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We report a cluster of 9 isolates of Parengyodontium album recovered from 4 patients who had surgical tissue specimens processed after dilution with a multiuse diluent saline solution. P album was also identified from a nonclinical sample on agar prepared with the same lot number of saline solution. Our epidemiological investigation revealed this to represent a pseudo-outbreak related to contaminated saline used to process specimens in the microbiology laboratory. • Importance of leadership knowledge of product substitutions during back orders. • Rapid investigation of unusual pathogens recovered from more than one specimen. • Multi-disciplinary approach for clinical management of patients when contamination is suspected. [ABSTRACT FROM AUTHOR]

• Hand hygiene technique was assessed using a thermal camera attached to a smartphone. • Thermal images showed if an alcohol hand sanitizer was applied to fingers and thumb. • Thermal camera readings revealed temperature changes due to sanitizer application. • Thermal imaging shows promise as a method of assessing hand hygiene technique. Currently, there is no standard method for assessing hand hygiene (HH) technique. We explored the use of thermal imaging to determine if alcohol-based sanitizer (ABHS) has been applied to fingertips and thumbs, areas often missed by healthcare personnel. A FLIR thermal camera attached to an iPhone with FLIR app was used to obtain thermal images of volunteers' dominant hand before and after performing HH with an ABHS. Temperature readings of the mid-palm area, and tips of 3rd finger and thumb were recorded before and at multiple time points after hand hygiene. In 11 of 12 volunteers, thermal images revealed significant decreases in mid-palm, finger and thumb temperatures after performing HH (P <.01 for all sites), confirming visual assessment of coverage. When HH was performed without including the thumb, a lack of colorimetric change in the thumb was visible. For persons with "cold" fingers at baseline, assessing ABHS coverage of the fingers was more difficult. Thermal imaging of HH performance shows promise for assessing HH technique. Additional studies involving a larger number of persons under varying conditions are needed to establish if thermal imaging can be a practical modality for teaching or monitoring HH technique. [ABSTRACT FROM AUTHOR]

Background Health care worker (HCW) vaccination rates have been low for many years (approximately 50%). Our goal was to implement an influenza declination form program (DFP) to assess feasibility, participation, HCW vaccination, and costs. Methods This was a prospective interventional pilot study using mixed methods to evaluate the DFP implementation processes and outcomes. We conducted a formative evaluation and interviews; data were transcribed and coded into themes. Secondary outcomes included self-reported HCW influenza vaccine uptake (pre-/postsurvey) and program costs; data were evaluated using descriptive and bivariate analyses. Results The DFP was compatible with ongoing strategies and unit culture. Barriers included multiple hospital shifts and competing demands. Facilitators included complementary ongoing strategies and leadership engagement. HCW vaccination rates were higher post- versus preimplementation (77.4% vs 53.5%, P =.01). To implement the DFP at site 1, using a mobile flu cart, 100% of declination forms were completed in 42.5 staff hours over <2 months. At site 2, using a vaccination table on all staff meeting days, 49% of forms were completed in 26.5 staff hours over 4.5 months. Average cost of staff time was $2,093 per site. Conclusion DFP implementation required limited resources and resulted in increased HCW influenza vaccine rates; this may have positive clinical implications for influenza infection control/prevention. [ABSTRACT FROM AUTHOR]

Background: Veterans Health Administration (VHA) is a national health care system with variation in hand hygiene (HH) measurement and improvement practices across its facilities. The objective of this national survey was to characterize this variability and identify opportunities for standardization. Methods: Survey covered 3 major areas of HH: (1) methods of measuring HH compliance, (2) interventions to improve HH compliance, and (3) site-specific targets for HH compliance. Results: One hundred forty-one (100%) VHA medical centers returned the survey. A majority (98.6%) of the medical centers conduct direct observations to measure HH compliance rates. Fewer than half (45.3%) validate the observer process at the onset, and fewer still (39.6%) continue to validate observers. Main behaviors that are considered HH opportunities are room entry (69.1%) and exit (71.9%). Improvement interventions include posters (97.2%), feedback (eg, 98.6% to leadership), and improved access to HH products (eg, 90.6% provide individual hand sanitizers to staff). Mandatory education programs for clinical staff are conducted in 88.5% of the medical centers. The majority of the medical centers (77.3%) set their HH compliance target over 90%. Conclusion: Although HH improvement interventions are relatively similar across VHA medical centers, variation exists in compliance monitoring. Findings will assist in standardizing surveillance and next steps in hand hygiene policy in VHA. [Copyright &y& Elsevier]

Summary: Objectives: Because of the difficulty of obtaining bacterial cultures from patients with cellulitis and erysipelas, the microbiology of these common infections remains incompletely defined. Given the emergence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) over the past decade the proportion of infections due to S. aureus has become particularly relevant. Methods: OVID was used to search Medline using the focused subject headings “ cellulitis ” , “ erysipelas ” and “ soft tissue infections ” . All references that involved adult patients with cellulitis or erysipelas and reported associated bacteremias and specific pathogens were included in the review. Results: For erysipelas, 4.6% of 607 patients had positive blood cultures, of which 46% were Streptococcus pyogenes, 29% were other β-hemolytic streptococci, 14% were Staphylococcus aureus, and 11% were Gram-negative organisms. For cellulitis, 7.9% of 1578 patients had positive blood cultures of which 19% were Streptococcus pyogenes, 38% were other β-hemolytic streptococci, 14% were Staphylococcus aureus, and 28% were Gram-negative organisms. Conclusions: Although the strength of our conclusions are somewhat limited by the heterogeneity of included cases, our results support the traditional view that cellulitis and erysipelas are primarily due to streptococcal species, with a smaller proportion due to S. aureus. Our results also argue against the current distinction between cellulitis and erysipelas in terms of the relative proportion of infections due to S. aureus. [Copyright &y& Elsevier]

Objective: Respiratory viruses are a common trigger for exacerbations of chronic obstructive pulmonary disease (COPD). Human metapneumovirus (hMPV) is a paramyxovirus associated with respiratory tract infections and wheezing. Our aim was to determine whether hMPV was associated with exacerbations of COPD.Methods: The study was designed as an observational cohort study carried out in a 944-bed urban teaching hospital located in New Haven, Connecticut. Between December 2002 and May 2003, patients hospitalized due to an exacerbation of COPD were identified. Nasopharyngeal specimens obtained from these patients were tested for human metapneumovirus by RT-PCR and for respiratory syncytial virus, influenza A and B, parainfluenza-1, -2, and -3 and adenovirus by a cytospin-enhanced direct immunofluorescence assay and/or viral culture.Results: Fifty individuals met enrollment criteria and hMPV was identified in 6 (12%), respiratory syncytial virus in 4 (8%), influenza A in 2 (4%) and parainfluenza type 3 in 1 (2%) patients. Both A and B hMPV genotypes were identified in patients hospitalized due to exacerbations of COPD.Conclusion: hMPV was frequently identified in patients hospitalized due to an exacerbation of COPD. Further studies are necessary to determine the epidemiology and the impact of hMPV in COPD patients. [ABSTRACT FROM AUTHOR]

The outbreak of COVID-19, and its current resurgence in the United States has resulted in a shortage of isolation rooms within many U.S. hospitals admitting COVID-19-positive cases. As a result, hospital systems, especially those at an epicenter of this outbreak, have initiated task forces to identify and implement various approaches to increase their isolation capacities. This paper describes an innovative temporary anteroom in addition to a portable air purifier unit to turn a general patient room into an isolation space. Using an aerosolization system with a surrogate oil-based substance, we evaluated the effectiveness of the temporary plastic anteroom and the portable air purifier unit. Moreover, the optimal location of the portable unit, as well as the effect of negative pressurization and door opening on the containment of surrogate aerosols were assessed. Results suggested that the temporary anteroom alone could prevent the migration of nearly 98% of the surrogate aerosols into the adjacent corridor. Also, it was shown that the best location of a single portable air purifier unit is inside the isolation room and near the patient's bed. The outcome of this paper can be widely used by hospital facilities managers when attempting to retrofit a general patient room into an airborne infection isolation room. • Temporary anteroom and portable HEPA filter were used to make an expedient isolation room. • The anteroom alone prevented nearly 98% of aerosols from migrating to adjacent corridor. • The HEPA filter unit was most effective when placed inside the isolation space next to patient bed. • The combination of anteroom, HEPA filtration, and negative pressure is an effective isolation strategy. [ABSTRACT FROM AUTHOR]

Chronic hepatitis B virus (HBV) infection screening usually includes only HBV surface antigen (HBsAg) testing; HBV core and surface antibody (anti-HBc, anti-HBs) assays, indicating resolved infection and immunity, are not routinely performed. Yet, serum HBV DNA is measurable in approximately 10% of HBsAg-negative/anti-HBc–positive cases, representing occult HBV infection (OBI). Patient blood samples from 2 Veterans Affairs medical center look-back investigations were screened for HBV infection using HBsAg enzyme immunoassays. Supplementary testing included anti-HBc and anti-HBs enzyme immunoassays. For anti-HBc–positive samples, HBV DNA testing was performed. Background OBI prevalence was further estimated at these 2 facilities based on HBV serology testing results from 1999-2012. Finally, a literature review was performed to determine OBI prevalence in the published literature. Of 1887 HBsAg-negative cohort patients, 98 (5.2%) were anti-HBc positive/anti-HBs negative; and 175 (9.3%), anti-HBc positive/anti-HBs positive. Six of 273 were HBV DNA positive, representing 0.3% of the total tested and 2.2% who were anti-HBc positive/anti-HBs negative or anti-HBc positive/anti-HBs positive. Among 32,229 general population veterans at these 2 sites who had any HBV testing, 4/108 (3.7%) were HBV DNA positive, none of whom were part of the cohort. In 129 publications with HBsAg-negative patients, 1817/1,209,426 (0.15%) had OBI. However, excluding blood bank studies with greater than 1000 patients, the OBI rate increased to 1800/17,893 (10%). OBI is not rare and has implications for transmission and disease detection. HBsAg testing alone is insufficient for detecting all chronic HBV infections. These findings may impact blood donation, patient HBV screening, follow-up protocols for patients assumed to have cleared the infection, and initiation of immunosuppression in patients with distant or undetected HBV. [ABSTRACT FROM AUTHOR]