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Biomedical subjects

R P Cooke

Publications and source records attributed to R P Cooke.

At least 19 recordsLinked to original sources
PubMed2001

An outbreak of hepatitis A amongst injecting drug users.

This descriptive study investigated an outbreak of hepatitis A virus (HAV) infection among injecting drug users (IDUs) and their contacts. Twenty-seven cases of acute HAV infection were identified in a 5-month period. Connections with the local injecting drug using (IDU) population were established for 25 of the cases of whom 14 admitted to injecting drug use. HAV RNA genotyping revealed two HAV variants, closely related to variants found in Scandinavian IDUs and in South East Asia. The study demonstrates that once HAV enters the IDU population extensive outbreaks are possible. We recommend that all IDUs should be tested for HAV and hepatitis B virus (HBV) infections and offered combined hepatitis A and B vaccines if non-immune.

Adult↗
PubMed2001

Developing an infection control for anaesthetic equipment.

Hospital risk management demands the development of broad and inclusive infection control policies. This is particularly true for anaesthetic equipment where appropriate recommendations on decontamination measures remains a difficult subject for infection control teams since there are no national guidelines. It is a topic which has perhaps been neglected in hospital infection control policies despite the widespread use of anaesthetic equipment in many clinical areas outside the theatre complex. This article offers practical guidance when preparing an infection control policy for anaesthetic equipment. The cost effectiveness of single patient use items versus reprocessing equipment is discussed. The importance of a multi-disciplinary approach, especially where the evidence base is weak, is highlighted.

Anesthesiology↗
PubMed2001

Is methicillin-resistant Staphylococcus aureus (MRSA) contamination of ward-based computer terminals a surrogate marker for nosocomial MRSA transmission and handwashing compliance?

A survey of two acute district general hospitals (A and B) was undertaken to investigate the extent of methicillin-resistant Staphylococcus aureus (MRSA) contamination of ward-based computer terminals. Of 25 terminals examined, MRSA was identified in six (24%). Environmental contamination was of a low level. Five of the MRSA positive terminals were from hospital A which had a significantly higher rate of MRSA transmission compared to hospital B (1.02 vs. 0.49 new inpatient MRSA cases per 100 hospital admissions for 1999). MRSA containment and handwashing policies were similar at both hospitals, though only hospital B actively audited handwashing compliance and had a 44% higher rate of paper towel usage per hospital bed. Ward-based computer terminals pose a low risk of MRSA cross-infection. This risk can be further reduced if all staff wash their hands before and after patient contact.

Computer Terminals↗
PubMed1998

Bacteria-free water for automatic washer-disinfectors: an impossible dream?

The ability of a new automatic washer-disinfector system (AWDS), fitted with a water filtration system to provide bacteria-free water and so avoid the risk of mycobacterial contamination of fibreoptic bronchoscopes, was examined. Four new Astec 'MP' Safescope washer-disinfectors, with coarse and fine (0.2 micron) filters attached close to the outlet taps, were supplied with non-softened mains water. Water samples from the tank supply and outlet taps were regularly assessed for bacterial quality over a six-month period. Outlet samples were also analysed after fine filter change and purgation with peracetic acid. All bronchoalveolar lavage specimens (BALS) were stained and cultured for mycobacteria. Only 13 out of 53 outlet samples (24%) were culture-negative. There was no improvement after filter change. Residual anti-bacterial effect of peracetic acid lasted up to 48 h following AWDS purgation. No tank samples were bacteria-free. Sixty BALS were processed, two samples were culture-positive and grew M. tuberculosis and one was also smear-positive. Though mycobacterial contamination of bronchoscopes was not evident, the water filtration system was unable to reliably provide sterile rinse water.

Bronchoalveolar Lavage Fluid↗
PubMed1997

Comparison of commercial slide agglutination kits with a tube coagulase test for the rapid identification of Staphylococcus aureus from blood culture.

Eighty clinical specimens of BACTEC 9240 blood culture vials, culture positive for staphylococci (38 Staphylococcus aureus and 42 coagulase negative staphylococci), were tested directly for the presence of clumping factor/protein A and free coagulase. Seven commercial slide agglutination kits were compared with a direct-tube coagulase (DTC) method. All tests were performed on blood culture pellets. Sensitivity, specificity, and negative and positive predictive values for the seven commercial kits were extremely variable, whereas a two-hour DTC test was highly predictive of S aureus. There was no significant difference between a two-, six- or 24-hour DTC test. Three (8%) S aureus isolates remained DTC negative even after 24 hours' incubation. Staphylococcal slide agglutination kits should not be used directly on blood culture broths. In contrast, a two-hour DTC test is a useful, rapid screening test for S aureus bacteraemia, provided isolates from DTC negative blood culture broths are re-tested using standard laboratory techniques.

Agglutination Tests↗
PubMed1997

Audit of once-daily dosing gentamicin therapy in neutropenic fever.

During a 12-month study, 42 adult patients with febrile neutropenia (granulocytes < 1 x 10(9)/l) were treated with once-daily gentamicin (5 mg/kg). Serum gentamicin trough levels were measured 24 hours after the first dose, then twice weekly if < 1 mg/l. Gentamicin was halved if the trough level was 1-2 mg/l and usually stopped if > 2 mg/l. One hundred and sixty samples were assayed: 122 (76%) < 1 mg/l, 27 (17%) l-2 mg/l and 11 (7%) > 2 mg/l. All 1-2 mg/l samples and three of the > 2 mg/l samples (taken at the wrong time) reverted to <1 mg/l with dosage adjustment. The protocol proved simple and effective with a low incidence of gentamicin-associated nephrotoxicity (7%) and no sepsis-related deaths.

Adolescent↗