scholarly journals A narrative review on current duodenoscope reprocessing techniques and novel developments

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Maarten Heuvelmans ◽  
Herman F. Wunderink ◽  
Henny C. van der Mei ◽  
Jan F. Monkelbaan
Keyword(s):  
The United States ◽  
Pathogen Transmission ◽  
Clinical Implementation ◽  
Sampling Protocol ◽  
Strict Adherence ◽  
United States Food ◽  
Control And Prevention ◽  
American Society ◽  
High Level ◽  
American Society For Microbiology

AbstractDuodenoscopy-associated infections occur worldwide despite strict adherence to reprocessing standards. The exact scope of the problem remains unknown because a standardized sampling protocol and uniform sampling techniques are lacking. The currently available multi-society protocol for microbial culturing by the Centers for Disease Control and Prevention, the United States Food and Drug Administration (FDA) and the American Society for Microbiology, published in 2018 is too laborious for broad clinical implementation. A more practical sampling protocol would result in increased accessibility and widespread implementation. This will aid to reduce the prevalence of duodenoscope contamination. To reduce the risk of duodenoscopy-associated pathogen transmission the FDA advised four supplemental reprocessing measures. These measures include double high-level disinfection, microbiological culturing and quarantine, ethylene oxide gas sterilization and liquid chemical sterilization. When the supplemental measures were advised in 2015 data evaluating their efficacy were sparse. Over the past five years data regarding the supplemental measures have become available that place the efficacy of the supplemental measures into context. As expected the advised supplemental measures have resulted in increased costs and reprocessing time. Unfortunately, it has also become clear that the efficacy of the supplemental measures falls short and that duodenoscope contamination remains a problem. There is a lot of research into new reprocessing methods and technical applications trying to solve the problem of duodenoscope contamination. Several promising developments such as single-use duodenoscopes, electrolyzed acidic water, and vaporized hydrogen peroxide plasma are already applied in a clinical setting.

scholarly journals The Invisible Army

2017 ◽  
Vol 55 (9) ◽  
pp. 2583-2589 ◽  
Author(s):  
Peter H. Gilligan
Keyword(s):  
Health Care ◽  
Clinical Microbiology ◽  
The United States ◽  
Rate Of Change ◽  
Health Care Funding ◽  
Future Challenges ◽  
History Of ◽  
American Society ◽  
American Society For Microbiology ◽  
The Invisible

ABSTRACT The “invisible army” of clinical microbiologists is facing major changes and challenges. The rate of change in both the science and technology is accelerating with no end in sight, putting pressure on our army to learn and adapt as never before. Health care funding in the United States is undergoing dramatic change which will require a new set of assumptions about how clinical microbiology is practiced here. A major challenge facing the discipline is the replacement of a generation of clinical microbiologists. In my opinion, it is incumbent on us in the invisible army to continue to work with the American Society for Microbiology (ASM) in meeting the future challenges faced by our discipline. In this commentary, I will first discuss some recent history of clinical microbiology within ASM and then some current challenges we face.

scholarly journals Superantigens Are Critical for Staphylococcus aureus Infective Endocarditis, Sepsis, and Acute Kidney Injury

mBio ◽  
2013 ◽  
Vol 4 (4) ◽  
Author(s):  
Wilmara Salgado-Pabón ◽  
Laura Breshears ◽  
Adam R. Spaulding ◽  
Joseph A. Merriman ◽  
Christopher S. Stach ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Acute Kidney Injury ◽  
Infective Endocarditis ◽  
Kidney Injury ◽  
The United States ◽  
Content Type ◽  
Lethal Sepsis ◽  
Control And Prevention ◽  
Bacterial Accumulation ◽  
High Level

ABSTRACTInfective endocarditis and kidney infections are serious complications ofStaphylococcus aureussepsis. We investigated the role of superantigens (SAgs) in the development of lethal sepsis, infective endocarditis, and kidney infections. SAgs cause toxic shock syndrome, but it is unclear if SAgs contribute to infective endocarditis and kidney infections secondary to sepsis. We show in the methicillin-resistantS. aureusstrain MW2 that lethal sepsis, infective endocarditis, and kidney infections in rabbits are critically dependent on high-level SAgs. In contrast, the isogenic strain lacking staphylococcal enterotoxin C (SEC), the major SAg in this strain, is attenuated in virulence, while complementation restores disease production. SAgs’ role in infective endocarditis appears to be both superantigenicity and direct endothelial cell stimulation. Maintenance of elevated blood pressure by fluid therapy significantly protects from infective endocarditis, possibly through preventing bacterial accumulation on valves and increased SAg elimination. These data should facilitate better methods to manage these serious illnesses.IMPORTANCEThe Centers for Disease Control and Prevention reported in 2007 thatStaphylococcus aureusis the most significant cause of serious infectious diseases in the United States (R. M. Klevens, M. A. Morrison, J. Nadle, S. Petit, K. Gershman, et al., JAMA 298:1763–1771, 2007). Among these infections are sepsis, infective endocarditis, and acute kidney injury. Infective endocarditis occurs in 30 to 60% of patients withS. aureusbacteremia and carries a mortality rate of 40 to 50%. Over the past decades, infective endocarditis outcomes have not improved, and infection rates are steadily increasing (D. H. Bor, S. Woolhandler, R. Nardin, J. Brusch, D. U. Himmelstein, PLoS One 8:e60033, 2013). There is little understanding of theS. aureusvirulence factors that are key for infective endocarditis development and kidney abscess formation. We demonstrate that superantigens are critical in the causation of all three infections. We show that their association results from both superantigenicity and direct toxic effects on endothelial cells, the latter likely contributing to delayed endothelium healing. Our studies contribute significantly to understanding the development of these illnesses and are expected to lead to development of important therapies to treat such illnesses.

scholarly journals When Should Asymptomatic Persons Be Tested for COVID-19?

2020 ◽  
Vol 59 (1) ◽  
pp. e02563-20
Author(s):  
Audrey N. Schuetz ◽  
Peera Hemarajata ◽  
Ninad Mehta ◽  
Sheldon Campbell ◽  
Stephanie Mitchell ◽  
...  
Keyword(s):  
Medical Knowledge ◽  
Mitigation Measures ◽  
Contact Tracing ◽  
Severe Illness ◽  
Routine Surveillance ◽  
Increased Risk ◽  
Control And Prevention ◽  
American Society ◽  
Asymptomatic Individuals ◽  
American Society For Microbiology

ABSTRACTOn 24 August 2020, the Centers for Disease Control and Prevention (CDC) updated its website to highlight that asymptomatic individuals, even those with exposure to a COVID-19-positive contact, do not necessarily need to be tested unless they have medical conditions associated with increased risk of severe illness from COVID-19. The CDC subsequently updated its guidance on 19 September 2020 to support testing of asymptomatic persons, including close contacts of persons with documented SARS-CoV-2 infection. In this editorial, the American Society for Microbiology Clinical and Public Health Microbiology Committee’s Subcommittee on Laboratory Practices comments on testing of asymptomatic individuals relative to current medical knowledge of the virus and mitigation measures. Specific points are provided concerning such testing when undertaking contact tracing and routine surveillance. Limitations to consider when testing asymptomatic persons are covered, including the need to prioritize testing of contacts of positive COVID-19 cases. We urge the CDC to consult with primary stakeholders of COVID-19 testing when making such impactful changes in testing guidance.

scholarly journals Comparison of Two Culture Methods for Use in Assessing Microbial Contamination of Duodenoscopes

2015 ◽  
Vol 54 (2) ◽  
pp. 312-316 ◽  
Author(s):  
Michaela A. Gazdik ◽  
Jana Coombs ◽  
John P. Burke ◽  
Bert K. Lopansri
Keyword(s):  
Recovery Rate ◽  
Culture Methods ◽  
Strict Adherence ◽  
Content Type ◽  
Carbapenem Resistant ◽  
Control And Prevention ◽  
Gram Negative Organisms ◽  
High Level ◽  
User Friendly ◽  
Recommended Guidelines

Recent outbreaks of carbapenem-resistantEnterobacteriaceaeinfections associated with duodenoscopes used for endoscopic retrograde cholangiopancreatography have highlighted the challenge of cleaning and high-level disinfection of these instruments. The Food and Drug Administration has suggested that duodenoscope surveillance by microbiological culturing, along with strict adherence to reprocessing protocols, may help reduce the risk of duodenoscope-associated infection transmission. We developed and validated an effective, user-friendly duodenoscope sampling and culture protocol and compared its performance to the interim Centers for Disease Control and Prevention–recommended guidelines. Our protocol resulted in a 65% recovery rate for Gram-negative organisms, demonstrating a 2-fold increased recovery rate compared to the CDC method. The implementation of this protocol may increase the feasibility of duodenoscope surveillance for microbiology laboratories and endoscopy departments.

ANOTHER LOOK AT HAND-WASHING BEHAVIOR

2005 ◽  
Vol 33 (7) ◽  
pp. 629-634 ◽  
Author(s):  
Elizabeth Monk-Turner ◽  
Donald Edwards ◽  
Josh Broadstone ◽  
Robert Hummel ◽  
Selena Lewis ◽  
...  
Keyword(s):  
Disease Control ◽  
Hand Washing ◽  
Data Support ◽  
Regional University ◽  
Control And Prevention ◽  
Centers For Disease Control ◽  
American Society ◽  
American Society For Microbiology

Hand-washing behavior among students at a large regional university was observed. The authors noted how hand-washing behavior varied by race, gender, and having an observer present. Of the 410 subjects observed, most (221) were men and 232 were white. The authors expected that more women than men would wash their hands and that few subjects would wash their hands for the time (15 seconds or more) recommended by the American Society for Microbiology (ASM) and the Centers for Disease Control and Prevention (CDC). The data support both of these propositions.

scholarly journals Providing planetary health diet meals to low-income families in Baltimore City during the COVID-19 pandemic

2020 ◽  
pp. 1-9
Author(s):  
Richard Semba ◽  
Rebecca Ramsing ◽  
Nihaal Rahman ◽  
Martin Bloem
Keyword(s):  
Food Insecurity ◽  
Low Income ◽  
Behavioral Problems ◽  
The United States ◽  
Moderate Amount ◽  
Baltimore City ◽  
Planetary Health ◽  
United States Food ◽  
Low Income Families ◽  
High Level

The COVID-19 pandemic has increased food insecurity, especially among low-income Black and His¬panic families in the United States. Food insecurity is associated with poorer health and higher mortality in adults and greater risk of impaired cognitive development and behavioral problems in children. Pro-viding food for low-income families is an important priority of the COVID-19 response. Food That Connects Us All is a program that provides healthy meals to low-income Black and Hispanic families in Baltimore City. The meals follow guidelines for the planetary health diet, a reference diet developed by the EAT-Lancet Commission to optimize health and be sustainable within planetary boundaries. The planetary health diet consists largely of vegetables, fruit, whole grains, legumes, nuts, and unsaturated oils, with a low to moderate amount of seafood and poultry and with little or no red or processed meats, refined grains, starchy vegetables, and added sugar. In a food survey, participants showed a high level of satisfaction with the taste, appearance, and healthfulness of the meals. Food That Connects Us All is a direct approach to reducing health disparities and demonstrates the feasibility of providing an ideal reference diet to vulnerable low-income families at high risk for poor health outcomes during the pandemic.

The interpretation of somatic genetic variants identified with high-throughput sequencing of DNA from paediatric solid tumors

2021 ◽  
pp. 3-25
Author(s):  
М.А. Спектор ◽  
Л.А. Ясько ◽  
А.Е. Друй
Keyword(s):  
Solid Tumors ◽  
High Throughput ◽  
Genetic Variants ◽  
High Throughput Sequencing ◽  
Genetic Research ◽  
The United States ◽  
Sequencing Analysis ◽  
Clinical Implementation ◽  
American Society

Активное внедрение высокопроизводительного секвенирования в клиническую практику требует общего подхода к интерпретации обнаруженных генетических вариантов, в частности, вариантов с соматическим статусом. В 2017 году Ассоциация молекулярной патологии США (AMP), Американская коллегия медицинской генетики и геномики (ACMG), Американское общество клинической онкологии (ASCO) и Коллегия американских патологов (CAP) опубликовали руководство по интерпретации соматических генетических вариантов и выдаче заключений по результатам высокопроизводительного секвенирования опухолевой ДНК. Данный обзор посвящен специфике применения руководства AMP/ACMG/ASCO/CAP для интерпретации результатов генетических исследований детских солидных опухолей. В статье приводятся критерии, на которых основана классификация соматических генетических вариантов, обсуждаются проблемы оценки клинической значимости генетических находок и приводятся примеры классификации генетических вариантов, выявленных в различных типах детских солидных опухолей. Active clinical implementation of high-throughput DNA sequencing requires a common approach to the interpretation of detected genetic variants, including variants with somatic status. In 2017, the United States Association of Molecular Pathology (AMP), the American College of Medical Genetics and Genomics (ACMG), the American Society of Clinical Oncology (ASCO), and the College of American Pathologists (CAP) published the guidelines for interpreting and reporting the somatic genetic variants in cancer identified using high-throughput sequencing analysis. This review focuses on the specific application of the AMP/ACMG/ASCO/CAP guidelines in the field of genetic research on paediatric solid tumors. In particular, the review provides the criteria for classification of somatic genetic variants, discusses the problems of evaluating the clinical significance of genetic findings in paediatric tumors, and provides examples of classification of genetic variants specific for certain types of childhood solid malignancies.

scholarly journals Systems Thinking and Leadership

2018 ◽  
Vol 13 (4) ◽  
pp. 655-662 ◽  
Author(s):  
Leslie P. Wong
Keyword(s):  
Organizational Behavior ◽  
Systems Thinking ◽  
Infection Prevention ◽  
Health Care Systems ◽  
The United States ◽  
Culture Of Safety ◽  
Control And Prevention ◽  
Care Systems ◽  
Dialysis Facilities ◽  
American Society

Infections are the second leading cause of death for patients with ESKD. Despite multiple efforts, nephrologists have been unable to prevent infections in dialysis facilities. The American Society of Nephrology and the Centers for Disease Control and Prevention have partnered to create Nephrologists Transforming Dialysis Safety to promote nephrologist leadership and engagement in efforts to “Target Zero” preventable dialysis infections. Because traditional approaches to infection control and prevention in dialysis facilities have had limited success, Nephrologists Transforming Dialysis Safety is reconceptualizing the problem in the context of the complexity of health care systems and organizational behavior. By identifying different parts of a problem and attempting to understand how these parts interact and produce a result, systems thinking has effectively tackled difficult problems in dynamic settings. The dialysis facility is composed of different physical and human elements that are interconnected and affect not only behavior but also, the existence of a culture of safety that promotes infection prevention. Because dialysis infections result from a complex system of interactions between caregivers, patients, dialysis organizations, and the environment, attempts to address infections by focusing on one element in isolation often fail. Creating a sense of urgency and commitment to eradicating dialysis infections requires leadership and motivational skills. These skills are not taught in the standard nephrology or medical director curriculum. Effective leadership by medical directors and engagement in infection prevention by nephrologists are required to create a culture of safety. It is imperative that nephrologists commit to leadership training and embrace their potential as change agents to prevent infections in dialysis facilities. This paper explores the systemic factors contributing to the ongoing dialysis infection crisis in the United States and the role of nephrologists in instilling a culture of safety in which infections can be anticipated and prevented.

Methyl bromide fumigation and cold storage for disinfestation of Granny Smith apples against Queensland and Mediterranean fruit flies

1982 ◽  
Vol 22 (115) ◽  
pp. 116 ◽  
Author(s):  
LE Rippon ◽  
G Singh ◽  
AN Sproul ◽  
WS Gilbert
Keyword(s):  
Cold Storage ◽  
Methyl Bromide ◽  
Fruit Fly ◽  
The United States ◽  
Maximum Residue Limit ◽  
Aeration Time ◽  
United States Food ◽  
States Food ◽  
Subsequent Storage ◽  
High Level

Granny Smith apples infested with eggs, young or old larvae of Queensland fruit fly, Dacus tryoni (Froggatt.), or Mediterranean fruit fly, Ceratitis capitata (Wiedeman.), were fumigated with 32 g/m3 methyl bromide (MB) for 2 h at 17�C or 10�C followed by cold storage at 1.5 � 0.5�C for periods from 0-1 0 d. With both insects, eggs were recognized as the most tolerant stage. MB alone was ineffective in completely killing any stage, and an additional eight days' cold storage was established as a conservative minimum time to give nil survivors in the most tolerant stage. A high level of security was subsequently demonstrated by the fumigation, in three trials, of at least 10 000 insects at the egg stage and none of them surviving. Initial MB residues ranged from 4.75-3.70 �g/g at 10�C and 17�C, respectively. During subsequent storage at 1.5�C residues declined, the data indicating that more than 60% of the MB reacted in situ with the fruit components. MB residues were not detected 7 d after fumigation. With an aeration time of 2 h at the fumigation temperatures, a period of 3-7 d at 15�C is necessary to avoid MB residues exceeding the maximum residue limit of 0.5 �g/g recommended by the National Health and Medical Research Council of Australia (NHMRC). At no time did inorganic residues exceed the maximum residue limit of 20 �g/g of the NHMRC and Codex, nor the 5 �g/g of the United States Food and Drug Administration.

scholarly journals Context Culture in CDC's Health Alert: For All Travelers

2021 ◽  
Author(s):  
David Randy ◽  
Nawiroh Vera
Keyword(s):  
Cultural Values ◽  
The United States ◽  
Communication Model ◽  
Semiotic Analysis ◽  
Cultural Backgrounds ◽  
Semiotic Model ◽  
American Values ◽  
Control And Prevention ◽  
High Level ◽  
Universal Communication

The high number of covid-19 cases and the US's mortality rate encourage The Centers for Disease Control and Prevention (CDC) to socialize and promote prevention guidance to stop the spreading. One of the preventive measures is by issuing travel warnings. Scholars have noted that the linguistic and cultural concept conveys norms of behavior and values in society at a particular stage of its development. In brief, advertisements messages are influenced by communicators' cultural backgrounds and references. It means the signs in the CDC poster can show American values. To examine and explore those cultural values in CDC publication materials, the authors conducted a semiotic analysis on a poster entitled Health Alert: For All Travelers. The method used is Ferdinand de Saussure's semiotic model. The study shows that the signs presented on the CDC poster are simple, use direct communication structures, and are equipped with universal meaning to understand the message conveyed easily. It indicates a representation of the dominant culture in the United States, the low-context culture with a high level of individualism values. Multidisciplinary research is needed to help create a universal communication model so that messages conveyed in advertisements can reach a wider audience.

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