Implementation of the Infection Risk Scan (IRIS) in nine hospitals in the Belgian-Dutch border region (i-4-1-Health project)

Background

A tool, the Infection Risk Scan has been developed to measure the quality of infection control and antimicrobial use. This tool measures various patient-, ward- and care-related variables in a standardized way. We describe the implementation of this tool in nine hospitals in the Dutch/Belgian border area and the obtained results.

Methods

The IRIS consists of a set of objective and reproducible measurements: patient comorbidities, (appropriate) use of indwelling medical devices, (appropriate) use of antimicrobial therapy, rectal carriage of Extended-spectrum beta-lactamase producing Enterobacterales and their clonal relatedness, environmental contamination, hand hygiene performance, personal hygiene of health care workers and presence of infection prevention preconditions. The Infection Risk Scan was implemented by an expert team. In each setting, local infection control practitioners were trained to achieve a standardized implementation of the tool and an unambiguous assessment of data.

Results

The IRIS was implemented in 34 wards in six Dutch and three Belgian hospitals. The tool provided ward specific results and revealed differences between wards and countries. There were significant differences in the prevalence of ESBL-E carriage between countries (Belgium: 15% versus The Netherlands: 9.6%), environmental contamination (median adenosine triphosphate (ATP) level Belgium: 431 versus median ATP level The Netherlands: 793) and calculated hand hygiene actions based on alcohol based handrub consumption (Belgium: 12.5/day versus The Netherlands: 6.3/day) were found.

Conclusion

The Infection risk Scan was successfully implemented in multiple hospitals in a large cross-border project and provided data that made the quality of infection control and antimicrobial use more transparent. The observed differences provide potential targets for improvement of the quality of care.

Feedback of ATP measurement as a tool for reducing environmental contamination in hospitals in the Dutch/Belgian border area

DESIGN

A two-phase prospective intervention study.

OBJECTIVE

The objective of this study was to determine if feedback of adenosine triphosphate (ATP) measurements decreases environmental contamination within hospitals in the Dutch/Belgian border area.

METHODS

Standardized ATP measurements were conducted in nine hospitals on pre-defined fomites. Four different fomite groups were defined: medical devices, patient-bound materials, ward-bound materials and sanitary items. ATP results were reported in relative light unit (RLU), RLU >1000 was considered as 'not clean.' Two rounds of ATP measurements were conducted. After the first round of ATP measurements, results were provided to the wards and cleaning staff. The second round of ATP measurements was performed one year later. The amount of surface contamination before and after the feedback was compared.

RESULTS

In total 1923 ATP measurements were performed. Before feedback 960 ATP measurements were conducted and after feedback 963 were conducted. The overall median reduction in RLU was 381 (P < 0.001), from 568 before feedback to 187 afterward. In each hospital there was a reduction of the median RLU after feedback.

CONCLUSIONS

Substantial reductions in RLU values were found after feedback of ATP measurements. Feedback of ATP measurement in itself was associated with a major reduction of surface contamination in hospitals.

ATP measurement as an objective method to measure environmental contamination in 9 hospitals in the Dutch/Belgian border area

Background

The objective of this study was to determine the level of environmental contamination in hospitals in the Dutch/Belgian border area, using ATP measurements.

Design

A cross-sectional observational survey.

Methods

Standardized ATP measurements were conducted in 9 hospitals on 32 hospital wards. Thirty pre-defined surfaces per hospital ward were measured with the 3 M Clean Trace NG luminometer. Results are displayed in relative light units (RLU). RLU > 1000 was considered as “not clean.” Differences in RLU values were compared between countries, hospitals, fomite groups and medical specialties.

Results

A total of 960 ATP measurements were performed, ranging from 60 up to 120 per hospital. The median RLU-value was 568 (range: 3–277,586) and 37.7% of the measurements were rated as not clean (RLU > 1000). There were significant differences between countries, hospitals and fomite groups.

Conclusion

ATP measurements can be used as a more objective approach to determine the level of environmental contamination in hospitals. Significant differences in ATP levels were found between hospitals and between countries. Also, substantial differences were found between different fomite groups. These findings offer potential targets for improvement of cleanliness in healthcare facilities.

Antimicrobial activity of metal oxide microspheres: an innovative process for homogeneous incorporation into materials

AIMS

To investigate the potent control of microbial surface contamination of an innovative process which consists in incorporating metal oxide microspheres homogeneously into materials.

METHODS AND RESULTS

Spherical microspheres containing zinc and magnesium oxides synthesized via a one-step manufacturing process (Pyrolyse Pulvérisée^® ) and incorporated into different plastic matrices were evaluated for their antimicrobial activity according to JIS Z 2801 standard. A significant activity was observed for microsphere-added polyethylene coupons with a reduction of all tested bacteria populations, including Gram negative and Gram positive even expressing acquired antibiotic resistance (Escherichia coli ESBL, Staphylococcus aureus metiR). An antiviral activity higher than 2 log of reduction was also observed on H1N1 and HSV-1 viruses. This antimicrobial effect was dose-dependent and time-dependent for both polyethylene and polypropylene matrices. Antimicrobial activity was maintained after exposition to disinfectants and totally preserved 50 months after the preparation of the coupons.

CONCLUSIONS

Incorporated into plastic matrices, metal oxide microspheres showed significant antibacterial and antiviral activities.

SIGNIFICANCE AND IMPACT OF STUDY

This is, to our knowledge, the first report on an original process incorporating metal oxide microspheres, which have specific physico-chemical and antimicrobial properties, into materials that could be used for surface contamination prevention.

Non-leachable highly luminescent ordered mesoporous SiO2 spherical particles

Ordered mesoporous highly luminescent SiO2 particles have been synthesized by spray pyrolysis from solutions containing tetraethylorthosilicate (TEOS) and either cetyltrimethylammonium bromide (CTAB) or the block copolymer Pluronic F-68 as structure-directing agents. Rhodamine B (RhB)-containing samples were prepared by using a simple wet impregnation method followed by the growing of a second silica shell in order to prevent leaching of the dye. The obtained materials were characterized by scanning electron microscopy (SEM), transmission electron microscopy (TEM), powder x-ray diffraction (XRD), ultraviolet-visible spectroscopy (UV-vis) and photoluminescence (PL). Powders with polydisperse spherical grains were obtained displaying an ordered hexagonal array of mesochannels. Luminescence results reveal that RhB molecules have been successfully encapsulated into the channels of mesoporous particles as monomeric species and that a well-defined silica coating hindered dye leaching.

Force and stiffness of the pelvic floor as function of muscle length: A comparison between women with and without stress urinary incontinence

AIMS

To compare passive and active mechanical properties in the pelvic floor as a function of tissue length in continent and incontinent parous women.

MATERIALS AND METHODS

Twenty-four parous continent and 21 parous incontinent women were examined with an intravaginal device. Passive and active force/stiffness were measured by increasing the transverse diameter of the vagina. To allow a more accurate comparison between groups, measured forces were normalized with respect to bodyweight, that is, force/bodyweight.

RESULTS

In both groups passive and active forces increased as a function of the increase in length of the pelvic floor tissues. No difference was found between the groups according to passive forces (P = 0.646), but active force was significantly higher (P = 0.030) in the continent group when normalized for bodyweight. There was an almost linear increase in normalized passive stiffness in the range tested. No differences were found between the groups (P = 0.855). Normalized active stiffness was significantly reduced in the incontinent group (P = 0.021).

CONCLUSIONS

This study indicates that both active force development and active stiffness in the pelvic floor tissues are significantly reduced in incontinent women, whereas the passive resting mechanical forces in the pelvic floor tissues in both groups are not different.

Force-length relationship in the pelvic floor muscles under transverse vaginal distension: a method study in healthy women

AIMS

The purpose of this study was to investigate whether there is a relationship between changes in the diameter of the urogenital hiatus and force developed in pelvic floor musculature. In addition, we wanted to examine the reliability of the method that measures force development in the pelvic floor in the transverse direction of the urogenital hiatus.

MATERIALS AND METHODS

Passive and total force in the pelvic floor was measured with an intra-vaginal device in 20 healthy parous volunteers. The measurements were done with a consecutively increasing diameter in the transverse plane of the urogenital hiatus. The procedure was repeated with a few days interval.

RESULTS

The measurements show an increase in force with an increasing device-diameter. The results are reliable at all the diameters tested, estimated by the within-subject day-to-day variability which was non-significant. The 40 mm diameter device is most favourable, estimated by Bland Altman plots of the test-retest measurements.

CONCLUSIONS

Force development in pelvic floor muscles increased as a function of vaginal diameter when measured in the frontal plane. The measurements were reliable at all the different diameters chosen.

Are fatigue and disturbances in pre-programmed activity of pelvic floor muscles associated with female stress urinary incontinence?

AIMS

To investigate whether there is a difference between a continent versus a stress urinary incontinent group of women regarding: (i) fatigue in pelvic floor muscles, and (ii) pre-activation times between pelvic floor and abdominal muscles during coughing.

METHODS

Twenty-six continent and 20 stress urinary incontinent parous women were examined. Fatigue was measured with an intravaginal device. Time to 10% decline of the initial reference force (RF) was defined as time-to-fatigue. Simultaneous recordings of force developed in levator ani muscle and electromyographic activity in the external oblique abdominal muscle were performed to determine whether contraction of pelvic floor muscles precedes activity in abdominal muscles during coughing.

RESULTS

Time-to-fatigue was identical in the two groups (10.5 sec in the continent and 11.5 sec in the incontinent group, median values). Normalized force was significantly reduced in the incontinent group. The pelvic floor muscles contracted 160 msec before the abdominal muscles in both groups. In 24% of the continent and in 30% of the incontinent women, however, abdominal muscle activity preceded activity of pelvic floor muscles.

CONCLUSIONS

Muscular fatigue, defined as rate of force loss, does not seem to be associated with urinary stress incontinence. Moreover, muscular activity recruitment patterns were equal in both groups suggesting that other factors than disturbances of ordered muscle recruitment, that is, pelvic floor followed by abdominal muscles, may be responsible for stress urinary incontinence. It is likely that reduced normalized force, as found in the incontinent group, is an important contributing factor.

Computerised morphometric study of the paraurethral tissue in young and elderly women

AIM

Changes in structural support of the urethra and bladder neck have been proposed to be among the most important factors in the pathogenesis of stress urinary incontinence. In this context, we histologically investigated the paraurethral area in continent women to quantify the relative distribution of connective tissue, smooth muscle, vessels, nerves, and striated muscle. Previously published literature gives only descriptive evaluations of the relative distribution of these tissue components.

METHODS

We used a computerised morphometric method, which allowed us to estimate the paraurethral tissue distribution in a more objective way. The material was obtained by dissection during autopsy in five premenopausal and five postmenopausal women.

RESULTS

Paraurethral tissue consisted of 56% connective tissue (SD, 5%), 30% smooth muscle (SD, 5%), 11% blood vessel (SD, 6%), 2% striated muscle (SD, 3%), and 1% nerves (SD, 1%). We also found that the distribution of different tissue components along the length of the urethra did not differ at a statistically significant level. Furthermore, there was a statistically significant difference in the amount of connective tissue and blood vessels in the postmenopausal women compared with the premenopausal women.

CONCLUSIONS

The present study shows that the paraurethral area is built of heterogeneous tissue with small changes in its composition along the course of urethra. Increase in connective tissue was found to be the dominating change in the process of ageing.

Structural and photomagnetic studies of two compounds in the system Cu(2+)/Mo(CN8)(4-): from trinuclear molecule to infinite network

The syntheses and structural and physical characterization of the compounds [Cu(bipy)(2)](2)[Mo(CN)(8)].5H(2)O. CH(3)OH (1) with bipy = 2,2'-bipyridine and M(II)(2)[Mo(IV)(CN)(8)].xH(2)O (2 with M = Cu, x = 7.5; 3 with M = Mn, x = 9.5) are presented. 1 crystallizes in the triclinic space group P1; (a = 11.3006(4) A, b = 12.0886(5) A, c = 22.9589(9) A, alpha = 81.799(2) degrees, beta = 79.787(2) degrees, gamma = 62.873(2) degrees, Z = 2). The structure of 1 consists of neutral trinuclear molecules in which a central [Mo(CN8)](4-) anion is linked to two [Cu(bipy)2](2+) cations through two cyanide bridges. 2 crystallizes poorly, and hence, structural information has been obtained from the wide-angle X-ray scattering (WAXS) technique, by comparison with 3 and Fe(II)(2)(H(2)O)(4)[Mo(IV)(CN)(8)].4H(2)O whose X-ray structure has been previously solved. 2, 3, and Fe(II)(2)(H(2)O)(4)[Mo(IV)(CN)(8)].4H(2)O form extended networks with all the cyano groups acting as bridges. The magnetic properties have shown that 1 and 2 behave as paramagnets. Under irradiation with light, they exhibit important modifications of their magnetic properties, with the appearance at low temperature of magnetic interactions. For 1 the modifications are irreversible, whereas they are reversible for 2 after cycling in temperature. These photomagnetic effects are thought to be caused by the conversion of Mo(IV) (diamagnetic) to Mo(V)(paramagnetic) through a photooxidation mechanism for 1 and a photoinduced electron transfer in 2. These results have been correlated with the structural features.

Usefulness of urodynamic examination in female urinary incontinence--lessons from a population-based, randomized, controlled study of conservative treatment

OBJECTIVE

To test the usefulness of urodynamic examination in female urinary incontinence.

MATERIAL AND METHODS

As part of a population-based, randomized, controlled treatment study in general practice, the control group was offered urodynamic examination before and after delayed treatment starting 6 months after inclusion in the study, i.e. after the first outcome evaluation comparing the initially treated group with the control group. The intervention group was offered urodynamic examination only after the final outcome evaluation at 12 months. Eighty-seven women, aged 50-74, from three Norwegian municipalities participated.

RESULTS

There was no difference in treatment outcome whether the patients had urodynamic examination or not. Eleven patients (26% of 42 control patients) had their diagnosis revised after urodynamic examination, ten of them with a subsequent change in treatment. The outcome for this group was no different than for the other patients. As a subgroup, the 11 patients had more severe leakage (p = 0.048) and more previous gynecological operations (p = 0.038) than the other control group patients.

CONCLUSIONS

Our study supports the idea that in general practice, or in rather unselected patients, women with urinary incontinence may be classified and treated without urodynamic examination. If there is little or no improvement during the first few months referral should be considered, and this should be done sooner for patients with severe incontinence or prior gynecological operations than for other patients.

[A new minimally invasive surgical method for stress incontinence in women]

Present surgical methods in the treatment of female urinary incontinence require relatively extensive surgery and several days in hospital. 84 consecutive patients (age 34-78 years) with proven stress incontinence were operated with the new tension-free vaginal tape procedure (TVT) and studied prospectively from November 1996 to August 1998. The operation was carried out under local anaesthesia, a procedure which allows the surgeon to check during the operation that continence is achieved. 52 patients (62%) were discharged from the hospital the same day. After four months, 79 out of 82 patients (96%) were cured or had improved considerably. No serious complications occurred. Four patients experienced various degrees of retention. The tension-free vaginal tape method seems to be an effective minimal invasive surgical procedure for the treatment of female stress incontinence. However, randomized controlled studies and long term follow-up are needed for a more complete evaluation of its merits versus the Burch colposuspension which is considered the "gold standard".

A population based, randomized, controlled trial of conservative treatment for urinary incontinence in women

BACKGROUND

Urinary incontinence remains a hidden and inadequately treated problem in a high proportion of women.

METHODS

Ninety women 50-74 years of age were recruited to a population-based, randomized, controlled clinical trial of conservative treatment for urinary incontinence, with delayed treatment for the control group. The study was performed in general practice in three north-Norwegian municipalities, in cooperation with two local departments of gynecology. Three patients were found protocol deviant and analysis was based on 87 patients.

INTERVENTION

Local estrogen, physiotherapy and electrostimulation combined with close follow-up.

MAIN OUTCOME MEASURES

1. Change in severity of incontinence from start of treatment (index range 0-8). 2. Change in impact from start of treatment (index range 0-4). 3. Quantitative measures in relation to micturition. 4. Criteria based classification into cured, improved, unchanged, worse.

RESULTS

Treatment reduced severity (index change 1.8 in the intervention group vs. 0.1 in the control group at six months) and impact (index change 0.8 vs. 0.0) of leakage. Almost one third of the patients did not complete all micturition tests, but in those who did, average number of wet episodes per 24 hours decreased with treatment, and so did average number of micturitions in urge and mixed incontinence. Forty-nine patients (56%) were cured or improved after one year.

CONCLUSION

Women 50 to 74 years of age with urinary incontinence may improve considerably through conservative treatment in general practice.