Identifying a competency improvement strategy for infection prevention and control professionals:A rapid systematic review and cluster analysis

Remarkable progress has been made in infection prevention and control(IPC)in many countries,but some gaps emerged in the context of the coronavirus disease 2019(COVID-19)pandemic.Core capabilities such as standard clinical precautions and tracing the source of infection were the focus of IPC in medical institutions during the pandemic.Therefore,the core competences of IPC professionals during the pandemic,and how these contributed to successful prevention and control of the epidemic,should be studied.To investigate,using a systematic review and cluster analysis,fundamental improvements in the competences of infection control and prevention professionals that may be emphasized in light of the COVID-19 pandemic.We searched the PubMed,Embase,Cochrane Library,Web of Science,CNKI,WanFang Data,and CBM databases for original articles exploring core competencies of IPC professionals during the COVID-19 pandemic(from January 1,2020 to February 7,2023).Weiciyun software was used for data extraction and the Donohue formula was followed to distinguish high-frequency technical terms.Cluster analysis was performed using the within-group linkage method and squared Euclidean distance as the metric to determine the priority competencies for development.We identified 46 studies with 29 high-frequency technical terms.The most common term was“infection prevention and control training”(184 times,17.3%),followed by“hand hygiene”(172 times,16.2%).“Infection prevention and control in clinical practice”was the most-reported core competency(367 times,34.5%),followed by“microbiology and surveillance”(292 times,27.5%).Cluster analysis showed two key areas of competence:Category 1(program management and leadership,patient safety and occupational health,education and microbiology and surveillance)and Category 2(IPC in clinical practice).During the COVID-19 pandemic,IPC program management and leadership,microbiology and surveillance,education,patient safety,and occupational health were the most important focus of development and should be given due consideration by IPC professionals.

Efficacy of spray flushing in the reprocessing of flexible endoscopes:A randomized controlled trial

BACKGROUND Commonly used cleaning brushes in the reprocessing of flexible endoscopes often cause damage within the working channels.AIM To develop a spray flushing system to achieving effective cleaning of the working channels while minimizing damage.METHODS This prospective study included 60 used endoscopes and 60 Teflon tubes randomly divided into a control group(n=30)and an experimental group(n=30).The material of Teflon tubes was the same as that of the endoscope working channel.Endoscopes in the control group were manually cleaned using traditional cleaning brushes,while those in the experimental group were cleaned using the newly developed spray flushing system.ATP levels,cleanliness,and microbiological testing of the working channels were measured.Additionally,Teflon tubes in the control group underwent 500 passes with a cleaning brush,while those in the experimental group were subjected to the spray flushing system,and channel damage was evaluated.RESULTS The ATP levels(RLU)in the two groups were 32.5(13-66)and 26(16-40),respectively(P>0.05).Cleanliness scores were 1.5(1-2)and 1(1-2),respectively(P>0.05).Debris was found in 73.3%of the control group,which was significantly higher than 46.7%in the experimental group(P<0.05).Microbiological tests for both groups yielded negative results.Teflon tube damage in the control group was rated at 4(4-5.25),which was significantly higher than in the experimental group 4(3-4)(P<0.01).CONCLUSION The spray flushing system demonstrated superior efficacy in removing debris and resulted in less damage to the endoscope working channels compared with traditional cleaning brushes.

Acute hepatitis B of genotype H resulting in persistent infection

A 47-year-old man presented with general fatigue and dark urine.The laboratory data showed increased levels of hepatic transaminases.The patient was positive for hepatitis B virus(HBV)markers and negative for antihuman immunodeficiency virus.The HBV-DNA titer was set to 7.7 log copies/mL.The patient was diagnosed with acute hepatitis B.The HBV infection route was obscure.The serum levels of hepatic transaminases decreased to normal ranges without any treatment,but the HBVDNA status was maintained for at least 26 mo,indicating the presence of persistent infection.We isolated HBV from the acute-phase serum and determined the genome sequence.A phylogenetic analysis revealed that the isolated HBV was genotype H.In this patient,the elevated peak level of HBV-DNA and the risk alleles at human genome single nucleotide polymorphisms s3077and rs9277535 in the human leukocyte antigen-DP locus were considered to be risk factors for chronic infection.This case suggests that there is a risk of persistent infection by HBV genotype H following acute hepatitis;further cases of HBV genotype H infection must be identified and characterized.Thus,the complete determination of the HBV genotype may be essential during routine clinical care of acute hepatitis B outpatients.

Selection of Health Care Workers for Screening for Latent Tuberculosis Infection

Introduction: The rate of latent tuberculosis infections (LTBIs) in health care workers (HCWs) is higher than that in non-HCWs. We studied to investigate the prevalence and risk factors of LTBIs and the acceptance rate for treatment of LTBI among HCWs in South Korea, a country with an intermediate tuberculosis (TB) burden. Methodology: LTBI screening was conducted for HCWs at a tertiary and a secondary hospital from April 2017 to August 2017. This was a retrospective study included all HCWs who underwent LTBI examination. HCWs were classified by the degree of risk into four groups, based on two factors: possibility of exposure to TB, and impact on patients at the time of TB onset in the HCWs. The interferon-gamma release assay was used for the diagnosis of LTBI. Results: A total of 1326 HCWs were included;they comprised 801 HCWs from a tertiary hospital and 525 from a secondary hospital. A total of 235 (17.7%) HCWs were diagnosed with LTBIs. According to risk classification, there was no significant difference (P = 0.24). In multivariate analysis, age was the only independent risk factor (P Conclusions: HCWs did not show any significant difference in the rate of LTBI by the degree of risk, and age was the independent risk factor. LTBI screening should be conducted for all HCWs regardless of risk classification.

Co-infection with Neisseria mucosa in a patient with tuberculous otitis media

Tuberculous otitis media(TOM) is a rare manifestation caused by Mycobacterium tuberculosis with low incidence rates among extrapulmonary tuberculosis cases. Diagnosis is often delayed because of the presence of several clinical manifestations and the high prevalence of secondary bacterial infections. Few reports have attributed secondary bacterial infections in patients with TOM to commensal Neisseria. Thus, understanding the pathogenic mechanisms and clinical features of commensal Neisseria is important, considering its recent presentation as an infection-causing pathogen. Neisseria mucosa is a commensal inhabitant in humans and is generally considered non-pathogenic but can cause infection in rare cases. Here, we report an atypical secondary infection caused by Neisseria mucosa in an 81-year-old woman with TOM being treated for pulmonary tuberculosis. Direct purulent otorrhea smear microscopy revealed no acid-fast bacilli using Ziehl-Neelsen staining, whereas the phagocytosis of gram-negative cocci by white blood cells was confirmed using Gram staining. Otorrhea culture revealed the growth of N. mucosa. Subsequently, M. tuberculosis infection in the otorrhea was identified using a culture-based method. Vigilance is critical for the early detection of TOM to prevent further complications. This report raises awareness regarding TOM and provides insight into the pathogenicity of N. mucosa in otitis media.

Assessment of Appropriateness of Diagnostic Lymph Node Tissue Collection from the Operating Theater and by Interventional Radiologist. A Clinical Audit

Background: Appropriate sample requesting, collecting and timely dispatch to the appropriate laboratory is essential in establishing diagnosis of pathologies with lesions. Much time and effort may be wasted if this is not done according to certain standards. We conducted this study to assess the route of lymph node samples from requests to reaching the laboratories. Methods: We conducted an audit over a period from 4th June until 10th Aug 2023. Data for all the procedures performed over this period on lymph node samples (was entered into and analysed using Excel. Results: A total of eighteen samples for sixteen patients were obtained during this period. Median age of the patients was 34 years (19 - 73) with a M:F ratio of 5:11. Among the IR samples, nine samples were from the neck, three from inguinal area and one from axilla. Seven samples (53.8%) were tru-cut biopsies, six samples (46.15%) were FNA. All samples were sent to the pathology laboratory fixed in formalin. Samples for TB were sent only for five cases (31.25%) and for only two cases (12.5%) were samples sent for bacterial culture. For the OR samples, none were sent for either bacterial culture or TB. Overall, eight patients (50%) were not investigated for any infectious etiologies like brucella, toxoplasmosis, CMV, EBV plus other possible causes. Repeat sampling was required for 25% of patients (within and out of the audit period). Conclusions: to avoid delays in making diagnoses, it is paramount to consider infectious etiologies as possible diagnosis for lymphadenopathy and request appropriate investigations. This requires liaising with infectious diseases/clinical microbiology experts to guide regarding types of samples, types of media and timely dispatch to the correct laboratory.

Helicobacter pylori infection and liver diseases: Epidemiology and insights into pathogenesis

Both Helicobacter pylori(H. pylori) infection and liver diseases, including nonalcoholic fatty liver disease(NAFLD), viral hepatitis, and hepatocellular carcinoma(HCC), have high prevalences worldwide, and the relationship between H. pylori infection and liver disease has been discussed for many years. Although positive correlations between H. pylori and NAFLD have been identified in some clinical and experimental studies, nega-tive correlations have also been obtained in high-quality clinical studies. Associations between H. pylori and the pathogenesis of chronic viral hepatitis, mainly disease progression with fibrosis, have also been suggested in some clinical studies. Concerning HCC, a possible role for H. pylori in hepatocarcinogenesis has been identified since H. pylori genes have frequently been detected in resected HCC specimens. However, no study hasrevealed the direct involvement of H. pylori in promoting the development of HCC. Although findings regarding the correlations between H. pylori and liver disease pathogenesis have been accumulating, the existing data do not completely lead to an unequivocal conclusion. Further high-quality clinical and experimental analyses are necessary to evaluate the efficacy of H. pylori eradication in ameliorating the histopathological changes observed in each liver disease.

Comparison of LAMP,GeneXpert,Mycobacterial Culture,Smear Microscopy,TSPOT.TB,TBAg/PHA Ratio for Diagnosis of Pulmonary Tuberculosis

Objective:To investigate the application value of loop-mediated isothermal amplification(LAMP),GeneXpert,mycobacterial culture,smear microscopy,TSPOT.TB(TSPOT),ratio of TB-specific antigen to phytohemagglutinin(TBAg/PHA ratio)in the detection of mycobacterium tuberculosis in the bronchoalveolar lavage fluid.Methods:A retrospective analysis was performed on the patients who underwent bronchoscopy from December 2018 to November 2019 in Tongji Hospital.The patients with positive tuberculosis culture or positive GeneXpert in bronchoalveolar lavage fluid were selected as the case group,and those without tuberculosis served as the control group.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of LAMP,GeneXpert,culture,smear microscopy,TSPOT,and TBAg/PHA ratio.Results:For the patients with positive cultures as case,the sensitivity of LAMP,GeneXpert,smear microscopy,TSPOT and TBAg/PHA ratio was 73.49%,89.16%,25.30%,80.00%,33.85%,respectively,the specificity was 99.00%,100.00%,99.00%,86.00%,100.00%,respectively,the area under the ROC curve(AUC)was 0.849,0.938,0.633,0.830,0.669,respectively.For the patients with positive GeneXpert as case,the sensitivity of LAMP,mycobacterial culture,smear microscopy,TSPOT and TBAg/PHA ratio was 73.20%,74.23%,22.68%,68.92%,29.73%,respectively,the specificity was 99.00%,100.00%,99.00%,86.00%,100.00%,respectively,the AUC was 0.853,0.878,0.623,0.775,0.649,respectively.Conclusion:The sensitivity of GeneXpert was best.The sensitivity and diagnostic value of LAMP were slightly lower than those of GeneXpert,and were similar to tuberculosis culture.The sensitivity of smear microscopy was low.The specificity of TSPOT was low.When TBAg/PHA ratio>0.2 was used as a diagnostic index,the specificity was improved,but the sensitivity was low.

Comparison of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol and total cholesterol/high-density lipoprotein cholesterol for the prediction of thin-cap fibroatheroma determined by intravascular optical coherence tomography

Background The correlation among the ratios of low-density lipoprotein cholesterol/high-density lipoprotein cholesterol(LDL-C/HDL-C), total cholesterol/high-density lipoprotein cholesterol(TC/HDL-C) and thin-cap fibroatheroma has not yet been established. Methods It was a single center, retrospective observational study. In total, we recruited 421 patients(82.4% men;mean age 65.73 ± 10.44 years) with one culprit vessel which determined by intravascular optical coherence tomography(OCT). The thinnest-capped fibroatheroma(TCFA) group was defined as lipid contents in > 2 quadrants, with the thinnest fibrous cap measuring less than 65 μm. Univariate and multivariate logistic regression were carried out to explore the relationship between lipoprotein ratios, TCFA and other characteristics of plaque. To compare different ratios, the area under curve(AUC) of receiver-operating characteristic(ROC) curve was assessed. Results OCT was performed in 421 patients(TCFA group(n = 109), non-TCFA group(n = 312)). LDL-C/HDL-C in the TCFA group was significantly higher than in the non-TCFA group(2.95 ± 1.20 vs. 2.43 ± 0.92, P < 0.05), as was TC/LDL in TCFA and non-TCFA group(4.57 ± 1.58 vs. 4.04 ± 1.13, P < 0.05). Both LDL-C/HDL-C(OR: 1.002(1.002-1.003), P < 0.05) and TC/HDL-C(OR: 1.001(1.001-1.004), P < 0.05) were considered independent factors for the prediction of TCFA according to the logistic regression. Based on the AUC comparison, LDL-C/HDL-C and TC/HDL-C had no significant difference statistically(LDL-C/HDL-C AUC: 0.63;TC/HDL-C AUC: 0.61;P = 0.10) for the prediction of TCFA. Conclusions LDL-C/HDL-C and TC/HDL-C could be the independent factors for predicting the presence of TCFA, indicating coronary plaque vulnerability in CAD patients. Moreover, TC/HDL-C also showed a comparative performance for the prediction of TCFA as LDL-C/HDL-C.

Identification of a Homozygous Missense Mutation in the TYR Gene in a Chinese Family with OCA1

Oculocutaneous albinism (OCA)is an autosomal recessive pigmentation abnormality,characterized by variable hair,skin,and ocular hypopigmentation.OCA1 is the most frequent subtype of OCA,caused by mutations in the tyrosinase gene (TYR). In this study,we investigated the genetic mutation of a Chinese family with a female OCA patient who came for genetic counseling before pregnancy.Complete physical examination was performed,and DNA from blood samples was collected from the family members.Mutations of TYR,OCA2,and SLC45A2 genes were examined in the proband, and verified in her parents by Sanger sequencing.Large deletion or duplication of TYR and OCA2 genes was detected by multiplex ligation-dependent probe amplification (MLPA).A homozygous TYR c.307T>C (p.Cys103Arg)missense mutation was identified in the proband,and both parents were heterozygous carriers.No large deletion or duplication was found in the proband.This mutation was absent in 1000G,ExAC,or HGMD database,and multiple lines of in silico tools supported a deleterious effect.These results suggest that TYR c.307T>C mutation might be responsible for OCA1,and our study further expands the mutation spectrum of OCA1 in the Chinese population.

The expression of Elf-1 and Ki-67 and their correlations in non-small-cell lung cancer

Objective: Elf-1 is a member of the proto-oncogenes Ets-related transcription factor family and over-expressed in many human tumors, Ki-67 is an important nuclear antigen associated with cell proliferation. This study investigated the expression of Elf-1 and Ki-67 in non-small-cell lung cancer(NSCLC) and studied their correlation with the clinicopathological features. Methods: Tissue microarray from 64 cases lung cancer tissue and 10 cases normal lung tissue was constructed, immunohistochemical method was used to evaluate the protein expressions of Elf-1 and Ki-67, correlations of the expression of Elf-1 and Ki-67 to clinicopathological features of NSCLC were analyzed. Results: Expression of Elf-1 and Ki-67 in NSCLC tissues were significantly higher than in normal lung tissues(P < 0.05), the positive rate of Elf-1 and Ki-67 was 73.44% and 64.06% in NSCLC group, Overexpression of Elf-1 in NSCLC was significantly related to histopathological grading, different clinical staging and the intensity of ELF-1 expression was significantly higher in the group with lymph node metastasis than that without(P < 0.05). Overexpression of Ki-67 was also closely related to tumor differentiation, clinical stages and lymph node metastasis(P < 0.05). In addition positive correlation was found between the expressive intensity of Elf-1 and Ki-67(τ = 0.295, P = 0.018). Conclusion: The high expression and positive correlation of Elf-1 and Ki-67 in NSCLC suggest that they probably play a role in onset and progression of lung cancer, united detecting their expression could be used as an valuable molecular biological index for predicting the malignant behavior and early diagnosis of NSCLC.

Antibacterial resistance patterns of Acinetobacter baumannii complex:The results of Isfahan Antimicrobial Resistance Surveillance-1 Program

Objective: To determine the antibiotic resistance patterns of the Acinetobacter(A.) baumannii complex isolates that cause the confirmed infection. Methods: The present descriptive study was performed from March 2016 to March 2018 in three referral hospitals in Isfahan, Iran. All A. baumannii complex strains isolated from different clinical samples were identified by conventional phenotypic methods and antibiotic susceptibility pattern was detected. After the clinical investigation, contaminated samples were excluded and the source(hospital/community) and site of the infection were determined. Data on antibiotic susceptibility testing were extracted from WHONET software and analysis was done with SPSS.Results: From 254 patients who had confirmed A. baumannii complex infection, 158(62.20%) cases were male, 27(10.63%) were less than 20 years old, 172(67.72%) had healthcare-associated infections and 96(37.79%) were admitted in intensive care units. The most frequent infection was bloodstream infections(111, 43.70%). Our results showed that most of the isolates were resistant to most of the antibiotics(more than 75.00%) and a lower rate of non-susceptibility was observed against minocycline(20, 44.44%) and colistin(0%). The rate of multidrug-resistant isolates was 88.97%. There was no significant difference between resistance of A. baumannii complex isolates according to age. However, the resistance to amikacin and minocycline and the rate of multidrug resistance(MDR) were significantly different between males and females. In patients with healthcare associated infection(HAI), MDR isolates were significantly different regarding admission in ICU ward. Resistance to levofloxacin and ciprofloxacin were lower in isolates from patients with bloodstream infections in comparison to other diagnoses.Conclusions: In our study, a high level of antibiotic resistance was detected in both community-acquired and healthcare-associated A. baumannii complex infections. Appropriate antibiotic prescription in a clinical setting is an essential need for the control and prevention of A. baumannii resistant infections.

Functional coupling of V-ATPase and CLC-5

Dent’s disease is an X-linked renal tubulopathy characterized by low molecular weight proteinuria, hypercalciuria and progressive renal failure. Disease aetiology is associated with mutations in the CLCN5 gene coding for the electrogenic 2Cl-/H＋ antiporter chloride channel 5 （CLC-5）, which is expressed in the apical endosomes of renal proximal tubules with the vacuolar type H＋-ATPase （V-ATPase）. Initially identified as a member of the CLC family of Cl- channels, CLC-5 was presumed to provide Cl shunt into the endosomal lumen to dissipate H＋ accumulation by V-ATPase, thereby facilitating efficient endosomal acidification. However, recent findings showing that CLC-5 is in fact not a Cl- channel but a 2Cl-/H＋ antiporter challenged this classical shunt model, leading to a renewed and intense debate on its physiological roles. Cl- accumulation via CLC-5 is predicted to play a critical role in endocytosis, as illustrated in mice carrying an artifcial Cl- channel mutation E211A that developed defective endocytosis but normal endo-somal acidification. Conversely, a recent functional analysis of a newly identifed disease-causing Cl- channel mutation E211Q in a patient with typical Dent’s disease confrmed the functional coupling between V-ATPase and CLC-5 in endosomal acidifcation, lending support to the classical shunt model. In this editorial, we will address the current recognition of the physiological role of CLC-5 with a specific focus on the functional coupling of V-ATPase and CLC-5.

Is Dose Adjustment Based on Several Factors of Body Size Descriptors Effective for Prevention of Thrombocytopenia by Linezolid Therapy in Hemodialysis Patients?

Previous study suggested that low body weight was one of the risk factors of thrombocytopenia induced by linezolid in non-hemodialysis patients. However, there have been little investigations for the linezolid-induced thrombocytopenia in hemodialysis patients. This study was to evaluate the association between several factors of body size descriptors and thrombocytopenia in hemodialysis-patients. No factor of body size descriptors showed significant correlation with linezolid-induced thrombocytopenia (patients with thrombocytopenia vs patients without thrombocytopenia: body weight;60.0 kg vs 55.3 kg, p = 0.82: body mass indices;21.1 kg/m2 vs 21.2 mg/m2, p = 0.44: ideal body weight;61.2 kg vs 59.5 kg, p = 0.21: lean body weight;50.1 kg vs 45.7 kg, p = 0.64: dosage amount;20.0 mg/kg vs 21.7 mg/kg, p = 0.74: body surface area;1.65 m2 vs 1.54 m2, p = 0.43). There were not significant differences in the body size descriptors between linezolid therapy for more than 14 days and for less than 13 days (more than 14 days vs less than 13 days: body weight;53.5 kg vs 56.8 kg, p = 0.75: body mass indices;20.9 kg/m2 vs 21.1 mg/m2, p = 0.47: ideal body weight;60.3 kg vs 59.9 kg, p = 0.17: lean body weight;44.3 kg vs 47.7 kg, p = 0.56: dosage amount;22.4 mg/kg vs 21.1 mg/kg, p = 0.67: body surface area;1.51 m2 vs 1.59 m2, p = 0.37). Our data suggested that dosage adjustment of linezolid based on body weight was not recommended in hemodialysis-patients.

Clinical and laboratory features of COVID-19 patients infected with SARS-CoV-2 variant B.1.1.7 versus those infected with other SARS-CoV-2 strains:A retrospective observational study

Objective:To investigate the clinical symptoms of coronavirus disease 2019(COVID-19)patients with and without B.1.1.7 mutation.Methods:This retrospective observational study included COVID-19 patients who were divided into two groups,the mutation and the non-mutation group.Demographics characteristics,clinical characteristics,laboratory parameters,and mortality rates were recorded and compared between the two groups.Results:A total of 196 patients were included in the study.The relationship between the mutant virus status and sex,age,comorbidity,survival status,and disease severity was not significant(P>0.05).No significant differences were found in duration of hospitalization between the mutation and the non-mutation group(P>0.05).However,there was a statistically significant difference between patients with and without mutant viruses in hemoglobin,mean platelet volume,procalcitonin,low density lipoprotein,iron-binding capacity,potassium,calcium,C-reactive protein,folate,creatine kinase myocardial band,D-dimer,and international normalized ratio(P<0.05).Conclusions:No significant difference is found in mortality rate,disease severity or duration of hospitalization between the patients with and without variant B.1.1.7.Careful monitoring of COVID-19 patients is required for all variants.

Mechanisms of Steatosis-Derived Hepatocarcinogenesis:Lessons from HCV Core Gene Transgenic Mice

Hepatitis C virus(HCV)is a major cause of chronic hepatitis,liver cirrhosis,and hepatocellular carcinoma(HCC)worldwide.Among the structural proteins of HCV,the HCV core protein has the ability to regulate gene transcription,lipid metabolism,cell proliferation,apoptosis,and autophagy,all of which are closely related to the development of HCC.Transgenic mice carrying the HCV core gene exhibited age-dependent insulin resistance,hepatic steatosis,and HCC that resembled the clinical characteristics of chronic hepatitis C patients.Several dietary modifications,including calorie restriction and diets rich in saturated fatty acids,trans fatty acids,or cholesterol,were found to influence hepatic steatogenesis and tumorigenesis in HCV core gene transgenic mice.These strategies modulated hepatocellular stress and proliferation,in addition to hepatic fibrotic processes and the microenvironment,thereby corroborating a close interconnection between dietary habits and steatosis-related hepatocarcinogenesis.In this review,we summarize the findings obtained from mouse models transgenic for the HCV genome,with a special focus on HCV core gene transgenic mice,and discuss the mechanisms of steatogenesis and hepatocarcinogenesis induced by the HCV core protein and the impact of dietary habits on steatosis-derived HCC development.

Possibility of Extension of Pre-operative Patient Preparation by Antiseptic Shower at the University Hospital Brno

Ensuring complex pre-operative patient preparation before planned surgery is an essential preventive measure of SSIs （surgical site infections）. The aim of this study was to evaluate the difference in the effectiveness of the use of common soap and a tested product to reduce the occurrence of bacterial microorganisms on the skin surface in the area of the assumed surgical incision. Two hypotheses have been identified： H0： the tested product can be considered as beneficial for common pre-operative patient preparation in the incision area in order to significantly reduce the microbial load （decrease in CFU on a defined area of the blood agar by half of the original number and less）. H1： the tested product exceeds common soap by at least 20% when reducing the microbial load in the incision area. There were 80 microbiological prints examined on filter paper using the cultivation method on culture medium. The statistical method of the classic hypothesis test on the binomial distribution parameter versus the one-sided alternative has been used to process the results for the occurrence of microorganisms. The statistical processing of the results obtained by microbiological examination of prints allows for the confirmation of H0 and rejection of the H1 hypothesis. The results have shown the importance of proper pre-operative hygiene of the patient’s skin, regardless of the detergent base.

A Human T Lymphotropic Virus Type 1 Carrier Coinfected with <i>Mycobacterium intracellulare</i>and <i>Pneumocystis jirovecii</i>with a Characteristic Compositional Change of Bone Marrow Cells

Human T lymphotropic virus type 1 (HTLV-1) is endemic in the southern part of Japan. Infection of the virus can cause adult T cell leukemia/lymphoma (ATL), while most infected individuals remain in a carrier state for a long period of time. Although rare cases of carriers, like ATL patients, who developed opportunistic infections, have been reported, hematological changes of carriers who are prone to opportunistic infections have not been well defined. Here, we present a case of an HTLV-1 carrier who developed Mycobacterium intracellulare infection and Pneumocystis jirovecii pneumonia (PcP) simultaneously. Flow cytometric analysis of bone marrow cells revealed an aberrant compositional change similar to that in ATL patients. This suggests the presence of a pre-ATL state prior to the development of ATL, which is notable in terms of underlying cellular immunodeficiency.

New evidence-based clinical practice guideline timely supports hospital infection control of coronavirus disease 2019

The outbreak of the coronavirus disease 2019(COVID-19,previously named 2019-nCoV)has become a serious public health situation in China.1,2 As of February 18,2020,over 70000 patients were diagnosed with COVID-19,including thousands of healthcare providers.Chinese hospitals,especially those in Hubei Province,are facing increasing admission of infected patients,and the epidemics involve hospitals across all levels.

Impact of relocation and environmental cleaning on reducing the incidence of healthcare-associated infection in NICU

Background:Hospital environment remains a risk for healthcare-associated infections (HAIs).This was a prospective study to evaluate the comprehensive impact of relocating a neonatal intensive care unit (NICU) to a new facility and improved environmental cleaning practice on the presence of methicillin-resistant Staphylococcus aureus (MRSA) on inanimate surfaces and the incident rate of HAIs.Methods:New environmental cleaning measures were adopted after the NICU was moved to a new and better-designed location.The effect of moving and the new environmental cleaning practice was investigated by comparing the positive number of MRSA on ward surfaces and the incidence density of HAIs between the baseline and intervention periods.Results:Only 2.5% of environmental surfaces were positive for MRSA in the intervention period compared to 44.0% in the baseline period (P<0.001).Likewise,the total incident rate of HAIs declined from 16.8 per 1000 cot-days to 10.0 per 1000 cot-days (P<0.001).Conclusion:The comprehensive measures of relocating the NICU to a new facility design with improved environmental cleaning practice are effective and significantly reduce the incidence of HAIs.