bluuebunny/crossref_metadata_2025 huggingface dataset:
Differences in Hand Hygiene Behavior Related to the Contamination Risk of Healthcare Activities in Different Groups of Healthcare Workers
Authors: Wendt Constanze , Knautz Donald , von Baum Heike
Published: April 2006

Background:

The Fulkerson scale lists 15 typical clinical activities ranked according to their risk of hand contamination.

Objective:

To investigate how often healthcare workers (HCWs) apply antiseptic handrubs after each of the specified activities ranked in the Fulkerson scale.

Design:

Observational study.

Setting:

University Hospital of Heidelberg, a 1,600-bed teaching hospital.

Methods:

Using a structured protocol, 41 observers recorded whether HCWs rubbed their hands in 1 of 15 given situations.

Results:

Handrubs were used in 1,115 (52.2%) of 2,138 observations. Comparatively high rates of handrub use were observed after contact with sterile materials (39.6%) and after contact with excretions (90% to 97%). Nurses used handrubs significantly more frequently than did physicians after contact with the inanimate environment, but physicians applied handrubs significantly more frequently after contact with body secretions.

Conclusions:

This study showed better compliance with hand hygiene than that reported by many previous studies, but compliance was still inadequate and varied significantly by type of HCW, type of activity, and location in the hospital.
Nosocomial Pediatric Bacteremia: The Role of Intravenous Set Contamination in Developing Countries
Authors: Macías Alejandro E. , Muñoz Juan M. , Herrera Laura E. , Medina Humberto , Hernández Isabel , Alcántar Dolores , Ponce de León Samuel
Published: April 2006

Objective:

To assess the rate of bacterial contamination of intravenous administration sets at their rubber injection ports and matching infusates.

Design:

Cultures of injection ports and infusate during 26 visits to 4 hospitals.

Setting:

Four public general pediatric hospitals in Mexico City with substandard care practices.

Patients:

Hospitalized pediatric patients receiving intravenous solutions.

Results:

Overall, 176 of 251 injection ports were contaminated (70.1%; 95% confidence interval [CI95], 64.5% to 75.8%), 35 (13.9%; CI95, 9.7% to 18.2%) with gram-negative rods, primarily of the tribe Klebsielleae. Cultures of infusates were positive in 17 cases (6.8%, CI95, 3.7% to 9.9%), 5 of which grew gram-negative rods (2%; CI95, 0.6% to 4.6%). In 3 cases (1.2%), the same species with gram-negative rods was found in the infusates and on the injection ports. During one visit, 8 clustered cases of injection port contamination with a clonal Enterobacter cloacae were found; this agent was also found in the blood culture, intravenous fluid, and parenteral nutrition of one patient. Inadequate chlorination of tap water, a potential risk factor, was recorded during 22 visits (84.6%).

Conclusion:

These data suggest that external contamination of the intravenous administration set could play a role in infusate contamination.
Outbreak ofBurkholderia CepaciaBacteremia Traced to Contaminated Hospital Water Used for Dilution of an Alcohol Skin Antiseptic
Authors: Nasser Rana M. , Rahi Amal C. , Haddad Mona F. , Daoud Ziad , Irani-Hakime Noha , Almawi Wassim Y.
Published: April 2006

Objective:

To identify the source of an epidemic ofBurkholderia cepaciabloodstream infections during 7 years (411 episodes in 361 patients).

Design:

Outbreak investigation.

Setting:

A 250-bed university hospital in Beirut, Lebanon.

Methods:

Matched case-control and retrospective cohort studies, and microbiological surveillance and polymerase chain reaction–restriction fragment length ascertainment were employed. Special media and filtration techniques were used to isolate organisms from water and diluted alcohol solutions.

Results:

In a group of 50 randomly selected case-matched patients from 1999, the positive blood cultures were concomitant with fever in 98%, intravenous phlebitis in 44%, and recurrent bacteremia in 20%. Fever disappeared approximately 6 hours after intravenous catheter removal. Polymerase chain reaction–restriction fragment length polymorphism revealed strain homogeneity in patient, water, and alcohol isolates. Contaminated tap water had been used to dilute alcohol for skin antisepsis and for decontamination of the caps of heparin vials. Only sporadic cases directly attributable to breach of protocol were reported after single-use alcohol swabs were substituted.

Conclusion:

This is potentially the largest single-source nosocomial bloodstream infection outbreak ever reported, and the first report of an alcohol skin antiseptic contaminated by tap water as a source for nosocomial bacteremia.
Device-Associated Nosocomial Infection Rates in Intensive Care Units of Argentina
Authors: Rosenthal Victor Daniel , Guzmán Sandra , Crnich Christopher
Published: April 2006

Background:

Nosocomial infections are an important public health problem in many developing countries, particularly in the intensive care unit (ICU) setting. No previous data are available on the incidence of device-associated nosocomial infections in different types of ICUs in Argentina.

Methods:

We performed a prospective nosocomial infection surveillance study during the first year of an infection control program in six Argentinean ICUs. Nosocomial infections were identified using the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance System definitions, and site-specific nosocomial infection rates were calculated.

Results:

The rate of catheter-associated bloodstream infections in medical-surgical ICUs was 30.3 per 1,000 device days; it was 14.2 per 1,000 device-days in coronary care units (CCUs). The rate of ventilator-associated pneumonia in medical-surgical ICUs was 46.3 per 1,000 device-days; it was 45.5 per 1,000 device-days in CCUs. The rate of symptomatic catheter-associated urinary tract infections in medical-surgical ICUs was 18.5 per 1,000 device-days; it was 12.1 per 1,000 device-days in CCUs.

Conclusion:

The high rate of nosocomial infections in Argentinean ICUs found during our surveillance suggests that ongoing targeted surveillance and implementation of proven infection control strategies is needed in developing countries such as Argentina.
Cost Implications of Successful Hand Hygiene Promotion
Authors: Pittet Didier , Sax Hugo , Hugonnet Stéphane , Harbarth Stephan
Published: April 2006

We evaluated the costs associated with a sustained and successful campaign for hand hygiene promotion that emphasized alcohol-based handrubs. The total cost of the hand hygiene promotion corresponded to less than 1% of the costs associated with nosocomial infections. Successful hand hygiene promotion is probably cost-saving.
Unnecessary Use of Central Venous Catheters: The Need to Look Outside the Intensive Care Unit
Authors: Trick William E. , Vernon Michael O. , Welbel Sharon F. , Wisniewski Mary F. , Jernigan John A. , Weinstein Robert A.
Published: April 2006

We developed criteria for justifiable CVC use and evaluated CVC use in a public hospital. Unjustified CVC-days were more common for non-ICU patients compared with ICU patients. Also, insertion-site dressings were less likely to be intact on non-ICU patients. Interventions to reduce CVC-associated bloodstream infections should include non-ICU patients.
Wound Ventilation With Ultraclean Air for Prevention of Direct Airborne Contamination During Surgery
Authors: Persson Mikael , Linden Jan van der
Published: April 2006

Background and Objective:

Despite the novelties in operating room ventilation, airborne bacteria remain an important source of surgical wound contamination. An ultraclean airflow from the ceiling downward may convey airborne particles from the surgical team into the wound, thus increasing the risk of infection. Therefore, similar ventilation from the wound upward should be considered. We investigated the effect of wound ventilation on the concentration of airborne particles in a wound model during simulated surgery.

Design:

Randomized experimental study simulating surgery with a wound cavity model.

Setting:

An operating room of a university hospital ventilated with ultraclean air directed downward.

Interventions:

Particles 5 um and larger were counted with and without a 5-cm deep cavity and with and with-out the insufflation of ultraclean air.

Results:

With the surgeon standing upright, no airborne particles could be detected in the wound model. In contrast, during simulated operations, the median number of particles per 0.1 cu ft reached 18 (25th and 75th percentiles, 12 and 22.25) in the model with a cavity and 15.5 (25th and 75th percentiles, 14 and 21.5) without. With a cavity, wound ventilation markedly reduced the median number of particles to 1 (range, 0 to 1.25; P< .001).

Conclusions:

To protect a surgical wound against direct airborne contamination, air should be directed away from the wound rather than toward it. This study provides supportive evidence to earlier studies that operating room ventilation with ultraclean air is imperfect during surgical activity and that wound ventilation may be a simple complement. Further clinical trials are needed.
Prevalence of Nosocomial Infections After Surgery in Greek Hospitals: Results of Two Nationwide Surveys
Authors: Gikas Achilleas , Roumbelaki Maria , Pediaditis John , Nikolaidis Pavlos , Levidiotou Stamatina , Kartali Sofia , Kioumis John , Maltezos Efstratios , Metalidis Symeon , Anevlavis Eleftherios , Haliotis George , Kolibiris Hariton , Tselentis Yiannis ,   the Hellenic Infection Control Network
Published: April 2006

Objective:

To determine the frequency and type of nosocomial infections (NIs) (especially surgical-site infections [SSIs]), risk factors, and the type and duration of antibiotic use among surgical patients in Greek hospitals.

Design:

Two point-prevalence studies.

Setting:

Fourteen Greek hospitals.

Patients:

Those in the hospitals during two prevalence surveys undergoing surgery during their stay.

Results:

In the 1999 survey, 129 of 1,037 surgical patients had developed 148 NIs (14.3%). A total of 1,093 operations were registered, and 49 SSIs (4.5%) were found. In the 2000 survey, 82 of 868 surgical patients had developed 88 NIs (10.1%). A total of 902 operations were registered, and 38 SSIs were detected (4.2%). The median length of stay (LOS) for surgical patients without SSI was 10.0 days (range, 1-19 days); for patients who developed SSI it was 30 days (range, 1-52 days; P < .001). The median LOS prior to surgery for patients without SSI was 1 day (range, 0-4 days); for patients who developed SSI it was 3 days (range, 0-7.5 days; P < .001). Among 30 possible risk factors studied, wound class, LOS prior to surgery, and central venous catheterization were independent predictors of SSI. Median durations of prophylactic antibiotic therapy were 4 days (range, 1-14 days) and 6 days (range, 1-16 days) in the 1999 and 2000 surveys, respectively.

Conclusion:

Surgical patients in Greek hospitals suffered higher rates of SSI than did surgical patients in other developed countries while prophylactic antibiotics were used excessively.
Value of an Infection Control Practitioner in Improving Infection Control Practices at Ambulatory Sites
Authors: Zimmerman Melanie , Pur Stacy , Schmitt Barbara , Levin Stuart , Harris Alan A. , Segreti John
Published: April 2006

Little information exists on the state of infection control (IC) practices in ambulatory sites. In preparation for a JCAHO survey, 62 ambulatory sites were visited to monitor and improve IC practices. A dedicated IC practitioner was instrumental in improving practices at ambulatory sites and in successfully completing a JCAHO survey.
Eradication of a Large Outbreak of a Single Strain of vanB Vancomycin-Resistant Enterococcus faecium at a Major Australian Teaching Hospital
Authors: Christiansen Keryn J. , Tibbett Patricia A. , Beresford William , Pearman John W. , Lee Rosie C. , Coombs Geoffrey W. , Kay Ian D. , O'Brien Frances G. , Palladino Silvano , Douglas Charles R. , Montgomery Philip D. , Orrell Terri , Peterson Allison M. , Kosaras Frank P. , Flexman James P. , Heath Christopher H. , McCullough Cheryll A.
Published: April 2006

Objective:

To demonstrate that nosocomial transmission of vancomycin-resistant enterococci (VRE) can be terminated and endemicity prevented despite widespread dissemination of an epidemic strain in a large tertiary-care referral hospital.

Interventions:

Two months after the index case was detected in the intensive care unit, 68 patients became either infected or colonized with an epidemic strain of vanB vancomycin-resistant Enterococcus faecium despite standard infection control procedures. The following additional interventions were then introduced to control the outbreak: (1) formation of a VRE executive group; (2) rapid laboratory identification (30 to 48 hours) using culture and polymerase chain reaction detection of vanA and vanB resistance genes; (3) mass screening of all hospitalized patients with isolation of carriers and cohorting of contacts; (4) environmental screening and increased cleaning; (5) electronic flagging of medical records of contacts; and (6) antibiotic restrictions (third-generation cephalosporins and vancomycin).

Results:

A total of 19,658 patient and 24,396 environmental swabs were processed between July and December 2001. One hundred sixty-nine patients in 23 wards were colonized with a single strain of vanB vancomycin-resistant E. faecium. Introducing additional control measures rapidly brought the outbreak under control. Hospital-wide screening found 39 previously unidentified colonized patients, with only 7 more nonsegregat-ed patients being detected in the next 2 months. The outbreak was terminated within 3 months at a cost of $2.7 million (Australian dollars).

Conclusion:

Despite widespread dissemination of VRE in a large acute care facility, eradication was achievable by a well-resourced, coordinated, multifaceted approach and was in accordance with good clinical governance.
Intervention to Reduce the Incidence of Methicillin-Resistant Staphylococcus aureus Skin Infections in a Correctional Facility in Georgia
Authors: Wootton Susan H. , Arnold Kathryn , Hill Holly A. , McAllister Sigrid , Ray Marsha , Kellum Molly , LaMarre Madie , Lane Mary Ellen , Chaitram Jasmine , Lance-Parker Susan , Kuehnert Matthew J.
Published: April 2006

Background and Objective:

In August 2001, a cluster of MRSA skin infections was detected in a correctional facility. An investigation was conducted to determine its cause and to prevent further MRSA infections.

Design:

Case-control study.

Setting:

A 200-bed detention center.

Patients:

A case was defined as a detainee with a skin lesion from which MRSA was cultured from July 24 through December 31, 2001. Case-patients were identified by review of laboratory culture results and by skin lesion screening through point-prevalence survey and admission examination. Controls were randomly selected from an alphabetized list of detainees.

Intervention:

Medical staff implemented measures to improve skin disease screening, personal hygiene, wound care, and antimicrobial therapy.

Results:

Sixteen cases were identified: 11, 5, and 0 in the preintervention, peri-intervention, and postintervention periods, respectively. Seven case-patients and 19 controls were included in the case-control study. On multivariable analysis, working as a dormitory orderly (OR, 9.8; CI95, 0.74-638; P= .10) and a stay of longer than 36 days (OR, 6.9; CI95, 0.65-128.2; P = .14) were the strongest predictors for MRSA skin infection. The preintervention, peri-intervention, and postintervention MRSA infection rates were 11.6, 8.8, and 0 per 10,000 detainee-days, respectively. The rate of MRSA skin infections declined significantly between both the preintervention and peri-intervention periods and the postintervention period (P < .01 for both comparisons).

Conclusions:

MRSA skin disease can become an emergent problem in a correctional facility. Interventions targeted at skin disease screening, appropriate antimicrobial treatment, and hygiene may decrease the risk of acquiring MRSA infection in correctional facilities.
Emergence of Vancomycin-Resistant Enterococci in San Francisco Bay Area Hospitals During 1994 to 1998
Authors: Rosenberg Jon , Jarvis William R. , Abbott Sharon L. , Vugia Due J. ,   California Emerging Infections Program
Published: April 2006

Objective:

To determine the magnitude of van-comycin-resistant enterococci (VRE) in three counties in the San Francisco Bay area.

Design:

Active laboratory-based surveillance for VRE from January 1995 through December 1996 and a laboratory-based and hospital-based questionnaire survey for 1993 to 1994 and 1997 to 1998.

Setting:

All 33 general acute care hospitals in three counties in the San Francisco Bay area.

Participants:

Laboratories and infection control professionals serving these hospitals, and staff of the California Emerging Infections Program.

Results:

The number of hospitals reporting 1 or more patient clinical VRE isolates was 1 (3%) in 1993, 7 (21%) in 1994, 31 (94%) in 1995, and 33 (100%) in 1996 to 1998. The number of patient isolates increased from 1 in 1993 to 24 in 1994, 176 in 1995,429 in 1996, 730 in 1997, and 864 in 1998. Most VRE isolates in 1995 and 1996 were from urine and were not associated with serious clinical disease. However, the number of isolates from blood increased from 9 (6% of total) in 1995 to 44 (12% of the total) in 1996, 90 (14%) in 1997, and 100 (13%) in 1998.

Conclusions:

Our data document the rapid emergence and increase of VRE in all hospitals in three counties in the San Francisco Bay area during 1994 to 1998. Infection control measures for VRE together with antibiotic utilization programs should be implemented to limit further spread.
Control of Nosocomial Acquisition of Vancomycin-Resistant Enterococcus Through Active Surveillance of Hemodialysis Patients
Authors: Axon R. Neal , Engemann John J. , Butcher James , Lockamy Kathy , Kaye Keith S.
Published: April 2006

Hemodialysis-dependent patients are an important VRE source. After implementation of active surveillance for VRE targeting hemodialysis patients, the hospital-wide nosocomial VRE rate increased by 41%, but decreased by 41% among non-hemodialysis patients (P = .05). To assess the effectiveness of active surveillance, patients undergoing active surveillance should be analyzed separately from other patients.
Surgical-Site Infection Rates and Risk Factor Analysis in Coronary Artery Bypass Graft Surgery
Authors: Harrington Glenys , Russo Philip , Spelman Denis , Borrell Sue , Watson Kerrie , Barr Wendy , Martin Rhea , Edmonds Diedre , Cocks Joanne , Greenbough John , Lowe Jill , Randle Leesa , Castell Jan , Browne Elizabeth , Bellis Kaye , Aberline Melissa
Published: April 2006

Background:

The Victorian Infection Control Surveillance Project (VICSP) is a multicenter collaborative surveillance project established by infection control practitioners. Five public hospitals contributed data for patients undergoing coronary artery bypass graft (CABG) surgery.

Objective:

To determine the aggregate and comparative interhospital surgical-site infection (SSI) rates for patients undergoing CABG surgery and the risk factors for SSI in this patient group.

Method:

Each institution used standardized definitions of SSI, risk adjustment, and reporting methodology according to the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention. Data on potential risk factors were prospectively collected.

Results:

For 4,474 patients undergoing CABG surgery, the aggregate SSI rate was 7.8 infections per 100 procedures (95% confidence interval [CI95], 7.0-8.5), with individual institutions ranging between 4.5 and 10.7 infections per 100 procedures. Multivariate risk factor analysis demonstrated age (odds ratio [OR], 1.02; CI95, 1.01-1.04; P < .001), obesity (OR, 1.8; CI95, 1.4-2.3; P < .001), and diabetes mellitus (OR, 1.6; CI95, 1.2-2.1; P < .001) as independent predictors of SSI. Three hundred thirty-four organisms were isolated from 296 SSIs. Of the total SSIs, methicillin-resistant Staphylococcus aureus was isolated from 32%, methicillin-sensitive S. aureus from 24%, gram-negative bacilli (eg, Enterobacter and Escherichia colt) from 18%, and miscellaneous organisms from the remainder.

Conclusion:

We documented aggregate and comparative SSI rates among five Victorian public hospitals performing CABG surgery and defined specific independent risk factors for SSI. VICSP data offer opportunities for targeted interventions to reduce SSI following cardiac surgery.
Staphylococcus aureus Nasal Carriage in a Student Community Prevalence, Clonal Relationships, and Risk Factors
Authors: Bischoff Werner E. , Wallis Michelle L. , Tucker Keith B. , Reboussin Beth A. , Sherertz Robert J.
Published: April 2006

Objective:

To evaluate the prevalence and risk factors of nasal Staphylococcus aureus (SA) in the community.

Design:

Cross-sectional study.

Setting:

Wake Forest University, Winston-Salem, North Carolina.

Participants:

Four hundred fifty students were screened for nasal SA carriage during the fall of 2000, 2001, and 2002.

Methods:

Students were screened by nose swabs. A self-administered questionnaire collected information on demographics and medical history. Antibiotic testing and PFGE were performed on isolates. Risk factors were determined by logistic regression analysis.

Results:

Of 450 volunteers, 131 (29%) were SA carriers. Antibiotic resistance was high for azithromycin (26%) and low for ciprofloxacin (1%), tetracycline (5%), mupirocin (1%), and methicillin (2%). PFGE patterns were not associated with carriage. Age, male gender, white race, medical student, allergen injection therapy, chronic sinusitis, rheumatoid arthritis, hospitalization for 6 months or less, and use of antibiotics were associated with carrier status by univariate analysis. Stepwise multivariate logistic regression led to a best fitting model with older age (OR, 1.04; CI95, 1.005-1.079), male gender (OR, 1.50; CI95, 0.982-2.296), and chronic sinusitis (OR, 2.71; CI95, 0.897-8.195) as risk factors. Antibiotic use (< 4 weeks) (OR, 0.41; CI95, 0.152-1.095) and allergen injection therapy (OR 0.41; CI95, 0.133-1.238) were protective. Analyses of carriers revealed candidate factors for persistent carriage to be nasal SA colonization rate and male gender. Factors for azithromycin resistance were non-medical students and antibiotic use in the past 6 months.

Conclusion:

Older male volunteers suffering from chronic sinusitis and not taking antibiotics were at higher risk for carrying SA.
Airborne Dispersal as a Novel Transmission Route of Coagulase-Negatwe Staphylococci Interaction Between Coagulase-Negative Staphylococci and Rhinovirus Infection
Authors: Bischoff Werner E. , Bassetti Stefano , Bassetti-Wyss Barbara A. , Wallis Michelle L. , Tucker Brian K. , Reboussin Beth A. , D'Agostino Ralph B. , Pfaller Michael A. , Gwaltney Jack M. , Sherertz Robert J.
Published: April 2006

Objective:

To investigate whether rhinovirus infection leads to increased airborne dispersal of coagulase-negative staphylococci (CoNS).

Design:

Prospective nonrandomized intervention trial.

Setting:

Wake Forest University School of Medicine, Winston-Salem, North Carolina.

Participants:

Twelve nasal Staphylococcus aureus-CoNS carriers among 685 students screened for S. aureus nasal carriage.

Interventions:

Participants were studied for airborne dispersal of CoNS in a chamber under three conditions (street clothes, sterile gown with a mask, and sterile gown without a mask). After 2 days of pre-exposure measurements, volunteers were inoculated with a rhinovirus and observed for 14 days. Daily quantitative nasal and skin cultures for CoNS and nasal cultures for rhinovirus were performed. In addition, assessment of cold symptoms was performed daily, mucous samples were collected, and serum titers before and after rhinovirus inoculation were obtained. Sneezing, coughing, and talking events were recorded during chamber sessions.

Results:

All participants had at least one nasal wash positive for rhinovirus and 10 developed a symptomatic cold. Postexposure, there was a twofold increase in airborne CoNS (P = .0004), peaking at day 12. CoNS dispersal was reduced by wearing a gown (57% reduction, P < .0001), but not a mask (P = .7). Nasal and skin CoNS colonization increased after rhinovirus infection (P<.05).

Conclusions:

We believe this is the first demonstration that a viral pathogen in the upper airways can increase airborne dispersal of CoNS in nasal S. aureus carriers. Gowns, gloves, and caps had a protective effect, whereas wearing a mask did not further reduce airborne spread.
The Value of Bacterial Culture During Clean Orthopedic Surgery a Prospective Study of 1,036 Patients
Authors: Bernard Louis , Sadowski Christophe , Monin Daniel , Stern Richard , Wyssa Blaise , Rohner Peter , Lew Daniel , Hoffmeyer Pierre ,   Groupe d'Etude sur l'Osteite
Published: April 2006

Objective:

To determine whether bacterial cultures of the wounds of patients undergoing clean orthopedic surgery would help predict infection.

Methods:

During 1 year, 1,256 cultures were performed for 1,102 patients who underwent clean orthopedic surgery. Results were analyzed to evaluate their ability to predict postoperative infection.

Results:

The sensitivity, specificity, positive predictive value, and negative predictive value of the cultures were 38%, 92%, 7%, and 99%, respectively.

Conclusions:

Cultures performed during clean orthopedic surgery were not useful for predicting postoperative infection.
Prevalence of Methicillin-Resistant Staphylococcus aureus Nasal Carriage Among Patients With Femoral Neck Fractures Implication for Antibiotic Prophylaxis
Authors: Merrer Jacques , Pisica-Donose Georges , Leneveu Michel , Pauthier François
Published: April 2006

Fifteen (8.4%) of 179 patients admitted with femoral neck fractures carried MRSA Among 96 patients admitted from their homes, only 2 (2%) were carriers, whereas 13 (15.6%) of 83 patients from nursing or residential homes or long-term-care facilities were colonized (P = .001). Routine prophylaxis with vancomycin is recommended in the latter group.
Is It Necessary to Shave the Pubic and Genital Regions of Patients Undergoing Endoscopic Urological Surgery?
Authors: Menéndez Violeta , Galán Juan Antonio , Elia Matilde , Collado Argimiro , Lioréns Francisco , Fernández Carlos , Garciá-López Francisco
Published: April 2006

To determine whether postoperative urinary infections were related to shaving before undergoing endoscopic urological surgery, 90 patients were randomly assigned to shaving or not shaving. Urinary cultures revealed infection in 10 patients. Half of them had been shaved, suggesting that this practice does not affect the incidence of urinary infections.
Factors Promoting Consistent Adherence to Safe Needle Precautions Among Hospital Workers
Authors: Vaughn Thomas E. , McCoy Kimberly D. , Beekmann Susan E. , Woolson Robert F. , Torner James C. , Doebbeling Bradley N.
Published: April 2006

Objective:

To examine organizational factors and occupational characteristics associated with adherence to occupational safety guidelines recommending never recapping needles.

Design:

Mail surveys were conducted with healthcare workers (HCWs) and infection control professionals (ICPs).

Setting:

The surveys were conducted at all non-federal general hospitals in Iowa, except one tertiary-care hospital. Survey data were linked to annual survey data of the American Hospital Association (AHA).

Participants:

HCWs were sampled from statewide rosters of physicians, nurses, and laboratory workers in Iowa. Eligible HCWs worked in a setting and position in which they were likely to routinely handle needles. ICPs at all hospitals in the state were surveyed.

Results:

Ninety-nine ICPs responded (79% response rate). AHA data were available for all variables from 84 (85%) of the hospitals. Analyses were based on 1,454 HCWs who identified one of these hospitals as their primary hospital (70% response rate). Analyses were conducted using multiple logistic regression. Positive predictors of consistent adherence included infection control personnel hours per full-time–equivalent employee (odds ratio [OR], 1.03), frequency of standard precautions education (OR, 1.11), facilities providing personal protective equipment (OR, 1.82), facilities using needleless intravenous systems (OR, 1.42), and management support for safety (OR, 1.05). Negative predictors were use of “blood and body fluid precautions” isolation category (OR, 0.74) and increased job demands (OR, 0.90).

Conclusion:

Healthcare organizations can improve staff safety by investing wisely in educational programs regarding approaches to minimize these risks, providing protective equipment, and eliminating the use of blood and body fluid precautions as an isolation policy.
Cost-Effectiveness of Hepatitis A–B Vaccine Versus Hepatitis B Vaccine for Healthcare and Public Safety Workers in the Western United States
Authors: Jacobs R. Jake , Gibson Gene A. , Meyerhoff Allen S.
Published: April 2006

Objective:

To determine the cost-effectiveness of substituting hepatitis A–B vaccine for hepatitis B vaccine when healthcare and public safety workers in the western United States are immunized to protect against occupational exposures to hepatitis B.

Participants:

A cohort of 100,000 hypothetical healthcare and public safety workers from 11 western states with hepatitis A rates twice the national average.

Design:

A Markov model of hepatitis A was developed using estimates from U.S. government databases, published literature, and an expert panel. Added costs of hepatitis A–B vaccine were compared with savings from reduced hepatitis A treatment and work loss. Cost-effectiveness was expressed as the ratio of net costs to quality-adjusted life-years (QALYs) gained.

Results:

Substituting hepatitis A–B vaccine would prevent 29,796 work-loss–days, 222 hospitalizations, 6 premature deaths, and the loss of 214 QALYs. Added vaccination costs of $5.4 million would be more than offset by $1.9 million and $6.1 million reductions in hepatitis A treatment and work loss costs, respectively. Cost-effectiveness improves as the time horizon is extended, from $232,600 per QALY after 1 year to less than $0 per QALY within 11 years. Estimates are most sensitive to community-wide hepatitis A rates and the degree to which childhood vaccination may reduce future rates.

Conclusion:

For healthcare and public safety workers in western states, substituting hepatitis A–B vaccine for hepatitis B vaccine would reduce morbidity, mortality, and costs.
A Large Nosocomial Outbreak of Hepatitis C and Hepatitis B Among Patients Receiving Pain Remediation Treatments
Authors: Comstock R. Dawn , Mallonee Sue , Fox Jan L. , Moolenaar Ronald L. , Vogt Tara M. , Perz Joseph F. , Bell Beth P. , Crutcher James M.
Published: April 2006

Background and Objective:

In August 2002, the Oklahoma State Department of Health received a report of six patients with unexplained hepatitis C virus (HCV) infection treated in the same pain remediation clinic. We investigated the outbreak's extent and etiology.

Design, Setting, and Participants:

We conducted a retrospective cohort study of clinic patients, including a serologic survey, interviews of infected patients, and reviews of medical records and staff infection control practices. Patients received outpatient pain remediation treatments one afternoon a week in a clinic within a hospital. Cases were defined as HCV or hepatitis B virus (HBV) infections among patients who reported no prior diagnosis or risk factors for disease or reported previous risk factors but had evidence of acute infection.

Results:

Of 908 patients, 795 (87.6%) were tested, and 71 HCV-infected patients (8.9%) and 31 HBV-infected patients (3.9%) met the case definition. Multiple HCV genotypes were identified. Significantly higher HCV infection rates were found among individuals treated after an HCV-infected patient during the same visit (adjusted odds ratio [AOR], 6.2; 95% confidence interval [CI95], 2.4–15.8); a similar association was observed for HBV (AOR, 2.9; CI95, 1.3–6.5). Review of staff practices revealed the nurse anesthetist had been using the same syringe–needle to sequentially administer sedation medications to every treated patient each clinic day.

Conclusions:

Reuse of needles–syringes was the mechanism for patient-to-patient transmission of HCV and HBV in this large nosocomial outbreak. Further education and stricter oversight of infection control practices may prevent future outbreaks.
Confirmation of Nosocomial Hepatitis C Virus Infection in a Hemodialysis Unit
Authors: Furusyo Norihiro , Kubo Norihiko , Nakashima Hisashi , Kashiwagi Kenichiro , Etoh Yoshitaka , Hayashi Jun
Published: April 2006

Objectives:

To investigate a hepatitis C virus (HCV) outbreak in a hemodialysis unit and determine the source of transmission.

Methods:

We have prospectively investigated the epidemiology of hemodialysis-related HCV infection in a single unit since 1989. In September 2000, acute hepatitis C (AH-C) was diagnosed in 5 patients by alanine aminotransferase elevation and HCV genotype lb viremia without antibody to HCV. We surveyed the epidemiologic situation and performed polymerase chain reaction sequence analysis of the HCV 5'-noncoding (5'NC) region in the patients for comparison with 9 patients with chronic HCV genotype 1b viremia.

Results:

Sequence analysis of the 5'NC region showed the consistency in the 5 independent clones from each AH-C patient and those from each chronic HCV viremia patient and no quasispecies over time in the clones of any of 14 analyzed patients. All AH-C patients had the same sequencing of the 6 variations in the region with the only other patient. A saline ampoule, used for heparin solution during hemodialysis, had a recap function. It was difficult to determine whether the ampoule was new or had already been used. The source-patient often underwent hemodialysis before the AH-C patients and most of their hemodialysis-related medicine was prepared during the source-patient's treatment. These findings suggested a high possibility that the AH-C patients shared a single heparin–saline solution ampoule contaminated by HCV from the source-patient.

Conclusion:

Nosocomial HCV infection occurred as a result of poor infection control practice when a patient with chronic HCV viremia received treatment prior to other hemodialysis patients.
Prevalence of Measles, Rubella, Mumps, and Varicella Antibodies Among Healthcare Workers in Japan
Authors: Hatakeyama Shuji , Moriya Kyoji , Itoyama Satoru , Nukui Yoko , Uchida Miho , Shintani Yoshizumi , Morisawa Yuji , Kimura Satoshi
Published: April 2006

Objectives:

To evaluate the immune status of healthcare workers (HCWs) against measles, rubella, mumps, and varicella in Japan, and to promote an adequate vaccination program among HCWs.

Setting:

University of Tokyo Hospital.

Participants:

Eight hundred seventy-seven HCWs.

Design:

Serologic screening for measles, rubella, mumps, and varicella was performed on HCWs. Antibodies against measles, rubella, and mumps were detected using hemagglutination inhibition (HI) assay ($4.20 per test). If serum was negative by HI assay, enzyme-linked immunosorbent assay (EIA) was performed ($12.60 per test). Anti-varicella antibodies were detected by EIA only.

Results:

Among tested HCWs, 98.5%, 90.4%, 85.8%, and 97.2% had immunity to measles, rubella, mumps, and varicella, respectively. All those born before 1970 were seropositive for measles. However, individuals susceptible to rubella, mumps, and varicella were present in all age groups. The sensitivities and negative predictive values of HI assay compared with EIA were 86.6% and 11.3% for measles, 99.1% and 92.2% for rubella, and 47.8% and 24.1% for mumps, respectively. For measles and mumps, prevaccination screening by HI assay in combination with EIA led to significant savings compared with EIA only. In contrast, it was estimated that prevaccination screening using only HI assay would be more economical for rubella.

Conclusions:

Aggressive screening and vaccination of susceptible HCWs was essential regardless of age. Prevaccination serologic screening using a combination of HI assay and EIA was more economical for measles and mumps.
Screening Healthcare Workers for Varicella-Zoster Virus: Can We Trust the History?
Authors: Almuneef Maha , Memish Ziad A. , Abbas Mostafa F. , Balkhy Hanan H.
Published: April 2006

Objective:

To determine the relationship between immunity and a history of chickenpox based on a self-administered questionnaire.

Methods:

We investigated immunity to varicella-zoster virus in a cohort of newly recruited employees with different job categories and different nationalities using enzyme-linked immunosorbent assay IgG.

Results:

There were 1,058 new recruits. Of these, 890 (84%) were immune and 168 (16%) were susceptible. The susceptibility rate was 23% (n = 77) for Asian, 15% (n = 14) for South African, 13% (n = 66) for Middle Eastern, and 9% (n = 11) for Western employees. Physicians were more likely to be immune (93%) than were nurses (85%), medical technicians (75%), or administrative clerks (84%). Seropositivity was not affected by age or gender. The positive predictive value of a history of chickenpox for the seropositivity was 89% (511 of 574); the negative predictive value was 22% (105 of 484). History of chickenpox had a sensitivity of 57% (511 of 890) and a specificity of 63% (105 of 168).

Conclusions:

The varicella-zoster virus seroprevalence among new employees was low, posing an important risk to existing employees and patients. Positive or negative history of chickenpox was an unreliable indicator of susceptibility among healthcare workers of different nationalities. Serologic screening of all employees and vaccination of those susceptible was recommended.
Postexposure Prophylaxis Against Varicella-Zoster Virus Infection Among Recipients of Hematopoietic Stem Cell Transplant: Unresolved Issues
Authors: Weinstock David M. , Boeckh Michael , Boulad Farid , Eagan Janet A. , Fraser Victoria J. , Henderson David K. , Perl Trish M. , Yokoe Deborah , Sepkowitz Kent A.
Published: April 2006

Recent guidelines for the prevention of opportunistic infections have addressed a variety of issues germane to recipients of hematopoietic stem cell transplant. However, there are several issues regarding postexposure prophylaxis against varicella-zoster virus that remain unresolved. We address these questions and offer several consensus recommendations.
Implications of Postvaccination Hepatitis B Surface Antigenemia in the Management of Exposures to Body Fluids
Authors: Martín-Ancel Ana , Casas María Luisa , Bonet Bartolomé
Published: April 2006

A neonate vaccinated against HBV was the source of an occupational exposure to blood. She was tested for hepatitis B surface antigen and found to be positive, leading to unnecessary treatment, retesting, and concern. Evaluation of the infectious status of HBV should rely on other means if vaccination has recently occurred.
Candida parapsilosis Bloodstream Infection in Pediatric Oncology Patients: Results of an Epidemiologic Investigation
Authors: Posteraro Brunella , Bruno Stefania , Boccia Stefania , Ruggiero Antonio , Sanguinetti Maurizio , Spica Vincenzo Romano , Ricciardi Gualtiero , Fadda Giovanni
Published: April 2006

Objective:

To investigate an outbreak of Candida parapsilosis bloodstream infections (BSIs) involving three patients admitted to a pediatric oncology unit between April and June 2002.

Methods:

After the third case was documented, cultures were performed of the hands of all medical and paramedical staff members in the pediatric oncology unit and of environmental surfaces in the rooms occupied by the three patients. Electrophoretic karyotyping with pulsed-field gel electrophoresis and arbitrarily primed polymerase chain reaction were used to assess the genetic relatedness among C. parapsilosis isolates.

Results:

The three cases of C. parapsilosis BSI were diagnosed based on blood cultures performed during a 38-day period. Evidence of prior C. parapsilosis colonization of the gastrointestinal tract was present in only the first case. Each patient had an indwelling central venous catheter (CVC), which was promptly removed, and semiquantitative catheter tip cultures also revealed C. parapsilosis. None of the 30 environmental cultures performed was positive for C. parapsilosis, but the fungus was isolated from the hands of 6 of the 20 nurses tested. Both molecular typing methods revealed identical DNA fingerprinting patterns for all 13 patient isolates (7 from blood, 3 from CVC tips, and 3 from the gastrointestinal tract) and for 5 of the 6 recovered from the nurses' hands.

Conclusions:

These findings suggest the possibility of cross-infection with a single C. parapsilosis strain that was transmitted (probably during CVC dressing changes) by nurses whose hands were colonized with it. The role of previous gastrointestinal colonization in the first case cannot be excluded.
Central Venous Catheter–Related Bacteremia Due to Gram-Negative Bacilli: Significance of Catheter Removal in Preventing Relapse
Authors: Hanna Hend , Afif Claude , Alakech Badie , Boktour Maha , Tarrand Jeffrey , Hachem Ray , Raad Issam
Published: April 2006

Objective:

To study the characteristics of catheter-related, gram-negative bacteremia (GNB) and the role of central venous catheter (CVC) removal.

Design:

This retrospective study involved a search of the microbiological department records of CVC and blood cultures and patients' medical records.

Setting:

University of Texas M. D. Anderson Cancer Center, a tertiary-care hospital in Houston, Texas.

Patients:

Patients with cancer who had catheter-related GNB, defined as (1) a positive catheter tip culture with at least 15 colony-forming units semiquantitatively, (2) isolation of the same organism from the tip and peripheral blood cultures, (3) no other source for bacteremia except the CVC, and (4) clinical manifestations of infection (fever or chills).

Results:

Between January 1990 and December 1996, 72 cases of catheter-related GNB were available for review. Most of the patients (67; 93%) had their CVCs removed in response to the bacteremia. Few patients (5; 7%) retained their CVCs and were treated with appropriate antibiotics. When CVCs were removed, only 1 patient (1%) relapsed with the same organism, whereas all 5 patients with retained CVCs relapsed after having responded (P < .001). The most commonly isolated organisms were Enterobacter, Klebsiella, Stenotrophomonas, Pseudomonas, and Acinetobacter species. Catheter removal within 72 hours of the onset of the catheter-related GNB was the only independent protective factor against relapse of the infection (odds ratio, 0.13; 95% confidence interval, 0.02–0.75; P = .02).

Conclusion:

In patients with documented catheter-related GNB, CVCs should be removed within 48 to 72 hours to prevent relapse.
Application of Data Mining Techniques to Healthcare Data
Authors: Obenshain Mary K.
Published: April 2006

A high-level introduction to data mining as it relates to surveillance of healthcare data is presented. Data mining is compared with traditional statistics, some advantages of automated data systems are identified, and some data mining strategies and algorithms are described. A concrete example illustrates steps involved in the data mining process, and three successful data mining applications in the healthcare arena are described.
An Outbreak of Methicillin-Resistant Staphylococcus aureus Infections Related to Central Venous Catheters for Hemodialysis
Authors: Lee Sai-Cheong , Chen Kuo-Su , Tsai Chi-Jen , Lee Ching-Chang , Chang Hung Yu , See Lai-Chu , Kao Yu-Chin , Chen Shu-Chu , Wang Cheng-Hsu
Published: April 2006

Objectives:

To determine risk factors for hemodialysis catheter-related bloodstream infections (HCRBSIs) and investigate whether use of maximal sterile barrier precautions would prevent HCRBSIs.

Setting:

Tertiary-care medical center hemodialysis unit.

Design:

Open trial with historical comparison and case-control study of risk factors for HCRBSIs.

Methods:

Prospective surveillance was used to compare HCRBSI rates for 1 year before and after implementation of maximal sterile barrier precautions. A case–control study compared 50 case-patients with HCRBSI with 51 randomly selected control-patients.

Results:

The HCRBSI rate was 1.6% per 100 dialysis runs (CI95, 1.1%–2.3%) in the first year and 0.77% (CI95, 0.5%–1.1%) in the second year (P = .0106). The most frequent cause of HCRBSI was MRSA in the first year (15 of 32) and MSSA in the second year (13 of 18). Ten MRSA blood isolates in the first year were identical by PFGE. Diabetes mellitus was a risk factor for HCRBSI. Age, gender, site of hemodialysis central venous catheter (CVC), other underlying diseases, coma score, APACHE II score, serum albumin level, and cholesterol level were not associated with HCRBSI and did not change between the 2 years. Hospital stay was prolonged for case-patients (32.78 ± 20.96 days) versus control-patients (22.75 ± 17.33 days), but mortality did not differ.

Conclusions:

Use of maximal sterile barrier precautions during the insertion of CVCs reduced HCRBSIs in dialysis patients and seemed cost-effective. Diabetes mellitus was associated with HCRBSI. An outbreak of MRSA in the first year was likely caused by cross-infection via medical personnel.
Influence of Selective Bowel Decontamination on the Organisms Recovered During Bacteremia in Neutropenic Patients
Authors: Daxboeck Florian , Rabitsch Werner , Blacky Alexander , Stadler Maria , Kyrle Paul A. , Hirschl Alexander M. , Koller Walter
Published: April 2006

Objective:

To assess the influence of prophylactic selective bowel decontamination (SBD) on the spectrum of microbes causing bloodstream infection (BSI).

Design:

The microbes causing BSI in neutropenic patients of a hematologic ward (HW) and a bone marrow transplantation unit (BMTU), respectively, were compared by retrospective analysis of blood culture results from January 1996 to June 2003.

Setting:

A 30-bed HW (no SBD) and a BMTU including a 7-bed normal care ward and an 8-bed intensive care unit (SBD used) of a 2,200-bed university teaching hospital.

Results:

The overall incidences of bacteremia in the HW and the BMTU were similar (72.6 vs 70.6 episodes per 1,000 admissions; P = .8). Two hundred twenty episodes of BSI were recorded in 164 neutropenic patients of the HW and 153 episodes in 127 neutropenic patients of the BMTU. Enterobacteriaceae (OR, 3.14; CI95, 1.67–5.97; P = .0002) and Streptococcus species (OR, 2.04; CI95, 1.14–3.70; P = .015) were observed more frequently in HW patients and coagulase-negative staphylococci more frequently in BMTU patients (OR, 0.15; CI95, 0.09–0.26; P< .00001). No statistically significant differences were found for gram-negative nonfermentative bacilli (P = .53), Staphylococcus aureus (P = .21), Enterococcus species (P = .48), anaerobic bacteria (P = .1), or fungi (P = .50).

Conclusions:

SBD did not lead to a significant reduction in the incidence of bacteremia, but significant changes in microbes recovered from blood cultures were observed. SBD should be considered when empiric antimicrobial therapy is prescribed for suspected BSI.