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Papers by Ian Hosein

Journal of Hospital Infection, 2006

, oxacillin-resistant (MIC, >4 ,ug/ml) Staphylococcus aureus (ORSA) strains were collected from C... more , oxacillin-resistant (MIC, >4 ,ug/ml) Staphylococcus aureus (ORSA) strains were collected from Clinical Center (National Institutes of Health) patients and patients from five other U.S. hospitals. From Clinical Center patients, 251 of 253 isolates (99%) were bacteriophage typed as phage group III. Five other hospitals contributed 203 ORSA strains, of which 188 (93%) were group III. The group III ORSA strains predominantly included a characteristic core pattern of phages, 7147153/54/75/77. For the low-level (borderline) oxacillin-resistant strains (MIC, 2 to 4 ,ug/ml), amoxicillin-clavulanic acid combination (Augmentin) testing disclosed 62 hyper-4-lactamase producers, of which 59 (95%) were of a separate, distinct S. aureus strain, with the phage pattern 92/94/96/292/D-11 (group V). Thus, ORSA and hyper-j(lactamase producing S. aureus are distinct epidemic strains.

Molecular characterization of clinical and environmental isolates of vancomycin-resistant Enteroc... more Molecular characterization of clinical and environmental isolates of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis from a teaching hospital in Wales

This is an Open Access article distributed under the terms of the Creative Commons Attribution Li... more This is an Open Access article distributed under the terms of the Creative Commons Attribution License

Sample of cases covered: Legal action for hospital-acquired infection An elderly woman with heada... more Sample of cases covered: Legal action for hospital-acquired infection An elderly woman with headache and vomiting Dysphagia following a nail puncture Needle-stick injury to a house officer An HIV positive man with chronic diarrhoea Chronic fatigue with an acute swelling of the knee.

British Journal of Infection Control

Clostridium difficile is identified as the most common cause of diarrhoea among hospitalised pati... more Clostridium difficile is identified as the most common cause of diarrhoea among hospitalised patients, and has been implicated in a number of outbreaks with significant morbidity and mortality. It is widely regarded as a hospital-acquired problem, associated with antibiotic use. An audit aimed at reviewing compliance against local Clostridium difficile- associated diarrhoea (CDAD) policy at the University Hospital of Wales, Cardiff was undertaken from May to July 1999. Despite the difficulty in adhering to national guidelines on single-room isolation, the prevalence of CDAD at our hospital has decreased in recent years. Community acquired CDAD accounted for 15% of our cases, which supports increasing levels of community CDAD (Kalstrom et al 1998). Recent antibiotic treatment was recorded for 82% of the audit cases, with beta-lactam being the most frequently prescribed. Antibiotic treatment for infection other than CDAD was stopped for only 11% of the cases. Where treatment was given...

British Journal of Infection Control

American Journal of Infection Control, 2016

Background: Pathogen transmission from contaminated surfaces can cause hospital-associated infect... more Background: Pathogen transmission from contaminated surfaces can cause hospital-associated infections. Although pulsed xenon ultraviolet (PX-UV) light devices have been shown to decrease hospital room bioburden in the United States, their effectiveness in United Kingdom (UK) hospitals is less understood. Methods: Forty isolation rooms at the Queens Hospital (700 beds) in North London, UK, were sampled for aerobic bacteria after patient discharge, after manual cleaning with a hypochlorous acid-troclosene sodium solution, and after PX-UV disinfection. PX-UV device efficacy on known organisms was tested by exposing inoculated agar plates in a nonpatient care area. Turnaround times for device usage were recorded, and a survey of hospital staff for perceptions of the device was undertaken. Results: After PX-UV disinfection, the bacterial contamination measured in colony forming units (CFU) decreased by 78.4%, a 91% reduction from initial bioburden levels prior to terminal cleaning. PX-UV exposure resulted in a 5-log CFU reduction for multidrug-resistant organisms (MDROs) on spiked plates. The average device turnaround time was 1 hour, with minimal impact on patient throughput. Ward staff were enthusiastic about device deployment, and device operators reported physical comfort in usage. Conclusions: PX-UV use decreased bioburden in patient discharge rooms and on agar plates spiked with MDROs. The implementation of the PX-UV device was well received by hospital cleaning and ward staff, with minimal disruption to patient flow.

American Journal of Obstetrics and Gynecology, 1992

Clinical Rheumatology, 1998

A 71-year-old male rheumatoid patient presented with MRSA septic arthritis. The impact of this or... more A 71-year-old male rheumatoid patient presented with MRSA septic arthritis. The impact of this organism on musculoskeletal practice is discussed.

The Pediatric Infectious Disease Journal, 1991

Journal of Clinical Microbiology

ABSTRACT

The Journal of the Florida Medical Association, 1990

Cervicovaginal smears from 86 patients with suspicious genital herpes were screened by routine Pa... more Cervicovaginal smears from 86 patients with suspicious genital herpes were screened by routine Papanicolaou stain. The slides were then destained and restained by a commercial immunoperoxidase kit for the detection of herpes simplex virus. Results were compared with standard viral cultures performed on the same lesions. A statistically significant difference (P less than 0.05) was observed between the results of Papanicolaou-stained cytology and the immunoperoxidase technique. This study suggests that the immunoperoxidase technique is a rapid and reliable method of confirming a suspected diagnosis of herpetic infection. It is particularly useful in those patients without prenatal care who present in early labor when a rapid diagnostic test is required.

Sexually Transmitted Infections, 2013

After a trend of increasing incidence of gonorrhoea in the 1990s, by 2004 the incidence was decli... more After a trend of increasing incidence of gonorrhoea in the 1990s, by 2004 the incidence was declining in England, but continuing to increase in Wales. This prompted an investigation of the epidemiology of gonorrhoea in Wales to inform future prevention and control measures. As an extension to Gonococcal Resistance to Antimicrobials Surveillance Programme, between May 2005 and September 2006, 540 consecutive gonococcal isolates were collected from three microbiology laboratories in South Wales. Isolates were typed using Neisseria gonorrhoeae Multi Antigen Sequence Typing tested for susceptibility to therapeutic agents and demographic and behavioural data were collected retrospectively from patient notes. 163 sequence types (STs) were identified in 475 N gonorrhoeae isolates from 502 patient episodes. The most frequently observed STs (>20 isolates) were: 2, 752, 471, 249 and 8, all of which were susceptible to the antimicrobial agents tested. A significant association between ST and sexual orientation was identified, the most frequently observed STs occurring in young (median age <25 years) heterosexuals. STs 147, 4, 1634 and 64 predominated in men who have sex with men. We confirm the existence of common STs across the UK, as well as identify a number of types that were novel to Wales. Discrete sexual networks were identified, the most localised being in young heterosexuals. Molecular typing provides a method for identifying local clusters of gonorrhoea, and could assist in the implementation and evaluation of targeted interventions.

Reviews in Medical Microbiology, 1994

ABSTRACT

Open Learning: The Journal of Open and Distance Learning, 2009

This paper reports on work by a team from Wales, supported by UNESCO Cymru‐Wales, to develop a di... more This paper reports on work by a team from Wales, supported by UNESCO Cymru‐Wales, to develop a distance learning module for Tanzanian clinical officers (COs) on the syndromic management and counselling of sexually transmissible infection (STI) and HIV patients. Preparation included documentary analysis and a questionnaire survey to ascertain COs’ learning needs regarding STIs and HIV and AIDS. The module

Medical Teacher, 2009

Background: Poor public health indicators in Tanzania have led to the upgrading of nursing and cl... more Background: Poor public health indicators in Tanzania have led to the upgrading of nursing and clinical personnel who currently have just core training. Clinical officers (COs) have 3 years training in basic and applied medicine and are responsible for healthcare of large and dispersed rural populations. Aims: UNESCO-Wales has funded colleagues in Wales (UK) to assist the upgrade of COs. An inquiry into their learning needs and the Tanzanian context has produced a framework for design of a module for COs on sexually transmissible infections and HIV & AIDS by distance learning. Methods: Face-to-face discussions were held with the Ministry of Health, healthcare workers, educators and administrators in Tanzania; a review of training documents was carried out; and a follow-up questionnaire issued to COs. Results: The discussions and review highlighted teacher-centred approaches, and management, infrastructure and resources obstacles to curriculum change. Principal learning needs of COs around STIs were: counselling, syndromic management, drugs management, laboratory diagnosis, health education, resources, staffing and service morale. Conclusions: Placing learning needs in context in dialogue with Tanzanian colleagues was an advance on simple transfer of educational technologies and expertise. The inquiry resulted in a draft study guide and resources pack that were positively reviewed by Tanzanian tutors. Management and resources issues raised problems of sustainability in the module implementation.

Journal of Medical Microbiology, 2003

The present study describes the first molecular characterization of environmental and clinical is... more The present study describes the first molecular characterization of environmental and clinical isolates of vancomycin-resistant enterococci (VRE) in Wales. Over a 3-month period (May-July 2000), 134 isolates of VRE (89 Enterococcus faecium and 45 Enterococcus faecalis) were isolated from the patient environment of the University Hospital of Wales (UHW) in Cardiff, Wales, UK. In addition, over the same time-period, 24 clinical isolates of VRE (20 isolates of E. faecium and four isolates of E. faecalis) were obtained from 14 patients. All study isolates were subjected to PFGE typing and their van genotypes were determined by using multiplex PCR. The vanA PCR product (231 bp) was evident in 146 (92 %) of 158 VRE isolates; the remaining 12 isolates (8 %) were positive for the vanB gene. All isolates of E. faecalis were found to be vanA-positive. In total, 16 PFGE banding profiles (pulsotypes) were observed for environmental isolates of E. faecium, whilst eight pulsotypes were found for isolates of E. faecalis. Some of these pulsotypes were isolated from multiple sites, whereas others were more restricted in their distribution. Eleven pulsotypes were evident for clinical isolates and eight of these (representing 11 isolates) were also encountered in environmental isolates. Eleven clinical isolates of E. faecium (55 %) shared an identical pulsotype that was not detected in environmental isolates. These results demonstrate a heterogeneous environmental population of VRE and an association of certain strains with clinical isolates. Predominance of a single pulsotype (not detected in the environment) amongst clinical isolates suggests non-environmental transmission between patients.

Journal of Hospital Infection, 2006

, oxacillin-resistant (MIC, >4 ,ug/ml) Staphylococcus aureus (ORSA) strains were collected from C... more , oxacillin-resistant (MIC, >4 ,ug/ml) Staphylococcus aureus (ORSA) strains were collected from Clinical Center (National Institutes of Health) patients and patients from five other U.S. hospitals. From Clinical Center patients, 251 of 253 isolates (99%) were bacteriophage typed as phage group III. Five other hospitals contributed 203 ORSA strains, of which 188 (93%) were group III. The group III ORSA strains predominantly included a characteristic core pattern of phages, 7147153/54/75/77. For the low-level (borderline) oxacillin-resistant strains (MIC, 2 to 4 ,ug/ml), amoxicillin-clavulanic acid combination (Augmentin) testing disclosed 62 hyper-4-lactamase producers, of which 59 (95%) were of a separate, distinct S. aureus strain, with the phage pattern 92/94/96/292/D-11 (group V). Thus, ORSA and hyper-j(lactamase producing S. aureus are distinct epidemic strains.

Molecular characterization of clinical and environmental isolates of vancomycin-resistant Enteroc... more Molecular characterization of clinical and environmental isolates of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis from a teaching hospital in Wales

This is an Open Access article distributed under the terms of the Creative Commons Attribution Li... more This is an Open Access article distributed under the terms of the Creative Commons Attribution License

Sample of cases covered: Legal action for hospital-acquired infection An elderly woman with heada... more Sample of cases covered: Legal action for hospital-acquired infection An elderly woman with headache and vomiting Dysphagia following a nail puncture Needle-stick injury to a house officer An HIV positive man with chronic diarrhoea Chronic fatigue with an acute swelling of the knee.

British Journal of Infection Control

Clostridium difficile is identified as the most common cause of diarrhoea among hospitalised pati... more Clostridium difficile is identified as the most common cause of diarrhoea among hospitalised patients, and has been implicated in a number of outbreaks with significant morbidity and mortality. It is widely regarded as a hospital-acquired problem, associated with antibiotic use. An audit aimed at reviewing compliance against local Clostridium difficile- associated diarrhoea (CDAD) policy at the University Hospital of Wales, Cardiff was undertaken from May to July 1999. Despite the difficulty in adhering to national guidelines on single-room isolation, the prevalence of CDAD at our hospital has decreased in recent years. Community acquired CDAD accounted for 15% of our cases, which supports increasing levels of community CDAD (Kalstrom et al 1998). Recent antibiotic treatment was recorded for 82% of the audit cases, with beta-lactam being the most frequently prescribed. Antibiotic treatment for infection other than CDAD was stopped for only 11% of the cases. Where treatment was given...

British Journal of Infection Control

American Journal of Infection Control, 2016

Background: Pathogen transmission from contaminated surfaces can cause hospital-associated infect... more Background: Pathogen transmission from contaminated surfaces can cause hospital-associated infections. Although pulsed xenon ultraviolet (PX-UV) light devices have been shown to decrease hospital room bioburden in the United States, their effectiveness in United Kingdom (UK) hospitals is less understood. Methods: Forty isolation rooms at the Queens Hospital (700 beds) in North London, UK, were sampled for aerobic bacteria after patient discharge, after manual cleaning with a hypochlorous acid-troclosene sodium solution, and after PX-UV disinfection. PX-UV device efficacy on known organisms was tested by exposing inoculated agar plates in a nonpatient care area. Turnaround times for device usage were recorded, and a survey of hospital staff for perceptions of the device was undertaken. Results: After PX-UV disinfection, the bacterial contamination measured in colony forming units (CFU) decreased by 78.4%, a 91% reduction from initial bioburden levels prior to terminal cleaning. PX-UV exposure resulted in a 5-log CFU reduction for multidrug-resistant organisms (MDROs) on spiked plates. The average device turnaround time was 1 hour, with minimal impact on patient throughput. Ward staff were enthusiastic about device deployment, and device operators reported physical comfort in usage. Conclusions: PX-UV use decreased bioburden in patient discharge rooms and on agar plates spiked with MDROs. The implementation of the PX-UV device was well received by hospital cleaning and ward staff, with minimal disruption to patient flow.

American Journal of Obstetrics and Gynecology, 1992

Clinical Rheumatology, 1998

A 71-year-old male rheumatoid patient presented with MRSA septic arthritis. The impact of this or... more A 71-year-old male rheumatoid patient presented with MRSA septic arthritis. The impact of this organism on musculoskeletal practice is discussed.

The Pediatric Infectious Disease Journal, 1991

Journal of Clinical Microbiology

ABSTRACT

The Journal of the Florida Medical Association, 1990

Cervicovaginal smears from 86 patients with suspicious genital herpes were screened by routine Pa... more Cervicovaginal smears from 86 patients with suspicious genital herpes were screened by routine Papanicolaou stain. The slides were then destained and restained by a commercial immunoperoxidase kit for the detection of herpes simplex virus. Results were compared with standard viral cultures performed on the same lesions. A statistically significant difference (P less than 0.05) was observed between the results of Papanicolaou-stained cytology and the immunoperoxidase technique. This study suggests that the immunoperoxidase technique is a rapid and reliable method of confirming a suspected diagnosis of herpetic infection. It is particularly useful in those patients without prenatal care who present in early labor when a rapid diagnostic test is required.

Sexually Transmitted Infections, 2013

After a trend of increasing incidence of gonorrhoea in the 1990s, by 2004 the incidence was decli... more After a trend of increasing incidence of gonorrhoea in the 1990s, by 2004 the incidence was declining in England, but continuing to increase in Wales. This prompted an investigation of the epidemiology of gonorrhoea in Wales to inform future prevention and control measures. As an extension to Gonococcal Resistance to Antimicrobials Surveillance Programme, between May 2005 and September 2006, 540 consecutive gonococcal isolates were collected from three microbiology laboratories in South Wales. Isolates were typed using Neisseria gonorrhoeae Multi Antigen Sequence Typing tested for susceptibility to therapeutic agents and demographic and behavioural data were collected retrospectively from patient notes. 163 sequence types (STs) were identified in 475 N gonorrhoeae isolates from 502 patient episodes. The most frequently observed STs (>20 isolates) were: 2, 752, 471, 249 and 8, all of which were susceptible to the antimicrobial agents tested. A significant association between ST and sexual orientation was identified, the most frequently observed STs occurring in young (median age <25 years) heterosexuals. STs 147, 4, 1634 and 64 predominated in men who have sex with men. We confirm the existence of common STs across the UK, as well as identify a number of types that were novel to Wales. Discrete sexual networks were identified, the most localised being in young heterosexuals. Molecular typing provides a method for identifying local clusters of gonorrhoea, and could assist in the implementation and evaluation of targeted interventions.

Reviews in Medical Microbiology, 1994

ABSTRACT

Open Learning: The Journal of Open and Distance Learning, 2009

This paper reports on work by a team from Wales, supported by UNESCO Cymru‐Wales, to develop a di... more This paper reports on work by a team from Wales, supported by UNESCO Cymru‐Wales, to develop a distance learning module for Tanzanian clinical officers (COs) on the syndromic management and counselling of sexually transmissible infection (STI) and HIV patients. Preparation included documentary analysis and a questionnaire survey to ascertain COs’ learning needs regarding STIs and HIV and AIDS. The module

Medical Teacher, 2009

Background: Poor public health indicators in Tanzania have led to the upgrading of nursing and cl... more Background: Poor public health indicators in Tanzania have led to the upgrading of nursing and clinical personnel who currently have just core training. Clinical officers (COs) have 3 years training in basic and applied medicine and are responsible for healthcare of large and dispersed rural populations. Aims: UNESCO-Wales has funded colleagues in Wales (UK) to assist the upgrade of COs. An inquiry into their learning needs and the Tanzanian context has produced a framework for design of a module for COs on sexually transmissible infections and HIV & AIDS by distance learning. Methods: Face-to-face discussions were held with the Ministry of Health, healthcare workers, educators and administrators in Tanzania; a review of training documents was carried out; and a follow-up questionnaire issued to COs. Results: The discussions and review highlighted teacher-centred approaches, and management, infrastructure and resources obstacles to curriculum change. Principal learning needs of COs around STIs were: counselling, syndromic management, drugs management, laboratory diagnosis, health education, resources, staffing and service morale. Conclusions: Placing learning needs in context in dialogue with Tanzanian colleagues was an advance on simple transfer of educational technologies and expertise. The inquiry resulted in a draft study guide and resources pack that were positively reviewed by Tanzanian tutors. Management and resources issues raised problems of sustainability in the module implementation.

Journal of Medical Microbiology, 2003

The present study describes the first molecular characterization of environmental and clinical is... more The present study describes the first molecular characterization of environmental and clinical isolates of vancomycin-resistant enterococci (VRE) in Wales. Over a 3-month period (May-July 2000), 134 isolates of VRE (89 Enterococcus faecium and 45 Enterococcus faecalis) were isolated from the patient environment of the University Hospital of Wales (UHW) in Cardiff, Wales, UK. In addition, over the same time-period, 24 clinical isolates of VRE (20 isolates of E. faecium and four isolates of E. faecalis) were obtained from 14 patients. All study isolates were subjected to PFGE typing and their van genotypes were determined by using multiplex PCR. The vanA PCR product (231 bp) was evident in 146 (92 %) of 158 VRE isolates; the remaining 12 isolates (8 %) were positive for the vanB gene. All isolates of E. faecalis were found to be vanA-positive. In total, 16 PFGE banding profiles (pulsotypes) were observed for environmental isolates of E. faecium, whilst eight pulsotypes were found for isolates of E. faecalis. Some of these pulsotypes were isolated from multiple sites, whereas others were more restricted in their distribution. Eleven pulsotypes were evident for clinical isolates and eight of these (representing 11 isolates) were also encountered in environmental isolates. Eleven clinical isolates of E. faecium (55 %) shared an identical pulsotype that was not detected in environmental isolates. These results demonstrate a heterogeneous environmental population of VRE and an association of certain strains with clinical isolates. Predominance of a single pulsotype (not detected in the environment) amongst clinical isolates suggests non-environmental transmission between patients.