Continuous monitoring of aerial bioburden within intensive care isolation rooms and identification of 'high risk' activities

Background: The spread of pathogens via the airborne route is often underestimated and little is known about the extent to which airborne microbial contamination levels vary throughout the day and night in hospital facilities. Aims: This study aims to evaluate variability in airborne contamination levels within ICU isolation rooms over extended time periods to improve understanding of the extent to which ward activities, and consequential increases in airborne bioburden, may contribute to cross-infection of patients. Methods: Environmental air monitoring was conducted within occupied and vacant inpatient isolation rooms. A sieve impactor sampler was used to collect 500 L air samples every 15 minutes over 10-hour (08:00-18:00 h) and 24-hour (08:00-08:00 h) periods. Samples were collected, room activity logged, and the bacterial contamination levels were recorded as cfu/m3 of air. Findings: A high degree of variability in levels of airborne contamination was observed across all scenarios in the studied isolation rooms. Air bioburden increased as room occupancy increased, with air contamination levels highest in rooms occupied for the longest time during the study (10 days) with a mean value of 104.4 cfu/m3 and a range of 12–510 cfu/m3. Counts were lowest in unoccupied rooms, with an average value of 20 cfu/m3 and during the night. Conclusion: Peaks in airborne contamination showed a direct relation to an increase in activity levels. This study provides first clear evidence of the extent of variability in microbial airborne levels over 24-hour periods in ICU isolation rooms and directly correlates microbial load to ward activity

Investigating the variability of airborne bacteria in a hospital Intensive Care Unit over a 24 hour period

Current knowledge of the clinical microflora is limited, however it is currently estimated that 10-33% of nosocomial infections are transmitted via air. This study aims to assess the variability and dynamics of airborne contamination in a hospital setting, and contribute to an improved understanding of the airborne bioburden in clinical environments. Environmental air monitoring, using a sieve-impactor air sampler, was conducted in an Intensive Care Unit, with 500L air samples collected every 15-min over 24-h periods (08:00-08:00h). Room activity was logged and bacterial contamination levels were recorded as CFU/m3 of air. A cascade impactor and aerosol spectrometer were also used to separate particles into size fractions correlating to human lung deposition. A high degree of variability in airborne contamination was observed over the course of a 24-h period in the hospital ICU. Contamination counts ranged from 12-510 CFU/m3 over 24-h in an isolation room occupied for 10 days by a patient with C. difficile infection. Levels were lowest during the night and in unoccupied rooms, with an average value of 20 CFU/m3. Peaks in airborne contamination showed a direct relation to an increase in room activity, such as bed changes and visiting times. This study demonstrates the variation and degree of airborne contamination that can occur in an ICU over a 24-h period. Numerous factors contributed to increasing microbial air contamination and consideration should be given to potential improved infection control strategies and decontamination technologies to reduce airborne contamination, with the ultimate aim of reducing healthcare-associated infections from environmental sources

Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2)

BACKGROUND: Worldwide data for cancer survival are scarce. We aimed to initiate worldwide surveillance of cancer survival by central analysis of population-based registry data, as a metric of the effectiveness of health systems, and to inform global policy on cancer control. METHODS: Individual tumour records were submitted by 279 population-based cancer registries in 67 countries for 25·7 million adults (age 15-99 years) and 75,000 children (age 0-14 years) diagnosed with cancer during 1995-2009 and followed up to Dec 31, 2009, or later. We looked at cancers of the stomach, colon, rectum, liver, lung, breast (women), cervix, ovary, and prostate in adults, and adult and childhood leukaemia. Standardised quality control procedures were applied; errors were corrected by the registry concerned. We estimated 5-year net survival, adjusted for background mortality in every country or region by age (single year), sex, and calendar year, and by race or ethnic origin in some countries. Estimates were age-standardised with the International Cancer Survival Standard weights. FINDINGS: 5-year survival from colon, rectal, and breast cancers has increased steadily in most developed countries. For patients diagnosed during 2005-09, survival for colon and rectal cancer reached 60% or more in 22 countries around the world; for breast cancer, 5-year survival rose to 85% or higher in 17 countries worldwide. Liver and lung cancer remain lethal in all nations: for both cancers, 5-year survival is below 20% everywhere in Europe, in the range 15-19% in North America, and as low as 7-9% in Mongolia and Thailand. Striking rises in 5-year survival from prostate cancer have occurred in many countries: survival rose by 10-20% between 1995-99 and 2005-09 in 22 countries in South America, Asia, and Europe, but survival still varies widely around the world, from less than 60% in Bulgaria and Thailand to 95% or more in Brazil, Puerto Rico, and the USA. For cervical cancer, national estimates of 5-year survival range from less than 50% to more than 70%; regional variations are much wider, and improvements between 1995-99 and 2005-09 have generally been slight. For women diagnosed with ovarian cancer in 2005-09, 5-year survival was 40% or higher only in Ecuador, the USA, and 17 countries in Asia and Europe. 5-year survival for stomach cancer in 2005-09 was high (54-58%) in Japan and South Korea, compared with less than 40% in other countries. By contrast, 5-year survival from adult leukaemia in Japan and South Korea (18-23%) is lower than in most other countries. 5-year survival from childhood acute lymphoblastic leukaemia is less than 60% in several countries, but as high as 90% in Canada and four European countries, which suggests major deficiencies in the management of a largely curable disease. INTERPRETATION: International comparison of survival trends reveals very wide differences that are likely to be attributable to differences in access to early diagnosis and optimum treatment. Continuous worldwide surveillance of cancer survival should become an indispensable source of information for cancer patients and researchers and a stimulus for politicians to improve health policy and health-care systems

Sport policy convergence: a framework for analysis

This is an Accepted Manuscript of an article published by Taylor & Francis Group in European Sport Management Quarterly on 30th April 2012, available online at: http://www.tandfonline.com/10.1080/16184742.2012.669390The growth in the comparative analysis of sport management processes and policy has led to an increased interest in the concept of convergence. However, the concept is too often treated as unproblematic in definition, measurement and operationalisation. It is argued in this paper that a more effective framework for examining claims of convergence is one that analyses the concept in terms of seven dimensions which can be explored through a mix of quantitative and qualitative methods of data collection. It is also argued that a deeper understanding of the process of convergence can be gained by operationalising the concept in the context of a selected range of meso-level theories of the policy process or of specific aspects of the process. The proposed analytic framework provides not only a definition of convergence but also the basis for a more nuanced investigation of hypotheses of convergence