Study reveals manual cleaning of medical instruments exposes staff and surrounding environment to potentially contaminated fluids

Findings reinforce importance of engineering controls and appropriate PPE use to protect processing personnel and reduce contamination risks

Peer-Reviewed Publication

ASSOCIATION FOR PROFESSIONALS IN INFECTION CONTROL

Arlington, Va., October 13, 2022 – A new study published today in the American Journal of Infection Control (AJIC) shows that manual cleaning of reusable medical instruments generates substantial splash more than seven feet from the source. The findings reinforce the importance of engineering controls and appropriate use of personal protective equipment (PPE) to reduce the risk of contamination for both processing personnel and their facilities.

“This study confirms that technicians working in sterile processing departments are at risk for exposure to water droplets that may contain blood, tissue and other patient fluids,” said Cori L. Ofstead, president and CEO of Ofstead & Associates, and the paper’s lead author. “Even in a sterile processing department optimally designed to reduce potential exposures, we were surprised by the abundance of droplets generated during the performance of instrument processing steps that were completed in accordance with manufacturers’ instructions for use.”

The study expands upon a pilot project completed by Ofstead and colleagues in 2021 - the first real-world evaluation of PPE effectiveness for sterile processing personnel – which concluded that personnel who process reusable medical instruments and equipment may be exposed to tissue, blood, and other patient fluids even when wearing recommended PPE. Previous research has demonstrated a link between contamination disseminated from sinks and healthcare facility outbreaks.

The current study was conducted at a large, urban academic medical center, within a new sterile-processing department that had been designed to optimize workflow and prevent cross-contamination. To quantify the amount of splash generated during manual processing activities, characterize droplet dispersal patterns, and assess PPE effectiveness, researchers engaged experienced, certified processing personnel to conduct simulated processing of a gastrointestinal endoscope and an ultrasound probe following manufacturers’ instructions for use (IFU). Prior to the simulations, moisture-detection paper was affixed to the PPE of technicians working at the sink and stationed 3-4 feet away, as well as environmental surfaces, including the department floors.

Following completion of the cleaning tasks, researchers measured the quantity of droplets generated as well as the extent of dispersal. Results show that every processing cycle generated splash at some point, with droplets detected up to 7.25 feet away from the processing sink. Some activities, particularly rinsing the ultrasound probe per IFU, generated substantial splash that exposed the environment and equipment near the sink, as well as the processing technician performing the cleaning. The technician at the sink was exposed to droplets from head to toe during most activities and extensive droplets were detected on gowns and shoe covers worn by technicians 3-4 feet away.

Beyond the implications for individuals in and around the processing sinks, splash represents a potential contamination source for other staff and patients in healthcare facilities. Standards state that liquids can act as a vehicle for the transfer of microorganisms. In the current study, transporting wet endoscopes dispersed droplets on a 15-foot path from the sink to the automated endoscope reprocessor.

“This study is instructive for infection preventionists and workplace safety professionals, providing a backdrop against which they should review Sterile Processing Department workflows and evaluate whether additional infection prevention or engineering control measures are needed to best protect workers and others in their facilities,” said Linda Dickey, RN, MPH, CIC, FAPIC, 2022 APIC president. “It also reinforces the critical importance of a safety culture that supports workers -- including processes and training that facilitate appropriate usage of PPE, such as sufficient time to doff and re-don PPE during the course of reprocessing instruments -- for adequate protection from moisture strikethrough.”

About APIC

Founded in 1972, the Association for Professionals in Infection Control and Epidemiology (APIC) is the leading association for infection preventionists and epidemiologists. With more than 15,000 members, APIC advances the science and practice of infection prevention and control. APIC carries out its mission through research, advocacy, and patient safety; education, credentialing, and certification; and fostering development of the infection prevention and control workforce of the future. Together with our members and partners, we are working toward a safer world through the prevention of infection. Join us and learn more at apic.org.

About AJIC

As the official peer-reviewed journal of APIC, The American Journal of Infection Control (AJIC) is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. Published by Elsevier, AJIC also publishes infection control guidelines from APIC and the CDC. AJIC is included in Index Medicus and CINAHL. Visit AJIC at ajicjournal.org.

NOTES FOR EDITORS

“Splash generation and droplet dispersal in a well-designed, centralized high-level disinfection unit,” by Cori L. Ofstead, Krystina M. Hopkins, Frank E. Daniels, Abigail G. Smart, and Henry P. Wetzler, was published online in AJIC on October 13, 2022. The article may be found online at: https://doi.org/10.1016/j.ajic.2022.08.016

AUTHORS

Cori L. Ofstead, MSPH (Corresponding author: cori@ofsteadinsights.com)

Ofstead & Associates, Inc., St. Paul, MN, USA

 

Krystina M. Hopkins, MPH

Ofstead & Associates, Inc., St. Paul, MN, USA

 

Frank E. Daniels, MSHA, CFER, CER, AGTS, CSPDT, CSPM

Virginia Commonwealth University Health, Richmond, VA, USA

 

Abigail G. Smart, MPH

Ofstead & Associates, Inc., St. Paul, MN

 

Harry P. Wetzler, MD MSPH

Ofstead & Associates, Inc., St. Paul, MN, USA

# # #

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JOURNAL

American Journal of Infection Control

DOI

10.1016/j.ajic.2022.08.016 

METHOD OF RESEARCH

Experimental study

SUBJECT OF RESEARCH

People

ARTICLE TITLE

Splash generation and droplet dispersal in a well-designed, centralized high-level disinfection unit

COI STATEMENT

This study was supported in part by a research grant from Healthmark Industries, which also provided droplet-detection paper. Healthmark was not involved in designing or conducting the study, interpreting the findings, or preparing this manuscript. CLO, KMH, AGS, and HPW have received research grants, study materials, educational materials, or consulting contracts from 3M Company, Ambu, Boston Scientific Corporation, Cleanis, Fortive/Advanced Sterilization Products, Healthmark Industries, Pentax, and Steris/Cantel/Medivators. FED has participated on an advisory board for Fortive/Advanced Sterilization Products. Conflicts of interest: None to report.

U$A

Two out of five adults who use cigarettes smoke menthol

An FDA ban on menthol would have a widespread public health impact especially among minority groups with over 80 percent of Black smokers using menthol

Peer-Reviewed Publication

COLUMBIA UNIVERSITY'S MAILMAN SCHOOL OF PUBLIC HEALTH

Menthol use has increased over the past decade among U.S. adults who smoke cigarettes, according to a study released by Columbia University Mailman School of Public Health and The City University of New York. Menthol use is much more common among adult smokers who are younger, from racial/ethnic minoritized groups and with mental health problems. The results are published in the journal Nicotine and Tobacco Research.

Menthol use was common among approximately two out of five cigarette smokers overall. Over 80 percent of Black smokers preferred menthol in 2020, which is stable relative to prior reports. “That approximately 50 percent of smokers who were Hispanic, female, ages 18-25 and 26-34, lesbian/gay and adults with mental health problems, used menthol in 2020 is higher than previously reported and suggests use has expanded across all segments of the population of adults who smoke cigarettes,” noted said Renee D. Goodwin, PhD, in the Department of Epidemiology at Columbia Mailman School.

Canada and the United Kingdom have banned menthol as a characterizing flavor while action in the U.S. Food and Drug Administration has been lacking although the Center for Tobacco Products announced its intention to issue a product standard that would ban menthol as a characterizing flavor in cigarettes. However, given the regulatory process required to issue a product standard and the potential for tobacco industry litigation, menthol cigarettes will likely remain on the market for a considerable amount of time, note experts.

“Our results suggest that banning menthol as a characterizing flavor in cigarettes by the U.S. Food and Drug Administration could have a widespread impact on public health, especially among younger people and marginalized groups,” said Goodwin.

To estimate trends in menthol use among adults who smoke cigarettes by sociodemographic, mental health and substance use variables, the researchers analyzed nationally representative annual, data from 128,327 individuals ages 18 and older residing in the U.S. from the 2008-2019 and 2020 from the National Survey on Drug Use and Health (NSDUH). Depression was assessed using the DSM-IV criteria for a major depressive episode.

There was a significant overall increase in menthol cigarette use among adults smoking cigarettes from 34 percent in 2008 to 41 percent in 2019.  In 2020, 43 percent of adults who smoked cigarettes in the past-month used menthol. Menthol use was most common among Black adults (80 percent). Over 50 percent of Hispanic, female, young (ages 18-34), lesbian/gay, with serious psychological distress, and with cigar use also used menthol. Menthol use grew more rapidly among adults, among Hispanics, light cigarette users (1-5 per day) and those who smoked cigars.

A notable finding was the increase and majority menthol use among Hispanic adults over the study period (34 percent in 2008 to 48 percent in 2019) and 51 percent in 2020, with a more rapid increase among Hispanic compared with Non-Hispanic white smokers. “Until now there was a lack of research in this area,” observes Goodwin, who offers a number of possible explanations for the increased popularity of menthol cigarettes among Hispanic smokers. “For one, there is evidence of greater marketing of menthol cigarettes to Hispanic adults.”

“Our study shows persistent and unmitigated inequities in menthol use among tobacco use disparity group members in particular,” said Goodwin. “Data from 2020 demonstrate that the increase in menthol use among smokers over the past decade was broadly evident across subgroups.”

Co-authors are Ollie Ganz and Cristine Delnevo, Rutgers University School of Public Health; Andrea H Weinberger, Yeshiva University and Albert Einstein College of Medicine; Philip H Smith, Miami University; and Katarzyna Wyka, The City University of New York.

Columbia University Mailman School of Public Health

Founded in 1922, the Columbia University Mailman School of Public Health pursues an agenda of research, education, and service to address the critical and complex public health issues affecting New Yorkers, the nation and the world. The Columbia Mailman School is the fourth largest recipient of NIH grants among schools of public health. Its nearly 300 multi-disciplinary faculty members work in more than 100 countries around the world, addressing such issues as preventing infectious and chronic diseases, environmental health, maternal and child health, health policy, climate change and health, and public health preparedness. It is a leader in public health education with more than 1,300 graduate students from 55 nations pursuing a variety of master’s and doctoral degree programs. The Columbia Mailman School is also home to numerous world-renowned research centers, including ICAP and the Center for Infection and Immunity. For more information, please visit www.mailman.columbia.edu.

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JOURNAL

Nicotine & Tobacco Research

Smelling in VR environment possible with new gaming technology

Peer-Reviewed Publication

STOCKHOLM UNIVERSITY

 

IMAGE: THE RESEARCH TEAM IS TESTING THE OLFACTOMETER IN THE LAB. view more 

CREDIT: JENS LASTHEIN

An odor machine, so-called olfactometer, makes it possible to smell in VR environments. First up is a “wine tasting game” where the user smells wine in a virtual wine cellar and gets points if the guess on aromas in each wine is correct. The new technology that can be printed on 3D printers has been developed in collaboration between Stockholm University and Malmö University. The research, funded by the Marianne and Marcus Wallenberg Foundation, was recently published in the International Journal of Human - Computer Studies.

“We hope that the new technical possibilities will lead to scents having a more important role in game development, says Jonas Olofsson, professor of psychology and leader of the research project at Stockholm University.

In the past, computer games have focused mostly on what we can see – moving images on screens. Other senses have not been present. But an interdisciplinary research group at Stockholm University and Malmö University has now constructed a scent machine that can be controlled by a gaming computer. In the game, the participant moves in a virtual wine cellar, picking up virtual wine glasses containing different types of wine, guessing the aromas. The small scent machine is attached to the VR system's controller, and when the player lifts the glass, it releases a scent.

“The possibility to move on from a passive to a more active sense of smell in the game world paves the way for the development of completely new smell-based game mechanics based on the players' movements and judgments,” says Simon Niedenthal, interaction and game researcher at Malmö University.

The olfactometer consists of four different valves each connected to a channel. In the middle there is a fan sucking the air into a tube. With the help of the computer, the player can control the four channels so that they open to different degrees and provide different mixtures of scent. Scent blends that can mimic the complexity of a real wine glass. The game has different levels of difficulty with increasing levels of complexity.

“In the same way that a normal computer game becomes more difficult the better the player becomes; the scent game can also challenge players who already have a sensitive nose. This means that the scent machine can even be used to train wine tasters or perfumers,” says Jonas Olofsson.

All code, blueprints and instructions for the machine are openly available online, as is code for the virtual wine tasting game. The research group, Sensory Cognitive Interaction Laboratory, which is located at the Department of Psychology, Stockholm University, now hopes that scented computer games can become useful for other purposes.

“For those who, for example, lost their sense of smell after COVID-19 or for other reasons, the new technology can mean an opportunity to regain their sense of smell with the help of game-based training,” says Jonas Olofsson, research team leader.

Smell training is a method recommended by doctors for those who lose their sense of smell after colds and other viruses, but according to Jonas Olofsson, many people stop training because it becomes too boring.

“I hope that the fact that drawings and code are openly available as "open source" will lead to an opportunity for game companies to start creating new, commercial products for scent training using the new technology,” says Jonas Olofsson.

According to Simon Niedenthal, “open source” leads to promoting accessibility, reproducibility and comparison of results in research. It also contributes to creating a cohesive research and design community within the game development field.

“But it also means that the costs of the equipment are greatly reduced, which makes it available to more people. To us that is important,” says Simon Niedenthal.

“We believe in open science, that research results should be made available to the public and that other researchers should be able to repeat our results. With the help of our research, others can build scent machines and explore new ways of using scents in games,” says Jonas Olofsson.

The technology for the olfactometer has been developed by Peter Lundén, research engineer at Stockholm University and member of the research team at SCI LAB.

CAPTION

The olfactometer

CREDIT

William Fredborg

CAPTION

Servo motors (1–4) and stepless valves (a). A diagrammatic illustration of the functionality of the olfactory display and the control of its airflow (b).

CREDIT

SCI LAB

CAPTION

The game environment in the wine tasting game.

CREDIT

SCI LAB

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DOI

10.1016/j.ijhcs.2022.102928 

SUBJECT OF RESEARCH

Not applicable

ARTICLE TITLE

A graspable olfactory display for virtual reality

The State of Open Data Report 2022: Researchers need more support to assist with open data mandates

New findings provide update on researchers’ attitudes towards open data

Reports and Proceedings

DIGITAL SCIENCE

 

IMAGE: ONE OF THE KEY FINDINGS OF THE 2022 STATE OF OPEN DATA REPORT view more 

CREDIT: FIGSHARE/DIGITAL SCIENCE

Researchers worldwide will need further assistance to help comply with an increasing number of open data mandates, according to the authors of a new report.

The State of Open Data Report 2022 – the latest in an annual collaborative series from Digital Science, Figshare and Springer Nature – is released today.

Based on a global survey, the report is now in its seventh year and provides insights into researchers’ attitudes towards and experiences of open data. With more than 5,400 respondents, the 2022 survey is the largest since the COVID-19 pandemic began.

This year’s report also includes guest articles from open data experts at the National Institutes of Health (NIH), the White House Office of Science and Technology Policy (OSTP), the Chinese Academy of Sciences (CAS), publishers and universities.

Founder and CEO of Figshare Mark Hahnel says: “This year’s State of Open Data Report comes at a unique point in time when we’re seeing a growing number of open data mandates from funding organizations and policymakers, most notably the NIH and OSTP in the United States, but also recently from the National Health and Medical Research Council (NHMRC) in Australia, and in Europe and the UK.

“What is clear from the findings of our report is that while most researchers embrace the concepts of open data and open science, they also have some reasonable misgivings about how open data policies and practices impact on them. In an environment where open data mandates are increasing, funding organizations would benefit from working even more closely with researchers and providing them with additional support to help smooth the transition to a fully open data future.

“We all have a role to play in driving a better future for open data and accessible research, and one way we can do that through this report is by listening to the voices of researchers, funders, institutions, and publishers,” he says.

 

CAPTION

A comment from NIH contributors to the 2022 State of Open Data report

CREDIT

Figshare/Digital Science

Primary findings from this year’s report indicated that:

• There is a growing trend in researchers being in favour of data being made openly available as common practice (4 out of every five researchers were in agreement with this), supported somewhat by now over 70% of respondents being required to follow a policy on data sharing.
• However, researchers still cite a key need in helping them to share their data as being more training or information on policies for access, sharing and reuse (55%) as well as long-term storage and data management strategies (52%).
• Credit and recognition were once again a key theme for researchers in sharing their data. Of those who had previously shared data, 66% had received some form of recognition for their efforts – most commonly via full citation in another article (41%) followed by co-authorship on a paper that had used the data.
• Researchers are more inclined to share their research data where it can have an impact on citations (67%) and the visibility of their research (61%), rather than being motivated by public benefit or journal/publisher mandate (both 56%).

Graham Smith, Open Data Program Manager, Springer Nature, says: “For the past seven years these surveys have helped paint a picture of researcher perspectives on open data. The report shows us not only the progress made but the steps that still need to be taken on the journey towards an open data future in support of the research community. Whether it’s the broad support of researchers for making research data openly available as common practice or the changing attitudes to open data mandates, we must learn from and deliver concrete steps forward to address what the community is telling us.

“Springer Nature is firmly committed to this and we continue to work closely with our partners, such as Figshare and Digital Science, to create better understanding around data sharing.”

Daniel Hook, CEO of Digital Science, says: “Digital Science is committed to making open, collaborative and inclusive research possible, as we believe this environment will lead to the greatest benefit for society. Now in its seventh year, while the articles in The State of Open Data Report represent a unique set of snapshots marking the evolution of attitudes about Open Data in our community, the data behind the survey constitutes a valuable resource to track researcher sentiment regarding open data and their experiences of data sharing. I believe that these data represent an amazing opportunity to understand the challenges and needs of our community so that we can collectively build better infrastructure to support research.”

The full report can be accessed on Figshare: https://doi.org/10.6084/m9.figshare.21276984

Join in the conversation at #StateOfOpenData

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Key findings via theme of the report

Support for open data

• Four out of every five respondents are in favour of research data being made openly available as common practice.
• 74% of respondents reported sharing their data during publication.
• Approximately one fifth of respondents reported having no concerns about sharing data openly – this proportion has been steadily growing since 2018.
• 88% of researchers surveyed are supportive of making research articles open access (OA) as a common scholarly practice.

Motivations and benefits

• When it comes to researchers sharing their data, citations of research papers (67%) and increased impact and visibility of papers (61%) outweigh public benefit or journal/publisher mandate (both 56%) as motivation.
• Of those who had previously shared data, 66% had received some form of recognition for their efforts – most commonly via full citation in another article (41%) followed by co-authorship on a paper that had used the data.
• A third of respondents indicated they had been involved in a research collaboration as a result of data they had previously shared.

Open data mandates

• 70% of respondents were required to follow a policy on data sharing for their most recent piece of research.
• More than two-thirds of respondents are supportive “to some extent” of a national mandate for making research data openly available. This number has been declining since 2019.
• Just over half (52%) of respondents in the 2022 survey felt that sharing data should be a part of the requirement for awarding research grants. Again, this number has been declining since 2019.

Drawbacks

• Only 19% of respondents believe that researchers get sufficient credit for sharing their data, while 75% say they receive too little credit.
• Just under a quarter of respondents indicated that they had previously received support with planning, managing or sharing their research data
• The greatest concern among respondents is misuse of their data (35%).
• The key needs of researchers which were felt more training or information would improve were better understanding and definitions for policies for access, sharing and reuse (55%) as well as long-term storage and data management strategies (52%) – things that impact both ends of the research cycle.

Key demographics of respondents

• Researchers from China now comprise 11% of all respondents, equal with that of the United States. China and the US are the two countries with the biggest response to the survey, followed by India, Japan, Germany, Italy, UK, Canada, Brazil, France and Spain.

• 31% of respondents were early career researchers (ECRs), while a further 31% classed themselves as senior researchers.

• Most respondents (42%) were from medicine & life sciences; 38% from mathematics, physics and applied sciences; and 17% from humanities and social sciences (an increase of 3%).

• Respondents were broadly categorised as: Open science advocates (32%), Open publishing advocates (26%), Cautiously pro open science (25%), Open science agnostics (11%), and Non-believers of open science (6%).

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About Figshare
Figshare is a leading provider of out-of-the-box, cloud repository software for research data, papers, theses, teaching materials, conference outputs, and more. Research outputs become more discoverable and impactful with search engine indexing and usage metrics including citations and altmetrics. Figshare provides a proficient platform for all types of research data to be shared and showcased in a FAIR way whilst enabling researchers to receive credit. Visit knowledge.figshare.com and follow @figshare on Twitter.

 

About Springer Nature
For over 180 years Springer Nature has been advancing discovery by providing the best possible service to the whole research community. We help researchers uncover new ideas, make sure all the research we publish is significant, robust and stands up to objective scrutiny, that it reaches all relevant audiences in the best possible format, and can be discovered, accessed, used, re-used and shared. We support librarians and institutions with innovations in technology and data; and provide quality publishing support to societies. As a research publisher, Springer Nature is home to trusted brands including Springer, Nature Portfolio, BMC, Palgrave Macmillan and Scientific American. For more information, please visit springernature.com and @SpringerNature

 

About Digital Science
Digital Science is a technology company working to make research more efficient. We invest in, nurture and support innovative businesses and technologies that make all parts of the research process more open and effective. Our portfolio includes admired brands including Altmetric, Dimensions, Figshare, ReadCube, Symplectic, IFI CLAIMS, Overleaf, Ripeta and Writefull. We believe that together, we can help researchers make a difference. Visit www.digital-science.com and follow @digitalsci on Twitter.

 

Media contacts

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DOI

10.6084/m9.figshare.21276984 

ARTICLE TITLE

The State of Open Data 2022

Heaviest element yet detected in an exoplanet atmosphere

Peer-Reviewed Publication

ESO

 

IMAGE: THIS ARTIST’S IMPRESSION SHOWS AN ULTRA-HOT EXOPLANET, A PLANET BEYOND OUR SOLAR SYSTEM, AS IT IS ABOUT TO TRANSIT IN FRONT OF ITS HOST STAR. WHEN THE LIGHT FROM THE STAR PASSES THROUGH THE PLANET’S ATMOSPHERE, IT IS FILTERED BY THE CHEMICAL ELEMENTS AND MOLECULES IN THE GASEOUS LAYER. WITH SENSITIVE INSTRUMENTS, THE SIGNATURES OF THOSE ELEMENTS AND MOLECULES CAN BE OBSERVED FROM EARTH. USING THE ESPRESSO INSTRUMENT OF ESO’S VERY LARGE TELESCOPE, ASTRONOMERS HAVE FOUND THE HEAVIEST ELEMENT YET IN AN EXOPLANET'S ATMOSPHERE, BARIUM, IN THE TWO ULTRA-HOT JUPITERS WASP-76 B AND WASP-121 B. view more 

CREDIT: ESO/M. KORNMESSER

Using the European Southern Observatory’s Very Large Telescope (ESO’s VLT), astronomers have discovered the heaviest element ever found in an exoplanet atmosphere — barium. They were surprised to discover barium at high altitudes in the atmospheres of the ultra-hot gas giants WASP-76 b and WASP-121 b — two exoplanets, planets which orbit stars outside our Solar System. This unexpected discovery raises questions about what these exotic atmospheres may be like.

“The puzzling and counterintuitive part is: why is there such a heavy element in the upper layers of the atmosphere of these planets?” says Tomás Azevedo Silva, a PhD student at the University of Porto and the Instituto de Astrofísica e Ciências do Espaço (IA) in Portugal who led the study published today in Astronomy & Astrophysics.

WASP-76 b and WASP-121 b are no ordinary exoplanets. Both are known as ultra-hot Jupiters as they are comparable in size to Jupiter whilst having extremely high surface temperatures soaring above 1000°C. This is due to their close proximity to their host stars, which also means an orbit around each star takes only one to two days. This gives these planets rather exotic features; in WASP-76 b, for example, astronomers suspect it rains iron.

But even so, the scientists were surprised to find barium, which is 2.5 times heavier than iron, in the upper atmospheres of WASP-76 b and WASP-121 b. “Given the high gravity of the planets, we would expect heavy elements like barium to quickly fall into the lower layers of the atmosphere,” explains co-author Olivier Demangeon, a researcher also from the University of Porto and IA.

“This was in a way an ‘accidental’ discovery,” says Azevedo Silva. “We were not expecting or looking for barium in particular and had to cross-check that this was actually coming from the planet since it had never been seen in any exoplanet before.”

The fact that barium was detected in the atmospheres of both of these ultra-hot Jupiters suggests that this category of planets might be even stranger than previously thought. Although we do occasionally see barium in our own skies, as the brilliant green colour in fireworks, the question for scientists is what natural process could cause this heavy element to be at such high altitudes in these exoplanets. ​​“At the moment, we are not sure what the mechanisms are,” explains Demangeon.

In the study of exoplanet atmospheres ultra-hot Jupiters are extremely useful. As Demangeon explains: “Being gaseous and hot, their atmospheres are very extended and are thus easier to observe and study than those of smaller or cooler planets”.

Determining the composition of an exoplanet’s atmosphere requires very specialised equipment. The team used the ESPRESSO instrument on ESO’s VLT in Chile to analyse starlight that had been filtered through the atmospheres of WASP-76 b and WASP-121 b. This made it possible to clearly detect several elements in them, including barium.

These new results show that we have only scratched the surface of the mysteries of exoplanets. With future instruments such as the high-resolution ArmazoNes high Dispersion Echelle Spectrograph (ANDES), which will operate on ESO’s upcoming Extremely Large Telescope (ELT), astronomers will be able to study the atmospheres of exoplanets large and small, including those of rocky planets similar to Earth, in much greater depth and to gather more clues as to the nature of these strange worlds.

More information

This research was presented in the paper “Detection of Barium in the atmospheres of ultra-hot gas giants WASP-76b & WASP-121b” to appear in Astronomy & Astrophysics (doi: 10.1051/0004-6361/202244489).

The team is composed of T. Azevedo Silva (Instituto de Astrofísica e Ciências do Espaço, Universidade do Porto, Portugal [IA/UPorto, CAUP] and Departamento de Física e Astronomia Faculdade de Ciências, Universidade do Porto, Portugal [FCUP]), O. D. S. Demangeon (IA/UPorto, CAUP and FCUP), N. C. Santos (IA/UPorto, CAUP and FCUP), R. Allart (Department of Physics, and Institute for Research on Exoplanets, Université de Montréal, Canada and Observatoire astronomique de l’Université de Genève, Switzerland [UNIGE]), F. Borsa (INAF – Osservatorio Astronomico di Brera, Italy) , E. Cristo (IA/UPorto, CAUP and FCUP) , E. Esparza-Borges (Instituto de Astrofísica de Canarias, Spain [IAC] and Departamento de Astrofísica, Universidad de La Laguna, Tenerife, Spain [IAC-ULL]) , J. V. Seidel (European Southern Observatory, Chile [ESO Chile]) , E. Palle (IAC) , S. G. Sousa (IA/UPorto), H. M. Tabernero (Centro de Astrobiología, CSIC-INTA, Spain [CSIC-INTA]), M. R. Zapatero Osorio (CSIC-INTA), S. Cristiani (INAF – Osservatorio Astronomico di Trieste, Italy [INAF Trieste]), F. Pepe (UNIGE) , R. Rebolo (IAC and IAC-ULL) , V. Adibekyan (IA/UPorto and FCUP), Y. Alibert (Physikalisches Institut, University of Bern,, Switzerland), S. C. C. Barros (IA/UPorto and FCUP), V. Bourrier (UNIGE) , P. Di Marcantonio (INAF Trieste), V. D’Odorico (INAF Trieste, Scuola Normale Superiore, Italy and Institute for Fundamental Physics of the Universe, Trieste, Italy [IFPU]), D. Ehrenreich (UNIGE and Centre Vie dans l’Univers, Faculté des sciences de l’Université de Genève, Switzerland), P. Figueira (UNIGE and IA/UPorto), J. I. González Hernández (IAC and Universidad de La Laguna, Departamento de Astrofísica, Spain), C. J. A. P. Martins (UA/UPorto and Centro de Astrofísica da Universidade do Porto, Portugal), A. Mehner (ESO Chile) , G. Micela (INAF – Osservatorio Astronomico di Palermo, Italy), P. Molaro (INAF Trieste and IFPU), D. Mounzer (UNIGE), N. J. Nunes (Instituto de Astrofísica e Ciências do Espaço, Faculdade de Ciências da Universidade de Lisboa and Departamento de Física, Faculdade de Ciências da Universidade de Lisboa, Portugal), A. Sozzetti (INAF - Osservatorio Astrofisico di Torino, Italy), A. Suárez Mascareño (IAC and IAC-ULL), and S. Udry (UNIGE).

The European Southern Observatory (ESO) enables scientists worldwide to discover the secrets of the Universe for the benefit of all. We design, build and operate world-class observatories on the ground — which astronomers use to tackle exciting questions and spread the fascination of astronomy — and promote international collaboration in astronomy. Established as an intergovernmental organisation in 1962, today ESO is supported by 16 Member States (Austria, Belgium, the Czech Republic, Denmark, France, Finland, Germany, Ireland, Italy, the Netherlands, Poland, Portugal, Spain, Sweden, Switzerland and the United Kingdom), along with the host state of Chile and with Australia as a Strategic Partner. ESO’s headquarters and its visitor centre and planetarium, the ESO Supernova, are located close to Munich in Germany, while the Chilean Atacama Desert, a marvellous place with unique conditions to observe the sky, hosts our telescopes. ESO operates three observing sites: La Silla, Paranal and Chajnantor. At Paranal, ESO operates the Very Large Telescope and its Very Large Telescope Interferometer, as well as survey telescopes such as VISTA. Also at Paranal ESO will host and operate the Cherenkov Telescope Array South, the world’s largest and most sensitive gamma-ray observatory. Together with international partners, ESO operates APEX and ALMA on Chajnantor, two facilities that observe the skies in the millimetre and submillimetre range. At Cerro Armazones, near Paranal, we are building “the world’s biggest eye on the sky” — ESO’s Extremely Large Telescope. From our offices in Santiago, Chile we support our operations in the country and engage with Chilean partners and society.

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Contacts

Tomás Azevedo Silva
Instituto de Astrofisica e Ciências do Espaço, Faculdade de Ciências, Universidade do Porto
Porto, Portugal
Email: Tomas.Silva@astro.up.pt

Olivier Demangeon
Instituto de Astrofisica e Ciências do Espaço, Faculdade de Ciências, Universidade do Porto
Porto, Portugal
Tel: +351 226 089 855
Email: olivier.demangeon@astro.up.pt

Nuno Santos
Instituto de Astrofisica e Ciências do Espaço, Faculdade de Ciências, Universidade do Porto
Porto, Portugal
Email: Nuno.Santos@astro.up.pt

María Rosa Zapatero Osorio
Centro de Astrobiología (CSIC-INTA)
Madrid, Spain
Email: mosorio@cab.inta-csic.es

Hugo Tabernero
Centro de Astrobiología (CSIC-INTA)
Madrid, Spain
Email: htabernero@cab.inta-csic.es

Jonay González Henández
Instituto de Astrofísica de Canarias
Tenerife, Spain
Email: jonay@iac.es

Alejandro Suárez Mascareño
Instituto de Astrofísica de Canarias
Tenerife, Spain
Email: alejandro.suarez.mascareno@iac.es

Paolo Molaro
INAF Osservatorio Astronomico di Trieste
Trieste, Italy
Email: paolo.molaro@inaf.it

Baptiste Lavie
University of Geneva
Geneva, Switzerland
Email: Baptiste.Lavie@unige.ch

Juan Carlos Muñoz Mateos
ESO Media Officer
Garching bei München, Germany
Tel: +49 89 3200 6176
Email: press@eso.org

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JOURNAL

Astronomy and Astrophysics

DOI

10.1051/0004-6361/202244489 

Anti-anaerobic antibiotics associated with increased risk of mortality in critically ill patients

Study by U-M researchers shows early treatment with specific antibiotics depletes the body of gut anaerobes that protect against pneumonia, organ failure, and mortality.

Peer-Reviewed Publication

MICHIGAN MEDICINE - UNIVERSITY OF MICHIGAN

ANN ARBOR, MI – A common clinical practice may be inadvertently harming patients, according to new research published October 13 in the European Respiratory Journal. The team of Michigan Medicine researchers behind the study suggest that administration of antibiotics with activity against anaerobic bacteria has a profound effect on the gut microbiome and, ultimately, an adverse impact on critically ill patients.  

“We talk about the gut microbiome as a metabolic and immune ‘organ,’ and when we give patients anti-anerobic antibiotics, I worry we are causing a hidden form of organ failure,” said senior author Robert Dickson, M.D., Associate Professor in Pulmonary and Critical Care Medicine and Deputy Director at the Weil Institute for Critical Care Research and Innovation at the University of Michigan. “Our research suggests that depleting the gut of these ‘good bugs’ may be contributing to worse clinical outcomes.”

In the paper, researchers found that, in critically ill patients, the practice of early administration of anti-anaerobic antibiotics is commonplace – about two-thirds of the 3,032 patients observed in the study’s cohort received such treatment.

“For sick patients in the Emergency Department and Intensive Care Unit, there has been a lot of focus on ‘time-to-antibiotics’ as a quality improvement measure,” said Dickson. “Our results demonstrate that antibiotics really can’t be considered a single entity, as they have widely different impacts on the microbiome and on our patients. Patients who received anti-anaerobic antibiotics did far worse than patients who didn’t. We think that which antibiotic is given probably matters more than how quickly they are administered.”

With support from the Weil Institute, along with funding from the National Institutes of Health, the researchers conducted a retrospective single-center cohort study of 3,032 critically ill patients, comparing those who did and did not receive early anti-anaerobic antibiotics. By comparing ICU outcomes in all patients, and changes in gut microbiota in 116 of the patients, they found that those who received anti-anaerobic antibiotics early in their hospital course had worse outcomes, whether measured in overall survival, infection-free survival, or pneumonia-free survival.

The authors also found dramatic consequences of these antibiotics on the gut microbiome – during hospitalization, patients who received anti-anaerobic antibiotics had decreased initial gut bacterial density, followed by increased expansion and domination of the microbiome Enterobacteriaceae (a genus of common bacteria, many of which are pathogenic and cause opportunistic infections in immunocompromised hosts). These findings confirm that anti-anaerobic antibiotics have a dramatic effect on gut bacterial communities.

While the primary findings were from an observational study in humans, the team confirmed the results using animal modeling. In two different mouse models (pneumonia and oxygen-induced lung injury), animals who were treated with anti-anaerobic antibiotics did worse. Anti-anaerobic antibiotics increased the susceptibility of mice to pneumonia due to Enterobacteriaceae and increased their mortality from oxygen toxicity.

Co-author Rishi Chanderraj, M.D., a Clinical Lecturer in Infectious Diseases at U-M, was the lead researcher on the initial project and will be carrying the work forward in future studies.

“In observational studies, there is always a risk that a mortality difference is due to confounding; maybe the patients who received anti-anaerobic antibiotics were just sicker,” he said. “But the fact that we were able to recapitulate these findings in two different animal models gives us confidence that these findings are real.”

“No one wants to withhold antibiotics from patients with life-threatening infections,” said Chanderraj. “But our study confirms that the risk of overtreating with antibiotics isn’t just theoretical. I’m concerned that we’re harming our patients.”

Paper cited: “In critically ill patients, anti-anaerobic antibiotics increase risk of adverse clinical outcomes,” European Respiratory Journal. DOI: 10.1183/13993003.00910-2022

Project team: Rishi Chanderraj1,2, Jennifer M. Baker3,4, Stephen G. Kay3, Christopher A. Brown3,5, Kevin J. Hinkle3, Daniel J. Fergle3, Roderick A. McDonald3, Nicole R. Falkowski3, Joseph D. Metcalf3, Keith S. Kaye6, Robert J. Woods1,2,7, Hallie C. Prescott3,8,9, Michael W. Sjoding3,7,8,10, Robert P. Dickson3,4,10

Affiliations:

1. Division of Infectious Diseases, Department of Internal Medicine, University of Michigan

Medical School, Ann Arbor, MI, USA.

2. Medicine Service, Infectious Diseases Section, Veterans Affairs (VA) Ann Arbor Healthcare

System, Ann Arbor, Michigan, USA.

3. Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine,

University of Michigan Medical School, Ann Arbor, MI, USA.

4. Department of Microbiology and Immunology, University of Michigan Medical School, Ann

Arbor, MI, USA.

5. Institute for Research on Innovation and Science, Institute for Social Research, University of

Michigan

6. Division of Infectious Diseases, Department of Medicine, Rutgers-New Jersey Medical

School

7. Computational Medicine and Bioinformatics, University of Michigan Medical School, Ann

Arbor, MI, USA.

8. Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.

9. VA Center for Clinical Management Research, Ann Arbor, Michigan.

10. Weil Institute for Critical Care Research & Innovation; Ann Arbor, Michigan

About the Weil Institute, formerly MCIRCC

The team at the Max Harry Weil Institute for Critical Care Research and Innovation (formerly the Michigan Center for Integrative Research in Critical Care) is dedicated to pushing the leading edge of research to develop new technologies and novel therapies for the most critically ill and injured patients. Through a unique formula of innovation, integration and entrepreneurship that was first imagined by Weil, their multi-disciplinary teams of health providers, basic scientists, engineers, data scientists, commercialization coaches, donors and industry partners are taking a boundless approach to re-imagining every aspect of critical care medicine. For more information, visit weilinstitute.med.umich.edu

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JOURNAL

European Respiratory Journal

DOI

10.1183/13993003.00910-2022