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Room for Improvement: Results of a Baseline Evaluation of Environmental Cleaning in a Resource-Limited Neonatal Unit
- Angela Dramowski, Marina Aucamp, Adrie Bekker, Kedisaletse Moloto, Sheylyn Pillay, Mark Cotton, Susan Coffin, Andrew Whitelaw
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s50-s51
- Print publication:
- October 2020
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Background: Contamination of the near-patient hospital environment including work surfaces and equipment, contributes to skin colonization and subsequent invasive bacterial infections in hospitalized neonates. In resource-limited settings, cleaning of the neonatal ward environment and equipment is seldom standardized and infrequently audited. Methods: A baseline multimodal assessment of surface and equipment cleaning was performed in a 30-bed high-care neonatal ward in Cape Town, South Africa, October 7–9, 2019. Adequacy of routine cleaning was evaluated using ATP bioluminescence assays, fluorescent ultraviolet (UV) markers, and quantitative bacterial surface cultures. For flat surfaces (eg, tables, incubators, trolleys), a 10×10-cm template was used to standardize the swab inoculum; for small equipment and devices with complex surfaces (eg, humidifiers, suction apparatus, stethoscopes), a standard swabbing protocol was developed for each item. Swabs in liquid transport medium were processed in the laboratory by vortexing for 30 seconds, plating onto blood and MacConkey agars, and incubating at 37°C for 48 hours. Manual counting of bacterial colony forming units was performed, followed by conventional biochemical testing and/or VITEK automated identification. Results: Of 100 swabs (58 from surfaces and 42 from equipment), 11 yielded growth of known neonatal pathogens (Enterobacteriaceae, A. baumannii, P. aeruginosa, S. aureus, S. agalactiae, and enterococci), 36 isolated potential neonatal pathogens (mostly coagulase-negative staphylococci). In addition, 4 grew environmental organisms and 49 showed no growth. The highest aerobic colony counts (ACCs) were obtained from swabs of suction tubing, milk kitchen surfaces, humidifiers, and sinks; the median ACC from swabs with any bacterial growth (n = 51) was 3 (IQR, 1–22). Only 40% of the 100 surface and equipment swabs had ATP values <200 relative light units (RLU) threshold for cleanliness. Median ATP values were 301 (IQ range, 179–732) RLUs for surface swabs versus 230 (IQ range, 78–699) RLUs for equipment swabs (P = .233). Of the 100 fluorescent UV markers placed on near-patient surfaces and high-touch equipment, only 23% had been removed after 2 staff shift changes (24 hours later). Surfaces had a higher proportion of UV marker removal than equipment (19 of 58 [32.8%] vs 4 of 42 [9.5%]; P = .008). Conclusions: Environmental cleaning of this neonatal ward was suboptimal, especially for equipment. Improvement of environmental cleaning practices is an important intervention for neonatal infection prevention in resource-limited settings. Future studies should evaluate the impact of staff training, environmental cleaning tools and repeated audit with feedback, on the adequacy of cleaning in neonatal wards.
Funding: Funding: for the laboratory work was provided by The Society for Healthcare Epidemiology of America (SHEA) International Ambassador Alumni Research Award and a South African Medical Research Council Self-initiated Research (SIR) Grant to Angela Dramowski, who is supported by a NIH Fogarty Emerging Global Leader Award K43 TW010682.
Disclosures: None
1 - Neurological outcome after perinatal asphyxia at term
- from Section 1 - Scientific background
- Edited by A. David Edwards, Denis V. Azzopardi, Alistair J. Gunn
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- Book:
- Neonatal Neural Rescue
- Published online:
- 05 March 2013
- Print publication:
- 04 April 2013, pp 1-15
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Summary
Introduction
It was nearly 150 years ago that an association between perinatal events and brain injury was first reported, claiming that “the act of birth does occasionally imprint upon the nervous and muscular systems of the infantile organism very serious and peculiar evils” [1]. While a great deal is now known about this association and the pathophysiology behind it, the quantification of these “evils” is still uncertain. While the World Health Organisation estimates that 25% of neonatal and 8% of all deaths under 5 years in low-income countries are due to birth asphyxia [2], there remains no agreed definition; therefore, the reported prevalence varies. Consequently, the number of infants exposed is unknown, although approximately 7% of term infants require resuscitation after birth [3]. It is well recognized that only a small proportion of these infants will go on to develop neurological signs in the neonatal period and an estimated 2 per 1000 births in the developed world [4] will develop neonatal encephalopathy.
While encephalopathy is, therefore, relatively uncommon, the outcome can be devastating to the infant and family and it remains a major cause of death and long-term disability with a substantial burden on the community as a whole. It is estimated that each infant with complex neurological sequelae will cost the state over 1 million US dollars (800,000 Euros) in health care, social support and lost productivity throughout their lifetime [5]. In addition, unmeasured impacts on behaviour, school failure and psychiatric disease are likely all to have additive effects. As well as the direct costs, other population impacts are also likely. Increasingly literature suggests a causal link between IQ and lifespan [6] and the true cost to society of perinatal asphyxia is likely to be extensive.
18 - Clinical assessment and therapeutic interventions for hypoxic–ischemic encephalopathy in the full-term infant
- from Section 4 - Clinical aspects
- Edited by Hugo Lagercrantz, Karolinska Institutet, Stockholm, M. A. Hanson, Laura R. Ment, Yale University, Connecticut, Donald M. Peebles, University College London
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- Book:
- The Newborn Brain
- Published online:
- 01 March 2011
- Print publication:
- 07 January 2010, pp 281-300
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Summary
Definition and diagnostic criteria
The term hypoxic–ischemic encephalopathy (HIE) implies a clinically apparent acute disturbance in brain function resulting from a period of critical deprivation of cerebral oxygen delivery and/or blood supply. For the diagnosis of HIE to be upheld there needs to have been obstetric evidence of risk of hypoxia/ischemia to the fetus (e.g., reduced fetal movements, prolapse of the umbilical cord, late decelerations of the fetal heart, fresh meconium, placental abruption, etc.) after which the infant is born in poor condition, with delayed onset of respiration, and is then observed to have cerebral dysfunction (e.g., hypotonia, inability to suck, abnormal posture, clonic movements).
The finding of metabolic acidosis or raised lactate levels in cord blood or blood taken within 30 minutes of birth provides important supporting evidence that there has been acute hypoxia–ischemia at or shortly before delivery. Further support for a global hypoxic–ischemic episode is provided by deranged liver function (raised transaminases), a period of renal impairment with oliguria and raised serum creatinine, cardiac dysfunction, and disseminated intravascular coagulation. The diagnosis of HIE also requires that steps have been taken to rule out other causes of cerebral dysfunction such as infection, preexisting anatomical abnormalities of the brain, or an inherited metabolic disease.
As it is often difficult to be sure if hypoxia–ischemia is the cause of encephalopathy, some authors prefer the term neonatal encephalopathy, which makes no assumptions or exclusions as to etiology.
THE ECONOMETRICS OF FINANCIAL MARKETS
- John Y. Campbell, Andrew W. Lo, A. Craig MacKinlay, Robert F. Whitelaw
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- Journal:
- Macroeconomic Dynamics / Volume 2 / Issue 4 / December 1998
- Published online by Cambridge University Press:
- 01 December 1998, pp. 559-562
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This book is an ambitious effort by three well-known and well-respected scholars to fill an acknowledged void in the literature—a text covering the burgeoning field of empirical finance. As the authors note in the preface, there are several excellent books covering financial theory at a level suitable for a Ph.D. class or as a reference for academics and practitioners, but there is little or nothing similar that covers econometric methods and applications. Perhaps the closest existing text is the recent addition to the Wiley Series in Financial and Quantitative Analysis. written by Cuthbertson (1996). The major difference between the books is that Cuthbertson focuses exclusively on asset pricing in the stock, bond, and foreign exchange markets, whereas Campbell, Lo, and MacKinlay (henceforth CLM) consider empirical applications throughout the field of finance, including corporate finance, derivatives markets, and market microstructure. The level of anticipation preceding publication can be partly measured by the fact that at least three reviews (including this one) have appeared since the book arrived. Moreover, in their reviews, both Harvey (1998) and Tiso (1998) comment on the need for such a text, a sentiment that has been echoed by numerous finance academics.