Compliance with good practice guidelines for the prevention of vascular access infections: the multi-centre PHYDEL survey in French haemodialysis units.

BACKGROUND: French guidelines for the prevention of vascular access infections in a haemodialysis setting were released in 2005. Compliance with these guidelines is currently unknown. The aim of this study was to assess compliance with the guidelines for vascular access infection prevention in French haemodialysis units, and to describe the difficulties reported. METHODS: A cross-sectional survey was conducted between March and December 2019 in 200 haemodialysis units in France, selected at random. Data were collected via questionnaire, completed by telephone interview with an infection control practitioner. A practice was deemed compliant when >85% of units declared that they always complied with the guidelines. RESULTS: In total, 103 units (51.5%) agreed to participate. Most practices complied with the guidelines; however, some practices did not reach the 85% compliance threshold for working in pairs when connecting central venous catheter (CVC) lines, performing hand hygiene before disconnecting lines, rinsing antiseptic soap before painting CVC exit site or arteriovenous fistula (AVF) puncture site, allowing antiseptic paint to dry, handling CVC branches with antiseptic impregnated gauze, performing hand hygiene after AVF compression with gloves, wearing protective eyewear when connecting/disconnecting CVC or when puncturing AVF, and wearing a gown when puncturing AVF. The most frequently reported difficulties were understaffing, difficulties with skin preparation because of exit site skin damage, and lack of buttonhole technical expertise. CONCLUSIONS: Despite good overall compliance, this survey highlights some shortcomings in compliance with infection prevention guidelines, which could be associated with either higher risk of vascular access infection or increased blood-borne virus transmission.

On the crucial influence of some supporting electrolytes during electrocoagulation in the presence of aluminum electrodes.

The influence of some supporting electrolytes on aluminum electrode oxidation and pH variation during electrocoagulation of an unskimmed milk sample and a cutting oil emulsion has been investigated. Among the electrolytes studied, sulfate anions were found to be quite harmful both for electrical consumption and electrocoagulation efficiency. At the opposite, chloride and ammonium ions were particularly benefic respectively for aluminum corrosion and pH regulation, whereas sodium cations were observed to have a neutral role. The results indicate that electrocoagulation can be realized at low anodic potential even in the presence of sulfate ions when the [Cl(-)]/[SO(4)(2-)] ratio is around or greater than 1/10. The detrimental effect of sulfates on electrocoagulation efficiency can be thwarted by the use of the ammonium salt thanks to its related buffer effect.

Influence of base electrolytes on the electrodeposition of iron onto a silicon surface.

Comparative electrodeposition of iron onto the surface of silicon was investigated at large overpotential in the presence of some base electrolytes. The nanostructure of the iron electrodeposits was analyzed with SEM and FE-SEM measurements. The results highlight the influences of ion specificity on the rate of hydrogen evolution and of selective ion adsorption on the morphology of the iron electrodeposits.

Electrochemical treatment of heavy metals (Cu2+, Cr6+, Ni2+) from industrial effluent and modeling of copper reduction.

An electrochemical technique was tested in a laboratory scale to treat heavy metals (Cu2+, Cr6+ and Ni2+) from plating industrial effluent. The experiments were performed in a membrane reactor having a capacity of 1 l. Stainless-steel sheets with surface area of 0.011 m2 and titanium coated with ruthenium oxide were used as cathode and anode, respectively. The electrolyte was circulated at a constant flow rate (0.42 l/min) and the pH was kept constant at 1. Applied current densities were 10 and 90 A/m2. According to the experiment, it was found that a membrane reactor with plane electrode was capable for treating plating wastewater with low energy consumption (42.30 kWh/kg metal) and low operating cost (5.43 US dollars/m3). More than 99% of metal reduction was achieved and the final concentrations of copper, chromium and nickel in treated water were 0.10-0.13, 0.19-0.20 and 0.05-0.13 ppm, respectively. The brightener had no effect on copper reduction whereas hexavalent chromium had strong effect. The kinetic of copper reduction in the presence of hexavalent chromium was modeled as a two-step process with respect to copper concentration.

Lower alkaline phosphatase activity and occurrence of an abnormal hybrid intestinal/tissue non-specific isoform in Down's syndrome amniotic fluids.

Quantitative and qualitative analysis of alkaline phosphatases (AP) was performed on amniotic fluid in 59 normal pregnancies and 14 Down's syndrome (DS) pregnancies at 16, 18 and 19 weeks of gestation. In DS cases, intestinal and placental isoenzyme levels were significantly reduced (P<0.001) and the AP electrophoretic pattern was seen to be modified on polyacrylamide gel electrophoresis. A unique component was detected. After extraction and purification of the abnormal isoenzyme, peptide fragments obtained after cyanogen bromide cleavage indicated a hybrid heterodimeric AP composed of intestinal and tissue non-specific subunits, as evaluated by SDS polyacrylamide gel electrophoresis.

Atypical neutrophil alkaline phosphatase associated with impaired neutrophil functions.

We report the case of a healthy young man presenting with atypical neutrophil alkaline phosphatase (NAP) and reduced neutrophil chemotactic activity, but with no susceptibility to infection. NAP activity was low, kinetic parameters were modified and immunoreactive properties and subcellular distribution were abnormal. Neutrophil morphology was normal. A similar pattern was observed in the patient's healthy brother. The profile of the observed anomalies offers some similarity to that previously described in patients with chronic myelogenous leukaemia. However, in the present case, the NAP deficiency with impaired neutrophil function was present in two brothers with no haematological symptoms and is probably related to a non-acquired neutrophil abnormality. This observation of a primary NAP variant reinforces the hypothesis of a direct link between NAP activity and functional properties of neutrophils.

Fetal sex and variations in kinetic properties of neutrophil alkaline phosphatase during the second trimester of normal pregnancy.

A kinetic parameter (the Vm/Km ratio), an index of neutrophil alkaline phosphatase catalytic efficiency, was studied in 36 women with normal pregnancies at 16-20 weeks' gestation. On each blood sample, determinations were achieved on enzyme extracted from maternal granulocytes by monitoring the phosphohydrolytic activity at 400 nm on a spectrophotometer equipped with software for computation of kinetic parameters. Infant sex was recorded at the delivery for all women included in this study. The recent introduction of NAP as a marker for some pathological pregnancies requires a better knowledge of the behaviour of that enzyme in physiological conditions. Data reported focus attention on fetal sex. It appears to be one of the factors involved in variations of kinetic parameters observed in maternal NAP. Sex-linked differences in placental maturation could explain these results.

Evaluation of two markers of cell maturation and proliferation in cultured amniotic cells of trisomic 18 fetuses at the 15th week of gestation.

Intensive studies have been conducted so far on biochemical markers available for screening of chromosome defects in obstetrical monitoring. In this paper we report further data on two protein phosphatases: alkaline phosphatase (a marker of cell maturation) and phosphotyrosine phosphatase (a marker of cell proliferation) assayed in cultured amniotic cells from fetuses with trisomy 18 at 15 weeks of gestation. Comparison with normal fetal cells showed a different behaviour for each enzyme: alkaline phosphatase was very significantly lowered while phosphotyrosine phosphatase remained a normal levels. These results provide a further enlargement of the field of biochemical markers used in the screening tests of trisomy 18.

Inhibition by sodium thiophosphate and L-p-bromotetramisole of neutrophil alkaline phosphatase in normal and trisomy 21 pregnancies.

Alkaline phosphatase concentrations are known to increase in blood neutrophils of normal pregnant women. The main kinetic parameters of this enzyme were analysed and compared in a group of 30 women with normal pregnancies and a group of 11 women whose fetuses had trisomy 21 (Down's syndrome = DS). The subjects were studied at an identical stage of gestation. Significant changes occurred in thermal stability and urea resistance in cases of DS pregnancies. We also investigated the inactivation constants for two chemicals: L-p-bromotetramisole, an uncompetitive inhibitor, and sodium thiophosphate, a competitive inhibitor. Ki measured for the two inhibitors were found to be significantly lower in cases of pathological pregnancies. The patterns observed in inhibition constants extend the biochemical characteristics of the atypical isoenzyme expressed in neutrophils of women with DS pregnancies.

Changes in immunological properties of neutrophil alkaline phosphatase in trisomy 21 pregnancies.

Immunoreactivity, cytochemical, immunocytochemical characteristics and subcellular distribution of neutrophil alkaline phosphatase (NAP) were investigated in blood and/or smear samples from 18 women aged 23-46 years (mean 32.5 years) with trisomy 21 fetuses (17-21 weeks) and 28 women aged 20-42 years (mean 31 years) with normal fetuses (17-22 weeks). Immunochemical NAP investigations were carried out in 8 pathological and 8 normal pregnancies; cytochemical and immunocytochemical procedures were carried out in 18 pregnant women with trisomy 21 fetuses and 28 controls. NAP from women with trisomy 21 fetuses is characterized by: (1) a significant decrease in reactivity with anti-liver-type alkaline phosphatase (AP) and anti-NAP antisera; (2) low or very slight reactivity with antiplacental or anti-intestinal antibodies; (3) marked dispersion of NAP lead citrate reaction products or anti-NAP antibody colloidal gold-labelling in neutrophil cytoplasms, as detected by electron microscopy. This subcellular AP distribution (extramembranous) is different from that of normal NAP sites associated with plasma membrane, nuclear membrane and secretory vesicles. The NAP immunochemical and cytochemical characteristics suggest that neutrophils of a woman with a trisomy 21 fetus contain two AP isoenzymes: the liver/bone type and an atypical AP.

Nuclear localization and characterization of alkaline phosphatase in neutrophils from normal controls and pregnant women.

There were controversial data concerning localization of alkaline phosphatase (AP) in neutrophil nuclei under physiological conditions. In this context, the AP pattern has been determined on nuclei preparations from normal human neutrophils. Blood cells were isolated from 10 healthy adults and from 3 women in the third trimester of an uncomplicated pregnancy. Purity of nuclear suspension was checked by electron microscopy and assay of organelle marker enzymes. Electron microscope cytochemistry and immunocytochemistry studies were carried out on WBC. Enzyme characterization was performed by the usual biochemical procedures. AP was found in nuclear preparations from four of ten normal controls. When present, AP was detected in approximately two-thirds of the nuclei examined, representing an average of 20% of the total cell activity. Conversely, a large amount of nucleus-bound enzyme (55% of total AP activity) was recognized in all pregnant women samples. Biochemical and immunological characteristics clearly differentiate AP forms in the two groups of subjects. Normal controls have an heterogeneous enzyme pattern. AP positive preparations contain a mixture of isoenzymes: a prominent heat labile form and a relatively heat stable minor component. The heat stable fraction displays some properties similar to those previously described in leukocyte AP. Pregnant women express a unique very heat labile isoenzyme identical in its main characteristics to the early placental type.

Phosphotyrosine phosphatase activity and haematologic changes in Down's syndrome patients.

Assays of neutrophil phosphotyrosine phosphatase activity and determination of haematological parameters were performed on 12 trisomic 21 probands without any clinical or biological symptom of other evolutive disease. Haematological studies showed the two main classical abnormalities: the existence of a macrocytosis and an enhanced lymphocyte count. Of interest are the very reduced rates of phosphotyrosine phosphatase activity found in granulocytes from these patients. This defect in protein phosphatase can be considered as an additional enzymatic change extending the list of modified factors recognized at molecular and cellular levels in subjects whose risk of leukaemia is significantly increased.

Alkaline phosphatase and phosphotyrosine phosphatase activities of cultured amniotic cells with trisomy 18.

In cultured amniotic cells from fetuses with Edward's syndrome (trisomy 18), the activities of two protein phosphatases, alkaline phosphatase and phosphotyrosine phosphatase, were measured. Comparison with normal fetal cells showed a different behavior for each enzyme. Alkaline phosphatase was significantly lowered while phosphotyrosine phosphatase remained at normal levels. The interest of these enzyme assays in the screening procedure of this severe chromosome defect is discussed.