Hand Hygiene When Being Potentially Exposed to Heavy Metal Dust.

It is important to recognize that hand washing cannot replace safe and hygienic work practices and the use of personal protective equipment when handling heavy metal-containing materials.

Reduction of CPR artifacts in the ventricular fibrillation ECG by coherent line removal.

BACKGROUND: Interruption of cardiopulmonary resuscitation (CPR) impairs the perfusion of the fibrillating heart, worsening the chance for successful defibrillation. Therefore ECG-analysis during ongoing chest compression could provide a considerable progress in comparison with standard analysis techniques working only during "hands-off" intervals. METHODS: For the reduction of CPR-related artifacts in ventricular fibrillation ECG we use a localized version of the coherent line removal algorithm developed by Sintes and Schutz. This method can be used for removal of periodic signals with sufficiently coupled harmonics, and can be adapted to specific situations by optimal choice of its parameters (e.g., the number of harmonics considered for analysis and reconstruction). Our testing was done with 14 different human ventricular fibrillation (VF) ECGs, whose fibrillation band lies in a frequency range of [1 Hz, 5 Hz]. The VF-ECGs were mixed with 12 different ECG-CPR-artifacts recorded in an animal experiment during asystole. The length of each of the ECG-data was chosen to be 20 sec, and testing was done for all 168 = 14 x 12 pairs of data. VF-to-CPR ratio was chosen as -20 dB, -15 dB, -10 dB, -5 dB, 0 dB, 5 dB and 10 dB. Here -20 dB corresponds to the highest level of CPR-artifacts. RESULTS: For non-optimized coherent line removal based on signals with a VF-to-CPR ratio of -20 dB, -15 dB, -10 dB, -5 dB and 0 dB, the signal-to-noise gains (SNR-gains) were 9.3 +/- 2.4 dB, 9.4 +/- 2.4 dB, 9.5 +/- 2.5 dB, 9.3 +/- 2.5 dB and 8.0 +/- 2.7 (mean +/- std, n = 168), respectively. Characteristically, an original VF-to-CPR ratio of -10 dB, corresponds to a variance ratio var(VF):var(CPR) = 1:10. An improvement by 9.5 dB results in a restored VF-to-CPR ratio of -0.5 dB, corresponding to a variance ratio var(VF):var(CPR) = 1:1.1, the variance of the CPR in the signal being reduced by a factor of 8.9. DISCUSSION: The localized coherent line removal algorithm uses the information of a single ECG channel. In contrast to multi-channel algorithms, no additional information such as thorax impedance, blood pressure, or pressure exerted on the sternum during CPR is required. Predictors of defibrillation success such as mean and median frequency of VF-ECGs containing CPR-artifacts are prone to being governed by the harmonics of the artifacts. Reduction of CPR-artifacts is therefore necessary for determining reliable values for estimators of defibrillation success. CONCLUSIONS: The localized coherent line removal algorithm reduces CPR-artifacts in VF-ECG, but does not eliminate them. Our SNR-improvements are in the same range as offered by multichannel methods of Rheinberger et al., Husoy et al. and Aase et al. The latter two authors dealt with different ventricular rhythms (VF and VT), whereas here we dealt with VF, only. Additional developments are necessary before the algorithm can be tested in real CPR situations.

Removal of CPR artifacts from the ventricular fibrillation ECG by adaptive regression on lagged reference signals.

BACKGROUND AND OBJECTIVE: Removing cardiopulmonary resuscitation (CPR)-related artifacts from human ventricular fibrillation (VF) electrocardiogram (ECG) signals provides the possibility to continuously detect rhythm changes and estimate the probability of defibrillation success. This could reduce "hands-off" analysis times which diminish the cardiac perfusion and deteriorate the chance for successful defibrillations. METHODS AND RESULTS: Our approach consists in estimating the CPR part of a corrupted signal by adaptive regression on lagged copies of a reference signal which correlate with the CPR artifact signal. The algorithm is based on a state-space model and the corresponding Kalman recursions. It allows for stochastically changing regression coefficients. The residuals of the Kalman estimation can be identified with the CPR-filtered ECG signal. In comparison with ordinary least-squares regression, the proposed algorithm shows, for low signal-to-noise ratio (SNR) corrupted signals, better SNR improvements and yields better estimates of the mean frequency and mean amplitude of the true VF ECG signal. CONCLUSIONS: The preliminary results from a small pool of human VF and animal asystole CPR data are slightly better than the results of comparable previous studies which, however, not only used different algorithms but also different data pools. The algorithm carries the possibility of further optimization.

CPR artifact removal in ventricular fibrillation ECG signals using Gabor multipliers.

BACKGROUND AND OBJECTIVE: We present an algorithm for discarding cardiopulmonary resuscitation (CPR) components from ventricular fibrillation ECG (VF ECG) signals and establish a method for comparing CPR attenuation on a common dataset. Removing motion artifacts in ECG allows for uninterrupted rhythm analysis and reduces "hands-off" time during resuscitation. METHODS AND RESULTS: The current approach assumes a multichannel setting where the information of the corrupted ECG is combined with an additional pressure signal in order to estimate the motion artifacts. The underlying algorithm relies on a localized time-frequency transformation, the Gabor transform, that reveals the perturbation components, which, in turn, can be attenuated. The performance of the method is evaluated on a small set of test signals in the form of error analysis and compared to two well-established CPR removal algorithms that use an adaptive filtering system and a state-space model, respectively. CONCLUSION: We primarily point out the potential of the algorithm for successful artifact removal; however, on account of the limited set of human VF and animal asystole CPR signals, we refrain from a statistical analysis of the efficiency of CPR attenuation. The results encourage further investigations in both the theoretical and the clinical setup.

Strong corruption of electrocardiograms caused by cardiopulmonary resuscitation reduces efficiency of two-channel methods for removing motion artefacts in non-shockable rhythms.

AIM: Cardiopulmonary resuscitation (CPR) artefact removal methods provide satisfactory results when the rhythm is shockable but fail on non-shockable rhythms. We investigated the influence of the corruption level on the performance of four different two-channel methods for CPR artefact removal. MATERIALS AND METHODS: 395 artefact-free ECGs and 13 pure CPR artefacts with corresponding blood pressure readings as a reference channel were selected. Using a simplified additive data model we generated CPR-corrupted signals at different signal-to-noise ratio (SNR) levels from -10 to +10 dB. The algorithms were optimized on learning data with respect to SNR improvement and then applied to testing data. Sensitivity and specificity were derived from the shock/no-shock advice of an automated external defibrillator before CPR corruption and after artefact removal. RESULTS: Sensitivity for the filtered data (>95%) was significantly superior to that for the unfiltered data (76%), p<0.001. However, specificity was similar for the filtered and unfiltered data (<90% vs 89.3%). For large artefacts (-10 dB) specificity decreased below 70%. No important difference in the performance of the four algorithms was found. CONCLUSION: Using a simplified data model we showed that, when the ECG rhythm is non-shockable, two-channel methods could not reduce CPR artefacts without affecting the rhythm analysis for shock recommendation. The reason could be poor reconstruction when the artefacts are large. However, poor reconstruction was not a hindrance to re-identifying shockable rhythms. Future investigations should both include the refinement of filter methods and also focus on reducing motion artefacts already at the recording stage.

Inactivation of parvovirus B19 during STIM-4 vapor heat treatment of three coagulation factor concentrates.

BACKGROUND: To enhance the viral safety margins, nanofiltration has been widely integrated into the manufacturing process of plasma-derived medicinal products. Removal of smaller agents such as parvovirus B19 (B19V) by filtration, however, is typically less efficient. Because recent investigations have demonstrated that B19V may be more heat sensitive than animal parvoviruses, the potential B19V inactivation by a proprietary vapor heating procedure (STIM-4) as incorporated into the manufacturing processes of several nanofiltered coagulation factor concentrates was investigated. STUDY DESIGN AND METHODS: An infectivity assay based on quantitative reverse transcription-polymerase chain reaction (TaqMan, Applied Biosystems) detection of B19V mRNA after inoculation of a permissive cell line (UT7 Epo S1 cells) was used to investigate the virus inactivation capacity of the STIM-4 vapor heat treatment as used during the manufacture of nanofiltered second-generation Factor VIII inhibitor-bypassing activity (FEIBA), F IX complex, and FVII products. RESULTS: In contrast to animal parvoviruses, both B19V genotypes investigated, that is, 1 and 2, were shown to be surprisingly effectively inactivated by the STIM-4 vapor heat treatment process, with mean log reduction factors of 3.5 to 4.8, irrespective of the product intermediate tested. CONCLUSION: The newly demonstrated effective inactivation of B19V by vapor heating, in contrast to the earlier used animal parvoviruses, results in significant B19V safety margins for STIM-4-treated coagulation factor concentrates.

Neutralization of human parvovirus B19 by plasma and intravenous immunoglobulins.

BACKGROUND: Human parvovirus B19 (B19V) is a highly prevalent pathogen, and plasma pools for manufacturing of plasma-derived products have been shown to contain antibodies against B19V (B19V immunoglobulin G [IgG]). STUDY DESIGN AND METHODS: The megakaryoblastic cell line UT7/Epo-S1 can be infected with B19V Genotype 1 and as demonstrated here by immunocytochemistry, Western blot, and reverse transcription-polymerase chain reaction (RT-PCR) of B19V-specific mRNA, also with the more recently discovered Genotype 2. Based on B19V RT-PCR analysis of infected UT7/Epo-S1 cells, an infectivity assay was established and implemented for a B19V neutralization assay. To investigate the role of B19V neutralization in relation to B19V IgG titers, more than 1,000 manufacturing plasma pools were tested by enzyme-linked immunosorbent assay. RESULTS: Plasma pools were found to contain a mean B19V IgG titer of 33 +/- 9 IU per mL, with the lowest titer at 11 IU per mL. These 11 IU per mL B19V IgG neutralized 4.6 log B19V Genotype 1 and greater than 3.9 log Genotype 2 infectivity. Accordingly, a 10 percent intravenous immunoglobulin (IVIG) product prepared from such pools was found to contain an even higher B19V neutralization capacity. CONCLUSION: A high capacity of B19V Genotypes 1 and 2 neutralization was demonstrated in plasma pools for fractionation, an inherent feature based on the constantly high titer of B19V IgG in these pools. The neutralizing activity of B19V IgG was shown to be maintained in the 10 percent IVIG product tested.

The tandem repeated irritation test: a new method to assess prevention of irritant combination damage to the skin.

The effect of a protective cream was tested in a new tandem repeated irritation test with tandem application of 0.5% sodium lauryl sulphate (SLS) and undiluted toluene. The irritants were applied twice daily for 30 min to the ventral forearms of 20 volunteers. Irritant cutaneous reactions were quantified by a visual score, transepidermal water loss, chromametry and skin capacitance. Concurrent application of SLS/toluene induced stronger reactions than those caused by twice daily application of each irritant on its own. A protective effect of the protective cream was obtained against all treatment combinations and was significant for SLS/SLS (p < or = 0.01) and SLS/ toluene (p < or = 0.05). Our results indicate that the tandem repetitive irritation test has great potential in the evaluation of skin care products to prevent irritant contact dermatitis.