Nanomechanical Stability of Laterally Heterogeneous Films of Corrosion Inhibitor Molecules Obtained by Microcontact Printing on Au Model Substrates.

Self-assembled monolayers of corrosion inhibitors of the mercaptobenzimidazole family, SH-BimH, SH-BimH-5NH2, and SH-BimH-5OMe, were formed on template-stripped ultraflat Au surfaces using microcontact printing, and subsequently analyzed using X-ray photoelectron spectroscopy (XPS), atomic force microscopy (AFM), and AFM-force spectroscopy (AFM-FS) using a quantitative imaging (QI) mode. Printing of all used inhibitor molecules resulted in clear patterns and in slightly more compact films compared to immersion. The stability of the monolayers is further probed by AFM-FS. Adhesion values of laterally heterogeneous inhibitor-modified surfaces compared to bare Au surfaces, nonpatterned areas, and fully covered surfaces are analyzed and discussed. Microcontact printing confers a superior nanomechanical stability to imidazole-modified films of the printed surface patches as compared to homogeneously covered surfaces by immersion into the inhibitor solution.

Displacement Effects of Conservation Grazing on Red Deer (Cervus elaphus) Spatial Behaviour.

Conservation grazing uses semi-feral or domesticated herbivores to limit encroachment in open areas and to promote biodiversity. However, we are still unaware of its effects on wild herbivores. This study investigates the influence of herded sheep and goats on red deer (Cervus elaphus) spatial behavior by testing three a-priori hypotheses: (i) red deer are expected to avoid areas used by livestock, as well as adjacent areas, when livestock are present, albeit (ii) red deer increase the use of these areas when sheep and goats are temporarily absent and (iii) there is a time-lagged disruption in red deer spatial behavior when conservation grazing practice ends. Using GPS-telemetry data on red deer from a German heathland area, we modelled their use of areas grazed by sheep and goats, using mixed-effect logistic regression. Additionally, we developed seasonal resource selection functions (use-availability design) to depict habitat selection by red deer before, during, and after conservation grazing. Red deer used areas less during conservation grazing throughout all times of the day and there was no compensatory use during nighttime. This effect mostly persisted within 21 days after conservation grazing. Effects on habitat selection of red deer were detectable up to 3000 meters away from the conservation grazing sites, with no signs of either habituation or adaption. For the first time, we demonstrate that conservation grazing can affect the spatio-temporal behavior of wild herbivores. Our findings are relevant for optimizing landscape and wildlife management when conservation grazing is used in areas where wild herbivores are present.

IRIXS Spectrograph: an ultra high-resolution spectrometer for tender RIXS.

The IRIXS Spectrograph represents a new design of an ultra-high-resolution resonant inelastic X-ray scattering (RIXS) spectrometer that operates at the Ru L3-edge (2840 eV). First proposed in the field of hard X-rays by Shvyd'ko [(2015), Phys. Rev. A, 91, 053817], the X-ray spectrograph uses a combination of laterally graded multilayer mirrors and collimating/dispersing Ge(111) crystals optics in a novel spectral imaging approach to overcome the energy resolution limitation of a traditional Rowland-type spectrometer [Gretarsson et al. (2020), J. Synchrotron Rad. 27, 538-544]. In combination with a dispersionless nested four-bounce high-resolution monochromator design that utilizes Si(111) and Al2O3(110) crystals, an overall energy resolution better than 35 meV full width at half-maximum has been achieved at the Ru L3-edge, in excellent agreement with ray-tracing simulations.

IRIXS: a resonant inelastic X-ray scattering instrument dedicated to X-rays in the intermediate energy range.

A new resonant inelastic X-ray scattering (RIXS) instrument has been constructed at beamline P01 of the PETRA III synchrotron. This instrument has been named IRIXS (intermediate X-ray energy RIXS) and is dedicated to X-rays in the tender-energy regime (2.5-3.5 keV). The range covers the L2,3 absorption edges of many of the 4d elements (Mo, Tc, Ru, Rh, Pd and Ag), offering a unique opportunity to study their low-energy magnetic and charge excitations. The IRIXS instrument is currently operating at the Ru L3-edge (2840 eV) but can be extended to the other 4d elements using the existing concept. The incoming photons are monochromated with a four-bounce Si(111) monochromator, while the energy analysis of the outgoing photons is performed by a diced spherical crystal analyzer featuring (102) lattice planes of quartz (SiO2). A total resolution of 100 meV (full width at half-maximum) has been achieved at the Ru L3-edge, a number that is in excellent agreement with ray-tracing simulations.

Challenges in interpretation of WGS and epidemiological data to investigate nosocomial transmission of vancomycin-resistant Enterococcus faecium in an endemic region: incorporation of patient movement network and admission screening.

OBJECTIVES: VRE are listed, by the WHO, among the leading resistant pathogens causing greatest public concern; hence the spread and transmission of VRE, especially in hospitalized patients, need to be monitored. Despite the advancements in typing methods since the implementation of WGS for outbreak investigations, data interpretation, especially for vancomycin-resistant Enterococcus faecium (VREfm) in an endemic setting, remains challenging. In this study we explored the potential added benefit of incorporating patient movement data and admission screening to accurately estimate the magnitude of an outbreak. METHODS: We sequenced 73 VREfm isolates from patients with bacteraemia (n = 43) and rectal colonization (n = 30/32). Genetic relatedness was determined by SNP distance (≤10) between isolates. Patient movements were visualized in a movement network, along with contact intensity and rectal colonization status prior to infection onset. RESULTS: ST117, ST80 and ST203 were the predominant STs in our study population. Forty-four percent (18/41) of VREfm bacteraemia cases were of endogenous origin. SNP analysis of infection and colonization isolates revealed nine clonal groups. Eighty-six percent (37/43) of the patients were visualized in a transmission network due to spatiotemporal overlap. Nineteen out of 43 (44%) belonged to five transmission clusters. Incorporation of prior colonization status revealed that transmission was very likely in only 63% (12/19) of patients in these transmission clusters. DISCUSSION: Although interpretation of WGS data is challenging, incorporation of patient movement data and colonization status by admission screening of high-risk patients may provide additional resolution when interpreting the magnitude of an outbreak in an endemic setting.

Structure and Dynamics of Confined Liquids: Challenges and Perspectives for the X-ray Surface Forces Apparatus.

The molecular-scale structure and dynamics of confined liquids has increasingly gained relevance for applications in nanotechnology. Thus, a detailed knowledge of the structure of confined liquids on molecular length scales is of great interest for fundamental and applied sciences. To study confined structures under dynamic conditions, we constructed an in situ X-ray surface forces apparatus (X-SFA). This novel device can create a precisely controlled slit-pore confinement down to dimensions on the 10 nm scale by using a cylinder-on-flat geometry for the first time. Complementary structural information can be obtained by simultaneous force measurements and X-ray scattering experiments. The in-plane structure of liquids parallel to the slit pore and density profiles perpendicular to the confining interfaces are studied by X-ray scattering and reflectivity. The normal load between the opposing interfaces can be modulated to study the structural dynamics of confined liquids. The confinement gap distance is tracked simultaneously with nanometer precision by analyzing optical interference fringes of equal chromatic order. Relaxation processes can be studied by driving the system out of equilibrium by shear stress or compression/decompression cycles of the slit pore. The capability of the new device is demonstrated on the liquid crystal 4'-octyl-4-cyano-biphenyl (8CB) in its smectic A (SmA) mesophase. Its molecular-scale structure and orientation confined in 100 nm to 1.7 µm slit pores was studied under static and dynamic nonequilibrium conditions.

Hop Extract Acts as an Antioxidant with Antimicrobial Effects against Propionibacterium Acnes and Staphylococcus Aureus.

Acne is associated with hyperkeratosis, elevated levels of skin sebum and growth of Propionibacterium acnes (P. acnes) and Staphylococcus aureus (S. aureus). Furthermore, P. acnes promotes inflammation by inducing IL-6 production and oxidative stress. The aim of this study was to assess the antioxidant, anti-inflammatory and antibacterial potential of a hop-CO2-extract with 50% humulone and lupulone. The susceptibility of P. acnes and S. aureus to the hop extract was tested by using the broth microdilution technique. The minimal inhibitory concentrations (MIC) for P. acnes and S. aureus were 3.1 and 9.4 µg/mL, respectively. In addition, the hop extract showed an antioxidative effect with a half maximal inhibitory concentration (IC50) of 29.43 µg/mL as well as additional anti-inflammatory effects by reducing the IL-6 expression (IC50: 0.8 µg/mL). In addition, a gel formulation with 0.3% hop extract (w/w) had antibacterial activity against P. acnes and S. aureus (inhibition zone value: 5.5 mm and 3 mm, respectively) which was significantly superior to the placebo gel. The positive control (a gel with the antibiotic clindamycin) showed an inhibition zone of 9 mm. Due to its antioxidant, anti-inflammatory and antibacterial effects hop extract might be a treatment option for acne-prone skin.

The best smellers make the best choosers: mate choice is affected by female chemosensory receptor gene diversity in a mammal.

The products of the genes of the major histocompatibility complex (MHC) are known to be drivers of pathogen resistance and sexual selection enhancing offspring genetic diversity. The MHC further influences individual odour types and social communication. However, little is known about the receptors and their volatile ligands that are involved in this type of chemical communication. Here, we have investigated chemosensory receptor genes that ultimately enable females to assess male genes through odour cues. As a model, we used an invasive population of North American raccoons ( Procyon lotor) in Germany. We investigated the effect of two groups of chemosensory receptor genes-trace amine-associated receptors (TAARs) and olfactory receptors (ORs)-on MHC-dependent mate choice. Females with more alleles of the TAAR or OR loci were more likely to choose a male with a diverse MHC. We additionally found that MHC class I genes have a stronger effect on mate choice than the recently reported effect for MHC class II genes, probably because of their immunological relevance for viral resistance. Our study is among the first to show a genetic link between behaviour and chemosensory receptor genes. These results contribute to understanding the link between genetics, olfaction and associated life-history decisions.

Can MHC-assortative partner choice promote offspring diversity? A new combination of MHC-dependent behaviours among sexes in a highly successful invasive mammal.

Sexual selection involving genetically disassortative mate choice is one of several evolutionary processes that can maintain or enhance population genetic variability. Examples of reproductive systems in which choosers (generally females) select mates depending on their major histocompatibility complex (MHC) genes have been reported for several vertebrate species. Notably, the role of MHC-dependent choice not in mating contexts, but in other kinds of social interactions such as in the establishment of complex social systems, has not yet drawn significant scientific interest and is virtually absent from the literature. We have investigated male and female MHC-dependent choice in an invasive population of North American raccoons (Procyon lotor) in Germany. Both male and female raccoons rely on olfaction for individual recognition. Males have an unusually complex social system in which older individuals choose unrelated younger ones to form stable male coalitions that defend territories and a monopoly over females. We have confirmed that females perform MHC-disassortative mate choice and that this behaviour fosters genetic diversity of offspring. We have also observed that males build coalitions by choosing male partners depending on their MHC, but in an assortative manner. This is the first observation of antagonistic MHC-dependent behaviours among sexes. We show that this is the only combination of MHC-dependent partner choice that leads to outbreeding. In the case of introduced raccoons, such behaviours can act together to promote the invasive potential of the species by increasing its adaptive genetic divergence.

Anion Layering and Steric Hydration Repulsion on Positively Charged Surfaces in Aqueous Electrolytes.

The molecular structure at charged solid/liquid interfaces is vital for many chemical or electrochemical processes, such as adhesion, catalysis, or the stability of colloidal dispersions. How cations influence structural hydration forces and interactions across negatively charged surfaces has been studied in great detail. However, how anions influence structural hydration forces on positively charged surfaces is much less understood. Herein we report force versus distance profiles on freshly cleaved mica using atomic force microscopy with silicon tips. We characterize steric anion hydration forces for a set of common anions (Cl- , ClO4- , NO3- , SO42- and PO43- ) in pure acids at pH ≈1, where protons are the co-ions. Solutions containing anions with low hydration energies exhibit repulsive structural hydration forces, indicating significant ion and/or water structuring within the first 1-2 nm on a positively charged surface. We attribute this to specific adsorption effects within the Stern layer. In contrast, ions with high hydration energies show exponentially repulsive hydration forces, indicating a lower degree of structuring within the Stern layer. The presented data demonstrates that anion hydration forces in the inner double layer are comparable to cation hydration forces, and that they qualitatively correlate with hydration free energies. This work contributes to understanding interaction processes in which positive charge is screened by anions within an electrolyte.

Pseudobacteremia outbreak of biofilm-forming Achromobacter xylosoxidans - environmental transmission.

BACKGROUND: Achromobacter xylosoxidans (AX) is known for intrinsic resistance to disinfectants. Our laboratory routine surveillance system detected an unexpected rise in AX bloodstream infections in a 2200-bed hospital. An epidemiological investigation was conducted to find the source and disrupt further transmission. METHODS: Outbreak cases were defined as patients with at least one positive blood culture positive for AX from May 2014 to May 2015. Medical records were reviewed, affected wards, as well as the microbiology laboratory were audited. Additionally, microbiologic culture and biofilm staining for suspected antiseptic reusable tissue dispensers were performed, and isolated AX strains were typed using RAPD PCR and PFGE. RESULTS: During the outbreak period, AX were isolated from blood cultures from 26 patients. The retrospective cohort study did not reveal common risk factors. The clinical features of the case patients suggested a pseudobacteremia. The reusable tissue dispensers containing Incidin® Plus solution product were found to be contaminated with biofilm-forming AX. Typing of the isolates revealed that blood culture isolates were identical with the strains found in the dispensers. CONCLUSIONS: After changing the usage of the product to single-use and educating staff, the outbreak was terminated. Contamination of dispensers occurred due to insufficient reprocessing, since biofilm disrupting steps were not included in the process.

Resonant inelastic X-ray scattering spectrometer with 25 meV resolution at the Cu K-edge.

An unparalleled resolution is reported with an inelastic X-ray scattering instrument at the Cu K-edge. Based on a segmented concave analyzer, featuring single-crystal quartz (SiO2) pixels, the spectrometer delivers a resolution near 25 meV (FWHM) at 8981 eV. Besides the quartz analyzer, the performance of the spectrometer relies on a four-bounce Si(553) high-resolution monochromator and focusing Kirkpatrick-Baez optics. The measured resolution agrees with the ray-tracing simulation of an ideal spectrometer. The performance of the spectrometer is demonstrated by reproducing the phonon dispersion curve of a beryllium single-crystal.

Influx of multidrug-resistant organisms by country-to-country transfer of patients.

BACKGROUND: Multidrug-resistant organisms (MDRO) are a worldwide problem. International migration and travel facilitate the spread of MDRO. Therefore the goal of our study was to assess the risk of influx of MDRO from patients transferred to one of Central Europe's largest hospitals from abroad. METHODS: A mono-centre study was conducted. All patients transferred from other countries were screened; additional data was collected on comorbidities, etc. Presence of carbapenemases of multidrug-resistant Gram-negatives was confirmed by PCR. The association between length of stay, being colonized and/or infected by a MDRO, country of origin, diagnosis and other factors was assessed by binomial regression analyses. RESULTS: From 2012 to 2013, one fifth of all patients were colonized with MDRO (Methicillin-resistant Staphylococcus aureus [4.1 %], Vancomycin-resistant Enterococci [2.9 %], multidrug-resistant Gram-negatives [12.8 %] and extensively drug-resistant Gram-negatives [3.4 %]). The Gram-negatives carried a variety of carbapenemases including OXA, VIM, KPC and NDM. The length of stay was significantly prolonged by 77.2 % in patients colonized with a MDRO, compared to those not colonized (p<0.0001). CONCLUSIONS: Country-to-Country transfer of patients to European hospitals represents a high risk of introduction of MDRO and infection control specialists should endorse containment and screening measures.

Impact of availability of guidelines and active surveillance in reducing the incidence of ventilator-associated pneumonia in Europe and worldwide.

BACKGROUND: To analyse whether the availability of written standards for management of mechanically ventilated patients and/or the existence of a surveillance system for cases of ventilation-associated pneumonia (VAP) are positively associated with compliance with 6 well-established VAP prevention measures. METHODS: Ecological study based on responses to an online-questionnaire completed by 1730 critical care physicians. Replies were received from 77 different countries, of which the majority, i.e. 1351, came from 36 European countries. RESULTS: On a cross-country level, compliance with VAP prevention measures is higher in countries with a large number of prevention standards and/or VAP surveillance systems in place at ICU level., Likewise, implementation of standards and VAP surveillance systems has a significant impact on self-reported total compliance with VAP prevention measures (both p < 0.001). Moreover, predictions of overall prevention measure compliance show the effect size of the availability of written standards and existence of surveillance system. For instance, a female physician with 10 years of experience in critical care working in a 15-bed ICU in France has a predicted baseline level of VAP prevention measure compliance of 63 per cent. This baseline level increases by 9.5 percentage points (p < 0.001) if a written clinical VAP prevention standard is available in the ICU, and by another 4 percentage points (p < 0.001) if complemented by a VAP surveillance system. CONCLUSIONS: The existence of written standards for management of mechanically ventilated patients in an ICU and the availability of VAP surveillance systems have shown to be positively associated with compliance with VAP prevention measures and should be fostered on a policy level.

Development of an advanced multiwavelength emission detector for the analytical ultracentrifuge.

An advanced design of the analytical ultracentrifuge with multiwavelength emission detection (MWE-AUC) is presented which offers outstanding performance concerning the spectral resolution and range flexibility as well as the quality of the data acquired. The excitation by a 520 nm laser is complemented with a 405 nm laser. An external spectrograph with three switchable tunable gratings permits optimisation of the spectral resolution in an order of magnitude range while keeping the spectral region broad. The new system design leads also to a significant reduction of systematic signal noise and allows the assessment and control of inner filter effects. Details regarding the very large signal dynamic range are presented, an important aspect when studying samples in a broad concentration range of up to five orders of magnitude. Our system is validated by complementary studies on two biological systems, fluorescent BSA and GFP, using the commercial Optima AUC with absorbance detection for comparison. Finally, we demonstrate the capabilities of our second generation MWE-AUC with respect to multiwavelength characterisation of gold nanoclusters, which exhibit specific fluorescence depending on their structure. Overall, this work depicts an important stepping stone for the concept of multiwavelength emission detection in AUC. The MWE-AUC developed, being to our knowledge the first and sole one of its kind, has reached the development level suitable for the future in-depth studies of size-, shape- and composition-dependent emission properties of colloids.

Alaria alata mesocercariae in raccoons (Procyon lotor) in Germany.

Alaria alata is a trematode of carnivores from Europe. The mesocercarial stage was recently identified in wild boar meat from Europe. Previous histopathologic studies showed the presence of unidentified parasitic cysts within the tongues of raccoons from northern Germany. For identification of the parasite species, tissue samples of 105 raccoons originating from a National Park in northern Germany and from Berlin metropolitan area were collected. Histological examination of cryotome sections of frozen as well as paraffin-embedded tongues were used to identify parasite cysts. These were located in the connective and adipose tissue and in close proximity to small arterioles, suggesting a hematogenous spread of the parasite. Often, cysts were surrounded with mild infiltration by inflammatory cells. Additionally, mesocercariae were isolated from defrosted tongue samples of 11 raccoons. Molecular-biology assays confirmed the parasite species as A. alata. Except for one positive raccoon from Berlin City, all other positive raccoons originated from the sylvan Müritz National park, indicating an abundance of intermediate hosts in this area. Our results show that raccoons can act as paratenic hosts for A. alata and extend the broad host range of this parasite to a species introduced into Germany.

Determination of 2D Particle Size Distributions in Plasmonic Nanoparticle Colloids via Analytical Ultracentrifugation: Application to Gold Bipyramids.

Multidimensional particle properties determine the product properties in numerous advanced applications. Accurate and statistically meaningful measurements of complex particles and their multidimensional distributions are highly challenging but strongly needed. 2D particle size distributions of plasmonic nanoparticles of complex regular shape can be obtained from analytical ultracentrifugation experiments via the optical back coupling method. A workflow for the calculation of frictional properties of arbitrarily shaped nanoparticles was developed based on bead shell models and applied to gold bipyramids with a pentagonal cross-section. The obtained 2D particle length-diameter distributions and the reduced cumulative 1D length and diameter distributions were compared to transmission electron microscopy measurements. While we find very good agreement for most measurements, the obtained length and diameter distributions were shifted by a few nanometers for some samples. Transmission electron microscopy, energy-dispersive X-ray spectroscopy, electron tomography, and finite element modeling indicate that the shift originated from a slight mismatch between the assumed shape of the simulated perfect bipyramids and the real particle shape and composition due to the presence of silver in the particles. This study demonstrates the feasibility of the applied techniques for complex shape analysis of nanoparticle ensembles with unmatched particle count numbers.

Opportunities and challenges for monitoring a recolonizing large herbivore using citizen science.

Monitoring is a prerequisite for evidence-based wildlife management and conservation planning, yet conventional monitoring approaches are often ineffective for species occurring at low densities. However, some species such as large mammals are often observed by lay people and this information can be leveraged through citizen science monitoring schemes. To ensure that such wildlife monitoring efforts provide robust inferences, assessing the quantity, quality, and potential biases of citizen science data is crucial. For Eurasian moose (Alces alces), a species currently recolonizing north-eastern Germany and occurring in very low numbers, we applied three citizen science tools: a mail/email report system, a smartphone application, and a webpage. Among these monitoring tools, the mail/email report system yielded the greatest number of moose reports in absolute and in standardized (corrected for time effort) terms. The reported moose were predominantly identified as single, adult, male individuals, and reports occurred mostly during late summer. Overlaying citizen science data with independently generated habitat suitability and connectivity maps showed that members of the public detected moose in suitable habitats but not necessarily in movement corridors. Also, moose detections were often recorded near roads, suggestive of spatial bias in the sampling effort. Our results suggest that citizen science-based data collection can be facilitated by brief, intuitive digital reporting systems. However, inference from the resulting data can be limited due to unquantified and possibly biased sampling effort. To overcome these challenges, we offer specific recommendations such as more structured monitoring efforts involving the public in areas likely to be roamed by moose for improving quantity, quality, and analysis of citizen science-based data for making robust inferences.

Combination of isothiocyanates and antibiotics increases susceptibility against Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis and Serratia marcescens.

BACKGROUND: The development and spread of multidrug-resistant organisms (MDRO) is evolving rapidly worldwide. Although effective antibiotics are still available, some infections are difficult to treat. Among MDROs, S. marcescens and A. baumannii are among the difficult-to-treat pathogens causing for instance sepsis and urinary tract infections (UTI). Isothiocyanates (ITC) are natural plant products. The antimicrobial properties of ITC appear to be more effective in combination with some antibiotics. PURPOSE: We investigated a mixture of ITC from nature-identical plant extracts of nasturtium and horseradish in different combined concentrations with broad-spectrum antibiotics against S. marcescens, A. baumannii, E. coli, K. pneumoniae and P. mirabilis. METHODS: First, we investigated the antibacterial activity of the compounds by standard agar disc diffusion test. Next, we evaluated the minimum inhibitory concentrations (MIC) via broth dilution tests. Checkerboard technique was used to assess antimicrobial effects against sulfamethoxazole-trimethoprim, ampicillin-sulbactam, nitrofurantoin, Fosfomycin, ciprofloxacin and imipenem combined with various concentrations of ITC. RESULTS: S. marcescens strains 1-3 showed reversal of resistance at >0.075 µg/mL ITC in combination with nitrofurantoin, whereas 0.05 µg/mL ITC increased antimicrobial susceptibility. Combination of fosfomycin with 0.003 µg/mL ITC resulted in increased efficacy against resistant S. marcescens strains, E. coli, K. pneumoniae and P. mirabilis. Remarkable additive antimicrobial activity was observed at 0.03 µg/mL and 0.06 µg/mL ITC in combination with 0.125 µg/mL imipenem (FIC > 0.5). CONCLUSION: The combination of ITC and antibiotics is a promising approach for the treatment of UTI caused by MDRO. The ITC combination with selected antibiotics had synergistic and additive effects.

Effect of didecyl dimethyl ammonium chloride-impregnated washcloth wipe whole-body bathing on catheter-related blood stream infections and central venous line-associated infections in adult intensive care units.

OBJECTIVE: To investigate the effect of daily whole-body bathing (WBB) using disposable washcloth wipes/caps impregnated with an antiseptic solution containing the quaternary ammonium base compound didecyl dimethyl ammonium chloride (DDAC). METHODS: A prospective double-blind randomized crossover trial was conducted to compare WBB of adult intensive care unit (ICU) patients with washcloth wipes/caps impregnated with either regular cleanser/shampoo or the antiseptic DDAC. The clinical trial was performed in a medical ICU (MICU) and a surgical ICU (SICU). The study period was divided into two 6-month intervals with alternating treatment regimens. RESULTS: A total of 1540 ICU patients (total length of ICU stay 10 470 days) were included in the trial. Compared to controls, DDAC bathing was found to be associated with reduced incidence rates per 1000 patient days for central-venous-line-associated infections (CLAIs) caused by Gram-positive bacteria (GPB) from 16.39 (95%CI 13.1-20.3) in the control group to 7.28 (95%CI 5.2-9.9) in the intervention group (p 0.01). A stratified analysis by unit showed that the incidence rates of CLAI due to GPB were reduced by the intervention in both the MICU and the SICU from 21.2 (95%CI 15.8-27.7) to 9.3 (95%CI 5.8-14.1) (p < 0.01) and from 12.1 (95%CI 8.3-17.0) to 5.7 (95%CI 3.4-9.1) (p 0.01), respectively. There was a trend towards reduction in catheter-related bloodstream infections (CRBSIs) and bloodstream infections (BSIs); however, this did not reach statistical significance due to carry-over effects and small numbers. CONCLUSIONS: Given the growing need for new concepts to prevent and control healthcare-associated infections, DDAC may be a new and promising agent for WBB of ICU patients.