Establishing a Long-Term Model for Analysis and Improvement of Underfilled Blood Culture Volumes.

Objectives: Underfilling of blood culture bottles decreases the sensitivity of the culture. We attempt to increase average blood culture fill volumes (ABCFVs) through an educational program. Methods: Partnerships were established with four hospital units (surgical intensive care unit [SICU], medical intensive care unit [MICU], medical intermediate care unit [MIMCU], and hematology and oncology unit [HEME/ONC]). ABCFVs were continuously tracked and communicated to each unit monthly. Educational sessions were provided to each unit. Results: ABCFVs for the SICU, MICU, MIMCU, and HEME/ONC were 4.8, 5.0, 5.0, and 6.3 mL/bottle, respectively. After the final education session, the SICU, MICU, MIMCU, and HEME/ONC were able to maintain an ABCFV of 6.8, 8.1, 7.9, and 8.2 mL/bottle, respectively. Conclusions: Partnering with a specific unit and providing monthly volume reports with educational sessions has a direct positive correlation on increasing ABCFVs. Increasing ABCFVs has the potential to decrease false-negative blood cultures, time to detection of positive blood cultures, and time to appropriate and specific antimicrobial therapy, as well as improve patient outcomes in high-acuity patient care units.

A case study of air quality - Pesticides and odorous phytochemicals on Kauai, Hawaii, USA.

This study was conducted after a series of incidences occurred at Waimea Canyon Middle School on Kauai, Hawaii. Some students and staff members exhibited symptoms such as throat irritation, tearing, and dizziness. These symptoms could be associated with natural causes or human activities, which include exposures to pesticides and odorous phytochemicals. At the time of the occurrences, Cleome gynandra (known locally as stinkweed) was growing in the fields near the school and might be a potential cause of the reported symptoms. This work was designed to study pesticides and phytochemicals in ambient air around Waimea Canyon Middle School in comparison with other locations on Kauai. Among many chemicals, top 29 were selected for the analysis of stinkweed-emitted chemicals in a chamber study. One out of the 29 chemicals was methyl isothiocyanate (MITC) that is a highly foul-smelling, noxious chemical at high concentrations. Approximately half of the 29 chemicals produced by stinkweed and trace amounts of five pesticides were detected in indoor and outdoor air samples collected from the passive and high volume air samplers. The average concentrations of MITC in Waimea outdoor air during daytime and nighttime were 13.1 and 5.6 ng m-3, respectively. The average concentrations of the five pesticides DDTs, HCHs, chlorpyrifos, bifenthrin, and metolachlor in Waimea outdoor air were respectively 2.5, 2.3, 35, 43, and 23 ng m-3during daytime and 2.4, 1.7, 33, 29, and 19 ng m-3 during nighttime. The concentrations of the pesticide and phytochemicals found in air on Kauai were below health concern levels.