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Transient acquisition of methicillin-resistant (MRSA) on healthcare personnel (HCP) gloves and gowns following patient care has been examined. However, the potential for transmission to the subsequent patient has not been studied. We explored the frequency of MRSA transmission from patient to HCP, and then in separate encounters from contaminated HCP gloves and gowns to a subsequent simulated patient as well as the factors associated with these 2 transmission pathways. We conducted a prospective cohort study with 2 parts. In objective 1, we studied MRSA transmission from random MRSA-positive patients to HCP gloves and gowns after specific routine patient care activities. In objective 2, we simulated subsequent transmission from random HCP gloves and gowns without hand hygiene to the next patient using a manikin proxy. For the first objective, among 98 MRSA-positive patients with 333 randomly selected individual patient-HCP interactions, HCP gloves or gowns were contaminated in 54 interactions (16.2%). In a multivariable analysis, performing endotracheal tube care had the greatest odds of glove or gown contamination (OR, 4.06; 95% CI, 1.3-12.6 relative to physical examination). For the second objective, after 147 simulated HCP-patient interactions, the subsequent transmission of MRSA to the manikin proxy occurred 15 times (10.2%). After caring for a patient with MRSA, contamination of HCP gloves and gown and transmission to subsequent patients following HCP-patient interactions occurs frequently if contact precautions are not used. Proper infection control practices, including the use of gloves and gown, can prevent this potential subsequent transmission.

BackgroundHospital-onset bacteraemia and fungaemia (HOB) is being explored as a surveillance and quality metric. The objectives of the current study were to determine sources and preventability of HOB in hospitalised patients in the USA and to identify factors associated with perceived preventability.MethodsWe conducted a cross-sectional study of HOB events at 10 academic and three community hospitals using structured chart review. HOB was defined as a blood culture on or after hospital day 4 with growth of one or more bacterial or fungal organisms. HOB events were stratified by commensal and non-commensal organisms. Medical resident physicians, infectious disease fellows or infection preventionists reviewed charts to determine HOB source, and infectious disease physicians with training in infection prevention/hospital epidemiology rated preventability from 1 to 6 (1=definitely preventable to 6=definitely not preventable) using a structured guide. Ratings of 1–3 were collectively considered ‘potentially preventable’ and 4–6 ‘potentially not preventable’.ResultsAmong 1789 HOB events with non-commensal organisms, gastrointestinal (including neutropenic translocation) (35%) and endovascular (32%) were the most common sources. Overall, 636/1789 (36%) non-commensal and 238/320 (74%) commensal HOB events were rated potentially preventable. In logistic regression analysis among non-commensal HOB events, events attributed to intravascular catheter-related infection, indwelling urinary catheter-related infection and surgical site infection had higher odds of being rated preventable while events with neutropenia, immunosuppression, gastrointestinal sources, polymicrobial cultures and previous positive blood culture in the same admission had lower odds of being rated preventable, compared with events without those attributes. Of 636 potentially preventable non-commensal HOB events, 47% were endovascular in origin, followed by gastrointestinal, respiratory and urinary sources; approximately 40% of those events would not be captured through existing healthcare-associated infection surveillance.DiscussionFactors identified as associated with higher or lower preventability should be used to guide inclusion, exclusion and risk adjustment for an HOB-related quality metric.

The gold standard for hand hygiene (HH) while wearing gloves requires removing gloves, performing HH, and donning new gloves between WHO moments. The novel strategy of applying alcohol-based hand rub (ABHR) directly to gloved hands might be effective and efficient. A mixed-method, multicenter, 3-arm, randomized trial. Adult and pediatric medical-surgical, intermediate, and intensive care units at 4 hospitals. Healthcare personnel (HCP). HCP were randomized to 3 groups: ABHR applied directly to gloved hands, the current standard, or usual care. Gloved hands were sampled via direct imprint. Gold-standard and usual-care arms were compared with the ABHR intervention. Bacteria were identified on gloved hands after 432 (67.4%) of 641 observations in the gold-standard arm versus 548 (82.8%) of 662 observations in the intervention arm ( < .01). HH required a mean of 14 seconds in the intervention and a mean of 28.7 seconds in the gold-standard arm ( < .01). Bacteria were identified on gloved hands after 133 (98.5%) of 135 observations in the usual-care arm versus 173 (76.6%) of 226 observations in the intervention arm ( < .01). Of 331 gloves tested 6 (1.8%) were found to have microperforations; all were identified in the intervention arm [6 (2.9%) of 205]. Compared with usual care, contamination of gloved hands was significantly reduced by applying ABHR directly to gloved hands but statistically higher than the gold standard. Given time savings and microbiological benefit over usual care and lack of feasibility of adhering to the gold standard, the Centers for Disease Control and Prevention and the World Health Organization should consider advising HCP to decontaminate gloved hands with ABHR when HH moments arise during single-patient encounters. NCT03445676.

Restorative justice has made significant progress in recent years and now plays an increasingly important role in and alongside the criminal justice systems of a number of countries in different parts of the world. In many cases, however, successes and failures, strengths and weaknesses have not been evaluated sufficiently systematically and comprehensively, and it has been difficult to gain an accurate picture of its implementation and the lessons to be drawn from this. Restorative Justice in Practice addresses this need, analyzing the results of the implementation of three restorative justice schemes in England and Wales in the largest and most complete trial of restorative justice with adult offenders worldwide. It aims to bring out the practicalities of setting up and running restorative justice schemes in connection with criminal justice, the costs of doing so and the key professional and ethical issues involved. At the same time the book situates these findings within the growing international academic and policy debates about restorative justice, addressing a number of key issues for criminal justice and penology, including: how far victim expectations of justice are and can be met by restorative justice aligned with criminal justice whether ‘community’ is involved in restorative justice for adult offenders and how this relates to social capital how far restorative justice events relate to processes of desistance (giving up crime), promote reductions in reoffending and link to resettlement what stages of criminal justice may be most suitable for restorative justice and how this relates to victim and offender needs the usefulness of conferencing and mediation as forms of restorative justice with adults. Restorative Justice in Practice will be essential reading for both students and practitioners, and a key contribution to the restorative justice debate. \"This seven year study is the most important research evidence on restorative justice (RJ) in this country. The work challenges some of the myths around restorative justice – for example the finding that 70% of victims of serious crimes chose to meet the offender when this was offered to them, challenges the prevailing view that RJ is only appropriate for less serious crime. Her research has confirmed earlier findings of the strong victim benefits from restorative justice; and provided new evidence for the impact of RJ in reducing re-offending, leading to cost-savings across Criminal Justice. This book will provide essential reading for policy makers interested in evidence-based policy; for criminal justice agencies seeking to give victims a stronger voice in justice; and includes a wealth of information for practitioners who want to know 'what works' and base their restorative practice on the evidence.\" – Lizzie Nelson, Director, Restorative Justice Council 'This book provides a state-of-the-art analysis of restorative justice, conferences, and mediation for serious cases and adult offenders. 　It is essential reading for policymakers and practitioners who wish to develop restorative justice schemes that work alongside conventional criminal justice. 　Its comprehensive and measured analysis is a welcome addition to the research literature. 　This is a scholarly treatment of restorative justice for the real world and ways to move it from the margins to the mainstream of criminal justice.' – Kathleen Daly, Professor of Criminology and Criminal Justice, Griffith University, Australia 'The authors promised to provide \"essential reading\" for students and practioners. They have met that promise in regard to both their description of applications of RJ in the adult justice system (pre-trial, during sentencing formulation, and post sentencing) and in their many probing questions regarding RJ in general.'　 -Eric Assur, in the Restorative Justice Online blog, 2 March 2012 Joanna Shapland is Professor of Criminal Justice in the School of Law, University of Sheffield, and Head of the School of Law; Gwen Robinson is Senior Lecturer in Criminal Justice in the School of Law at the University of Sheffield; Angela Sorsby is a freelance criminologist specialising in data analysis and statistics. 1. Setting the Scene 2. Setting the Schemes in Context: A Review of the Aims, Histories and Results of Restorative Justice 3. Setting Up and Running Restorative Justice Schemes 4. Accountability, Regulation and Risk Experiencing Restorative Justice 5. Approaching Restorative Justice 6. Through a Different Lens: Examining Restorative Justice Using Case Studies 7. During Restorative Justice Events Looking Back at Restorative Justice: What Do People Think it Achieved? 8. The Victims’ View: Satisfaction and Closure 9. Outcome Agreements and their Progress 10. The Offenders’ View: Reoffending and the Road to Desistance 11. Restorative Justice: Lessons from Practice

We conducted a laboratory simulation to evaluate the contamination of environmental surfaces when using wipe vs spray methods of personal protective equipment (PPE) decontamination. We did not observe any environmental contamination with the bacteriophage MS-2 when bleach solution spray or wipes were used for PPE disinfection.

Foot ulcers are a common complication of diabetes, often resulting from peripheral neuropathy and inadvertent trauma. Poor healing is exacerbated by peripheral arterial disease and poor glycemic control. Off-loading, a key treatment, leads to prolonged immobility. Patients rarely regain baseline mobility. Mobility is crucial to improve glycemia, promote vascular health, and improve immobility as it leads to nursing home admissions. There is limited research on exercise during ulcer remission. This pilot study will assess the feasibility and acceptability of a home-based exercise regimen aimed at safely increasing mobility and function, focusing on improving lower extremity strength, tissue perfusion, and glycemic control. Veterans aged ≥50 years with a recently healed diabetic plantar foot ulcer receiving care in the US Department of Veterans Affairs (VA) Maryland Health Care System and enrolled in a remote temperature-sensing mat program will be eligible. Potential participants will be identified via administrative codes used for the Prevention of Amputation in Veterans Everywhere directive, as well as using the VA's Podimetrics SmartMat dashboard. In this pilot study, 25 veterans will be randomized (in a 3:1 ratio) to a 12-week home-based exercise regimen or standard of care. Participants will undergo tests for gait speed, knee extension strength, cutaneous perfusion, and community mobility. The intervention group will participate in internet-based videoconference exercise classes twice a week led by the study team and home cycling 3 times a week. The control group will receive standard-of-care guidance. Outcome measures will include feasibility; acceptability; and changes in gait speed, physical activity levels, and strength. This study was funded on July 1, 2024, with data collection planned from October 1, 2024, to March 31, 2026. The protocol was approved by the University of Maryland Institutional Review Board on May 13, 2024, and by the Baltimore VA Research and Development Committee on June 13, 2024. As of June 12, 2025, 12 participants have been enrolled in the study, and 6 (50%) participants have been randomized. Recruitment is expected to continue through December 2025. This project has potential for clinical rehabilitation translation. If it is found to be feasible and acceptable, the exercise intervention will be tested in a future multisite randomized clinical trial to assess its impact on mobility, cardiovascular events, and ulcer recurrence. ClinicalTrials.gov NCT06312579; https://clinicaltrials.gov/ct2/show/NCT06312579. DERR1-10.2196/71237.

We examined the effect of glove decontamination prior to removal on bacterial contamination of healthcare personnel hands in a laboratory simulation study. Glove decontamination reduced bacterial contamination of hands following removal. However, hand contamination still occurred with all decontamination methods, reinforcing the need for hand hygiene following glove removal.

In this paper, we draw on our experience as evaluators of three restorative justice schemes in England and Wales which were funded under the auspices of the Home Office's 'Crime Reduction Programme' to reflect upon the theoretical and empirical potential of restorative justice (in particular, conferencing) to bring about reductions in reoffending on the part of participating offenders. We propose that there is a case to be made for a subtle shift in ways of thinking about the recidivism reduction potential of restorative justice: that is, as an opportunity to facilitate a desire, or consolidate a decision, to desist.

Importance Current guidelines require hand hygiene before donning nonsterile gloves, but evidence to support this requirement is lacking. Objective To evaluate the effectiveness of a direct-gloving policy on adherence to infection prevention practices in a hospital setting. Design, Setting, and Participants This mixed-method, multicenter, cluster randomized clinical trial was conducted at 4 academic centers in Baltimore, Maryland, or Iowa City, Iowa, from January 1, 2016, to November 30, 2017. Data analysis was completed April 25, 2019. Participants were 3790 health care personnel (HCP) across 13 hospital units. Intervention Hospital units were randomly assigned to direct gloving, with hand hygiene not required before donning gloves (intervention), or to usual care (hand hygiene before donning nonsterile gloves). Main Outcomes and Measures The primary outcome was adherence to the expected practice at room entry and exit. A random sample of HCPs’ gloved hands were imprinted on agar plates at entry to contact precautions rooms. The intention-to-treat approach was followed, and all analyses were conducted at the level of the participating unit. Primary and secondary outcomes between treatment groups were assessed using generalized estimating equations with an unstructured working correlation matrix to adjust for clustering; multivariate analysis using generalized estimating equations was conducted to adjust for covariates, including baseline adherence. Results In total, 13 hospital units participated in the trial, and 3790 HCP were observed. Adherence to expected practice was greater in the 6 units with the direct-gloving intervention than in the 7 usual care units (1297 of 1491 [87%] vs 954 of 2299 [41%];P < .001) even when controlling for baseline hand hygiene rates, unit type, and universal gloving policies (risk ratio [RR], 1.76; 95% CI, 1.58-1.97). Glove use on entry to contact precautions rooms was also higher in the direct-gloving units (1297 of 1491 [87%] vs 1530 of 2299 [67%];P = .008. The intervention had no effect on hand hygiene adherence measured at entry to non–contact precautions rooms (951 of 1315 [72%] for usual care vs 1111 of 1688 [66%] for direct gloving; RR, 1.00 [95% CI, 0.91-1.10]) or at room exit (1587 of 1897 [84%] for usual care vs 1525 of 1785 [85%] for direct gloving; RR, 0.98 [95% CI, 0.91-1.07]). The intervention was associated with increased total bacteria colony counts (adjusted incidence RR, 7.13; 95% CI, 3.95-12.85) and greater detection of pathogenic bacteria (adjusted incidence RR, 10.18; 95% CI, 2.13-44.94) on gloves in the emergency department and reduced colony counts in pediatrics units (adjusted incidence RR, 0.34; 95% CI, 0.19-0.63), with no change in either total colony count (RR, 0.87 [95% CI, 0.60 to 1.25] for adult intensive care unit; RR, 0.59 [95% CI, 0.31-1.10] for hemodialysis unit) or presence of pathogenic bacteria (RR, 0.93 [95% CI, 0.40-2.14] for adult intensive care unit; RR, 0.55 [95% CI, 0.15-2.04] for hemodialysis unit) in the other units. Conclusions and Relevance Current guidelines require hand hygiene before donning nonsterile gloves, but evidence to support this requirement is lacking. The findings from this cluster randomized clinical trial indicate that a direct-gloving strategy without prior hand hygiene should be considered by health care facilities. Trial Registration ClinicalTrials.gov Identifier:NCT03119389

Little is known about the effect of meteorological conditions and geographical location on bacterial colonization rates particularly of antibiotic-resistant Gram-positive bacteria. We aimed to evaluate the effect of season, meteorological factors, and geographic location on methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) colonization. The prospective cohort included all adults admitted to 20 geographically-dispersed ICUs across the US from September 1, 2011 to October 4, 2012. Nasal and perianal swabs were collected at admission and tested for MRSA and VRE colonization respectively. Poisson regression models using monthly aggregated colonization counts as the outcome and mean temperature, relative humidity, total precipitation, season, and/or latitude as predictors were constructed for each pathogen. A total of 24,704 ICU-admitted patients were tested for MRSA and 24,468 for VRE. On admission, 10% of patients were colonized with MRSA and 12% with VRE. For MRSA and VRE, a 10% increase in relative humidity was associated with approximately a 9% increase in prevalence rate. Southerly latitudes in the US were associated with higher MRSA colonization, while northerly latitudes were associated with higher VRE colonization. In contrast to MRSA, the association between VRE colonization and latitude was observed only after adjusting for relative humidity, which demonstrates how this effect is highly driven by this meteorological factor. To our knowledge, we are the first to study the effect of meteorological factors and geographical location/latitude on MRSA and VRE colonization in adults. Increasing humidity was associated with greater MRSA and VRE colonization. Southerly latitudes in the US were associated with greater MRSA and less VRE. The effect of these factors on MRSA and VRE rates has the potential not only to inform patient management and treatment, but also infection prevention interventions.