Pentti Huovinen

Hand washing with soap and water together with behavioural recommendations prevents infections in common work environment: an open cluster-randomized trial.

BackgroundHand hygiene is considered as an important means of infection control. We explored whether guided hand hygiene together with transmission-limiting behaviour reduces infection episodes and lost days of work in a common work environment in an open cluster-randomized 3-arm intervention trial.MethodsA total of 21 clusters (683 persons) were randomized to implement hand hygiene with soap and water (257 persons), with alcohol-based hand rub (202 persons), or to serve as a control (224 persons). Participants in both intervention arms also received standardized instructions on how to limit the transmission of infections. The intervention period (16 months) included the emergence of the 2009 influenza pandemic and the subsequent national hand hygiene campaign influencing also the control arm.ResultsIn the total follow-up period there was a 6.7% reduction of infection episodes in the soap-and water arm (p = 0.04). Before the onset of the anti-pandemic campaign, a statistically significant (p = 0.002) difference in the mean occurrence of infection episodes was observed between the control (6.0 per year) and the soap-and-water arm (5.0 per year) but not between the control and the alcohol-rub arm (5.6 per year). Neither intervention had a decreasing effect on absence from work.ConclusionsWe conclude that intensified hand hygiene using water and soap together with behavioural recommendations can reduce the occurrence of self-reported acute illnesses in common work environment. Surprisingly, the occurrence of reported sick leaves also increased in the soap-and water-arm.Trial RegistrationClinicalTrials.gov: NCT00981877Source of fundingThe Finnish Work Environment Fund and the National Institute for Health and Welfare.

Parental experiences and attitudes regarding the management of acute otitis media--a comparative questionnaire between Finland and The Netherlands.

BACKGROUND Both treatment guidelines and the amount of antibiotics used for acute otitis media (AOM) vary across western countries. Parental expectations and their awareness of antimicrobial use and resistance, which may also be influenced by the guidelines, are not yet completely known. OBJECTIVE To compare parental experiences and opinions regarding the management of AOM in children with AOM in Finland and The Netherlands. METHODS We sent the questionnaires via public day care in Turku, Finland, and Utrecht, The Netherlands. We asked about family background, childs history of AOM and parental experiences and attitudes about AOM treatment and antimicrobial resistance. RESULTS Of 1151 participants, 83% in Finland and 49% in The Netherlands had had at least one episode of AOM. Antibiotics were used more frequently in Finland than in The Netherlands, 99% versus 78%, respectively. More Finnish parents reported to believe that antibiotics are necessary in the treatment of AOM as compared to Dutch parents. Use of analgesics for AOM was similar (80% in Finland and 86% in The Netherlands). One-third of the parents had discussed resistance with their doctor. According to parental experiences, antimicrobial resistance had caused more problems in Finland than in The Netherlands (20% versus 2%). Finally, 88% of parents in Finland and 65% in The Netherlands were worried that bacteria could become resistant to antibiotics. CONCLUSIONS Treatment practices and parental expectations seem to interact with each other. Therefore, if we aim to change AOM treatment practices, we have to modify both guidelines and parental expectations.

STOPFLU: is it possible to reduce the number of days off in office work by improved hand-hygiene?

BackgroundAcute infectious diseases are major causes of short periods of days off from work, day care and school. These diseases are mainly caused by viruses and hands have a key role in their transmission. Thus, hypothetically, they can be controlled with means of intensified hand hygiene. In this study we aim to elucidate the effect of acute infectious diseases on the work contribution in common office work and study the influence of improved hand hygiene on possible reduction of infectious disease episodes and days off from work due to acute infectious diseases.DesignThe voluntary participants have been recruited from six companies in the Helsinki region. The designated 21 study clusters were identified as operationally distinct working units each containing at least 50 people. The clusters were matched and randomized based on results of a pre-trial contagion risk survey. Improved hand hygiene is being executed with guided hand-washing with soap and water in one intervention arm and with alcohol based hand rubbing disinfectant in the other. Participants in both arms have received guidance on how to avoid infections and how to implement contagion stopping habits. A control arm is acting as before regarding hand hygiene. Data collection for evaluation of the efficacy of the interventions is based on self-reporting through weekly electronic reports. The questionnaire is enquiring about possible respiratory or gastrointestinal symptoms during the preceding week, and requests a daily report of presence of symptoms and working capacity. Etiology of the symptoms is not searched for individually, but contribution of different viruses is evaluated by sentinel surveillance, where occupational health clinics located in the premises of the participating companies collect specimens from employees visiting the clinic. Common causative agents of the diseases are being searched for using real-time PCR techniques. The duration of the intervention will be 16 months. Primary endpoints of the study are the number of reported infection episodes in a cluster within a time frame of 100 reporting weeks and the number of reported sick leave episodes in a cluster within a time frame of 100 reporting weeks.Trial RegistrationClinicalTrials.gov Identifier: NCT00821509

Hidden qnrB12 gene in a Finnish faecal microbiota isolate from 1994

Sir, Plasmid-mediated quinolone resistance was first reported in 1998, in a Klebsiella pneumoniae isolated in 1994 in Alabama, USA. Since then, a number of surveys have reported an increasing prevalence of qnr genes, starting in the mid-1990s, and the appearance of aac(60)-Ib-cr from 2000 onwards. The oldest qnr genes found so far are from isolates obtained in 1988 (a qnrB8-like gene in a Citrobacter freundii from the USA and a qnrB9-like gene in a K. pneumoniae from Argentina); a qnr-positive Enterobacter isolate from 1994 has also been found in Israel. The earliest reported qnr genes from the Nordic countries are from 2002, while a recent paper from Sweden found qnr-positive ESBL strains from 2006 onwards in a collection spanning the years 2001–08. Most surveys have studied clinical isolates, although it has been observed that the qnr genes presumably have been circulating for some time, due to their appearance in various genera on all continents. The surprisingly high prevalence of qnr genes found in faecal enterobacteria (54% contained qnrB) in healthy children in South America shows the importance of commensal bacteria as a resistance gene pool. We decided to screen our older Enterobacteriaceae collections from the 1990s for the presence of qnr genes. The collections consisted of 365 faecal isolates, which were collected during research projects studying resistance levels in the human faecal microbiota. These consisted of 227 isolates from 1993– 94, from healthy persons living in Turku, Finland, who had not received antibiotics for 3 months before sampling, and 138 isolates from long-term patients collected in 1994 (mean hospitalization time 22 months). We also included 561 isolates from vegetables (fresh and frozen) isolated in 1996–97. Isolates with ciprofloxacin MICs of 0.125 mg/L were selected, and 43 such isolates were found: one from the healthy group; two from the patient group; and the rest from the vegetable collection. Of these, 23 were recovered from storage. To prepare DNA, bacteria were cultured overnight and a colony was suspended in sterile water and lysed by heating at 958C for 10 min. Screening for qnrA, qnrB and qnrS genes was carried out by multiplex PCR using a previously described method and specific primers. Any qnr-positive results were confirmed by direct sequencing of both strands of amplicons using specific PCR primers. Sequencing reactions were performed using an ABI BigDye Terminator Cycle Sequencing Kit version 3.1 (Applied Biosystems, Espoo, Finland) and sequenced with an Applied Biosystems 3730 DNA Analyser. The DNA sequences were analysed and translated into amino acid sequences with Vector NTI software (Informax, Inc., No. Bethesda, MD, USA). The closest matches to these amino acid sequences were then obtained using the BLAST search engine (http://www.ebi.ac.uk/Tools/blast/). One isolate was positive for qnrB. Sequencing showed it to be qnrB12, according to the Jacoby et al. nomenclature. The isolate was a Citrobacter youngae, as determined by API20E (bioMerieux, France), isolated on 29 June 1994 from a healthy person .30 years old. The qnrB12-positive strain was susceptible to all antibiotics (Table 1), with the possible exception of co-amoxiclav (the activities of the intrinsic b-lactamases of the Citrobacter genus vary and there is not much published on C. youngae). qnrB12 has been reported once before, in three German Citrobacter werkmanii poultry isolates from the years 1999, 2002 and 2005. The gene was chromosomally located in these strains. This is the first report of qnr genes from Finland and the oldest reported so far in Europe, and, indeed, is among the oldest also internationally. The fact that it is not a clinical strain corroborates the observation that these genes have been circulating widely for a long time. Since the strain is susceptible by both CLSI and EUCAST (‘European Committee on Antimicrobial Susceptibility Testing’) breakpoint criteria, the presence of the gene would pass unobserved until further mechanisms were acquired.

Reply to "Disk Diffusion Method for Erythromycin and Ciprofloxacin Susceptibility Testing of Campylobacter jejuni and Campylobacter coli"

We thank Dr. Gaudreau for her comments in the [foregoing letter][1] on our article concerning the repeatability of Campylobacter disk diffusion susceptibility testing. We definitely agree that disk diffusion testing, like all other antimicrobial susceptibility tests, should give reliable results—