Pilot evaluation of a ward-based automated hand hygiene training system.

A novel artificial intelligence (AI) system (SureWash; GLANTA, Dublin, Ireland) was placed on a ward with 45 staff members for two 6-day periods to automatically assess hand hygiene technique and the potential effectiveness of the automated training system. Two human reviewers assessed videos from 50 hand hygiene events with an interrater reliability (IIR) of 88% (44/50). The IIR was 88% (44/50) for the human reviewers and 80% (40/50) for the software. This study also investigated the poses missed and the impact of feedback on participation (+113%), duration (+11%), and technique (+2.23%). Our findings showed significant correlation between the human raters and the computer, demonstrating for the first time in a clinical setting the potential use of this type of AI technology in hand hygiene training.

Evaluation of screening risk and nonrisk patients for methicillin-resistant Staphylococcus aureus on admission in an acute care hospital.

BACKGROUND: Screening for methicillin-resistant Staphylocccus aureus (MRSA) is advocated as part of control measures, but screening all patients on admission to hospital may not be cost-effective. OBJECTIVE: Our objective was to evaluate the additional yield of screening all patients on admission compared with only patients with risk factors and to assess cost aspects. METHODS: A prospective, nonrandomized observational study of screening nonrisk patients ≤72 hours of admission compared with only screening patients with risk factors over 3 years in a tertiary referral hospital was conducted. We also assessed the costs of screening both groups. RESULTS: A total of 48 of 892 (5%) patients was MRSA positive; 28 of 314 (9%) during year 1, 12 of 257 (5%) during year 2, and 8 of 321 (2%) during year 3. There were significantly fewer MRSA-positive patients among nonrisk compared with MRSA-risk patients: 4 of 340 (1%) versus 44 of 552 (8%), P ≤ .0001, respectively. However, screening nonrisk patients increased the number of screening samples by 62% with a proportionate increase in the costs of screening. A backward stepwise logistic regression model identified age > 70 years, diagnosis of chronic pulmonary disease, previous MRSA infection, and admission to hospital during the previous 18 months as the most important independent predictors to discriminate between MRSA-positive and MRSA-negative patients on admission (94.3% accuracy, P < .001). CONCLUSION: Screening patients without risk factors increased the number of screenings and costs but resulted in few additional cases being detected. In a hospital where MRSA is endemic, targeted screening of at-risk patients on admission remains the most efficient strategy for the early identification of MRSA-positive patients.

Comparison of the antimicrobial activity of Ulmo honey from Chile and Manuka honey against methicillin-resistant Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa.

BACKGROUND: Honey has previously been shown to have wound healing and antimicrobial properties, but this is dependent on the type of honey, geographical location and flower from which the final product is derived. We tested the antimicrobial activity of a Chilean honey made by Apis mellifera (honeybee) originating from the Ulmo tree (Eucryphia cordifolia), against selected strains of bacteria. METHODS: Ulmo 90 honey was compared with manuka UMF 25+ (Comvita) honey and a laboratory synthesised (artificial) honey. An agar well diffusion assay and a 96 well minimum inhibitory concentration (MIC) spectrophotometric-based assay were used to assess antimicrobial activity against five strains of methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli and Pseudomonas aeruginosa. RESULTS: Initial screening with the agar diffusion assay demonstrated that Ulmo 90 honey had greater antibacterial activity against all MRSA isolates tested than manuka honey and similar activity against E. coli and P. aeruginosa. The MIC assay, showed that a lower MIC was observed with Ulmo 90 honey (3.1% - 6.3% v/v) than with manuka honey (12.5% v/v) for all five MRSA isolates. For the E. coli and Pseudomonas strains equivalent MICs were observed (12.5% v/v). The MIC for artificial honey was 50% v/v. The minimum bactericidal concentration for all isolates tested for Ulmo 90 honey was identical to the MIC. Unlike manuka honey, Ulmo 90 honey activity is largely due to hydrogen peroxide production. CONCLUSIONS: Due to its high antimicrobial activity, Ulmo 90 may warrant further investigation as a possible alternative therapy for wound healing.

Enhanced discrimination of highly clonal ST22-methicillin-resistant Staphylococcus aureus IV isolates achieved by combining spa, dru, and pulsed-field gel electrophoresis typing data.

ST22-methicillin-resistant Staphylococcus aureus type IV (ST22-MRSA-IV) is endemic in Irish hospitals and is designated antibiogram-resistogram type-pulsed-field group (AR-PFG) 06-01. Isolates of this highly clonal strain exhibit limited numbers of pulsed-field gel electrophoresis (PFGE) patterns and spa types. This study investigated whether combining PFGE and spa typing with DNA sequencing of the staphylococcal cassette chromosome mec element (SCCmec)-associated direct repeat unit (dru typing) would improve isolate discrimination. A total of 173 MRSA isolates recovered in one Irish hospital during periods in 2007 and 2008 were investigated using antibiogram-resistogram (AR), PFGE, spa, dru, and SCCmec typing. Isolates representative of each of the 17 pulsed-field group 01 (PFG-01) spa types identified underwent multilocus sequence typing, and all isolates were ST22. Ninety-seven percent of isolates (168 of 173) exhibited AR-PFG 06-01 or closely related AR patterns, and 163 of these isolates harbored SCCmec type IVh. The combination of PFGE, spa, and dru typing methods significantly improved discrimination of the 168 PFG-01 isolates, yielding 65 type combinations with a Simpson's index of diversity (SID) of 96.53, compared to (i) pairwise combinations of spa and dru typing, spa and PFGE typing, and dru and PFGE typing, which yielded 37, 44, and 43 type combinations with SIDs of 90.84, 91.00, and 93.57, respectively, or (ii) individual spa, dru, and PFGE typing methods, which yielded 17, 17, and 21 types with SIDs of 66.9, 77.83, and 81.34, respectively. Analysis of epidemiological information for a subset of PFG-01 isolates validated the relationships inferred using combined PFGE, spa, and dru typing data. This approach significantly enhances discrimination of ST22-MRSA-IV isolates and could be applied to epidemiological investigations of other highly clonal MRSA strains.

The effect of rapid screening for methicillin-resistant Staphylococcus aureus (MRSA) on the identification and earlier isolation of MRSA-positive patients.

OBJECTIVES: (1) To determine whether rapid screening with polymerase chain reaction (PCR) assays leads to the earlier isolation of patients at risk for methicillin-resistant Staphylococcus aureus (MRSA) colonization, (2) to assess compliance with routine MRSA screening protocols, (3) to confirm the diagnostic accuracy of the Xpert MRSA real-time PCR assay (Cepheid) by comparison with culture, and (4) to compare turnaround times for PCR assay results with those for culture results. DESIGN: Before-and-after study conducted in a 700-bed acute tertiary care referral hospital. Study periods were (1) a 5-week period before PCR testing began, (2) a 10-week period when the PCR assay was used, and (3) a 5-week period after PCR testing was discontinued. RESULTS: Among 489 at-risk patients, MRSA was isolated from 20 (33%) of 60 patients during period 1, 77 (22%) of 349 patients during period 2, and 18 (23%) of 80 patients during period 3. Twenty-two (27%) of 82 at-risk patients were not screened during period 1, compared with 40 (10%) of 389 at-risk patients not screened during period 2 (P < .001). More MRSA-positive patients were preemptively isolated during periods 1 and 3 compared with period 2 (34 [24%] of 140 vs 28 [8%] of 389; P < .001); however, more MRSA-positive patients were isolated after notification of MRSA-positive results during period 2 (47 [13%] of 349) compared with periods 1 and 3 (2 [1%] of 140; P < .001). The sensitivity, specificity, positive predictive value, and negative predictive value of the PCR assay were 95%, 97%, 82%, and 99%, respectively. The mean turnaround time from receipt of specimens in the laboratory to PCR assay result was 2.6 hours. CONCLUSIONS: Rapid screening with the Xpert MRSA PCR assay facilitated compliance with screening policies and the earlier isolation of MRSA-positive patients. Discrepant results confirm that PCR testing should be used as a screening tool rather than as a diagnostic tool.

A novel quantitative reverse-transcription PCR (qRT-PCR) for the enumeration of total bacteria, using meat micro-flora as a model.

A sensitive quantitative reverse-transcription PCR (qRT-PCR) method was developed for enumeration of total bacteria. Using two sets of primers separately to target the ribonuclease-P (RNase P) RNA transcripts of gram positive and gram negative bacteria. Standard curves were generated using SYBR Green I kits for the LightCycler 2.0 instrument (Roche Diagnostics) to allow quantification of mixed microflora in liquid media. RNA standards were used and extracted from known cell equivalents and subsequently converted to cDNA for the construction of standard curves. The number of mixed bacteria in culture was determined by qRT-PCR, and the results correlated (r(2)=0.88, rsd=0.466) with the total viable count over the range from approx. Log(10) 3 to approx. Log(10) 7 CFU ml(-1). The rapid nature of this assay (8 h) and its potential as an alternative method to the standard plate count method to predict total viable counts and shelf life are discussed.

Development and validation of a rapid real-time PCR based method for the specific detection of Salmonella on fresh meat.

In this study, a combined enrichment/real-time PCR method for the rapid detection of Salmonella on fresh meat carcasses, was designed, developed and validated in-house following requirements outlined in ISO 16140:2003. The method included an 18h non-selective enrichment in buffered peptone water (BPW) and a 6h selective enrichment in Rappaport Vasilliadis Soya (RVS) broth, based on the traditional culture method, ISO 6579:2002. The real-time PCR assay included an internal amplification control (IAC), was 100% specific and was sensitive to one cell equivalent. The alternative method was validated against the traditional culture method and relative accuracy of 94.9%, sensitivity of 94.7% and specificity of 100% were determined using 150 fresh meat carcass swabs. This alternative method had a detection limit of 1-10CFU/100cm(2) for fresh meat carcass swabs and was performed in 26h. Following further inter-laboratory studies, this alternative method could be suitable for implementation in testing laboratories for the analysis of carcass swabs.

Analytical performance characteristics of nanoelectrospray emitters as a function of conductive coating.

As miniaturization of electrospray continues to become more prevalent in the mass spectrometry arsenal, numerous types of conductive coatings have been developed with miniaturized electrospray emitters. Different conductive coatings have different properties that may lead to differences in analytical performance. This paper investigates and compares the analytical properties of a series of applied conductive coatings for low-flow electrospray ionization developed in this laboratory vs. commercially-available types. Evaporated graphite is thoroughly compared with commercially available polyaniline (PANI) coated emitters and metal coated emitters. Each set of emitters was investigated to determine various performance characteristics, including susceptibility to electrical discharge in both positive and negative ionization modes, as well as emitter reproducibility and generation of a standard curve to determine each emitter coating's limit of detection and limit of quantitation. Furthermore, evaporated graphite and polyaniline coated fused silica capillaries were investigated to determine which coating is more stable over long-term analyses and during electrical discharge.

Analysis of polyaniline oligomers by laser desorption ionization and solventless MALDI.

While direct laser desorption ionization of soluble polyaniline dried onto metal sample plates results in mass spectra that are similar to previously shown electrospray ionization data of similar samples, laser desorption of unsolubilized solid polyaniline results in major fragmentation of the phenyl rings. Solventless MALDI, a recently developed technique for insoluble or slightly soluble species, involves the use of only solid analyte and matrix during sample preparation. Solventless MALDI of solid polyaniline results in mass spectra that are similar to the direct laser desorption ionization spectra of the soluble oligomers with some larger molecular weight oligomers also being detected. Based on the matrix used, different series of polyaniline with dissimilar end groups are detected. The matrix also affects the percentages of benzenoid and quinoid units in the oligomers. Thus, solventless MALDI appears to be a promising new technique for the mass spectrometric analysis of low solubility, but industrially important, polyanilines.