ABSTRACT
INTRODUCTION: Healthcare associated pathogens, including Staphylococcus capitis, can contaminate incubator surfaces and are of significant concern in neonatal intensive care units (NICUs). Effective incubator decontamination is essential for infection prevention and control, with submersion decontamination often recommended. This may not always be achievable, with wipe decontamination seen as an alternative. Here we compare the ability of a two-step (submersion in enzymatic detergent followed by wiping with hypochlorite-based wipes) with a one-step (wiping with quaternary ammonium compound-impregnated wipes) decontamination procedure to remove microbial surrogate markers from neonatal incubator surfaces. METHODS: Three Cauliflower Mosaic Virus derived microbial surrogate markers were inoculated onto the fan, a mattress seam and the external arm port door clips of two Giraffe™ Omnibed™ Carestation™ incubators. Incubators were decontaminated either by the one-step or two-step decontamination process. Swab samples were collected from 28 sites on each incubator and surrounding environment, with marker presence determined by qPCR. RESULTS: Following two-step decontamination, 3/28 (11%) sample sites were positive for any marker, compared to 12/28 (43%) after one-step decontamination. Markers were transferred to several incubator surfaces and recovered from the originally inoculated sites following one-step decontamination, with the marker inoculated on door clips having the greatest transfer. Markers inoculated onto the mattress persisted through both decontamination strategies. DISCUSSION: Microbial surrogate markers were not completely removed from incubator surfaces by one-step decontamination alone. Two-step decontamination was the most effective method and removed markers from submergible surfaces, but not from the mattress. These findings indicate microorganisms can persist after incubator terminal decontamination, particularly on mattresses and when a two-step decontamination process is not used. This highlights the importance of effective decontamination practices to mitigate microorganism persistence on incubator surfaces.
ABSTRACT
In June 2021, a national incident team was formed due to an increased detection of Staphylococcus capitis in samples from hospitalised infants. Staphylococcus capitis has been known to cause outbreaks in neonatal units across the globe, but the extent of the UK spread was unclear. A literature review was undertaken to support case identification, clinical management and environmental infection control. A literature search was undertaken on multiple databases from inception to 24 May 2021, using keywords such as "Staphylococcus capitis", "NRCS-A", "S. capitis", "neonate", "newborn" and "neonatal intensive care unit" (NICU). After screening, 223 articles of relevance were included. Results show incidences of S. capitis outbreaks have frequently been associated with the outbreak clone (NRCS-A) and environmental sources. The NRCS-A harbours a multidrug resistance profile that includes resistance to beta-lactam antibiotics and aminoglycosides, with several papers noting resistance or heteroresistance to vancomycin. The NRCS-A clone also harbours a novel SCCmec-SCCcad/ars/cop composite island and increased vancomycin resistance. The S. capitis NRCS-A clone has been detected for decades, but the reasons for the potentially increased frequency are unclear, as are the most effective interventions to manage outbreaks associated with this clone. This supports the need for improvements in environmental control and decontamination strategies to prevent transmission.
ABSTRACT
(+)-Allomatrine (1) has been synthesized using an imino-aldol reaction and N-acyliminium cyclization as key steps. Strategically, use of the tert-butylsulfinimine derivative of (E)-4-(trimethylsilyl)but-2-enal enabled the staged formation of three C-C bonds, a C-N bond, and the four stereogenic centers within the target.