Assessment of mould remediation in a healthcare setting following extensive flooding.

BACKGROUND: A new hospital building was close to completion when a large pipe carrying clean water broke, causing extensive flooding. AIM: To determine the flood-associated fungal risk to susceptible patients who would use that building. METHODS: Though standard flood remediation by the builders was relatively straightforward, there was no model for specialist assessment of patient risk due to the flood-associated mould growth. As levels of background airborne fungal spores can be expected to vary significantly over time, we could not use absolute levels to indicate either an excess of airborne fungal spores or successful remediation. Therefore it was decided to use weekly settle plates, exposed at the same time in flooded (test) and equivalent non-flooded (control) areas to compensate for variations in background levels. Flood-related risk was estimated by the ratio between fungal colonies on the test and control sets of settle plates, rather than absolute number. FINDINGS: Whereas the physical flood remediation, including the use of 'anti-fungal' treatments, was completed in three weeks post flooding, fungal contamination in flooded areas took 38 weeks to return to control levels and remained so for a further six weeks of observation. CONCLUSION: By the use of this method, we were able to assure the absence of flood-associated fungal risk to susceptible patients who would use that building. We recommend that infection prevention and control teams consider using this approach should they be faced with similar situations.

Comparison of methods for sampling and detection of carbapenemase-producing organisms in clinical handwash basin drains in health care.

There are currently no standardized methods for the sampling and testing of clinical handwash basin (HWB) samples for the detection of carbapenemase-producing organisms (CPOs). Methods used for sampling (drain aspirate vs swab from top of drain) and detection of CPOs in clinical HWB drains in two different healthcare settings, one which was dealing with a hospital-wide CPO outbreak (Hospital A) and another with no reported outbreaks (Hospital B), were compared. Drain aspirates and swabs from HWB drains were tested using multiplex polymerase chain reaction (PCR) together with culture-based methods. No significant difference in detection of CPOs was found between drain aspirate or swab methods of sampling. Direct PCR on samples detected significantly more carbapenemase genes than culture on CARBA agar (P<0.0001 and 0.0045, respectively). A higher percentage of HWB drains were positive in Hospital A both by culture and by direct PCR, and a significantly higher number of carbapenemase genes were detected in HWB drain aspirates at Hospital A, both by PCR and by culture (P=0.014 and 0.0071, respectively). There was high correlation between drain swab positivity by PCR and culture in Hospital A (91%) compared with Hospital B (33%). No difference in drain contamination rates was found when HWBs with a rear drain were compared with HWBs with the drain directly below the tap. Colonization of HWBs at the top of the drain may be related to risk of cross-transmission of CPOs from the healthcare environment to patients.

Whole-genome sequencing links cases dispersed in time, place, and person while supporting healthcare worker management in an outbreak of Panton-Valentine leucocidin meticillin-resistant Staphylococcus aureus; and a review of literature.

This is a report on an outbreak of Panton-Valentine leucocidin-producing meticillin-resistant Staphylococcus aureus (PVL-MRSA) in an intensive care unit (ICU) during the COVID-19 pandemic that affected seven patients and a member of staff. Six patients were infected over a period of ten months on ICU by the same strain of PVL-MRSA, and a historic case identified outside of the ICU. All cases were linked to a healthcare worker (HCW) who was colonized with the organism. Failed topical decolonization therapy, without systemic antibiotic therapy, resulted in ongoing transmission and one preventable acquisition of PVL-MRSA. The outbreak identifies the support that may be needed for HCWs implicated in outbreaks. It also demonstrates the role of whole-genome sequencing in identifying dispersed and historic cases related to the outbreak, which in turn aids decision-making in outbreak management and HCW support. This report also includes a review of literature of PVL-MRSA-associated outbreaks in healthcare and highlights the need for review of current national guidance in the management of HCWs' decolonization regimen and return-to-work recommendations in such outbreaks.

Unintended consequences of long-sleeved gowns in a critical care setting during the COVID-19 pandemic.

At the peak of the coronavirus disease 2019 (COVID-19) pandemic, hand hygiene audits indicated decreased compliance in a 12-bed critical care (CC) area with ventilated COVID-19 patients, where staff used personal protective equipment (PPE), including sessional use of long-sleeved gowns in accordance with the recommendations of Public Health England. There was also a cluster of three central venous catheter (CVC) infections along with increases in the number of patients from whom enteric Gram-negative bacteria (GNB) were isolated from sterile sites. Environmental sampling of near-patient surfaces and frequently touched sites demonstrated that 11.5% of areas were contaminated with enteric GNB in the COVID-19 CC area, compared with 2.6% and 2.7% in COVID-19 and non-COVID-19 general wards, respectively. Following a risk assessment, hospital policy was changed to replace long-sleeved gowns with short-sleeved gowns. The CC unit underwent enhanced cleaning with hypochlorite-based disinfectant and was resampled 8 days later. On resampling, no GNB were isolated from the CC unit. Following this change in PPE, hand hygiene compliance returned to baseline standards and no further CVC infections were identified. Staff reported a preference for short-sleeved gowns. No evidence currently exists that PPE beyond that recommended for pandemic influenza (respiratory protection plus standard PPE) adds to the protection of healthcare workers (HCWs) from severe acute respiratory syndrome coronavirus-2. Long-sleeved gowns prevent HCWs performing hand hygiene effectively. While it is imperative that HCWs are adequately protected, protection of patients from infection hazards is equally important. Further studies are necessary to establish risks from PPE to inform a review of current guidance.

Lateralized effects on reaching by children.

This study examined the limb selection profiles of children for a reach-to-grasp task presented in various positions of hemispace. Underlying questions focused on the use of attentional information and lateralized effects in motor programming for reaching movements. As expected, both right- and left-handed groups used their dominant limb more frequently at the midline and in their own ipsilateral hemispace. However, in response to stimuli presented in contralateral (to the dominant limb) hemispace, both groups switched to using their nondominant limbs at significant levels. As a general comparison, right-handers exhibited greater use of their dominant limb, but arguably, motor dominance in this context may have intervened with the participant's ability to use attentional information to produce a more efficient response. Overall, these findings address the phenomenon associated with motor dominance and use of attentional information in programming.

Foot-preference behavior: a developmental perspective.

The developmental course of foot-preference behavior was examined in participants spanning early childhood to young adulthood. Results indicated significant age-group differences, with no effect for gender. Evidence suggests that footedness adheres to some variant developmental features characterized primarily by a significant shift toward greater right-footedness between 8 and 11 years, after which preferences remain relatively stable. Complementing this shift is a substantial decrease in mixed-footedness across the same time line. Of the existing models of hemispheric specialization, Annett's (1978, 1985) right-shift hypothesis, which considers cultural and environmental effects, provides a partial explanation for the findings. Hand-preference data were also collected and are contrasted with foot-preference data.

Attentional stimuli and programming hand selection: a developmental perspective.

This experiment examined the use of attentional stimuli for reaching in hemispace by strong right-dominant adults and children. Driving the hypothesis was the notion that developmental factors associated with use of attentional information may affect the programming of reaching movements in hemispace. Although the general pattern of responses was similar for both samples, children did not use attentional cues to program reaching movements in contralateral hemispace as effectively as adults. This result suggests that motor dominance and perhaps other factors were pivotal in motor programming for children. One possible explanation for the general behavior observed underlies an attentional hemispheric bias for a tendency to use the hand that is on the same side as the stimulus.