Toimenpideohje norovirus-tartuntojen ehkäisemiseksi

Ohjeen tavoitteena on antaa ohjeita norovirusepidemian rajoittamiseksi erityisesti sellaisissa puitteissa, joissa sairastumisvaarassa olevien henkilöiden määrä on suuri tai tiheästi vaihtuva kuten majoituslaitoksissa ja risteilylaivoilla. Suositus on tarkoitettu terveydenhuolto- ja terveydensuojeluviranomaisten tueksi ohjattaessa epidemian torjuntatoimia

Point prevalence survey is useful for introducing effective surveillance of healthcare-associated infections

Publisher Copyright: © 2021 The AuthorsBackground: In Finland, the surveillance of healthcare-associated infections (HAI) became obligatory by the renewed Communicable Diseases Act on the 1st March 2017. Aim: To introduce HAI surveillance protocol (HALT-2 by ECDC) in primary care hospitals in the largest hospital district in Finland, and to measure the burden of HAIs and antimicrobial use patterns for improvement. Methods: Two identical point prevalence surveys (PPS) were organized in autumn 2015 and in spring 2017. The infection control persons (ICP) in the hospitals were inducted to the HAI definitions and the study protocol to collect the data with questionnaires on the study days. The data were checked and analyzed by the areal infection control unit. The hospitals were provided feedback of the results and HAI prevention methods. Findings: In 2015, 2218 patients from 22 hospitals and in 2017, 2343 patients from 25 hospitals were studied. The prevalence of HAI was 11% in both surveys (ranges per hospital 4–24% and 4–31%, respectively). Of all HAIs, 37% originated from referring hospitals. Respiratory tract, urinary tract and skin were the most frequent sites of infection. One fourth of all patients received at least one systemic antimicrobial. The process showed that recognition of HAIs may be difficult for non-experienced ICPs. Conclusions: The HALT-2 protocol proved useful in introducing HAI surveillance and prevention in primary care hospitals with active patient transfer from other hospitals and relatively high prevalence of HAI and antimicrobial use. For annually repeated surveys, slightly shorter electronic questionnaires are essential.Peer reviewe

Perhosmiehen piinalliset selkävaivat - tapauksen ratkaisu

Perhosharrastaja hakeutui päivystykseen selkävaivojen pahennuttua ja oikean suupielen alettua roikkua

Hoitoon liittyvien infektioiden seuranta ja infektiolukujen julkinen vertailu

Hoitoon liittyvien infektioiden seuranta on tärkeä keino tunnistaa infektio-ongelmia, kun suunnitellaan toimia niiden ehkäisemiseksi ja hoidon laadun ja potilasturvallisuuden parantamiseksi. Yksittäisten sairaaloiden infektiolukuja vertailemalla ei kuitenkaan voi tehdä suoraan johto-päätöksiä torjuntatoimien laadusta ja puutteista, ellei oteta huomioon kuinka vaikeasti sairaita potilaita sairaalassa hoidetaan. Nämä tulkintaongelmat on huomioitava, jos Suomessa suunnitellaan pakollista sairaalainfektioiden seurantaa ja julkista raportointia. Myös rakenne- ja prosessi-indikaattoreita, kuten sairaalahygieniayksikön toimintaa, infektion-torjuntaohjeiden olemassaoloa ja toteutumista sekä käsihuuhdekulutuslukuja tulisi hyödyntää, kun arvioidaan sairaalaan infektiotorjunnan laatua

Churg-Strauss Syndrome as an Unusual Aetiology of Stroke with Haemorrhagic Transformation in a Patient with No Cardiovascular Risk Factors

Background: We present here a case of haemorrhagic brain infarction in a middle-aged and physically active male, who had never smoked. This case report aims to remind the internist and neurologist to bear in mind unusual aetiologies of brain infarcts in patients without classical cardiovascular risk factors. Case Description: A 49-year-old male with pulmonary asthma and a prior history of nasal polyps had a wake-up stroke with left-sided symptoms and speech disturbance. A head MRI and MR angiography revealed a recent haemorrhagic infarct in the right putamen and corona radiata. The left hemiparesis progressed to sensory-motor hemiplegia on the 4th day. In the head CT, it was shown that the haemorrhagic infarct had progressed to a large haematoma. A pansinusitis was also diagnosed. The aetiological investigations revealed a minor atrial septal defect (ASD) with shunting and a heterozygotic clotting factor V R506Q mutation. A remarkable blood eosinophilia of 9.80 E9/l (42%) together with fever, sinusitis, wide-spread bilateral nodular pulmonary infiltrates that did not respond to wide-spectrum antimicrobial treatment, positive anti-neutrophilic cytoplasmic antibodies, a high myeloperoxidase antibody level and slightly positive anti-proteinase 3 antibodies suggested the diagnosis of Churg-Strauss syndrome. These inflammatory symptoms and findings promptly responded to treatment with corticosteroids and cyclophosphamide. Conclusions: Even after the concomitant findings of the low risk factors, i.e. small ASD and heterozygotic clotting factor mutation, continued search for the final aetiology of stroke revealed Churg-Strauss syndrome, which was the key to the treatment

Suspicion of Lyme borreliosis in patients referred to an infectious diseases clinic : what did the patients really have?

Objective: To evaluate the conditions behind the symptoms in patients with suspected Lyme borreliosis (LB) who were referred to an infectious diseases clinic. Methods: In this retrospective, population-based study, we collected data from the medical records of all patients referred for infectious disease consultations in 2013 due to presumed LB from a population of 1.58 million. The patients were classified according to the certainty of LB on the basis of their symptoms, signs and laboratory results. Data on the outcomes and subsequent alternative diagnoses during the 4-year follow-up period were reviewed from all of the available patient records from public, private and occupational healthcare providers. Results: A total of 256 patients (16/100 000) were referred as a result of suspicion of LB; 30 (12%) of 256 were classified with definite, 36 (14%) with probable and 65 (25%) with possible LB. LB was unlikely in 121 (47%) patients. A novel diagnosis was discovered in the background symptoms in 73 (29%) of pa-tients. Previously diagnosed comorbidities caused at least some of the symptoms in 48 (19%) patients. Other explanations for symptoms were found in 81 (67%) of 121 of unlikely and 22 (34%) of 65 of possible LB patients. The spectrum of conditions behind the symptoms was quite broad and most often were musculoskeletal, neurological, psychological or functional disorders. Conclusions: LB was unlikely in half of the patients with presumed LB. In most cases the patients had other conditions that explained their symptoms. Elisa Kortela, Clin Microbiol Infect 2021;27:1022 (c) 2020 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Reusable ω-transaminase sol-gel catalyst for the preparation of amine enantiomers

Heterogeneous &omega;-transaminase sol-gel catalysts were prepared and characterized in terms of immobilization degree, loading capacity and catalytic behavior in the kinetic resolution of racemic 1-phenylethylamine (a model compound) with sodium pyruvate in phosphate buffer (pH 7.5). The catalyst obtained when &omega;-transaminase from Arthrobacter sp. was encapsulated from the aqueous solution of the enzyme, isopropyl alcohol and polyvinyl alcohol in the sol-gel matrices, consisting of the 1:5 mixture of tetramethoxysilane and methyltrialkoxysilane, proved to be optimal including the reuse and storage stabilities of the catalyst. &nbsp;The optimized immobilizate was shown to perform well in the kinetic resolution of four structurally different aromatic primary amines in aqueous DMSO (10 v/v-%). The enzyme preparation showed synthetic potential by enabling the catalyst reuse in five consecutive preparative scale kinetic resolutions using 100 mM 1-phenylethylamine in aqueous DMSO (10 v/v-%). It was typical to fresh catalyst preparations that the kinetic resolution tended to exceed 50% before the reaction stopped leaving the (S)-amine unreacted while thereafter in reuse the reactions stopped at 50% conversion as expectable to highly enantioselective reactions.</p

Moniresistenttien ongelmamikrobien aiheuttamat hoitoon liittyvät infektiot Suomessa vuonna 2011

Lähtökohdat Moniresistenttien mikrobien aiheuttamien hoitoon liittyvien oireisten infektioiden määrästä Suomessa ei ole tarkkaa tietoa. Esitämme arvion vuoden 2011 tilanteesta. Menetelmät Arvioimme seitsemän keskeisen moniresistentin mikrobin (Staphylococcus aureus, Enterococcus faecium, Escherichia coli, Klebsiella pneumoniae, Enterobacter-lajit, Pseudomonas aeruginosa ja Acinetobacter-lajit) aiheuttamien bakteremioiden määriä valtakunnallisen tartuntatautirekisterin, mikrobiologian laboratorioiden resistenssiverkon (Fire) ja sairaalainfektio-ohjelman (SIRO) tapaus-lukumäärien ja bakteerien herkkyystietojen perusteella. Näiden mikrobien aiheuttamien muiden infektioiden (leikkausalueen infektiot, keuhkokuume ja virtsatieinfektiot) määrät arvioitiin sairaala-infektioiden valtakunnallisen prevalenssitutkimuksen infektiojakauman perusteella. Kuolemat arvioitiin prevalenssitutkimuspotilaiden kuolin- ja kuolemansyytiedoista. Tulokset Vuonna 2011 moniresistenttien mikrobien aiheuttamia infektioita oli Suomen akuuttisairaaloissa arviolta 2 412, noin 5 % kaikista hoitoon liittyvistä infektioista. Näihin infektioihin liittyi lähes 80 kuolemaa. Yleisimpiä olivat laajakirjoisia beetalaktamaaseja (ESBL) tuottavien E. coli -bakteerien aiheuttamat infektiot. Päätelmät Moniresistentit ongelmamikrobit aiheuttavat Suomessa toistaiseksi melko vähän hoitoon liittyviä infektioita. Koska suuri osa hoitoon liittyvistä infektioista on muiden kuin moniresistenttien mikrobien aiheuttamia ja infektioiden aiheuttajamikrobit ovat useimmiten peräisin potilaan omasta mikrobi-floorasta, pelkällä tartunnan torjunnalla ei voida ehkäistä hoitoon liittyviä infektioita. Siksi on keskeistä tarjota hoitohenkilökunnalle selkeää opastusta erityyppisten hoitoon liittyvien infektioiden ehkäisy- ja torjuntakeinoista