2441. Automated, Rapid Detection of Potential Healthcare-Acquired Infection Clusters Based on Microbiology And Patient Geotemporal Data

Abstract Background Whole-genome sequencing (WGS) has shown promise in identifying transmissions of healthcare-associated infections (HAIs), but it may be costly to sequence all potential HAIs. By automatically identifying samples likely to be HAIs, WGS can be focused on specific samples. We describe an algorithm that quickly identifies potential HAI clusters by analyzing patient geotemporal and pathogen microbiology data. This approach systematically triages potential HAI investigations to aid infection control professionals (ICPs) in their workflow. Methods This novel algorithm within Philips IntelliSpace Epidemiology scores the potential of transmission for pairs of infections. Inputs include microbiology (MB) data (genus- or species-level identification and antimicrobial susceptibility test results) and geotemporal (GT) data (timing of sample collection and shared location stays). From the resulting pairwise scores, clusters of potential HAIs are identified. Leveraging 9 months (June, 2018 – March, 2019) of data from a 900-bed US hospital (i.e., 2825 samples, 1814 patients and 13 organisms—of which a subset of 404 samples had WGS performed concomitantly with MB studies), we evaluated the extent to which this algorithm captures genetically similar sample pairs. Results Pairwise scores enrich for genetically similar samples when considering MB data only (odds ratio: 17.3), GT only (odds ratio: 6.1) and a combination of both (odds ratio: 19.8), with highly significant P-values for all (P < 10−16). Considering MB only, 91% of samples group together in potential transmission clusters. With MB and GT data, this fraction drops to 24.6% (694 samples) forming 178 possible clusters, 173 of which contain fewer than ten samples each. The 5 larger clusters contain 40–64 samples each and span multiple units in the hospital. Conclusion The proposed system automatically suggests potential HAI clusters. By combining MB and GT data, the number of samples to review is reduced, enabling ICPs to focus their attention and sequencing efforts. By focusing on a targeted group of higher probability clusters, ICPs may be able to increase their efficiency and effectiveness in controlling the spread of HAIs—thus boosting potential for patient safety and amelioration of cost of care. Disclosures All authors: No reported disclosures.

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Clinical Evaluation of the Torq Zero Delay Centrifuge System for Decentralized Blood Collection and Stabilization

Diagnostics ◽

10.3390/diagnostics11061019 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1019

Author(s):

Kyungjin Hong ◽

Gabriella Iacovetti ◽

Ali Rahimian ◽

Sean Hong ◽

Jon Epperson ◽

...

Keyword(s):

Clinical Chemistry ◽

Blood Collection ◽

Test Results ◽

Sample Collection ◽

Rapid Separation ◽

Cell Counts ◽

Collection Device ◽

Precision Study ◽

Clinically Significant ◽

Blood Specimens

Blood sample collection and rapid separation—critical preanalytical steps in clinical chemistry—can be challenging in decentralized collection settings. To address this gap, the Torq™ zero delay centrifuge system includes a lightweight, hand-portable centrifuge (ZDrive™) and a disc-shaped blood collection device (ZDisc™) enabling immediate sample centrifugation at the point of collection. Here, we report results from clinical validation studies comparing performance of the Torq System with a conventional plasma separation tube (PST). Blood specimens from 134 subjects were collected and processed across three independent sites to compare ZDisc and PST performance in the assessment of 14 analytes (K, Na, Cl, Ca, BUN, creatinine, AST, ALT, ALP, total bilirubin, albumin, total protein, cholesterol, and triglycerides). A 31-subject precision study was performed to evaluate reproducibility of plasma test results from ZDiscs, and plasma quality was assessed by measuring hemolysis and blood cells from 10 subject specimens. The ZDisc successfully collected and processed samples from 134 subjects. ZDisc results agreed with reference PSTs for all 14 analytes with mean % biases well below clinically significant levels. Results were reproducible across different operators and ZDisc production lots, and plasma blood cell counts and hemolysis levels fell well below clinical acceptance thresholds. ZDiscs produce plasma samples equivalent to reference PSTs. Results support the suitability of the Torq System for remotely collecting and processing blood samples in decentralized settings.

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Effectiveness of Ultraviolet-C Room Disinfection on Preventing Healthcare-Associated Clostridioides difficile Infection

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.512 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s33-s33

Author(s):

Michihiko Goto ◽

Erin Balkenende ◽

Gosia Clore ◽

Rajeshwari Nair ◽

Loretta Simbartl ◽

...

Keyword(s):

Acute Care ◽

Acute Care Hospitals ◽

Incidence Rates ◽

Positive Test ◽

Negative Binomial Regression Model ◽

Test Results ◽

Clostridioides Difficile ◽

Ultraviolet C ◽

Healthcare Associated ◽

Uv C

Background: Enhanced terminal room cleaning with ultraviolet C (UVC) disinfection has become more commonly used as a strategy to reduce the transmission of important nosocomial pathogens, including Clostridioides difficile, but the real-world effectiveness remains unclear. Objectives: We aimed to assess the association of UVC disinfection during terminal cleaning with the incidence of healthcare-associated C. difficile infection and positive test results for C. difficile within the nationwide Veterans Health Administration (VHA) System. Methods: Using a nationwide survey of VHA system acute-care hospitals, information on UV-C system utilization and date of implementation was obtained. Hospital-level incidence rates of clinically confirmed hospital-onset C. difficile infection (HO-CDI) and positive test results with recent healthcare exposures (both hospital-onset [HO-LabID] and community-onset healthcare-associated [CO-HA-LabID]) at acute-care units between January 2010 and December 2018 were obtained through routine surveillance with bed days of care (BDOC) as the denominator. We analyzed the association of UVC disinfection with incidence rates of HO-CDI, HO-Lab-ID, and CO-HA-LabID using a nonrandomized, stepped-wedge design, using negative binomial regression model with hospital-specific random intercept, the presence or absence of UVC disinfection use for each month, with baseline trend and seasonality as explanatory variables. Results: Among 143 VHA acute-care hospitals, 129 hospitals (90.2%) responded to the survey and were included in the analysis. UVC use was reported from 42 hospitals with various implementation start dates (range, June 2010 through June 2017). We identified 23,021 positive C. difficile test results (HO-Lab ID: 5,014) with 16,213 HO-CDI and 24,083,252 BDOC from the 129 hospitals during the study period. There were declining baseline trends nationwide (mean, −0.6% per month) for HO-CDI. The use of UV-C had no statistically significant association with incidence rates of HO-CDI (incidence rate ratio [IRR], 1.032; 95% CI, 0.963–1.106; P = .65) or incidence rates of healthcare-associated positive C. difficile test results (HO-Lab). Conclusions: In this large quasi-experimental analysis within the VHA System, the enhanced terminal room cleaning with UVC disinfection was not associated with the change in incidence rates of clinically confirmed hospital-onset CDI or positive test results with recent healthcare exposure. Further research is needed to understand reasons for lack of effectiveness, such as understanding barriers to utilization.Funding: NoneDisclosures: None

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Impact of the Centers for Medicare and Medicaid Services Hospital-Acquired Conditions Policy on Billing Rates for 2 Targeted Healthcare-Associated Infections

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.86 ◽

2015 ◽

Vol 36 (8) ◽

pp. 871-877 ◽

Cited By ~ 13

Author(s):

Alison Tse Kawai ◽

Michael S. Calderwood ◽

Robert Jin ◽

Stephen B. Soumerai ◽

Louise E. Vaz ◽

...

Keyword(s):

New York ◽

Odds Ratio ◽

Times Series ◽

Hospital Acquired Conditions ◽

Medicare Patients ◽

Study Population ◽

Tract Infections ◽

Additional Payment ◽

Healthcare Associated ◽

Hospital Acquired

BACKGROUNDThe 2008 Centers for Medicare & Medicaid Services hospital-acquired conditions policy limited additional payment for conditions deemed reasonably preventable.OBJECTIVETo examine whether this policy was associated with decreases in billing rates for 2 targeted conditions, vascular catheter-associated infections (VCAI) and catheter-associated urinary tract infections (CAUTI).STUDY POPULATIONAdult Medicare patients admitted to 569 acute care hospitals in California, Massachusetts, or New York and subject to the policy.DESIGNWe used an interrupted times series design to assess whether the hospital-acquired conditions policy was associated with changes in billing rates for VCAI and CAUTI.RESULTSBefore the policy, billing rates for VCAI and CAUTI were increasing (prepolicy odds ratio per quarter for VCAI, 1.17 [95% CI, 1.11–1.23]; for CAUTI, 1.19 [1.16–1.23]). The policy was associated with an immediate drop in billing rates for VCAI and CAUTI (odds ratio for change at policy implementation for VCAI, 0.75 [95% CI, 0.69–0.81]; for CAUTI, 0.87 [0.79–0.96]). In the postpolicy period, we observed a decreasing trend in the billing rate for VCAI and a leveling-off in the billing rate for CAUTI (postpolicy odds ratio per quarter for VCAI, 0.98 [95% CI, 0.97–0.99]; for CAUTI, 0.99 [0.97–1.00]).CONCLUSIONSThe Centers for Medicare & Medicaid Services hospital-acquired conditions policy appears to have been associated with immediate reductions in billing rates for VCAI and CAUTI, followed by a slight decreasing trend or leveling-off in rates. These billing rates, however, may not correlate with changes in clinically meaningful patient outcomes and may reflect changes in coding practices.Infect. Control Hosp. Epidemiol. 2015;36(8):871–877

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Impact of remote biometric monitoring on cost and hospitalization outcomes in peritoneal dialysis

Journal of Telemedicine and Telecare ◽

10.1177/1357633x18784417 ◽

2018 ◽

Vol 25 (10) ◽

pp. 581-586 ◽

Cited By ~ 11

Author(s):

Susie Q Lew ◽

Neal Sikka ◽

Clinton Thompson ◽

Manya Magnus

Keyword(s):

Blood Pressure ◽

Peritoneal Dialysis ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Hospital Length ◽

Cost Of Care ◽

Hospital Length Of Stay ◽

Inpatient Setting ◽

Post Intervention

IntroductionPeritoneal dialysis is a home-based therapy for individuals with end-stage renal disease. Telehealth, and in particular – remote monitoring, is making inroads in managing this cohort.MethodsWe examined whether daily remote biometric monitoring (RBM) of blood pressure and weight among peritoneal dialysis patients was associated with changes in hospitalization rate and hospital length of stay, as well as outpatient, inpatient and overall cost of care.ResultsOutpatient visit claim payment amounts (in US dollars derived from CMS data) decreased post-intervention relative to pre-intervention for those at age 18-54 years. For certain subgroups, non- or nearly-significant changes were found among female and Black participants. There was no change in inpatient costs post-intervention relative to pre-intervention for females and while the overall visit claim payment amounts increased in the outpatient setting slightly (US$511.41 (1990.30) vs. US$652.61 (2319.02), p = 0.0783) and decreased in the inpatient setting (US$10,835.30 (6488.66) vs. US$10,678.88 (15,308.17), p = 0.4588), these differences were not statistically significant. Overall cost was lower if RBM was used for assessment of blood pressure and/or weight (US$–734.51, p < 0.05). Use of RBM collected weight was associated with fewer hospitalizations (adjusted odds ratio 0.54, 95% confidence interval 0.33–0.89) and fewer days hospitalized (adjusted odds ratio 0.46, 95% confidence interval 0.26–0.81). Use of RBM collected blood pressure was associated with increased days of hospitalization and increased odds of hospitalization.ConclusionsRBM offers a powerful opportunity to provide care to those receiving home therapies such as peritoneal dialysis. RBM may be associated with reduction in both inpatient and outpatient costs for specific sub-groups receiving peritoneal dialysis.

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Implementation of a pharmacist-provided pharmacogenomics service in an executive health program

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxab137 ◽

2021 ◽

Author(s):

Ina Liko ◽

Lisa Corbin ◽

Eric Tobin ◽

Christina L Aquilante ◽

Yee Ming Lee

Keyword(s):

Health Program ◽

Medical Center ◽

Academic Medical Center ◽

Test Results ◽

Sample Collection ◽

Team Members ◽

University Of Colorado ◽

Academic Medical ◽

Previous Medication ◽

Selection Of

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose We describe the implementation of a pharmacist-provided pharmacogenomics (PGx) service in an executive health program (EHP) at an academic medical center. Summary As interest in genomic testing grows, pharmacists have the opportunity to advance the use of PGx in EHPs, in collaboration with other healthcare professionals. In November 2018, a pharmacist-provided PGx service was established in the EHP at the University of Colorado Hospital. The team members included 3 physicians, a pharmacist trained in PGx, a registered dietitian/exercise physiologist, a nurse, and 2 medical assistants. We conducted 4 preimplementation steps: (1) assessment of the patient population, (2) selection of a PGx test, (3) establishment of a visit structure, and (4) selection of a billing model. The PGx consultations involved two 1-hour visits. The first visit encompassed pretest PGx education, review of the patient’s current medications and previous medication intolerances, and DNA sample collection for genotyping. After this visit, the pharmacist developed a therapeutic plan based on the PGx test results, discussed the results and plan with the physician, and created a personalized PGx report. At the second visit, the pharmacist reviewed the PGx test results, personalized the PGx report, and discussed the PGx-guided therapeutic plan with the patient. Overall, the strategy worked well; minor challenges included evaluation of gene-drug pairs with limited PGx evidence, communication of information to non-EHP providers, scheduling issues, and reimbursement. Conclusion The addition of a PGx service within an EHP was feasible and provided pharmacists the opportunity to lead PGx efforts and collaborate with physicians to expand the precision medicine footprint at an academic medical center.

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Clinical Utilization and Cost of Thrombophilia Testing in Patients with Venous Thromboembolism

TH Open ◽

10.1055/s-0040-1714334 ◽

2020 ◽

Vol 04 (03) ◽

pp. e153-e162

Author(s):

Manila Gaddh ◽

En Cheng ◽

Maha A.T. Elsebaie ◽

Imre Bodó

Keyword(s):

Venous Thromboembolism ◽

Patient Management ◽

Clinical Decision Making ◽

Factor V Leiden ◽

Direct Costs ◽

Cost Of Care ◽

Factor V ◽

Test Results ◽

Thrombophilia Testing ◽

The Impact

Abstract Introduction Testing for inherited and acquired thrombophilias adds to the cost of care of patients with venous thromboembolism (VTE), though results may not influence patient management. Methods This is a single-center, retrospective study conducted at Emory University Hospitals from January to December 2015 to (1) determine the pattern of thrombophilia testing in patients with VTE, (2) study the impact of results of thrombophilia testing on clinical decision-making, and (3) determine the direct costs of thrombophilia testing in patients with VTE. Results Of the 266 eligible patients, 189 (71%) underwent testing; 51 (26.9%) tested positive and the results impacted management in 32 (16.9%) of tested patients. Patient undergoing testing were more likely to be younger than 40 years (30.9 vs. 18.2%), have had prior pregnancy loss (9.0 vs. 0%), or known family history of hypercoagulability (24.9 vs. 10.4%), and were less likely to have had provoked VTE (37 vs. 79.2%). The most common thrombophilias tested were antiphospholipid syndrome (60.1%), factor V Leiden (59.7%), and prothrombin gene mutation (57.5%). Direct costs of thrombophilia testing were $2,364.32 per patient, $12,331.55 to diagnose 1 positive, and $19,653.41 per patient-management affected. Conclusion We noted significant variability in selection of patients and panel of tests, sparse utilization of test results in patient management, but high cost associated with thrombophilia testing in patients with VTE. With guidelines advocating selective use of thrombophilia testing and attention to potential impact of test results in patient management, we propose the need for measures at institutional levels to improve test-ordering practices.

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Public health implications of soil contaminated with helminth eggs in the metropolis of Kaduna, Nigeria

Journal of Helminthology ◽

10.1017/s0022149x07874220 ◽

2008 ◽

Vol 82 (2) ◽

pp. 113-118 ◽

Cited By ~ 15

Author(s):

B.V. Maikai ◽

J.U. Umoh ◽

O.J. Ajanusi ◽

I. Ajogi

Keyword(s):

Odds Ratio ◽

Economic Status ◽

Soil Samples ◽

Sample Collection ◽

Dry Period ◽

Rainy Period ◽

Socio Economic Status ◽

Cultural Variables ◽

Dipylidium Caninum ◽

Helminth Eggs

AbstractEnvironmental and socio-cultural variables influencing the distribution of helminth eggs in 608 soil samples were studied in 14 playgrounds that differ in socio-economic status in Kaduna metropolis, Nigeria, using a modified sieving method and a sucrose flotation medium of specific gravity 1.27. Helminth eggs were found in 62% of the soil samples and the distribution was as follows: Toxocara spp. 50.4%, Taenia spp./Echinococcus spp. 36.9%, Dipylidium caninum 26.3%, Ancylostoma spp. 9.0%, Ascaris spp. 7.2%, Trichuris spp. 3.7% and Ascaridia spp. 1.9%. A higher prevalence (68.1%) was recorded during the dry harmattan period while in the rainy period the rate was 58.1%. Mean egg densities ranged from 1.11 ± 0.32 to 3.92 ± 2.47 in areas moderately rated. Samples from site 14, which was highly rated, were more contaminated (78.1%) than those collected from other sites, while the intensity of contamination (14.0%) was more in moderately rated site 4 than in the rest of the sites. There were significant associations between the prevalence of helminth eggs and rainy period of the study (odds ratio (OR) = 0.38; 95% confidence interval (CI) on OR: 0.20 < OR < 0.70), presence of dogs (OR = 0.56; 95% CI on OR: 0.37 < OR < 0.85) and grass (vegetation) (OR = 1.44; 95% CI on OR: 1.03 < OR < 2.04) in the sites. On the other hand, there was no association between the prevalence of helminth eggs and the dry period of the study, presence of refuse in the playgrounds, topography of playgrounds, depth of sample collection and socio-economic status of people in playgrounds (P>0.05). This study shows that the period of study, the presence of dogs and vegetation influence the prevalence of helminth eggs in soil in Kaduna metropolis.

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Colonization Levels of Streptococcus Mutans between Mother and Infant: A Postnatal Prospective Cohort Study

Journal of Clinical Pediatric Dentistry ◽

10.17796/jcpd.38.3.9k6613858x2n82j0 ◽

2014 ◽

Vol 38 (3) ◽

pp. 197-200 ◽

Cited By ~ 1

Author(s):

S Ruiz-Rodriguez ◽

V Lacavex-Aguilar ◽

M Pierdant-Perez ◽

P Mandeville ◽

M Santos-Diaz ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Direct Relationship ◽

Total Sample ◽

Test Results ◽

Sample Collection ◽

Gram Staining ◽

Activity Test ◽

Oral Sample

Objective: To investigate the possible association between maternal S. mutans levels and those of the infant during the period between birth and 5 months and evaluate possible risk factors in the S mutans colonization. Study Design: A prospective cohort study was carried out comprising 62 infants and their mothers, selected at the time of childbirth. For each infant, a sample swab was taken at 0, 15, 30, 90, and 150 days postpartum; on the same days, a sample was obtained from the mothers. TYCSB medium was employed for identifying the microorganism, which was later confirmed by Gram staining, the catalase activity test, and the API strep test. Results: The final total sample consisted of 60 infants, from which S. mutans was detected in only 2 (3%) at the 150th day of oral sample collection. Of the sample of 60 mothers, 54 exhibited colonization levels. Conclusions: In the studied sample pairs up to 150 days, it was not possible to demonstrate the presence of a direct relationship between maternal S. mutans oral levels.

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Epidemiology and Outcomes of Hospitalizations with Complicated Skin and Skin-Structure Infections: Implications of Healthcare-Associated Infection Risk Factors

Infection Control and Hospital Epidemiology ◽

10.1086/648083 ◽

2009 ◽

Vol 30 (12) ◽

pp. 1203-1210 ◽

Cited By ~ 36

Author(s):

Marya D. Zilberberg ◽

Andrew F. Shorr ◽

Scott T. Micek ◽

Alex P. Hoban ◽

Victor Pham ◽

...

Keyword(s):

Confidence Interval ◽

Odds Ratio ◽

Length Of Hospital Stay ◽

Mixed Infections ◽

Gram Negative ◽

Skin Structure ◽

Inappropriate Treatment ◽

Complicated Skin ◽

Gram Negative Organisms ◽

Healthcare Associated

Objective.Healthcare-associated infections are likely to be caused by drug-resistant and possibly mixed organisms and to be treated with inappropriate antibiotics. Because prompt appropriate treatment is associated with better outcomes, we studied the epidemiology of healthcare-associated complicated skin and skin-structure infections (cSSSIs).Patients.Persons hospitalized with cSSSI and a positive culture result.Methods.We conducted a single-center retrospective cohort study from April 2006 through December 2007. We differentiated healthcare-associated from community-acquired cSSSIs by at least 1 of the following risk factors: (1) recent hospitalization, (2) recent antibiotics, (3) hemodialysis, and (4) transfer from a nursing home. Inappropriate treatment was defined as no antimicrobial therapy with activity against the offending pathogen(s) within 24 hours after collection of a culture specimen. Mixed infections were those caused by both a gram-positive and a gram-negative organism.Results.Among 717 hospitalized patients with cSSSI, 527 (73.5%) had healthcare-associated cSSSI. Gram-negative organisms were more common (relative risk, 1.24 [95% confidence interval, 1.14–1.35) and inappropriate treatment trended toward being more common (odds ratio, 1.29 [95% confidence interval, 0.85–1.95]) in healthcare-associated cSSSI than in community-acquired cSSSI. Mixed cSSSIs occurred in 10.6% of patients with healthcare-associated cSSSI and 6.3% of those with community-acquired cSSSI (P = .082) and were more likely to be treated inappropriately than to be nonmixed infections (odds ratio, 2.42 [95% confidence interval, 1.43–4.10]). Both median length of hospital stay (6.2 vs 2.9 days; P < .001) and mortality rate (6.6% vs 1.1%; P = .003) were significantly higher for healthcare-associated cSSSI than community-acquired cSSSI.Conclusions.Healthcare-associated cSSSIs are common and are likely to be caused by gram-negative organisms. Mixed infections carry a <2-fold greater risk of inappropriate treatment. Healthcare-associated cSSSIs are associated with increased mortality and prolonged length of hospital stay, compared with community-acquired cSSSIs.

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BACTERIAL TEST RESULTS OF GRADE-A RAW MILK SAMPLES AS A MEASURE OF FARM PRODUCTION CONDITIONS1

Journal of Milk and Food Technology ◽

10.4315/0022-2747-31.12.388 ◽

1968 ◽

Vol 31 (12) ◽

pp. 388-392 ◽

Cited By ~ 2

Author(s):

J. C. Hartley ◽

G. W. Reinbold ◽

E. R. Vedamuthu ◽

W. S. Clark

Keyword(s):

Leucocyte Count ◽

Raw Milk ◽

Test Results ◽

Sample Collection ◽

Fresh Sample ◽

Bacterial Counts ◽

Reduction Time ◽

Coliform Count ◽

Farm Production ◽

Production Conditions

Milk from 30 grade-A farms was subjected to bacteriological tests including the Standard Plate, total, coliform, psychrophilic, thermoduric, and enterococcus count, resazurin reduction time, and leucocyte count to determine the correlation between these tests and farm production conditions. Farm conditions were evaluated at sample collection time by a farm score, which was based mainly on sanitation. After collection and immediate transportation to the laboratory, half of each sample was stored at 3.3 C for 72 hr, the remainder was preincubated at 12.8 C for 18 hr after storage at 3.3 C for 54 hr; determinations were then performed. The leucocyte count was determined on the fresh sample. The psychrophilic count was the only bacterial test that showed significant correlation with the farm score. For samples stored at 3.3 C for 72 hr, all comparisons among bacterial counts showed significant correlation except: psychrophilic count vs. resazurin reduction time; coliform count vs. resazurin reduction time; and, coliform count vs. enterococcus count. For preincubated samples, all comparisons among bacterial counts showed significant correlation except: psychrophilic count vs. resazurin reduction time; coliform count vs. resazurin reduction time; and, coliform count vs. thermoduric count. Higher correlations were obtained on the preincubated samples for all bacterial tests except the thermoduric count. Within this experimental design, preliminary incubation did not improve the ability of the bacterial tests to show statistically significant correlation with the farm score. The leucocyte count showed significant correlation with the farm score, but not with the bacterial test results. Evaluation of data shows that the bacterial test results are not highly correlated with farm production conditions as measured by farm score. Milking-time inspections are necessary to assure that recommended practices are used in grade-A milk production.

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