Xenex Disinfection Services (United States)

Клиническая иммунология

Objectives:Although routine disinfection of portable medical equipment is required inmost hospitals, frontline staff may not be able to disinfect portablemedical equipment at a rate that adequately maintains low bioburden onhigh-use equipment. This study quantified bioburden over an extended timeperiod for two types of portable medical equipment, workstations on wheelsand vitals machines, across three hospital wards.Methods:Bioburden was quantified via press plate samples taken from high touchsurfaces on 10 workstations on wheels and 5 vitals machines on each of 3medical surgical units. The samples were taken at three timepoints each dayover a 4-week period, with random rotation of timepoints and portablemedical equipment, such that frontline staff were not aware at whichtimepoint their portable medical equipment would be sampled. The meanbioburden from the different locations and portable medical equipment wasestimated and compared with Bayesian multilevel negative binomial regressionmodels.Results:Model estimated mean colony counts (95% credible interval) were 14.4(7.7–26.7) for vitals machines and 29.2 (16.1–51.1) for workstations onwheels. For the workstations on wheel, colony counts were lower on themouse, 0.22 (0.16–0.29), tray, 0.29 (0.22, 0.38), and keyboard, 0.43(0.32–0.55), when compared to the arm, as assessed by incident rateratios.Conclusions:Although routine disinfection is required, bioburden is still present acrossportable medical equipment on a variety of surfaces. The difference inbioburden levels among surfaces likely reflects differences in touchpatterns for the different portable medical equipment and surfaces on theportable medical equipment. Although the association of portable medicalequipment bioburden to healthcare-associated infection transmission was notassessed, this study provides evidence for the potential of portable medicalequipment as a vector for healthcare-associated infection transmissiondespite hospital disinfection requirements.

Whether COVID-19 vaccination and the associated immune response increases susceptibility to immune-related adverse events (irAEs) among patients treated with immune checkpoint inhibition (ICI) remains unknown. Short-term follow-up can assess the safety of concurrent administration of the vaccine and ICI treatment. We conducted an electronic health record analysis of a cohort of 408 patients with cancer receiving ICI therapy and who were vaccinated for COVID-19 between January 16 and March 27, 2021. Patients were seen in follow-up for 90 days from the day of the first dose in this single-institution tertiary care center. We evaluated the incidence of irAEs and the frequency of each event type and grade among patients who experienced an irAE. We also evaluated the incidence of irAEs in patients who began a new immunotherapy agent after vaccination. Among 408 patients with cancer receiving ICI therapy (median age, 71 years; 217 [53%] male), administration of a COVID-19 mRNA vaccine within 90 days of ICI treatment was not associated with an increased incidence of irAEs. A total of 27 (7%) patients experienced a new irAE within the observation period. Among patients with previous irAEs from ICIs (n=54), 3 (6%) experienced a recurrent irAE, and of those initiating a new immunotherapy (n=52), 9 (17%) experienced an irAE. No excess risk of COVID-19 diagnosis was seen in this subset of patients receiving ICI therapy, and no breakthrough COVID-19 cases were seen after full COVID-19 vaccination. These findings should reassure providers that COVID-19 vaccination during ICI therapy is safe and efficacious.

BackgroundKlebsiella pneumoniae is among the leading causes of healthcare-associated infections (HAI). Multidrug-resistant (MDR) Klebsiella variants are difficult to treat and have been reported with increasing frequency in hospitals. Whole genome multi-locus sequence typing (wg-MLST) of K. pneumoniae HAI isolates was used to compare antibiotic resistance genetic patterns against epidemiologic typing.Figure 1. Prevalence of ABX resistance genes for each drug class.Figure 2. Prevalence of ABX resistance genes by hospital.MethodsForty-six clinical bacterial HAI isolates were collected from patients admitted to two disparate tertiary care hospitals in Detroit, Michigan between 2017 and 2019. Data output from wg-MLST was de novo assembled using SPAdes (version 3.7.1) assembler on the Bionumerics calculation engine. Minimum spanning tree (MST) analysis categorized isolates into unique MLST Pasteur serotypes (ST). Antimicrobial resistance genes and/or chromosomal mutations were identified using the ResFinder Database (version 3.2). K. pneumoniae isolates were compared for antibiotic-resistance patterns by hospital, unit, and ST.Figure 3. Hospital 1 clusters and strains that detected gene qnr1, arranged by unit for visual comparison.Figure 4. Sample of clinically significant genes and prevalence, excluding SHV family of genes for simplicity.ResultsThere was significant genetic diversity among the isolates, and no predominant strain was identified. MST analysis revealed 17 unique strains. Only six strains had genetically unique resistance genes detected in more than one isolate, and only three of six were hospital-specific; none were unit-specific. Out of the 75 unique resistance genes detected, only 8 genes had a prevalence >50%: oqxA (100%), oqxB (100%), fosA (89%), blaCTX-M-15 (76%), aac(6’)-Ib-cr (61%), blaTEM-1B (52%), blaOXA-1 (52%), and catB3 (52%). No colistin resistance genes were detected. Of the remaining 69 low-prevalence resistance genes, only 8 hospital-specific genes were detected in more than one isolate (qnrB1, blaSHV-1, blaSHV-110, ac(6’)-Ib3, blaCTX-M-3, blaSHV-36, blaSHV-80, blaSHV-178) with a prevalence range of 4%-22%.ConclusionOur genetic analysis of antibiotic resistance patterns and wg-MLST revealed significant heterogeneity among the isolates, indicating no common source of transmission for either hospital. Although K. pneumoniae is a very common nosocomial pathogen, etiologic analysis suggests diverse community strains (e.g., gut colonization) may actually be responsible for previously-designated HAI.DisclosuresChetan Jinadatha, MD, MPH, AHRQ (Research Grant or Support)Department of Veterans Affairs (Other Financial or Material Support, Owner: Department of Veterans Affairs. Licensed to: Xenex Disinfection System, San Antonio, TX)Inventor (Other Financial or Material Support, Methods for organizing the disinfection of one or more items contaminated with biological agents)NiH/NINR (Research Grant or Support)NSF (Research Grant or Support)Xenex Healthcare Services (Research Grant or Support) Mark Stibich, PhD MHS, Xenex Disinfection Services, Inc (Board Member, Employee)

Typization of natural foci of HFRS of the Republic of Bashkortostan and differentiation of their territories. by the degree of potential epidemic hazard. Materials of epizootologic and epidemiologic monitoring of natural foci of HFRS of the Republic of Bashkortostan for 1980 - 2014 were used. Evaluation of area of territory with high, medium and low potential epidemic hazard by HFRS was carried out taking into account multi-year param- eters of morbidity by administrative districts of the Republic of Bashkortostan. 3 gradations of morbidity level by HFRS - more than 201, 101 - 200, less than 100 per 100 thousand of the population - were used for epidemiologic differentiation ofthe territory. 3 main landscape- epidemiologic types of HFRS foci were isolated - forest, forest-barrens, barrens, as well as their landscape variants. The area with a high degree of potential epidemic hazard by HFRS was estab= lished to be around 3.8%; medium - 15.9%, low - 80.3%.of the whole territory of the Republic of Bashkortostan. -A necessity of a differentiated approach to territories with various degree of potential epidemic hazard by HFRS is justified during execution of prophylaxis activi- ties.

The standard for Clostridium difficile surface decontamination is bleach solution at a concentration of 10 % of sodium hypochlorite. Pulsed xenon UV light (PX-UV) is a means of quickly producing germicidal UV that has been shown to be effective in reducing environmental contamination by C. difficile spores. The purpose of this study was to investigate whether PX-UV was equivalent to bleach for decontamination of surfaces in C. difficile infection isolation rooms. High-touch surfaces in rooms previously occupied by C. difficile infected patients were sampled after discharge but before and after cleaning using either bleach or non-bleach cleaning followed by 15 min of PX-UV treatment. A total of 298 samples were collected by using a moistened wipe specifically designed for the removal of spores. Prior to disinfection, the mean contamination level was 2.39 c.f.u. for bleach rooms and 22.97 for UV rooms. After disinfection, the mean level of contamination for bleach was 0.71 c.f.u. (P = 0.1380), and 1.19 c.f.u. (P = 0.0017) for PX-UV disinfected rooms. The difference in final contamination levels between the two cleaning protocols was not significantly different (P = 0.9838). PX-UV disinfection appears to be at least equivalent to bleach in the ability to decrease environmental contamination with C. difficile spores. Larger studies are needed to validate this conclusion.