High Levels of Hand-Hygiene Compliance Are a Worthwhile Pursuit

To the Editor—We read with great interest the excellent review of evidence-based recommendations for the prevention of Clostridium difficile infection (CDI) by Louh et al.1 In this article, the authors reviewed 4 studies that assessed the impact of hand-hygiene campaigns to reduce CDI. Based on these papers, the authors did not recommend any hand-hygiene interventions to reduce CDI

Receptor Activator of NF-κB (RANK) Confers Resistance to Chemotherapy in AML and Associates with Dismal Disease Course.

Although treatment options of acute myeloid leukemia (AML) have improved over the recent years, prognosis remains poor. Better understanding of the molecular mechanisms influencing and predicting treatment efficacy may improve disease control and outcome. Here we studied the expression, prognostic relevance and functional role of the tumor necrosis factor receptor (TNFR) family member Receptor Activator of Nuclear Factor (NF)-κB (RANK) in AML. We conducted an experimental ex vivo study using leukemic cells of 54 AML patients. Substantial surface expression of RANK was detected on primary AML cells in 35% of the analyzed patients. We further found that RANK signaling induced the release of cytokines acting as growth and survival factors for the leukemic cells and mediated resistance of AML cells to treatment with doxorubicin and cytarabine, the most commonly used cytostatic compounds in AML treatment. In line, RANK expression correlated with a dismal disease course as revealed by reduced overall survival. Together, our results show that RANK plays a yet unrecognized role in AML pathophysiology and resistance to treatment, and identify RANK as "functional" prognostic marker in AML. Therapeutic modulation of RANK holds promise to improve treatment response in AML patients

Inhaled antibiotics for hospital- acquired and ventilator- associated pneumonia

To the Editor—We would like to comment on the hospital-acquired (HAP) and ventilator-associated pneumonia (VAP) guidelines recently published in Clinical Infectious Diseases [1]. These guidelines recommend inhaled antibiotics for patients with VAP due to gram-negative bacilli susceptible only to aminoglycosides or polymyxins and for patients not responding to intravenous (IV) antibiotics. It also suggests adjunctive inhaled colistin for HAP or VAP due to Acinetobacter strains susceptible only to polymyxins. Several important considerations related to inhaled antibiotics were not addressed

Bezlotoxumab: A Novel Agent for the Prevention of Recurrent Clostridium difficile Infection

During the past decade, the incidence and severity of Clostridium difficile infection (CDI) have significantly increased, leading to a rise in CDI-associated hospitalizations, health care costs, and mortality. Although treatment options exist for CDI, recurrence is frequent following treatment. Furthermore, patients with at least one CDI recurrence are at an increased risk of developing additional recurrences. A novel approach to the prevention of recurrent CDI is the use of monoclonal antibodies directed against the toxins responsible for CDI as an adjunct to antibiotic treatment. Bezlotoxumab, a human monoclonal antibody that binds and neutralizes C. difficile toxin B, is the first therapeutic agent to receive United States Food and Drug Administration approval for the prevention of CDI recurrence. Clinical studies have demonstrated superior efficacy of bezlotoxumab in adults receiving antibiotic therapy for CDI compared with antibiotic therapy alone for the prevention of CDI recurrence. Bezlotoxumab was well tolerated in clinical trials, with the most common adverse effects being nausea, vomiting, fatigue, pyrexia, headache, and diarrhea. The demonstrated efficacy, safety, and characteristics of bezlotoxumab present an advance in prevention of CDI recurrence

Monte Carlo study of the critical temperature for the planar rotator model with nonmagnetic impurities

We performed Monte Carlo simulations to calculate the Berezinskii-Kosterlitz-Thouless (BKT) temperature $T_{BKT}$ for the two-dimensional planar rotator model in the presence of nonmagnetic impurity concentration $(\rho)$. As expected, our calculation shows that the BKT temperature decreases as the spin vacancies increase. There is a critical dilution $\rho_c \approx 0.3$ at which $T_{BKT} =0$. The effective interaction between a vortex-antivortex pair and a static nonmagnetic impurity is studied analytically. A simple phenomenological argument based on the pair-impurity interaction is proposed to justify the simulations.Comment: 5 pages, 5 figures, Revetex fil

The compliance coach: A bedside observer, auditor, and educator as part of an infection prevention department's team approach for improving central line care and reducing central line-associated bloodstream infection risk

A compliance coach who audits central line maintenance and provides feedback and education to bedside nurses through timely, nonpunitive conversation is an effective addition to busy infection prevention departments. Staff nurses and nurse managers reported receiving clearly communicated and actionable information from the coach and compliance improved over time in multiple areas of central line maintenance

Epidemiologic characteristics of health care–associated outbreaks and lessons learned from multiple outbreak investigations with a focus on the usefulness of routine molecular analysis

Background: Single outbreaks have often been reported in health care settings, but the frequency of outbreaks at a hospital over time has not been described. We examined epidemiologic features of all health care–associated outbreak investigations at an academic hospital during a 5-year period. Methods: Health care–associated outbreak investigations at an academic hospital (2012-2016) were retrospectively reviewed through data on comprehensive hospital-wide surveillance and pulsed-field gel electrophoresis (PFGE) analysis. Results: Fifty-one health care–associated outbreaks (annual range, 8-15), including 26 (51%) outbreaks in intensive care units (ICUs), and 263 infected-colonized patients involved in these outbreaks were identified. The frequency of pathogens varied by affected location, specifically multidrug-resistant organisms (20/26 outbreaks, 77% in ICUs vs 2/25 outbreaks, 8% in non-ICUs; P <.0001) and gastroenteritis because of Clostridium difficile, norovirus, or adenovirus (1/26 outbreaks, 4% in ICUs vs 17/25 outbreaks, 68% in non-ICUs; P <.0001). Outbreaks occurred in approximately one-third of all units (37%) with some repeated instances of the same pathogens. Of 16 outbreaks caused by a bacterial pathogen evaluated by PFGE, 12 (75%) included some indistinguishable strains, suggesting person-to-person transmission or a common source. Conclusions: This study demonstrated epidemiologic characteristics of multiple outbreaks between ICUs and non-ICUs and the value of molecular typing in understanding the epidemiology of health care–associated outbreaks

Reducing health care-associated infections by implementing a novel all hands on deck approach for hand hygiene compliance

Hand hygiene is a key intervention for preventing health care-associated infections; however, maintaining high compliance is a challenge, and accurate measurement of compliance can be difficult. A novel program that engaged all health care personnel to measure compliance and provide real-time interventions overcame many barriers for compliance measurement and proved effective for sustaining high compliance and reducing health care-associated infections

Coordinated infraslow neural and cardiac oscillations mark fragility and offline periods in mammalian sleep.

Rodents sleep in bouts lasting minutes; humans sleep for hours. What are the universal needs served by sleep given such variability? In sleeping mice and humans, through monitoring neural and cardiac activity (combined with assessment of arousability and overnight memory consolidation, respectively), we find a previously unrecognized hallmark of sleep that balances two fundamental yet opposing needs: to maintain sensory reactivity to the environment while promoting recovery and memory consolidation. Coordinated 0.02-Hz oscillations of the sleep spindle band, hippocampal ripple activity, and heart rate sequentially divide non-rapid eye movement (non-REM) sleep into offline phases and phases of high susceptibility to external stimulation. A noise stimulus chosen such that sleeping mice woke up or slept through at comparable rates revealed that offline periods correspond to raising, whereas fragility periods correspond to declining portions of the 0.02-Hz oscillation in spindle activity. Oscillations were present throughout non-REM sleep in mice, yet confined to light non-REM sleep (stage 2) in humans. In both species, the 0.02-Hz oscillation predominated over posterior cortex. The strength of the 0.02-Hz oscillation predicted superior memory recall after sleep in a declarative memory task in humans. These oscillations point to a conserved function of mammalian non-REM sleep that cycles between environmental alertness and internal memory processing in 20- to 25-s intervals. Perturbed 0.02-Hz oscillations may cause memory impairment and ill-timed arousals in sleep disorders

Dependence of direct detection signals on the WIMP velocity distribution

The signals expected in WIMP direct detection experiments depend on the ultra-local dark matter distribution. Observations probe the local density, circular speed and escape speed, while simulations find velocity distributions that deviate significantly from the standard Maxwellian distribution. We calculate the energy, time and direction dependence of the event rate for a range of velocity distributions motivated by recent observations and simulations, and also investigate the uncertainty in the determination of WIMP parameters. The dominant uncertainties are the systematic error in the local circular speed and whether or not the MW has a high density dark disc. In both cases there are substantial changes in the mean differential event rate and the annual modulation signal, and hence exclusion limits and determinations of the WIMP mass. The uncertainty in the shape of the halo velocity distribution is less important, however it leads to a 5% systematic error in the WIMP mass. The detailed direction dependence of the event rate is sensitive to the velocity distribution. However the numbers of events required to detect anisotropy and confirm the median recoil direction do not change substantially.Comment: 21 pages, 7 figures, v2 version to appear in JCAP, minor change