Contamination of hospital tap water: the survival and persistence of Pseudomonas aeruginosa on conventional and 'antimicrobial' outlet fittings

BACKGROUND

Pseudomonas aeruginosa infections have been linked to contaminated hospital taps, highlighting the potential for tap outlet fittings (OF) to harbour biofilm. P. aeruginosa may be transferred to OFs via contaminated cleaning cloths. Suggested interventions include flushing regimens and alternative OF designs.

AIM

To investigate the transfer of P. aeruginosa from a contaminated cleaning cloth to conventional and 'antimicrobial/antibiofilm' OFs and to determine whether this contamination persists and/or leads to contamination of tap water.

METHODS

Microfibre cloths contaminated with P. aeruginosa (10⁸ cfu/mL) were used to wipe four different types of OF [one of conventional design (OF-A) and three marketed as 'antimicrobial' and/or 'antibiofilm' (OF- B, -C and -D)]. OFs were inserted into an experimental water distribution system for up to 24 h. Survival was assessed by culture. Single and multiple water samples were collected and cultured for P. aeruginosa.

FINDINGS

The median number of P. aeruginosa transferred from cloth to OF was 5.7 × 10⁵ cfu (OF-A), 1.9 × 10⁶ cfu (OF-B), 1.4 × 10⁵ cfu (OF-C) and 2.9 × 10⁶ cfu (OF-D). Numbers declined on all OFs during the 24 h period with log reductions ranging from 3.5 (OF-C) to 5.2 (OF-B; P > 0.05). All water samples delivered immediately after OF contamination contained P. aeruginosa at ≥10 cfu per 100 mL. Contamination of water delivered from OF-A persisted despite continued flushing. Water delivered from OF-B did not contain P. aeruginosa beyond the first flush.

CONCLUSION

Contaminated cleaning cloths may transfer P. aeruginosa to OFs, leading to contamination of tap water. Although not removing the potential for contamination, 'antimicrobial/antibiofilm' OFs may prevent P. aeruginosa from continually contaminating water delivered from the outlet.

Increasing the frequency of physical activity very brief advice by nurses to cancer patients. A mixed methods feasibility study of a training intervention

OBJECTIVES

To examine the impact, acceptability, practicability and implementation of a training intervention, designed using the Behaviour Change Wheel, on the delivery of very brief advice on physical activity, by nurses to cancer patients.

STUDY DESIGN

A mixed methods feasibility study.

METHOD

A purposeful sample of nurses (n = 62) were recruited across two delivery arms, face-to-face (n = 55) and online (n = 7). Frequency of delivery of physical activity advice was collected at baseline with follow-up at 12 weeks. The 'capability, opportunity and motivation' of nurses to deliver very brief advice was measured via questionnaire. Semi-structured phone interviews (n = 14) were completed and analyzed thematically. A cost consequence analysis was undertaken.

RESULTS

The intervention improved the 'capability, opportunity and motivation' of nurses resulting in a change in knowledge, attitudes and beliefs towards physical activity. The intervention was both acceptable and practical. Face-to-face was the preferred mode of delivery, however there was also value in the online option. The cost of delivery per participant was £33.87 for face-to-face delivery, and £103.83 for online delivery inflated due to low recruitment numbers. A significant improvement was seen in delivery of very brief advice at 12 weeks (Z = -4.39, P ≤ 0.01).

CONCLUSION

The intervention is acceptable, practical and improves delivery of very brief advice on physical activity by nurses to cancer patients in the short-term. Both face-to-face and online delivery should be considered.

Phagocytosis of Colloidal Carbon by the Fixed Tissue and Peritoneal Macrophages of New Zealand Mice

The peritoneal cellular response to colloidal carbon has been studied in NZB, NZW, BWF1, BALB/c, CBA and C3Hf mice aged 8 to 10 weeks. The overall patterns of total and differential peritoneal cell counts was similar in all 6 strains of mice. No inter-strain differences were noted in either the removal of carbon from the peritoneal cavity or the distribution of carbon in the fixed tissue macrophages. The results show that phagocytosis of colloidal carbon, an inert particle, is normal in New Zealand mice.

Intravenous carbon clearance studies performed on NZB, BALB/c and CBA mice showed that phagocytosis of carbon was identical in each strain when correction was made for variations in liver and spleen weight.

Increasing the frequency of physical activity very brief advice for cancer patients. Development of an intervention using the behaviour change wheel

BACKGROUND

Being physically active has multiple benefits for cancer patients. Despite this only 23% are active to the national recommendations and 31% are completely inactive. A cancer diagnosis offers a teachable moment in which patients might be more receptive to lifestyle changes. Nurses are well placed to offer physical activity advice, however, only 9% of UK nurses involved in cancer care talk to all cancer patients about physical activity. A change in the behaviour of nurses is needed to routinely deliver physical activity advice to cancer patients. As recommended by the Medical Research Council, behavioural change interventions should be evidenced-based and use a relevant and coherent theoretical framework to stand the best chance of success.

OBJECTIVE

This paper presents a case study on the development of an intervention to improve the frequency of delivery of very brief advice (VBA) on physical activity by nurses to cancer patients, using the Behaviour Change Wheel (BCW).

METHOD

The eight composite steps outlined by the BCW guided the intervention development process. An iterative approach was taken involving key stakeholders (n = 45), with four iterations completed in total. This was not defined a priori but emerged during the development process.

RESULTS

A 60 min training intervention, delivered in either a face-to-face or online setting, with follow-up at eight weeks, was designed to improve the capability, opportunity and motivation of nurses to deliver VBA on physical activity to people living with cancer. This intervention incorporates seven behaviour change techniques of goal setting coupled with commitment; instructions on how to perform the behaviour; salience of the consequences of delivering VBA; a demonstration on how to give VBA, all delivered via a credible source with objects added to the environment to support behavioural change.

CONCLUSION

The BCW is a time consuming process, however, it provides a useful and comprehensive framework for intervention development and greater control over intervention replication and evaluation.

Best available technology for European livestock farms: Availability, effectiveness and uptake

Concerns over the negative environmental impact from livestock farming across Europe continue to make their mark resulting in new legislation and large research programs. However, despite a huge amount of published material and many available techniques, doubts over the success of national and European initiatives remain. Uptake of the more cost-effective and environmentally-friendly farming methods (such as dietary control, building design and good manure management) is already widespread but unlikely to be enough in itself to ensure that current environmental targets are fully met. Some of the abatement options available for intensive pig and poultry farming are brought together under the European IPPC/IED directive where they are listed as Best Available Techniques (BAT). This list is far from complete and other methods including many treatment options are currently excluded. However, the efficacies of many of the current BAT-listed options are modest, difficult to regulate and in some cases they may even be counterproductive with respect to other objectives ie pollution swapping. Evaluation of the existing and new BAT technologies is a key to a successful abatement of pollution from the sector and this in turn relies heavily on good measurement strategies. Consideration of the global effect of proposed techniques in the context of the whole farm will be essential for the development of a valid strategy.