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A survey of sports medicine specialists investigating the preferred management of contaminated anterior cruciate ligament grafts.

PURPOSE: To survey leaders in sports medicine who perform anterior cruciate ligament (ACL) reconstructions to determine the preferred management when ACL graft contamination occurs. TYPE OF STUDY: Survey study of expert opinions and experiences on the management of ACL graft contamination. METHODS: We mailed 337 surveys to directors of academic sports medicine programs and graduates from an accredited sports medicine fellowship. The survey questioned the incidence, treatment, and outcome of ACL graft contamination. RESULTS: Twelve surveys were returned to sender; 196 surgeons responded from the remaining 325 surveys (60%). Forty-nine of 196 (25%) surgeons reported at least 1 contamination during their career. Of those 49, 43 surgeons (88%) had 1 contaminated graft, 5 (10%) had 2, and 1 had 4, for a total of 57 reported contaminated grafts. Of the surgeons who reported a contaminated graft, 22 (45%) performed between 40 and 100 ACL reconstructions annually, and 17 (35%) performed more than 100 ACL reconstructions annually. Forty-three of the 57 (75%) contaminated grafts were managed with cleansing of the graft and proceeding with reconstruction. Ten (18%) were managed by harvesting a different graft, and 4 (7%) were substituted with an allograft. No infections in any of the contaminated grafts were reported. Sixty-five of the 147 (43%) surgeons without graft contamination gave hypothetical management responses. Thirty-eight (58%) would cleanse the graft and proceed with the procedure, 22 (34%) would harvest a different graft, and 5 (8%) would use an allograft. CONCLUSIONS: Surgeons who perform a high volume of ACL reconstruction surgery most often choose graft cleansing as the preferred management for intraoperative ACL graft contamination. LEVEL OF EVIDENCE: Level V, expert opinion.

Anterior Cruciate Ligament↗

Microbial contamination of hematopoietic stem cell products: incidence and clinical sequelae.

Microbial contamination of hematopoietic stem cell products is a rare but potentially fatal complication of hematopoietic stem cell transplantation. We report the incidence of contaminated products and describe the clinical outcomes for 35 patients at the University of Minnesota who received contaminated products from January 1990 to December 2004. In total, 2935 products were infused for 2863 transplants during this time, 36 of which 36 (1.2%) were contaminated. Coagulase negative Staphylococcus was the predominant species isolated on culture of the hematopoietic stem cell products. Patients received prophylactic antibiotics before infusion of the contaminated product based on the organism identified from culture and antibiotic sensitivities, if known. After transplantation, blood cultures from 2 patients grew the same pathogen as in the infused contaminated product, including 1 patient who had blood cultures positive for Pseudomonas cepacia. All patients who received contaminated products had benign post-transplantation courses except for the patient with Pseudomonas bacteremia, who ultimately died from complications. These results suggest that, although rare, microbial contamination of stem cell products does occur and there must be ongoing efforts by physicians and laboratory personnel to minimize the risk for introduction of contaminants. Prophylactic antibiotics are useful for certain contaminants; however, caution must be exercised when gram-negative contaminated products are administered.

Academic Medical Centers↗

Contaminants in the Canadian Arctic: 5 years of progress in understanding sources, occurrence and pathways.

Recent studies of contaminants under the Canadian Northern Contaminants Program (NCP) have substantially enhanced our understanding of the pathways by which contaminants enter Canada's Arctic and move through terrestrial and marine ecosystems there. Building on a previous review (Barrie et al., Arctic contaminants: sources, occurrence and pathways. Sci Total Environ 1992:1-74), we highlight new knowledge developed under the NCP on the sources, occurrence and pathways of contaminants (organochlorines, Hg, Pb and Cd, PAHs, artificial radionuclides). Starting from the global scale, we examine emission histories and sources for selected contaminants focussing especially on the organochlorines. Physical and chemical properties, transport processes in the environment (e.g. winds, currents, partitioning), and models are then used to identify, understand and illustrate the connection between the contaminant sources in industrial and agricultural regions to the south and the eventual arrival of contaminants in remote regions of the Arctic. Within the Arctic, we examine how contaminants impinge on marine and terrestrial pathways and how they are subsequently either removed to sinks or remain where they can enter the biosphere. As a way to focus this synthesis on key concerns of northern residents, a number of special topics are examined including: a mass balance for HCH and toxaphene (CHBs) in the Arctic Ocean; a comparison of PCB sources within Canada's Arctic (Dew Line Sites) with PCBs imported through long-range transport; an evaluation of concerns posed by three priority metals--Hg, Pb and Cd; an evaluation of the risks from artificial radionuclides in the ocean; a review of what is known about new-generation pesticides that are replacing the organochlorines; and a comparison of natural vs. anthropogenic sources of PAH in the Arctic. The research and syntheses provide compelling evidence for close connectivity between the global emission of contaminants from industrial and agricultural activities and the Arctic. For semi-volatile compounds that partition strongly into cold water (e.g. HCH) we have seen an inevitable loading of Arctic aquatic reservoirs. Drastic HCH emission reductions have been rapidly followed by reduced atmospheric burdens with the result that the major reservoir and transport agent has become the ocean. In the Arctic, it will take decades for the upper ocean to clear itself of HCH. For compounds that partition strongly onto particles, and for which the soil reservoir is most important (e.g. PCBs), we have seen a delay in their arrival in the Arctic and some fractionation toward more volatile compounds (e.g. lower-chlorinated PCBs). Despite banning the production of PCB in the 1970s, and despite decreases of PCBs in environmental compartments in temperate regions, the Arctic presently shows little evidence of reduced PCB loadings. We anticipate a delay in PCB reductions in the Arctic and environmental lifetimes measured in decades. Although artificial radionuclides have caused great concern due to their direct disposal on Russian Shelves, they are found to pose little threat to Canadian waters and, indeed, much of the radionuclide inventory can be explained as remnant global fallout, which was sharply curtailed in the 1960s, and waste emissions released under license by the European reprocessing plants. Although Cd poses a human dietary concern both for terrestrial and marine mammals, we find little evidence that Cd in marine systems has been impacted by human activities. There is evidence of contaminant Pb in the Arctic, but loadings appear presently to be decreasing due to source controls (e.g. removal of Pb from gasoline) in Europe and North America. Of the metals, Hg provokes the greatest concern; loadings appear to be increasing in the Arctic due to global human activities, but such loadings are not evenly distributed nor are the pathways by which they enter and move within the Arctic well understood.

Animals↗

Indirect effects of contaminants in aquatic ecosystems.

Contaminants such as petroleum hydrocarbons, heavy metals and pesticides can cause direct toxic effects when released into aquatic environments. Sensitive species may be impaired by sublethal effects or decimated by lethality, and this ecological alteration may initiate a trophic cascade or a release from competition that secondarily leads to responses in tolerant species. Contaminants may exert direct effects on keystone facilitator and foundation species, and contaminant-induced changes in nutrient and oxygen dynamics may alter ecosystem function. Thus, populations and communities in nature may be directly and/or indirectly affected by exposure to pollutants. While the direct effects of toxicants usually reduce organism abundance, indirect effects may lead to increased or decreased abundance. Here we review 150 papers that reference indirect toxicant effects in aquatic environments. Studies of accidental contaminant release, chronic contamination and experimental manipulations have identified indirect contaminant effects in pelagic and benthic communities caused by many types of pollutants. Contaminant-induced changes in behavior, competition and predation/grazing rate can alter species abundances or community composition, and enhance, mask or spuriously indicate direct contaminant effects. Trophic cascades were found in 60% of the manipulative studies and, most commonly, primary producers increased in abundance when grazers were selectively eliminated by contaminants. Competitive release may also be common, but is difficult to distinguish from trophic cascades because few experiments are designed to isolate the mechanism(s) causing indirect effects. Indirect contaminant effects may have profound implications in environments with strong trophic cascades such as the freshwater pelagic. In spite of their undesirable environmental influence, contaminants can be useful manipulative tools for the study of trophic and competitive interactions in natural communities.

Animals↗

Estimating the annual fraction of eggs contaminated with Salmonella enteritidis in the United States.

Using available data on the occurrence of Salmonella enteritidis (SE) in US layer flocks and eggs, and a probabilistic scenario tree method, an estimate of the fraction of SE-contaminated eggs produced annually is derived with attendant uncertainty. In lieu of a definitive prevalence survey, the approach presented here provides insight to the relative contribution of various pathways leading to contaminated eggs. A Monte Carlo model with four branches is developed. The first branch predicts the proportion of all US flocks that are SE-affected. The second branch apportions SE-affected flocks into three categories (high, moderate, and low level affected flocks) based on population-adjusted epidemiologic data. The third branch predicts the proportion of affected flocks that are molted and producing eggs during a high risk period subsequent to molt. The fourth branch predicts the fraction of contaminated eggs produced by flocks of the type described by the pathway (e.g. high level affected flocks that are not molted) based on egg sampling evidence from naturally infected flocks. The model is simulated to account for uncertainty in the data used to estimate the branch probabilities. Correlation analysis is used to estimate the sensitivity of model output to various model inputs. The output of this model is an uncertainty distribution for the fraction of all eggs that are SE-contaminated during 1 year of production in the US. The expected value of this distribution is approximately one SE-affected egg in every 20,000 eggs annually produced, and the 90% certainty interval is between one SE-contaminated egg in 30,000 eggs, and one SE-contaminated egg in 12,000 eggs. The model estimates that an average of 14% of all eggs (i.e. contaminated and not contaminated) from affected flocks are produced by high level, non-molted affected flocks, but these flocks are estimated to account for more than two-thirds of the total fraction of contaminated eggs produced annually. Sensitivity analysis also suggests that the proportion of affected flocks that are high level flocks - and the egg contamination frequency for these types of flocks - are the most sensitive model inputs. The model's pathways provide a framework for evaluating interventions to reduce the number of contaminated eggs produced in the US. Furthermore, sensitivity analysis of the model identifies those inputs whose uncertainty is most influential on the model's output. Future farm-level research priorities can be established on the basis of this analysis, but public policy decisions require a fuller exposure assessment and dose-response analysis to account for microbial growth dynamics, meal preparation, and consumption demographics among US egg consumers.

Animals↗

A partition-limited model for the plant uptake of organic contaminants from soil and water.

In dealing with the passive transport of organic contaminants from soils to plants (including crops), a partition-limited model is proposed in which (i) the maximum (equilibrium) concentration of a contaminant in any location in the plant is determined by partition equilibrium with its concentration in the soil interstitial water, which in turn is determined essentially by the concentration in the soil organic matter (SOM) and (ii) the extent of approach to partition equilibrium, as measured by the ratio of the contaminant concentrations in plantwater and soil interstitial water, alphapt (< or = 1), depends on the transport rate of the contaminant in soil water into the plant and the volume of soil water solution that is required for the plant contaminant level to reach equilibrium with the external soil-water phase. Through reasonable estimates of plant organic-water compositions and of contaminant partition coefficients with various plant components, the model accounts for calculated values of alphapt in several published crop-contamination studies, including near-equilibrium values (i.e., alphapt approximately equals 1) for relatively water-soluble contaminants and lower values for much less soluble contaminants; the differences are attributed to the much higher partition coefficients of the less soluble compounds between plant lipids and plant water, which necessitates much larger volumes of the plant water transport for achieving the equilibrium capacities. The model analysis indicates that for plants with high water contents the plant-water phase acts as the major reservoir for highly water-soluble contaminants. By contrast, the lipid in a plant, even at small amounts, is usually the major reservoir for highly water-insoluble contaminants.

Lipids↗

Solvent extraction for separating micellar-solubilized contaminants and anionic surfactants.

Decontamination of contaminant-laden surfactant solutions is critical to successful implementation of surfactant-enhanced aquifer remediation (SEAR). Solvent extraction was studied for removing micellar-solubilized contaminants having low equivalent alkyl carbon numbers (EACNs) from surfactant solutions. Factors influencing the solvent extraction of micellar-solubilized contaminant were studied, including surfactant concentration, solution salinity, solvent solubilization, and solvent/solution volumetric ratio. A model was developed to quantify the impacts of these factors on contaminant removal. The good agreement between experimental results and model predictions corroborates assumptions made in the model development. From these results, it is concluded that extracting solvents must have much higher EACNs than that of the contaminant to reduce the micellar solubilization of the solvents, which can significantly reduce contaminant removal efficiency. However, the highest EACN solvent is not necessarily the best one for contaminant removal due to other constraints (e.g., molecular weight and viscosity). Increasing the total surfactant concentration or salinity of an anionic surfactant solution increases its contaminant solubilization capacity but reduces the contaminant removal efficiency by solvent extraction. Continuous column extraction operated at a low column surface loading rate allowed contaminant partitioning to approach equilibrium conditions, and multistage column extraction was able to improve the contaminant removal efficiency while minimizing solvent requirement.

Anions↗

Sources and sequelae of bacterial contamination of hematopoietic stem cell components: implications for the safety of hematotherapy and graft engineering.

BACKGROUND: It is important to compare the incidence of bacterial contamination of components collected from the peripheral blood or bone marrow (BM), as well as of components processed with or without cell selection or depletion, and to evaluate the sequelae of such contamination. STUDY DESIGN AND METHODS: Bacterial contamination rates were compared in 1380 untreated autologous peripheral blood progenitor cells (PBPCs), 291 untreated autologous BM samples, 916 monoclonal antibody (MoAb)-treated autologous and allogeneic BM samples, and in 45 autologous PBPC components from which the CD34+ cells were selected. Bacterial cultures were performed at sequential time points during the processing of MoAb-treated BM. RESULTS: Bacterial contamination was documented in 44 of 2632 components from 1593 patients (1.67% of components, 2.76% of patients) before cryopreservation. Although only 0.65% of untreated PBPCs were contaminated before cryopreservation, each patient was more likely to have given a contaminated PBPC component than a contaminated BM component (2.41% vs. 0%, p < 0.01). Bacterial contamination of MoAb-treated BM was greater during or after manipulation than it was before (2.33% vs. 0.77%, p < 0.05). At thawing, contamination was documented in 42 (1.97%) of 2136 components cultured. Ten (13.7%) of 73 patients who received hematopoietic progenitor cells that were contaminated before cryopreservation or at thawing developed fever or positive blood cultures within 48 hours of transfusion. Fever was associated with bacteremia in two cases, but no irreversible clinical sequelae were noted. CONCLUSION: These studies suggest that, despite careful attention to sterile procedures, low-level contamination of hematopoietic stem cell components can be introduced before or during manipulation as well as at thawing, and that standards for monitoring of the procedures for collection, processing, cryopreservation, thawing, and transfusion of hematopoietic progenitor cells are necessary.

Antibodies, Monoclonal↗

The use of a modified technique to reduce radioactive air contamination in aerosol lung ventilation imaging.

The aim of this study was to reduce airborne contamination resulting from the use of aerosols in lung ventilation scintigraphy. Lung ventilation imaging is frequently performed with 99mTc-diethylenetriaminepentaacetate aerosol (DTPA), derived from a commercial nebuliser. Airborne contamination is a significant problem with this procedure; it results in exposure of staff to radiation and can reduce gamma camera performance when the ventilation is performed in the camera room. We examined the level of airborne contamination resulting from the standard technique with one of the most popular nebuliser kits and tested a modification which significantly reduced airborne contamination. Air contamination was measured while ventilating 122 patients. The modified technique reduced air contamination by a mean value of 64% (p = 0.028) compared with the standard control technique. Additionally, differences in contamination were examined when a mask or mouthpiece was used as well as differences between operators. A simplified method of monitoring air contamination is presented using a commonly available surface contamination monitor. The index so derived was proportional to air contamination (r = 0.88). The problems and regulations associated with airborne contamination are discussed.

Aerosols↗

An epidemiological study after a water contamination incident near Worcester, England in April 1994.

STUDY OBJECTIVES: To investigate whether exposure to tap water contaminated in a major river pollution incident with 2 ethyl 5,5 dimethyl 1,3 dioxane (EDD) and 2 ethyl 4 methyl 1,3 dioxolane (EMD) was associated with an increase of self reported symptoms. To assess the extent of association between noticing the water had an unusual taste or odour and self reported symptoms. DESIGN: Retrospective cohort study. SETTING: A city and two nearby towns in a semi-rural area of England, UK. PARTICIPANTS: A total of 3861 people who replied to a postal questionnaire asking about symptoms and water consumption sent to a sample of 1000 households in each of three areas--one area supplied with contaminated water (study group) and two control areas that were unaffected (control groups). MAIN RESULTS: The household response rates were 65% for the study group and 56% and 57% for the two control groups. Self reporting of 10 individual symptoms was significantly increased in the study group compared with controls. Within the study group, reporting of one or more symptoms was significantly higher in subjects who consumed contaminated water but not among subjects who used it to wash or cook. Subjects who drank contaminated water showed a dose-response relationship for self reporting of one or more symptoms and for seven individual symptoms. Within the study group, however, only 62% (867 of 1398 subjects) noticed that the water had an unusual taste or odour. Among subjects who did not notice that the water had an unusual taste or odour, no association was found between drinking contaminated water and reporting one or more symptoms, or between drinking contaminated water and reporting of individual symptoms, although a dose-response relationship was shown between the amount of water consumed and self reporting of nausea. Among subjects who noticed the water had an unusual taste or odour, both an association and a dose-response relationship were found between consumption of contaminated water and the self reporting of six symptoms--diarrhoea, nausea, headache, stomach pains, skin irritation, and itchy eyes. CONCLUSIONS: Higher rates of symptom reporting were associated with the water contamination incident. Reported symptoms seemed, however, to be associated with the ability to detect an unusual taste or odour in the water. Because concentrations of the contaminants would be expected to be evenly distributed in the tap water in the affected area, irrespective of taste or odour, and because of the known toxicity of the parent compounds of EMD and EDD, it is concluded that the increase in self reported symptoms in the study group respondents was associated with noticing the unpleasant taste or odour of the tap water and not with the chemical contamination. It is concluded that the observed increase in reporting of nausea with increasing water consumption was due to public anxiety caused by the incident but did not pose a serious risk to the public's health. The increase in self reported symptoms in the area affected by the contamination was an important reminder of the wider health implications of "health scares".

Adolescent↗

Uptake and transport of radioactive nickel and cadmium into three vegetables after wet aerial contamination.

Knowledge of radionuclide or trace element retention and translocation to plants following an aerial contamination event, for example, sprinkling with contaminated water, is necessary for the evaluation of human exposure through consumption of contaminated vegetables. The fate of 63Ni and 109Cd in all plant parts of three different vegetables after wet deposition on leaves or on fruits was studied. Lettuce (Lactuca sativa L.), radish (Raphanus sativus L.), and bean (Phaseolus vulgaris L.) grown under controlled conditions in a growth chamber were contaminated with 63Ni and 109Cd either on leaves, by means of two different contamination methods (a single early contamination and a repetitive one), or on bean husks (third contamination method: a single contamination at a late stage). Spiked and nonspiked organs were harvested at maturity and radionuclide contents were measured. The fraction retained was on average 56% of the initially administered doses of 63Ni and 87% of 109Cd. The leaf-to-other organ translocation factor was considerably higher for 63Ni (on average 43% of retained radioactivity) than for 109Cd (8%). Nickel-63 migrated throughout the whole plant following foliar contamination, and mainly toward young leaves, seeds in formation, and sink organs, whereas 109Cd migrated to a much lesser extent and only to the organs that were closest to the spiked one, and not at all into fruit. After a fruit contamination event, both radionuclides were translocated into the seeds of spiked fruits. Radionuclide retention and translocation were not affected by plant species, but principally by the type of organ contaminated.

Biomass↗

Effects of feeding grains naturally contaminated with Fusarium mycotoxins with and without a polymeric glucomannan mycotoxin adsorbent on reproductive performance and serum chemistry of pregnant gilts.

Contamination of animal feedstuffs with Fusarium mycotoxins can cause reduced feed intake and hyperaminoacidemia resulting from reduced hepatic protein synthesis. The current study investigated the effects of feeding grains naturally contaminated with Fusarium mycotoxins on reproductive performance, serum chemistry, ADFI, and ADG of gilts, and tested the ability of a polymeric glucomannan mycotoxin adsorbent (GMA) to reduce or eliminate the effects of the contaminated feeds. Thirty-six Yorkshire gilts were fed 3 diets (n = 12 gilts/diet) from 91 +/- 3 d of gestation until farrowing. Diets included 1) control, 2) contaminated grains, and 3) contaminated grains + 0.2% GMA. Diets contaminated with Fusarium mycotoxins did not affect ADFI (P = 0.24), but ADG (P = 0.029) and G:F (P = 0.047) were reduced. Serum concentrations of beta-hydroxybutyrate, haptoglobin, protein, albumin, globulin, urea, glucose, cholesterol, Ca, Na, Mg, P, K, and Cl, and hepatic enzyme activities were not affected by diet. The frequency of stillborn piglets was greater (P = 0.03) for gilts fed contaminated grains compared with that of gilts fed contaminated grains + GMA. The feeding of contaminated grains + GMA also increased (P = 0.026) the percentage of pigs born alive compared with gilts fed the contaminated diets. In conclusion, feeding gilts diets that are naturally contaminated with Fusarium mycotoxins can increase the incidence of stillborn piglets and this effect can be reduced by dietary supplementation with GMA.

Abortion, Veterinary↗

In vitro shear bond strength of adhesive to normal and fluoridated enamel under various contaminated conditions.

OBJECTIVE: This study examined the shear bond strength of bonding agents to normal or fluoridated enamel following use of weak or strong acids to prepare enamel surfaces and after contamination with a measured amount of saliva at various stages of the bonding procedure. METHOD AND MATERIALS: One hundred extracted human third molar teeth were randomly separated into 2 basic groups (normal or fluoridated teeth), then divided into 5 subgroups. Group A specimens were not contaminated. After etching, enamel surfaces were dry and clean. Group B was left with wet surfaces after etching. Group C specimens were contaminated with artificial saliva and then dried. Group D specimens were contaminated with artificial saliva, rinsed, and then dried. In group E, all enamel surfaces were left contaminated with saliva after the etching procedures (with maleic acid or phosphoric acids). Adhesive resins were applied to all enamel surfaces according to the manufacturer's instructions. The specimens were then mounted and tested to determine shear bond strength. RESULTS: If normal enamel surfaces were rinsed and dried immediately after contamination, there was no significant reduction of shear bond strength of adhesive to enamel. Specimens in group E and group C had significantly lower bond strengths than did control specimens (group A). In the fluoridated groups etched with the phosphoric acid, statistically significant reductions in bond strengths were obtained in all contamination groups and in the control group. In the fluoridated specimens, there were no statistically significant differences between any of the contamination groups and the control group when maleic acid was used. CONCLUSION: Saliva contamination may not be a risk factor for successful bonding between bonding agent and dental tissues for normal or fluoridated enamel surfaces if they are rinsed and dried immediately after contamination. Etching of normal enamel surfaces with phosphoric acid in the presence of contamination may provide higher shear bond strength than etching with maleic acid.

Acid Etching, Dental↗

Effect of saliva contamination on the bond of dentin to resin-modified glass-ionomer cement.

This in vitro study compared the shear bond strength of a resin-modified glass-ionomer restorative material (Fuji II LC) bonded to saliva-contaminated dentin versus non-contaminated dentin. Seventy-five extracted human molar teeth were randomly divided into five groups of 15 samples each. The dentin was treated with 10% polyacrylic acid for 20 seconds, rinsed, and dried. The acid-treated dentin surfaces in Groups 1-4 were contaminated with saliva. In Group 1, the saliva was air thinned. In Groups 2-4, saliva was dried completely with compressed air. The saliva-contaminated dentin in Group 3 was rinsed and dried. The saliva-contaminated dentin in Group 4 was rinsed, dried, treated with 10% polyacrylic acid, and dried. Specimens in Group 5 received no contamination. The resin-modified glass-ionomer cement restorative material was mixed and applied to the dentin surfaces. Following placement of the restorative material and 7 days of storage, the specimens were thermo-cycled 300 times. Using the Instron Universal Testing Machine, a shear force was applied to the restorative material. Shear bond strength values were compared among the groups using a one-way ANOVA and Student-Neuman-Keuls Multiple Range Test (alpha = 0.05). The non-contaminated specimens (Group 5) were significantly stronger than the contaminated specimens (Groups 1-4). There were no significant differences in bond strength among the groups containing contaminated specimens. Salivary contamination occurring after dentin etching significantly reduced the bond strength of the resin-modified glass-ionomer restorative material to dentin. Neither rinsing nor rinsing and re-etching resulted in bond strengths as great as to non-contaminated dentin.

Analysis of Variance↗

A quantitative analysis of cross-contamination of Salmonella and Campylobacter spp. via domestic kitchen surfaces.

Epidemiological data indicate that cross-contamination during food preparation in the home contributes noticeably to the occurrence of foodborne diseases. To help prevent such occurrences, the inclusion of a cross-contamination model in exposure assessments would aid in the development and evaluation of interventions used to control the spread of pathogenic bacteria. A quantitative analysis was carried out to estimate the probability of contamination and the levels of Salmonella and Campylobacter spp. on salads as a result of cross-contamination from contaminated chicken carcasses via kitchen surfaces. Data on the prevalence and numbers of these bacteria on retail chicken carcasses and the use of unwashed surfaces to prepare foods were collected from scientific literature. The rates of bacterial transfer were collected from laboratory experiments and literature. A deterministic approach and Monte Carlo simulations that incorporated input parameter distributions were used to estimate the contamination of the product. The results have shown that the probability of Campylobacter spp. contamination on salads is higher than that of Salmonella spp., since both the prevalence and levels of Campylobacter spp. on chicken carcasses are higher than those of Salmonella spp. It is realistic to expect that a fraction of the human exposure to Campylobacter spp., in particular, originates from cross-contamination in private kitchens during food handling. The number of human campylobacteriosis cases could be reduced either by reducing the degree of Campylobacter spp. contamination on chicken carcasses or by improving the hygiene in private kitchens. To eliminate the cross-contamination route, it is important to use separate surfaces or to properly wash the surfaces during the preparation of raw and cooked foods or ready-to-eat foods.

Animals↗

Contamination of patients' files in intensive care units: an indication of strict handwashing after entering case notes.

BACKGROUND: The extent to which bedside patients' files become contaminated and the range of bacterial flora attributable to contamination in high-risk areas of the hospital are not known with certainty. The aim of the present study was to determine the degree of contamination of the patient's files and also to analyze and compare the spectrum of contaminant bacterial flora between the intensive care unit (ICU) and surgical wards, the 2 most high-risk areas for nosocomial transmission of infection. METHODS: Microbiologic samples were collected from the exposed outer surface of the patients' files kept bedside in the ICU and surgical wards with sterile swabs moistened with sterile normal saline. Swabs were cultured within an hour of collection on blood agar and MacConkey's agar plates, which were incubated at 37 degrees C for 48 hours. Gram-negative bacilli were identified by Gram's stain, catalase, oxidase tests, and API 20E and API 20NE. Staphylococcus species were identified by Gram's stain, catalase test, and tube coagulase test. Antibiotic susceptibility of the isolated bacteria was determined by the disk diffusion technique according to the criteria of National Committee for Clinical Laboratory Standards (NCCLS). RESULTS: In ICU, 85.2% (87/102) and, in surgical wards, 24.7% (22/89) of patient's files were found to be contaminated with pathogenic and potentially pathogenic bacteria (OR, 17.664; 95% CI: 8.050-39.423; P < .0001). Pseudomonas aeruginosa was the most commonly isolated bacteria (32.3%, 33/102) in ICUs, whereas Staphylococcus aureus was the peak contaminant (11.2%, 10/89) of the files in surgical wards. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from 6.8% (7/102) of ICU patient's files, whereas only 1.1% (1/89) of patient's files in surgical wards were contaminated with MRSA (OR, 6.484; 95% CI: 3.215-13.463; P < .0001). The multidrug-resistant P aeruginosa, Acinetobacter baumannii, Klebsiella pneumoniae, and Serretia marcesens isolated from the patient's files had the same antibiotic resistance pattern as of these bacteria isolated from the patients. CONCLUSION: The majority of the patient's files in ICUs were contaminated often with multidrug-resistant bacteria and even MRSA. Contaminated files could be a source of transmission of infection. To prevent this, handwashing practice should be strictly followed after attending the patient and before entering the case notes in the patient's file. The maintenance of good hand hygiene by the health care workers (HCWs) after handling contaminated files should perhaps be the most prudent approach to prevent patient-patient transmission of infection in high-risk areas including ICU and surgical wards.

Cross Infection↗

Contaminants of PC-SPES are not responsible for cytotoxicity in human small-cell lung carcinoma cells.

PC-SPES is a mixture of herbs used in the treatment of prostate cancer. Batches of this product were found to contain traces of synthetic drugs, and the product was removed from the market. On the basis of a correlation between contaminant levels and cytotoxicity in prostate carcinoma cell lines, Sovak et al. [M. Sovak, A. Seligson, M. Konas, M. Hajduch, M. Dolezal, M. Machala, R. Nagourney, Herbal composition PC-SPES for management of prostate cancer: identification of active principles, J. Natl Cancer Inst. 94 (2002) 1275-1281] concluded that the contaminants were responsible for cytotoxicity of this preparation. Previously, we showed that extracts of PC-SPES are cytotoxic and pro-apoptotic in both drug-sensitive (H69) and drug resistant (H69V) human small-cell lung carcinoma (SCLC) cell lines. Here, we investigated whether the contaminants might be responsible for these effects. In contrast to the data reported for prostate carcinoma cells, extracts of batches of PC-SPES from the year 1998 (reportedly contaminated) and 2001 (much less contaminated) were equally cytotoxic in both SCLC cell lines. Tests of individual contaminants gave IC50 values far in excess of the amounts reported to be present in the IC50 level for the PC-SPES extracts: diethlystilbesterol: actual IC50 in H69 cells, >1000 microM; concentration present in herbal extract at IC50, 0.05-0.2 microM; indomethacin: actual IC50 in H69 cells, 800 microM; concentration in herbal extract, 1.5-20 microM; warfarin: actual IC50 in H69 cells, 950 microM; concentration in herbal extract, 0.57-0.93 microM. Adding the calculated maximum concentration of the contaminants, singly or in combination, to extracts of the less contaminated batch (2001) of PC-SPES did not alter the cytotoxicity of the extract in H69 or H69V cells. At the contaminated concentrations, as well as 5 x those concentrations, none of the contaminants was pro-apoptotic, as indicated by a DNA fragmentation kinetics assay. However, extracts of both early and late batches of PC-SPES were pro-apoptotic in SCLC cells. We conclude that the traces of pharmaceuticals found in PC-SPES were not responsible for its cytotoxic and pro-apoptotic activities of this herbal mixture on SCLC cells.

Antineoplastic Agents, Phytogenic↗

Eggshell factors influencing eggshell penetration and whole egg contamination by different bacteria, including Salmonella enteritidis.

Trans-shell infection routes and whole egg contamination of 7 selected bacterial strains; Staphylococcus warneri, Acinetobacter baumannii, Alcaligenes sp., Serratia marcescens, Carnobacterium sp., Pseudomonas sp. and Salmonella enteritidis, recovered from egg contents, were studied. The first objective was to correlate bacterial eggshell penetration with various eggshell characteristics and bacterial strains. An agar approach was used to assess the eggshell penetration. The second objective was to assess the contamination of whole eggs with the bacterial strains; whole intact eggs were used in this case. The intact shells of agar-filled and whole eggs were inoculated with 10(3) -10(4) cfu of the selected strains. During 3 weeks storage at 20 degrees C and 60% relative humidity, the bacterial eggshell penetration was regularly monitored. The whole egg contamination was only analyzed after 3 weeks. The eggshell characteristics such as area eggshell, shell thickness and number of pores did not influence the bacterial eggshell penetration. For each individual bacterial strain the mean cuticle deposition was lower for penetrated compared to non-penetrated eggshells. For the individual strain Carnobacterium sp. and for the global results of all strains this difference was statistical significantly. The whole egg contamination was not influenced by neither the area of the eggshell nor the porosity of the eggshell. The results of the agar approach indicate that the Gram-negative, motile and non-clustering bacteria penetrated the eggshell most frequently; Pseudomonas sp. (60%) and Alcaligenes sp. (58%) were primary invaders followed by S. enteritidis (43%). All selected strains were able to penetrate; penetration was observed most frequently after ca. 4-5 days. Particularly S. enteritidis was a primary invader of whole eggs: the membranes and/or the content of 32% of the whole eggs was contaminated. The remaining bacterial eggshell contamination with the selected strain was determined after 3 weeks storage. Penetrated eggshells and contaminated whole eggs showed a significantly higher bacterial contamination on the eggshell compared to non-penetrated eggshells and non-contaminated whole eggs respectively (global results of all strains). The influence of hen age on bacterial eggshell penetration and egg content contamination was not significant. While the agar approach is suitable to study the influence of the eggshell characteristics on the bacterial eggshell penetration, the intact egg approach gives an estimation of the penetration of the shell followed by the probability of survival and migration in whole eggs.

Animals↗