Comparison of steam technology and a two-step cleaning (water/detergent) and disinfecting (1,000 resp. 5,000 ppm hypochlorite) method using microfiber cloth for environmental control of multidrug-resistant organisms in an intensive care unit.

Aim: The aim of this prospective observational study was to evaluate the impact of two cleaning and disinfecting methods and the use of steam against methicillin-resistant Staphyl ococcus aureus , vancomycin-resistant Enterococcus faecalis , carbapenem-resistant Pseudomonas aeruginosa and multidrug-resistant (MDR) Acinetobacter baumannii in a tertiary referral hospital. Methods: McFarland 0.5 suspensions (content 1.5 x 108 cfu/ml) of four challenge bacterial species were prepared and used to inoculate different sites in three ICU rooms. One of the following methods was used in each room: steam technology (Tecnovap Evo 304) resp. cleaning with microfiber cloths, soaked with detergent and water, thereafter disinfection with 1,000 ppm hypochlorite or the same procedure with 5,000 ppm hypochlorite. Qualitative microbiology and ATP bioluminescence were performed before and after cleaning with each method. The Wilcoxon test was used for paired samples to check for ordinal variables. The cost of each cleaning method was analyzed. Results: Environmental cleaning with steam technology was found to be as effective against MDR microorganisms as a two-step cleaning process (water/detergent and disinfecting with 1,000 resp. 5,000 ppm hypochlorite) in ICUs. No bacterial growth was detected after any of the three cleaning methods. Steam technology was 76% and 91% cheaper than using 5,000 ppm and 1,000 ppm hypochlorite, respectively.Conclusions: When compared to, steam technology was found to have an advantage over the 2-step procedure with cleaning and disinfection, because it avoids the use of chemicals, reduces water consumption, labor time and costs for cleaning.Zielsetzung: In einer prospektiven Beobachtungsstudie sollte die Wirksamkeit von zwei Verfahren der desinfizierenden Reinigung bzw. der Anwendung von Dampf gegen Methicillin-resistente Staphylococcus aureus (MRSA), Vancomycin-resistente Enterococcus faecalis (VRE), Carbapenem-resistente Pseudomonas aeruginosa und multiresistente (MDR) Acinetobacter baumannii in einem Krankenhaus der Tertiärversorgung verglichen werden.Methode: Von den vier Bakterienspecies wurden Suspensionen mit einem Gehalt von 1,5 x 108 KbE/ml hergestellt und zur Kontamination von drei Lokalisationen in drei Intensivstationen eingesetzt. In jedem Raum wurde eine der folgenden Reinigungsmethoden angewendet: Dampftechnologie (Tecnovap Evo 304) oder 2 Formen der desinfizierenden Reinigung in zwei Schritten: zuerst Reinigung mit Tensid getränktem Mikrofasertuch, anschließend Wischdesinfektion mit 1.000 ppm oder analoges Vorgehen nur mit 5.000 ppm Hypochlorit. Vor und nach der desinfizierenden Reinigung wurde ein qualitativer Erregernachweis geführt und die Reinigungswirkung mittels ATP-Biolumineszenz gemessen. Der Wilcoxon-Test wurde für gepaarte Stichproben zur Überprüfung ordinaler Variablen verwendet. Die Kosten für jede Reinigungsmethode wurden analysiert.Ergebnisse: Die drei Verfahren erwiesen sich als gleich wirksam. Nach keiner der drei Reinigungsmethoden war ein Bakterienwachstum nachweisbar. Die Dampftechnologie war 76% bzw. 91% preiswerter als die Verwendung von 5.000 ppm bzw. 1.000 ppm Hypochlorit.Schlussfolgerung: Im Vergleich zur zweistufigen desinfizierenden Reinigung mit Chlorlösungen erwies sich die Dampftechnologie als vorteilhafter, da auf den Einsatz von Chemikalien verzichtet und der Verbrauch von Wasser, benötigter Arbeitszeit und Reinigungskosten reduziert wird

Herpes simplex virus encephalitis in pregnancy

[No abstract available

Evaluation of cervical computed tomography findings in oropharyngeal tularaemia

Cervical contrast-enhanced computed tomography (CECT) was performed in 16 cases (5M, 11F) of oropharyngeal tularaemia, diagnosed at Zonguldak Karaelmas University, Turkey, between January 2004 and March 2006. All patients showed lymphadenopathy with contrast enhancement, 12 of them with peripheral contrast enhancement. Lymph node necrosis was found in 13 of the patients, abscess formation in 9 and cyst formation in 13. This appears to be the largest series of cervical CECT in oropharyngeal tularaemia reported to date. Tularaemia is a differential diagnosis of massive adenotonsillar enlargement and extensive necrotic cervical lymphadenopathy

Effects of various tool plunge depths on microstructure evolution, mechanical properties and dome structure features of friction stir spot welded AA5052-H32 similar jointsAuswirkungen verschiedener Eintauchtiefen des Werkzeugs auf die Entwicklung von Gefuge, mechanischen Eigenschaften und Eigenschaften der Kuppelstruktur von ruhrreibpunktgeschweissten Verbindungen der Aluminiumlegierung (AA5052-H32)

WOS: 000577757300008The solid-state nature of friction stir spot welding process provides outstanding advantages for the sound joining of aluminum alloys. Within this study, 3 mm-thick AA5052-H32 sheets are successfully joined by friction stir spot welding using 2344 hot-worked steel pin to investigate the effects of various tool plunge depths on the microstructure, mechanical and metallurgical properties of similar welds. Therefore, the experiments are performed at different plunge depths in the range of 3 mm-4 mm. Accordingly, the relationships between the process parameter (tool plunge depth) and the responses (microstructure, dome structure, microhardness and lap shear tensile load) are established. Microstructure analyses demonstrate that the increase in the plunge depth leads to more grain refinement within the stir zone, which significantly affects the mechanical performance of the similar joints. This study also indicates that the tool plunge depth in friction stir spot welding process has a noteworthy influence on the characteristic features of the 5052 aluminum alloy joints, such as the dome structure. Moreover, an explicit increase in the microhardness towards the weld stir zone is observed in all specimens. It is found that the average maximum tensile-shear force enhances with the increment in the tool plunge depth from 3 mm to 4 mm

Piperacillin-tazobactam versus carbapenem therapy with and without amikacin as empirical treatment of febrile neutropenia in cancer patients: Results of an open randomized trial at a University hospital

Objective: Empirical beta-lactam monotherapy has become the standard therapy in febrile neutropenia. The aim of this study was to compare the efficacy and safety of piperacillin-tazobactam versus carbapenem therapy with or without amikacin in adult patients with febrile neutropenia. Methods: In this prospective, open, single-center study, 127 episodes were randomized to receive either piperacillin-tazobactam (4 × 4.5 g IV/day) or carbapenem [meropenem (3 × 1 g IV/day) or imipenem (4 × 500 mg IV/day)] with or without amikacin (1 g IV/day). Doses were adjusted according to renal function. Clinical response was determined during and at completion of therapy. Results: One hundred and twenty episodes were assessable for efficacy (59 piperacillin-tazobactam, 61 carbapenem). Mean duration of treatment was 14.8 ± 9.6 days in the piperacillin-tazobactam group and 14.7 ± 8.8 days in the carbapenem group (P> 0.05). Mean days of fever resolution were 5.97 and 4.48 days for piperacillin-tazobactam and carbapenem groups, respectively (P> 0.05). Similar rates of success without modification were found in the piperacillin-tazobactam (87.9%) and in the carbapenem groups (75.4%; P > 0.05). Fungal infection occurrence rates were 30.5 and 18% in piperacillin-tazobactam and carbapenem groups, respectively (P = 0.05). Antibiotic modification rates were 30.5 and 13.1% (P = 0.02) and the addition of glycopeptides to empirical antibiotic regimens rates were 15.3 and 44.3% for piperacillin-tazobactam and carbapenem groups, respectively (P = 0.001). The rude mortality rates were 14% (6/43) and 29.3% (12/41) in piperacillin-tazobactam and carbapenem groups, respectively (P = 0.08). Conclusions: The effect of empirical regimen of piperacillin-tazobactam regimen is equivalent to carbapenem in adult febrile neutropenic patients. © The Author (2010). Published by Oxford University Press. All rights reserved

Mortality attributable to carbapenem-resistant nosocomial Acinetobacter baumannii infections in a Turkish university hospital

This study was performed to compare the mortality associated with carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-sensitive A. baumannii (CSAB) infections, to identify potential risk factors for CRAB infections, and to investigate the effects of potential risk factors on mortality in CRAB and CSAB patients. This retrospective case-control study was conducted in a university hospital between January 1, 2005 and December 30, 2006. One hundred and ten patients with CRAB and 55 patients with CSAB infection were identified during the study period. The mortality rate was 61.8z and 52.7z in CRAB and CSAB cases, respectively (P = 0.341). In CRAB cases, the risk factors for mortality were identified as intubation (odds ratio [OR], 3.3; 95z confidence interval [CI], 1.0-10.1; P = 0.042) and high APACHE II score (OR, 1.2; 95zCI, 1.1-1.3; P = 0.000), by multivariate analysis. Previous use of carbapenem (OR, 6.1; 95z CI, 2.2-17.1; P = 0.001) or aminopenicillin (OR, 2.5; 95z CI, 1.2-5.1; P = 0.013) were independently associated with carbapenem resistance. Although the mortality rate was higher among patients with CRAB infections, this difference was not found to be statistically significant. Previous use of carbapenem and aminopenicillin were found to be independent risk factors for infections with CRAB