seat section of an aircraft cabin with realistic pollution sources was built inside a climate chamber capable of providing fresh outside air at very low humidity. Maintaining a constant 200 l/s rate of total air supply, i.e. recirculated and make-up air, to the cabin, experiments simulating 7-h transatlantic flights were carried out at four rates of fresh outside air supply--1.4, 3.3, 4.7, and 9.4 l/s per person (3, 7, 10, and 20 cfm/person)--resulting in humidity levels, ranging from 7% to 28% relative humidity (RH). Four groups of 16-18 subjects acted as passengers and crew and were each exposed to the four simulated flight conditions. During each flight the subjects completed questionnaires three times to provide subjective ratings of air quality and of symptoms commonly experienced during flight. Physiological tests of eye, nose, and skin function were administered twice. Analysis of the subjective assessments showed that increasing RH in the aircraft cabin to 28% RH by reducing outside flow to 1.4 l/s per person did not reduce the intensity of the symptoms that are typical of the aircraft cabin environment. On the contrary, it intensified complaints of headache, dizziness, and claustrophobia, due to the increased level of contaminants. PRACTICAL IMPLICATIONS: The investigation shows that increasing aircraft cabin humidity by decreasing the ventilation flow rate of fresh outside air would not decrease reports of discomfort made by cabin occupants.

Subjective perceptions, symptom intensity and performance: a comparison of two independent studies, both changing similarly the pollution load in an office.

The present paper shows that introducing or removing the same pollution source in an office in two independent investigations, one in Denmark and one in Sweden, using similar experimental methodology, resulted in similar and repeatable effects on subjective assessments of perceived air quality, intensity of sick building syndrome symptoms and performance of office work. Removing the pollution source improved the perceived air quality, decreased the perceived dryness of air and the severity of headaches, and increased typing performance. These effects were observed separately in each experiment and were all significant (P < or = 0.05) after combining the data from both studies, indicating the advantages of pollution source strength control for health, comfort, and productivity.