Suitability of DIALux for designing UVC disinfection cabins.

During the present Sars-CoV-2 pandemic, there has been an increase in the development of UVC disinfection systems. Researchers and members of the lighting community shifted their interests to this new field to help develop systems for disinfecting facemasks and other small equipment. In this paper we show that it is possible to use DIALux to simulate the irradiance distribution provided by a lamp emitting in the UVC range. We will compare the results provided by DIALux with those obtained from Zemax OpticStudio in three different scenarios. We compared the minimum, maximum, and mean irradiance at the detection plane. The differences between the two software were less than 12%, 2%, and 6%, respectively. We also compared the contour maps of isoirradiance lines. We conclude that DIALux is well suited for UVC lighting design in the UVC range. We think that this finding will contribute to increasing the design and manufacturing of new UVC disinfection systems needed to fight against the Sars-CoV-2 pandemic.

A Process for Assessing Products for Infection Prevention in Health Care Settings: A Framework From the Healthcare Infection Control Practices Advisory Committee of the Centers for Disease Control and Prevention.

Infection control is a complex task that spans people, products, and practices in diverse settings. For years, the Healthcare Infection Control Practices Advisory Committee (HICPAC) has provided advice and guidance to the Centers for Disease Control and Prevention (CDC) on how best to prevent infections. These recommendations have focused largely on health care delivery practices and occasionally on general categories of products. With an influx of novel infection control products and growing use of these products by frontline clinicians, an efficient process for developing transparent, rigorous product recommendations that includes myriad data sources was necessary. To address this gap, the CDC asked HICPAC to develop a process that would help inform committees considering product-related recommendations. This article describes the process to develop this approach and provides an outline of how the tool may be used when products with infection control claims are recommended in guidelines or recommendations for infection prevention.

Operational considerations and challenges of biochemistry laboratories during the COVID-19 outbreak: an IFCC global survey.

Objectives: The International Federation of Clinical Chemistry and Laboratory Medicine (IFCC) Task Force on COVID-19 conducted a global survey to understand how biochemistry laboratories manage the operational challenges during the coronavirus disease 2019 (COVID-19) pandemic. Materials and methods: An electronic survey was distributed globally to record the operational considerations to mitigate biosafety risks in the laboratory. Additionally, the laboratories were asked to indicate the operational challenges they faced. Results: A total of 1210 valid submissions were included in this analysis. Most of the survey participants worked in hospital laboratories. Around 15% of laboratories restricted certain tests on patients with clinically suspected or confirmed COVID-19 over biosafety concerns. Just over 10% of the laboratories had to restrict their test menu or services due to resource constraints. Approximately a third of laboratories performed temperature monitoring, while two thirds of laboratories increased the frequency of disinfection. Just less than 50% of the laboratories split their teams. The greatest reported challenge faced by laboratories during the COVID-19 pandemic is securing sufficient supplies of personal protective equipment (PPE), analytical equipment, including those used at the point of care, as well as reagents, consumables and other laboratory materials. This was followed by having inadequate staff, managing their morale, anxiety and deployment. Conclusions: The restriction of tests and services may have undesirable clinical consequences as clinicians are deprived of important information to deliver appropriate care to their patients. Staff rostering and biosafety concerns require longer-term solutions as they are crucial for the continued operation of the laboratory during what may well be a prolonged pandemic.

Chlorhexidine-impregnated sponge versus chlorhexidine gel dressing for short-term intravascular catheters: which one is better?

BACKGROUND: Chlorhexidine-gluconate (CHG) impregnated dressings may prevent catheter-related bloodstream infections (CRBSI). Chlorhexidine-impregnated sponge dressings (sponge-dress) and gel dressings (gel-dress) have never been directly compared. We used the data collected for two randomized-controlled trials to perform a comparison between sponge-dress and gel-dress. METHODS: Adult critically ill patients who required short-term central venous or arterial catheter insertion were recruited. Our main analysis included only patients with CHG-impregnated dressings. The effect of gel-dress (versus sponge-dress) on major catheter-related infections (MCRI) and CRBSI was estimated using multivariate marginal Cox models. The comparative risks of dressing disruption and contact dermatitis were evaluated using logistic mix models for clustered data. An explanatory analysis compared gel-dress with standard dressings using either CHG skin disinfection or povidone iodine skin disinfection. RESULTS: A total of 3483 patients and 7941 catheters were observed in 16 intensive care units. Sponge-dress and gel-dress were utilized for 1953 and 2108 catheters, respectively. After adjustment for confounders, gel-dress showed similar risk for MCRI compared to sponge-dress (HR 0.80, 95% CI 0.28-2.31, p = 0.68) and CRBSI (HR 1.13, 95% CI 0.34-3.70, p = 0.85), less dressing disruptions (OR 0.72, 95% CI 0.60-0.86, p < 0.001), and more contact dermatitis (OR 3.60, 95% CI 2.51-5.15, p < 0.01). However, gel-dress increased the risk of contact dermatitis only if CHG was used for skin antisepsis (OR 1.94, 95% CI 1.38-2.71, p < 0.01). CONCLUSIONS: We described a similar infection risk for gel-dress and sponge-dress. Gel-dress showed fewer dressing disruptions. Concomitant use of CHG for skin disinfection and CHG-impregnated dressing may significantly increase contact dermatitis. TRIALS REGISTRATION: These studies were registered within ClinicalTrials.gov (numbers NCT01189682 and NCT00417235 ).

Chlorhexidine Gluconate Utilization for Infection Prevention in the NICU: A Survey of Current Practice.

BACKGROUND: Central-line-associated bloodstream infection (CLABSI) contributes to significant morbidity and mortality in the neonatal intensive care unit (NICU). Disinfection of skin is part of bundled cares aimed at prevention of CLABSI. While considered an essential component of insertion and maintenance bundles, the optimal solution to disinfect neonatal skin remains controversial. PURPOSE: The purpose of this project was to survey neonatal nurse practitioners and nursing leaders across NICUs regarding the current use of chlorhexidine gluconate (CHG) in term and preterm infants. METHODS: This descriptive study involved the collection of survey data to determine NICU practices related to the use of CHG in their infant population. The sample was composed of nursing directors of NICUs and neonatal nurse practitioners who completed an electronic survey via a provided link. FINDINGS/RESULTS: Chlorhexidine was reported to be used in 53 (82.81%) of the NICUs and was the primary agent used to prepare the skin for central vascular catheter insertion (53.23%) followed by povidone-iodine (45.16%), and 70% isopropyl alcohol (1.61%). Gestational age or birth weight restrictions for CHG use were reported in 43 (82.69%) NICUs. Trends in the data demonstrated nursing's role in using CHG in the NICU. Adverse events reported from CHG included burns, redness, dermatitis, and other irritations. Concerns included risk of absorption, burns, skin irritation, lack of evidence, and overall safety. IMPLICATIONS FOR PRACTICE: Systematic monitoring by nurse leaders is needed to identify evidence related to skin disinfection and CHG in neonates. Targeted education for nursing staff related to directed to developmental maturation of the skin, safe use of CHG, review of best evidence, rationale for usage of CHG, and potential iatrogenic effects is recommended. IMPLICATIONS FOR RESEARCH: Research is needed to evaluate the impact of educational offerings and surveillance for adverse events on CLABSI rates.

COVID-19 Recommendations From Ophthalmic and Plastic Reconstructive Surgery Societies Worldwide.

PURPOSE: The COVID-19 pandemic has brought unprecedented challenges for oculoplastic surgeons worldwide, in terms of care delivery, medical equipment and at-risk patient management. To date, there are no centralized or compiled international COVID-19 guidelines for oculoplastic surgeons. METHODS: We examined COVID-19 guidelines published by oculoplastic societies worldwide. All countries around the world were initially considered in this study, but only 9 oculoplastic societies met the inclusion criteria: (1) publicly available guidelines displayed on the oculoplastic society's website, or (2) guidelines received from the oculoplastic society after contacting them twice using the contact information on their website. RESULTS: The 9 oculoplastic societies examined include: the American Society of Ophthalmic Plastic and Reconstructive Surgery, the British Oculoplastic Surgery Society, the Canadian Society of Oculoplastic Surgery, the European Society of Ophthalmic Plastic and Reconstructive Surgery, la Sociedad Española de Cirugía Plástica Ocular y Orbitaria, la Asociación Colombiana de Cirugía Plastica Ocular, the Asia Pacific Society of Ophthalmic Plastic & Reconstructive Surgery, the Oculoplastics Association of India, and the Philippine Society of Ophthalmic Plastic and Reconstructive Surgery. They all agree that urgent procedures should not be delayed, while non-necessary procedures (including all elective clinic services) should be postponed. When adequate protective equipment is available, oculoplastic surgeons must treat urgent cases. Eight out of 9 societies have provided recommendations on personal protective equipment use in order to prevent the spread of COVID-19 and to adequately protect mucous membranes. Other recommendations provided by certain societies are related to shelter in place measures, hand hygiene and surface disinfection protocols, patient triage, and thyroid eye disease management. CONCLUSIONS: All 9 societies with published recommendations have provided valuable recommendations to their members, regarding urgency of care and infection control solutions (personal protective equipment, hand hygiene, telemedicine, and social isolation).

Transvaginal ultrasound probes are human papillomavirus-free following low-level disinfection: cross-sectional multicenter survey.

OBJECTIVES: To assess the frequency of detection of high-risk human papillomavirus (hrHPV) on transvaginal ultrasound (TVS) probes and keyboards and evaluate operator compliance with national recommendations for prevention of cross-infection during TVS. METHODS: This was a multicenter observational survey involving 46 public and private centers, in the Paris region of France, in which at least five consecutive TVS examinations were performed per day. We audited 676 TVS procedures. We recorded preventive hygiene actions undertaken by the operator at three stages: (1) during TVS; (2) during probe disinfection; and (3) during preparation of the probe for the next TVS. After probe disinfection, we collected one sample from the bare probe and one from the ultrasound keyboard; following probe preparation for the next examination, an additional sample was obtained from the covered probe. The samples were tested for presence of hrHPV DNA using the Cobas® 4800 System. RESULTS: We did not detect hrHPV DNA in samples collected from uncovered or covered probes (0%; 95% CI, 0.00-0.55%). Keyboard samples were positive for hrHPV in two cases (0.3%; 95% CI, 0.04-1.07%). During TVS, the operator avoided touching the keyboard with a hand that had touched the patient's vulva in 86% of cases and held the probe with a gloved hand in 68%. Before probe disinfection, the operator wore new gloves, or performed hand disinfection in 8% of cases. The probe disinfection technique used was adequate in 87% of cases, not performed at all in 12% and insufficient in 1%. Before preparing the probe for the next scan, the operators disinfected their hands or used new gloves in 81% of cases. The probe cover and the coupling gel used complied with recommendations in 98% and 46% of cases, respectively. Of the seven preventive hygiene actions recommended in national guidelines, all were performed in 2%, three to six in 95% and two in 3% of observations. In four (9%) centers, disinfection was not performed in over half the observations. CONCLUSIONS: No evidence of hrHPV DNA was found on TVS probes and probe covers following low-level disinfection, despite suboptimal compliance with hygiene guidelines. Routine TVS practice could be made easier and safer with a global approach to probe disinfection and hand hygiene. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

[Aspects of animal health, animal welfare and biosecurity during 101 transports of piglets in Switzerland]. / Untersuchung von Tiergesundheit, Tierwohl und Biosicherheit während 101 Transporten von Mastferkeln in der Schweiz.

INTRODUCTION: The transfer of piglets is associated with stress for the transported animals. In addition, animal transports are a risk factor for the spread of pathogenic and antibiotic-resistant bacteria and for the introduction of diseases into the herd. In the present study, 101 randomly selected transports of piglets were accompanied from the breeding facility to the pig farm. Parameters related to animal health, animal welfare and biosecurity were assessed. Transported piglets showed signs of abscesses, hernias or cannibalism in 30% and diarrhea or cough in 15% of the cases. The proportion of animals with injuries from conflicts were higher after (15%) than before transport (8%). Suboptimal conditions in regard to density, temperature and lighting were found in 19%, 55% and 36% of the transports. Vehicles were cleaned and disinfected only in 55% of transports before arriving at the breeding facility. Thirty percent of the vehicles were soiled and 20% had already loaded piglets when arriving at the sending facility. Vehicles were neither cleaned nor disinfected in 83% between two piglet transports. Overall, there was a great potential for improvement in animal loading and risk of disease transmission in the investigated piglet transports.

INTRODUCTION: Les transports sont associés à du stress pour les animaux. Ils sont en outre un facteur de risque pour la dissémination de germes pathogènes et antibio-résistants ainsi que pour l'introduction de maladies dans les effectifs d'animaux. Pour la présente étude, on a accompagné 101 transports de porcelets choisis au hasard depuis l'exploitation de production jusqu'à celle d'engraissement. A cette occasion, des paramètres relatifs à la santé des animaux, à leur bien-être et à la biosécurité ont été jugés. Dans environ 30% des cas, des porcelets présentant des abcès, des hernies ou des signes de cannibalisme ont été transportés et dans 15% des cas des animaux souffrant de diarrhée ou de toux. La proportion d'animaux présentant des traces de bagarres était plus élevée de 15% après le transport qu'avant (8%). En ce qui concerne le taux d'occupation, la température et l'éclairage, des carences ont été constatées dans respectivement 19%, 55% et 36% des transports. Les véhicules n'avaient été nettoyés et désinfectés avant leur arrivée dans l'exploitation de production que dans 55% des cas. Trente pour cent des véhicules étaient souillés par des excréments et 20% transportaient déjà des porcelets à leur arrivée sur l'exploitation. Lors de 83% des transports, les véhicules n'ont été ni nettoyés ni désinfectés entre deux transports de porcelets. Il existe un grand potentiel d'amélioration dans les transports de porcelets que nous avons accompagnés, que ce soit du point de vue de l'exposition des animaux au stress ou de la dissémination potentielle de germes.

Research progress of disinfection and disinfection by-products in China.

Disinfection is an indispensable water treatment process for killing harmful pathogens and protecting human health. However, the disinfection has caused significant public concern due to the formation of toxic disinfection by-products (DBPs). Lots of studies on disinfection and DBPs have been performed in the world since 1974. Although related studies in China started in 1980s, a great progress has been achieved during the last three decades. Therefore, this review summarized the main achievements on disinfection and DPBs studies in China, which included: (1) the occurrence of DBPs in water of China, (2) the identification and detection methods of DBPs, (3) the formation mechanisms of DBPs during disinfection process, (4) the toxicological effects and epidemiological surveys of DBPs, (5) the control and management countermeasures of DBPs in water disinfection, and (6) the challenges and chances of DBPs studies in future. It is expected that this review would provide useful information and reference for optimizing disinfection process, reducing DBPs formation and protecting human health.

[Povidone-iodine versus the benzethonium chloride wipe for penile skin disinfection before semen collection from sperm donors].

Objective: To study the influence of povidone-iodine (PI) versus that of the benzethonium chloride wipe (BCW) on semen collection and semen quality of sperm donors undergoing penile skin disinfection and provide some evidence for the selection of disinfection methods for semen collection. METHODS: We used PI from August to December 2015 and BCWs from January to July 2016 for penile skin disinfection before semen collection, with two samples from each donor, one collected with and the other without penis skin disinfection (the blank control group). After semen collection, we conducted a questionnaire investigation on the influence of the two disinfection methods on semen collection and compared the semen parameters between the two groups of sperm donors. RESULTS: Totally, 185 sperm donors were included in this study, of whom 63 underwent penile skin disinfection with PI and the other 122 with BCWs before semen collection. Statistically significant differences were found between the PI and BCW groups in the adaptability to the disinfectant and rigid disinfection procedures (P <0.05), but not in the other items of the questionnaire (P >0.05). Compared with the sperm donors of the blank control group, those of the PI group showed statistically significant difference in the percentage of progressively motile sperm (PMS) (ï¼»63.02 ± 3.18ï¼½% vs ï¼»61.45 ± 4.78ï¼½%, P<0.05), but not in the abstinence time (ï¼»4.97 ± 1.79ï¼½ vs ï¼»4.7 ± 0.94ï¼½ d, P >0.05), semen volume (ï¼»4.11 ± 1.54ï¼½ vs ï¼»4.15 ± 1.61ï¼½ ml, P >0.05), sperm concentration (ï¼»110 ± 29.6ï¼½ vs ï¼»107.5 ± 31.79ï¼½ ×106/ml, P >0.05), or total sperm count (ï¼»439.10 ± 170.13ï¼½ vs ï¼»434.02 ± 186.91ï¼½ ×106/ejaculate, P >0.05), while those of the BCW group exhibited no remarkable difference in any of the above parameters (P >0.05). Among the samples with abnormal semen quality, significantly fewer were found with abnormal PMS in the BCW than in the PI group (1.64% ï¼»2/122ï¼½ vs 9.68% ï¼»6/62ï¼½, P <0.05). However, there were no significant differences between the PI and BCW groups in the abnormal semen volume, abnormal sperm concentration, or the rate of semen bacterial contamination (P >0.05). CONCLUSIONS: Before semen collection from donors, penile skin disinfection with povidone-iodine may affect both the semen collection process and the quality of donor sperm, while the benzethonium chloride wipe can reduce the influence on the semen collection process and does not affect the semen parameters.

Perioperative management of external fixation in staged protocols: an international survey.

INTRODUCTION: Despite the frequent use of external fixation, various regimes of antibiotic prophylaxis, surgical technique and postoperative pin care exist and underline the lack of current evidence. The aim of the study was to assess the variability or consensus in perioperative protocols to prevent implant-associated infections for temporary external fixation in closed fractures of the extremities. MATERIALS AND METHODS: A 26-question survey was sent to 170 members of the Traumaplatform. The survey included questions concerning demographics, level of training, type of training and perioperative protocols as: antibiotic prophylaxis, intraoperative management, disinfection and postoperative pin site care. All responses were statistically analysed, and intraoperative measures rated on a 5-point Likert scale. RESULTS: The responses of fifty orthopaedic trauma and general surgeons (response rate, 29.4%) were analysed. The level of experience was more than 5 years in 92% (n = 46) with up to 50 closed fractures of the extremities annually treated with external fixation in 80% (n = 40). Highest consensus could be identified in the following perioperative measures: preoperative antibiotic prophylaxis with a second-generation cephalosporin (86%, n = 43), changing gloves if manipulation of the external fixator is necessary during surgery (86%, n = 43; 4.12 points on the Likert scale), avoid overlapping of the pin sites with the definitive implant site (94%, n = 47; 4.12 points on the Likert scale) and soft tissue protection with a drill sleeve (83.6%, n = 41). CONCLUSION: Our survey could identify some general principles, which were rated as important by a majority of the respondents. Futures studies' focus should elucidate the role of perioperative antibiotics and different disinfection protocols on implant-associated infections after temporary external fixation in staged protocols. LEVEL OF EVIDENCE: This study provides Level IV evidence according to Oxford centre for evidence-based medicine.

Hemodialyzer Reuse and Gram-Negative Bloodstream Infections.

BACKGROUND: Clusters of bloodstream infections caused by Burkholderia cepacia and Stenotrophomonas maltophilia are uncommon, but have been previously identified in hemodialysis centers that reprocessed dialyzers for reuse on patients. We investigated an outbreak of bloodstream infections caused by B cepacia and S maltophilia among hemodialysis patients in clinics of a dialysis organization. STUDY DESIGN: Outbreak investigation, including matched case-control study. SETTING & PARTICIPANTS: Hemodialysis patients treated in multiple outpatient clinics owned by a dialysis organization. PREDICTORS: Main predictors were dialyzer reuse, dialyzer model, and dialyzer reprocessing practice. OUTCOMES: Case patients had a bloodstream infection caused by B cepacia or S maltophilia; controls were patients without infection dialyzed at the same clinic on the same day as a case; results of environmental cultures and organism typing. RESULTS: 17 cases (9 B cepacia and 8 S maltophilia bloodstream infections) occurred in 5 clinics owned by the same dialysis organization. Case patients were more likely to have received hemodialysis with a dialyzer that had been used more than 6 times (matched OR, 7.03; 95% CI, 1.38-69.76) and to have been dialyzed with a specific reusable dialyzer (Model R) with sealed ends (OR, 22.87; 95% CI, 4.49-∞). No major lapses during dialyzer reprocessing were identified that could explain the outbreak. B cepacia was isolated from samples collected from a dialyzer header-cleaning machine from a clinic with cases and was indistinguishable from a patient isolate collected from the same clinic, by pulsed-field gel electrophoresis. Gram-negative bacteria were isolated from 2 reused Model R dialyzers that had undergone the facility's reprocessing procedure. LIMITATIONS: Limited statistical power and overmatching; few patient isolates and dialyzers available for testing. CONCLUSIONS: This outbreak was likely caused by contamination during reprocessing of reused dialyzers. Results of this and previous investigations demonstrate that exposing patients to reused dialyzers increases the risk for bloodstream infections. To reduce infection risk, providers should consider implementing single dialyzer use whenever possible.

Rate of humidifier and humidifier disinfectant usage in Korean children: A nationwide epidemiologic study.

In South Korea, a cluster of humidifier disinfectant-induced lung injury (HDLI) cases developed between 2006 and 2011. There are no existing reports regarding the rate of humidifier disinfectant (HD) usage in the general population of Korean children. The purpose of this study was to investigate the rate of humidifier and HD usage in the general population of Korean children. This is a general population-based birth cohort multicenter study, Panel Study of Korean Children (PSKC) from 2008, a humidifier and HD-related questionnaire administered to 1577 subjects (809 male, 768 female) in 2015 (n=1577). The questionnaire consisted of four categories (humidifier usage, HD usage, exposure duration, and type of HD brands). A total of 75.6% (1192/1577) had used a humidifier, and the rate of HD usage was found to be 31.1% (409/1316). Polyhexamethylene guanidine (PHMG), used as a disinfectant, was found to have the highest usage rate (62.0%). HD was used for less than 3 months of the entire lifetime of most of the subjects. In conclusion, approximately 30% of young Korean children were exposed to HD. PHMG-containing HD was the most commonly used. These results suggest that a nationwide epidemiologic investigation is needed urgently, and children exposed to HD should be investigated regarding their status of lung injury, including a pulmonary function test. Moreover, a long-term follow-up period may be required to evaluate HD usage-associated lung injury.

[The usage of protective gloves for routine disinfection of patient contact areas : An anonymous survey of work doctors and hygienists (infection control nurses, link nurses and physicians)]. / Einsatz von Schutzhandschuhen bei der routinemäßigen Desinfektion patientennaher Kontaktflächen : Befragung von Betriebsärzten, Hygienefachkräften und Hygienebeauftragten.

BACKGROUND: Disinfection, routinely carried out in healthcare facilities and known as "ongoing disinfection" or "untargeted disinfection", covers areas that are suspected of being contaminated with pathogen-containing material without being recognizable or visible in individual cases. The use of chemical resistant protective gloves is indispensable for surface disinfection. However, it is unclear if healthcare facilities set specific requirements regarding the selection and application of gloves. METHOD: The usage of protective gloves for routine disinfection of patient contact areas was assessed in an anonymous cross-sectional study. Work doctors and hygienists (infection control nurses, link nurses and physicians) were queried by questionnaire. RESULTS: Disposable gloves were predominantly used, in most cases largely in accordance with EN 374. The most common glove material was nitrile. Glove change was mostly reported between rooms. Reprocessing of reusable gloves is inconsistent. Several professions are responsible for selecting protective gloves. CONCLUSIONS: Procedures for glove selection and application for disinfection of contact surfaces vary between the surveyed institutions. Therefore, more attention has to be paid to these three aspects in the future and these must be included in the hygiene plans.

Safe drinking water and sanitary measures: A cross-sectional study in peri-urban community of Islamabad.

OBJECTIVE: To assess sources of drinking water and its methods of disinfection, sanitary situation and waste disposal methods. METHODS: This cross-sectional study was conducted over a period of 6 months from April 2015 to September 2015 in the village of Nurpur Shahan, a peri-urban slum area of Islamabad, Pakistan. Systemic random sampling method was employed to gather data from an adult household member aged between 18 and 45 years through a structured questionnaire. SPSS 21 was used for data analysis.. RESULTS: A total of 2,078 households were included in the study. The mean age of the participants was 31.5±8.17 years. Moreover, 1,600(77%) residents did not disinfect drinking water. Boiling was the most common 378(18.2) method of disinfection. Majority of the households 1,936(93.2%) had latrine inside their houses. The most common mode of waste disposal was burning 951(45.8%), followed by dumping 601(28.9%) and throwing away in the street 415(20%). CONCLUSIONS: Most participants did not disinfect drinking water.

Social network targeting to maximise population behaviour change: a cluster randomised controlled trial.

BACKGROUND: Information and behaviour can spread through interpersonal ties. By targeting influential individuals, health interventions that harness the distributive properties of social networks could be made more effective and efficient than those that do not. Our aim was to assess which targeting methods produce the greatest cascades or spillover effects and hence maximise population-level behaviour change. METHODS: In this cluster randomised trial, participants were recruited from villages of the Department of Lempira, Honduras. We blocked villages on the basis of network size, socioeconomic status, and baseline rates of water purification, for delivery of two public health interventions: chlorine for water purification and multivitamins for micronutrient deficiencies. We then randomised villages, separately for each intervention, to one of three targeting methods, introducing the interventions to 5% samples composed of either: randomly selected villagers (n=9 villages for each intervention); villagers with the most social ties (n=9); or nominated friends of random villagers (n=9; the last strategy exploiting the so-called friendship paradox of social networks). Participants and data collectors were not aware of the targeting methods. Primary endpoints were the proportions of available products redeemed by the entire population under each targeting method. This trial is registered with ClinicalTrials.gov, number NCT01672580. FINDINGS: Between Aug 4, and Aug 14, 2012, 32 villages in rural Honduras (25-541 participants each; total study population of 5773) received public health interventions. For each intervention, nine villages (each with 1-20 initial target individuals) were randomised, using a blocked design, to each of the three targeting methods. In nomination-targeted villages, 951 (74·3%) of 1280 available multivitamin tickets were redeemed compared with 940 (66·2%) of 1420 in randomly targeted villages and 744 (61·0%) of 1220 in indegree-targeted villages. All pairwise differences in redemption rates were significant (p<0·01) after correction for multiple comparisons. Targeting nominated friends increased adoption of the nutritional intervention by 12·2% compared with random targeting (95% CI 6·9-17·9). Targeting the most highly connected individuals, by contrast, produced no greater adoption of either intervention, compared with random targeting. INTERPRETATION: Introduction of a health intervention to the nominated friends of random individuals can enhance that intervention's diffusion by exploiting intrinsic properties of human social networks. This method has the additional advantage of scalability because it can be implemented without mapping the network. Deployment of certain types of health interventions via network targeting, without increasing the number of individuals targeted or the resources used, could enhance the adoption and efficiency of those interventions, thereby improving population health. FUNDING: National Institutes of Health, The Bill & Melinda Gates Foundation, Star Family Foundation, and the Canadian Institutes of Health Research.

Solar Disinfection of Viruses in Polyethylene Terephthalate Bottles.

Solar disinfection (SODIS) of drinking water in polyethylene terephthalate (PET) bottles is a simple, efficient point-of-use technique for the inactivation of many bacterial pathogens. In contrast, the efficiency of SODIS against viruses is not well known. In this work, we studied the inactivation of bacteriophages (MS2 and ϕX174) and human viruses (echovirus 11 and adenovirus type 2) by SODIS. We conducted experiments in PET bottles exposed to (simulated) sunlight at different temperatures (15, 22, 26, and 40°C) and in water sources of diverse compositions and origins (India and Switzerland). Good inactivation of MS2 (>6-log inactivation after exposure to a total fluence of 1.34 kJ/cm(2)) was achieved in Swiss tap water at 22°C, while less-efficient inactivation was observed in Indian waters and for echovirus (1.5-log inactivation at the same fluence). The DNA viruses studied, ϕX174 and adenovirus, were resistant to SODIS, and the inactivation observed was equivalent to that occurring in the dark. High temperatures enhanced MS2 inactivation substantially; at 40°C, 3-log inactivation was achieved in Swiss tap water after exposure to a fluence of only 0.18 kJ/cm(2). Overall, our findings demonstrate that SODIS may reduce the load of single-stranded RNA (ssRNA) viruses, such as echoviruses, particularly at high temperatures and in photoreactive matrices. In contrast, complementary measures may be needed to ensure efficient inactivation during SODIS of DNA viruses resistant to oxidation.

The Connection between Persistent, Disinfectant-Resistant Listeria monocytogenes Strains from Two Geographically Separate Iberian Pork Processing Plants: Evidence from Comparative Genome Analysis.

The aim of this study was to investigate the basis of the putative persistence of Listeria monocytogenes in a new industrial facility dedicated to the processing of ready-to-eat (RTE) Iberian pork products. Quaternary ammonium compounds, which included benzalkonium chloride (BAC), were repeatedly used as surface disinfectants in the processing plant. Clean and disinfected surfaces were sampled to evaluate if resistance to disinfectants was associated with persistence. Of the 14 isolates obtained from product contact and non-product contact surfaces, only five different pulsed-field gel electrophoresis (PFGE) types were identified during the 27-month study period. Two of these PFGE types (S1 and S10-1) were previously identified to be persistent and BAC-resistant (BAC(r)) strains in a geographically separate slaughterhouse belonging to the same company. The remaining three PFGE types, which were first identified in this study, were also BAC(r). Whole-genome sequencing and in silico multilocus sequence typing (MLST) analysis of five BAC(r) isolates of the different PFGE types identified in this study showed that the isolate of the S1 PFGE type belonged to MLST sequence type 31 (ST31), a low-virulence type characterized by mutations in the inlA and prfA genes. The isolates of the remaining four PFGE types were found to belong to MLST ST121, a persistent type that has been isolated in several countries. The ST121 strains contained the BAC resistance transposon Tn6188. The disinfection-resistant L. monocytogenes population in this RTE pork product plant comprised two distinct genotypes with different multidrug resistance phenotypes. This work offers insight into the L. monocytogenes subtypes associated with persistence in food processing environments.

Efficacy of two antiseptic regimens on skin colonization of insertion sites for two different catheter types: a randomized, clinical trial.

PURPOSE: Catheter-related bloodstream infections affect patients in surgical and intensive care settings worldwide, causing complications, aggravation of existing symptoms and increased length of stay. The trial aimed at comparing two registered skin antiseptics with respect to their residual and therefore infection-preventing effects. METHODS: In a parallel, monocentric, prospective, triple-blind, randomized trial the difference in bacterial recolonization of catheter skin sites in central venous (CVC) and epidural catheters (EC) was investigated by comparing two alcoholic-based skin disinfectants. Patients receiving planned surgeries or intensive care were eligible for the trial. Those in the trial group received skin disinfection with the additive octenidine dihydrochloride (OCT) (n = 51), those in the control group were treated with benzalkonium chloride as additive (BAC) (n = 59) prior to catheter insertion. Randomization was carried out by assigning patients to groups week-wise. Endpoints of the investigation were skin colonization of the catheter site counted in colony forming units per swab at three time points: (1) prior to catheter insertion, on untreated skin; (2) directly after catheter insertion, prior to sterile coverage; (3) 48 h after catheter insertion. The hypothesis was tested by a Wilcoxon test with a two-sided alpha = 5 %. RESULTS: From second to third swab, recolonization of the catheter-surrounding skin was significantly lower in the trial group for both sorts of catheters: delta 2-3 OCT group: 0.72 (95 % CI: 0.42; 1.02); delta 2-3 BAC group: 1.97 (95 % CI: 1.45; 2.50); p < 0.001. None of the patients enrolled developed a catheter-related blood stream infection (CRBSI) during follow-up. CONCLUSIONS: Previous studies have shown that skin colonization is strongly associated with the occurrence of CRBSI. This randomized controlled trial supports the observations made in previous trials that octenidine dihydrochloride in disinfectants is more effective than agents containing other additives with regard to skin recolonization surrounding CVC and EC insertion sites. Therefore, it is likely to also reduce the risk of CRBSI in these patient groups. The trial was approved by the North Rhine Medical Association in July 2014 (application-no.: 2014222).

Effectiveness of a programme to reduce the burden of catheter-related bloodstream infections in a tertiary hospital.

The objective of this study was to assess the effectiveness of a catheter-related bloodstream infection (CR BSI) reduction programme and healthcare workers' compliance with recommendations. A 3-year surveillance programme of CR BSIs in all hospital settings was implemented. As part of the programme, there was a direct observation of insertion and maintenance of central venous catheters (CVCs) to determine performance. A total of 38 education courses were held over the study period and feedback reports with the results of surveillance and recommendations were delivered to healthcare workers every 6 months. A total of 6722 short-term CVCs were inserted in 4982 patients for 58 763 catheter-days. Improvements of compliance with hand hygiene was verified at the insertion (87·1-100%, P < 0·001) and maintenance (51·1-72·1%, P = 0·029) of CVCs; and the use of chlorhexidine for skin disinfection was implemented at insertion (35·7-65·4%, P < 0·001) and maintenance (33·3-45·9%, P < 0·197) of CVCs. There were 266 CR BSI incidents recorded with an annual incidence density of 5·75/1000 catheter-days in the first year, 4·38 in the second year [rate ratio (RR) 0·76, 95% confidence interval (CI) 0·57-1·01] and 3·46 in the third year (RR 0·60, 95% CI 0·44-0·81). The education programme clearly improved compliance with recommendations for CVC handling, and was effective in reducing the burden of CR BSIs.