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www.totoku.eu The new CCL650i2 When size matters - 6 Megapixel - 30inch - 800cd/m² brightness LEDBACKLIGHT C M Y CM MY CY CMY K EUROPEAN HOSPITAL Vol 23 Issue 5/14 LABORATORY Sending that vital hand hygiene message Lessons from Report: Jane MacDougal The human gut literally teems with microorganisms from at least 1,000 different species that are increasingly considered to be a valuable resource for the prediction, aetiology and prognosis of disease. Their presence is necessary for healthy functioning of the gastrointestinal tract and, by default, the entire body. However, due to continual contact with the environment, primarily via food, the gut is susceptible to infection when a virus, parasite or bacterium enters the area and disrupts normal gut microbiota (or flora). Common symptoms of gastroen- teritis, while varying in intensity, include diarrhoea, vomiting and abdominal pain. While often mild, consequences such as dehydration Report: Brenda Marsh Want to put a message across quick- ly? Answer: Show an image. A starv- ing child with huge tearful eyes prompts an instant flow of charita- ble donations. The same message in words might go unread, or a response would take longer – or worse, be forgotten. So, how do you tackle that BIG hygiene message – Wash your hands!? Promoters of the European Tissue Paper Industry Association (ETPIA) hit on the idea of offering top prizes to any young graphic designer who could devise an eye-catching car- can be dangerous especially in vul- nerable populations – e.g. the very young or elderly. Rapid diagnosis so that appropriate treatment and infec- tion control measures can be instigat- ed is an important healthcare goal. During JIB 2014, held in Paris this October, Medical Biologists attended a training course on the latest developments in diagnosis of infections caused by the bacteria Helicobacter pylori, Campylobacter sp. and Clostridium difficile and the enteric virus Norovirus. Quick, accurate diagnosis of a gastrointestinal infection remains a challenge for the routine laboratory. A French study found that 55.6% of C. difficile infections were not diag- nosed, either because of false nega- tives or clinicians not ordering the test. Classical serum antibodies are toon. Aptly, the European Tissue Symposium Cartoon Contest winners were announced on Global Hand Washing Day*, and their work is now exhibited in Bologna, shown on Facebook, and will become part of a wider social media roll-out to stress hand hygiene importance in infec- tion containment. The International Cartoon Contest Winner is Rahim Biyarash, from Iran, for his design ‘Soap – paper’. Christian Ghisellini, chairman of the judges, said: ‘Rahim charmed us with his extreme synthetic design and ironic approach. He has captured the concept and the theme perfectly.’ Elisa Canaglia, from Italy, won 1st prize in the ETS Academy Cartoon Contest for her design ‘Our Future’. ‘Hand hygiene is such a key part of our daily life; that’s why I depicted its importance in a childhood mem- ory almost everyone can relate to,’ she explained. Three specialist ETS prizes were also awarded to Erica Dalle Luche for ‘Just relax with tissue’; Martina Tonello for ‘Soapy Pirates’ and Chiara Martinelli for ‘Racoon’. Handwashing with soap, ETPIA emphasises, ‘…could save more lives than any other medical interven- tion and is critical to meeting the Millennium Development Goal of reducing deaths among children under five years old by two-thirds by 2015. The importance of hand not useful in the diagnosis of gastro- intestinal infection. Therefore, more traditional microbiological methods of culturing the invasive pathogen, carrying out enzymatic tests and per- forming an antibiogramme are used. These are still completely valid, particularly for the wealth of infor- mation gathered, e.g. in terms of antimicrobial resistance and, in the case of C. difficile, are required for diagnosis confirmation. They do however, require expert knowledge and sometimes specialised media and culturing conditions. A major drawback is that the results are slow in coming e.g. campylobacter culture needs 72-96 hours in micro-anaero- bic conditions. Therefore, newer, molecular and enzymatic diagnostic tools and tech- niques have been introduced in an attempt to provide the rapid and accurate diagnoses required. Unlike other invasive pathogens, Helicobacter pylori colonises the duodenum and stomach where it may remain asymptomatic or cause ulcers and/or gastric reflux from the excessive production of acid, or alternatively diminish acid produc- tion and lead to gastrointestinal can- cers and lymphoma. While improved standards of living and hygiene have reduced the incidence of infection in Europe, approximately 15.5% of the adult population is infected. Diagnosis of H. pylori is often made from biopsy taken during endoscopy, a highly useful analysis because histological data can be added to the microbiological work- washing and drying is further under- lined in the recent consensus state- ment* from six eminent European microbiologists and hospital hygien- ists. It concludes that hand drying completes the hand washing pro- cess by reducing the transmission of up, but it is highly invasive. As an alternative to bacterial culture, real- time PCR (polymerase chain reac- tion) with FRET can rapidly detect not only the presence of the bacteria but also genotypic mutations, pre- dictive for antibiotic resistance to clarithromycin and fluoroquinolones. A problem in France, however, is the difficulty in obtaining the kit to per- form this PCR (GenoType HelicoDR from Hain Lifescience GmbH). PCR diagnosis of H. pylori remains an invasive technique, unlike for the other three infections that are con- sidered where the diarrhoeal stool, or even a rectal swab, provides the starting material for PCR. Additionally, PCR can be used to identify the campylobacter species C. jejuni and C. coli, but this technique has been developed in-house by reference laboratories, using FRET of the gyrA gene. A commercially available multiplex PCR kit, Seeplex Diarrhea-B1 ACE Detection (Seegene, Bionobis) identi- fying Campylobacter spp., Salmonella sp., Shigella sp., Vibrio spp., and Clostridium difficile toxin B, is both sensitive and specific. Nevertheless PCR remains fairly expensive and requires specialist knowledge to per- form correctly. Despite this, real-time PCR is the gold standard for the diagnosis of norovirus gastroenteritis, a signifi- cant cause of gastrointestinal morbid- ity and mortality in young children, even in industrialised countries. Immunochromatographic point-of- care tests (ICT) have been developed microbes and that a system should be chosen that takes into account the risk of contaminating hands, other individuals or the environment. This has significant implications for the spread of infection in public wash- rooms and healthcare environments.’ * Global Hand Washing Day is on the annual calendar of governments, schools, NGOs, private companies and scientific organisations around the world to promote good hygiene and health. * Consensus statement: http://www.europeantissue.com/hygiene/ expert-consensus-statement/ and several are commercially avail- able in Europe. Simple and rapid diagnosis enables suitable treatment to be initiated early, but the existing tests are not yet considered stan- dalone diagnostic tools. In the case of H. pylori infec- tion the commercially available test CLOtest Rapid Urease test (Kimberly Clark) again requires a biopsy for the starting material, but can provide an answer within one hour with 80% sensitivity. However, because it is known as a ‘doctor test’ it is not reim- bursed by social security in France. The two commercially available tests for Campylobacter sp. performed directly on the stool sample are ImmunoCardStat! Campy (Meridian Biosciences) and RidaQuick Campylobacter (R-Biopharm AG) while rapid – response within 15-20 minutes – their accuracy is low, with A picture is worth a thousand words Diagnosing gastrointestinal infe Continuous medical training for medical biologists and primary healthcare workers Elisa Canaglia’s Our Future Rahim Biyarash’s Soap – paper Helicobacter pylori 20

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