Person to person droplets transmission characteristics in unidirectional ventilated protective isolation room: The impact of initial droplet size

Person to person droplets/particles or contaminant cross transmission is an important issue in ventilated environment, especially in the unidirectional ventilated protective isolation room (UVPIR) where the patient's immune system is extremely low and easily infected. We simulated the dispersion process of the droplets with initial diameter of 100 μm, 10 μm and gaseous contaminant in unidirectional ventilated protective isolation room and studied the droplets dispersion and cross transmission with different sizes. The droplets with initial size of 100 μm settle out of the coughing jet quickly after coming out from mouth and cannot be carried by the coughing jet to the human thermal plume affecting (HTPA) zone of the susceptible manikin. Hence, the larger droplets disperse mainly in the HTPA zone of the source manikin, and the droplets cross transmission between source manikin and susceptible manikin is very small. The droplets with initial size of 10 μm and gaseous contaminant have similar dispersion but different removal process in the UVPIR. Part of the droplets with initial size of 10 μm and gaseous contaminant that are carried by the higher velocity coughing airflow can enter the HTPA zone of the susceptible manikin and disperse around it. The other part cannot spread to the susceptible manikin's HTPA zone and mainly spread in the source manikin's HTPA zone. The results from this study would be useful for UVPIR usage and operation in order to minimize the risk of cross infection.

A practical approach to investigating nosocomial acquisition of Aspergillus

Invasive mould disease (IMD) has a high mortality in immunosuppressed patients. Invasive aspergillosis (IA) is the most common IMD. A guideline for preventing IA has been published jointly by the Centers for Disease Control and Prevention, the Infectious Disease Society of America, and the American Society of Blood and Marrow Transplantation. Use of high-efficiency particulate air filters, adequate air exchange rates, sealing of patient rooms, and preventing exposure to moulds by nursing patients in areas away from construction sites are recommended by the guideline. However, there is limited information in relation to the actions to be undertaken by infection prevention and control teams in the event of one or more cases of nosocomial aspergillosis. In this review, we describe a systematic approach to aspergillosis by defining possible and probable nosocomial acquisition based on the number of days since hospital admission. We advocate an incremental response to the investigation of nosocomial aspergillosis in patients in protective isolation taking into account the number of cases and the likelihood of nosocomial origin. For single cases of nosocomial IA, we suggest that infection control investigations should focus on case surveillance and walk-through inspection escalating in a stepwise manner to enhanced case surveillance, verification of environmental controls, environmental monitoring, genotyping of clinical and environmental isolates, and review of antifungal prophylaxis for multiple cases and outbreaks. Where applicable, the construction site should be inspected with the aim to reduce the dispersal of conidia. Surveillance systems need to be strengthened to better understand the epidemiology of IA.

Psychosocial interventions with art and music during stem cell transplantation: An integrative review

OBJECTIVES

The objective of this study is to systematically review the literature with the following aims: to survey the art and music interventions offered to the stem cell transplant population; to define the interventions' beneficial properties by conceptualising themes; to analyse these themes using behavioural activation principles as a lens and explore their value in alleviating isolation-related distress.

BACKGROUND

Patients undergoing stem cell transplant are at great risk of psychological morbidity, partly on account of prolonged hospital stays in protective isolation. This risk extends beyond discharge and into ambulatory care, negatively affecting quality-of-life and survival rates of the transplant recipients.

DESIGN

Integrative review methodology.

METHODS

A systematic search of 10 bibliographic databases was undertaken using terms relating to art, music and stem cell transplantation for the years 2012 to 2019. Records were assessed for quality and risk-of-bias using a critical appraisal tool and following the PRISMA Systematic Review checklist to guide reporting. Studies were analysed narratively and thematically.

RESULTS

The 16 papers were of mixed quality. Findings and treatment effects differed between and within studies. The beneficial attributes of the treatments were clustered and divided into two groups. The first consisted of intrinsic, patient-focussed factors: (1) Creative outlet or acquisition of a new skill; (2) achievement of normality; (3) mutual or peer-support; (4) relationship-building and (5) meaningful recreation, distraction and diversion. The second group considered extrinsic factors: (6) Improved communication; (7) enhanced spiritual care and (8) better healthcare experience.

CONCLUSIONS

Several art and music interventions have been attempted which were beneficial to patients and generated a sense of achievement, connection and enjoyment. The interventions appear to uphold the principles of person-centred holistic care and have potential to generate a high-quality, supportive healthcare and working environment.

RELEVANCE TO CLINICAL PRACTICE

Psychosocial interventions with art and music have improved the care and experience of patients undergoing stem cell transplant.