Sleeping well.

In a study by Cruse et al. published in BMC Medicine, patients with severe brain damage who were in the Vegetative or Minimally Conscious States (VS or MCS, respectively) from traumatic and nontraumatic etiologies had assessments of circadian rhythms using an actigraph, a device worn on a limb to evaluate circadian rhythmicity, in this population. This is a novel approach and is being used as a surrogate for polysomnography and other reference standards. Cruse et al. showed more disruption in circadian rhythms in the VS when compared to the MCS. This suggests that more brain injury occurs in the areas that control circadian rhythmicity in VS than in MCS patients. The study provides opportunities for improved prognostication and rehabilitation strategies in this patient population.

Neonatal exposure to active pulmonary tuberculosis in a health care professional.

Nosocomial transmission of tuberculosis (TB) is a recognized risk. Although many outbreaks of TB in health care settings have been reported, there are few cases of nosocomial transmission to neonates. We report our experience in investigating and managing the exposure over 16 days of 124 neonates, 301 visitors and 219 health care workers to a health care worker with active TB in a neonatal intensive care unit.

The survival of foodborne pathogens during domestic washing-up and subsequent transfer onto washing-up sponges, kitchen surfaces and food.

In this study, the survival of Salmonella, Campylobacter and Escherichia coli O157: H7, when exposed to a range of constant temperatures (47-60 degrees C), in hard or soft water, in the presence/absence of detergent (0-0.3%) and organic matter, and during drying, was investigated. Further experiments used a washing-up process simulation, where soiled dishes contaminated with bacteria were washed in a bowl of warm water containing detergent. In addition, this study considered the risk of bacterial transfer onto (1) sterile dishes and sponges via contaminated water, (2) kitchen surfaces wiped with a contaminated sponge, (3) items placed in direct contact with a contaminated kitchen surface, (4) food placed on a contaminated dish or (5) dishes from contaminated food. A proportion of dishes remained contaminated with all pathogen types after a typical washing-up. Water hardness did not appear to affect survival. E. coli, and to a lesser extent Salmonella, survived towel- or air-drying on dishes and after towel-drying the cloth became contaminated on every occasion, regardless of the test organism. A proportion of sterile dishes washed after contaminated dishes became contaminated with pathogens but transfer from dishes onto food was rare. Washing-up sponges frequently became contaminated with pathogens. The results of this study highlight the potential for survival and cross contamination of food borne pathogens in the kitchen environment.

The early postoperative course of surgical sleep apnea patients.

OBJECTIVES/HYPOTHESIS: Recent guidelines from the American Society of Anesthesiologists recommended postoperative monitoring for most patients undergoing surgery for obstructive sleep apnea (OSA). These guidelines, however, are largely based on retrospective literature and expert opinion. The appropriate level of postoperative monitoring remains controversial. Our objective was to prospectively document the early postoperative course of patients undergoing OSA surgery. STUDY DESIGN: Prospective cohort study. METHODS: One hundred twenty-one patients (age 43.9 + or - 13.5 years, 79.8% male) with sleep-study proven OSA (apnea-hypopnea index 31.9 + or - 22.7) who were undergoing surgery for OSA at our tertiary care center were recruited from 2007 to 2009. Outcome measures were: 1) incidence of respiratory complications requiring nursing intervention, 2) level of postoperative blood oxygen saturation divided into three groups: mean oxygen saturation in recovery room (SpO2(recovery)), mean oxygen saturation in step-up unit (SpO2(step-up)), and lowest oxygen saturation over the 24 hour period (SpO2(minimum)). These results were then compared to the benchmark literature. RESULTS: The overall incidence of nursing intervention in response to a respiratory complication (3.4%) was significantly less than expected (P < .002). Mean SpO2(recovery) was 92.9 + or - 3.2%, SpO2(step-up) was 95.9 + or - 1.6%, and SpO2(minimum) was 92.8 + or - 3.1%. No variables were identified as being predictive of any of the outcome measures. CONCLUSIONS: The incidence of respiratory events requiring intervention in the early postoperative course of OSA patients was low (3.4%). Routine postoperative inpatient monitoring may not be required in many cases.