Bacterial contamination of fabric and metal-bead identity card lanyards: A cross-sectional study

Symbols and rituals are alive and well in clinical practice in Australia: Perspectives from a longitudinal qualitative professional identity study

PURPOSE

Many factors impact an individual's professional identity on their journey to becoming a doctor, including their experiences, the learning environment, role models, and symbols and rituals. Rituals and symbols associated with the medical profession have historically included wearing a white coat (now rare) and the stethoscope. This study explored two medical students' perspectives of symbolic identifiers in a six-year longitudinal study in Australia (2012-2017).

METHODOLOGY

A 2012 qualitative cross-sectional qualitative professional identity study in an Australian five-year undergraduate medical programme was extended to a longitudinal study with annual interviews. A conversation about the symbolism of the stethoscope and other identifiers began in Year 1 and concluded when the students were junior doctors.

FINDINGS

Symbols and rituals remain part of the 'becoming' and 'being' a doctor. In the context of Australian hospitals, the stethoscope appears to no longer be exclusively associated with the medical profession, with 'professional attire' distinguishing medical students and doctors from other team members (uniform). The study identified lanyard colour and design as a symbol and language as a ritual.

CONCLUSIONS

Although symbols and rituals may change over time and across cultural contexts, some forms of treasured material possessions and rituals will persist in medical practice.[Box: see text].

Evaluation of a Domestic Steam Disinfector-Dryer Device for Disinfection of Health Care Workers' Identification Lanyards

BACKGROUND

Fabric lanyards are commonly worn by health care workers (HCWs) and are known to harbor infectious organisms and contribute to the transmission of infection to HCWs and patients. A diverse range of nosocomial pathogens have been found on lanyards, but there are very few studies describing how to successfully disinfect lanyards to break the chain of transmission. Recently, a steam disinfector-dryer device has come on the market, which performs rapid disinfection against nosocomial pathogens and also dries the contents of the device. It was the aim of this study to evaluate steam disinfection-drying as a method to eliminate pathogens from lanyards.

METHODS

Thirty-eight strips of new, unused, and autoclaved polyester neck lanyards (4 × 2 cm) were inoculated with 30 (12 Gram-positive + 18 Gram-negative) bacteria and one yeast organism. The inoculated lanyard fabric (five organisms per lanyard strip) was placed into a steam disinfector-dryer device and disinfected for 5 minutes and dried for 30 minutes, in accordance with the manufacturer's instructions. Following disinfection and drying, the presence of viable organisms on lanyard fabric was evaluated using enhanced microbiological broth culture methods for 48 hours. Control lanyard strips were treated with organisms and left at room temperature without undergoing disinfection and drying procedures.

FINDINGS

Steam disinfection-drying eradicated all test organisms from treated lanyards, with no culturable organisms detected following disinfection-drying, even when employing enhanced bacteriological culture conditions. All test organisms remained viable on the control lanyards.

CONCLUSION/APPLICATION TO PRACTICE

Steam disinfection-drying offers a simple method of decontaminating lanyards, producing dry lanyards for immediate reuse. Occupational health practitioners and hospitals should consider assessing the feasibility of adopting this method in their settings to aid in breaking the chain of transmission of nosocomial pathogens via contaminated lanyards.

Cloth Lanyards as a Source of Intermittent Transmission of Candida auris on an ICU

OBJECTIVES

Candida auris has been implicated in ICU outbreaks worldwide and is notable for being difficult to identify and treat, its resilience in the environment, and significant patient mortality associated with invasive disease. Here, we describe a small C. auris outbreak and how it was terminated.

DESIGN

Single-center, observational.

SETTING

Two general adult ICUs at an urban U.K. teaching hospital.

PATIENTS

All patients positive for C. auris during the 5-month outbreak were included (n = 7).

INTERVENTIONS

Stepwise implementation of enhanced infection prevention and control precautions was introduced including twice-weekly screening, contact tracing, isolation precautions, and environmental decontamination. A detailed environmental screen was performed to identify potential reservoirs. This included the patient bed space and clinical equipment and a frequently handled cloth lanyard attached to a key used to access controlled drugs. Personal possessions such as mobile phones, lanyards, and identification badges were also screened.

MEASUREMENTS AND MAIN RESULTS

The index case and six linked acquisitions were identified. Four of six (67%) patients were identified after discharge of all known previous C. auris cases from ICU, highlighting potential for an environmental reservoir. Environmental screening identified C. auris from a patient bed space following deep cleaning, prompting review and enhancement of cleaning procedures. The controlled drug cloth lanyard was positive for C. auris, which prompted removal and culture of all staff lanyards. C. auris was identified on 1/100 staff lanyards (1%). No mobile phones or identification badges were positive for C. auris. The outbreak terminated following withdrawal of lanyards from ICU.

CONCLUSIONS

This outbreak further implicates environmental reservoirs as sustaining C. auris ICU outbreaks. Identification of C. auris on cloth lanyards highlights the need to identify commonly handled moveable objects during an outbreak. We suggest that ICUs with a C. auris outbreak should investigate similar infrequently cleaned items as potential reservoirs and review their policies on lanyard use.

Recommendations for approaches to meticillin-resistant staphylococcal infections of small animals: diagnosis, therapeutic considerations and preventative measures.: Clinical Consensus Guidelines of the World Association for Veterinary Dermatology

BACKGROUND

Multiple drug resistance (MDR) in staphylococci, including resistance to the semi-synthetic penicillinase-resistant penicillins such as meticillin, is a problem of global proportions that presents serious challenges to the successful treatment of staphylococcal infections of companion animals.

OBJECTIVES

The objective of this document is to provide harmonized recommendations for the diagnosis, prevention and treatment of meticillin-resistant staphylococcal infections in dogs and cats.

METHODS

The authors served as a Guideline Panel (GP) and reviewed the literature available prior to September 2016. The GP prepared a detailed literature review and made recommendations on selected topics. The World Association of Veterinary Dermatology (WAVD) provided guidance and oversight for this process. A draft of the document was presented at the 8th World Congress of Veterinary Dermatology (May 2016) and was then made available via the World Wide Web to the member organizations of the WAVD for a period of three months. Comments were solicited and posted to the GP electronically. Responses were incorporated by the GP into the final document.

CONCLUSIONS

Adherence to guidelines for the diagnosis, laboratory reporting, judicious therapy (including restriction of use policies for certain antimicrobial drugs), personal hygiene, and environmental cleaning and disinfection may help to mitigate the progressive development and dissemination of MDR staphylococci.

Identification badge lanyards as infection control risk: a cross-sectional observation study with epidemiological analysis

Staphylococcus aureus cultures from name badge lanyards were phenotypically and genotypically indistinguishable from the wearer's nasal carrier strains by pulsed-field gel electrophoresis and antibiogram. Lanyards had a mean age of 22 months and hygiene was poor with only 9% ever having been laundered. Molecular analysis showed that 26% of S. aureus nasal carriers shared an indistinguishable strain on their lanyard. Lanyards should not be recommended for staff in frontline clinical care.