Pseudomonas - current and emerging issues.

Susan Pearson reports on some of the most interesting presentations at an International Biodeterioration and Biodegradation Society (IBBS) and Public Health England conference on 'Water microbiology - current and emerging issues in healthcare', held at the University of Winchester in early September. Two and a half years after the publication of the Addendum to HTM 04-01 - which gave advice on controlling and minimising the risk of morbidity and mortality due to P. aeruginosa in augmented care units - a major focus at the event was on how well the Addendum had been working for those 'at the frontline of infection control', and what improvements, if any, might be needed.

Silver biocide's real-world success.

Although temperature control has been the UK's longest-serving means of controlling the growth and proliferation of Legionella in hot and cold water systems, there are other factors, including major rises in energy costs, that warrant the use of biocides--including in the healthcare sector. In 2000, the HSE's new 'L8' guidelines took this into account, giving equal weight to both temperature reg~mes and biocides, such as chlorine dioxide, as control methods. Susan Pearson BSc reports on one potentially effective biocide- silver hydrogen peroxide, explains how it 'works' in practice, and highlights the recent 'real-world' evidence of its effectiveness and advantages.

Navigating through 'a labyrinth' of guidance.

Devising a strategy to deliver safe water to thousands of outlets spread across numerous buildings is always going to be a challenge, so how do you navigate your way through a bewildering labyrinth of sometimes contradictory guidance documents? Is there, in fact, simply too much guidance? Posing this question at a recent one-day conference on waterborne infections in healthcare facilities, Paul Nolan, authorised water engineer (AE), and operations manager for PFI provider, Lend Lease, took delegates through a review of the latest guidance and regulations, as Susan Pearson reports.

Pilot project for rapid Legionella testing.

Susan Pearson BSc, a freelance journalist and communications consultant specialising in medicine and the environment (see also HEJ - April 2013), reports on discussions, at a recent educational seminar, on a pilot project undertaken by the Environmental Microbiology Unit at the Brighton and Sussex University Hospitals (BSUH) NHS Trust, which compared the effectiveness and accuracy of conventional 'culture' testing for Legionella in water systems, with a new, 'less labour-intensive', DNA-based testing system that can produce results 'in a matter of hours'.

Brain atrophy in type 2 diabetes: regional distribution and influence on cognition.

Objective: Type 2 diabetes (T2DM) is associated with brain atrophy and cerebrovascular disease. We aimed to define the regional distribution of brain atrophy in T2DM and to examine whether atrophy or cerebrovascular lesions are feasible links between T2DM and cognitive function.

Research Design And Methods: This cross-sectional study used magnetic resonance imaging (MRI) scans and cognitive tests in 350 participants with T2DM and 363 participants without T2DM.

Does compliance make a facility safe?

'Every defect is a treasure, if the company can uncover its cause and work to prevent it across the corporation' - Kiichiro Toyoda, founder, Toyota. This quote, as true in healthcare as it in the manufacturing sphere, set the tone for discussion at a recent Dublin conference, which examined the thorny issue of whether compliance is really enough to ensure safety. Focusing especially on water safety, the event aimed to promote collaboration and knowledge sharing between Irish and UK healthcare professionals, including technical services managers, infection control staff, quality and risk personnel, support service managers, hospital directors, and CEOs.

Water quality key to protecting patients.

According to David Graham of the Scottish National Blood Transfusion Service (SNBTS), "the importance of the safe diagnosis and treatment of patients cannot be overstated - yet the role played by water quality in patient safety has sometimes been under-stated". David Graham was speaking at a one day Pall Medical-sponsored meeting on the prevention and control of healthcare-associated waterborne infections in healthcare facilities held in Edinburgh earlier this year. David Graham, other speakers, and the chair, Consultant Microbiologist and Infection Prevention and Control Doctor for NHS Grampian, Dr Anne Marie Karcher, stressed that good quality water is essential in healthcare premises to prevent the potentially catastrophic consequences of contaminated water for some patients.

A practical approach to ensuring safe water.

Susan Pearson BSc reports on a recent specialist waterborne diseases 'masterclass' held in Nottingham, at which leading experts discussed not only the control of Pseudomonas, but also other problematic waterborne pathogens such as Legionella, the cause of Legionnaires' disease. The Pall Medical-sponsored event provided plenty of 'food for thought' for estates and facilities personnel responsible for hospital water systems, and clearly demonstrated how difficult and persistent a foe organisms such as Pseudomonas aeruginosa and Legionella pneumophila, which, if left unchecked, pose significant patient health risks, can be.

Making hospital water safe, examined.

What are the best methods for monitoring hospital water systems to prevent contamination by waterborne pathogens such as Pseudomonas aeruginosa and Legionella? How can hospital staff determine whether a Pseudomonas outbreak is due to cross-contamination between patients and staff, or to the contamination of a systemic water supply, and how can we best protect our most vulnerable patients from infection with the array of pathogenic organisms lurking in hospitals? As Susan Pearson reports, these were among the questions discussedby leading microbiologists at a recent one-day "waterborne infections" seminar organised by Pall Medical in Glasgow.

Faster Legionella testing on horizon.

While the "traditional" way to measure Legionella quantitatively in water is based on a complex culture method where results can take up to 14 days, the last few years have seen the availability of very rapid real-time monitoring of the bacterium in water systems, with the development of quantitative polymerase chain reaction (qPCR), a process which gives results "within hours". To date, however, a lack of consensus on how to interpret such results in relation to those from culture has been a stumbling block, although, as Susan Pearson, a freelance journalist and public relations consultant specialising in medicine and the environment, reports, the positive results of a recent multi-centre European study mean this could soon all change.

NHS plans to lead on carbon cutting.

While the UK's Climate Change Bill is debated in Parliament, the NHS has been putting in place its plans to lead the way in public sector carbon cutting, which aim for a 60% reduction in CO2 emissions by 2050. Susan Pearson talks to Dr David Pencheon, director of the new NHS Sustainable Development Unit.

Identification of ethanol responsive domains of adenylyl cyclase.

Background: The activity of adenylyl cyclase (AC) is enhanced by pharmacologically relevant concentrations of ethanol. The enhancing effect of ethanol on AC activity is AC isoform-specific. Therefore, we hypothesized that within a cyclic AMP-generating system, AC is the target of ethanol's action and that ethanol-sensitive AC molecules contain structural elements modulated by ethanol.

Coblation adenotonsillectomy: an improvement over electrocautery technique?

Objectives: To compare postoperative complication rates of coblation and electrocautery adenotonsillectomies.

Study Design: Retrospective chart review.

Results: From January 2000 to June 2004, 1997 pediatric patients underwent adenotonsillectomy.

Decreased hearing after combined modality therapy for head and neck cancer.

Purpose: Combined platinum-based chemoradiation therapy is frequently being used as therapy for head and neck cancer at multiple sites. These therapies are individually ototoxic, but little has been reported on their combined toxicity.

Materials And Methods: A retrospective investigation of 37 patients known to have undergone therapy with both agents, in combination, for head and neck malignancy was performed.

The use of a "liquid" electrode in hepatic electrolysis.

Background: The use of direct current electrolysis as a local nonthermal ablative technique for colorectal liver metastases promises to be a simple, safe, and effective therapy. Under general anesthesia, electrolysis is presently limited to tumors smaller than 5 cm, due to the protracted nature of its administration. In an attempt to enhance the effect of electrolysis, a direct current was passed through a preinjected bolus of acetic acid.

Complications of otitis media before placement of tympanostomy tubes in children.

Objectives: To report the incidence of short-term complications from otitis media in children before placement of tympanostomy tubes (TTs) and to compare children treated according to the Agency for Health Care Policy and Research guidelines with those who were treated earlier or later than recommended.

Design: Retrospective outcomes review.

Patients: Subjects were children aged 10 or younger who had TTs inserted at a tertiary care county hospital from January 1, 1999, to December 31, 2000.

Acromial hyperplasia, the sequel of deltoid contracture: A case report.

The major complications of deltoid contracture frequently encountered are abduction contracture, winging of the scapula, humeral head flattening and shoulder dislocation (Bhattacharyya 1966; Chatterjee and Gupta 1983). To our knowledge acromium hyperplasia has not been a reported complication of deltoid contracture in the English-language literature. We encountered a patient who had bilateral acromium hyperplasia that appeared to be secondary to deltoid muscle contracture due to large volumes of fluid injected intramuscularly as a child.