scholarly journals 799. A Pseudo-Outbreak of Pseudomonas fluorescens Infections

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S494-S495
Author(s):  
Tariq Jaber ◽  
Vikram Saini ◽  
Laura Morris ◽  
James D Como ◽  
Nitin Bhanot ◽  
...  
Keyword(s):  
Pseudomonas Fluorescens ◽  
Operating Room ◽  
Normal Saline ◽  
Laboratory Data ◽  
Retrospective Chart Review ◽  
Team Approach ◽  
Operating Room Personnel ◽  
Sterile Normal Saline ◽  
Specimen Processing ◽  
Tissue Specimens

Abstract Background Pseudomonas fluorescens is a water-borne pathogen that has been associated with outbreaks from transfusion of contaminated blood products or medical equipment. Our institution had a cluster of cultures that grew an uncommonly encountered microbe P. fluorescens within a period of one week. This prompted an internal investigation. We summarize the investigational process that led to the resolution of this pseudo-outbreak. Methods We conducted a retrospective chart review of surgical and non-surgical patients with cultures positive for P. fluorescens from July 2nd to July 8th 2020. Baseline patient characteristics, clinical course, laboratory data, use of blood-associated products, and microbiology cultures were analyzed. Results Eight patients were identified with positive tissue cultures for P. fluorescens. Among those, 5 specimens (62.5%) were from osteoarticular sites (1 prosthetic hip, 1 prosthetic knee, 1 right foot, 1 sternum, and 1 vertebral source). One culture (12.5%) was obtained from a sacral soft tissue wound. Two tissue specimens (25%) were collected from respiratory sites (1 lung tissue and 1 bronchoalveolar lavage). No association with specific surgical personnel or operating room was identified. During routine specimen processing, a small amount of sterile normal saline is added to the conical grinder prior to culture preparation. It was discovered that a non-sterile normal saline had been inadvertently utilized during that step. These eight tissue specimens were subsequently reprocessed with sterile solution; P. fluorescens was not re-isolated. Specimen processing protocols were reinforced. Adjustment of antimicrobial therapy was made accordingly without reported subsequent adverse clinical outcomes. Conclusion A multi-faceted team approach in collaboration with Infection Prevention, Infectious Diseases, Surgery, operating room personnel, and Microbiology identified an unintended breakdown in sterile laboratory protocols which resulted in a cluster of falsely positive cultures. An increased incidence of infection with an uncommon pathogen initiated a prompt investigation that resulted in the identification of a pseudo-outbreak event. Disclosures All Authors: No reported disclosures

scholarly journals Seasonal influence of tuberculosis diagnosis in Rwanda

2021 ◽  
Vol 49 (1) ◽  
Author(s):  
Doris Uwamahoro ◽  
Aly Beeman ◽  
Vinay K. Sharma ◽  
Michael B. Henry ◽  
Stephanie Chow Garbern ◽  
...  
Keyword(s):  
Rainy Season ◽  
Laboratory Data ◽  
Retrospective Chart Review ◽  
Dry Season ◽  
University Teaching ◽  
Health Concern ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Tropical Country ◽  
Included Patient

Abstract Background Tuberculosis (TB) remains a major global health concern. Previous research reveals that TB may have a seasonal peak during the spring and summer seasons in temperate climates; however, few studies have been conducted in tropical climates. This study evaluates the influence of seasonality on laboratory-confirmed TB diagnosis in Rwanda, a tropical country with two rainy and two dry seasons. Methods A retrospective chart review was performed at the University Teaching Hospital-Kigali (CHUK). From January 2016 to December 2017, 2717 CHUK patients with TB laboratory data were included. Data abstracted included patient demographics, season, HIV status, and TB laboratory results (microscopy, GeneXpert, culture). Univariate and multivariable logistic regression (adjusted for age, gender, and HIV status) analyses were performed to assess the association between season and laboratory-confirmed TB diagnoses. Results Patients presenting during rainy season periods had a lower odds of laboratory-confirmed TB diagnosis compared to the dry season (aOR=0.78, 95% CI 0.63–0.97, p=0.026) when controlling for age group, gender, and HIV status. Males, adults, and people living with HIV were more likely to have laboratory-confirmed TB diagnosis. On average, more people were tested for TB during the rainy season per month compared to the dry season (120.3 vs. 103.3), although this difference was not statistically significant. Conclusion In Rwanda, laboratory-confirmed TB case detection shows a seasonal variation with patients having higher odds of TB diagnosis occurring in the dry season. Further research is required to further elucidate this relationship and to delineate the mechanism of season influence on TB diagnosis.

Health Experiences of Operating Room Personnel

1985 ◽  
Vol 62 (3) ◽  
pp. 325-330 ◽  
Author(s):  
Julie E. Buring ◽  
Charles H. Hennekens ◽  
Sherry L. Mayrent ◽  
Bernard Rosner ◽  
E. Robert Greenberg ◽  
...  
Keyword(s):  
Operating Room ◽  
Operating Room Personnel ◽  
Health Experiences

scholarly journals 1241. PfSPZ Vaccine Administered by Direct Venous Inoculation to Prevent Plasmodium falciparum Malaria is as Safe as Normal Saline – a Meta-analysis of 12 Randomized Controlled Clinical Trials

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S639-S640
Author(s):  
L W Preston Church
Keyword(s):  
Plasmodium Falciparum ◽  
Random Effects ◽  
Normal Saline ◽  
Meta Analysis ◽  
Laboratory Data ◽  
Plasmodium Falciparum Malaria ◽  
Sub Saharan Africa ◽  
Sensitivity Analyses ◽  
Double Blind ◽  
Significant Difference

Abstract Background Sanaria’s PfSPZ Vaccine prevents Plasmodium falciparum (Pf) infection transmitted in the field and by controlled human malaria infection. Safety of PfSPZ Vaccine has been demonstrated in 12 randomized, double-blind, placebo-controlled trials (RCT) varying in regimen from 3 to 5 doses over 4 to 20 weeks and in size from 18 to 332 subjects in adults in the US and EU and 5-month to 65-year-olds in 5 countries in sub-Saharan Africa. This study was conducted to analyze solicited adverse event (AE) and laboratory data by random effects meta-analysis. Methods PfSPZ Vaccine is composed of radiation-attenuated, aseptic, purified, cryopreserved Pf sporozoites (SPZ) administered by direct venous inoculation (DVI). Normal saline (NS) is always the placebo. Data from all completed RCTs were included as either age > 18 years (n=598) or age 5 months to 17 years (n=641). Any subject receiving at least one dose was included. A random-effects model was used to study vaccine safety and I2 to evaluate heterogeneity. Analysis was performed for any systemic solicited AE and for the most frequently observed AEs and laboratory abnormalities. Sensitivity analyses were performed by removal of trials with zero events to evaluate potential bias. Results When examined individually, only 1 trial had a significant difference between PfSPZ Vaccine and NS for any AE (myalgias in adults). In the adult meta-analysis, there was no difference in the random effects risk ratios (RR) for having any vaccine-related AEs (1.40, 95% confidence interval (CI) 0.88-2.28), or for fever (0.75, 0.24-2.35), headache (1.23, 0.74-2.02), fatigue (0.72, 0.19-2.54), or myalgia (1.09, 0.26-4.68). In the pediatric meta-analysis there was no difference between the RR for PfSPZ Vaccine and NS for any AE (0.84, 0.59-1.18) or for fever (1.09, 0.44-2.69). No significant differences in the most common grade 2 or higher laboratory abnormalities – declines in hemoglobin, neutrophil or platelet count – were detected. Sensitivity analysis did not change the results. Conclusion There was no difference in risk for AEs or lab abnormalities between PfSPZ Vaccine and NS, indicating that PfSPZ Vaccine administered by DVI was extremely safe and well tolerated in 5-month- to 65-year-olds. Disclosures LW Preston Church, MD, FIDSA, Sanaria Inc. (Employee)

Oxidative status and DNA damage in operating room personnel

2009 ◽  
Vol 42 (3) ◽  
pp. 189-193 ◽  
Author(s):  
Zeynep Baysal ◽  
Mustafa Cengiz ◽  
Abdullah Ozgonul ◽  
Muslum Cakir ◽  
Hakim Celik ◽  
...  
Keyword(s):  
Dna Damage ◽  
Operating Room ◽  
Oxidative Status ◽  
Operating Room Personnel

177Lu-dotatate use in chronic kidney disease patients: A single center experience

2021 ◽  
Vol 5 (3) ◽  
pp. 162-171
Author(s):  
Sandhya Manohar ◽  
Panagiotis Kompotiatis ◽  
Thorvardur R Halfdanarson ◽  
Timothy J Hobday ◽  
Matthew Thorpe ◽  
...  
Keyword(s):  
Laboratory Data ◽  
Peptide Receptor Radionuclide Therapy ◽  
Retrospective Chart Review ◽  
Drug Dose ◽  
Hematological Toxicity ◽  
Close Monitoring ◽  
Novel Therapy ◽  
Single Center Experience ◽  
Safety Studies ◽  
Long Term Impact

Background: Peptide receptor radionuclide therapy with 177Lu-dotatate is a novel therapy for metastatic neuroendocrine cancers. It undergoes reabsorption at the proximal tubule; after the breakdown of the peptide fragment, 177Lu is retained and continues its decay process exposing the nephron to continuous low dose radiation. Pivotal NETTER-1 trial did not include patients with eGFR <50 and so its effects in CKD patients is not known. Methods: We performed a retrospective chart review of all consecutive adult patients that received 177Lu-dotatate over 1 year at Mayo Clinic, Rochester. We analyzed renal and hematological laboratory data obtained prior to each of four treatment cycles and at 3- and 6-month post completion of all treatment. We defined CKD as eGFR <60 ml/min and AKI as creatinine increase of ⩾0.3 from baseline by AKIN criteria. Results: Overall 86 patients were included in the study with 39 (45%) with known CKD. About three patients had CKD, four with eGFR of 20–30 ml/min. About 4 (4.6%) patients had AKI and the predominant cause being hypotension. Among the CKD patients the average eGFR improved after the first cycle of PRRT therapy from baseline of 49 (13) to 53.5 (17) ml/min ( p = 0.01) with no significant decline of renal function noted at 3- and 6-months post treatment follow up. Rate of thrombocytopenia and leukopenia were significantly more in the CKD patients starting even after single treatment. No drug dose correlation was noted. Conclusion: Patients with CKD are at a higher risk of hematological toxicity especially with thrombocytopenia and require close monitoring and ongoing dose adjustment. Ongoing safety studies to assess the long-term impact of 177Lu-dotatate on the kidney are needed.

Lack of Mutagens in Urines of Operating Room Personnel

1980 ◽  
Vol 53 (3) ◽  
pp. 195-198 ◽  
Author(s):  
Jeffrey M. Baden ◽  
Merijean Kelley ◽  
Andrew Cheung ◽  
Kristien Mortelmans
Keyword(s):  
Operating Room ◽  
Operating Room Personnel

Preoperative Localization of Spinal and Peripheral Pathologies for Surgery by Computed Tomography–Guided Placement of a Specialized Needle System

Neurosurgery ◽  
2010 ◽  
Vol 66 (4) ◽  
pp. 784-787 ◽  
Author(s):  
Philipp Slotty ◽  
Patrick Kröpil ◽  
Mark Klingenhöfer ◽  
Hans-Jakob Steiger ◽  
Daniel Hänggi ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Peripheral Nerve ◽  
Radiation Exposure ◽  
Operating Room ◽  
Operating Room Personnel ◽  
Peripheral Nerve Surgery ◽  
Preoperative Marking ◽  
Intraoperative Fluoroscopy ◽  
Nerve Surgery ◽  
Intraoperative Localization

Abstract OBJECTIVE Exact intraoperative localization of pathologies in spinal and peripheral nerve surgery is not easily achieved. In spinal surgery, intraoperative fluoroscopy is the common method for identification of the level affected. It seldom visualizes the pathology itself and is prone to error in identifying anatomic disorders and superimposing structures. In peripheral nerve surgery, intraoperative fluoroscopy is of little value. The present technical study was conducted to evaluate the feasibility of using a preoperative computed tomography–guided needle marking system, which was previously developed for use in gynecology. The goal was to reduce intraoperative localization error and radiation exposure to patients and operating room personnel. METHODS We used a flexible hooked-wire needle marking system, which has previously been used for preoperative marking of breast lesions, to localize and tag spinal and peripheral nerve pathologies. Marking was carried out under computed tomographic control before surgery. Seven illustrative cases were chosen for this report: 6 patients with disorders of the spine and 1 patient with a peripheral nerve schwannoma. RESULTS No adverse reactions, aside from minor discomfort, were observed in this study. In all cases, the needle could be used as a reliable guide for the surgical approach and led directly to the pathology. In no case was additional intraoperative fluoroscopy needed. The level of radiation exposure to the patient as a result of computed tomography–based marking was similar to or less than that encountered in conventional intraoperative x-ray localization. Radiation exposure to the operating room personnel was eliminated by this method. CONCLUSION Preoperative marking of spinal level or peripheral nerve pathologies with a flexible hooked-wire needle marking system is feasible and appears to be safe and useful for neurosurgical spinal and peripheral procedures.

scholarly journals Early, Subclinical Hematological Changes Associated with Occupational Exposure to High Levels of Nitrous Oxide

Toxics ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. 70 ◽  
Author(s):  
Fatemeh Amiri ◽  
Masoud Neghab ◽  
Fatemeh Shouroki ◽  
Saeed Yousefinejad ◽  
Jafar Hassanzadeh
Keyword(s):  
Nitrous Oxide ◽  
Occupational Exposure ◽  
Operating Room ◽  
Control Group ◽  
Mean Corpuscular Hemoglobin ◽  
Corpuscular Hemoglobin ◽  
Operating Room Personnel ◽  
Historical Cohort ◽  
Inhalation Anesthetics ◽  
Hematological Changes

This study was undertaken to determine whether exposure of operating room personnel to inhalation anesthetics, nitrous oxide, isoflurane, and sevoflurane was associated with any hematological changes. This historical cohort study was performed in 2018 at a large public hospital in Shiraz, where 52 operating room personnel and 52 administrative staff were investigated. The blood sample was taken from all individuals for Complete Blood Count. Furthermore, demographic information was collected through questionnaires. Mean atmospheric concentrations of nitrous oxide, isoflurane, and sevoflurane, to which subjects were exposed, were 850.92, 2.40, and 0.18 ppm, respectively. The hematological parameters were within the normal range in both groups. However, the mean values of hemoglobin, hematocrit, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red blood cell count in the exposed group were significantly lower than the control group. No significant differences were noted between the two groups as far as other hematological factors were concerned. These findings provide circumstantial evidence to further substantiate the notion that occupational exposure to inhalation anesthetics, under the exposure scenario explained in this study, is associated with subtle, subclinical, prepathologic hematological changes. Long-term consequence and ramifications of these effects require further investigation. The range of exposure levels to anesthetic gases in operating rooms.

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