scholarly journals Bare Below the Elbows: A Randomized Trial to Determine Whether Wearing Short-Sleeved Coats Reduces the Risk for Pathogen Transmission

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S34-S34
Author(s):  
Amrita John ◽  
Heba Alhmidi ◽  
Melany Gonzalez-Orta ◽  
Jennifer Cadnum ◽  
Curtis J Donskey
Keyword(s):  
Patient Care ◽  
Randomized Trial ◽  
Mosaic Virus ◽  
Dna Marker ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Healthcare Personnel ◽  
Dress Code ◽  
Viral Dna ◽  
The Uk

Abstract Background Physician’s white coats are frequently contaminated, but seldom cleaned. Therefore, in the UK, a “bare below the elbows” dress code policy includes a recommendation that personnel wear short sleeves. However, it has not been demonstrated that wearing short sleeves reduces the likelihood of pathogen transmission. Methods We conducted a randomized, cross-over trial involving simulated patient care interactions to test the hypothesis that transmission of pathogens occurs less frequently when personnel wear short- vs long-sleeved coats. Healthcare personnel were randomized to wear either long- or short-sleeved white coats while examining a mannequin contaminated with cauliflower mosaic virus DNA followed by examination of an uncontaminated mannequin. We compared the frequency of transfer of the DNA marker with the sleeves and/or wrists and with the uncontaminated mannequin. During work rounds, physicians were observed to determine how often the sleeves of white coats contacted patients or the environment. Results During work rounds and simulated examinations, the sleeve cuff of long-sleeved coats frequently contacted the patient/mannequin or environment. Contamination with the DNA marker was detected significantly more often on the sleeves and/or wrists when personnel wore long- vs short-sleeved coats (5 of 20, 25% vs 0 of 20, 0%; P = 0.02). In one of five (20%) instances of sleeve and/or wrist contamination, the DNA marker was transferred to the second mannequin. It was also observed that healthcare personnel were less likely to include their wrist in handwashing between simulations if they were wearing long-sleeved coats. Conclusion During simulations of patient care, the sleeve cuff of long-sleeved white coats frequently became contaminated with a viral DNA marker that could be transferred. These results provide support for the recommendation that healthcare personnel wear short sleeves to reduce the risk for pathogen transmission. Disclosures All authors: No reported disclosures.

scholarly journals Dissemination of Methicillin-Resistant Staphylococcus aureus (MRSA) and Viral Surrogate Markers Outside Patient Rooms

2020 ◽  
Vol 41 (S1) ◽  
pp. s193-s194
Author(s):  
Daniel Li ◽  
Natalia Pinto Herrera ◽  
Heba Alhmidi ◽  
Jennifer Cadnum ◽  
Curtis Donskey
Keyword(s):  
Staphylococcus Aureus ◽  
Mosaic Virus ◽  
Dna Marker ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Surrogate Markers ◽  
Viral Dna ◽  
Term Care ◽  
Methicillin Resistant ◽  
Bacteriophage Ms2

Background: Patients with methicillin-resistant Staphylococcus aureus (MRSA) colonization often shed MRSA, resulting in contamination of surfaces in their room. It is not known whether MRSA-colonized patients also frequently contaminate surfaces during medical appointments and other activities outside their room. Methods: We conducted an observational cohort study of MRSA-colonized long-term care facility (LTCF) residents to determine the frequency and mechanisms of contamination of surfaces outside patient rooms. Nares, skin, and clothing of patients in contact precautions for MRSA were cultured for MRSA, and high-touch surfaces in the residents’ room were contaminated with the live virus bacteriophage MS2 and cauliflower mosaic virus DNA. The participants were observed during activities and medical appointments outside their rooms for 3 days, and sites that were contacted were sampled for recovery of MRSA, bacteriophage MS2, and cauliflower mosaic virus DNA. Results: As shown in Fig. 1, bacteriophage MS2 and cauliflower mosaic virus DNA was transferred to 1 or more surfaces outside the resident’s room by 5 of the 7 participants, and MRSA was recovered from surfaces touched by 6 (86%) participants. MRSA was recovered during 16 of 35 episodes (46%) where sampling was performed, and recovery was similar for medical appointments (eg, hemodialysis, physical therapy) and nonmedical activities (eg, using the dining room or activity center). Moreover, MRSA, MS2, and the viral DNA marker were recovered both from sites contacted only by participants’ hands and from sites contacted only by clothing. Bacteriophage MS2 and the viral DNA marker were also recovered from portable equipment and from the nursing station. Conclusions: MRSA-colonized LTCF residents frequently disseminated MRSA and viral surrogate markers to surfaces outside their rooms through contact with contaminated hands and clothing. Efforts to reduce contamination of hands and clothing might reduce the risk for pathogen transmission.Funding: NoneDisclosures: None

Effectiveness of barrier precautions for prevention of patient-to-patient transfer of a viral DNA surrogate marker

2020 ◽  
pp. 1-6
Author(s):  
Heba Alhmidi ◽  
Jennifer L. Cadnum ◽  
Yilen K. Ng-Wong ◽  
Annette L. Jencson ◽  
Brigid M. Wilson ◽  
...  
Keyword(s):  
Dna Markers ◽  
Odds Ratio ◽  
Dna Marker ◽  
Surrogate Marker ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Patient Transfer ◽  
Viral Dna ◽  
Patient Interactions ◽  
Subsequent Patient

Abstract Background: Gloves and gowns are used during patient care to reduce contamination of personnel and prevent pathogen transmission. Objective: To determine whether the use of gowns adds a substantial benefit over gloves alone in preventing patient-to-patient transfer of a viral DNA surrogate marker. Methods: In total, 30 source patients had 1 cauliflower mosaic virus surrogate marker applied to their skin and clothing and a second to their bed rail and bedside table. Personnel caring for the source patients were randomized to wear gloves, gloves plus cover gowns, or no barrier. Interactions with up to 7 subsequent patients were observed, and the percentages of transfer of the DNA markers were compared among the 3 groups. Results: In comparison to the no-barrier group (57.8% transfer of 1 or both markers), there were significant reductions in transfer of the DNA markers in the gloves group (31.1% transfer; odds ratio [OR], 0.16; 95% confidence interval [CI], 0.02-0.73) and the gloves-plus-gown group (25.9% transfer; OR, 0.11; 95% CI, 0.01–0.51). The addition of a cover gown to gloves during the interaction with the source patient did not significantly reduce the transfer of the DNA marker (P = .53). During subsequent patient interactions, transfer of the DNA markers was significantly reduced if gloves plus gowns were worn and if hand hygiene was performed (P < .05). Conclusions: Wearing gloves or gloves plus gowns reduced the frequency of patient-to-patient transfer of a viral DNA surrogate marker. The use of gloves plus gowns during interactions with the source patient did not reduce transfer in comparison to gloves alone.

scholarly journals 1142. Use of DNA Markers to Assess the Potential for Pathogen Transmission from Physicians’ White Coats

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S343-S343
Author(s):  
Daniel Van Aartsen ◽  
Manish Thakur ◽  
Khalid M Dousa ◽  
Anubhav Kanwar ◽  
Jennifer Cadnum ◽  
...  
Keyword(s):  
Dna Markers ◽  
Dna Marker ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Clinical Settings ◽  
Dress Code ◽  
Indirect Contact ◽  
Environmental Surfaces ◽  
Polymerase Chain ◽  
Healthcare Associated

Abstract Background Physicians’ white coats are often contaminated, but seldom cleaned. A “bare below the elbows” dress code policy has been advocated as a strategy to reduce the risk for transmission of healthcare-associated pathogens by white coats. However, transfer of contamination by clothing has not been demonstrated in clinical settings and it is not known if long sleeves are the major source of transfer. Methods We observed physicians during routine patient encounters and characterized the frequency of direct and indirect contact between white coats and the patient or environmental surfaces. To assess transfer from white coats in clinical settings, we applied one cauliflower mosaic virus DNA marker to the sleeve cuffs and another to the coat pockets of physicians prior to routine patient encounters. Polymerase chain reaction was used to determine whether DNA markers from the clothing sites were transferred to patients or environmental surfaces. Results Ninety percent of observed patient encounters included one or more direct or indirect contacts between a physician’s white coat and a patient or the environment. Direct contact occurred on average 1.7 times per encounter and indirect contact (i.e., physicians’ hands contacting the coat prior to touching the patient or environment) occurred on average 2.3 times per encounter. The figure shows the frequency and distribution of sites of direct and indirect contact with white coats. Of 11 patient encounters with DNA-contaminated white coats, five (45%) resulted in transfer of one or both DNA markers; there were three transfers from sleeve cuffs and three from coat pockets. Conclusion Contaminated white coats may be an under-appreciated source for transmission of healthcare-associated pathogens. Our results provide support for the bare below the elbows policy, but also highlight the potential for indirect transfer of pathogens from other sites on white coats. Disclosures All authors: No reported disclosures.

scholarly journals Differential Roles of AC2 and AC4 of Cassava Geminiviruses in Mediating Synergism and Suppression of Posttranscriptional Gene Silencing

2004 ◽  
Vol 78 (17) ◽  
pp. 9487-9498 ◽  
Author(s):  
Ramachandran Vanitharani ◽  
Padmanabhan Chellappan ◽  
Justin S. Pita ◽  
Claude M. Fauquet
Keyword(s):  
Gene Silencing ◽  
Mosaic Virus ◽  
Defense Mechanism ◽  
Fluorescent Protein ◽  
Cauliflower Mosaic Virus ◽  
African Cassava Mosaic Virus ◽  
35S Promoter ◽  
Viral Dna ◽  
Posttranscriptional Gene Silencing ◽  
Cassava Mosaic Virus

ABSTRACT Posttranscriptional gene silencing (PTGS) in plants is a natural defense mechanism against virus infection. In mixed infections, virus synergism is proposed to result from suppression of the host defense mechanism by the viruses. Synergistic severe mosaic disease caused by simultaneous infection with isolates of the Cameroon strain of African cassava mosaic virus (ACMV-[CM]) and East African cassava mosaic Cameroon virus (EACMCV) in cassava and tobacco is characterized by a dramatic increase in symptom severity and a severalfold increase in viral-DNA accumulation by both viruses compared to that in singly infected plants. Here, we report that synergism between ACMV-[CM] and EACMCV is a two-way process, as the presence of the DNA-A component of ACMV-[CM] or EACMCV in trans enhanced the accumulation of viral DNA of EACMCV and ACMV-[CM], respectively, in tobacco BY-2 protoplasts. Furthermore, transient expression of ACMV-[CM] AC4 driven by the Cauliflower mosaic virus 35S promoter (p35S-AC4) enhanced EACMCV DNA accumulation by ∼8-fold in protoplasts, while p35S-AC2 of EACMCV enhanced ACMV-[CM] DNA accumulation, also by ∼8-fold. An Agrobacterium-based leaf infiltration assay determined that ACMV-[CM] AC4 and EACMCV AC2, the putative synergistic genes, were able to suppress PTGS induced by green fluorescent protein (GFP) and eliminated the short interfering RNAs associated with PTGS, with a correlated increase in GFP mRNA accumulation. In addition, we have identified AC4 of Sri Lankan cassava mosaic virus and AC2 of Indian cassava mosaic virus as suppressors of PTGS, indicating that geminiviruses evolved differently in regard to interaction with the host. The specific and different roles played by these AC2 and AC4 proteins of cassava geminiviruses in regulating anti-PTGS activity and their relation to synergism are discussed.

Strand-specific viral DNA synthesis in purified viroplasms isolated from turnip leaves infected with cauliflower mosaic virus

Virology ◽  
1985 ◽  
Vol 145 (2) ◽  
pp. 293-303 ◽  
Author(s):  
L. Mazzolini ◽  
J.M. Bonneville ◽  
M. Volovitch ◽  
M. Magazin ◽  
P. Yot
Keyword(s):  
Dna Synthesis ◽  
Mosaic Virus ◽  
Cauliflower Mosaic Virus ◽  
Viral Dna ◽  
Turnip Leaves

Use of simulations to evaluate the effectiveness of barrier precautions to prevent patient-to-patient transfer of healthcare-associated pathogens

2020 ◽  
pp. 1-6
Author(s):  
Heba Alhmidi ◽  
Daniel F. Li ◽  
Jennifer L. Cadnum ◽  
Muhammed F. Haq ◽  
Natalia C. Pinto-Herrera ◽  
...  
Keyword(s):  
Mosaic Virus ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Surrogate Markers ◽  
Fluorescent Tracer ◽  
Clostridioides Difficile ◽  
Bacteriophage Ms2 ◽  
Different Types ◽  
Healthcare Associated ◽  
Standardized Examinations

Abstract Background: There is controversy regarding whether the addition of cover gowns offers a substantial benefit over gloves alone in reducing personnel contamination and preventing pathogen transmission. Design: Simulated patient care interactions. Objective: To evaluate the efficacy of different types of barrier precautions and to identify routes of transmission. Methods: In randomly ordered sequence, 30 personnel each performed 3 standardized examinations of mannequins contaminated with pathogen surrogate markers (cauliflower mosaic virus DNA, bacteriophage MS2, nontoxigenic Clostridioides difficile spores, and fluorescent tracer) while wearing no barriers, gloves, or gloves plus gowns followed by examination of a noncontaminated mannequin. We compared the frequency and routes of transfer of the surrogate markers to the second mannequin or the environment. Results: For a composite of all surrogate markers, transfer by hands occurred at significantly lower rates in the gloves-alone group (OR, 0.02; P < .001) and the gloves-plus-gown group (OR, 0.06; P = .002). Transfer by stethoscope diaphragms was common in all groups and was reduced by wiping the stethoscope between simulations (OR, 0.06; P < .001). Compared to the no-barriers group, wearing a cover gown and gloves resulted in reduced contamination of clothing (OR, 0.15; P < .001), but wearing gloves alone did not. Conclusions: Wearing gloves alone or gloves plus gowns reduces hand transfer of pathogens but may not address transfer by devices such as stethoscopes. Cover gowns reduce the risk of contaminating the clothing of personnel.

scholarly journals Evaluation of Viral Surrogate Markers for Study of Pathogen Dissemination During Simulations of Patient Care

2017 ◽  
Vol 4 (3) ◽  
Author(s):  
Heba Alhmidi ◽  
Amrita John ◽  
Thriveen C. Mana ◽  
Sreelatha Koganti ◽  
Jennifer L. Cadnum ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Patient Care ◽  
Mosaic Virus ◽  
Personal Protective Equipment ◽  
Cauliflower Mosaic Virus ◽  
Protective Equipment ◽  
Surrogate Markers ◽  
Bacteriophage Ms2

Abstract During patient care simulations, cauliflower mosaic virus DNA and bacteriophage MS2 performed similarly as surrogate markers of pathogen dissemination. These markers disseminated to the environment in a manner similar to Clostridium difficile spores but were more frequently detected on skin and clothing of personnel after personal protective equipment removal.

Cauliflower mosaic virus-induced viroplasms support viral DNA synthesis in a cell-free system

Virology ◽  
1984 ◽  
Vol 133 (2) ◽  
pp. 289-300 ◽  
Author(s):  
N. Modjtahedi ◽  
M. Volovitch ◽  
L. Sossountzov ◽  
Y. Habricot ◽  
J.M. Bonneville ◽  
...  
Keyword(s):  
Dna Synthesis ◽  
Mosaic Virus ◽  
Cauliflower Mosaic Virus ◽  
Viral Dna ◽  
Free System ◽  
Cell Free System ◽  
A Cell

Use of viral DNA surrogate markers to study routes of transmission of healthcare-associated pathogens

2020 ◽  
pp. 1-6
Author(s):  
Manish Thakur ◽  
Heba Alhmidi ◽  
Jennifer L. Cadnum ◽  
Annette L. Jencson ◽  
Jessica Bingham ◽  
...  
Keyword(s):  
Dna Markers ◽  
Veterans Affairs ◽  
Pathogen Transmission ◽  
Cauliflower Mosaic Virus ◽  
Healthcare Personnel ◽  
Portable Equipment ◽  
Environmental Surfaces ◽  
Observational Cohort ◽  
Healthcare Associated

Abstract Background: The hands of healthcare personnel are the most important source for transmission of healthcare-associated pathogens. The role of contaminated fomites such as portable equipment, stethoscopes, and clothing of personnel in pathogen transmission is unclear. Objective: To study routes of transmission of cauliflower mosaic virus DNA markers from 31 source patients and from environmental surfaces in their rooms. Design: A 3-month observational cohort study. Setting: A Veterans’ Affairs hospital. Methods: After providing care for source patients, healthcare personnel were observed during interactions with subsequent patients. Putative routes of transmission were identified based on recovery of DNA markers from sites of contact with the patient or environment. To assess plausibility of fomite-mediated transmission, we assessed the frequency of transfer of methicillin-resistant Staphylococcus aureus (MRSA) from the skin of 25 colonized patients via gloved hands versus fomites. Results: Of 145 interactions involving contact with patients and/or the environment, 41 (28.3%) resulted in transfer of 1 or both DNA markers to the patient and/or the environment. The DNA marker applied to patients’ skin and clothing was transferred most frequently by stethoscopes, hands, and portable equipment, whereas the marker applied to environmental surfaces was transferred only by hands and clothing. The percentages of MRSA transfer from the skin of colonized patients via gloved hands, stethoscope diaphragms, and clothing were 52%, 40%, and 48%, respectively. Conclusions: Fomites such as stethoscopes, clothing, and portable equipment may be underappreciated sources of pathogen transmission. Simple interventions such as decontamination of fomites between patients could reduce the risk for transmission.

Sign in / Sign up

Export Citation Format

Share Document