Diversity and persistence of MRSA and VRE in skilled nursing facilities: environmental screening, whole-genome sequencing and development of a dispersion index.

BACKGROUND: Environmental contamination with meticillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) in skilled nursing facilities (SNFs) may contribute to patient acquisition. This study assessed diversity and association of MRSA and VRE isolates in an SNF wing, and developed a mathematical index to define the tendency of each strain to persist in rooms and spread horizontally. METHODS: This was a longitudinal study of MRSA and VRE colonization and contamination among successive patient occupancies in a cluster of nine SNF private rooms over 8 months, characterized by microbiological testing and whole-genome isolate typing. The 'dispersion index' of a strain was defined as the number of rooms in which it was found (including if it was found in the patient), divided by the average number of times it was found consecutively in the same room. FINDINGS: MRSA (10 strain types) and VRE (seven types) were recovered from the room or patient in 16.4% and 35.6% of the occupancies, respectively. MRSA showed moderate horizontal spread and several episodes of same-room persistence (three distinct strain types) (overall dispersion index 1.08). VRE showed a high tendency towards horizontal spread/new introductions (overall dispersion index 3.25) and only one confirmed episode of persistence. INTERPRETATION: The emerging picture of high diversity among contaminating strains and high likelihood of room persistence despite terminal cleaning (MRSA) and horizontal spread between rooms (VRE) in this setting calls for improved cleaning practices, heightened contact precautions and, most of all, establishment of individually tailored facility screening programmes to enable informed choices based on local, measurable and actionable epidemiologic parameters.

Caregiving burden among informal caregivers of African American cancer survivors.

PURPOSE: Relatively little is known about caregivers of African American cancer survivors. Our goal was to identify the extent of burden among this group of caregivers. METHODS: Responses from 560 informal caregivers of African American participants of the Research on Cancer Survivors (ROCS) study in Detroit, MI, were analyzed including demographics, assistance provided including activities of daily living (ADLs) and instrumental activities of daily living (IADLs), time spent in caregiving, and caregiver burden (CGB). We assessed relationships between CGB and demographic variables, ADLs/IADLs, and level of care. Multivariable logistic regression determined which ADLs and IADLs were associated with high CGB. RESULTS: Over 75% of caregivers were female and 97% identified as African American. Mean age was 52.6 years. Fifty-six percent were employed outside the home, and 90% were related to the survivor. Caregivers averaged 35.7 h/week providing care, assisting with on average 2.8 ADLs and 5.0 IADLs. Despite the many hours and activities reported, no caregivers rated CGB as severe; only 4% rated it moderate to severe. ADLs associated with the top quartile of CGB were feeding and toileting; IADLs were finances, telephoning, housework, and medications. CONCLUSIONS: Caregivers for African American cancer survivors provide many hours of care, yet most describe their CGB as low. Although ADL assistance is often available through the healthcare system, assistance with IADLs presents an opportunity to lessen the burden for these caregivers and their care recipients. IMPLICATIONS FOR CANCER SURVIVORS: African American cancer survivors receive much care from informal family caregivers, who assist with multiple ADLs and IADLs. Formal IADL assistance programs, similar to those available for ADLs, would benefit both survivors and caregivers.

Mercury contamination of soil and water media from different illegal artisanal small-scale gold mining operations (galamsey).

Environmental media contamination with mercury, because of illegal artisanal small-scale gold mining (popularly called galamsey), is a major concern in Ghana; yet specific details as to how such contaminations are influenced or distributed across different galamsey operations have been lacking. We monitored mercury levels across nine different galamsey operations (Washing Board, Washing Plant, Anwona, Dig and Wash, Dredging, Underground Abandoned Shaft, Underground Sample Pit, Chamfi and Mill House) in three hotspot assemblies (Tarkwa Nsuaem, Amenfi East and Prestea Huni Valley) of the Western Region of Ghana. Triplicate samples each of background soil, surface water/drainage, slurry/sludge and galamsey waste materials (totaling 160) were obtained and analyzed using Atomic Absorption Spectrophotometer (AAS) to determine total Hg concentrations. From the comparison of mean ranked concentration of mercury, using the Kruskal-Wallis Test, it was realized that the observed differences in ranking was significant for all four environmental media considered. Thus, the poor handling, usage and disposal of mercury from the different galamsey activities did result in elevation of harmful quantities of mercury into the environment. Overall, the highest median value obtained for mercury was recorded at the Mill House galamsey sites and within slurry/sludge medium. This was followed by Chamfi, Washing Board, Washing Plant, Anwona, Dig and Wash and Dredging in descending order, with the Underground Abandoned Shaft and Underground Sample Pit galamsey types recording values below detection limit. In terms of their contribution to mercury contamination to the environment, Mill House, Chamfi, Anwona, Washing Board and Washing Plant galamsey types recorded the highest mean rankings. Overall, key priority information required for influencing reclamation and cleanup policy decisions for mercury, for the many affected wastelands across the country, can be derived from this paper.

Influence of illegal artisanal small-scale gold mining operations (galamsey) on oil and grease (O/G) concentrations in three hotspot assemblies of Western Region, Ghana.

This study determined the contamination levels of oil and grease (O/G) across nine (9) galamsey operations under different environmental media (background soil, surface drainage, slurry/sludge and galamsey wastes) in three galamsey hotspot assemblies (Tarkwa Nsuaem, Amenfi East and Prestea Huni Valley) within the Western region of Ghana. Triplicate samples each of the four environmental media for the nine galamsey types (Washing Board, Washing Plant, Anwona, Dig and Wash, Dredging, Underground Abandoned Shaft, Underground Sample Pit, Chamfi and Mill House) were collected and analysed using n-hexane extractable materials in acidic medium by extraction and gravimetry to determine O/G concentrations. From the comparison of mean ranked concentration of O/G, using Kruskal-Wallis Test, the observed differences in the ranking was significant across all four media. The O/G concentrations for Anwona, Chamfi, Mill House, Washing Board and Washing Plant galamsey recorded exceedances when compared to the Ghana EPA Effluent Guideline Value of 100 mg/L for water and The New Dutch Lists' Target and Intervention Value of 50 mg/kg and 500 mg/kg for solid/semi-solid materials. Consistently and for all environmental media types, the levels of O/G across the galamsey types were in the descending order of: Washing Board, Chamfi, Anwona, Mill House, Washing Plant, Underground Sample Pit, River Dredging, Dig and Wash, Underground Abandoned Shaft and Control Sample (non-galamseyed areas). In general, the surface drainage medium was predominantly found to be the most impacted upon medium from hydrocarbons by seven of the nine galamsey operations (Washing Board, Anwona, Chamfi, Mill House, Dredging, Dig and Wash and Underground Sample Pit). This was followed by slurry/sludge, background soil and waste media in that order. Expectedly, there were no exceedances for the Reference or Control Samples (non-galamseyed areas).

Spatial distribution patterns of illegal artisanal small scale gold mining (Galamsey) operations in Ghana: A focus on the Western Region.

Recently, there have been efforts by stakeholders to monitor illegal mining (galamsey) activities, foster their formalization and reclaim the many abandoned wastelands in Ghana. However, limited information exists on the locations, abundance, scope and scale of galamsey types, which hinders the development of effective policy response. This study attempts to map and analyze the distribution patterns, abundance, activity statuses and the extents of nine (9) galamsey types within eleven (11) Municipal and District Assemblies (MDAs) of Ghana's Western Region. It explores the utility of field-based survey, using the Open Data Kit (ODK) system, ArcGIS and Google Earth Imagery to map and visualize different galamsey types under a hostile working environment. A total of 911 galamsey sightings, of which 547 were found in clusters (corresponding to approximately 7106 individual operational units) and 364 in stand-alone mode. Overall, a total of 7470 individual galamsey operations were encountered in 312 different communities (towns and villages). Operationally, the Alluvial Washing Board, Mill-House and Chamfi were found to be the three most popular and practiced galamsey types. The three main galamsey hotspot districts (out of the 11) are the Tarkwa Nsuaem (294 sightings and 3648 individual galamsey sites), Amenfi East (223 sightings and 1397 individual galamsey sites) and Prestea Huni-Valley Districts (156 sightings and 1130 individual galamsey sites). In terms of their activity statuses, 199 abandoned operations (entailing 1855 individual operations), 664 active (entailing 5055 individuals operations) and 48 semi-active (comprising 560 individuals within clusters) galamsey operations were sighted at the time of the study. While galamsey is generally acknowledged to be widespread in Ghana, the results suggest a scale that probably surpasses any previous estimate or expectation. The findings will adequately inform the prioritization of reclamation efforts.