To study the ability of a medical waste disposal process using chlorine dioxide to inactivate human immunodeficiency virus type 1 (HIV 1).

Stock HIV-1 (HTLV-IIIB strain) was treated with chlorine dioxide under the following settings: cell culture medium alone, culture medium with 25% blood, culture medium with medical supplies treated by the Condor machine (Winfield Environmental Corp., Escondido, CA). MT-2 cells in 96-well tissue culture plates were inoculated with serial tenfold dilutions of treated and untreated HIV-1. Cytopathic effect was read on day five, and the TCID50 (50% tissue culture infectious dose) was calculated.

Treatment of HIV-1 with chlorine dioxide in culture medium alone resulted in a 5.25 log10 reduction in TCID50. Treatment of HIV-1 with chlorine dioxide in the presence of 25% blood caused a 6.25 log10 reduction in HIV-1 infectivity Treatment of HIV-1 with chlorine dioxide in the presence of medical supplies treated in the Condor machine resulted in a 4.75 log10 reduction in HIV infectivity.

Chlorine dioxide inactivated HIV-1 in vitro. Chlorine dioxide inactivated HIV-1 in the presence of blood and in the presence of medical supplies under conditions that simulated the conditions existing in the Condor machine.

To determine whether patients who were colonized or infected with methicillin-resistant Staphylococcus aureus (MRSA) persistently carried the same strain and to identify the extent of strain variation within a population of patients.

Molecular typing by pulsed-field gel electrophoresis (PFGE) of stored MRSA isolates.

A Veterans Administration Medical Center with 288 hospital, 45 intermediate-care, and 75 extended-care beds.

Between January 1991 and March 1993, 91 patients had MRSA identified in routine cultures. One hundred isolates from 57 patients (63%) were available for typing.

Before 1988, only occasional MRSA isolates were identified. By 1993, 50% of S. aureus isolates from unique patients were resistant to methicillin. PFGE identified 7 MRSA strains, 3 of which were identified in specimens from 1 patient each. The most common strains were SD4 (20 patients), SD1 (12 patients), SD2 (12 patients), and SD5a (5 patients). Twenty patients had 2 or more isolates obtained at least 1 week apart (mean, 30.7 weeks; range, 1 to 102 weeks). Of these patients, 12 were colonized or infected with only one strain (mean time observed, 25.1 weeks; range, 1 to 82 weeks). Eight patients had at least 2 different strains (mean time observed, 39 weeks; range, 2 to 102 weeks).

Numerous MRSA strains circulated in tiiis endemic setting; 40% of patients observed over time were colonized or infected witii more than one strain. Molecular typing was an essential tool for evaluating the epidemiology of MRSA in this setting.

To describe OXA-48–like carbapenem-producing Enterobacteriaceae (CPE) outbreaks at Singapore General Hospital between 2018 and 2020 and to determine the risk associated with OXA-48 carriage in the 2020 outbreak.

Outbreak report and case–control study.

Singapore General Hospital (SGH) is a tertiary-care academic medical center in Singapore with 1,750 beds.

Active surveillance for CPE is conducted for selected high-risk patient cohorts through molecular testing on rectal swabs or stool samples. Patients with CPE are isolated or placed in cohorts under contact precautions. During outbreak investigations, rectal swabs are repeated for culture. For the 2020 outbreak, a retrospective case–control study was conducted in which controls were inpatients who tested negative for OXA-48 and were selected at a 1:3 case-to-control ratio.

Hospital wide, the median number of patients with healthcare-associated OXA-48 was 2 per month. In the 3-year period between 2018 and 2020, 3 OXA-48 outbreaks were investigated and managed, involving 4 patients with Klebsiella pneumoniae in 2018, 55 patients with K. pneumoniae or Escherichia coli in 2019, and 49 patients with multispecies Enterobacterales in 2020. During the 2020 outbreak, independent risk factors for OXA-48 carriage on multivariate analysis (49 patients and 147 controls) were diarrhea within the preceding 2 weeks (OR, 3.3; 95% CI, 1.1–10.7; P = .039), contact with an OXA-48–carrying patient (OR, 8.7; 95% CI, 1.9–39.3; P = .005), and exposure to carbapenems (OR, 17.2; 95% CI, 2.2–136; P = .007) or penicillin (OR, 16.6; 95% CI, 3.8–71.0; P < .001).

Multispecies OXA-48 outbreaks in our institution are likely related to a favorable ecological condition and selective pressure exerted by antimicrobial use. The integration of molecular surveillance epidemiology of the healthcare environment is important in understanding the risk of healthcare–associated infection to patients.

To test the feasibility of targeted gown and glove use by healthcare personnel caring for high-risk nursing-home residents to prevent Staphylococcus aureus acquisition in short-stay residents.

Uncontrolled clinical trial.

This study was conducted in 2 community-based nursing homes in Maryland.

The study included 322 residents on mixed short- and long-stay units.

During a 2-month baseline period, all residents had nose and inguinal fold swabs taken to estimate S. aureus acquisition. The intervention was iteratively developed using a participatory human factors engineering approach. During a 2-month intervention period, healthcare personnel wore gowns and gloves for high-risk care activities while caring for residents with wounds or medical devices, and S. aureus acquisition was measured again. Whole-genome sequencing was used to assess whether the acquisition represented resident-to-resident transmission.

Among short-stay residents, the methicillin-resistant S. aureus acquisition rate decreased from 11.9% during the baseline period to 3.6% during the intervention period (odds ratio [OR], 0.28; 95% CI, 0.08–0.92; P = .026). The methicillin-susceptible S. aureus acquisition rate went from 9.1% during the baseline period to 4.0% during the intervention period (OR, 0.41; 95% CI, 0.12–1.42; P = .15). The S. aureus resident-to-resident transmission rate decreased from 5.9% during the baseline period to 0.8% during the intervention period.

Targeted gown and glove use by healthcare personnel for high-risk care activities while caring for residents with wounds or medical devices, regardless of their S. aureus colonization status, is feasible and potentially decreases S. aureus acquisition and transmission in short-stay community-based nursing-home residents.

The primary study aim was to describe all direct healthcare costs associated with Clostridioides difficile infection (CDI), both in and out of the hospital, in patients with hematologic malignancies in the United States.

A retrospective analysis was conducted utilizing data from US databases of Truven Health Analytics.

We analyzed health insurance claims between January 2014 and December 2017 of patients diagnosed with hematological cancer: acute myeloid leukemia (AML), acute lymphoblastic leukemia, Hodgkin’s lymphoma, and non-Hodgkin’s lymphoma (NHL).

Patients with CDI after cancer diagnosis (CDI+, cases) were matched with patients without CDI reported (CDI−, controls). Matched cases and controls were compared to identify the CDI-associated costs in the 90 days following the onset of CDI.

We matched 622 CDI+ patients with 11,111 CDI− patients. NHL (41.7%) and AML (30.9%) were the predominant underlying diseases in the CDI+ groups. During study period, the average time in-hospital of CDI+ patients was 23.1 days longer than for CDI− patients (P < 2×10−16). Overall, CDI onset increased costs of care by an average of US$57,159 per patient (P = 6×10−12), mainly driven by hospital costs.

This study confirms the significant economic burden associated with CDI in the United States, especially in patients with hematological malignancies. These findings highlight the need for prevention of CDI in this specific patient population.