Feedback of ATP measurement as a tool for reducing environmental contamination in hospitals in the Dutch/Belgian border area.

DESIGN: A two-phase prospective intervention study. OBJECTIVE: The objective of this study was to determine if feedback of adenosine triphosphate (ATP) measurements decreases environmental contamination within hospitals in the Dutch/Belgian border area. METHODS: Standardized ATP measurements were conducted in nine hospitals on pre-defined fomites. Four different fomite groups were defined: medical devices, patient-bound materials, ward-bound materials and sanitary items. ATP results were reported in relative light unit (RLU), RLU >1000 was considered as 'not clean.' Two rounds of ATP measurements were conducted. After the first round of ATP measurements, results were provided to the wards and cleaning staff. The second round of ATP measurements was performed one year later. The amount of surface contamination before and after the feedback was compared. RESULTS: In total 1923 ATP measurements were performed. Before feedback 960 ATP measurements were conducted and after feedback 963 were conducted. The overall median reduction in RLU was 381 (P < 0.001), from 568 before feedback to 187 afterward. In each hospital there was a reduction of the median RLU after feedback. CONCLUSIONS: Substantial reductions in RLU values were found after feedback of ATP measurements. Feedback of ATP measurement in itself was associated with a major reduction of surface contamination in hospitals.

Retrospective evaluation of control measures for contacts of patient with Marburg hemorrhagic fever.

After an imported case of Marburg hemorrhagic fever was reported in 2008 in the Netherlands, control measures to prevent transmission were implemented. To evaluate consequences of these measures, we administered a structured questionnaire to 130 contacts classified as either having high-risk or low-risk exposure to body fluids of the case-patient; 77 (59.2%) of 130 contacts responded. A total of 67 (87.0%) of 77 respondents agreed that temperature monitoring and reporting was necessary, significantly more often among high-risk than low-risk contacts (p<0.001). Strict compliance with daily temperature monitoring decreased from 80.5% (62/77) during week 1 to 66.2% (51/77) during week 3. Contacts expressed concern about development of Marburg hemorrhagic fever (58.4%, 45/77) and infecting a family member (40.2%, 31/77). High-risk contacts had significantly higher scores on psychological impact scales (p<0.001) during and after the monitoring period. Public health authorities should specifically address consequences of control measures on the daily life of contacts.

ATP measurement as an objective method to measure environmental contamination in 9 hospitals in the Dutch/Belgian border area.

BACKGROUND: The objective of this study was to determine the level of environmental contamination in hospitals in the Dutch/Belgian border area, using ATP measurements. DESIGN: A cross-sectional observational survey. METHODS: Standardized ATP measurements were conducted in 9 hospitals on 32 hospital wards. Thirty pre-defined surfaces per hospital ward were measured with the 3 M Clean Trace NG luminometer. Results are displayed in relative light units (RLU). RLU > 1000 was considered as "not clean." Differences in RLU values were compared between countries, hospitals, fomite groups and medical specialties. RESULTS: A total of 960 ATP measurements were performed, ranging from 60 up to 120 per hospital. The median RLU-value was 568 (range: 3-277,586) and 37.7% of the measurements were rated as not clean (RLU > 1000). There were significant differences between countries, hospitals and fomite groups. CONCLUSION: ATP measurements can be used as a more objective approach to determine the level of environmental contamination in hospitals. Significant differences in ATP levels were found between hospitals and between countries. Also, substantial differences were found between different fomite groups. These findings offer potential targets for improvement of cleanliness in healthcare facilities.

Analysis of 36 Y-STR marker units including a concordance study among 2085 Dutch males.

The genotypes of 36 Y-chromosomal short tandem repeat (Y-STR) marker units were analysed in a Dutch population sample of 2085 males. Profiling results were compared for several partially overlapping kits, i.e. PowerPlex Y, Yfiler, PowerPlex Y23, and two in-house designed multiplexes with rapidly mutating Y-STRs. Nineteen Y-STR marker units, of which two are rapidly mutating, reside in at least two of these multiplexes, and for these markers concordance testing was performed. Two samples showed discordant genotyping results and the probable causative base change was revealed by Sanger sequencing. In addition, we encountered concordant, but aberrant genotyping results including one allele with low peak height and several null alleles. For 12 samples, this involved a null allele in two adjacent loci suggesting a large and recurrent deletion as the samples represent three distinct haplogroups. For each marker unit, the allele counts and frequencies are presented, as are the haplotype counts and haplotype diversities for several combinations of markers.

Comparing six commercial autosomal STR kits in a large Dutch population sample.

Regularly, STR results obtained with different PCR amplification kits are compared, for instance with old cases, when revisiting cold cases or when addressing cross-border crimes. It is known that differences in primer design for the same loci in different kits may give rise to null alleles or shifted alleles. In this study, the genotyping results of 2085 Dutch male samples were compared for six autosomal STR kits (Promega's PowerPlex(®) 16, ESX-16 and ESI-17 Systems, Qiagen's Investigator(®) ESSplex Kit and Applied Biosystems' AmpFlSTR(®) Identifiler and NGM PCR Amplification Kits). A total of 19 discordant autosomal genotyping results were obtained that were examined by sequence analysis using Roche-454 next generation sequencing and/or Sanger sequencing. A further 25 discordances were found and sequenced for the Amelogenin locus. The 24 samples showing the same primer binding site mutation at the Amelogenin locus were subjected to X-STR analysis in order to assess whether they could share a common origin, which appeared not to be the case. Based on the sequencing results, we set the final genotypes and determined the allele frequencies of 23 autosomal STRs for the Dutch reference database.