The Effect of non-Surgical Periodontal Treatments on the Severity of Arthritis Rheumatoid

Background: periodontal disease with alveoli bone degeneration and losing teeth is seen in many people, including those with arthritis rheumatoid. Objective This study aims to evaluate the effect of non-surgical periodontal treatments on the severity of arthritis rheumatoid. Methods: this randomized control clinical trial was conducted on 60 patients who concurrently had arthritis and mild to moderate periodontitis. Patients divided into three groups of 20 subjects (group C had tooth cleaning and antibiotic therapy, group B had only tooth cleaning and group A was control). DAS28 questionnaire was filled out for all three groups at the beginning of the study. After ending the treatment and improvement, patients were examined in days 45 and 90 in terms of improvement indicators for arthritis rheumatoid. Data were finally analyzed by SPSS18. Results: the highest reduction rate of ESR, DAS28, CRP and RF was in different time periods in tooth cleaning intervention +antibiotic group and then, teeth cleaning group. The lowest reduction was seen in control group. RF, CRP and DAS28 indices showed significant differences in different time periods in tooth cleaning group and tooth cleaning+ antibiotic group (P<0.05). Conclusion: non-surgery periodontal treatment and RA indices, without considering the medicines used for treatment, had positive effect on the treatment of this disease.

Quantification of the Mechanized Ballast Cleaning Process Efficiency Using GPR Technology

Ground Penetrating Radar (GPR) has been used recently for diagnostics of the railway infrastructure, particularly the ballast layer. To overcome ballast fouling, mechanized ballast cleaning process, which increases track occupancy time and cost, is usually used. Hence it is of crucial significance to identify at which stage of track ballast life cycle, and level of fouling, ballast cleaning should be initiated. In the present study, a series of in situ GPR surveys on selected railway track sections in Czechia was performed to obtain railway granite ballast relative dielectric permittivity (RDP) values in several phases of railway track lifecycle. GPR data were collected in the form of B-scan, and time-domain analysis was used for post-processing. The results indicate (i) change of railway ballast RDP in time (long term); (ii) a dependency of ballast fouling level on RDP; and (iii) the RDP change during the ballast cleaning process, thus its efficiency. This research aimed to provide new perspectives into the decision-making process in initiating the mechanized ballast cleaning intervention based on the GPR-measured data.

NeoCLEAN: a multimodal strategy to enhance environmental cleaning in a resource-limited neonatal unit

Background Contamination of the hospital environment contributes to neonatal bacterial colonization and infection. Cleaning of hospital surfaces and equipment is seldom audited in resource-limited settings. Methods A quasi-experimental study was conducted to assess the impact of a multimodal cleaning intervention for surfaces and equipment in a 30-bed neonatal ward. The intervention included cleaning audits with feedback, cleaning checklists, in-room cleaning wipes and training of staff and mothers in cleaning methods. Cleaning adequacy was evaluated for 100 items (58 surfaces, 42 equipment) using quantitative bacterial surface cultures, adenosine triphosphate bioluminescence assays and fluorescent ultraviolet markers, performed at baseline (P1, October 2019), early intervention (P2, November 2019) and late intervention (P3, February 2020). Results Environmental swabs (55/300; 18.3%) yielded growth of 78 potential neonatal pathogens with Enterococci, S. marcescens, K. pneumoniae, S. aureus and A. baumannii predominating. Highest aerobic colony counts were noted from moist surfaces such as sinks, milk kitchen surfaces, humidifiers and suction tubing. The proportion of surfaces and equipment exhibiting no bacterial growth increased between phases (P1 = 49%, P2 = 66%, P3 = 69%; p = 0.007). The proportion of surfaces and equipment meeting the ATP “cleanliness” threshold (< 200 relative light units) increased over time (P1 = 40%, P2 = 54%, P3 = 65%; p = 0.002), as did the UV marker removal rate (P1 = 23%, P2 = 71%, P3 = 74%; p < 0.001). Conclusion Routine environmental cleaning of this neonatal ward was sub-optimal at baseline but improved significantly following a multimodal cleaning intervention. Involving mothers and nursing staff was key to achieving improved environmental and equipment cleaning in this resource-limited neonatal unit.

NeoCLEAN: a multimodal strategy to enhance environmental cleaning in a resource-limited neonatal unit

Background: Contamination of the hospital environment contributes to neonatal bacterial colonization and infection. Cleaning of hospital surfaces and equipment is seldom audited in resource-limited settings.Methods: A quasi-experimental study was conducted to assess the impact of a multimodal cleaning intervention (NeoCLEAN) for surfaces and equipment in a 30-bed neonatal ward. The intervention included cleaning audits with feedback, cleaning checklists, in-room cleaning wipes and training of staff and mothers in cleaning methods. Cleaning adequacy was evaluated for 100 items (58 surfaces, 42 equipment) using quantitative bacterial surface cultures, adenosine triphosphate (ATP) bioluminescence assays and fluorescent ultraviolet (UV) markers, performed at baseline (P1, October 2019), early intervention (P2, November 2019) and late intervention (P3, February 2020). Results: Environmental swabs (55/300; 18.3%) yielded growth of 78 potential neonatal pathogens with Enterococci, S. marcescens, K. pneumoniae, S. aureus and A. baumannii predominating. Highest aerobic colony counts were noted from moist surfaces such as sinks, milk kitchen surfaces, humidifiers and suction tubing. The proportion of surfaces and equipment exhibiting no bacterial growth increased between phases (P1=49%, P2=66%, P3=69%; p=0.007). The proportion of surfaces and equipment meeting the ATP “cleanliness” threshold (<200 relative light units) increased over time (P1=40%, P2=54%, P3=65%; p=0.002), as did the UV marker removal rate (P1=23%, P2=71%, P3=74%; p<0.001).Conclusion: Routine environmental cleaning of this neonatal ward was sub-optimal at baseline but improved significantly following a multimodal cleaning intervention. Involving mothers and nursing staff was key to achieving improved environmental and equipment cleaning in this resource-limited neonatal unit.

Chemical, Mechanical, and Heat Cleaning to Decontaminate Hospital Drains Harboring Carbapenemase-Producing Enterobacteriales

Background: Carbapenemase-producing Enterobacteriales (CPE) outbreaks have been linked to contaminated wastewater drainage systems in hospitals. The optimal strategy for CPE decontamination of drains is unknown. In this randomized controlled trial, we aimed to determine whether combining chemical, mechanical, and heat cleaning was superior to routine cleaning for drain decontamination. Methods: We enrolled CPE-contaminated hospital drains at 2 geographic locations. Eligible drains were those initially found to be culture positive in a 2017 study and that remained positive (by RT-PCR) when retested twice in August 2018. Drains were stratified by type (sink versus shower) and randomized with a 1:1 allocation ratio (as per computer-generated randomization) to standard-of-care cleaning (comparator) or combined chemical, mechanical, and heat cleaning (intervention) on day 0. Drain tail pieces were swabbed on days 0 (before administration of the intervention), 1, 2, 3, 7, and 14, and at months 1, 2, 3, 4, 5, and 6. Swabs were placed into brain heart infusion with 10% Dey-Engley neutralizing broth and incubated overnight. Direct RT-PCR was performed to detect KPC, VIM, NDM, OXA-48–like, IMP, GES, and SME genes. The primary outcome was drain decontamination, defined as no detectable carbapenemase gene in the drain from day 1 to 7 (inclusive). Results: Overall, 33 CPE-contaminated drains were enrolled (7 sink and 26 shower); 17 and 16 drains were randomized to the intervention and comparator, respectively. Moreover, 12 (36%) drains met the primary outcome of decontamination, 18 (55%) remained contaminated, and 3 (9%) could not be assessed. Among drains that could be assessed, 11 of 15 (74%) in the intervention group met the primary outcome of decontamination compared to 1 of 15 (7%) in the comparator group (P = .0005). Of the 11 drains in the intervention group that were decontaminated, the carbapenemase gene present at enrollment was subsequently detected in 10 (91%): 1 (10%) at day 14, 3 (30%) at month 1, 4 (40%) at month 3, 1 (10%) at month 4, and 1 (10%) at month 6. The median time to a swab yielding CPE was 1 day in the comparator group versus 14 days in the intervention group (Fig. 1). Overall, 24 drains (73%) had a carbapenemase gene (that was not detectable at enrollment) appear in the follow-up. Of patients identified as CPE colonized or infected during this study, none occupied rooms with these drains. Conclusions: Chemical, mechanical, and heat cleaning were superior to standard cleaning for CPE decontamination of hospital drains at 7 days, but these trends were not sustained. Such cleaning may be useful if applied repeatedly.Funding: NoneDisclosures: Allison McGeer reports funds to her institution for studies for which she is the principal investigator from Pfizer and Merck as well as consulting fees from Sanofi-Pasteur, Sunovion, GSK, Pfizer, and Cidara.

A Simple Cleaning Intervention to Prevent Transmission of Carbapenemase-Producing Enterobacterales from Hospital Sinks

Background: A prolonged outbreak of carbapenemase-producing Serratia marcescens (CPSM) was identified in our quaternary healthcare center over a 2-year period from 2015 through 2017. A reservoir of IMP-4–producing S. marcescens in sink drains of clinical hand basins (CHB) was implicated in propagating transmission, supported by evidence from whole-genome sequencing (WGS). We assessed the impact of manual bioburden reduction intervention on further transmission of CPSM. Methods: Environmental sampling of frequently touched wet and dry areas around CPSM clinical cases was undertaken to identify potential reservoirs and transmission pathways. After identifying CHB as a source of CPSM, a widespread annual CHB cleaning intervention involving manual scrubbing of sink drains and the proximal pipes was implemented. Pre- and postintervention point prevalence surveys (PPS) of CHB drains performed to assess for CPSM colonization. Surveillance for subsequent transmission was conducted through weekly screening of patients and annual screening of CHB in transmission areas, and 6-monthly whole-hospital PPS of patients. All CPSM isolates were assessed by WGS. Results: In total, 6 patients were newly identified with CPSM from 2015 to 2017 (4.3 transmission events per 100,000 surveillance bed days [SBD]; 95% CI, 1.6–9.4). All clinical CPSM isolates were linked to CHB isolates by WGS. The CHB cleaning intervention resulted in a reduction in CHB colonization with CPSM in transmission areas from 72% colonization to 28% (ARR, 0.44; 95% CI, 0.25–0.63). A single further clinical case of CPSM linked to the CHB isolates was detected over 2 years of surveillance from 2017 to 2019 following the implementation of the annual CHB cleaning program (0.7 transmissions per 100,000 SBD; 95% CI, 0.0–3.9). No transmissions were linked to undertaking the cleaning intervention. Conclusions: A simple intervention targeted at reducing the biological burden of CPSM in CHB drains at regular intervals was effective in preventing transmission of carbapenemase-producing Enterobacterales from the hospital environment to patients over a prolonged period of intensive surveillance. These findings highlight the importance of detailed cleaning for controlling the spread of multidrug-resistant organisms from healthcare environments.Funding: NoneDisclosures: Jason Kwong, Austin Health

Quantity and quality benefits of in-service invasive cleaning of trunk mains

Trunk mains are high risk critical infrastructure where poor performance can impact on large numbers of customers. Both quantity (e.g. hydraulic capacity) and quality (e.g. discolouration) of trunk main performance are affected by asset deterioration in the form of particle accumulation at the pipe wall. Trunk main cleaning techniques are therefore desirable to remove such material. However, little is quantified regarding the efficacy of different maintenance interventions or longer-term changes following such cleaning. This paper presents an assessment of quantity and quality performance of a trunk main system pre, post and for 12 months following cleaning using pigging with ice slurry. Hydraulic calibration showed a 7 times roughness height reduction after ice slurry pigging, evidencing substantially improved hydraulic capacity and reduced headloss. Turbidity response due to carefully imposed shear stress increase remained significant after the cleaning intervention, showing that relatively loose material had not been fully removed from the pipe wall. Overall the results demonstrate that cleaning by pigging with ice slurry can be beneficial for quantity performance, but care and further assessment may be necessary to realise the full quality benefits.

Quantity and Quality Benefits of in-Service Invasive Cleaning of Trunk Mains

Trunk mains are high risk critical infrastructure where poor performance can impact on large numbers of customers. Both quantity (e.g. hydraulic capacity) and quality (e.g. discolouration) of trunk main performance are affected by asset deterioration in the form of particle accumulation at the pipe wall. Trunk main cleaning techniques are therefore desirable to remove such material. However little is quantified regarding the efficacy of different maintenance interventions, or longer term changes following such cleaning. This paper presents an assessment for quantity and quality performance of a trunk main system pre, post and for twelve months following cleaning using pigging with ice slurry. Hydraulic calibration showed a 7x roughness height reduction after ice slurry pigging, evidencing substantially improved hydraulic capacity and reduced headloss. Turbidity response due to carefully imposed shear stress increase remained significant after the cleaning intervention evidencing that relatively loose materials had be not been fully removed from the pipe wall. Ongoing material accumulation and associated discolouration risk was shown, with the rate of accumulation found to correlate with temperature. Overall the results demonstrate that cleaning by pigging with ice slurry can be beneficial for quantity performance, but care and further assessment may be necessary to realise the full quality benefits.