Reply to Randal W. Eveland regarding comparative evaluation of the microbicidal activity of low-temperature sterilization technologies to steam sterilization

To the Editor—We thank Dr Randal Eveland, Steris Corporation, for his letter regarding our paper that compared the microbicidal activity of low-temperature sterilization technologies (ie, vaporized hydrogen peroxide [VHP], ethylene oxide [ETO], and hydrogen peroxide gas plasma [HPGP]) to steam sterilization in the presence of salt and serum to simulate inadequate precleaning. As noted in our paper, the literature contains a paucity of information on the comparative microbicidal activity of the sterilization technologies cleared by the Food and Drug Administration (FDA) for sterilizing medical and surgical devices. We believe that the data from this study will help clinicians in infection prevention assess the robustness of healthcare sterilization technologies and the risk of infection to patients when an uncleaned instrument is unintentionally brought into the operating room or used on a patient

Perturbed geodesics on the moduli space of flat connections and Yang-Mills theory

If we consider the moduli space of flat connections of a non trivial principal SO(3)-bundle over a surface, then we can define a map from the set of perturbed closed geodesics, below a given energy level, into families of perturbed Yang-Mills connections depending on a small parameter. In this paper we show that this map is a bijection and maps perturbed geodesics into perturbed Yang-Mills connections with the same Morse index.Comment: 58 pages, 3 figure

Overzomerende ganzen op melkveebedrijven: bedrijfsschade, diergezondheidsrisico's en oplossingsrichtingen = Summer grazing by wild geese on dairy farms: damage costs, risks for animal health and possible solutions

Wild geese grazing on dairy farms during the summer cause economic damage to these farms by eating and polluting grass that is meant for cattle. In this research we investigated the damage costs, risks for animal health and possible solutions for the problems caused by the increase of summer geese in grassland area

Effective High-Level Disinfection of Cystoscopes: Is Perfusion of Channels Required?

In the United States, more than 4 million cystoscopies are performed each year. Cystoscopy is a diagnostic procedure that uses an endoscope specially designed to examine the bladder, lower urinary tract, and prostate gland or is used to collect urine samples, perform biopsies, or remove small stones. A flexible or rigid scope can be used to carry out the procedure. Because the procedure involves a medical device in contact with the patient’s mucous membranes, it is considered a semicritical device that must, at a minimum, undergo highlevel disinfection. Failure to properly high-level disinfect or sterilize equipment can lead to transmission of infection

Antimicrobial activity of a continuous visible light disinfection system

We evaluated the ability of high-intensity visible violet light with a peak output of 405 nm to kill epidemiologically important pathogens. The high irradiant light significantly reduced both vegetative bacteria and spores at some time points over a 72-hour exposure period

Patient Room Decontamination against Carbapenem-Resistant Enterobacteriaceae and Methicillin-Resistant Staphylococcus aureus Using a Fixed Cycle-Time Ultraviolet-C Device and Two Different Radiation Designs

The contaminated surface environment of hospital rooms has been demonstrated to be a source of patient-to-patient transmission of multidrug-resistant organisms (MDROs), including methicillin-resistant Staphylococcus aureus (MRSA).1,2 MDROs can survive on surfaces for days to weeks (for months in some cases).3 Following terminal room cleaning and disinfection, frequent contamination by these pathogens has been reported.1,2 Patients admitted to a room where the previous occupant was also colonized or infected with an MDRO are at substantial risk for acquisition of this MDRO.4 For these reasons, “no-touch” methods of room disinfection have been evaluated, including devices that emit ultraviolet (UV) light or produce hydrogen peroxide vapor.5 Use of UV devices has been demonstrated to reduce healthcare-associated pathogens.

Antimicrobial activity of a continuously active disinfectant against healthcare pathogens

A novel disinfectant studied using an EPA protocol demonstrated sustained antimicrobial activity (ie, 3-5 log10 reduction) in 5 minutes after 24 hours for Staphylococcus aureus, vancomycin-resistant Enterococcus, Candida auris, carbapenem-resistant Escherichia coli and antibiotic-susceptible E. coli, and Enterobacter spp. Only ∼2 log10 reduction occurred with carbapenem-resistant Enterobacter spp and K. pneumoniae, and antibiotic-susceptible K. pneumoniae

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