The Relationship between Hospital Infection Surveillance and Control Activities and Antibiotic Resistant Pathogen Rates

Objective: The purpose of the study was to examine the relationship of surveillance and control activities in Canadian hospitals with rates of nosocomial methicillin-resistant S. aureus (MRSA), C. difficile associated diarrhea (CDAD), and vancomycin-resistant Enterococcus (VRE). Methods: Surveys were sent to Infection Control programs in hospitals that participated in an earlier survey of infection control practices in Canadian acute care hospitals. Results: One hundred and twenty of 145 (82.8%) hospitals responded to the survey. The mean MRSA rate was 2.0 (SD 2.9) per 1,000 admissions, the mean CDAD rate was 3.8 (SD 4.3), and the mean VRE rate was 0.4 (SD 1.5). Multiple stepwise regression analysis found hospitals that reported infection rates by specific risk groups (r = - 0.27, p < 0.01) and that kept attendance records of infection control teaching activities (r = - 0.23, p < 0.01) were associated with lower MRSA rates. Multiple stepwise regression analysis found larger hospitals (r = 0.25, p < 0.01) and hospitals where infection control committees or staff had the direct authority to close a ward or unit to further admissions due to outbreaks (r = 0.22, p < 0.05) were associated with higher CDAD rates. Multiple logistic regression analysis found larger hospitals (OR = 1.6, CI 1.2 - 2.0, p = 0.003) and teaching hospitals (OR = 3.7, CI 1.2 - 11.8, p = 0.02) were associated with the presence of VRE. Hospitals were less likely to have VRE when infection control staff frequently contacted physicians and nurses for reports of new infections (OR = 0.5, CI 0.3 - 0.7, p = 0.02) and there were in-service programs for updating nursing and ancillary staff on current infection control practices (OR = 0.2, CI 0.1 - 0.7, p = 0.01). Conclusions: Surveillance and control activities were associated with MRSA and CDAD rates and the presence of VRE. Surveillance and control activities might be especially beneficial in large and teaching hospitals.

THE MICROSTRUCTURES OF ZR-EXCEL ALLOY: EFFECTS OF HEAVY ION IRRADIATION, PLASTIC DEFORMATION, THERMAL TREATMENT AND IN-SITU HEATING

Zr-Excel alloy (Zr-3.5Sn-0.8Nb-0.8Mo) is a dual phase (α + β) alloy in the as-received pressure tube condition. It has been proposed to be the pressure tube candidate material for the Generation-IV CANDU-Supercritical Water Reactor (CANDU-SCWR). In this dissertation, the effects of heavy ion irradiation, deformation and heat treatment on the microstructures of the alloy were investigated to enable us to have a better understanding of the potential in-reactor performance of this alloy. In-situ heavy ion (1 MeV) irradiation was performed to study the nucleation and evolution of dislocation loops in both α- and β-Zr. Small and dense type dislocation loops form under irradiation between 80 and 450 °C. The number density tends to saturate at ~ 0.1 dpa. Compared with the α-Zr, the defect yield is much lower in β-Zr. The stabilities of the metastable phases (β-Zr and ω-Zr) and the thermal-dynamically equilibrium phase, fcc Zr(Mo, Nb)2, under irradiation were also studied at different temperatures. Chemi-STEM elemental mapping was carried out to study the elemental redistribution caused by irradiation. The stability of these phases and the elemental redistribution are strongly dependent on irradiation temperature. In-situ time-of-flight neutron diffraction tensile and compressive tests were carried out at different temperatures to monitor lattice strain evolutions of individual grain families during these tests. The β-Zr is the strengthening phase in this alloy in the as-received plate material. Load is transferred to the β-Zr after yielding of the α-Zr grains. The temperature dependence of static strain aging and the yielding sequence of the individual grain families were discussed. Strong tensile/compressive asymmetry was observed in the {0002} grain family at room temperature. The microstructures of the sample deformed at 400 °C and the samples only subjected to heat treatment at the same temperature were characterized with TEM. Concentration of β phase stabilizers in the β grain and the morphology of β grain have significant effect on the stability of β- and ω-Zr under thermal treatment. Applied stress/strain enhances the decomposition of isothermal ω phase but suppresses α precipitation inside the β grains at high temperature. An α → ω/ZrO phase transformation was observed in the thin foils of Zr-Excel alloy and pure Zr during in-situ heating at 700 °C in TEM.