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Goldsworthy A, Olsen M, Koh A, Demaneuf T, Singh G, Almheiri R, Chapman B, Almazrouei S, Ghemrawi R, Senok A, McKirdy S, Alghafri R, Tajouri L. Extended Reality Head-Mounted Displays Are Likely to Pose a Significant Risk in Medical Settings While Current Classification Remains as Non-Critical. Microorganisms 2024; 12:815. [PMID: 38674759 PMCID: PMC11052361 DOI: 10.3390/microorganisms12040815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Extended reality (XR) devices, including virtual and augmented reality head-mounted displays (HMDs), are increasingly utilised within healthcare to provide clinical interventions and education. Currently, XR devices are utilised to assist in reducing pain and improving psychological outcomes for immunocompromised patients in intensive care units, palliative care environments and surgical theatres. However, there is a paucity of research on the risks of infection from such devices in healthcare settings. Identify existing literature providing insights into the infection control risk XR HMDs pose within healthcare facilities and the efficacy of current infection control and cleaning procedures. Three databases (PubMed, Embase and CINAHL) in addition to Google Scholar were systematically searched. A total of seven studies were identified for this review. Microorganisms, including pathogenic bacteria (e.g., Staphylococcus aureus and Pseudomonas aeruginosa), were found to be present on XR HMDs. Published cleaning and infection control protocols designed to disinfect XR HMDs and protect users were heterogeneous in nature. Current cleaning protocols displayed varying levels of efficacy with microbial load affected by multiple factors, including time in use, number of users and XR HMD design features. In healthcare settings, fitting XR HMDs harbouring microorganisms near biological and mucosal entry points presents an infection control risk. An urgent revision of the Spaulding classification is required to ensure flexibility that allows for these devices to be reclassified from 'Non-critical' to 'Semi-Critical' depending on the healthcare setting and patient population (surgery, immunocompromised, burns, etc.). This review identified evidence supporting the presence of microorganisms on XR HMDs. Due to the potential for HMDs to contact mucosal entry points, devices must be re-considered within the Spaulding classification as 'Semi-critical'. The existence of microbial contaminated XR HMDs in high-risk medical settings such as operating wards, intensive care units, emergency departments, labour and delivery wards and clinical areas with immunosuppressed patients requires urgent attention. Public health authorities have a duty of care to develop revised guidelines or new recommendations to ensure efficient sanitation of such devices.
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Affiliation(s)
- Adrian Goldsworthy
- Harry Butler Institute, Murdoch University, Perth, WA 6150, Australia; (A.G.); (B.C.); (S.M.); (R.A.)
- Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, QLD 4226, Australia; (M.O.); (G.S.)
| | - Matthew Olsen
- Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, QLD 4226, Australia; (M.O.); (G.S.)
| | - Andy Koh
- Department of Forensic Medicine, Kindai University, Osaka 589-8511, Japan;
| | | | - Gobinddeep Singh
- Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, QLD 4226, Australia; (M.O.); (G.S.)
| | - Reem Almheiri
- Dubai Police Scientists Council, Dubai Police, Dubai, United Arab Emirates;
| | - Brendan Chapman
- Harry Butler Institute, Murdoch University, Perth, WA 6150, Australia; (A.G.); (B.C.); (S.M.); (R.A.)
| | - Shaima Almazrouei
- International Centre for Forensic Sciences, Dubai Police, Dubai, United Arab Emirates;
| | - Rose Ghemrawi
- Health and Biomedical Research Center, College of Pharmacy, Al Ain University, Al Ain, United Arab Emirates;
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Abiola Senok
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates;
- School of Dentistry, Cardiff University, Cardiff CF10 3AT, UK
| | - Simon McKirdy
- Harry Butler Institute, Murdoch University, Perth, WA 6150, Australia; (A.G.); (B.C.); (S.M.); (R.A.)
| | - Rashed Alghafri
- Harry Butler Institute, Murdoch University, Perth, WA 6150, Australia; (A.G.); (B.C.); (S.M.); (R.A.)
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Lotti Tajouri
- Harry Butler Institute, Murdoch University, Perth, WA 6150, Australia; (A.G.); (B.C.); (S.M.); (R.A.)
- Faculty of Health Sciences and Medicine, Bond University, Robina, Gold Coast, QLD 4226, Australia; (M.O.); (G.S.)
- Dubai Police Scientists Council, Dubai Police, Dubai, United Arab Emirates;
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Jinadatha C, Navarathna T, Negron-Diaz J, Ghamande G, Corona BA, Adrianza A, Coppin JD, Choi H, Chatterjee P. Understanding the significance of microbiota recovered from health care surfaces. Am J Infect Control 2024; 52:220-224. [PMID: 38206212 DOI: 10.1016/j.ajic.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Microbial contamination of hospital surfaces remains despite adherence to routine disinfection. Our study demonstrates bioburden from various types of hospital high-touch surfaces and the pathogenicity of all bacteria recovered. METHODS Several high-touch hospital surfaces from a single medical-surgical unit were sampled and cultured using replicate organism detection and counting (RODAC) Tryptic Soy agar plates. Colonies were then subcultured to blood agar plates and speciated using MALDI-TOF. The local microbiology laboratory database was queried for any clinical isolate match with the environmental samples recovered. RESULTS Manikins, bed rails, and workstations-on-wheels were the most contaminated surfaces with the largest variety of bacteria isolated from manikins and bed rails. A total of 60 different types of pathogens were isolated, 18 of which were well-known pathogens, and 7 were classified as important in the health care setting by CDC. Our clinical microbiology laboratory identified 29 of 60 hospital surface bacteria in clinical isolates. Urine, soft tissue, and blood were the most common sources of clinical isolates. CONCLUSIONS Surfaces in the health care environment harbor both well-known and not-so-well-known human pathogens. Several not-so-well-known pathogens are skin flora or environmental bacteria, which in the right setting, can become pathogenic and cause diseases including meningitis, brain abscess, endocarditis, and bacteremia.
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Affiliation(s)
- Chetan Jinadatha
- Department of Research, Central Texas Veterans Health Care System, Temple, TX
| | - Thanuri Navarathna
- Department of Research, Central Texas Veterans Health Care System, Temple, TX
| | - Juan Negron-Diaz
- Department of Research, Central Texas Veterans Health Care System, Temple, TX; Department of Internal Medicine, Baylor Scott and White Health, Temple, TX
| | - Gautam Ghamande
- Department of Research, Central Texas Veterans Health Care System, Temple, TX
| | - Brandon A Corona
- Department of Research, Central Texas Veterans Health Care System, Temple, TX
| | - Andres Adrianza
- Department of Research, Central Texas Veterans Health Care System, Temple, TX; Department of Internal Medicine, Baylor Scott and White Health, Temple, TX
| | - John D Coppin
- Department of Research, Central Texas Veterans Health Care System, Temple, TX
| | - Hosoon Choi
- Department of Research, Central Texas Veterans Health Care System, Temple, TX
| | - Piyali Chatterjee
- Department of Research, Central Texas Veterans Health Care System, Temple, TX.
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Kandeel A, Fahim M, Deghedy O, H Roshdy W, K Khalifa M, El Shesheny R, Kandeil A, Wagdy S, Naguib A, Afifi S, Abdelghaffar K. Multicenter study to describe viral etiologies, clinical profiles, and outcomes of hospitalized children with severe acute respiratory infections, Egypt 2022. Sci Rep 2023; 13:21860. [PMID: 38071208 PMCID: PMC10710477 DOI: 10.1038/s41598-023-48814-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
In late 2022, severe acute respiratory infections (SARI) surveillance reported an abrupt increase in non-COVID-19 infections among children after three years of drastic reductions. Signals of increased absenteeism due to respiratory symptoms among primary and preparatory school children were detected by Event-Based Surveillance. We conducted a hospital-based survey of children who were admitted with SARI to identify the causative pathogen(s) and estimate the burden of infection. A survey was conducted among children < 16 years in 21 referral hospitals in the three governorates with the highest SARI rates. Patients' demographics, clinical symptoms, and severity were collected from medical records using a line list. Patients were swabbed and tested for a panel of 33 respiratory pathogens by RT-PCR at the Central Laboratory in Cairo. Descriptive data analysis was performed for demographic data. Patients' characteristics were compared by causative agents' clinical picture and severity using Chi2 with a p < 0.05 significance. Overall, 317 patients were enrolled, 58.3% were ≤ 1 year of age, 61.5% were males. Of 229 (72.7%) of positively tested patients, viruses caused 92.1% including RSV 63.8%, Rhinovirus 10.0%, Influenza 9.2%, Adenovirus 5.2%, and 1.3% co-infected with two viruses. Bacteria caused 3.5% of cases and 4.4% had mixed viral-bacterial infections. Rhinovirus was the most common cause of death among children with SARI, followed by RSV (8.7% and 1.4%), whereas influenza and Adenovirus did not result in any deaths. Patients with viral-bacterial infections are more likely to be admitted to ICU and die at the hospital than bacterial or viral infections (60% and 20% vs. 31.8% and 1.9% vs. 12.5% and 12.5%, p < 0.001). Viruses particularly RSV are the leading cause of SARI causing significant health problem among children < 16 years in Egypt. Bacterial on top of viral infection can worsen disease courses and outcomes. Studies are required to estimate the SARI burden accurately among Egyptian children and a comprehensive approach tailored to Egypt is necessary to reduce its burden.
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Affiliation(s)
- Amr Kandeel
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Manal Fahim
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt
| | - Ola Deghedy
- Preventive Sector, Ministry of Health and Population, Cairo, Egypt.
| | - Wael H Roshdy
- Central Public Health Laboratories, Ministry of Health and Population, Cairo, Egypt
| | - Mohamed K Khalifa
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, 12622, Egypt
| | - Rabeh El Shesheny
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, 12622, Egypt
| | - Ahmed Kandeil
- Centre of Scientific Excellence for Influenza Viruses, National Research Centre, Dokki, Giza, 12622, Egypt
| | - Saly Wagdy
- Central Public Health Laboratories, Ministry of Health and Population, Cairo, Egypt
| | - Amel Naguib
- Central Public Health Laboratories, Ministry of Health and Population, Cairo, Egypt
| | - Salma Afifi
- Consultant Ministry of Health and Population, Cairo, Egypt
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Kaur H, Rosenberg M, Kook M, Danilian D, Kisand V, Ivask A. Antibacterial activity of solid surfaces is critically dependent on relative humidity, inoculum volume, and organic soiling. FEMS MICROBES 2023; 5:xtad022. [PMID: 38213394 PMCID: PMC10781430 DOI: 10.1093/femsmc/xtad022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 11/21/2023] [Accepted: 11/29/2023] [Indexed: 01/13/2024] Open
Abstract
Antimicrobial surface materials potentially prevent pathogen transfer from contaminated surfaces. Efficacy of such surfaces is assessed by standard methods using wet exposure conditions known to overestimate antimicrobial activity compared to dry exposure. Some dry test formats have been proposed but semi-dry exposure scenarios e.g. oral spray or water droplets exposed to ambient environment, are less studied. We aimed to determine the impact of environmental test conditions on antibacterial activity against the model species Escherichia coli and Staphylococcus aureus. Surfaces based on copper, silver, and quaternary ammonium with known or claimed antimicrobial properties were tested in conditions mimicking microdroplet spray or larger water droplets exposed to variable relative air humidity in the presence or absence of organic soiling. All the environmental parameters critically affected antibacterial activity of the tested surfaces from no effect in high-organic dry conditions to higher effect in low-organic humid conditions but not reaching the effect size demonstrated in the ISO 22169 wet format. Copper was the most efficient antibacterial surface followed by silver and quaternary ammonium based coating. Antimicrobial testing of surfaces using small droplet contamination in application-relevant conditions could therefore be considered as one of the worst-case exposure scenarios relevant to dry use surfaces.
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Affiliation(s)
- Harleen Kaur
- Institute of Molecular and Cell Biology, University of Tartu, Riia 23, 51010 Tartu, Estonia
| | - Merilin Rosenberg
- Institute of Molecular and Cell Biology, University of Tartu, Riia 23, 51010 Tartu, Estonia
| | - Mati Kook
- Institute of Physics, University of Tartu, W. Ostwaldi 1, 50411 Tartu, Estonia
| | - Dmytro Danilian
- Institute of Physics, University of Tartu, W. Ostwaldi 1, 50411 Tartu, Estonia
| | - Vambola Kisand
- Institute of Physics, University of Tartu, W. Ostwaldi 1, 50411 Tartu, Estonia
| | - Angela Ivask
- Institute of Molecular and Cell Biology, University of Tartu, Riia 23, 51010 Tartu, Estonia
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Knobling B, Franke G, Belmar Campos C, Büttner H, Christner M, Klupp EM, Maurer PM, Knobloch JK. Tolerance of clinical vancomycin-resistant Enterococcus faecium isolates against UV-C light from a mobile source. Antimicrob Resist Infect Control 2023; 12:63. [PMID: 37403134 PMCID: PMC10320914 DOI: 10.1186/s13756-023-01259-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 05/29/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Admission to a room previously occupied by patients carrying environmentally robust pathogens implies an increased risk of acquiring those pathogens. Therefore, 'No-touch' automated room disinfection systems, including devices based on UV-C irradiation, are discussed to improve terminal cleaning. It is still unclear if clinical isolates of relevant pathogens behave differently under UV-C irradiation compared to laboratory strains used in the approval process of disinfection procedures. In this study we analysed the susceptibility of well characterized clonally divergent vancomycin-resistant enterococci (VRE) strains, including a linezolid-resistant isolate, against UV-C radiation. METHODS Susceptibility against UV-C of ten clonally divergent clinical isolates of VRE was determined in comparison to the commonly used test organism Enterococcus hirae ATCC 10541. Ceramic tiles contaminated with 105 to 106 colony forming units/25 cm² of the different enterococci were positioned at a distance of 1.0 and 1.5 m and irradiated for 20 s, resulting in a UV-C dose of 50 and 22 mJ/cm², respectively. Reduction factors were calculated after quantitative culture of the bacteria recovered from treated and untreated surfaces. RESULTS Susceptibility to UV-C varied considerably among the strains studied, with the mean value of the most robust strain being up to a power of ten lower compared to the most sensitive strain at both UV-C doses. The two most tolerant strains belonged to MLST sequence types ST80 and ST1283. The susceptibility of the laboratory strain E. hirae ATCC 10541 ranged between the most sensitive and most tolerant isolates for both irradiation doses. However, for UV-C dose of 22 mJ/cm², the reduction of the most tolerant isolate of ST1283 was statistically significantly lower compared to E. hirae ATCC 10541. The most susceptible strains belonged to the MLST sequence types ST117 and ST203. CONCLUSIONS These results indicate that UV-C doses reported in the literature are sufficient for the reduction of commonly used reference strains of enterococci but could be insufficient for the reduction of tolerant patient VRE-isolates in a hospital setting. Therefore, for future studies, the most tolerant clinical isolates should be used to validate automated UV-C devices or longer exposure times should be expected to ensure efficacy in the real world.
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Affiliation(s)
- B Knobling
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Franke
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Belmar Campos
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - H Büttner
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M Christner
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E M Klupp
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P M Maurer
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - J K Knobloch
- Institute for Medical Microbiology, Virology and Hygiene, Department Infection Prevention and Control, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Sinclair LG, Dougall LR, Ilieva Z, McKenzie K, Anderson JG, MacGregor SJ, Maclean M. Laboratory evaluation of the broad-spectrum antibacterial efficacy of a low-irradiance visible 405-nm light system for surface-simulated decontamination. HEALTH AND TECHNOLOGY 2023; 13:1-15. [PMID: 37363345 PMCID: PMC10264887 DOI: 10.1007/s12553-023-00761-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023]
Abstract
Purpose Lighting systems which use visible light blended with antimicrobial 405-nm violet-blue light have recently been developed for safe continuous decontamination of occupied healthcare environments. This paper characterises the optical output and antibacterial efficacy of a low irradiance 405-nm light system designed for environmental decontamination applications, under controlled laboratory conditions. Methods In the current study, the irradiance output of a ceiling-mounted 405-nm light source was profiled within a 3×3×2 m (18 m3) test area; with values ranging from 0.001-2.016 mWcm-2. To evaluate antibacterial efficacy of the light source for environmental surface decontamination, irradiance levels within this range (0.021-1 mWcm-2) at various angular (Δ ϴ=0-51.3) and linear (∆s=1.6-2.56 m) displacements from the source were used to generate inactivation kinetics, using the model organism, Staphylococcus aureus. Additionally, twelve bacterial species were surface-seeded and light-exposed at a fixed displacement below the source (1.5 m; 0.5 mWcm-2) to demonstrate broad-spectrum efficacy at heights typical of high touch surfaces within occupied settings. Results Results demonstrate that significant (P≤0.05) inactivation was successfully achieved at all irradiance values investigated, with spatial positioning from the source affecting inactivation, with greater times required for inactivation as irradiance decreased. Complete/near-complete (≥93.28%) inactivation of all bacteria was achieved following exposure to 0.5 mWcm-2 within exposure times realistic of those utilised practically for whole-room decontamination (2-16 h). Conclusion This study provides fundamental evidence of the efficacy, and energy efficiency, of low irradiance 405-nm light for bacterial inactivation within a controlled laboratory setting, further justifying its benefits for practical infection control applications.
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Affiliation(s)
- Lucy G Sinclair
- The Robertson Trust Laboratory for Electronic Sterilisation Technologies, Department of Electronic & Electrical Engineering, University of Strathclyde, Glasgow, UK
| | - Laura R Dougall
- The Robertson Trust Laboratory for Electronic Sterilisation Technologies, Department of Electronic & Electrical Engineering, University of Strathclyde, Glasgow, UK
| | - Zornitsa Ilieva
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Karen McKenzie
- The Robertson Trust Laboratory for Electronic Sterilisation Technologies, Department of Electronic & Electrical Engineering, University of Strathclyde, Glasgow, UK
| | - John G Anderson
- The Robertson Trust Laboratory for Electronic Sterilisation Technologies, Department of Electronic & Electrical Engineering, University of Strathclyde, Glasgow, UK
| | - Scott J MacGregor
- The Robertson Trust Laboratory for Electronic Sterilisation Technologies, Department of Electronic & Electrical Engineering, University of Strathclyde, Glasgow, UK
| | - Michelle Maclean
- The Robertson Trust Laboratory for Electronic Sterilisation Technologies, Department of Electronic & Electrical Engineering, University of Strathclyde, Glasgow, UK
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
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Improving infection control in a veterinary hospital: a detailed study on patterns of faecal contamination to inform changes in practice. Ir Vet J 2023; 76:4. [PMID: 36782258 PMCID: PMC9924846 DOI: 10.1186/s13620-023-00229-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 01/04/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND The main purpose of this study was to investigate the cleanliness and microbial burden of a veterinary hospital to establish the extent of cross-contamination with faecal bacteria as an aid to reducing nosocomial infections. Enterococci and Escherichia coli were used as faecal indicator organisms as they can survive on inanimate surfaces for months and pose a threat to animal health. The study consisted of several elements: (i) a cross-sectional study to identify sites currently contaminated with faecal organisms that could be usefully included in a longitudinal study, (ii) a 3-week longitudinal study to identify sites from which faecal bacteria were repeatedly recovered, (iii) once-off monitoring of hand hygiene, (iv) a review of all hospitalised cases with confirmed E. coli or enterococcal infection during the 8-week study period to investigate possible hospital-acquired (HAI) infection and relationship with environmental contamination. Environmental surface and hand hygiene were assessed using 3M™ Clean-Trace™ ATP test, 3M™ Petrifilm™ plates and bacteriological culture of Enterococcus species and E. coli. Cross contamination was assessed using results of antimicrobial susceptibility testing. RESULTS In the cross-sectional study, 26 of 113 (24.5%) of sites sampled exceeded the accepted microbial threshold (2.5 CFU/cm2) and Enterococcus species were isolated from 31 (27.4%) and E. coli from 9 (7.9%) of 113 samples. Organic residue and microbial levels were high in the dog kennels even after cleaning and faecal organisms were also recovered from sites such as the dispensary, a student computer and staff common room. Four of 51 (7.8%) hand samples were contaminated with faecal bacteria. Nine sites were monitored on three occasions in the longitudinal study and a total of 23 Escherichia coli and 6 Enterococcus species were recovered. Seven of the nine sites were positive for faecal organisms on more than one occasion. There was no change in cleanliness or microbial burden over 3 weeks. Twenty-one of the 73 isolates (28.8%) recovered during all parts of the study were multi-drug resistant. Enterococci and E. coli isolates with similar resistance patterns were recovered from the environment in the large and small animal hospitals and from a small number of patients during the same timeframe, suggesting possible hospital acquired infections. CONCLUSIONS Results suggested that movement between the small and large animal hospital areas may have been responsible for cross-contamination and possible hospital-acquired infections. The data show that cross-sectional and longitudinal monitoring of faecal contamination across all hospital areas can play an important role in informing review of infection control protocols in veterinary hospital settings. Changes in practices in the hospital based on results generated are outlined.
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Schutte-Smith M, Erasmus E, Mogale R, Marogoa N, Jayiya A, Visser HG. Using visible light to activate antiviral and antimicrobial properties of TiO 2 nanoparticles in paints and coatings: focus on new developments for frequent-touch surfaces in hospitals. JOURNAL OF COATINGS TECHNOLOGY AND RESEARCH 2023; 20:789-817. [PMID: 36777289 PMCID: PMC9904533 DOI: 10.1007/s11998-022-00733-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/27/2022] [Accepted: 10/30/2022] [Indexed: 05/05/2023]
Abstract
The COVID-19 pandemic refocused scientists the world over to produce technologies that will be able to prevent the spread of such diseases in the future. One area that deservedly receives much attention is the disinfection of health facilities like hospitals, public areas like bathrooms and train stations, and cleaning areas in the food industry. Microorganisms and viruses can attach to and survive on surfaces for a long time in most cases, increasing the risk for infection. One of the most attractive disinfection methods is paints and coatings containing nanoparticles that act as photocatalysts. Of these, titanium dioxide is appealing due to its low cost and photoreactivity. However, on its own, it can only be activated under high-energy UV light due to the high band gap and fast recombination of photogenerated species. The ideal material or coating should be activated under artificial light conditions to impact indoor areas, especially considering wall paints or frequent-touch areas like door handles and elevator buttons. By introducing dopants to TiO2 NPs, the bandgap can be lowered to a state of visible-light photocatalysis occurring. Naturally, many researchers are exploring this property now. This review article highlights the most recent advancements and research on visible-light activation of TiO2-doped NPs in coatings and paints. The progress in fighting air pollution and personal protective equipment is also briefly discussed. Graphical Abstract Indoor visible-light photocatalytic activation of reactive oxygen species (ROS) over TiO2 nanoparticles in paint to kill bacteria and coat frequently touched surfaces in the medical and food industries.
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Affiliation(s)
- M. Schutte-Smith
- Department of Chemistry, University of the Free State, P.O. Box 339, Bloemfontein, 9300 South Africa
| | - E. Erasmus
- Department of Chemistry, University of the Free State, P.O. Box 339, Bloemfontein, 9300 South Africa
| | - R. Mogale
- Department of Chemistry, University of the Free State, P.O. Box 339, Bloemfontein, 9300 South Africa
| | - N. Marogoa
- Department of Chemistry, University of the Free State, P.O. Box 339, Bloemfontein, 9300 South Africa
| | - A. Jayiya
- Department of Chemistry, University of the Free State, P.O. Box 339, Bloemfontein, 9300 South Africa
| | - H. G. Visser
- Department of Chemistry, University of the Free State, P.O. Box 339, Bloemfontein, 9300 South Africa
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Rankin DA, Spieker AJ, Perez A, Stahl AL, Rahman HK, Stewart LS, Schuster JE, Lively JY, Haddadin Z, Probst V, Michaels MG, Williams JV, Boom JA, Sahni LC, Staat MA, Schlaudecker EP, McNeal MM, Harrison CJ, Weinberg GA, Szilagyi PG, Englund JA, Klein EJ, Gerber SI, McMorrow M, Rha B, Chappell JD, Selvarangan R, Midgley CM, Halasa NB. Circulation of Rhinoviruses and/or Enteroviruses in Pediatric Patients With Acute Respiratory Illness Before and During the COVID-19 Pandemic in the US. JAMA Netw Open 2023; 6:e2254909. [PMID: 36749589 PMCID: PMC10408278 DOI: 10.1001/jamanetworkopen.2022.54909] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/19/2022] [Indexed: 02/08/2023] Open
Abstract
IMPORTANCE Rhinoviruses and/or enteroviruses, which continued to circulate during the COVID-19 pandemic, are commonly detected in pediatric patients with acute respiratory illness (ARI). Yet detailed characterization of rhinovirus and/or enterovirus detection over time is limited, especially by age group and health care setting. OBJECTIVE To quantify and characterize rhinovirus and/or enterovirus detection before and during the COVID-19 pandemic among children and adolescents seeking medical care for ARI at emergency departments (EDs) or hospitals. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the New Vaccine Surveillance Network (NVSN), a multicenter, active, prospective surveillance platform, for pediatric patients who sought medical care for fever and/or respiratory symptoms at 7 EDs or hospitals within NVSN across the US between December 2016 and February 2021. Persons younger than 18 years were enrolled in NVSN, and respiratory specimens were collected and tested for multiple viruses. MAIN OUTCOMES AND MEASURES Proportion of patients in whom rhinovirus and/or enterovirus, or another virus, was detected by calendar month and by prepandemic (December 1, 2016, to March 11, 2020) or pandemic (March 12, 2020, to February 28, 2021) periods. Month-specific adjusted odds ratios (aORs) for rhinovirus and/or enterovirus-positive test results (among all tested) by setting (ED or inpatient) and age group (<2, 2-4, or 5-17 years) were calculated, comparing each month during the pandemic to equivalent months of previous years. RESULTS Of the 38 198 children and adolescents who were enrolled and tested, 11 303 (29.6%; mean [SD] age, 2.8 [3.7] years; 6733 boys [59.6%]) had rhinovirus and/or enterovirus-positive test results. In prepandemic and pandemic periods, rhinoviruses and/or enteroviruses were detected in 29.4% (9795 of 33 317) and 30.9% (1508 of 4881) of all patients who were enrolled and tested and in 42.2% (9795 of 23 236) and 73.0% (1508 of 2066) of those with test positivity for any virus, respectively. Rhinoviruses and/or enteroviruses were the most frequently detected viruses in both periods and all age groups in the ED and inpatient setting. From April to September 2020 (pandemic period), rhinoviruses and/or enteroviruses were detectable at similar or lower odds than in prepandemic years, with aORs ranging from 0.08 (95% CI, 0.04-0.19) to 0.76 (95% CI, 0.55-1.05) in the ED and 0.04 (95% CI, 0.01-0.11) to 0.71 (95% CI, 0.47-1.07) in the inpatient setting. However, unlike some other viruses, rhinoviruses and/or enteroviruses soon returned to prepandemic levels and from October 2020 to February 2021 were detected at similar or higher odds than in prepandemic months in both settings, with aORs ranging from 1.47 (95% CI, 1.12-1.93) to 3.01 (95% CI, 2.30-3.94) in the ED and 1.36 (95% CI, 1.03-1.79) to 2.44 (95% CI, 1.78-3.34) in the inpatient setting, and in all age groups. Compared with prepandemic years, during the pandemic, rhinoviruses and/or enteroviruses were detected in patients who were slightly older, although most (74.5% [1124 of 1508]) were younger than 5 years. CONCLUSIONS AND RELEVANCE Results of this study show that rhinoviruses and/or enteroviruses persisted and were the most common respiratory virus group detected across all pediatric age groups and in both ED and inpatient settings. Rhinoviruses and/or enteroviruses remain a leading factor in ARI health care burden, and active ARI surveillance in children and adolescents remains critical for defining the health care burden of respiratory viruses.
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Affiliation(s)
- Danielle A. Rankin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
- Vanderbilt Epidemiology PhD Program, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Andrew J. Spieker
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ariana Perez
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
- General Dynamics Information Technology Inc, Falls Church, Virginia
| | - Anna L. Stahl
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Herdi K. Rahman
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura S. Stewart
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Joana Y. Lively
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Zaid Haddadin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Varvara Probst
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marian G. Michaels
- Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - John V. Williams
- Department of Pediatrics, University of Pittsburgh School of Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julie A. Boom
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston
| | - Leila C. Sahni
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston
| | - Mary A. Staat
- Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Elizabeth P. Schlaudecker
- Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Monica M. McNeal
- Division of Infectious Diseases, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Christopher J. Harrison
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Geoffrey A. Weinberg
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Peter G. Szilagyi
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
- Department of Pediatrics, UCLA (University of California, Los Angeles) Mattel Children’s Hospital, UCLA, Los Angeles
| | - Janet A. Englund
- Seattle Children’s Hospital, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Eileen J. Klein
- Seattle Children’s Hospital, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Susan I. Gerber
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Meredith McMorrow
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian Rha
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - James D. Chappell
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rangaraj Selvarangan
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, Kansas City, Missouri
- Department of Pathology and Laboratory Medicine, Children’s Mercy Kansas City, Kansas City, Missouri
| | - Claire M. Midgley
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Natasha B. Halasa
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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10
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Murray AF, Bryan D, Garfinkel DA, Jorgensen CS, Tang N, Liyanage WLNC, Lass EA, Yang Y, Rack PD, Denes TG, Gilbert DA. Antimicrobial properties of a multi-component alloy. Sci Rep 2022; 12:21427. [PMID: 36503913 PMCID: PMC9741758 DOI: 10.1038/s41598-022-25122-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/24/2022] [Indexed: 12/14/2022] Open
Abstract
High traffic touch surfaces such as doorknobs, countertops, and handrails can be transmission points for the spread of pathogens, emphasizing the need to develop materials that actively self-sanitize. Metals are frequently used for these surfaces due to their durability, but many metals also possess antimicrobial properties which function through a variety of mechanisms. This work investigates metallic alloys comprised of several metals which individually possess antimicrobial properties, with the target of achieving broad-spectrum, rapid sanitation through synergistic activity. An entropy-motivated stabilization paradigm is proposed to prepare scalable alloys of copper, silver, nickel and cobalt. Using combinatorial sputtering, thin-film alloys were prepared on 100 mm wafers with ≈50% compositional grading of each element across the wafer. The films were then annealed and investigated for alloy stability. Antimicrobial activity testing was performed on both the as-grown alloys and the annealed films using four microorganisms-Phi6, MS2, Bacillus subtilis and Escherichia coli-as surrogates for human viral and bacterial pathogens. Testing showed that after 30 s of contact with some of the test alloys, Phi6, an enveloped, single-stranded RNA bacteriophage that serves as a SARS-CoV-2 surrogate, was reduced up to 6.9 orders of magnitude (> 99.9999%). Additionally, the non-enveloped, double-stranded DNA bacteriophage MS2, and the Gram-negative E. coli and Gram-positive B. subtilis bacterial strains showed a 5.0, 6.4, and 5.7 log reduction in activity after 30, 20 and 10 min, respectively. Antimicrobial activity in the alloy samples showed a strong dependence on the composition, with the log reduction scaling directly with the Cu content. Concentration of Cu by phase separation after annealing improved activity in some of the samples. The results motivate a variety of themes which can be leveraged to design ideal antimicrobial surfaces.
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Affiliation(s)
- Anne F. Murray
- grid.411461.70000 0001 2315 1184Department of Food Science, University of Tennessee, Knoxville, TN 37996 USA ,grid.411461.70000 0001 2315 1184Department of Ecology and Evolutionary Biology, University of Tennessee, Knoxville, TN 37996 USA
| | - Daniel Bryan
- grid.411461.70000 0001 2315 1184Department of Food Science, University of Tennessee, Knoxville, TN 37996 USA
| | - David A. Garfinkel
- grid.411461.70000 0001 2315 1184Department of Materials Science and Engineering, University of Tennessee, Knoxville, TN 37996 USA
| | - Cameron S. Jorgensen
- grid.411461.70000 0001 2315 1184Department of Materials Science and Engineering, University of Tennessee, Knoxville, TN 37996 USA
| | - Nan Tang
- grid.411461.70000 0001 2315 1184Department of Materials Science and Engineering, University of Tennessee, Knoxville, TN 37996 USA
| | - WLNC Liyanage
- grid.411461.70000 0001 2315 1184Department of Materials Science and Engineering, University of Tennessee, Knoxville, TN 37996 USA
| | - Eric A. Lass
- grid.411461.70000 0001 2315 1184Department of Materials Science and Engineering, University of Tennessee, Knoxville, TN 37996 USA
| | - Ying Yang
- grid.135519.a0000 0004 0446 2659Materials Science and Technology Division, Oak Ridge National Laboratory, Oak Ridge, TN 37831 USA
| | - Philip D. Rack
- grid.411461.70000 0001 2315 1184Department of Materials Science and Engineering, University of Tennessee, Knoxville, TN 37996 USA
| | - Thomas G. Denes
- grid.411461.70000 0001 2315 1184Department of Food Science, University of Tennessee, Knoxville, TN 37996 USA
| | - Dustin A. Gilbert
- grid.411461.70000 0001 2315 1184Department of Materials Science and Engineering, University of Tennessee, Knoxville, TN 37996 USA ,grid.411461.70000 0001 2315 1184Department of Physics and Astronomy, University of Tennessee, Knoxville, TN 37996 USA
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11
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Commercial toilets emit energetic and rapidly spreading aerosol plumes. Sci Rep 2022; 12:20493. [PMID: 36481924 PMCID: PMC9732293 DOI: 10.1038/s41598-022-24686-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/18/2022] [Indexed: 12/13/2022] Open
Abstract
Aerosols can transmit infectious diseases including SARS-CoV-2, influenza and norovirus. Flushed toilets emit aerosols that spread pathogens contained in feces, but little is known about the spatiotemporal evolution of these plumes or the velocity fields that transport them. Using laser light to illuminate ejected aerosols we quantify the kinematics of plumes emanating from a commercial flushometer-type toilet, and use the motion of aerosol particles to compute velocity fields of the associated flow. The toilet flush produces a strong chaotic jet with velocities exceeding 2 m/s; this jet transports aerosols to heights reaching 1.5 m within 8 seconds of initiating a flush. Quantifying toilet plumes and associated flow velocities provides a foundation for future design strategies to mitigate plume formation or to disinfect pathogens within it.
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12
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Efficacy of hypochlorous acid (HOCl) fog in sanitizing surfaces against Enterococcus faecalis. Am J Infect Control 2022; 50:1311-1315. [PMID: 35307474 DOI: 10.1016/j.ajic.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Fogging is an efficient method when disinfection of large areas is desired. METHODS Two methods of ultrasonic fogging, pulsed and continuous, were compared on bacteria dried on either aluminum or polystyrene surfaces. We characterized commercial and home-made hypochlorous acid (HOCl) with respect to storage and means of production. RESULTS We found that the initial chlorine concentration of the commercial solution was approximately 550 ppm, and when stored open under ambient conditions, the chlorine content decreased at a rate of 30% every 100 days. The HOCl produced using the home synthesizers had a maximum chlorine content of 257.6 ppm which decayed by 65% after 100 days. A second synthesizer produced a liquid with high chlorine content and pH, 750ppm and pH = 8.55. The anti-bacterial efficacy was probed using Enterococcus faecalis, a persistent source of infection in public and clinical spaces. Time course studies determined that E. faecalis could survive dry on surfaces for more than 12 weeks, but was easily eliminated in half the fogging time. CONCLUSIONS The most effective mode of application was determined to be continuous fogging where a 6.59 log reduction was established in vertical geometry. The optimal pulsed fogging protocol produced a similar reduction, but required nearly 5 times as long. The home synthesized versions yielded much lower log bacterial reductions. No significant differences in outcome were determined between polymer or metal surfaces.
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13
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Omatola CA, Olaniran AO. Epidemiological significance of the occurrence and persistence of rotaviruses in water and sewage: a critical review and proposal for routine microbiological monitoring. ENVIRONMENTAL SCIENCE. PROCESSES & IMPACTS 2022; 24:380-399. [PMID: 35174845 DOI: 10.1039/d1em00435b] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Globally, waterborne gastroenteritis attributable to rotaviruses is on the increase due to the rapid increase in population growth, poor socioeconomic conditions, and drastic changes in climatic conditions. The burden of diarrhea is quite alarming in developing nations where the majority of the populations still rely on untreated surface water that is usually polluted for their immediate water needs. Humans and animals of all ages are affected by rotaviruses. In humans, the preponderance of cases occurs in children under 5 years. Global efforts in advancing water/wastewater treatment technologies have not yet realized the objective of complete viral removal from wastewater. Most times, surface waters are impacted heavily by inadequately treated wastewater run-offs thereby exposing people or animals to preventable health risks. The relative stability of rotaviruses in aquatic matrices during wastewater treatment, poor correlation of bacteriological indicators with the presence of rotaviruses, and their infectiousness at a low dose informed the proposal for inclusion in the routine microbiological water screening panel. Environmental monitoring data have been shown to provide early warnings that can complement clinical data used to monitor the impact of current rotavirus vaccination in a community. This review was therefore undertaken to critically appraise rotavirus excretion and emission pathways, and the existence, viability and persistence in the receiving aquatic milieu. The efficiency of the current wastewater treatment modality for rotavirus removal, correlation of the current bacteriological water quality assessment strategy, public health risks and current laboratory methods for an epidemiological study were also discussed.
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Affiliation(s)
- Cornelius A Omatola
- Discipline of Microbiology, School of Life Sciences, College of Agriculture, Engineering and Science, University of KwaZulu-Natal (Westville Campus), Private Bag X54001, Durban 4000, Republic of South Africa.
| | - Ademola O Olaniran
- Discipline of Microbiology, School of Life Sciences, College of Agriculture, Engineering and Science, University of KwaZulu-Natal (Westville Campus), Private Bag X54001, Durban 4000, Republic of South Africa.
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14
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Peters A, Schmid MN, Parneix P, Lebowitz D, de Kraker M, Sauser J, Zingg W, Pittet D. Impact of environmental hygiene interventions on healthcare-associated infections and patient colonization: a systematic review. Antimicrob Resist Infect Control 2022; 11:38. [PMID: 35183259 PMCID: PMC8857881 DOI: 10.1186/s13756-022-01075-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/01/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Healthcare-associated infections (HAI) are one of the gravest threats to patient safety worldwide. The importance of the hospital environment has recently been revalued in infection prevention and control. Though the literature is evolving rapidly, many institutions still do not consider healthcare environmental hygiene (HEH) very important for patient safety. The evidence for interventions in the healthcare environment on patient colonization and HAI with multidrug-resistant microorganisms (MDROs) or other epidemiologically relevant pathogens was reviewed. METHODS We performed a systematic review according to the PRISMA guidelines using the PubMed and Web of Science databases. All original studies were eligible if published before December 31, 2019, and if the effect of an HEH intervention on HAI or patient colonization was measured. Studies were not eligible if they were conducted in vitro, did not include patient colonization or HAI as an outcome, were bundled with hand hygiene interventions, included a complete structural rebuild of the healthcare facility or were implemented during an outbreak. The primary outcome was the comparison of the intervention on patient colonization or HAI compared to baseline or control. Interventions were categorized by mechanical, chemical, human factors, or bundles. Study quality was assessed using a specifically-designed tool that considered study design, sample size, control, confounders, and issues with reporting. The effect of HEH interventions on environmental bioburden was studied as a secondary outcome. FINDINGS After deduplication, 952 records were scrutinized, of which 44 were included for full text assessment. A total of 26 articles were included in the review and analyzed. Most studies demonstrated a reduction of patient colonization or HAI, and all that analyzed bioburden demonstrated a reduction following the HEH intervention. Studies tested mechanical interventions (n = 8), chemical interventions (n = 7), human factors interventions (n = 3), and bundled interventions (n = 8). The majority of studies (21/26, 81%) analyzed either S. aureus, C. difficile, and/or vancomycin-resistant enterococci. Most studies (23/26, 88%) reported a decrease of MDRO-colonization or HAI for at least one of the tested organisms, while 58% reported a significant decrease of MDRO-colonization or HAI for all tested microorganisms. Forty-two percent were of good quality according to the scoring system. The majority (21/26, 81%) of study interventions were recommended for application by the authors. Studies were often not powered adequately to measure statistically significant reductions. INTERPRETATION Improving HEH helps keep patients safe. Most studies demonstrated that interventions in the hospital environment were related with lower HAI and/or patient colonization. Most of the studies were not of high quality; additional adequately-powered, high-quality studies are needed. Systematic registration number: CRD42020204909.
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Affiliation(s)
- Alexandra Peters
- Infection Control Programme and WHO Collaborating Center on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva 14, Switzerland.,University of Geneva, Geneva, Switzerland
| | | | - Pierre Parneix
- Nouvelle Aquitaine Healthcare-Associated Infection Control Centre, Bordeaux University Hospital, Bordeaux, France
| | - Dan Lebowitz
- Infection Control Programme and WHO Collaborating Center on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva 14, Switzerland
| | - Marlieke de Kraker
- Infection Control Programme and WHO Collaborating Center on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva 14, Switzerland
| | - Julien Sauser
- Infection Control Programme and WHO Collaborating Center on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva 14, Switzerland
| | - Walter Zingg
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital of Zurich, Zurich, Switzerland
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Center on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva 14, Switzerland.
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15
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Colston JM, Zaitchik BF, Badr HS, Burnett E, Ali SA, Rayamajhi A, Satter SM, Eibach D, Krumkamp R, May J, Chilengi R, Howard LM, Sow SO, Jahangir Hossain M, Saha D, Imran Nisar M, Zaidi AKM, Kanungo S, Mandomando I, Faruque ASG, Kotloff KL, Levine MM, Breiman RF, Omore R, Page N, Platts‐Mills JA, Ashorn U, Fan Y, Shrestha PS, Ahmed T, Mduma E, Yori PP, Bhutta Z, Bessong P, Olortegui MP, Lima AAM, Kang G, Humphrey J, Prendergast AJ, Ntozini R, Okada K, Wongboot W, Gaensbauer J, Melgar MT, Pelkonen T, Freitas CM, Kosek MN. Associations Between Eight Earth Observation-Derived Climate Variables and Enteropathogen Infection: An Independent Participant Data Meta-Analysis of Surveillance Studies With Broad Spectrum Nucleic Acid Diagnostics. GEOHEALTH 2022; 6:e2021GH000452. [PMID: 35024531 PMCID: PMC8729196 DOI: 10.1029/2021gh000452] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 10/12/2021] [Accepted: 11/18/2021] [Indexed: 05/10/2023]
Abstract
Diarrheal disease, still a major cause of childhood illness, is caused by numerous, diverse infectious microorganisms, which are differentially sensitive to environmental conditions. Enteropathogen-specific impacts of climate remain underexplored. Results from 15 studies that diagnosed enteropathogens in 64,788 stool samples from 20,760 children in 19 countries were combined. Infection status for 10 common enteropathogens-adenovirus, astrovirus, norovirus, rotavirus, sapovirus, Campylobacter, ETEC, Shigella, Cryptosporidium and Giardia-was matched by date with hydrometeorological variables from a global Earth observation dataset-precipitation and runoff volume, humidity, soil moisture, solar radiation, air pressure, temperature, and wind speed. Models were fitted for each pathogen, accounting for lags, nonlinearity, confounders, and threshold effects. Different variables showed complex, non-linear associations with infection risk varying in magnitude and direction depending on pathogen species. Rotavirus infection decreased markedly following increasing 7-day average temperatures-a relative risk of 0.76 (95% confidence interval: 0.69-0.85) above 28°C-while ETEC risk increased by almost half, 1.43 (1.36-1.50), in the 20-35°C range. Risk for all pathogens was highest following soil moistures in the upper range. Humidity was associated with increases in bacterial infections and decreases in most viral infections. Several virus species' risk increased following lower-than-average rainfall, while rotavirus and ETEC increased with heavier runoff. Temperature, soil moisture, and humidity are particularly influential parameters across all enteropathogens, likely impacting pathogen survival outside the host. Precipitation and runoff have divergent associations with different enteric viruses. These effects may engender shifts in the relative burden of diarrhea-causing agents as the global climate changes.
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16
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Abstract
Self-disinfecting surfaces are a current pressing need for public health and safety in view of the current COVID-19 pandemic, where the keenly felt worldwide repercussions have highlighted the importance of infection control, frequent disinfection, and proper hygiene. Because of its potential impact upon real-world translation into downstream applications, there has been much research interest in multiple disciplines such as materials science, chemistry, biology, and engineering. Various antimicrobial technologies have been developed and currently applied on surfaces in public spaces, such as elevator buttons and escalator handrails. These technologies are mainly based on conventional methods of grafting quaternary ammonium salts (QACs) such as benzalkonium chloride or the immobilization of metal species of silver or copper. However, neither the long-term efficacy nor the fast-killing properties have been proven, and the future repercussions from extended use, such as environmental hazards and the induction of MDR development, is unknown. Nanostructured surfaces with excellent antimicrobial activities have been claimed to be the next generation of self-disinfecting surfaces with various promising applications and passive antimicrobial mechanisms, without the potential repercussions of active ingredient overuse. In this Account, we briefly introduce the concept of mechanobactericidal action realized by these nanostructured surfaces first discovered on cicada wings. The elimination of microbes on the surface was actualized by the physical rupture of the microbe cell wall by nanoprotusions, without any involvement of chemical species. By mimicking the physical features of naturally occurring biocidal surfaces, the fabrication of nanostructures on various substrates such as titania, silicon, and polymers has been well described. Observations of the dependence of their antimicrobial efficacy on physical characteristics such as height, density, and rigidity have also been documented. However, the complex fabrication of such nanostructures remains the main drawback preventing its widespread application. We outline our efforts in fabricating a series of zinc-based nanostructured materials with facile and generally applicable wet chemistry methods, including nanodaggered zeolitic imidazolate frameworks (ZIF-L) and ZnO nanoneedles. In our investigations, we discovered that there were additional modes of action that contributed to the excellent biocidal activities of our materials. The impact of surface chemistry and charge was partially responsible for the selectivity and efficacy of ZIF-L-coated surfaces, where the positively charged surfaces were able to attract and adhere negatively charged bacteria to the surface. The combination of semiconductor ZnO nanoneedles on electron-donating substrates allowed for the generation of reactive oxygen species (ROS), realizing the remote killing of bacteria unadhered to the nanostructured surface. Additionally, we demonstrate several real-life applications of the synthesized materials, underscoring the importance of materials development suited for scale-up and eventual translation to potential applications and commercial end products.
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Affiliation(s)
| | - Yugen Zhang
- Institute of Bioengineering and Bioimaging, 31 Biopolis Way, S138669 Singapore
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17
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Kwon KY, Cheeseman S, Frias-De-Diego A, Hong H, Yang J, Jung W, Yin H, Murdoch BJ, Scholle F, Crook N, Crisci E, Dickey MD, Truong VK, Kim TI. A Liquid Metal Mediated Metallic Coating for Antimicrobial and Antiviral Fabrics. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2021; 33:e2104298. [PMID: 34550628 DOI: 10.1002/adma.202104298] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/24/2021] [Indexed: 05/24/2023]
Abstract
Fabrics are widely used in hospitals and many other settings for bedding, clothing, and face masks; however, microbial pathogens can survive on surfaces for a long time, leading to microbial transmission. Coatings of metallic particles on fabrics have been widely used to eradicate pathogens. However, current metal particle coating technologies encounter numerous issues such as nonuniformity, processing complexity, and poor adhesion. To overcome these issues, an easy-to-control and straightforward method is reported to coat a wide range of fabrics by using gallium liquid metal (LM) particles to facilitate the deposition of liquid metal copper alloy (LMCu) particles. Gallium particles coated on the fabric provide nucleation sites for forming LMCu particles at room temperature via galvanic replacement of Cu2+ ions. The LM helps promote strong adhesion of the particles to the fabric. The presence of the LMCu particles can eradicate over 99% of pathogens (including bacteria, fungi, and viruses) within 5 min, which is significantly more effective than control samples coated with only Cu. The coating remains effective over multiple usages and against contaminated droplets and aerosols, such as those encountered in facemasks. This facile coating method is promising for generating robust antibacterial, antifungal, and antiviral fabrics and surfaces.
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Affiliation(s)
- Ki Yoon Kwon
- School of Chemical Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
- Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, NC, 27695, USA
| | - Samuel Cheeseman
- School of Science, STEM College, RMIT University, Melbourne, VIC, 3001, Australia
| | - Alba Frias-De-Diego
- College of Veterinary Medicine, Department of Population Health and Pathobiology, North Carolina State University, Raleigh, NC, 27695, USA
| | - Haeleen Hong
- School of Chemical Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Jiayi Yang
- Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, NC, 27695, USA
| | - Woojin Jung
- School of Chemical Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
| | - Hong Yin
- Advanced Manufacturing and Fabrication, School of Engineering, RMIT University, Melbourne, VIC, 3000, Australia
| | - Billy J Murdoch
- School of Science, STEM College, RMIT University, Melbourne, VIC, 3001, Australia
| | - Frank Scholle
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, 27695, USA
| | - Nathan Crook
- Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, NC, 27695, USA
| | - Elisa Crisci
- College of Veterinary Medicine, Department of Population Health and Pathobiology, North Carolina State University, Raleigh, NC, 27695, USA
| | - Michael D Dickey
- Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, NC, 27695, USA
| | - Vi Khanh Truong
- Department of Chemical and Biomolecular Engineering, North Carolina State University, Raleigh, NC, 27695, USA
- School of Science, STEM College, RMIT University, Melbourne, VIC, 3001, Australia
| | - Tae-Il Kim
- School of Chemical Engineering, Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
- Biomedical Institute for Convergence at SKKU (BICS), Sungkyunkwan University (SKKU), Suwon, 16419, Republic of Korea
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18
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Bäumler W, Eckl D, Holzmann T, Schneider-Brachert W. Antimicrobial coatings for environmental surfaces in hospitals: a potential new pillar for prevention strategies in hygiene. Crit Rev Microbiol 2021; 48:531-564. [PMID: 34699296 DOI: 10.1080/1040841x.2021.1991271] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Recent reports provide evidence that contaminated healthcare environments represent major sources for the acquisition and transmission of pathogens. Antimicrobial coatings (AMC) may permanently and autonomously reduce the contamination of such environmental surfaces complementing standard hygiene procedures. This review provides an overview of the current status of AMC and the demands to enable a rational application of AMC in health care settings. Firstly, a suitable laboratory test norm is required that adequately quantifies the efficacy of AMC. In particular, the frequently used wet testing (e.g. ISO 22196) must be replaced by testing under realistic, dry surface conditions. Secondly, field studies should be mandatory to provide evidence for antimicrobial efficacy under real-life conditions. The antimicrobial efficacy should be correlated to the rate of nosocomial transmission at least. Thirdly, the respective AMC technology should not add additional bacterial resistance development induced by the biocidal agents and co- or cross-resistance with antibiotic substances. Lastly, the biocidal substances used in AMC should be safe for humans and the environment. These measures should help to achieve a broader acceptance for AMC in healthcare settings and beyond. Technologies like the photodynamic approach already fulfil most of these AMC requirements.
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Affiliation(s)
- Wolfgang Bäumler
- Department of Dermatology, University Hospital, Regensburg, Germany
| | - Daniel Eckl
- Department of Microbiology, University of Regensburg, Regensburg, Germany
| | - Thomas Holzmann
- Department of Infection Control and Infectious Diseases, University Hospital, Regensburg, Germany
| | - Wulf Schneider-Brachert
- Department of Infection Control and Infectious Diseases, University Hospital, Regensburg, Germany
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19
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Munir MT, Maneewan N, Pichon J, Gharbia M, Oumarou-Mahamane I, Baude J, Thorin C, Lepelletier D, Le Pape P, Eveillard M, Irle M, Pailhoriès H, Aviat F, Belloncle C, Federighi M, Dubreil L. Confocal spectral microscopy, a non-destructive approach to follow contamination and biofilm formation of mCherry Staphylococcus aureus on solid surfaces. Sci Rep 2021; 11:15574. [PMID: 34341378 PMCID: PMC8329050 DOI: 10.1038/s41598-021-94939-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/01/2021] [Indexed: 01/23/2023] Open
Abstract
Methods to test the safety of wood material for hygienically sensitive places are indirect, destructive and limited to incomplete microbial recovery via swabbing, brushing and elution-based techniques. Therefore, we chose mCherry Staphylococcus aureus as a model bacterium for solid and porous surface contamination. Confocal spectral laser microscope (CSLM) was employed to characterize and use the autofluorescence of Sessile oak (Quercus petraea), Douglas fir (Pseudotsuga menziesii) and poplar (Populus euramericana alba L.) wood discs cut into transversal (RT) and tangential (LT) planes. The red fluorescent area occupied by bacteria was differentiated from that of wood, which represented the bacterial quantification, survival and bio-distribution on surfaces from one hour to one week after inoculation. More bacteria were present near the surface on LT face wood as compared to RT and they persisted throughout the study period. Furthermore, this innovative methodology identified that S. aureus formed a dense biofilm on melamine but not on oak wood in similar inoculation and growth conditions. Conclusively, the endogenous fluorescence of materials and the model bacterium permitted direct quantification of surface contamination by using CSLM and it is a promising tool for hygienic safety evaluation.
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Affiliation(s)
| | | | - Julien Pichon
- UMR703 PAnTher APEX, INRAE/ONIRIS - La Chantrerie, 101 Route de Gachet, 44307, Nantes, France
| | | | | | - Jessica Baude
- CIRI, Inserm U1111, Lyon 1 University, ENS Lyon, CNRS UMR 5308, Lyon, France
| | | | | | - Patrice Le Pape
- EA 1155 IICiMed, IRS 2, University of Nantes, 44200, Nantes, France
| | - Matthieu Eveillard
- CRCINA, Inserm, University of Nantes, University of Angers, 44200, Angers, France.,Laboratory of Bacteriology-Hygiene, University Hospital of Angers, 49933, Angers, France
| | - Mark Irle
- LIMBHA, Ecole Supérieure du Bois, 44000, Nantes, France
| | - Hélène Pailhoriès
- Laboratory of Bacteriology-Hygiene, University Hospital of Angers, 49933, Angers, France.,HIFIH, UPRES EA3859, SFR 4208, University of Angers, Angers, France
| | - Florence Aviat
- Your ResearcH-Bio-Scientific, 44430, Le Landreau, France
| | | | | | - Laurence Dubreil
- UMR703 PAnTher APEX, INRAE/ONIRIS - La Chantrerie, 101 Route de Gachet, 44307, Nantes, France.
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20
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Chen See J, Ly T, Shope A, Bess J, Wall A, Komanduri S, Goldman J, Anderson S, McLimans CJ, Brislawn CJ, Tokarev V, Wright JR, Lamendella R. A Metatranscriptomics Survey of Microbial Diversity on Surfaces Post-Intervention of cleanSURFACES® Technology in an Intensive Care Unit. Front Cell Infect Microbiol 2021; 11:705593. [PMID: 34354962 PMCID: PMC8330600 DOI: 10.3389/fcimb.2021.705593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/05/2021] [Indexed: 12/16/2022] Open
Abstract
Hospital-acquired infections (HAIs) pose a serious threat to patients, and hospitals spend billions of dollars each year to reduce and treat these infections. Many HAIs are due to contamination from workers’ hands and contact with high-touch surfaces. Therefore, we set out to test the efficacy of a new preventative technology, AIONX® Antimicrobial Technologies, Inc’s cleanSURFACES®, which is designed to complement daily chemical cleaning events by continuously preventing re-colonization of surfaces. To that end, we swabbed surfaces before (Baseline) and after (Post) application of the cleanSURFACES® at various time points (Day 1, Day 7, Day 14, and Day 28). To circumvent limitations associated with culture-based and 16S rRNA gene amplicon sequencing methodologies, these surface swabs were processed using metatranscriptomic (RNA) analysis to allow for comprehensive taxonomic resolution and the detection of active microorganisms. Overall, there was a significant (P < 0.05) global reduction of microbial diversity in Post-intervention samples. Additionally, Post sample microbial communities clustered together much more closely than Baseline samples based on pairwise distances calculated with the weighted Jaccard distance metric, suggesting a defined shift after product application. This shift was characterized by a general depletion of several microbes among Post samples, with multiple phyla also being reduced over the duration of the study. Notably, specific clinically relevant microbes, including Staphylococcus aureus, Clostridioides difficile and Streptococcus spp., were depleted Post-intervention. Taken together, these findings suggest that chemical cleaning events used jointly with cleanSURFACES® have the potential to reduce colonization of surfaces by a wide variety of microbes, including many clinically relevant pathogens.
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Affiliation(s)
- Jeremy Chen See
- Contamination Source Identification, Huntingdon, PA, United States
| | - Truc Ly
- Contamination Source Identification, Huntingdon, PA, United States
| | - Alexander Shope
- Contamination Source Identification, Huntingdon, PA, United States.,AIONX, Hershey, PA, United States
| | | | - Art Wall
- Nextflex, San Jose, CA, United States
| | | | | | - Samantha Anderson
- Contamination Source Identification, Huntingdon, PA, United States.,Department of Biology, Juniata College, Huntingdon, PA, United States
| | - Christopher J McLimans
- Contamination Source Identification, Huntingdon, PA, United States.,Department of Biology, Juniata College, Huntingdon, PA, United States
| | - Colin J Brislawn
- Contamination Source Identification, Huntingdon, PA, United States
| | - Vasily Tokarev
- Contamination Source Identification, Huntingdon, PA, United States.,Department of Biology, Juniata College, Huntingdon, PA, United States
| | - Justin R Wright
- Contamination Source Identification, Huntingdon, PA, United States
| | - Regina Lamendella
- Contamination Source Identification, Huntingdon, PA, United States.,Department of Biology, Juniata College, Huntingdon, PA, United States
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21
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Ma B, Linden YS, Gundy PM, Gerba CP, Sobsey MD, Linden KG. Inactivation of Coronaviruses and Phage Phi6 from Irradiation across UVC Wavelengths. ENVIRONMENTAL SCIENCE & TECHNOLOGY LETTERS 2021; 8:425-430. [PMID: 37566360 PMCID: PMC7986976 DOI: 10.1021/acs.estlett.1c00178] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 03/10/2021] [Accepted: 03/11/2021] [Indexed: 05/19/2023]
Abstract
Ultraviolet (UV) devices emitting UVC irradiation (200-280 nm) have proven to be effective for virus disinfection, especially on surfaces and in air, due to their rapid effectiveness and limited to no material corrosion. Numerous studies of UV-induced inactivation focused on nonenveloped viruses. Little is known about UVC action on enveloped viruses across UVC wavelengths. In this study, we determined inactivation efficiencies of two coronaviruses (ssRNA) and an enveloped dsRNA bacteriophage surrogate in buffered aqueous solution (pH 7.4) using five commonly available UVC devices that uniquely emit light at different wavelengths spanning 222 nm emitting krypton chloride (KrCl*) excimers to 282 nm emitting UVC LEDs. Our results show that enveloped viruses can be effectively inactivated using UVC devices, among which the KrCl* excimer had the best disinfection performance (i.e., highest inactivation rate) for all three enveloped viruses. The coronaviruses exhibited similar sensitivities to UV irradiation across the UVC range, whereas the bacteriophage surrogate was much more resistant and exhibited significantly higher sensitivity to the Far UVC (<230 nm) irradiation. This study provides necessary information and guidance for using UVC devices for enveloped virus disinfection, which may help control virus transmission in public spaces during the ongoing COVID-19 pandemic and beyond.
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Affiliation(s)
- Ben Ma
- Department of Civil, Environmental,
and Architectural Engineering, University of Colorado
Boulder, 4001 Discovery Dr., Boulder, Colorado
80303, United States
| | - Yarrow S. Linden
- Department of Civil, Environmental,
and Architectural Engineering, University of Colorado
Boulder, 4001 Discovery Dr., Boulder, Colorado
80303, United States
| | - Patricia M. Gundy
- Department of Environmental Science,
University of Arizona, 2959 W. Calle
Agua Nueva, Tucson, Arizona 85745, United
States
| | - Charles P. Gerba
- Department of Environmental Science,
University of Arizona, 2959 W. Calle
Agua Nueva, Tucson, Arizona 85745, United
States
| | - Mark D. Sobsey
- Department of Environmental Science and
Engineering, Gillings School of Public Health, University
of North Carolina, Chapel Hill, North Carolina
27599, United States
| | - Karl G. Linden
- Department of Civil, Environmental,
and Architectural Engineering, University of Colorado
Boulder, 4001 Discovery Dr., Boulder, Colorado
80303, United States
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22
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Ma Y, Wisuthiphaet N, Bolt H, Nitin N, Zhao Q, Wang D, Pourdeyhimi B, Grondin P, Sun G. N-Halamine Polypropylene Nonwoven Fabrics with Rechargeable Antibacterial and Antiviral Functions for Medical Applications. ACS Biomater Sci Eng 2021; 7:2329-2336. [DOI: 10.1021/acsbiomaterials.1c00117] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Yue Ma
- Department of Biological and Agricultural Engineering, University of California, One Shields Ave, Davis, California 95616, United States
| | - Nicharee Wisuthiphaet
- Department of Food Science and Technology, University of California, Davis, California 95616, United States
| | - Hunter Bolt
- Department of Biological and Agricultural Engineering, University of California, One Shields Ave, Davis, California 95616, United States
| | - Nitin Nitin
- Department of Biological and Agricultural Engineering, University of California, One Shields Ave, Davis, California 95616, United States
- Department of Food Science and Technology, University of California, Davis, California 95616, United States
| | - Qinghua Zhao
- Materials Science and Engineering, Wuhan Textile University, Wuhan 430073, China
| | - Dong Wang
- Materials Science and Engineering, Wuhan Textile University, Wuhan 430073, China
| | - Behnam Pourdeyhimi
- The Nonwoven Institute, North Carolina State University, Raleigh, North Carolina 27606, United States
| | - Pierre Grondin
- The Nonwoven Institute, North Carolina State University, Raleigh, North Carolina 27606, United States
| | - Gang Sun
- Department of Biological and Agricultural Engineering, University of California, One Shields Ave, Davis, California 95616, United States
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23
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Balter S, Rodriguez MA, Pike JA, Kleiman NJ. Microbial Contamination Risk and Disinfection of Radiation Protective Garments. HEALTH PHYSICS 2021; 120:123-130. [PMID: 33369969 PMCID: PMC7872069 DOI: 10.1097/hp.0000000000001387] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
ABSTRACT Healthcare-associated infections are a major public health concern for both patients and medical personnel. This has taken on greater urgency during the current COVID-19 pandemic. Radiation Personal Protective Equipment (RPPE) may contribute to risks of microbial contamination. This possibility was tested in 61 personal or shared-use lead aprons and thyroid collars at Columbia Presbyterian Irving Medical Center. Fifty percent tested positive for either bacterial or fungal contamination, mostly around the neckline of lead vests and thyroid collars. Repeated testing of garments some weeks to months later confirmed continued presence of microbial contamination. The possibility that hospital-approved disinfection agents could degrade the radio-protective features of these garments was also examined. Samples of identical construction to garments in regular use were subjected to either daily or weekly wipes with hypochlorite or alcohol-based hospital-approved cleaning agents for 6 mo. A third group of samples was maintained in contact with the cleaning agents for 6 mo. All samples were fluoroscoped four times during the study. None demonstrated any degradation in radioprotection. All samples were photographed monthly. Physical degradation of the outer plastic covering by concentrated hypochlorite and limited mechanical damage around stitched seams of the samples cleaned daily with alcohol was noted. Based on the high prevalence of microbial contamination, regular cleaning and disinfection protocols should be implemented. Regular cleaning with medical-facility-approved cleaning and disinfecting agents is likely to be effective at reducing the microbial load and unlikely to result in significant reduction in radioprotective properties of these garments.
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Affiliation(s)
- Stephen Balter
- Departments of Radiology and Medicine College of Physicians and Surgeons Columbia University, New York, NY 10032
| | - Michelle A. Rodriguez
- City University of New York (CUNY) Graduate School of Public Health and Health Policy New York, NY 10027
| | - Janett A. Pike
- Infection Prevention & Control New York-Presbyterian Hospital New York, NY 10032
| | - Norman J. Kleiman
- Department of Environmental Health Sciences Mailman School of Public Health Columbia University, New York, NY 10032
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24
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Princess I, Vadala R. Clinical Microbiology in the Intensive Care Unit: Time for Intensivists to Rejuvenate this Lost Art. Indian J Crit Care Med 2021; 25:566-574. [PMID: 34177177 PMCID: PMC8196372 DOI: 10.5005/jp-journals-10071-23810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
We live in an era of evolving microbial infections and equally evolving drug resistance among microorganisms. In any healthcare facility, intensivists play the most pivotal role with critically ill patients under their direct care. Majority of the critically ill patients already harbor a microorganism at admission or acquire one in the form of healthcare-associated infections during their course of intensive care unit stay. It is therefore rather imperative for intensivists to possess sound knowledge in clinical microbiology. On a negative note, most clinicians have very meager and remote knowledge acquired during their undergraduate years. This knowledge is rather theoretical than applied and wanes over the years becoming nonbeneficial in intensive patient care. We, therefore, intend to explore important concepts in applied microbiology and infection control that intensivists should know and implement in their clinical practice on a day-to-day basis. How to cite this article: Princess I, Vadala R. Clinical Microbiology in the Intensive Care Unit: Time for Intensivists to Rejuvenate this Lost Art. Indian J Crit Care Med 2021;25(5):566–574.
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Affiliation(s)
- Isabella Princess
- Department of Microbiology, Apollo Speciality Hospitals, Vanagaram Branch, Chennai, Tamil Nadu, India
| | - Rohit Vadala
- Metro Centre for Respiratory Diseases, Metro Multispeciality Hospital, Noida, Uttar Pradesh, India
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25
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Vahedifard F, Chakravarthy K. Nanomedicine for COVID-19: the role of nanotechnology in the treatment and diagnosis of COVID-19. EMERGENT MATERIALS 2021; 4:75-99. [PMID: 33615140 PMCID: PMC7881345 DOI: 10.1007/s42247-021-00168-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 01/19/2021] [Indexed: 05/12/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the recent outbreak of coronavirus 2019 (COVID-19). Although nearly two decades have passed since the emergence of pandemics such as SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV), no effective drug against the CoV family has yet been approved, so there is a need to find newer therapeutic targets. Currently, simultaneous research across the globe is being performed to discover efficient vaccines or drugs, including both conventional therapies used to treat previous similar diseases and emerging therapies like nanomedicine. Nanomedicine has already proven its value through its application drug delivery and nanosensors in other diseases. Nanomedicine and its components can play an important role in various stages of prevention, diagnosis, treatment, vaccination, and research related to COVID-19. Nano-based antimicrobial technology can be integrated into personal equipment for the greater safety of healthcare workers and people. Various nanomaterials such as quantum dots can be used as biosensors to diagnose COVID-19. Nanotechnology offers benefits from the use of nanosystems, such as liposomes, polymeric and lipid nanoparticles, metallic nanoparticles, and micelles, for drug encapsulation, and facilitates the improvement of pharmacological drug properties. Antiviral functions for nanoparticles can target the binding, entry, replication, and budding of COVID-19. The toxicity-related inorganic nanoparticles are one of the limiting factors of its use that should be further investigated and modified. In this review, we are going to discuss nanomedicine options for COVID-19 management, similar applications for related viral diseases, and their gap of knowledge.
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Affiliation(s)
- Farzan Vahedifard
- Altman Clinical and Translational Research Institute, University of California San Diego Health Center, San Diego, CA USA
| | - Krishnan Chakravarthy
- Division of Pain Medicine, Department of Anesthesiology, University of California San Diego Health Center, 9400 Campus Point Dr, La Jolla, San Diego, CA USA
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26
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Vorotnikova NA, Bardin VA, Vorotnikov YA, Kirakci K, Adamenko LS, Alekseev AY, Meyer HJ, Kubát P, Mironov YV, Lang K, Shestopalov MA. Heterogeneous photoactive antimicrobial coatings based on a fluoroplastic doped with an octahedral molybdenum cluster compound. Dalton Trans 2021; 50:8467-8475. [PMID: 34047321 DOI: 10.1039/d1dt01102b] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite the wide variety of strategies developed to combat pathogenic microorganisms, the infectious diseases they cause remain a worldwide health issue. Hence, the search for new disinfectants, which prevent infection spread, constitutes an extremely urgent task. One of the most promising methods is the use of photoactive compounds - photosensitizers, capable of generating reactive oxygen species, in particular, singlet oxygen (O2(1Δg)), which causes rapid and effective death of microorganisms of all types. In this work, we propose the utilization of the powdered cluster complex (Bu4N)2[{Mo6I8}(OTs)6] as a photoactive additive to commercially available fluoroplastic lacquer F-32L to create heterogeneous self-sterilizing coatings. We show that soaking of the prepared films in water for 60 days did not lead to a decrease in their photosensitization properties indicating their excellent stability. Moreover, the use of the cluster complex in the solid state allowed significant expansion of the operating wavelength range, which covers the UV region and a large part of the visible region (250-650 nm). The films displayed high photoantimicrobial activity against five common pathogens (bacteria and fungi) under white-light irradiation. Overall, the properties demonstrated make these materials promising for practical use in everyday outdoor and indoor disinfection since they are active under both sunlight and artificial lighting.
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Affiliation(s)
- Natalya A Vorotnikova
- Nikolaev Institute of Inorganic Chemistry SB RAS, 3 Acad. Lavrentieva, 630090 Novosibirsk, Russia.
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27
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Campos EVR, Pereira AES, de Oliveira JL, Carvalho LB, Guilger-Casagrande M, de Lima R, Fraceto LF. How can nanotechnology help to combat COVID-19? Opportunities and urgent need. J Nanobiotechnology 2020; 18:125. [PMID: 32891146 PMCID: PMC7474329 DOI: 10.1186/s12951-020-00685-4] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 08/28/2020] [Indexed: 12/11/2022] Open
Abstract
Incidents of viral outbreaks have increased at an alarming rate over the past decades. The most recent human coronavirus known as COVID-19 (SARS-CoV-2) has already spread around the world and shown R0 values from 2.2 to 2.68. However, the ratio between mortality and number of infections seems to be lower in this case in comparison to other human coronaviruses (such as severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)). These outbreaks have tested the limits of healthcare systems and have posed serious questions about management using conventional therapies and diagnostic tools. In this regard, the use of nanotechnology offers new opportunities for the development of novel strategies in terms of prevention, diagnosis and treatment of COVID-19 and other viral infections. In this review, we discuss the use of nanotechnology for COVID-19 virus management by the development of nano-based materials, such as disinfectants, personal protective equipment, diagnostic systems and nanocarrier systems, for treatments and vaccine development, as well as the challenges and drawbacks that need addressing.
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Affiliation(s)
- Estefânia V R Campos
- Human and Natural Sciences Center, Federal University of ABC. Av. dos Estados, 5001. Bl. A, T3 Lab. 503-3. Bangú, Santo André, SP, Brazil
| | - Anderson E S Pereira
- São Paulo State University-UNESP, Institute of Science and Technology, Sorocaba, SP, Brazil
| | | | | | | | - Renata de Lima
- Universidade de Sorocaba, Rodovia Raposo Tavares km 92,5, Sorocaba, São Paulo, Brazil.
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28
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Ogunsola FT, Mehtar S. Challenges regarding the control of environmental sources of contamination in healthcare settings in low-and middle-income countries - a narrative review. Antimicrob Resist Infect Control 2020; 9:81. [PMID: 32517810 PMCID: PMC7285732 DOI: 10.1186/s13756-020-00747-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 06/01/2020] [Indexed: 01/18/2023] Open
Abstract
Background Healthcare-associated infections (HAI) especially outbreaks of multi-drug-resistant organisms within hospitals are recognized as a major contributor to morbidity and mortality of hospitalized patients. The healthcare environment can act as an amplifier of HAI during outbreaks. The risk of acquiring HAI are 20 times higher in Low-and-middle-income countries. The purpose of this article is to review the challenges associated with controlling environmental contamination in low and lower-middle income countries (LMIC), highlighting possible solutions. Method This is a narrative review. A literature search was carried out in Google scholar, PubMed, Science Direct, EBSCOHOST, CENGAGE, Scopus, ProQuest, Clinical Key and African journals online using the key words - Health care Associated Infections (HCAIs) in LMICs, Challenges of HAIs in LMIC, Challenges of Prevention and Control of HAIs in LMICs, Environment of care and infection transmission, Contaminated environment and HAIs. Results From the accessed databases, 1872 articles related to environmental sources of contamination in healthcare settings were found. Of these, only 530 articles focused on LMICs. However, only 186 articles met the inclusion criteria studies published in English, conducted between 2000 and 2019 and exploring environmental sources of contamination in LMIC healthcare settings). The sources of environmental contamination in healthcare are numerous and commonly associated with poor governance, Inadequate infrastructure, human capacity and inadequate funding. Low awareness exists at all levels as to the role of the environment in healthcare outcomes and may explain in part the low priority given for funding. Conclusion Leadership and trained personnel, both Infection prevention and control practitioners and cleaners are crucial to drive and sustain the process to reduce environmental contamination in healthcare environments.
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Affiliation(s)
- Folasade T Ogunsola
- College of Medicine, University of Lagos, Ishaga, Lagos, PMB 12003, Nigeria. .,Infection Control Africa Network, Cape Town, South Africa.
| | - Shaheen Mehtar
- Infection Control Africa Network, Cape Town, South Africa.,Stellenbosch University Cape Town, Cape Town, South Africa
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29
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Chopyk J, Akrami K, Bavly T, Shin JH, Schwanemann LK, Ly M, Kalia R, Xu Y, Kelley ST, Malhotra A, Torriani FJ, Sweeney DA, Pride DT. Temporal variations in bacterial community diversity and composition throughout intensive care unit renovations. MICROBIOME 2020; 8:86. [PMID: 32513256 PMCID: PMC7278141 DOI: 10.1186/s40168-020-00852-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/01/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Inanimate surfaces within a hospital serve as a reservoir of microbial life that may colonize patients and ultimately result in healthcare associated infections (HAIs). Critically ill patients in intensive care units (ICUs) are particularly vulnerable to HAIs. Little is known about how the microbiome of the ICU is established or what factors influence its evolution over time. A unique opportunity to bridge the knowledge gap into how the ICU microbiome evolves emerged in our health system, where we were able to characterize microbial communities in an established hospital ICU prior to closing for renovations, during renovations, and then after re-opening. RESULTS We collected swab specimens from ICU bedrails, computer keyboards, and sinks longitudinally at each renovation stage, and analyzed the bacterial compositions on these surfaces by 16S rRNA gene sequencing. Specimens collected before ICU closure had the greatest alpha diversity, while specimens collected after the ICU had been closed for over 300 days had the least. We sampled the ICU during the 45 days after re-opening; however, within that time frame, the alpha diversity never reached pre-closure levels. There were clear and significant differences in microbiota compositions at each renovation stage, which was driven by environmental bacteria after closure and human-associated bacteria after re-opening and before closure. CONCLUSIONS Overall, we identified significant differences in microbiota diversity and community composition at each renovation stage. These data help to decipher the evolution of the microbiome in the most critical part of the hospital and demonstrate the significant impacts that microbiota from patients and staff have on the evolution of ICU surfaces. Video Abstract.
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Affiliation(s)
- Jessica Chopyk
- Department of Pathology, University of California, San Diego, USA
| | - Kevan Akrami
- Department of Medicine, University of California, San Diego, USA
| | - Tovia Bavly
- Department of Pathology, University of California, San Diego, USA
| | - Ji H Shin
- Department of Pathology, University of California, San Diego, USA
| | | | - Melissa Ly
- Department of Pathology, University of California, San Diego, USA
| | - Richa Kalia
- Department of Biology, San Diego State University, San Diego, USA
| | - Ying Xu
- Department of Biology, San Diego State University, San Diego, USA
| | - Scott T Kelley
- Department of Biology, San Diego State University, San Diego, USA
| | - Atul Malhotra
- Department of Medicine, University of California, San Diego, USA
| | | | - Daniel A Sweeney
- Department of Medicine, University of California, San Diego, USA
| | - David T Pride
- Department of Pathology, University of California, San Diego, USA.
- Department of Medicine, University of California, San Diego, USA.
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Naqvi SS, Javed S, Naseem S, Sadiq A, Khan N, Sattar S, Shah NA, Bostan N. G3 and G9 Rotavirus genotypes in waste water circulation from two major metropolitan cities of Pakistan. Sci Rep 2020; 10:8665. [PMID: 32457481 PMCID: PMC7251132 DOI: 10.1038/s41598-020-65583-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 04/02/2020] [Indexed: 11/27/2022] Open
Abstract
Rotavirus A (RVA) is a diarrheal pathogen affecting children under age five, particularly in developing and underdeveloped regions of the world due to malnutrition, poor healthcare and hygienic conditions. Water and food contamination are found to be major sources of diarrheal outbreaks. Pakistan is one of the countries with high RVA related diarrhea burden but with insufficient surveillance system. The aim of this study was to gauge the RVA contamination of major open sewerage collecting streams and household water supplies in two major metropolitan cities of Pakistan. Three concentration methods were compared using RNA purity and concentration as parameters, and detection efficiency of the selected method was estimated. Water samples were collected from 21 sites in Islamabad and Rawalpindi in two phases during the year 2014-2015. Meteorological conditions were recorded for each sampling day and site from Pakistan Meteorological Department (PMD). Nested PCR was used to detect the presence of RVA in samples targeting the VP7 gene. Logistic regression was applied to assess the association of weather conditions with RVA persistence in water bodies. Statistical analysis hinted at a temporal and seasonal pattern of RVA detection in water. Phylogenetic analysis of selected isolates showed a close association of environmental strains with clinical RVA isolates from hospitalized children with acute diarrhea during the same period. This is the first scientific report cataloging the circulating RVA strains in environmental samples from the region. The study highlights the hazards of releasing untreated sewerage containing potentially infectious viral particles into collecting streams, which could become a reservoir of multiple pathogens and a risk to exposed communities. Moreover, routine testing of these water bodies can present an effective surveillance system of circulating viral strains in the population.
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Affiliation(s)
| | - Sundus Javed
- Department of Biosciences, COMSATS University, Islamabad, Pakistan
| | - Saadia Naseem
- Department of Biosciences, COMSATS University, Islamabad, Pakistan
| | - Asma Sadiq
- Department of Biosciences, COMSATS University, Islamabad, Pakistan
| | - Netasha Khan
- Department of Biosciences, COMSATS University, Islamabad, Pakistan
| | - Sadia Sattar
- Department of Biosciences, COMSATS University, Islamabad, Pakistan
| | - Naseer Ali Shah
- Department of Biosciences, COMSATS University, Islamabad, Pakistan
| | - Nazish Bostan
- Department of Biosciences, COMSATS University, Islamabad, Pakistan.
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Shajahan A, Culp CH, Williamson B. Effects of indoor environmental parameters related to building heating, ventilation, and air conditioning systems on patients' medical outcomes: A review of scientific research on hospital buildings. INDOOR AIR 2019; 29:161-176. [PMID: 30588679 PMCID: PMC7165615 DOI: 10.1111/ina.12531] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 12/10/2018] [Accepted: 12/21/2018] [Indexed: 05/04/2023]
Abstract
The indoor environment of a mechanically ventilated hospital building controls infection rates as well as influences patients' healing processes and overall medical outcomes. This review covers the scientific research that has assessed patients' medical outcomes concerning at least one indoor environmental parameter related to building heating, ventilation, and air conditioning (HVAC) systems, such as indoor air temperature, relative humidity, and indoor air ventilation parameters. Research related to the naturally ventilated hospital buildings was outside the scope of this review article. After 1998, a total of 899 papers were identified that fit the inclusion criteria of this study. Of these, 176 papers have been included in this review to understand the relationship between the health outcomes of a patient and the indoor environment of a mechanically ventilated hospital building. The purpose of this literature review was to summarize how indoor environmental parameters related to mechanical ventilation systems of a hospital building are impacting patients. This review suggests that there is a need for future interdisciplinary collaborative research to quantify the optimum range for HVAC parameters considering airborne exposures and patients' positive medical outcomes.
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Affiliation(s)
- Amreen Shajahan
- Energy Systems LaboratoryTexas A&M UniversityCollege StationTexas
- Department of ArchitectureTexas A&M UniversityCollege StationTexas
| | - Charles H. Culp
- Energy Systems LaboratoryTexas A&M UniversityCollege StationTexas
- Department of ArchitectureTexas A&M UniversityCollege StationTexas
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32
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Pastorino B, de Lamballerie X, Charrel R. Biosafety and Biosecurity in European Containment Level 3 Laboratories: Focus on French Recent Progress and Essential Requirements. Front Public Health 2017; 5:121. [PMID: 28620600 PMCID: PMC5449436 DOI: 10.3389/fpubh.2017.00121] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 05/08/2017] [Indexed: 11/18/2022] Open
Abstract
Even if European Union (EU) Member States are obliged to implement EU Directives 2000/54/EC on the protection of workers from risks related to exposure to biological agents at work, national biosafety regulations and practices varied from country to country. In fact, EU legislation on biological agents and genetically modified microorganisms is often not specific enough to ensure harmonization leading to difficulties in implementation for most laboratories. In the same way, biosecurity is a relatively new concept and a few EU Member States are known to have introduced national laboratory biosecurity legislation. In France, recent regulations have reinforced biosafety/biosecurity in containment level 3 (CL-3) laboratories but they concern a specific list of pathogens with no correlation in other European Members States. The objective of this review was to summarize European biosafety/biosecurity measures concerning CL-3 facilities focusing on French specificities. Essential requirements needed to preserve efficient biosafety measures when manipulating risk group 3 biological agents are highlighted. In addition, International, European and French standards related to containment laboratory planning, operation or biosafety equipment are described to clarify optimal biosafety and biosecurity requirements.
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Affiliation(s)
- Boris Pastorino
- UMR “Emergence des Pathologies Virales” (EPV: Aix-Marseille Univ – IRD 190 – Inserm 1207 – EHESP – IHU Méditerranée Infection), Marseille, France
- UMR 190 “Emergence des Pathologies Virales”, Virology, 19-21 bd jean moulin faculté de medecine de la timone, Institut hospitalo-universitaire Méditerranée infection, APHM Public Hospitals of Marseille, Marseille, France
| | - Xavier de Lamballerie
- UMR “Emergence des Pathologies Virales” (EPV: Aix-Marseille Univ – IRD 190 – Inserm 1207 – EHESP – IHU Méditerranée Infection), Marseille, France
- UMR 190 “Emergence des Pathologies Virales”, Virology, 19-21 bd jean moulin faculté de medecine de la timone, Institut hospitalo-universitaire Méditerranée infection, APHM Public Hospitals of Marseille, Marseille, France
| | - Rémi Charrel
- UMR “Emergence des Pathologies Virales” (EPV: Aix-Marseille Univ – IRD 190 – Inserm 1207 – EHESP – IHU Méditerranée Infection), Marseille, France
- UMR 190 “Emergence des Pathologies Virales”, Virology, 19-21 bd jean moulin faculté de medecine de la timone, Institut hospitalo-universitaire Méditerranée infection, APHM Public Hospitals of Marseille, Marseille, France
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Hopkins P, Patel S. Beware the Trojan Horse - a timely reality check about re-using single-use devices. Anaesthesia 2016; 72:8-12. [PMID: 27748514 DOI: 10.1111/anae.13523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- P Hopkins
- King's Critical Care, King's College Hospital, London, UK
| | - S Patel
- King's Critical Care, King's College Hospital, London, UK
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