Minimal intervention for controlling nosocomial transmission of Methicillin-Resistant Staphylococcus aureus in resource limited setting with high endemicity

Objective: To control nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in resource-limited healthcare setting with high endemicity. Methods: Three phases of infection control interventions were implemented in a University-affiliated hospital between 1- January-2004 and 31-December-2012. The first phase of baseline period, defined as the first 48-months of the study period, when all MRSA patients were managed with standard precautions, followed by a second phase of 24-months, when a hospital-wide hand hygiene campaign was launched. In the third phase of 36-months, contact precautions in open cubicle, use of dedicated medical items, and 2% chlorhexidine gluconate daily bathing for MRSA-positive patients were implemented while hand hygiene campaign was continued. The changes in the incidence rates of hospital-acquired MRSA-per- 1000-patient admissions, per-1000-patient-days, and per-1000-MRSA-positive-days were analyzed using segmented Poisson regression (an interrupted time series model). Usage density of broad-spectrum antibiotics was monitored. Results: During the study period, 4256 MRSA-positive patients were newly diagnosed, of which 1589 (37.3%) were hospitalacquired. The reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000- MRSA-positive-days from phase 1 to 2 was 36.3% (p<0.001), 30.4% (p<0.001), and 19.6% (p = 0.040), while the reduction of hospital-acquired MRSA per 1000-patient admissions, per 1000-patient-days, and per 1000-MRSA-positive-days from phase 2 to 3 was 27.4% (p<0.001), 24.1% (p<0.001), and 21.9% (p = 0.041) respectively. This reduction is sustained despite that the usage density of broad-spectrum antibiotics has increased from 132.02 (phase 1) to 168.99 per 1000 patient-days (phase 3). Conclusions: Nosocomial transmission of MRSA can be reduced with hand hygiene campaign, contact precautions in open cubicle, and 2% chlorhexidine gluconate daily bathing for MRSA-positive despite an increasing consumption of broadspectrum antibiotics. © 2014 Cheng et al.published_or_final_versio

A novel risk factor associated with colonization by Carbapenemase-Producing Enterobacteriaceae: Use of Proton Pump Inhibitors in addition to Antimicrobial Treatment

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Emergence of Carbapenem-Resistant Acinetobacter baumannii in Nursing Homes With High Background Rates of MRSA Colonization

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Effect of heat treatment during curing of provisional restorative materials

Session: Dental MaterialsObjectives: To investigate in vitro the influence of heat treatment during setting on the flexural strength of four resin-based acrylic provisional restorative dental biomaterials. Methods: Four provisional restoration biomaterials, namely poly(methyl methacrylate)(DuraLay, Illinois, USA), poly(ethyl methacrylate) (Trim II, Illinois, USA), bis-acrylic composites (Luxatemp Star, Hamburg, Germany and Protemp 4, Seefeld, Germany) were selected for this laboratory investigation. Rectangular specimen beams with the dimensions of 25 mm x 2 mm x 2 mm were prepared using a stainless steel mould according to the manufacturers' instructions. Next, the specimens were chemically cured either in room temperature (23°C) or in a water bath at 100°C for 1 min. Ten specimens per experimental group were subjected to thermo-cycling (3000 cycles, between 5-55°C,with an immersion time of 20 s). Flexural strength of each specimen was determined by 3-point bending test at crosshead speed of 1 mm/min. Data was analyzed using 2-sample t-test and 2-way ANOVA. Results: The mean flexural strength (±SD) of DuraLay, Trim II, Luxatemp Star and Protemp 4 were 73.31±7.89MPa, 41.79±5.09MPa, 106.20±27.16MPa and 87.50±9.76MPa, respectively (p=0.003). Heat treatment reduced substantially the mean flexural strength of DuraLay (55.65MPa vs.73.31MPa; p<0.001) and Trim II (3.62MPa vs. 41.79MPa; p<0.001) by 24% and 91%, respectively. Heat treatment had no significant effects on Luxatemp Star (106.20MPa vs. 96.14MPa; p<0.383), but it increased the mean flexural strength of Protemp 4 (107.87MPa vs. 87.05MPa; p<0.001) by 23%. Conclusions: In this laboratory study, the two bis-acryl resin composites exhibited superior flexural strength than poly(methyl methacrylate) and poly(ethyl methacrylate) resins. Heat treatment using a water bath at 100°C for 1 min adversely affected the flexural strength of poly(methyl methacrylate) and poly(ethyl methacrylate) resins, but it enhanced flexural strength of a bis-acrylic composite