contaminated sinks and contamination of ultra-filtrate bags as possible route of transmission?

Background We report on an outbreak in a surgical, interdisciplinary intensive care unit (ICU) of a tertiary care hospital. We detected a cluster of ICU patients colonized or infected with multidrug-resistant Pseudomonas aeruginosa. We established an outbreak investigation team, performed an exploratory epidemiological analysis and initiated an epidemiology-based intervention. Methods As part of the outbreak investigation, we performed microbiological examinations of the sinks in the patient rooms and a retrospective case-control study. All patients admitted to the outbreak ICU between January 2012 and February 2014 were included. Cases were patients colonized with the outbreak strain. Controls were patients with a different Pseudomonas aeruginosa strain. Risk factors were evaluated using multivariable conditional logistic regression analysis. Strain typing was performed using the repetitive element-based polymerase chain reaction (rep-PCR) DiversiLab system. Results The outbreak strain was found in the sinks of five (of 16) patient rooms. Altogether 21 cases and 21 (randomly selected) controls were included. In the univariate analysis, there was no significant difference in baseline data of the patients. In the multivariate analysis, stay in a room with a colonized sink (Odds Ratio[OR] 11.2, p = 0.007) and hemofiltration (OR 21.9, p = 0.020) were independently associated with an elevated risk for colonization or infection by the outbreak strain. In a subsequent evaluation of the work procedures associated with hemofiltration, we found that the ultra-filtrate bags had been on average five times per day emptied in the sinks of the patient rooms and were used multiple for the same patient. We exchanged the traps of the contaminated sinks and eliminated work procedures involving sinks in patient rooms by implementation of single use bags, which are emptied outside patient rooms to reduce splash water at the sinks. In the 20 month follow-up period, the outbreak strain was detected only once, which indicated that the outbreak had been ceased (incidence 0.75% vs. 0.04%, p < 0.001) Furthermore, the incidence of Pseudonomas aeruginosa overall was significantly decreased (2.5% vs. 1.5%, p < 0.001). Conclusion In ICUs, limiting work processes involving sinks results in reduced multidrug-resistant Pseudomonas aeruginosa rates. ICUs with high rates of Pseudomonas aeruginosa should consider eliminating work processes that involve sinks and potentially splash water in close proximity to patients. Trial registration All data were surveillance based data which were obtained within the German Law on Protection against Infection (“Infektionsschutzgesetz”). Therefore a trial registration was not required

Sepsis Caused by Extended-Spectrum Beta-Lactamase (ESBL)-Positive K. pneumoniae and E. coli: Comparison of Severity of Sepsis, Delay of Anti- Infective Therapy and ESBL Genotype

Infections with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) are associated with increased mortality. Outcome differences due to various species of ESBL-E or ESBL genotypes are not well investigated. We conducted a cohort study to assess risk factors for mortality in cases of ESBL-E bacteremia (K. pneumoniae or E. coli) and the risk factors for sepsis with organ failure. All consecutive patients of our institution from 2008 to 2011 with bacteremia due to ESBL-E were included. Basic epidemiological data, underlying comorbidities, origin of bacteremia, severity of sepsis and delay of appropriate anti-infective treatment were collected. Isolates were PCR- screened for the presence of ESBL genes and plasmid-mediated AmpC β-lactamases. Cox proportional hazard regression on mortality and multivariable logistic regression on risk factors for sepsis with organ failure was conducted. 219 cases were included in the analysis: 73.1% due to E. coli, 26.9% due to K. pneumoniae. There was no significant difference in hospital mortality (ESBL-E. coli, 23.8% vs. ESBL-K. pneumoniae 27.1%, p = 0.724). However, the risk of sepsis with organ failure was associated in cases of K. pneumoniae bacteremia (OR 4.5, p<0.001) and patients with liver disease (OR 3.4, p = 0.004) or renal disease (OR 6.8, p<0.001). We found significant differences in clinical presentation of ESBL-E bacteremia due to K. pneumoniae compared to E. coli. As K. pneumoniae cases showed a more serious clinical presentation as E. coli cases and were associated with different risk factors, treatment and prevention strategies should be adjusted accordingly

an observational study

Background Currently there is no ARDS definition or classification system that allows optimal prediction of mortality in ARDS patients. This study aimed to examine the predictive values of the AECC and Berlin definitions, as well as clinical and respiratory parameters obtained at onset of ARDS and in the course of the first seven consecutive days. Methods The observational study was conducted at a 14-bed intensive care unit specialized on treatment of ARDS. Predictive validity of the AECC and Berlin definitions as well as PaO2/FiO2 and FiO2/PaO2*Pmean (oxygenation index) on mortality of ARDS patients was assessed and statistically compared. Results Four hundred forty two critically-ill patients admitted for ARDS were analysed. Multivariate Cox regression indicated that the oxygenation index was the most accurate parameter for mortality prediction. The third day after ARDS criteria were met at our hospital was found to represent the best compromise between earliness and accuracy of prognosis of mortality regarding the time of assessment. An oxygenation index of 15 or greater was associated with higher mortality, longer length of stay in ICU and hospital and longer duration of mechanical ventilation. In addition, non-survivors had a significantly longer length of stay and duration of mechanical ventilation in referring hospitals before admitted to the national reference centre than survivors. Conclusions The oxygenation index is suggested to be the most suitable parameter to predict mortality in ARDS, preferably assessed on day 3 after admission to a specialized centre. Patients might benefit when transferred to specialized ICU centres as soon as possible for further treatment

Metadata as a normalising mechanism for information-transfer behaviour in higher education institutions : the information culture perspective

Introduction. The paper discusses the problem of information-transfer behaviour in higher education institutions. The goal of this study is to observe how metadata of IT systems in higher education environment influence information-transfer behaviour in the ongoing process of organisational change. Changes in the national higher education system have a strong impact on knowledge workers’ awareness of information needs and processes. Metadata as a factor supporting information awareness can play an important role in the information-transfer efficiency. Method. The study was attended by 27 university administration employees from six higher education institutions. The purpose of the sense-making interviews was to determine the behavioural conditions of the information-transfer processes in higher education institutions. Analysis. Nonaka and Takeuchi’s SECI (socialisation, externalisation, combination and internalisation) model was used to analyse observed behavioural patterns. Findings. A model for metadata-based normalisation of information-transfer behaviour in higher education institution has been developed. Conclusion. Metadata structures of IT systems have been identified as crucial for information-transfer behaviour normalisation. Metadata fragmentise responsibilities and disseminate employees’ awareness about reporting processes

Predictors of survival in critically ill patients with acute respiratory distress syndrome (ARDS): an observational study

Number of patients receiving extracorporeal lung assist devices (ELAD) on each day. (DOC 26 kb

Renovation of the historic Olsztyn villa Casablanca

The paper outlines the details of the design and difficulties that had to be overcome in the course of the renovation and adaptation of a rich German factory owner’s residence from 1912, which in 1988 was entered into the register of historic buildings of the Warmia and Mazury region

Microbiological Hazards Associated with Archaeological Works, Illustrated with an Example of Fredro Crypt (Przemyśl, Poland)

The human remains and other materials found in crypts can be highly contaminated with microorganisms. Archaeologists are exposed to microorganisms in many ways (e.g by inhaling dust, contaminating scratches or cuts). We aimed at evaluating microbial hazards associated with human remains and bioaerosols formed during archaeological works in burial crypts. The samples of the human remains, bioaerosols and personal protective equipment (dust respirators, disposable coveralls) were collected during archaeological works in the vault of the Cathedral Basilica of St. John the Baptist and the Assumption of the Blessed Virgin Mary in Przemyśl (Fredro crypt). The microbiological examination involved determining the number of spores of aerobic and anaerobic bacteria, the number of mesophilic and hemolytic bacteria, and the number of xerophilic, non- xerophilic and keratinolytic fungi. The air as well as objects and materials found in crypts are highly contaminated with bacteria and fungi. The xerophilic fungi were the most numerous in all samples of human remains 1–230·103 cfu(colony forming units/g). The non-xerophilic fungi were predominant in bioaerosols (>104 cfu/m3 during archaeological works). The majority of bacterial strains (81.3%) belonged to the genus Bacillus. Fungi belonging to the genera Penicillium (65.2%) and Aspergillus (28.6%) dominated among the isolated fungi. Fogging sterilization of the crypt turned out to be ineffective. The high number of microorganisms both in the air and on human remains indicates that there is a need for particular caution during archaeological works which cause dust emission. In order to reduce exposure to harmful biological factors, the use of disposable personal protective equipment seems necessary

Climate and Ties in Workplace versus Sense of Danger and Stress, Based on Empirical Research in the Aviation Industry

The climate of the workplace, as well as the issues of relations and ties in the professional environment have long aroused considerable interest among psychologists and management practitioners. The organizational climate, which is defined as a set of beliefs about the organization, its relations, the atmosphere of the workplace, circulation of communication, development opportunities, etc., has often been associated with well-being and job satisfaction. Performing work related to numerous stress factors and difficult situations may significantly affect how both the professional environment and employees’ well-being are perceived. Many empirical studies concerning work psychology and organization, including the works of Rosenstiel and Boegel, Gonzales-Roma, Peiro, Schneider and Earhart underline the importance of the organization climate in the construction of efficient and effectively functioning organizations. One of its important aspects is the level of social relationships and cooperation within an organization. Ties in the workplace are defined as the quality and depth of relations between members of an organization. Studies presented in this paper are of an exploratory nature due to the sector specificity, i.e., aviation and provision of services related to ground control operations. The aim of the empirical research presented herein is to verify the assumption about mutual relations between such variables as the perceived climate of the workplace and interpersonal bonds, as well as experiencing negative emotional states, such as the sense of danger and stress. The psychological literature suggests that low evaluation of the organizational climate parameters should be related to worse, more negative evaluation of the workplace and that the dissatisfaction within the scope of ties and relations with employees affects the perception of stress and threat. In the course of the study, 326 persons working at Pyrzowice and Szymany (Poland) and Kosice (Slovakia) have been examined. Polish employees dominated in this group (250 persons). The remaining group was constituted of individuals working at the Kosice (Slovakia) airport. The respondents represent a specific professional group. The authors tried to learn the specificity of the stress and threat experiencing process due to organizational variables—such as aspects related to evaluation of the workplace and the feeling of ties. To achieve this goal, in the course of statistical analyses, models were built to predict the sense of danger and stress among the surveyed population. A hierarchical regression analysis was carried out in order to determine which of the variables allow predicting the sense of danger and stress in the examined occupational group. The results showed that the higher sense of threat was predicted by the less positive views about the workload, the social support and by the higher ratings of ties in the workplace. In this model, the statistically significant predictors of the sense of threat were the perception of workload (β = − 0.184; s.e. = 0.29; t = −3.297; p < 0.001), the social support (β = − 0.272; s.e. = 0.52; t = −3.916; p < 0.001) and ties in the workplace (β = 0.115; s.e. = 0.51; t = 2.162; p = 0.031). Additionally, the higher level of sense of stress was predicted by the less positive views about the workload, fair play and by the higher sense of threat. The final model explained 12% of all variability regarding the sense of stress (R2 = 0.115; F [8, 317] = 5.122; p < 0.001). In this model, the statistically significant predictors of the sense of stress were the workload (β = − 0.120; s.e. = 0.11; t = −2.079; p = 0.038), sense of justice (β = 0.160; s.e. = 0.20; t = 1.965; p < 0.001) and the sense of threat (β = 0.219; s.e. = 0.02; t = 3.859; p < 0.001). The interest in employees from the aviation sector stems from the lack of empirical data on how people working in this industry function psychologically. This branch of industry is currently developing extremely dynamically and is expected to evolve even more in the wake of the industrial revolution 4.0. Work in the field of modern industry 4.0 forces the employees to acquire many important competencies related to managing new, automated working conditions. As suggested by some authors (Popkova, 2019; Neufeind, 2018), in the light of the 4.0 revolution, one must assume that both the requirements of the work environment and reactions and behavior of employees will differ from the more typical and stable organizational conditions. Meanwhile, in the light of automation and specificity of the industry in question, not much attention is paid to human resources, who—while cooperating in various teams (organic and inorganic)—experience various challenges, as well as difficulties resulting from their professional work