Scott W. Riddell

Nosocomial Contamination of Laryngoscope Handles: Challenging Current Guidelines

BACKGROUND: Laryngoscope blades are often cleaned between cases according to well-defined protocols. However, despite evidence that laryngoscope handles could be a source of nosocomial infection, neither our institution nor the American Society of Anesthesiologists has any specific guidelines for handle disinfection. We hypothesized that laryngoscope handles may be sufficiently contaminated with bacteria and viruses to justify the implementation of new handle-cleaning protocols. METHODS: Sixty laryngoscope handles from the adult operating rooms were sampled with premoistened sterile swabs. Collection was performed between cases, in operating rooms hosting a broad variety of subspecialty procedures, after the room and equipment had been thoroughly cleaned for the subsequent case. Samples from 40 handles were sent for aerobic bacterial culture, and antimicrobial susceptibility testing was performed for significant isolates. Samples from 20 handles were examined for viral contamination using a polymerase chain reaction assay that detects 17 respiratory viruses. RESULTS: Of the 40 samples sent for culture, 30 (75%) were positive for bacterial contamination. Of these positive cultures, 25 (62.5%) yielded coagulase-negative staphylococci, seven (17.5%) Bacillusspp. not anthracis, three (7.5%) &agr;-hemolytic Streptococcusspp., and one each (2.5%) of Enterococcusspp., Staphylococcus aureus(S. aureus), and Corynebacteriumspp. No vancomycin-resistant enterococci, methicillin-resistant S. aureus, or Gram-negative rods were detected. All viral tests were negative. CONCLUSION: We found a high incidence of bacterial contamination of laryngoscope handles despite low-level disinfection. However, no vancomycin-resistant enterococci, methicillin-resistant S. aureus, Gram-negative rods, or respiratory viruses were detected. Our results support adoption of guidelines that include, at a minimum, mandatory low-level disinfection of laryngoscope handles after each patient use.

Actinomyces meyeri infection: Case report and review of the literature

Actinomyces meyeri is an uncommon cause of actinomycosis. We present a patient with pneumonia and empyema due to A. meyeri. The patient underwent open thoracotomy with decortication and was discharged home on a twelve-month course of oral penicillin. Review of the English literature revealed thirty-two cases of infection due to A. meyeri. The majority of patients were male, and a significant number had poor dental hygiene and a history of alcoholism. More than other Actinomyces species, A. meyeri causes pulmonary infection and has a predilection for dissemination. Prognosis is favorable with prolonged penicillin therapy combined with surgical debridement, if needed.

Viral Etiology of Acute Febrile Respiratory Illnesses in Hospitalized Children Younger Than 24 Months

Background: Respiratory infections are a leading cause of pediatric hospitalizations. This study investigated whether virus—virus or virus—Bordetella co-infections are more frequent or more severe than previously recognized. Methods: This is a 3-year prospective study of children younger than 24 months hospitalized with a febrile respiratory illness. Viral pathogens were detected using multiplex polymerase chain reaction (PCR), enzyme-linked immunoassays, and/or viral cultures from nasopharyngeal samples. Bordetella infections were detected by PCR. Results: A total of 201 patients were enrolled. Respiratory viruses were detected in 187 (93%) patients, with 52 (28%) multipathogen infections. The most common viruses detected were respiratory syncytial virus and rhinovirus/enterovirus. There were no differences in illness severity when comparing patients infected with one pathogen and those with multipathogen infection. Conclusion: Virus co-infection in young children hospitalized with an acute febrile respiratory infection is common but does not appear to be associated with illness severity.

Should All Stools Be Screened for Shiga Toxin-Producing Escherichia coli?

ABSTRACT In October 2009, the Centers for Disease Control and Prevention recommended that clinical laboratories test all stools submitted for the detection of enteric bacterial pathogens for the presence of Shiga toxin-producing Escherichia coli (STEC). In order to do this, it is recommended that all stools be cultured for Escherichia coli O157:H7 on selective medium as well as that testing for the presence of Shiga toxin be done by immunoassay to detect non-O157 STEC (3). There are a variety of products that are FDA approved for detection of Shiga toxin. Further, it is recommended that Shiga toxin detection be done by testing overnight enrichment broth cultures of stools rather than directly examining stools for this toxin. This recommendation was made approximately 18 months ago. We have asked Mario Marcon of Nationwides Children Hospital in Columbus, OH, to explain the rationale for his decision to follow this recommendation, while we have asked Deanna Kiska and Scott Riddell of Upstate University Hospital in Syracuse, NY, why these guidelines have not been adopted by their laboratory.

Dipylidium Caninum Mimicking Recurrent Enterobius Vermicularis (Pinworm) Infection

Pinworm infection is a very common diagnosis in young children that is not always confirmed through laboratory evaluation before empiric therapy is prescribed. This article describes a toddler who was treated several times for pinworms because small white worms were seen in her perianal area. Laboratory analysis of parasite material found in her diaper later confirmed a diagnosis of dipylidiasis. Because the signs of dipylidiasis and pinworm infection overlap and the treatments for these parasitic infections are different, the laboratory should clinically confirm suspected persistent or recurrent pinworms.

Incidence of Invasive Community-Onset Staphylococcus aureus Infections in Children in Central New York

We determined the incidence of invasive community-onset Staphylococcus aureus infections, clinical characteristics, and antibiotic susceptibilities in 128 hospitalized children in central New York. The prevalence of invasive S aureus infections in our institution remained <1% between 1996 and 2006, although the proportion of methicillin-resistant S aureus infections significantly increased.

High fecal hand contamination among wilderness hikers

Information about hand hygiene and fecal hand contamination among the general public is limited. Hands are an important vector in transmission of various pathogenic bacteria. We found high (31%) prevalence of fecal hand contamination among healthy adults engaged in hiking.

Identification of mold on seasonal indoor coniferous trees

thereby representing a novel time course for desensitization. Our starting dose was higher than the 0.02-mg starting dose administered to a non-HIV patient during fluconazole desensitization; however, our initial dose was equal to or less than other protocols involving HIV-infected patients.1,5,6 Given this patient’s HIV status, we used a cautious desensitization approach (eg, dose escalation every 6 hours) because of the evidence that HIV-infected individuals may experience possibly more severe drug-induced reactions, which may result from enhanced TH2-type responses in the setting of HIV.7,8 Within 2 days, the patient was able to tolerate the full, therapeutic dose of 200 mg twice per day of oral fluconazole. This protocol was completed without any adverse reactions. Premedication with diphenhydramine, 25 mg, and famotidine, 20 mg, was administered 30 minutes before starting desensitization. Diphenhydramine, 25 mg, was then given every 8 hours during the protocol, and famotidine was given every 12 hours. The patient was not taking systemic steroids before or during the desensitization. This premedication regimen was chosen because the patient was determined to have a high likelihood of drug-induced allergic reactions. This case demonstrates that a more rapid oral fluconazole desensitization may be possible in HIV-infected patients with a history of hypersensitivity to this medication. Further studies with more patients are needed to better characterize rapid desensitization protocols in patients with HIV/AIDS with fluconazole hypersensitivity.