Success of MRSA eradication in hospital routine: depends on compliance

BACKGROUND

To prevent transmission of MRSA, eradication by antiseptic washings and nasal ointment is recommended. There are few studies, which investigated the success of eradication of MRSA carriage during everyday clinical working conditions and results are controversial. We wanted to assess the effectiveness of MRSA eradication procedures--especially octenidine whole body washings and mupirocin nasal ointment--under conditions of everyday life.

PATIENTS AND METHODS

We retrospectively analyzed the files of all patients who were admitted to the medical department of a tertiary care hospital between 1999 and 2004 and who were infected or colonized by MRSA. According to hospital's standards of care patients should have been washed with octenidine and should have got mupirocin nasal ointment only in case of nasal carriage. Patients were regarded as MRSA-eradicated when swabs taken on three consecutive days, earliest, three days after discontinuation of antiseptic and antiinfective procedures were without proof of MRSA.

RESULTS

Only 6% of patients were eradicated. MRSA could be cultured from swabs taken on dismissal of 60% of patients. Fifteen percent of patients had only one or two negative series of swabs. In 19% of patients success of eradication remained unknown. Besides we found that under every day clinical working conditions compliance with several tasks of the eradication protocol was insufficient.

CONCLUSION

Under every day clinical working conditions MRSA eradication is successful only in few patients. Whole body washings should be tested in detailed studies before they should become a recommendation for eradication of MRSA.

[Hygiene in home care. A study with home care providers]

We studied the implementation of infection control guidelines of 9 providers of home care in the German Ruhr area. The study included 22 nurses, and 214 home care patients were seen. The following main problems were identified: Qualified infection control staff is lacking, infection control protocols are lacking or are not adapted, the cooperation with family doctors often is problematic, there are deficits in hand hygiene and great deficits with clothing hygiene and waste disposal. We suggest improvements for some care tasks, e.g., handling of urinary catheters, infusions and prescription of tracheostomy tubes.

[Experiences with anthrax emergency measures during 2001 and 2002 in the city of Essen]

After the terrorist attacks of 11 September 2001 suspected cases of anthrax also occurred in Germany. No case could be confirmed. From October 2001 to November 2002 the fire brigade of the city of Essen was called in 110 cases of suspected anthrax contamination. In 78 cases specimens were transported to diagnostic laboratories, in 22 cases persons were transported. Only in the first few days patients with suspected contamination had to stay in hospital and underwent chemoprophylaxis. Cooperation between the fire brigade, the local health authorities and the hygienists of the involved hospitals was very intense. It seems necessary to evaluate all the German experiences with suspected anthrax cases to develop risk estimations for different exposure situations and to develop specific recommendations for decontamination, disinfection and initial therapy.

Fire eater's risk: lipoid pneumonia following aspiration of a liquid hydrocarbon mixture

Acute aspiration of a liquid hydrocarbon mixture by fire eaters may cause severe lipoid pneumonia. The toxic effect of ingested hydrocarbon chains depends on their length and biophysical qualities. We report the case of a patient who accidentally aspirated a hydrocarbon liquid resulting in a lipoid pneumonia. The pathomechanism, diagnostic work-up, and the therapeutic approach are discussed.

[Occupational lead poisoning due to deficient protective measures at the work place]

Occupational lead poisoning due to deficient protective measures at the work place.

HISTORY AND ADMISSION FINDINGS

A 27-year-old man who was working in the mixing plant of a company manufacturing synthetic materials, was admitted with colicky upper abdominal pain, loss of appetite and postprandial nausea for 3 weeks. On examination he had pain without guarding over the abdomen.

INVESTIGATIONS

He had a normochronic anaemia (haemoglobin 12.5. g/dl). Ultrasound of the abdomen revealed splenomegaly. Gastroscopy excluded an ulcer. Deep duodenal biopsy showed Giardia intestinalis histologically.

DIAGNOSIS, TREATMENT AND COURSE

As part of the differential diagnosis of abdominal colic and anaemia, lead poisoning was found, with the lead level markedly elevated to 1776 microgram/l. Penicillamine treatment rapidly reduced the blood lead level, but it had not yet become normal after 4 months. Exposure to lead at his work place was discovered. Subsequent tests there by the federal agency for occupational protection revealed massive deficiencies in protective measures.

CONCLUSION

In present conditions abdominal colic must be viewed as a cardinal symptom of lead poisoning. Blood levels must be obtained as part of the differential diagnosis of abdominal pain of uncertain aetiology. If the diagnosis has been established and an occupational risk is possible, the appropriate occupational organizations and, if necessary, federal agency must be informed in order to exclude occupational exposure to lead. In Germany there still exist marked deficiencies in the protection of workers occupationally exposed to lead. Notification is essential to protect others similarly at risk.

Biomarkers of genetic damage and inflammation in blood and bronchoalveolar lavage fluid among former German uranium miners: a pilot study

Former East German uranium miners who are known to have been exposed to radon are estimated to be at high risk for lung carcinogenesis. Among these miners over 200 occupationally caused lung cancer cases are expected to occur each year, resulting in a total of 7,000-24,000 excess lung cancer cases in the coming years. It is still unknown whether there is a correlation between biomarkers and the exposure of the uranium miners to ionizing radiation that might enable us to trace those miners with high lung cancer risk. The primary aim of this pilot study was to test the possibility of performing a biomarker study in this unique cohort of former uranium miners in spite of several limitations that had to be taken into consideration when comparing them with healthy controls, such as old age, age-dependent diseases and potential confounding artefacts from dissimilar smoking patterns. The second aim was to test a range of biomarkers for DNA damage and inflammation in leukocytes and bronchoalveolar fluid for their ability to detect biological effects. In this cohort of miners we found an increased frequency of chromosomal aberrations in blood lymphocytes and an increased prevalence of both fibronectin and tumour necrosis factor alpha in the bronchoalveolar fluid.

Efficiency of continuous positive airway pressure versus theophylline therapy in sleep apnea: comparative sleep laboratory studies on objective and subjective sleep and awakening quality

Sleep apnea is the most common sleep-related breathing disorder characterized by repetitive episodes of hypoxemia. Therapies include behavioral, surgical, orthodontic, pneumological, and pharmacological interventions. The aim of the present study was to compare the efficiency of pneumological therapy by nasal continuous positive airway pressure (CPAP) versus a pharmacological approach with theophylline (Respicur retard(R) 400 mg) on respiratory variables as well as objective and subjective sleep and awakening quality in patients with moderate sleep apnea measured by polysomnography and psychometry. Under CPAP therapy all respiratory variables improved and normalized, while under theophylline only the apnea-hypopnea index and the desaturation index improved but still did not return to normal values. Regarding sleep initiation and maintenance, CPAP therapy prolonged sleep latency and reduced movement time, while patients treated with theophylline showed reduced total sleep period, total sleep time and sleep efficiency. Sleep architecture demonstrated an increase in deep sleep and REM stages under CPAP therapy, and remained unchanged under theophylline. Concerning subjective sleep and awakening quality, both treatments improved well-being in the morning. Regarding objective awakening quality, reaction time performance was improved in both groups. In conclusion, CPAP treatment is more effective than theophylline regarding respiratory variables as well as the normalization of sleep maintenance and sleep architecture in sleep apnea patients.

p53 mutations and codon 213 polymorphism of p53 in lung cancers of former uranium miners

PURPOSE

There is a high prevalence of G-->T transversions of p53 in lung cancers of smokers. One study has reported a special "hotspot" mutation at codon 249 of p53 in lung cancers of former uranium miners. The aim of our study was to look for mutational spectra of p53 in former German uranium miners with lung cancers.

METHODS

We investigated 16 patients with lung cancer who had worked as uranium miners in Germany and 13 lung cancer patients without a mining history of the same region. By means of the polymerase chain reaction and sequencing we looked for mutations in exons 5 7 of the p53 gene.

RESULTS

We could not find any suggestion of hotspot mutations. The only G-->T mutation in former uranium miners was detected in the only nonsmoker. In 3 patients (19% of the total) we found a codon 213/3 polymorphism.

CONCLUSIONS

The results indicate that G-->T transversions do not seem to be very common mutations in p53 in lung cancers probably caused by radiation. Therefore, p53 may be mutated early in lung cancer development if radiation exposure is a critical factor in carcinogenesis. In accordance with studies of thyroid cancer patients in the Chernobyl region, our results may indicate an overrepresentation of codon 213/3 polymorphism in p53 in radiation-caused cancers.

Elevated DNA single-strand breakage frequencies in lymphocytes of welders exposed to chromium and nickel

DNA damage (alkaline filter elution) and sister chromatid exchange (SCE) frequencies were measured in lymphocytes of 39 welders and 39 controls. The welders showed a significantly higher rate of DNA single-strand breakages and significantly elevated SCE values. These results are not in accordance with those of a former study in which only DNA-protein cross-links were measured. The different results may be explained on the basis of different exposure levels for chromium(VI) and nickel. Both methods are not specific but sensitive enough to measure genotoxic damage after occupational exposure to chromium(VI) and nickel in the range of threshold values for the workplace on a collective basis. Additionally, the results indicate that DNA single-strand breakage and DNA-protein cross-links show different increases depending on the exposure levels for chromium and nickel.

[Geriatric assessment--the Vienna model]

Geriatric Assessment is a structured interdisciplinary process for the diagnosis of the functional status and potential for rehabilitation of geriatric inpatients. This paper describes the possibilities and scope of the Vienna Model of Geriatric Assessment oriented in terms of practicability and focused implementation of resources. By using this multidimensional proceeding the rehabilitation-quotient of patients has increased more than 39%. From this point of view Geriatric Assessment in a geriatric hospital is a practical instrument to prevent hospitalization, to increase survival at home, and to improve functional status in elderly patients.

DNA single strand breakage, DNA adducts, and sister chromatid exchange in lymphocytes and phenanthrene and pyrene metabolites in urine of coke oven workers

OBJECTIVES

To investigate the specificity of biological monitoring variables (excretion of phenanthrene and pyrene metabolites in urine) and the usefulness of some biomarkers of effect (alkaline filter elution, 32P postlabelling assay, measurement of sister chromatid exchange) in workers exposed to polycyclic aromatic hydrocarbons (PAHs).

METHODS

29 coke oven workers and a standardised control group were investigated for frequencies of DNA single strand breakage, DNA protein cross links (alkaline filter elution assay), sister chromatid exchange, and DNA adducts (32P postlabelling assay) in lymphocytes. Phenanthrene and pyrene metabolites were measured in 24 hour urine samples. 19 different PAHs (including benzo(a)pyrene, pyrene, and phenanthrene) were measured at the workplace by personal air monitoring. The GSTT1 activity in erythrocytes and lymphocyte subpopulations in blood was also measured.

RESULTS

Concentrations of phenanthrene, pyrene, and benzo(a)pyrene in air correlated well with the concentration of total PAHs in air; they could be used for comparisons of different workplaces if the emission compositions were known. The measurement of phenanthrene metabolites in urine proved to be a better biological monitoring variable than the measurement of 1-hydroxypyrene. Significantly more DNA strand breaks in lymphocytes of coke oven workers were found (alkaline filter elution assay); the DNA adduct rate was not significantly increased in workers, but correlated with exposure to PAHs in a semiquantitative manner. The number of sister chromatid exchanges was lower in coke oven workers but this was not significant; thus counting sister chromatid exchanges was not a good variable for biomonitoring of coke oven workers. Also, indications for immunotoxic influences (changes in lymphocyte subpopulations) were found.

CONCLUSIONS

The measurement of phenanthrene metabolites in urine seems to be a better biological monitoring variable for exposure to PAHs than measurement of hydroxypyrene. The alkaline filter elution assay proved to be the most sensitive biomarker for genotoxic damage, whereas the postlabelling assay was the only one with some specificity for DNA alterations caused by known compounds.

Biomonitoring of urinary aromatic amines and arylamine hemoglobin adducts in exposed workers and nonexposed control persons

The renal excretion of arylamines in occupationally exposed and nonexposed subjects was measured by a gas chromatography-electron capture detector method. Additionally, in the occupationally exposed persons hemoglobin adduct levels of arylamines were determined by a liquid chromatography-electrochemical detector method, together with the individual acetylator status. The aromatic amines aniline, p-toluidine, 2-naphthylamine, and 4-chloro-o-toluidine were detected in the urine of nonsmoking subjects who were not occupationally exposed to arylamines. Significantly higher concentrations of aniline, o-toluidine, m-toluidine, 2-naphthylamine, and 4-methyl-1,3-phenylenediamine could be observed in the urine of smoking control persons in comparison to nonsmokers. Comparison of smokers and nonsmokers in a group of workers primarily exposed to aniline and 4-chloroaniline revealed significant differences (P < 0.05) in the formation of 4-aminodiphenyl hemoglobin adducts and in the renal excretion of 2-naphthylamine. The slow acetylators in this group produced significantly more hemoglobin adducts of aniline and 4-chloroaniline than did the fast acetylators. In slow acetylators among the smoking workers there was a significant increase in the formation of 4-aminodiphenyl hemoglobin adducts and in the renal excretion of 4-chloroaniline and m-toluidine. The results indicate that there are influences of smoking habits and acetylator status on the levels of arylamine hemoglobin adducts as well as urinary arylamine concentrations. Hemoglobin adducts seem to be good parameters for monitoring aniline and 4-chloroaniline exposure at the workplace, especially if the acetylator polymorphism can be taken into account. 4-Aminodiphenyl hemoglobin adducts might be good parameters for monitoring individual smoking habits. The determination of urinary arylamine concentrations provides additional information concerning acute exposures to aromatic amines.

[New data on syncarcinogenesis in tumors of exogenous origin]

Little is known about syncarcinogenic effects of occupational and environmental substances although it is supposed that different exogenous factors may play critical roles in the development of many human tumors. Epidemiologic results prove syncarcinogenesis for asbestos exposure and smoking (lung cancer), radon exposure and smoking (lung cancer), exposure to aromatic amines and smoking (bladder cancer) and alcohol abuse and smoking (oral, larynx and oesophagus cancer). Animal experiments point to additive effects in carcinogenesis for different nitrosamines and substances like benzo(a)pyrene, carbon tetrachloride, ethanol, vinyl chloride and ionising radiation. It can be concluded from modern concepts of carcinogenesis that syncarcinogenic mechanisms may not only result from genotoxicity but also from influences on cell proliferation and mitogenesis as well as toxicokinetics, DNA repair, intercellular communication, immune system and hormonal effects. New methods of molecular epidemiology seem very promising to study syncarcinogenic effects in animals and humans.

The metameric pattern of the head mesoderm--does it exist?

It is a long-standing question whether the paraxial head mesoderm of vertebrate embryos is segmentally organized into somites like the trunk or not. On the one hand, no somites are seen in the anterior head mesoderm in vertebrate embryos, on the other hand, such a segmental pattern has been described under the name of somitomeres. In order to investigate the patterning of mesodermal cells in the head of avian embryos we performed scanning electron microscopy, computer assisted reconstructions of the head mesoderm and density analyses of head mesoderm cells. We observed regional differences within the head mesoderm of avian embryos, but we could not see a consistent somitomeric pattern in the head mesoderm. In sum, we consider that the avian head mesoderm is not arranged in a metameric pattern.

Comparison of the single breath with the intrabreath method for the measurement of the carbon monoxide transfer factor in subjects with and without airways obstruction

BACKGROUND

Measurement of the carbon monoxide transfer factor (TLCO) has traditionally been performed using the single breath method but recently the intrabreath method has been developed. The aim of this study was to compare the two methods in the clinical evaluation of patients with obstructive and non-obstructive pulmonary disorders.

METHODS

Measurements of TLCO with the intrabreath method were carried out on a study sample composed of 50 patients with non-obstructive disorders and 50 with airways obstruction (FEV1/FVC < 70%) either before or after a single breath measurement of the TLCO had been performed. The method involves the continuous analysis of a single slow expirate using a computerised rapid multigas infrared analyser. TLCO, alveolar volume (VA), TLCO/VA, and inspired vital capacity (IVC) values were obtained for both groups by both methods.

RESULTS

When measured with the intrabreath method the group with airways obstruction showed lower TLCO and TLCO/VA values than the non-obstructive group. VA was higher in both patient groups when measured with the intrabreath technique. The same test also showed higher TLCO values with the intrabreath method in the group with non-obstructive disorders and lower TLCO/VA values with the intrabreath method in those with airways obstruction. The corresponding parameters obtained by the two methods correlated closely, with no correlation between the magnitude of the differences with the magnitude of the readings. An index of gas mixing indicated a better distribution of the inspired air for the intrabreath method than for the single breath method. The VA values obtained with the intrabreath method showed a closer agreement to the actual total lung capacities measured by body plethysmography.

CONCLUSION

The intrabreath method of determining TLCO is comparable to the traditional single breath method. Measurement of alveolar volume by the intrabreath method approximates more closely to total lung capacity, even in subjects with airways obstruction.