Comparison of electric hand dryers and paper towels for hand hygiene: a critical review of the literature.

Numerous studies are published on the benefits of electric hand dryers vs paper towels (PT) for drying hands after washing. Data are conflicting and lacking key variables needed to assess infection risks. We provide a rapid scoping review on hand-drying methods relative to hygiene and health risks. Controlled vocabulary terms and keywords were used to search PubMed (1946-2018) and Embase (1947-2018). Multiple researchers independently screened abstracts for relevance using predetermined criteria and created a quality assessment scoring system for relative study comparisons. Of 293 papers, 23 were included in the final analysis. Five studies did not compare multiple methods; however, 2 generally favoured electric dryers (ED); 7 preferred PT; and 9 had mixed or statistically insignificant results (among these, 3 contained scenarios favourable to ED, 4 had results supporting PT, and the remaining studies had broadly conflicting results). Results were mixed among and within studies and many lacked consistent design or statistical analysis. The breadth of data does not favour one method as being more hygienic. However, some authors extended generalizable recommendations without sufficient scientific evidence. The use of tools in quantitative microbial risk assessment is suggested to evaluate health exposure potentials and risks relative to hand-drying methods. We found no data to support any human health claims associated with hand-drying methods. Inconclusive and conflicting results represent data gaps preventing the advancement of hand-drying policy or practice recommendations.

Impact of disinfectant wipes on the risk of Campylobacter jejuni infection during raw chicken preparation in domestic kitchens.

AIMS: In the present study, we conducted a quantitative microbial risk assessment forecasting the exposure to Campylobacter jejuni contaminated surfaces during preparation of chicken fillets and how using a disinfectant-wipe intervention to clean a contaminated work area decreases the risk of infection following the preparation of raw chicken fillet in a domestic kitchen. METHODS AND RESULTS: Using a Monte Carlo simulation of the risk of transferring Camp. jejuni strain A3249, from various surfaces to hands and subsequently transferring it to the mouth was forecasted. The use of a disinfectant-wipe intervention to disinfect contaminated surface area was also assessed. Several assumptions were used as input parameters in the classical Beta-Poisson model to determine the risk of infection. The disinfectant-wipe intervention reduced the risk of Camp. jejuni infection by 2-3 orders on all fomites. CONCLUSIONS: The use of disinfectant wipes after the preparation of raw chicken meat reduces the risk of Camp. jejuni infections. SIGNIFICANCE AND IMPACT OF THE STUDY: This risk assessment shows that the use of disinfectant wipes to decontaminate surface areas after chicken preparation reduces the annual risk of Camp. jejuni infections up to 99·2%, reducing the risk from 2 : 10 to 2 : 1000.

Impregnated bed nets for malaria control: biological success and social responsibility.

Malaria is a serious public health problem in numerous countries of the world. In Africa alone, it is estimated that more than a million children less than five years of age die each year from this disease. The problem has become more critical with the development of Plasmodium falciparum resistance to chloroquine, the high cost of replacement antimalarials, and vector resistance to the cheaper insecticides such as DDT. Emphasis now is on sustainable control programs that can be implemented by communities with assistance from primary health care providers. This has led to a re-examination of impregnated bed nets (IBNs) that serve as a physical barrier to break human-vector contact. Over the last decade, bed nets impregnated with cheap and long-lasting pyrethroids used in Africa and Asia have shown their utility in reducing human-vector contact, inoculation of humans with sporozoites, clinical episodes of fever, and high levels of parasitemia. One study in The Gambia demonstrated that mortality in young children was significantly reduced, and the results of that study have led to the initiation of large-scale mortality studies in different epidemiologic areas in Africa. This paper reviews current bed net materials, recommended insecticides, an impregnation technique, costs, and the importance of community participation. As a malaria control option IBNs appear to be very promising, but further entomologic and epidemiologic assessments, including mortality studies, are needed. Future use of IBNs should be considered as part of a larger program that includes other vector control measures, proper case management, appropriate use of antimalarials for prevention in specific target groups, surveillance, and program monitoring with attention to changing epidemiologic situations and developing technology.

Parasitologic and clinical efficacy of 25 and 50 mg/kg of chloroquine for treatment of Plasmodium falciparum malaria in Rwandan children.

The standard chloroquine treatment for Plasmodium falciparum malaria is 25 mg (base)/kg (C25) given over 3 days. In Rwanda, 50 mg/kg (C50) administered over 6 days has been recommended by the Faculty of Medicine, Ministry of Health. The present study compared clinical and parasitological efficacy and side effects of C25 and C50 in children less than or equal to 5 years of age. In vitro studies with chloroquine, mefloquine, pyrimethamine, and quinine were also performed. Ninety children were given a 3-day treatment of C25 and 48 a 5-day treatment of C50. Cases were followed for a total of 15 days (D0 to D14). At day 14, 73% of the C25 and 67% of the C50 children were still parasitemic, but the mean geometric parasite density had decreased by at least 96% in both groups. Clinically, 44 C25 and 12 C50 children had fever on day 0; by day 14 only 4 (9%) C25 and 4 (33%) C50 children still had fever. Side effects were found to be minimal. The chloroquine in vitro tests corroborated the in vivo findings. P. falciparum was found to be quite sensitive to mefloquine and quinine, but showed a high (59%) resistance to pyrimethamine.

Amodiaquine and sulfadoxine-pyrimethamine as treatment for chloroquine-resistant Plasmodium falciparum in Rwanda.

The efficacy of amodiaquine and sulfadoxine-pyrimethamine combination as a second-line therapy for chloroquine-resistant Plasmodium falciparum infections was investigated in Rwanda in September 1986. Children less than or equal to 5 years old presenting with a P. falciparum parasitemia 14 days after treatment with chloroquine were administered either amodiaquine (25 mg/kg over 3 days, 64 patients) or sulfadoxine-pyrimethamine (as a single dose with tablets containing 500 mg of sulfadoxine and 25 mg of pyrimethamine: 1/4 tablet for children under 1 year, 1/2 for those 1-3 years old, and 1 tablet for those 4-5 years old; 34 patients) and followed for 7 days. Seven days after starting treatment with amodiaquine, 50 (76%) children were aparasitemic. All the children who had received sulfadoxine-pyrimethamine were aparasitemic 7 days after initiation of therapy.

The effectiveness of insecticide-impregnated bed nets in reducing cases of malaria infection: a meta-analysis of published results.

The use of insecticide-impregnated bed nets to minimize human-vector contact may reduce the incidence of malaria. Consequently, several field trials have evaluated their effectiveness as a malaria prevention strategy. A meta-analysis of published reports of field trials that measured the incidence of infections was performed to provide a measure of the effectiveness of insecticide-treated bed nets in preventing clinical malaria. Subsetted analyses were performed on the 10 field trials to calculate pooled incidence rate ratios of infection among the study groups. For the studies comparing insecticide-impregnated bed nets with untreated bed nets, the summary incidence rate ratio for acquiring malarial infections was 0.757 (95% confidence interval [CI] = 0.612-0.938), representing a reduction of 24%. For the studies comparing permethrin-impregnated bed nets with controls without bed nets, the summary incidence rate ratio was 0.497 (95% CI = 0.417-0.592) (Rothman-Boice heterogeneity statistics = 17.27 [P = 0.004] and 23.55 [P = 0.0003], respectively). These data suggest that insecticide-impregnated bed nets are effective in preventing malaria, decreasing the incidence rate ratio by approximately 50% in field trials performed to date.

Permethrin-impregnated curtains and bed-nets prevent malaria in western Kenya.

The effectiveness of permethrin-impregnated (0.5 g/m2) bed-nets and curtains as malaria control measures was evaluated in Uriri, Kenya in 1988. One hundred five families were randomly assigned to 1 of 3 study groups (control, bed-net, or curtain). All participants were cured of parasitemia with pyrimethamine/sulfadoxine. Selective epidemiologic and entomologic parameters were measured weekly, while knowledge, attitude, and practices surveys were conducted at the beginning and end of the 15 week study. Plasmodium falciparum infections per person week at risk were significantly higher in the control group than in either the curtain group (5.42 vs. 2.35 cases/100 person weeks risk) or the bed-net group (5.42 vs. 3.77 cases/100 person weeks risk). The curtain group had fewer infections per person week at risk than the bed-net group (2.35 vs. 3.77 cases/100 person weeks risk). A difference was found in clinical malaria among the groups: 45% of persons in the bed-net and curtain groups vs. 30% of those in the control group reported no episodes of fever and chills (chi 2, P less than 0.05). Indoor resting Anopheles gambiae or An. funestus were found on 94 occasions in the control houses, but only twice in the treated houses during weekly visits to each house over the study period (chi 2 P less than 0.001). The pyrethrum knockdown method produced similar results with a total of 195, 23, and 3 An. gambiae and An. funestus collected in the control, bed-net, and curtain houses during the same period, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Effectiveness of permethrin-impregnated bed nets and curtains for malaria control in a holoendemic area of western Kenya.

The effectiveness of village-wide use of permethrin-impregnated bed nets or eave, window, and door curtains as control measures for Plasmodium falciparum malaria was evaluated during two successive high-transmission seasons in western Kenya. Pairs of villages were assigned to one of three study groups: bed net, curtain, or control. Clinical, parasitologic, and entomologic measures were made from March to July 1990 and again 12 months later. When compared with the controls in 1990 and 1991, we observed a marked reduction in the incidence of P. falciparum infections in children less than six years old in the bed net villages (reduced by 40% and 48%) and a smaller but still significant reduction in the curtain villages (10% and 33%). Significant reductions were also seen in the incidence of P. falciparum parasitemias greater than 2,500/mm3 in the bed net group (reduced by 44% and 49%) and curtain group (16% and 32%). Additionally, we observed significant reductions in the incidence of documented fevers in association with P. falciparum parasitemia in bed net (reduced by 63%) and curtain villages (53%) when compared with controls. Entomologic inoculation rates in both bed net and control villages decreased by more than 50% below control values during both high transmission seasons. The results of this study, together with a 1988 study in the same area during the low transmission season, show that bed nets offer greater year-round of protection against P. falciparum infection than curtains. However, during the high transmission season, this technique reduces the frequency of P. falciparum infection rather than preventing it entirely.

Single-dose chloroquine therapy for Plasmodium falciparum in children in Togo, West Africa.

Chloroquine, in a single dose of 10 mg of base/kg, was given orally to Togolese children less than 5 years of age as primary therapy for Plasmodium falciparum malaria. A simplified World Health Organization in vivo method was used, as was a sequential analysis procedure for determining if the drug trial was a success or failure. A total of 178 children in 3 regions were treated; 174 (98%) responded successfully, which required a greater than or equal to 75% reduction in parasites by day 2 and elimination of parasites by day 7. All 4 failures had low blood levels of chloroquine and desethylchloroquine at day 7. A single dose of chloroquine for treating malaria can be considered for those areas of Africa where the efficacy of such therapy is documented, and where an antimalarial drug sensitivity monitoring system is operating.

Response of children with Plasmodium falciparum to chloroquine and development of a national malaria treatment policy in Zaire.

In vivo sensitivity of Plasmodium falciparum to chloroquine was evaluated in 4 of 9 regions of Zaire in 1985 to develop a national strategy for treatment of malaria. Children less than 5 years of age were treated with either a single dose of chloroquine base, 10 mg/kg, or a dose of 25 mg/kg given over 3 d. A modified 7-day World Health Organization in vivo test was used with follow-up 2, 3 and 7 d after the start of treatment. 339 children were studied. In Bwamanda 92% of children were aparasitaemic 7 days after chloroquine, 10 mg/kg, but in Kinshasa only 44% were free of parasites after 25 mg/kg chloroquine. The mean drop in parasite density among those who did not clear parasites by day 7 was greater than 98% of the initial value. Although the parasite density decreased markedly, the failure of most subjects to become aparasitaemic indicated a marked decrease in parasite sensitivity since 1983. Only one child of 51 who were initially febrile remained febrile, although 14 (28%) of these had resistant parasites. The decrease in parasitaemia and temperature, even among children with resistant strains, led the Ministry of Health to recommend 25 mg/kg chloroquine as first line treatment for fever/malaria in their national malaria control plan. The plan includes drug sensitivity surveillance and a referral system for patients who do not respond to chloroquine treatment.

Use of practice tracks in the medical specialties.

OBJECTIVES: To evaluate the use of practice tracks by each of the 24 medical specialty boards and to compare this with the experience in emergency medicine (EM). METHODS: Scripted telephone surveys were conducted with representatives of each of the specialty boards. RESULTS: Of 24 specialties currently recognized by the American Board of Medical Specialties (ABMS), 14 (58%) reported a history of a practice track. Eight boards reported never having a practice track and 2 were unsure. All practice tracks have been limited in duration, most commonly closing after a specified period. The mean duration of the practice tracks was 9.8 years, the median was 7.5 years, and the range was 3-27 years. The practice track in EM was open for 9 years. CONCLUSIONS: Practice tracks were common in the early years of most specialties and most were limited by duration. The history of the practice track in EM is not dissimilar to those of other specialties.

Does wearing a necktie influence patient perceptions of emergency department care?

We conducted a prospective study of discharged emergency department (ED) patients to determine the effect of wearing a necktie by emergency physicians (EPs) had on patients' impression of their medical care. All male EPs were assigned randomly by dates to wear a necktie or no necktie, and the attire worn was otherwise similar in all respects. The study was conducted at a community teaching hospital with an Emergency Medicine residency and an annual census of 40,000. A total of 316 patients were surveyed. There were no statistically significant differences between patient groups in any of the five areas surveyed, including patient perception of physicians' appearance. Nearly 30% of patients incorrectly identified their doctor as wearing a necktie when no necktie was worn, and the perception of tie wearing was correlated with a positive impression of physician appearance. Wearing or not wearing a necktie did not significantly affect patients' impression of their physician or the care they received. However, patients seemingly preferred the appearance of physicians who were perceived to wear neckties.

The biting and resting behavior of Anopheles albimanus in northern Haiti.

A one-year study of the biting and resting habits of the malaria vector Anopheles albimanus was carried out in four rural villages of northern Haiti. Man-biting rates and nightly biting cycles were determined by the use of all-night man-biting captures inside and outside houses. Seasonal changes in density and behavior were determined by repeating the captures on a bimonthly basis throughout one year. Exophily was demonstrated in these anopheline populations by a comparison of inside-biting with inside-resting densities. These behavior characteristics are discussed in relation to malaria transmission and to the choice of malaria control methods.

Comparison of an experimental updraft ultraviolet light trap with the CDC miniature light trap and biting collections in sampling for Anopheles albimanus in Haiti.

Three methods of capturing Anopheles albimanus mosquitoes were compared during a field study in four villages in northern Haiti. Updraft ultraviolet (UV) light traps proved to be more effective than biting collections, regardless of season or whether the tests were done indoors or outdoors. Biting collections were in turn more effective than the Centers for Disease Control (CDC) miniature light traps. Updraft UV light traps and biting collections yielded more An. albimanus outdoors than indoors; the reverse was found for the CDC miniature light traps. The updraft UV light traps caught An. albimanus on 86% of the occasions used outside and 75% of the occasions inside. The biting collections were equally as successful as the traps in catching mosquitoes outside but caught An. albimanus only on 64% of the occasions when used inside houses. The CDC miniature light traps were successful in collecting An. albimanus on 33% of the occasions outside and 60% of the occasions inside.

Neurogenic influence on pulmonary surface tension and cholesterol in cats.

Previous work showed that stress involving the sympathetic nervous system via mechanical head injury and hyperbaric oxygen results in a decreased lung compliance and altered alveolar surfactants. Similar changes were associated with sympathetic nerve stimulation via the stellate ganglion. In view of reports that the minimum surface tension attained by lung wash fluid is increased by very small amounts of cholesterol content of the alveoli. The results show a nearly 200% increase in intra-alveolar cholesterol as well as high minimum surface tensions following sympathetic nerve stimulation. Such changes developed in the absence of any increase in lung wet wt/dry wt ratios. The results from the present study suggest that the previously reported decreased lung compliance and increased minimum surface tension associated with sympathetic stimulation may be due at least in part to contamination of the alveolar surfactants with large amounts of cholesterol.

Chlorine inhalation: the big picture.

BACKGROUND: Causes of acute chlorine exposures from community pool accidents have many reported etiologies. This case series involves 13 children exposed to high levels of chlorine at two community pools after an unusual mishap in the chlorination maintenance procedure. CASE REPORT: During maintenance, the water feeding lines to pools are normally turned off, the chemicals replaced, the water turned back on, and the chemicals then reinjected into the line. In two separate disasters in the summer of 1996, the feeding lines were not reprimed with water before the reactants, sodium hypochlorite and muriatic acid, were injected. This caused an unusually high volume of concentrated chlorinated water to be released when refed to the pool. RESULTS: All patients were treated with beta agonists and humidified oxygen, and five were admitted. None received bicarbonate inhalation. An extensive literature review of chlorine inhalation injuries indicates considerable variance in opinions of the pathophysiology, clinical presentation and treatment modalities, especially steroids and bicarbonate inhalation. CONCLUSION: In community pools, failure to reprime feeding lines with water after replacing and injecting chlorinating reactants may result in severe and large-scale chlorine exposures. Beta agonist administration and humidified oxygen remains the mainstay of treatment; steroid therapy and bicarbonate inhalation are still inadequately supported.

Impact of emergency medicine residents on ancillary test utilization.

The effect of the addition of emergency medicine residency on the use of ancillary testing in a teaching hospital's emergency department (ED) staffed previously by emergency medicine board-certified physicians was studied. Prospectively, the utilization of three common ancillary tests (electrolyte levels, X-ray, or electrocardiogram) for four common chief complaints of patients eventually discharged from the ED was evaluated. A 12-month period before and a 15-month period after introduction of an emergency medicine residency program were compared. The mean number of ancillary tests utilized by the ED attending physicians working with residents was compared with the mean number of tests generated by the same physicians (all emergency medicine board-certified) for the same complaints in the year before the residents' arrival. There was no significant difference in test use before and after introduction of the residency (P = .66). Faculty use of tests was also unaffected by the concurrent presence of residents (P = .068). These results show that the use of testing for a sample of common ED complaints was not affected by the introduction of emergency medicine residents to a previously emergency medicine board-certified staff in one community teaching hospital.

Monitoring community response to malaria control using insecticide-impregnated bed nets, curtains and residual spray at Nsukka, Nigeria.

A project testing the efficacy of insecticide (permethrin)-impregnated bed nets, compared with impregnated door and window curtains, residual house spraying, and a control group was implemented in 12 village clusters in the Nsukka Local Government Area of Enugu State, Nigeria, using epidemiologic and entomologic indicators. The appropriate materials and services were given free to all families. During the first year of study, three monitoring exercises were carried out in a random selection of homes where children under 5 years of age resided. Information was collected on perceived effectiveness of the interventions, condition of nets and curtains, reasons for not sleeping under nets, and recall of steps required in caring for nets and curtains. Bed nets were perceived as more effective in reducing mosquito bites compared with the two other interventions. At the last monitoring period, which occurred a few weeks before a re-impregnation exercise, respondents also perceived bed nets to be most effective in preventing malaria. These findings coincided with epidemiologic evidence. Curtains, especially those at doors, were more likely to be torn and dirty than bed nets. Although holes would not reduce the effectiveness of the insecticide, they could reduce the 'beauty' of the curtains, a perceived benefit that initially attracted villagers to both curtains and nets. Bed net owners reported significantly less frequent use of other mosquito control measures in their homes than did members of the other groups. Finally, bed net users demonstrated increased knowledge of use and care steps than did those with curtains. These findings suggested a high level of social acceptability of bed nets, and point to the need to test their acceptability further under conditions where people would pay for nets and communities would manage distribution and re-impregnation systems.

In vivo and in vitro susceptibility to chloroquine of Plasmodium falciparum in Kinshasa and Mbuji-Mayi, Zaire.

From April to June 1983, combined in vivo and in vitro studies were conducted to assess the response to chloroquine of Plasmodium falciparum in Kinshasa and Mbuji-Mayi, Zaire. A total of 109 patients were treated with chloroquine, either as a single dose of 10 mg/kg or as a full dose of 25 mg/kg. All patients rapidly cleared their asexual parasitaemia, no recurrence being noted during the subsequent 3 weeks of follow-up. In the fourth week, recurrences were noted in 3 out of 66 patients treated with the full dose of chloroquine and in 10 out of 43 patients treated with the single dose. A total of 101 in vitro tests (30 macro tests, 39 micro tests, and 32 48-hour tests) were successfully performed with blood samples collected from 51 of these patients. Full sensitivity to chloroquine was demonstrated in all but 3 of the successful in vitro tests, the results from these 3 tests being contradicted either by alternative in vitro tests or by the corresponding in vivo findings. These investigations thus failed to detect chloroquine resistance at the level reported in East Africa or eastern Zaire (in Kivu).