Mohamed Yassin

Evaluation of a New Monochloramine Generation System for Controlling Legionella in Building Hot Water Systems

OBJECTIVE To evaluate the efficacy of a new monochloramine generation system for control of Legionella in a hospital hot water distribution system. SETTING A 495-bed tertiary care hospital in Pittsburgh, Pennsylvania. The hospital has 12 floors covering approximately 78,000 m(2). METHODS The hospital hot water system was monitored for a total of 29 months, including a 5-month baseline sampling period prior to installation of the monochloramine system and 24 months of surveillance after system installation (postdisinfection period). Water samples were collected for microbiological analysis (Legionella species, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Acinetobacter species, nitrifying bacteria, heterotrophic plate count [HPC] bacteria, and nontuberculous mycobacteria). Chemical parameters monitored during the investigation included monochloramine, chlorine (free and total), nitrate, nitrite, total ammonia, copper, silver, lead, and pH. RESULTS A significant reduction in Legionella distal site positivity was observed between the pre- and postdisinfection periods, with positivity decreasing from an average of 53% (baseline) to an average of 9% after monochloramine application (P<0.5]). Although geometric mean HPC concentrations decreased by approximately 2 log colony-forming units per milliliter during monochloramine treatment, we did not observe significant changes in other microbial populations. CONCLUSIONS This is the first evaluation in the United States of a commercially available monochloramine system installed on a hospital hot water system for Legionella disinfection, and it demonstrated a significant reduction in Legionella colonization. Significant increases in microbial populations or other negative effects previously associated with monochloramine use in large municipal cold water systems were not observed.

Safety and utilization of peripherally inserted central catheters versus midline catheters at a large academic medical center

BACKGROUND Peripherally inserted central catheters (PICCs) are a commonly used central intravenous (IV) access device, which can be associated with significant complications. Midline catheters (MCs) are peripheral IV access devices that may reduce the need for central lines and hence decrease central line-associated bloodstream infections. The objective of this study is to compare the utilization and safety of PICCs and MCs. METHODS This was a retrospective study comparing the use and outcomes of PICCs and MCs at a large academic medical center between January and May 2015. Data were collected using electronic medical records and IV team insertion data. Statistical software was used for analysis. RESULTS A total of 206 PICCs and 200 MCs were inserted in 367 patients within the study duration. Patients with MCs were more likely to have complications than those with PICCs (19.5% vs 5.8%, P < .0001). CONCLUSIONS MCs were associated with a higher risk of non-life-threatening complications versus PICCs, which showed fewer but more serious complications, including bacteremia. The decision to move toward more use of MCs is not without risk. Institutions should continue to review the utilization and safety data of IV catheter use to determine the most appropriate use of these devices.

Role of ultraviolet (UV) disinfection in infection control and environmental cleaning.

Ultraviolet (UV) radiation is capable of disinfecting surfaces, water and air. The UV technology was used for many years. However, safer and more effective delivery systems of UV radiation, make it a very useful option for disinfection. Effective disinfection of environmental surfaces is a key step in the prevention of spread of infectious agents. The traditional manual cleaning is essential in assuring adequate elimination of contamination. However, terminal cleaning is frequently suboptimal or unpredictable in many circumstances. UV-C radiation is an adjunctive disinfectant new technology that could kill a wide array of microorganisms including both vegetative and spore forming pathogens. The technology is getting more affordable and has produced consistent reproducible significant reduction of bacterial contamination.

Role of Infection Control in Prevention of Hepatitis B virus (HBV) in Hemodialysis (HD) Patients.

Hemodialysis (HD) patients are particularly vulnerable to Hepatitis B virus (HBV) and have less sustained and lower antibody response to HBV vaccination. Among blood-borne pathogens, HBV can stay alive on environmental surfaces for over a week. The incidence of HBV was extremely high among HD patients. HBV vaccination, screening of blood products and infection control measures lead to significant decrease of HBV among HD patients. The infection control measures include; Medication safety and injection practices, environmental cleaning and disinfection, reuse of dialyzers for same patients, hand hygiene, isolation and barrier precautions, HBV vaccination and routine serology checking, assuring HBV immune status for HD unit staff, transmission based precautions and outbreak management.

Monochloramine Use for Prevention of Legionella in Hospital Water Systems.

Eradication of Legionella species from water distribution systems especially in hospital settings has proven to be challenging. Legionella species causes Legionnaires disease that is a potentially fatal respiratory disease often acquired through the aerosolization of contaminated water. Monochloramine has been used successfully in the municipal water systems to eradicate Legionella and there is currently limited data to support its use in the hospital setting. This technology appears to be affordable, safe and effective at penetrating biofilm in water distribution systems.

An Unexpected Cause of Eye Irritation: A Case of Zoonotic Ocular Onchocerciasis

A 19-year-old male residing in Pittsburgh presented with irritation and watering from his right eye and was diagnosed to have a right subconjunctival nodule. Surgical excision revealed both dead and living worms and histopathological staining of the worms confirmed these to be zoonotic species of Onchocerca. The morphologic characteristics of the worm suggest it to be either O. lupi or O. lienalis which were first detected in wolves and cattle, respectively. Mystery remains as to the mode of transmission and the hosts for this parasite in this part of the United States. This case adds to the growing number of cases of zoonotic ocular onchocerciasis reported from all over the world.

Diverticulitis complicated by pylephlebitis: a case report

IntroductionPylephlebitis is defined as septic thrombophlebitis of the portal venous system, usually secondary to infection or inflammation in the abdomen. In the current report, we present a case of pylephlebitis that complicated the course of a very common pathology, diverticulitis.Case presentationA 62-year-old Caucasian woman with a history of sigmoid diverticulitis presented to our facility with a three-week history of abdominal pain, fevers, chills, loss of appetite and fatigue. Her laboratory test results showed leukocytosis and elevated alkaline phosphatase. A computed tomography scan revealed portal vein thrombosis and a sigmoid diverticulitis with an abscess. Our patient was given pipercillin-tozabactam followed by sigmoid colectomy and loop transverse colostomy. A peritoneal fluid sample culture grew Escherichia coli. Our patient had an uneventful post-operative course and the leukocytosis resolved in the next four days. She improved clinically and was discharged home on ertapenem and enoxaparin. A follow-up computed tomography scan two weeks later showed a new pelvic abscess that was drained by a pigtail catheter but there was no change in the portal venous thrombus. A repeat computed tomography scan one month later revealed resolution of the pelvic abscess but persistence of portal vein thrombus, for which enoxaparin was continued.ConclusionsThis is a classic case of pylephlebitis that demonstrates the importance of recognizing that the portal vein thrombus is infected and treating the condition appropriately.

Human pulmonary dirofilariasis presenting as a solitary pulmonary nodule: A case report and a brief review of literature.

Human pulmonary dirofilariasis (HPD) is an uncommon disease in the United States. Dirofilaria is commonly known as “heartworm” based on the false belief that the worm resides in the heart which was based on findings from early necropsy reports. The first case was reported as an incidental autopsy finding in 1941. Since then only 87 more cases have been reported so far. We present an interesting case of this rare zoonotic disease affecting an elderly gentleman who presented with a rapidly growing lung nodule. We present a brief review of literature concerning the diagnosis and management of this disease.

Cardiac Implantable Electronic Device Infection: From an Infection Prevention Perspective.

A cardiac implantable electronic device (CIED) is indicated for patients with severely reduced ejection fraction or with life-threatening cardiac arrhythmias. Infection related to a CIED is one of the most feared complications of this life-saving device. The rate of CIED infection has been estimated to be between 2 and 25; though evidence shows that this rate continues to rise with increasing expenditure to the patient as well as healthcare systems. Multiple risk factors have been attributed to the increased rates of CIED infection and host comorbidities as well as procedure related risks. Infection prevention efforts are being developed as defined bundles in numerous hospitals around the country given the increased morbidity and mortality from CIED related infections. This paper aims at reviewing the various infection prevention measures employed at hospitals and also highlights the areas that have relatively less established evidence for efficacy.

Comparison between transthoracic and transesophageal echocardiogram in the diagnosis of endocarditis: A retrospective analysis

1. Al Jama AH, Al Salem AH, Al Dabbous IA. Massive splenic infarction in Saudi patients with sickle cell anemia: A unique manifestation. Am J Hematol 2002;69:205‐9. 2. Stock AE. Splenic infarction associated with high altitude flying and sickle cell trait. Ann Intern Med 1956;44:554‐6. 3. O’Brien RT, Pearson HA, Godley JA, Spencer RP. Splenic infarction and sickle‐(cell) trait. N Engl J Med 1972;287:720. Figure 1: A contrast enhanced computed tomography (CT) scan of the abdomen and pelvis was consistent with splenic infarction Figure 2: Hemoglobin electrophoresis was consistent with sickle cell trait