- 'Off the Rails': Hospital bed rail design, contamination, and the evaluation of their microbial ecology. [Review]
- JHJ Hosp Infect 2019 Jun 20
- Microbial contamination of the near-patient environment is an acknowledged reservoir for nosocomial pathogens. The hospital bed and specifically bed rails have been shown to be frequently and heavily…
Microbial contamination of the near-patient environment is an acknowledged reservoir for nosocomial pathogens. The hospital bed and specifically bed rails have been shown to be frequently and heavily contaminated in observational and interventional studies. While the complexity of bedrail design has evolved over the years, the microbial contamination of these surfaces has been incompletely evaluated. In many published studies, key design variables are not described, compromising the extrapolation of results to other settings. This report reviews the evolving structure of hospital beds and bed rails, the possible impact of different design elements on microbial contamination and their role in pathogen transmission. Our findings support the need for clearly defined standardized assessment protocols to accurately assess bedrail and similar patient zone surfaces levels of contamination, as part of environmental hygiene investigations.
- The Impact of the Built Environment on Patient Falls in Hospital Rooms: An Integrative Review. [Journal Article]
- JPJ Patient Saf 2019 May 30
- CONCLUSIONS: Some environmental elements have not been examined in past relational or causal studies, and the level of evidence for the examined attributes is not high enough to gain robust confidence in healthcare design decision-making. Because of the low level of evidence for several environmental elements, conclusions must be taken with caution. More studies using quantitative, relational, or causal designs are recommended to develop actionable interventions on patient falls in hospital rooms.
- Releasing forced grasp reflex by use of concomitant imitation behaviour during rehabilitation of a stroke patient. [Journal Article]
- BCBMJ Case Rep 2019 May 29; 12(5)
- An 80-year-old woman had a stroke during treatment for diffuse large B cell lymphoma. She exhibited left hemispatial inattention, forced grasping with her left hand and moderate left hemiplegia. She …
An 80-year-old woman had a stroke during treatment for diffuse large B cell lymphoma. She exhibited left hemispatial inattention, forced grasping with her left hand and moderate left hemiplegia. She always grasped the guard rail of the bed with her left hand, which prevented her from standing up and performing activities of daily living (ADL) centred on move and transfer operations. During a medical examination, she showed an imitation behaviour (IB), mimicking gestures visually presented by the examiner, such as holding up. By using her IB in rehabilitation training, flexor-dominated posture of the upper arm was gradually reduced and performance of ADL improved. Her brain lesion was localised in the right middle frontal gyrus. Based on our experience of concomitant appearance of forced grasping and IB in this case, the pathophysiological involvement of the lesion was discussed.
- Flat-out napping: The quantity and quality of sleep obtained in a seat during the daytime increase as the angle of recline of the seat increases. [Journal Article]
- CIChronobiol Int 2018; 35(6):872-883
- Some shiftwokers in the long-haul transportation industries (i.e. road, rail, sea, air) have the opportunity to sleep in on-board rest facilities during duty periods. These rest facilities are typica…
Some shiftwokers in the long-haul transportation industries (i.e. road, rail, sea, air) have the opportunity to sleep in on-board rest facilities during duty periods. These rest facilities are typically fitted with a seat with a maximum back angle to the vertical of 20°, 40°, or 90°. The aim of this study was to examine the impact of "back angle" on the quantity and quality of sleep obtained in a seat during a daytime nap. Six healthy adults (3 females aged 27.0 years and 3 males aged 22.7 years) each participated in three conditions. For each condition, participants had a 4-h sleep opportunity in a bed (02:00-06:00 h) followed by a 4-h sleep opportunity in a seat (13:00-17:00 h). The only difference between conditions was in the back angle of the seat to the vertical during the seat-based sleep periods: 20° (upright), 40° (reclined), and 90° (flat). Polysomnographic data were collected during all sleep episodes. For the seat-based sleep episodes, there was a significant effect of back angle on three of four measures of sleep quantity, i.e. total sleep time, slow-wave sleep, and rapid eye movement (REM) sleep, and three of four measures of sleep quality, i.e. latency to REM sleep, arousals, and stage shifts. In general, the quantity and quality of sleep obtained in the reclined and flat seats were better than those obtained in the upright seat. In particular, compared to the flat seat, the reclined seat resulted in similar amounts of total sleep and slow-wave sleep, but 37% less REM sleep; and the upright seat resulted in 29% less total sleep, 30% less slow-wave sleep, and 79% less REM sleep. There are two main mechanisms that may explain the results. First, it is difficult to maintain the head in a comfortable position for sleep when sitting upright, and this is likely exacerbated during REM sleep, when muscle tone is very low. Second, an upright posture increases sympathetic activity and decreases parasympathetic activity, resulting in a heightened level of physiological arousal.
- Environmental Panels as a Proxy for Nursing Facility Patients With Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus Colonization. [Journal Article]
- CIClin Infect Dis 2018 Aug 31; 67(6):861-868
- CONCLUSIONS: Environmental panels used as a proxy for patient colonization and incorporated into facility surveillance protocols can guide decolonization strategies, improve awareness of MRSA and VRE burden, and inform efforts to reduce transmission. Targeted environmental screening may be a viable surveillance strategy for MRSA and VRE detection in NFs.
- The Shrail: A Comparison of a Novel Attachable Rail System With the Current Deployment Operating Table. [Case Reports]
- JSJ Spec Oper Med 2018; 18(1):29-31
- The current forward surgical team (FST) operating table is heavy and burdensome and hinders essential movement flexibility. A novel attachable rail system, the Shrail, has been developed to overcome …
The current forward surgical team (FST) operating table is heavy and burdensome and hinders essential movement flexibility. A novel attachable rail system, the Shrail, has been developed to overcome these obstacles. The Shrail turns a North Atlantic Treaty Organization litter into a functional operating table. A local FST compared the assembly of the FST operating table with assembling the Shrail. Device weight, storage space, and assembly space were directly measured and compared. The mean assembly time required for the Shrail was significantly less compared with the operating table (23.36 versus 151.6 seconds; p ≤ .01). The Shrail weighs less (6.80kg versus 73.03kg) and requires less storage space (0.019m3 versus 0.323m3) compared with the current FST operating table. The Shrail provides an FST with a faster, lighter surgical table assembly. For these reasons, it is better suited for the demands of an FST and the implementation of prolonged field care.
- Nipah Virus Contamination of Hospital Surfaces during Outbreaks, Bangladesh, 2013-2014. [Journal Article]
- EIEmerg Infect Dis 2018; 24(1):15-21
- Nipah virus (NiV) has been transmitted from patient to caregivers in Bangladesh presumably through oral secretions. We aimed to detect whether NiV-infected patients contaminate hospital surfaces with…
Nipah virus (NiV) has been transmitted from patient to caregivers in Bangladesh presumably through oral secretions. We aimed to detect whether NiV-infected patients contaminate hospital surfaces with the virus. During December 2013-April 2014, we collected 1 swab sample from 5 surfaces near NiV-infected patients and tested surface and oral swab samples by real-time reverse transcription PCR for NiV RNA. We identified 16 Nipah patients; 12 cases were laboratory-confirmed and 4 probable. Of the 12 laboratory-confirmed cases, 10 showed NiV RNA in oral swab specimens. We obtained surface swab samples for 6 Nipah patients; 5 had evidence of NiV RNA on >1 surface: 4 patients contaminated towels, 3 bed sheets, and 1 the bed rail. Patients with NiV RNA in oral swab samples were significantly more likely than other Nipah patients to die. To reduce the risk for fomite transmission of NiV, infection control should target hospital surfaces.
- A Test Bed to Examine Helmet Fit and Retention and Biomechanical Measures of Head and Neck Injury in Simulated Impact. [Journal Article]
- JVJ Vis Exp 2017 09 21; (127)
- Conventional wisdom and the language in international helmet testing and certification standards suggest that appropriate helmet fit and retention during an impact are important factors in protecting…
Conventional wisdom and the language in international helmet testing and certification standards suggest that appropriate helmet fit and retention during an impact are important factors in protecting the helmet wearer from impact-induced injury. This manuscript aims to investigate impact-induced injury mechanisms in different helmet fit scenarios through analysis of simulated helmeted impacts with an anthropometric test device (ATD), an array of headform acceleration transducers and neck force/moment transducers, a dual high speed camera system, and helmet-fit force sensors developed in our research group based on Bragg gratings in optical fiber. To simulate impacts, an instrumented headform and flexible neck fall along a linear guide rail onto an anvil. The test bed allows simulation of head impact at speeds up to 8.3 m/s, onto impact surfaces that are both flat and angled. The headform is fit with a crash helmet and several fit scenarios can be simulated by making context specific adjustments to the helmet position index and/or helmet size. To quantify helmet retention, the movement of the helmet on the head is quantified using post-hoc image analysis. To quantify head and neck injury potential, biomechanical measures based on headform acceleration and neck force/moment are measured. These biomechanical measures, through comparison with established human tolerance curves, can estimate the risk of severe life threatening and/or mild diffuse brain injury and osteoligamentous neck injury. To our knowledge, the presented test-bed is the first developed specifically to assess biomechanical effects on head and neck injury relative to helmet fit and retention.
- Treadmill exercise within lower-body negative pressure attenuates simulated spaceflight-induced reductions of balance abilities in men but not women. [Journal Article]
- NMNPJ Microgravity 2016; 2:16022
- Spaceflight causes sensorimotor adaptations that result in balance deficiencies on return to a gravitational environment. Treadmill exercise within lower-body negative pressure (LBNP) helps protect p…
Spaceflight causes sensorimotor adaptations that result in balance deficiencies on return to a gravitational environment. Treadmill exercise within lower-body negative pressure (LBNP) helps protect physiological function during microgravity as simulated by bed rest. Therefore, we hypothesized that treadmill exercise within LBNP would prevent balance losses in both male and female identical twins during 30 days of 6° head-down tilt bed rest. Fifteen (seven female and eight male) identical twin sets participated in this simulation of microgravity. Within each twin pair, one twin was randomly assigned to an exercise group that performed 40 min of supine treadmill exercise within LBNP set to generate 1.0-1.2 body weight, followed by 5 min of static feet-supported LBNP, 6 days per week. Their identical sibling was assigned to a non-exercise control group with all other bed rest conditions equivalent. Before and immediately after bed rest, subjects completed standing and walking rail balance tests with eyes open and eyes closed. In control subjects, standing rail balance times (men: -42%, women: -40%), rail walk distances (men: -44%, women: -32%) and rail walk times (men: -34%, women: -31%) significantly decreased after bed rest. Compared with controls, treadmill exercise within LBNP significantly attenuated losses of standing rail balance time by 63% in men, but the 41% attenuation in women was not significant. Treadmill exercise within LBNP did not affect rail walk abilities in men or women. Treadmill exercise within LBNP during simulated spaceflight attenuates loss of balance control in men but not in women.
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- Factors Leading to Transmission Risk of Acinetobacter baumannii. [Multicenter Study]
- CCCrit Care Med 2017; 45(7):e633-e639
- CONCLUSIONS: Healthcare worker hands/gloves are frequently contaminated with A. baumannii after patient care. Patient-level factors were not associated with an increased transmission risk; however, having multidrug-resistant-A. baumannii and specific healthcare worker activities led to an increased contamination risk. Our findings reveal a potential selective advantage possessed by multidrug-resistant-A. baumannii in this environment and suggest possible areas for future research.