TGF-β Gives an Air of Exclusivity to Alveolar Macrophages

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Bart N. Lambrecht
Tissue-resident macrophages shape the development and homeostasis of the organs that they colonize. Yu et al. (2017) demonstrate that, unique to the lung, the instructive cytokine TGF-β collaborates with GM-CSF to induce the master transcription factor PPARγ to drive alveolar macrophage differentiation and maintenance early in life.

Teaser

Tissue-resident macrophages shape the development and homeostasis of the organs that they colonize. Yu et al. (2017) demonstrate that, unique to the lung, the instructive cytokine TGF-β collaborates with GM-CSF to induce the master transcription factor PPARγ to drive alveolar macrophage differentiation and maintenance early in life.


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The Silent Undertakers: Macrophages Programmed for Efferocytosis

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Judith E. Allen, Dominik Rückerl
Two recent Immunity papers provide new insight into efferocytosis by tissue-resident macrophages. Baratin et al. (2017) identify a resident macrophage population in the T cell zone of lymph nodes responsible for the silent uptake of vast numbers of apoptotic cells. Roberts et al. (2017) find that resident macrophages can be programmed by local tissue signals not to respond to the nucleic acid of apoptotic cells.

Teaser

Two recent Immunity papers provide new insight into efferocytosis by tissue-resident macrophages. Baratin et al. (2017) identify a resident macrophage population in the T cell zone of lymph nodes responsible for the silent uptake of vast numbers of apoptotic cells. Roberts et al. (2017) find that resident macrophages can be programmed by local tissue signals not to respond to the nucleic acid of apoptotic cells.


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The Skinny: Pancreatic ILC2s Promote Insulin Secretion

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Kelly M. Cautivo, Ari B. Molofsky
Regulation of pancreatic insulin production is pivotal in the pathophysiology and treatment of diabetes. In this issue of Immunity, Dalmas et al. (2017) describe a type 2 immune circuit where pancreatic interleukin-33 (IL-33) promotes insulin secretion via the activity of islet-associated group 2 innate lymphoid cells (ILC2s).

Teaser

Regulation of pancreatic insulin production is pivotal in the pathophysiology and treatment of diabetes. In this issue of Immunity, Dalmas et al. (2017) describe a type 2 immune circuit where pancreatic interleukin-33 (IL-33) promotes insulin secretion via the activity of islet-associated group 2 innate lymphoid cells (ILC2s).


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A CD103+ Conventional Dendritic Cell Surveillance System Prevents Development of Overt Heart Failure during Subclinical Viral Myocarditis

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Xavier Clemente-Casares, Siyavash Hosseinzadeh, Iulia Barbu, Sarah A. Dick, Jillian A. Macklin, Yiming Wang, Abdul Momen, Crystal Kantores, Laura Aronoff, Maylis Farno, Tiffany M. Lucas, Joan Avery, Dorrin Zarrin-Khat, Heidi J. Elsaesser, Babak Razani, Kory J. Lavine, Mansoor Husain, David G. Brooks, Clinton S. Robbins, Myron Cybulsky, Slava Epelman
Innate and adaptive immune cells modulate heart failure pathogenesis during viral myocarditis, yet their identities and functions remain poorly defined. We utilized a combination of genetic fate mapping, parabiotic, transcriptional, and functional analyses and demonstrated that the heart contained two major conventional dendritic cell (cDC) subsets, CD103⁺ and CD11b⁺, which differentially relied on local proliferation and precursor recruitment to maintain their tissue residency. Following viral infection of the myocardium, cDCs accumulated in the heart coincident with monocyte infiltration and loss of resident reparative embryonic-derived cardiac macrophages. cDC depletion abrogated antigen-specific CD8⁺ T cell proliferative expansion, transforming subclinical cardiac injury to overt heart failure. These effects were mediated by CD103⁺ cDCs, which are dependent on the transcription factor BATF3 for their development. Collectively, our findings identified resident cardiac cDC subsets, defined their origins, and revealed an essential role for CD103⁺ cDCs in antigen-specific T cell responses during subclinical viral myocarditis.

Teaser

Dendritic cells (DCs) within the myocardium are poorly characterized. Clemente-Casares et al. demonstrate that the myocardium contains heterogeneous conventional DC subsets that differentially utilize recruitment and proliferation to maintain residency. They identify a BATF3-dependent CD103⁺ cDC surveillance system that prevents the transition of subclinical viral myocarditis to overt heart failure.


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Swell, or Not Too Swell: Cytokines Regulate Arterial Aneurysm Formation

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Peter Libby, Amélie Vromman
Arterial remodeling participates pivotally in many diseases including arterial aneurysms. In this issue of Immunity, Da Ros et al. (2017) report that, in experimental aortic aneurysm formation, neutralization of interleukin-1β reduced arterial wall stiffness and hampered aneurysm development.

Teaser

Arterial remodeling participates pivotally in many diseases including arterial aneurysms. In this issue of Immunity, Da Ros et al. (2017) report that, in a model of aortic aneurysm formation, neutralization of interleukin-1β reduced arterial wall stiffness and hampered aneurysm development.


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Glycans Function as Anchors for Antibodies and Help Drive HIV Broadly Neutralizing Antibody Development

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Raiees Andrabi, Ching-Yao Su, Chi-Hui Liang, Sachin S. Shivatare, Bryan Briney, James E. Voss, Salar Khan Nawazi, Chung-Yi Wu, Chi-Huey Wong, Dennis R. Burton




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Brain, Immunity, Gut: “BIG” Links between Pregnancy and Autism

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Myka L. Estes, A. Kimberley McAllister
Although dysregulation of brain, immune, and gut physiology during pregnancy have each been implicated in neuropsychiatric disorders, whether and how these presumably distinct systems are linked to cause disease is unclear. Kim et al. (2017) and Shin Yim et al. (2017) identify a pathway to explain how these aspects of our physiology are deeply and inextricably connected.

Teaser

Although dysregulation of brain, immune, and gut physiology during pregnancy has each been implicated in neuropsychiatric disorders, how these presumably distinct systems are linked to cause disease is unclear. Kim et al. (2017) and Shin Yim et al. (2017) identify a pathway to explain how these aspects of our physiology are deeply and inextricably connected.


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The Broad Spectrum of Human Natural Killer Cell Diversity

Publication date: 21 November 2017
Source:Immunity, Volume 47, Issue 5
Author(s): Aharon G. Freud, Bethany L. Mundy-Bosse, Jianhua Yu, Michael A. Caligiuri
Natural killer (NK) cells provide protection against infectious pathogens and cancer. For decades it has been appreciated that two major NK cell subsets (CD56^bright and CD56^dim) exist in humans and have distinct anatomical localization patterns, phenotypes, and functions in immunity. In light of this traditional NK cell dichotomy, it is now clear that the spectrum of human NK cell diversity is much broader than originally appreciated as a result of variegated surface receptor, intracellular signaling molecule, and transcription factor expression; tissue-specific imprinting; and foreign antigen exposure. The recent discoveries of tissue-resident NK cell developmental intermediates, non-NK innate lymphoid cells, and the capacity for NK cells to adapt and differentiate into long-lived memory cells has added further complexity to this field. Here we review our current understanding of the breadth and generation of human NK cell diversity.

Teaser

Recent advances in the field of human natural killer cell biology have revealed that there is a remarkably high amount of cellular diversity within different tissues. Freud et al. review these advances and provide insight into the generation of natural killer cell diversity and its roles in innate immunity.


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Environmental and body contamination from cleaning vomitus in a health care setting: A simulation study

Publication date: Available online 22 November 2017
Source:American Journal of Infection Control
Author(s): Linh Phan, Yu-Min Su, Rachel Weber, Charissa Fritzen-Pedicini, Osayuwamen Edomwande, Rachael M. Jones
BackgroundEnvironmental service workers may be exposed to pathogens during the cleaning of pathogen-containing bodily fluids.MethodsParticipants with experience cleaning hospital environments were asked to clean simulated, fluorescein-containing vomitus using normal practices in a simulated patient room. Fluorescein was visualized in the environment and on participants under black lights. Fluorescein was quantitatively measured on the floor, in the air, and on gloves and shoe covers.ResultsIn all 21 trials involving 7 participants, fluorescein was found on the floor after cleaning and on participants' gloves. Lower levels of floor contamination were associated with the use of towels to remove bulk fluid (ρ = −0.56, P = .01). Glove contamination was not associated with the number or frequency of contacts with environmental surfaces, suggesting contamination occurs with specific events, such as picking up contaminated towels. Fluorescein contamination on shoe covers was measured in 19 trials. Fluorescein was not observed on participants' facial personal protective equipment, if worn, or faces. Contamination on other body parts, primarily the legs, was observed in 8 trials. Fluorescein was infrequently quantified in the air.ConclusionsUsing towels to remove bulk fluid prior to mopping is part of the recommended cleaning protocol and should be used to minimize residual contamination. Contamination on shoes and the floor may serve as reservoirs for pathogens.



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Bacteriuria is not associated with surgical site infection in patients undergoing cardiovascular surgery: Methodologic issues

Publication date: Available online 15 December 2017
Source:American Journal of Infection Control
Author(s): Saeid Safiri, Ahad Ashrafi-Asgarabad




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Risk factors for bacteremia with extended-spectrum β-lactamase production in positive Escherichia coli bacteremia in a pediatric setting

Publication date: 1 December 2017
Source:American Journal of Infection Control, Volume 45, Issue 12
Author(s): Fatoş Alkan, Salih Gözmen, Nuri Bayram, Gamze Gülfidan, Hurşit Apa, Nurettin Ünal, İlker Devrim




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Does nurse job satisfaction influence adherence to the central line insertion checklist and central line–associated bloodstream infections in the Veterans Health Administration?

Publication date: Available online 15 December 2017
Source:American Journal of Infection Control
Author(s): Heather M. Gilmartin, Paula Langner, Madhura Gokhale, Katerine Osatuke, Rachael Hasselbeck, Catherine Battaglia
Nurses satisfied with their jobs report less job stress, more effective nurse-physician collaboration, and higher patient satisfaction scores. It is unknown if job satisfaction influences adherence to best practices or patient outcomes. This secondary data analysis investigated the relationship between job satisfaction, adherence to the central line insertion checklist, and central line–associated bloodstream infections (CLABSIs). Results showed a decreased risk of CLABSI with higher job satisfaction, on average. No relationship was observed with checklist adherence.



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Wearing long sleeves while prepping a patient in the operating room decreases airborne contaminants

Publication date: Available online 6 December 2017
Source:American Journal of Infection Control
Author(s): Troy A. Markel, Thomas Gormley, Damon Greeley, John Ostojic, Jennifer Wagner
BackgroundThe use of long sleeves by nonscrubbed personnel in the operating room has been called into question. We hypothesized that wearing long sleeves and gloves, compared with having bare arms without gloves, while applying the skin preparation solution would decrease particulate and microbial contamination.MethodsA mock patient skin prep was performed in 3 different operating rooms. A long-sleeved gown and gloves, or bare arms, were used to perform the procedure. Particle counters were used to assess airborne particulate contamination, and active and passive microbial assessment was achieved through air samplers and settle plate analysis. Data were compared with Student's t-test or Mann-Whitney U, and P < .05 was considered to be significant.ResultsOperating room B demonstrated decreased 5.0- µm particle sizes with the use of sleeves, while operating rooms A and C showed decreased total microbes only with the use of sleeves. Despite there being no difference in the average number of total microbes for all operating rooms assessed, the use of sleeves specifically appeared to decrease the shed of Micrococcus.ConclusionThe use of long sleeves and gloves while applying the skin preparation solution decreased particulate and microbial shedding in several of the operating rooms tested. Although long sleeves may not be necessary for all operating room personnel, they may decrease airborne contamination while the skin prep is applied, which may lead to decreased surgical site infections.



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Epidemiologic surveillance of multidrug-resistant bacteria in a teaching hospital: A 3-year experience

Publication date: Available online 6 December 2017
Source:American Journal of Infection Control
Author(s): Mirian Nicéa Zarpellon, Giselle Fukita Viana, Cecília Saori Mitsugui, Bruno Buranello Costa, Nathalie Kira Tamura, Elisabeth Eyko Aoki, Cesar Helbel, Sheila Alexandra Belini Nishiyama, Silvia Maria dos Santos Saalfeld, Maria Cristina Bronharo Tognim
BackgroundThe objective of this prospective study was to verify the effectiveness of a multidisciplinary surveillance program that was implemented in a teaching hospital in southern Brazil, to prevent and control the spread of multidrug-resistant organisms.MethodsThe program implemented involved establishment of prevention guidelines, hand-hygiene promotion, isolation of patients colonized or infected by such organisms, enforced contact precautions, and terminal cleaning and disinfection of isolation rooms. A microbiology service, previously provided by an external laboratory, was established in the hospital. Detection of bacteria-resistant genes and molecular typing were performed also.ResultsStatistically significant differences were observed between the pre- and post-intervention periods (P = .00198). Control measures were effective in blocking the dissemination of a previously endemic clone of Acinetobacter baumannii. Changes were observed in the dissemination pattern, from a monoclonal to a polyclonal mode. The incidence of vancomycin-resistant Enterococcus during the surveillance period was low. Only 2 isolates of BLAKPC-positive Klebsiella pneumoniae (distinct profiles), and 5 isolates of BLASPM-positive Pseudomonas aeruginosa (a single cluster), were detected.ConclusionsThese results indicate that the surveillance program implemented was effective in preventing the spread of multidrug-resistant organisms in the hospital.



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Effect of hand hygiene on infectious diseases in the office workplace: A systematic review

Publication date: Available online 28 November 2017
Source:American Journal of Infection Control
Author(s): Paul N. Zivich, Abigail S. Gancz, Allison E. Aiello
BackgroundExtensive data suggests that hand hygiene is a critical intervention for reducing infectious disease transmission in the clinical setting. However, it is unclear whether hand hygiene is effective at cutting down on infectious illnesses in non-clinical workplaces. The aim of this review is to assess the current literature concerning the effects of hand-washing interventions on infectious disease prevention among employees in nonclinical, office-based workplaces.MethodsIn compiling this review, PubMed, Scopus, and Business Source Premier were examined for studies published from 1960 through 2016.ResultsEleven studies (eight experimental, two observational, one a simulation) were identified as eligible for inclusion. Hand-hygiene interventions at various levels of rigor were shown to reduce self-reported illness symptoms.ConclusionsHand hygiene is thought to be more effective against gastrointestinal illness than it is against respiratory illness, but no clear consensus has been reached on this point. Minimal hand-hygiene interventions seem to be effective at reducing the incidence of employee illness. Along with reducing infections among employees, hand-hygiene programs in the workplace may provide additional benefits to employers by reducing the number of employee health insurance claims and improving employee morale. Future research should use objective measures of hand hygiene and illness, and explore economic impacts on employers more fully.



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HPV vaccinations in low- and middle-income countries

Publication date: Available online 6 December 2017
Source:American Journal of Infection Control
Author(s): Hossein Bannazadeh Baghi, Mohammad Aghazadeh




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Lessons from the domestic Ebola response: Improving health care system resilience to high consequence infectious diseases

Publication date: Available online 15 December 2017
Source:American Journal of Infection Control
Author(s): Diane Meyer, Tara Kirk Sell, Monica Schoch-Spana, Matthew P. Shearer, Hannah Chandler, Erin Thomas, Dale A. Rose, Eric G. Carbone, Eric Toner
BackgroundThe domestic response to the West Africa Ebola virus disease (EVD) epidemic from 2014-2016 provides a unique opportunity to distill lessons learned about health sector planning and operations from those individuals directly involved. This research project aimed to identify and integrate these lessons into an actionable checklist that can improve health sector resilience to future high-consequence infectious disease (HCID) events.MethodsInterviews (N = 73) were completed with individuals involved in the domestic EVD response in 4 cities (Atlanta, Dallas, New York, and Omaha), and included individuals who worked in academia, emergency management, government, health care, law, media, and public health during the response. Interviews were transcribed and analyzed qualitatively. Two focus groups were then conducted to expand on themes identified in the interviews. Using these themes, an evidence-informed checklist was developed and vetted for completeness and feasibility by an expert advisory group.ResultsSalient themes identified included health care facility issues—specifically identifying assessment and treatment hospitals, isolation and treatment unit layout, waste management, community relations, patient identification, patient isolation, limitations on treatment, laboratories, and research considerations—and health care workforce issues—specifically psychosocial impact, unit staffing, staff training, and proper personal protective equipment.ConclusionsThe experiences of those involved in the domestic Ebola response provide critical lessons that can help strengthen resilience of health care systems and improve future responses to HCID events.



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Table of Contents

Publication date: 1 December 2017
Source:American Journal of Infection Control, Volume 45, Issue 12





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Health care-associated infections studies project: An American Journal of Infection Control and National Healthcare Safety Network data quality collaboration

Publication date: 1 December 2017
Source:American Journal of Infection Control, Volume 45, Issue 12
Author(s): Katherine Allen-Bridson, Cindy Gross, Angela Anttila, Janet E. Brooks, Joan N. Hebden, Denise Leaptrot, Georganne Ryan, Eileen Scalise, Henrietta Smith, Marc-Oliver Wright
This case study is part of a series centered on the Centers for Disease Control and Prevention/National Healthcare Safety Network (NHSN) health care-associated infection (HAI) surveillance definitions. This specific case study focuses on the definitions and protocols used to make HAI infection determinations, such as the infection window period and secondary bloodstream infection attribution period. The case reflects the real-life and complex patient scenarios that infection preventionists (IPs) face when identifying and reporting HAIs to NHSN. The intent of the case study series is to foster standardized application of the NHSN HAI surveillance definitions among IPs and encourage accurate determination of HAI events. An online survey link is provided where participants may confidentially answer questions related to the case study and receive immediate feedback in the form of correct answers and explanations and rationales. Details of the case study, answers, and explanations have been reviewed and approved by NHSN staff. We hope that participants take advantage of this educational offering and thereby gain a greater understanding of NHSN HAI surveillance definitions.



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Editorial Board

Publication date: 1 December 2017
Source:American Journal of Infection Control, Volume 45, Issue 12





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