There are a variety of methods routinely used in the sterilization of medical devices using hydrogen peroxide (H2O2) including vaporization, plasma generation and ionization. Many of these systems are used for sterilization and are validated for bioburden reduction using bacterial spores. Here, we explored the benefits of using vaporized H2O2 (VHP) treatment of N95 respirators for emergency decontamination and reuse to alleviate PPE shortages for healthcare workers in the COVID-19 emergency. The factors that are considered for the effective reuse of these respirators are the fit, the filter efficiency and the decontamination/disinfection level for SARS-CoV-2, which is the causative virus for COVID-19 and other organisms of concern in the hospital environment such as methicillin-resistant Staphylococcus aureus or Clostridium difficile. WE showed that the method did not affect fit or filter efficiency at least for one cycle and resulted in a >6 log reduction in bacterial spores and >3.8 log reduction in the infectious SARS-CoV2 load on N95 respirators.

Background: 3-epi-25-hydroxyvitamin D 3 (3-epi-25OHD 3 ) interferes in most liquid chromatography-tandem mass spectrometry (LC-MS/MS) assays for 25-hydroxyvitamin D (25OHD). The clinical significance of this is unclear, with concentrations from undetectable to 230 nmol/L reported. Many studies have quantified 3-epi-25OHD 3 based on 25OHD 3 calibrators or other indirect methods, and we speculated that this contributes to the observed variability in reported 3-epi-25OHD 3 concentrations. Methods: We compared continuous MS/MS infusions of 3-epi-25OHD 3 and 25OHD 3 solutions, spiked both analytes into the same serum matrix and analysed patient samples to assess the effect of three different quantitation methods on 3-epi-25OHD 3 concentration. Experiments were performed on an LC-MS/MS system using a phenyl column which does not resolve 3-epi-25OHD 3 , and a modified method utilizing a Zorbax SB-CN column that chromatographically resolves 3-epi-25OHD 3 from 25OHD 3 . Results: A greater 3-epi-25OHD 3 signal, compared with 25OHD 3 , was observed during equimolar post-column continuous infusion of analyte solutions, and following analysis of a serum pool spiked with both analytes. 3-epi-25OHD 3 signal enhancement was dependent on mobile phase composition. Compared with 3-epi-25OHD 3 calibrators, indirect quantitation methods resulted in up to 10 times as many samples having 3-epi-25OHD 3 concentrations ! 10 nmol/L, and an approximately fourfold increase in the maximum observed 3-epi-25OHD 3 concentration to 95 nmol/L. Conclusions: Enhanced 3-epi-25OHD 3 signal leads to overestimation of its concentrations in the indirect quantitation methods used in many previous studies. The enhanced signal may contribute to greater interference in some 25OHD LC-MS/MS assays than others. We highlight that equimolar responses cannot be assumed in LC-MS/MS systems, even if two molecules are structurally similar.

Background: Acute kidney injury (AKI) is frequently under-recognized and contributes to poor outcomes. Electronic alerts (e-alerts) to highlight AKI based on changes in serum creatinine may facilitate earlier recognition and treatment, and sophisticated algorithms for AKI detection have been proposed or implemented elsewhere. However, many laboratories currently lack the resources or capability to replicate these systems. Methods: A real-time automated delta check e-alert flags a 50% increase in creatinine to a concentration of >50 mmol/L from the most recent result within a 90-day period and automatically adds the comment '?AKI -creatinine increase >50% from previous' with a link to local AKI guidelines. In addition, creatinine results >300 mmol/L are retrospectively reviewed and phoned if AKI is suspected. For each alert over a 12-day period we manually reviewed previous and subsequent creatinine results to determine baseline creatinine and stage AKI according to Acute Kidney Injury Network (AKIN) criteria. Results: From 11,930 creatinine requests, 63 of 90 (70%) delta check e-alerts were due to AKI, identifying 61 episodes of AKI. Thirty four of 54 (63%) creatinine results >300 mmol/L were due to AKI, identifying a further 10 episodes of AKI. The positive predictive value (PPV) for AKI of a delta check e-alert was greater when the trigger creatinine was >100 mmol/L (PPV 89%) or when the absolute change in creatinine was >50 mmol/L (PPV 93%). Conclusion:This study demonstrates that a simple automated delta check can detect and flag AKI in real time, continuously, at little extra cost and without manual input. KeywordsRenal disease, creatinine, laboratory methods, AKIN, delta check Accepted: 17th April 2014 IntroductionAcute kidney injury (AKI) is a sudden decline in renal function, generally occurring over hours or days. AKI is increasingly recognized as a common and serious complication of many hospital admissions and is associated with poor outcomes such as increased mortality, 1 chronic kidney disease (CKD) progression, 2 prolonged hospital stay and increased healthcare costs. Furthermore, there is evidence that AKI is frequently under-recognized; delays in recognizing and treating AKI were a major criticism in a 2009 National Confidential Enquiry into Patient Outcomes and Death report into the care of patients who died with a primary diagnosis of AKI. 4 Electronic alerts (e-alerts) to highlight possible AKI to the requesting clinician or renal team based on changes in serum creatinine are one strategy to facilitate earlier recognition and treatment of AKI. This approach has been backed by a 2012 UK Consensus Conference on AKI management hosted by the Royal College of Physicians

No abstract

No abstract