BACKGROUND For alcohol-based hand rubs, the currently recommended application time of 30 seconds is longer than the actual time spent in clinical practice. We investigated whether a shorter application time of 15 seconds is microbiologically safe in neonatal intensive care and may positively influence compliance with the frequency of hand antisepsis actions. METHODS We conducted in vitro experiments to determine the antimicrobial efficacy of hand rubs within 15 seconds, followed by clinical observations to assess the effect of a shortened hand antisepsis procedure under clinical conditions in a neonatal intensive care unit (NICU). An independent observer monitored the frequency of hand antisepsis actions during shifts. RESULTS All tested hand rubs fulfilled the requirement of equal or even significantly higher efficacy within 15 seconds when compared to a reference alcohol propan-2-ol 60% (v/v) within 30 seconds. Microbiologically, reducing the application time to 15 seconds had a similar effect when compared to 30-second hand rubbing, but it resulted in significantly increased frequency of hand antisepsis actions (7.9±4.3 per hour vs 5.8±2.9 per hour; P=.05). CONCLUSION Time pressure and workload are recognized barriers to compliance. Therefore, reducing the recommended time for hand antisepsis actions, using tested and well-evaluated hand rub formulations, may improve hand hygiene compliance in clinical practice. Infect Control Hosp Epidemiol 2017;38:1430-1434.

This report describes a case of invasive Exophiala dermatitidis infection after double lung transplantation in a 76-year-old man. After thoracotomy, the patient's wound showed dehiscence with purulent secretion. The black yeast was isolated from cultures taken from the wound, and species identification was confirmed by sequence analysis of the internal transcribed spacer (ITS-S2) region. The results of the susceptibility testing showed voriconazole as the most active drug. Despite adaptation of the antifungal therapy the clinical condition worsened, and the patient died. In addition, we evaluated the fungicidal activity of antiseptics towards E. dermatitidis and aimed to provide a brief literature review of previously reported infections caused by this rare fungus. To the best of our knowledge, this is the first report of a rapidly progressing invasive fungal infection with E. dermatitidis originating from a colonized wound after lung transplantation.

During cutaneous tick attachment, the feeding cavity becomes a site of transmission for tick salivary compounds and tick-borne pathogens. However, the immunological consequences of tick feeding on human skin remain unclear. Here, we assessed human skin and blood samples upon tick bite and developed a human skin explant model mimicking Ixodes ricinus bite and tick-borne pathogen infection. Following tick attachment, we observed rapidly occurring patterns of immunomodulation including increase in neutrophils and cutaneous B and T cells. T cells up-regulated tissue-residency markers, while lymphocytic cytokine production was impaired.In early stages of Borrelia burgdorferi model infections, we detected strain-specific immune responses and close spatial relationships of macrophages and spirochetes. Pre-incubation of spirochetes with tick salivary gland extracts hampered accumulation of immune cells and increased spirochete loads. Collectively, we showed that tick feeding exerts profound changes on the skin immune network, which interfere with the primary response against tick-borne pathogens.