bluuebunny/crossref_metadata_2025 huggingface dataset:
Resistance to Imipenem Among Selected Gram-Negative Bacilli in the United States
Authors: Gaynes Robert P. , Culver David H. ,   The National Nosocomial Infections Surveillance System
Published: September 2009

Objectives:

Identification of imipenem resistance among selected gram-negative bacilli, especially Pseudomonas aeruginosa and Enterobacter species.

Methods:

We analyzed 1986-1990 National Nosocomial Infection Surveillance (NNIS) data from 3,316 P aeruginosa isolates and 1,825 Enterobacter species isolates for which susceptibility results to imipenem were reported.

Results:

For P aeruginosa, 11.1% of the isolates were resistant to imipenem; 16.1% were either intermediate-susceptible or resistant to the drug. A logistic regression model found that resistance was more common among P aeruginosa isolated from the respiratory tract, patients in intensive care units, and in teaching hospitals. Additionally, resistance to imipenem increased by 25% in teaching hospitals from 1986-1988 to 1989-1990. For Enterobacter species, 1.3% of the isolates were resistant to imipenem; 2.3% were either intermediate-susceptible or resistant to the drug. However, imipenem resistance for these isolates did not differ between the two periods and was not more common in patients in an intensive care unit or infections at any specific site.

Conclusions:

The frequency of resistance to imipenem is greater among P aeruginosa than among Enterobacter species. Resistance to imipenem among the P aeruginosa isolates is more common from strains isolated from patients with nosocomial infections in an intensive care unit, from the respiratory tract, and from teaching hospitals. Resistance appears to be increasing among nosocomial P aeruginosa isolated in teaching hospitals.
Cross-Sectional Epidemiology of Phlebitis and Catheter-Related Infections
Authors: Ena Javier , Cercenado Emilia , Martinez David , Bouza Emilio
Published: September 2009

Objectives:

To describe the characteristics and the problems arising from the use of vascular catheterization in a general hospital and to identify avoidable risk factors associated with catheter-related infections.

Design:

Cross-sectional, including the entire hospitalized population.

Setting:

A university-affiliated hospital.

Results:

Three-hundred fifty-three intravascular catheters were implanted in 315 of a total of 1,838 hospitalized patients (17.1%, confidence interval [CI] = 15.7-18.5). Of the 353 intravascular catheters, 26 (7.3%) were intraarterial, 273 (77.3%) were peripheral, and 54 (15.3%) were central. The median (range) duration of the catheterization was 3 (1-1 1) days for arterial catheters, 1 (1-24) for peripheral catheters, and 5 (1- 130) for central catheters. Fifty-three (15%, CI = 11.5-19.5) showed signs of infection. Independent risk factors associated with infection were the presence of infection located elsewhere (odds ratio [OR]=8.7, CI=4.13-18.3, p<.0001), inappropriate catheter care (OR= 5.3, CI = 2.5-11.2, p<.0001), inappropriate length of catheter use (OR= 3.5, CI = 1.4-9.02, p<.01), and duration of hospitalization exceeding 14 days (OR=2.6, CI=O.9-7.83,p=.07).

Conclusion:

The risk factors associated with catheter-related infections suggest that many are preventable by improved protocols for management. This hypothesis can easily be tested.
Intervention to Discontinue Parenteral Antimicrobial Therapy in Patients Hospitalized with Pulmonary Infections: Effect on Shortening Patient Stay
Authors: Ehrenkranz N. Joel , Nerenberg Debra E. , Shultz James M. , Slater Kenneth C.
Published: September 2009

Objectives:

Current efforts to contain antimicrobial costs in hospitals are based on restricting drugs. We explored the effects of unsolicited case-specific recommendations to physicians to discontinue parenteral antimicrobial therapy in medically stable patients with pneumonia, in order to shorten hospital length of stay

Methods:

A nurse-interventionist, working as an emissary of an appropriate committee in 3 nonteaching community hospitals, presented randomly assigned physicians withnonconfrontational suggestions to substitute comparable oral antimicrobials for parenteral antimicrobials. Blinded observers evaluated in-hospital and30-day postdischarge courses of patients of physicianswhohad been contacted by the nurse (cases) and those who had not (controls).

Results:

Eighty-two patient episodes (47 physicians) met study criteria. There were 53 cases and 29 controls. In 42 of 53 (79%) case episodes, physicians discontinued parenteral antimicrobials; patients' mean length of stay was 2.4 days less than for 29 control episodes (estimated cost savings was$884/patient). In 11 (21%) episodes, case physicians continuedparenteraltherapy; patients' mean length of stay was 1.9 days longer than for controls (estimated cost excess was$704/patient). Education, training and practice characteristics were comparable in physician groups. Severity of illness indicators and postdischarge outcomes were comparable in patient groups.

Conclusions:

The major cost-saving potential for shifting from par-enter-al to oral antimicrobial therapy is shortened length of stay. Timely information about alternative drug therapies, offered on a patient-specific basis, appears to modify the treating behavior of physicians. The program as currently conducted is cost-effective, with an estimated net savings of $50,000 per 100 interventions.
Patient Selection for Clinical Investigation of Ventilator-Associated Pneumonia: Criteria for Evaluating Diagnostic Techniques
Authors: Pingleton Susan K. , Fagon Jean-Yves , Leeper Kenneth V.
Published: September 2009

Nosocomial pneumonia in patients receiving ventilation is a common ICU occurrence. The exact frequency is not known because of the lack of specificity of the clinical diagnosis and existing standard diagnostic techniques. We have attempted to come to consensus in identifying a patient population with a clinical suspicion of nosocomial pneumonia and establishing a definition of pneumonia by which new diagnostic techniques can be compared.
The Standardization of Bronchoscopic Techniques for Ventilator-Associated Pneumonia
Authors: Meduri G. Umber-to , Chastre Jean
Published: September 2009

During the last decade, several centers have directed their research efforts at defining more efficient modalities for the accurate diagnosis of ventilator-associated pneumonia (VAP). Accurate diagnosis is an essential prerequisite for clinical investigation. Initial studies, which correlated histologic findings and quantitative bacterial cultures of the lung with the findings of protected specimen brush cultures have stimulated clinical investigation of VAF! Two diagnostic techniques, protected specimen brushing (PSB) and bronchoalveolar lavage (BAL), have been extensively investigated and have shown promising results. Advancements in the field, however, have been limited by the lack of standardization, particularly for BAL. In this communication, we attempt to standardize methodology for presently available bronchoscopic techniques and interpretation of data obtained by bronchoscopy to facilitate comparisons among investigations and to promote multicenter collaboration.
Guidelines for Reading and Interpreting Chest Radiographs in Patients Receiving Mechanical Ventilation
Authors: Winer-Muram Helen T. , Rubin Sanford A. , Miniati Massimo , Ellis James V.
Published: September 2009

The technical limitations of portable chest radiography, the lack of lateral radiographs, and the difficulties in positioning critically ill patients hinder the radiologic diagnosis of pneumonia, especially in patients receiving mechanicalventilation (MV). Optimally, anteroposterior (AP) portable radiographs are obtained utilizing high kilovoltage (120 to 130 kV), short exposure time, and fast filmscreen combinations to increase radiographic latitude and decrease motion unsharpness. Whenever possible, constant source-tofilm and source-to-patient distance should be maintained to allow for proper assessment of changes in mediastinal or cardiac diameters. Multiple factors should be recorded, including radiographic technique, focus-film distance, kilovoltage (kv), milliampere (mA), patient position, and ventilator settings for positive end-expiratory pressure (PEEP) and peak inspiratory pressure (PIP).
The Standardization of Criteria for Processing and Interpreting Laboratory Specimens in Patients With Suspected Ventilator-Associated Pneumonia
Authors: Baselski Vickie S. , El-Torky Mahmoud , Coalson Jacqueline J. , Griffin John P.
Published: September 2009

The microbiologic analysis of respiratory specimens is a key component of both the clinical investigation of ventilator-associated pneumonia (VAP) and patient care. Although there is a substantial body of literature on the use of a variety of lower respiratory tract specimens, there is little standardization of the approaches to processing and interpreting results from the various specimens. The purpose of this communication is to delineate specific recommendations for the microbiologic analysis of specimens originating from the lower respiratory tract, as developed by the Laboratory Analysis Group of the Consensus Conference.
Methodology for Clinical Investigation of Ventilator-Associated Pneumonia: Epidemiology and Therapeutic Intervention
Authors: Wunderink Richard G. , Mayhall C. Glen , Gibert Claude
Published: September 2009

We now have the ability to accurately diagnose ventilator-associated pneumonia (VAP), which should lead to re-examination of nondiagnostic aspects of VAP Previous data regarding the epidemiology, treatment, and prevention of VAP were derived almost exclusively from studies in which the diagnoses were based on clinical criteria and cultures of endotracheal aspirates. These criteria are inaccurate in as many as 60 percent of cases compared to autopsy or quantitative cultures of bronchoscopic specimens. Many recent studies of VAP have focused on the accuracy of bronchoscopic and other methods of obtaining uncontaminated specimens from the lower respiratory tract for diagnosis. In anticipation of the use of these more accurate techniques to validate conclusions derived from studies based on the clinical diagnosis of VAP, the appropriateness of the design and conclusions of these published studies have been reviewed. In this communication, we discuss the areas in which sufficient data exist to reach consensus regarding methods for future studies in the epidemiology, treatment, and prevention of VAP and also attempt to delineate areas for future research endeavors.
Continuous Quality Improvement in a Community Teaching Hospital
Authors: Scheckler William E.
Published: September 2009

The purpose of this report is to describe the workings of continuous quality improvement (CQI) in a nonprofit community teaching hospital. An earlier report reviewed the adoption by a hospital system of CQI and discussed the implications and opportunities for the discipline of hospital epidemiology. This article will further develop the theme of CQI, discussed in recent months in Infection Control and Hospital Epidemiology and other journals, by offering a case history of one hospital's journey down the CQI management pathway-the origins, the aids, and the barriers to adoption, the development of the first CQI teams, and future prospects.
A Cluster of Pseudofungemia Associated With Hospital Renovation
Adjacent to the Microbiology Laboratory
Authors: Hruszkewycz Victoria , Ruben Bruce , Hypes Catherine M. , Bostic Grace D. , Staszkiewicz Joanna , Band Jeffrey D.
Published: September 2009

Objective:

To determine the clinical significance and source of fungemia following a
cluster of positive blood cultures during a 3-day period.

Design:

Chart review was used to determine the clinical significance of positive
blood cultures. Microbiologic sampling of the laboratory environment was
used to determine potential sources of fungal contamination.

Setting:

A large, tertiary care, community teaching hospital.

Patients:

All patients with blood cultures positive for Aspergillus
species, Penicillium species, or both during the outbreak
period.

Results:

Thirteen patients, all children, were reported to have positive blood
cultures for fungus during a 3-day period in early 1990. None had
clinical features consistent with fungemia. Investigation of specimen
processing procedures revealed that microbiologic plates were not
processed-as per protocol-under the biologic hood but inadvertently were
left open to air on the work bench by laboratory technicians. Settling
plates left at the workbench, at door entry sites, and at sites of
renovation immediately adjacent to the laboratory were positive for
Aspergillus and/or Penicillium;
control plates placed elsewhere were negative. Airflow patterns suggested
spread into the microbiologic laboratory through an open door located
near the implicated workbench station and a false ceiling above the
workbench area.

Conclusions:

Our investigation demonstrates that faulty technique in the laboratory
coupled with a change in environmental conditions can result in
false-positive cultures and an outbreak of pseudofungemia.
Antimicrobial Therapy for Methicillin-Resistant
Staphylococcus aureus Colonization in Residents and
Staff of a Veterans Affairs Nursing Home Care Unit
Authors: Strausbaugh Larry J. , Jacobson Cleone , Sewell David L. , Potter Susan , Ward Thomas T.
Published: September 2009

Objective:

TO evaluate the effect of antimicrobial therapy on patients and staff
colonized with methicillin-resistant Staphylococcus
aureus (MRSA) in a skilled nursing facility and to assess the
role of the environment as a potential reservoir for MRSA in the nursing
home setting.

Design:

As part of a comprehensive program to control an MRSA outbreak in a
nursing home, patients and staff colonized with MRSA received 1 of 3
antimicrobial decolonization regimens depending upon the site and extent
of colonization. Followup cultures were performed during therapy and on
days 2, 7, 14, and 30 following the completion of therapy. Cultures of
tbe patients' inanimate environment (pajamas, sheet, and floor) were
obtained during and after therapy Antimicrobial susceptibility tests were
performed on 54 MRSA isolates obtained before and 44 MRSA isolates
recovered after therapy

Setting:

A 120-bed Veterans Affairs nursing home care unit.

Participannts:

Thirty-six patients and 7 staff nurses colonized with MRSA at 1 or more
sites.

Intervention:

Decolonization therapy with rifampin, trimethoprim-sulfamethoxazole, and
clindamycin used alone or in various combinations for 5 or 10 days in
conjunction with other infection control measures employed to combat the
MRSA outbreak.

Results:

Twenty (56%) of the 36 NHCU patients were either persistently colonized
or became recolonized with MRSA during tbe 30-day followup period.
Positive cultures on day 3 during therapy frequently identified patients
who subsequently exhibited persistent or recurrent colonization. Before
therapy, 92% of MRSA isolates were susceptible to rifampin, whereas only
43% of the isolates obtained after therapy were susceptible. Sixteen
(80%) of 20 patients with persistent or recurrent colonization had
rifampin-resistant strains of MRSA isolated after therapy Twenty-three
(18%) of 125 environmental cultures obtained during and after therapy
from patients who exhibited persistent or recurrent colonization were
positive for MRSA, in contrast to 9 (8%) of 107 from patients who were
successfully decolonized.

Conclusions:

The decolonization component of the outbreak control program was judged
to be ineffective and potentially hazardous because colonization
persisted or recurred in more than half of the patients, and substantial
antimicrobial resistance was noted in MRSA strains isolated after therapy
Resistance, especially to rifampin, and possibly re-acquisition of MRSA
from other human or environmental sources were 2 factors that appeared to
impede the decolonization effort.
Reported Hospital Needlestick Injuries in Relation to Knowledge/Skill, Design, and Management Problems
Authors: English Judith Fay Boylan
Published: September 2009

Objectives:

To investigate reported needlestick injuries in hospital workers from an adult learner theory perspective: identifying safe needle device knowledge and practice, and flaws in needle designs and management practices surrounding such problems.

Design:

Exploratory descriptive study of reported needlestick injuries from hollow needled devices in a hospital. Injured healthcare workers were counseled via hospital protocol, then a survey was filled out containing no identifiers of individual or institution.

Setting:

Seventeen Metropolitan Washington, DC, area hospitals.

Participants:

All workers reporting needlestick injuries during February 1-28, 1990.

Results:

Seventy-two injuries were reported; there were no multiple injuries to any individual. Thirty-three (45.8%) were to registered nurses (RNs)-more than any other group of workers. Recapping accounted for a higher percentage than any other activity (10 sticks, 14.1%). Of workers incurring recapping injuries, 3 identified a knowledge of a one-handed spearing technique and did not practice it; 4 neither knew nor practiced it. Eighteen (25.0%) were to “down-stream” housekeepers and aides who did not use such devices in their practice. Disposable needle/syringes caused 49.3% of injuries; hypodermic needles on intravenous lines caused 16.9%. Of the needlesticks, 60.6% were after use and before disposal, 4.2% occurred as the worker was putting an item into a needlebox, and 9.9% occurred from needles protruding from inappropriate bags. Many injuries occurred in the first 2 hours of work after being off the previous day, on Sunday, and on Monday

Conclusions:

Of nurses and medical technologists reporting knowledge of a spearing recapping technique, 97.3% suffered injury via other methods. This strongly suggests that knowledge leads to different action. Safer needled devices and needle-free systems would make a safer workplace. Further study is indicated to identify if and why the first two hours after returning to work on Sunday or Monday are risky for needlestick injuries. Management practices must ensure compliance to safe practice both by employees and related medical staff.
A Five-Year Study of Needlestick Injuries: Significant Reduction Associated With Communication, Education, and Convenient Placement of Sharps Containers
Authors: Haiduven Donna J. , DeMaio Tammy M. , Stevens David A.
Published: September 2009

Objective:

To decrease the numbers of needlesticks among healthcare workers.

Design:

All reported needlestick injuries at Santa Clara Valley Medical Center, San Jose, California, were reviewed, analyzed, and tabulated by the infection control department yearly from 1986 to 1990.

Setting:

A 588-bed county teaching hospital in San Jose, California, affiliated with Stanford University.

Participants:

All employees of Santa Clara Valley Medical Center who reported needlestick injuries on injury report forms.

Interventions:

From April to December 1987, more needle disposal containers were added to as many patient care areas and as close to the area of use as possible. Results of 1986, 1988, 1989, and 1990 analyses were communicated yearly to all personnel, extensive educational programs were conducted in 1987 and 1988, and educational efforts continued in 1989 and 1990.

Results:

In 1986, there were 259 needlestick injuries at our institution, 22% (32) from recapping. After needle disposal containers were added to all patient care areas, needlestick injuries for 1988 totalled 143, a 45% decrease in the total needlestick injuries and a 53% decrease in recapping injuries. Communication of results to all areas of the hospital and educational activities were started in 1987 and continued through the next 3 years. In 1989, there were 135 needlestick injuries, a decrease of 6% from 1988; recapping injuries decreased 40% from 1988. In 1990, there were 104 needlestick injuries, a 23% decrease since 1989, and a 33% decrease in recapping injuries. The total number of needlestick injuries from 1986 to 1990 decreased by 60%, and those injuries from recapping decreased by 81% to 89%.

Conclusions:

We have continued to monitor needlestick injuries, communicate findings to all personnel, and include needlestick prevention in educational programs. We contend that more convenient placement of needle disposal containers, communication of tidings, and education do decrease needlestick injuries in healthcare workers.
A Cluster of Severe Postoperative Bleeding Following Open Heart Surgery
Authors: Villarino Margarita E. , Gordon Steven M. , Valdon Carol , Potts Diana , Fish Kevin , Uyeda Charles , McCarthy Patrick M. , Bland Lee A. , Anderson Roger L. , Jarvis William R.
Published: September 2009

Objective:

To investigate a cluster of postoperative bleeding following open heart surgery.

Design:

A cohort and case/control study.

Setting:

Palo Alto Veterans Administration Medical Center, Palo Alto, California.

Participants:

Six (21.4%) of 28 patients undergoing open heart surgery who developed severe, nonsurgical, postoperative bleeding from July 1 through August 30, 1988 (outbreak period). All case-patients had chest tube drainage of > 1000 ml within 4 hours of surgery but did not have identifiable bleeding vessel(s) on exploration.

Results:

Upon comparison of the pre-outbreak (January 1986 through June 1988) and the outbreak period, a significant increase was found in the incidence of postoperative nonsurgical bleeding (5/440 versus 6/28, p = .0006), but not of postoperative surgical bleeding (8/440 versus 0/28, p = 1 .0). Of all patients undergoing open heart surgery during the outbreak period, case patients were found to be older (67.8 versus 60.6, p= .02) and to have received a larger volume of hetastarch (HES), a synthetic colloidal plasma-volume expander (mean = 19.4 ml/kg versus 14.1 ml/kg, p= .02).

Conclusions:

We conclude that the use of large volumes of HES during surgery in the elderly open heart surgery patient may increase the risk for severe, nonsurgical postoperative bleeding, probably caused by alterations of the coagulation system. As the incidence of open heart surgery increases among the elderly, surgeons and anesthesiologists should be alert to possible adverse reactions from exposures not associated with adverse reactions in younger patients.
Predictive Value of Blood Cultures
Authors: Stratton Charles W. , Lorian Victor , Amaral Leonard
Published: September 2009

The rising incidence of immunocompromised-patient infections caused by bacteria that are normally nonvirulent and indigenous to normal flora has focused attention on the contamination rate of blood cultures. This contamination is usually a consequence of the mode of collection or processing within the laboratory.

The contamination rates of blood cultures usually are reported to a hospital's quality assurance component and to the medical staff. In addition, the identification of organisms isolated from blood cultures is reported to the physician, regardless of whether the organism isolated is a contaminant or the infectious agent. Consequently, reporting positive blood cultures that reflect contamination in certain cases may trigger some physicians to initiate prompt antibacterial therapy. The contamination rate of the blood culture has, therefore, a serious impact on medical consequences as well as on resource use.
Bland Soap Handwash or Hand Antisepsis? The Pressing Need for Clarity
Authors: Ehrenkranz N. Joel
Published: September 2009

A pervasive misconception in infection control circles is that simple bland soap handwash reliably prevents hand transmission of transiently acquired bacteria, disregarding the level of hand contamination. Often cited to support this widespread misapprehension is a bigger misconception-the efficacy of bland soap handwash is rooted in the epidemiological research of Ignaz Semmelweis. As emphasized by Walter and Beck, Semmelweis did no such thing. Indeed, it was the observation by Semmelweis of failure of bland soap handwash to prevent healthcare workers from spreading puerperal sepsis that led to his investigations of chlorine hand antisepsis for control of cross-infection. These studies ultimately resulted in his demonstrating that effective hand antisepsis (and not bland soap handwash) could prevent transmission of the agents of postpartum endometritis, sepsis, and death.
The Agenda for Change Development of the Joint Commission Infection Control Indicators
Authors: Kazlauskas Kristina L. , Nadzam Deborah M.
Published: September 2009

The Joint Commission on Accreditation of Healthcare Organizations (Joint Commission) implemented the Agenda for Change initiative in 1986 as a major research and development effort. The focus of the initiative is the continuous assessment and improvement of patient outcomes. Measurement of the delivery of care may be assessed both through patient outcomes and related processes of care. The Agenda for Change shifts the emphasis of evaluation from an organization's capability to provide good care to its actual performance.

The specific objectives of the Agenda for Change include: redirection of the Joint Commission standards, improvement in the survey process, and establishment of performance monitoring capabilities.

There are several major aspects in the establishment of a performance monitoring system. First, performance measures need to be developed and tested for reliability and validity. Second, a mechanism needs to be established for both the Joint Commission and the healthcare organization to support data collection, analysis, and feedback. Third, a national database needs to be established that incorporates standards compliance and performance data. It is intended that the information generated by the performance data base will contribute to the continuous improvement in patient care delivery by stimulating healthcare organizations to analyze and improve processes affecting patient outcome.
Human Immunodeficiency Virus Testing Experience and Hepatitis B Vaccination and Testing Status of Healthcare Workers in South Carolina: Implications for Compliance With US Public Health Service Guidelines
Authors: Lettau Ludwig A. , Blackhurst Dawn W. , Steed Connie
Published: September 2009

Objective:

To assess the previous human immunodeficiency virus (HIV) testing experience and the hepatitis B (HB) vaccination and testing status of healthcare workers potentially involved in invasive surgical procedures.

Design:

Anonymous questionnaire survey.

Setting:

Tertiary care and community-teaching medical center and affiliated healthcare facilities in Greenville County, South Carolina.

Participants:

Physicians (including residents in training), dentists, nurses and surgical technicians working in the operating room and labor/delivery areas.

Results:

Of 506 responding physicians and dentists (65% of the sample), 60% previously had had a test for HIV, and 72% had received HB vaccine. Testing had occurred most often because of a requirement by an insurance company or because of blood donation. Eighty percent of tested respondents had their most recent test within 2 years of the time of the survey (August 1991). Of 145 responding nurses and surgical technicians (73% of the sample), 26% had had a test for HIV and 77% had received HB vaccine.

Conclusions:

The majority of surgeons and dentists in Greenville County, South Carolina, already have been tested for HIV for a variety of reasons and thus are aware of their HIV infection status, at least as of the time of the most recent test. The majority of local healthcare workers who are potentially involved with invasive surgical procedures have received HB vaccine. Programs developed in response to recent US Public Health Service guidelines should take HIV testing of healthcare workers for any reason into consideration and should emphasize HB vaccination and testing for vaccine-induced HB immunity
Impact of a Shielded Safety Syringe on Needlestick Injuries Among Healthcare Workers
Authors: Younger Barbara , Hunt Ella H. , Robinson Cecil , McLemore Cheryl , Hickey Sherri
Published: September 2009

Objectives:

Evaluate the impact of a shielded 3 cc safety syringe on needlestick injuries among healthcare workers.

Design:

Surveillance study.

Setting:

Three medical centers.

Results:

The total number of needlesticks from all sources rose from 134 during the baseline period to 140 during the study phase. However, the overall rate of needlesticks involving 3 cc syringes decreased from 14/100,000 inventory units to 2/100,000, and the frequency declined substantially at each of the participating medical centers.

Conclusions:

These results suggest that shielded syringes and related technology may offer potential for reducing the risk of needlestick injuries among hospital and other healthcare employees. This study should be viewed as a preliminary effort to assess the potential of shielded-syringe technology for reducing the risk of needlestick injuries among healthcare workers. The results are encouraging, but more clinical experience with this new device and longer follow up are essential to provide the data necessary for a definitive assessment of efficacy.
Wound Infection Rates in Clean Surgery: A Potentially Misleading Risk Classification
Authors: Ferraz Edmundo Machado , Bacelar Tercio Souto , Aguiar Jose Lamartine de Andrade , Ferraz Alvaro Antonio Bandeira , Pagnossin Gilberto , Batista Jose Edmilson Mazza
Published: September 2009

Objectives:

To evaluate the incidence of wound infection in inguinal hernioplasties, incisional hernioplasties, splenectomies, and splenectomies performed in patients with hepatosplenic schistomiasis, and to examine the relationship of surgical wound infection to antibiotic use, patient age, length of stay in the hospital prior to surgery, and the duration of the operation.

Design:

Retrospective surveillance study.

Results:

One thousand five hundred forty-two clean operations were analyzed. Comparing response (wound infection) and explanatory variables (age, length of hospital stay, duration of surgery, antibiotics, and surgery type), we found that age, use of antibiotics, and type of surgery were statistically significant, while length of hospital stay and duration of surgery were not significant.

Conclusions:

From these results, we can predict that the probability of wound infection in surgical patients considering these significant variables is lower for patients ages 14 to 30 years and higher for patients ages 31 to 60 years and lower for patients with prophylactic antibiotic use (up to 72 hours of use) and higher for patients with prolonged use (more than 72 hours); and lower for patients undergoing inguinal heria, followed in ascending order by nonschistosomotic patients undergoing splenectomy in schistosomotic patients.
Rapid Inactivation of Infectious Pathogens by Chlorhexidine-Coated Gloves
Authors: Modak Shanta , Sampath Lester , Miller Harvey S.S. , Millman Irving
Published: September 2009

Objective:

Gloves containing chlorhexidine gluconate in an instant-release matrix on their inner surface (CHG gloves) were tested to determine their ability to rapidly inactivate infectious pathogens that may permeate or leak through the latex surface.

Design:

CHG gloves were exposed for 1 to 10 minutes to blood or media containing infectious pathogens (e.g., bacteria, fungi, parasites, and viruses) as well as to lymphocytes and macrophages that are known to be the primary carriers of human immunodeficiency virus (HIV). Inactivation of pathogens was determined either by in vitro assay or in vivo infectivity. Stressed control and CHG glove fingers were submerged in a viral pool (retrovirus or bacteriophage) and after a set time, the glove interiors were checked for presence of permeated viz-ions.

Results:

CHG gloves rapidly inactivate all the pathogens tested including retrovirus and hepatitis B virus (90% to 100%). In the stressed glove fingers, live virus was detected in 26% of the control group but not in any of the CHG group.

Conclusions:

The use of CHG gloves may reduce the risk of exposure to infectious fluidborne pathogens should the integrity of the latex barrier be compromised by overt failure or by permeation of viruses. Rapid destruction of lymphocytes and macrophages may facilitate inactivation of HIV associated with these cells. Tests have shown that CHG coating does not alter physical properties of the glove, and, furthermore, CHG gloves do not show potential for dermal irritation or sensitization.
“Through a Drinking Glass and What Was Found There”: Pseudocontamination of a Hospital's Drinking Water
Authors: Klotz Stephen A. , Normand Richard E. , Kalinsky Robert G.
Published: September 2009

Oejective:

Examination of suspended macroscopic debris that was noted in hospital cafeteria drinking water over a prolonged period of time.

Setting:

A tertiary care hospital.

Design:

A retrospective description of events.

Methods:

Conventional medical microbiology techniques were employed to determine if contamination of drinking water had occurred.

Results:

Microscopic examinations of the debris showed live nematodes similar to Strongyloides stercoralis rhabditiform larvae and amoebic trophozoites. A culture of an ice container in the cafeteria yielded coliform bacteria. Hospital employees lost work because of a diarrheal illness thought to be contracted from drinking cafeteria water. Further investigation revealed that the debris contained numerous ciliated organisms, nematodes, fresh water amoebae, bacterial mats, flagellated fungi, and unidentified cysts suggesting that the debris was of a freshwater origin rather than fecal contamination. Another hospital served by a collateral city water line experienced a similar problem. The debris was observed in November when lake water in the reservoir undergoes inversion.

Conclusions:

Nonpathogenic freshwater microbiota probably originating from the city reservoir were the cause of pseudocontamination of hospital drinking water.
‘Look-Back’ Notifications for HIV/HBV-Positive Healthcare Workers
Authors:   AIDS Committee of The Society for Hospital Epidemiology of America
Published: September 2009

In December 1990, the Society for Hospital Epidemiology of America (SHEA), in conjunction with the Association for Practitioners in Infection Control, published a position paper entitled, ‘The HIV-Infected Healthcare Worker,” in which we outlined our approach to the evaluation and management of such individuals. In that position paper, we wrote that we did not favor widespread or compulsory testing for human immunodeficiency virus (HIV), hepatitis B, or other bloodborne pathogens for any group of healthcare workers including those doing invasive procedures. We indicated that the vast majority of patient contacts, including most invasive procedures, could be safely carried out by healthcare workers infected with HIV or other bloodborne pathogens, provided that such individuals were familiar with and adhered to proper infection control practices including those of “Universal Blood and Body Fluid Precautions” and assuming that such individuals had no other evidence of functional impairment due to medical, emotional, or neurological disease, which could affect their capacity to carry out such procedures. We recognized, however, that a small subset of invasive procedures, principally those involving by-feel manipulation of pointed or sharp objects within body cavities (including “blind” sewing) might pose a heightened risk of accidental injury and inadvertent transmission of bloodborne pathogens. We suggested therefore that healthcare workers infected with HIV or hepatitis B virus (HBV) be counseled to avoid, voluntarily, that small subset of procedures that in the past had been linked epidemiologically to the transmission of hepatitis B virus.
Flavimonas oryzihabitans (CDC Group Ve-2)
Authors: Chaudhry Humayun J. , Schoch Paul E. , Cunha Burke A.
Published: September 2009

Flavimonas oryzihabitans is an uncommon organism with distinctive microbiological and biochemical features that is infrequently isolated from humans. The presence of foreign material, including indwelling intravascular catheters and artificial grafts, or various surgical procedures appear to predispose patients with underlying disease to bacteremic infection with Flavimonas. A gram-negative bacillus, F oryzihabitans is sensitive to most antibiotics except first- and second-generation cephalosporins. F oryzihabitans isolated from blood should be considered pathogenic in patients with indwelling catheters or prosthetic materials.

Previously designated Pseudomonas oryzihabitans and also known as Centers for Disease Control (CDC) Group Ve-2, F oryzihabitans is an unusual gram-negative, nonfermenting, oxidase-negative bacillus that is uncommonly associated with serious illness in humans.’ First described by Dresel and Stickl in 1928 and initially assigned the name Bacterium typhiflavum because of its similarity to the typhoid bacillus, the organism has been isolated from a variety of human sources, including blood, wounds, and abscesses, and (in mixed cultures) from sputum, urine, and cervical cultures.
Prevention of Legionella Infections in a Bone Marrow Transplant Unit: Multifaceted Approach to Decontamination of a Water System
Authors: Matulonis Ursula , Rosenfeld Craig S. , Shadduck Richard K.
Published: September 2009

Objective:

To evaluate measures intended to reduce Legionella infections in patients undergoing bone marrow transplantation (BMT).

Design:

Ongoing clinical and microbiological surveillance for Legionella colonization or infection was undertaken. All neutropenic patients with pulmonary infiltrates and fever unresponsive to broad-spectrum antibiotics were tested for Legionella organisms.

Setting:

A 505-bed medical-surgical hospital with a designated BMT unit.

Patients:

Two hundred twenty-five patients underwent BMT; 201 were treated on a new BMT unit. The incidence of Legionella infections was compared to that seen in an estimated 150 neutropenic patients treated on other units.

Intervention:

A combined approach to decontamination of a hospital water supply was assessed. This included heating, particulate filtration, ultraviolet sterilization, and monthly pulse hyperchlorination of water supplied to the BMT unit. The incidence of Legionella infections was assessed on the BMT unit and compared with the frequency elsewhere in the hospital.

Results:

There were only three cases of Legionella pneumonia among 201 patients undergoing transplantation on a new BMT unit. In contrast, 33 cases of Legionella infections were detected from approximately 150 patients treated on general medical floors.

Conclusion:

A multifaceted approach to decontamination of a hospital water system led to a marked reduction in Legionella infections.
Infection with Methicillin-Resistant Staphylococcus aureus Among Hospital Employees
Authors: Muder Robert R. , Brennen Carole , Goetz Angella M.
Published: September 2009

Objective:

To describe the spectrum of clinical infection caused bymethicillin-resistant Staphylococcus aureus (MRSA) in healthcare workers.

Design:

Case series.

Setting:

Two Veterans Affairs hospitals in which methicillin-resistant S aureus (MRSA) is endemic.

Patients:

Five employees presenting to employee health or infectious disease clinic.

Results:

All employees had had direct exposure to patients colonized with MRSA. Employee infections included cellulitis, impetigo, folliculitis, paronychia, and conjunctivitis. MRSA was isolated from all clinically infected sites and from the anterior nares of two employees. Three employees received a variety of ineffective oral antimicrobials before MRSA was recognized as the causative agent. All infections responded to appropriate therapy.

Conclusions:

Employees of hospitals with endemic MRSA may acquire MRSA infection. Presentation in our employees was that of relatively uncomplicated soft tissue infection, but several employees received inappropriate therapy before bacteriologic diagnosis. We recommend that culture and susceptibility testing be obtained prior to institution of therapy when hospital employees present with soft tissue infection.
Association Between Climate and Enterobacter Colonization in Swedish Neonatal Units
Authors: Fryklund Birgitta A. , Tullus Kjell , Burman Lars G.
Published: September 2009

Objective:

To study risk factors for the highly variable local colonization rates with unrelated Enterobacter species strains previously found in 22 Swedish neonatal units (0% to 32.4% of the infants).

Patients and Setting:

The fecal Enterobacter species carriage rates among 953 infants in the 22 special-care neonatal units were correlated with variables related to the ward (size, crowding, staffing, work load, antibiotic usage, level of care, hygienic precautions), and the hospital (temperature of water supplied, geographical location).

Results:

The average Enterobacter species carriage rate was highest at seven days of age (17% of the infants) and then declined to 3%. Only location of the hospital in an area with warmer climate according to horticultural zone showed an association with Enterobacter species carriage in multivariate analysis (P= 0.005).

Conclusion:

Although Enterobacter species mainly cause nosocomially acquired infections, the occurrence of the organism in special-care neonatal units seemed to be determined more by extrahospital than by intrahospital factors.
Nosocomial Outbreak of Pseudomonas cepacia Associated with Contamination of Reusable Electronic Ventilator Temperature Probes
Authors: Weems J. John
Published: September 2009

Objective:

The investigation and control of an outbreak of nosocomial Pseudomonas cepacia respiratory tract colonization and infection.

Design:

Epidemiologic investigation based on infection control surveillance data, including definition and characterization of case patients, environmental cultures based on epidemiologic information, and institution of control measures based on study results.

Setting:

A 1,171 -bed, university-affiliated tertiary care hospital.

Results:

Between January 1, 1988, and June 30, 1989, 127 patients were culture-positive for P cepacia, 117 (92%) of whom were culture-positive from sputum and were treated in the intensive care unit. Review of respiratory care procedures revealed that when mechanical ventilators were serviced between patients, the electronic temperature probes used with servo-controlled humidifiers were wiped with the same odor-counteractant cleaning solution used on ventilator cabinets, P cepacia was isolated from nine of 12 in-use temperature probe tips, three of which were from patients with negative sputum cultures for P cepacia, one of whom subsequently developed culture positivity for P cepacia.

P cepacia also was isolated from the diluted odor-counteractant solution. Following the institution of a disinfection procedure for temperature probe tips, the incidence of P cepacia sputum culture positivity in ICU patients fell significantly compared to the outbreak period (138 of 5,225 discharges versus 52 of 3,678 discharges, P<0.01).

Conclusions:

This investigation identified contamination of reusable electronic temperature probes as a source of nosocomial respiratory infection due to P cepacia and emphasizes the need to carefully evaluate disinfection practices for reusable patient care equipment.
Outbreak of Candida tropicalis Fungemia in a Neonatal Intensive Care Unit
Authors: Finkelstein R. , Reinhertz G. , Hashman N. , Merzbach D.
Published: September 2009

Objective:

To describe an outbreak of Candida tropicalis fungemia in a neonatal intensive care unit (NICU), to evaluate the risk factors associated with this infection and the possible mode of nosocomial transmission.

Design:

Descriptive and case-control study

Patients and Methods:

Surveillance cultures were taken from hospitalized patients, personnel, and inanimate objects in the NICU. Six patients with C tropicalis fungemia (cases) were compared with C tropicalis culture-negative patients matched for duration of exposure to the NICU (controls).

Results:

During a five-month period, C tropicalis was isolated from 29 blood cultures of six premature infants. The same organism also was isolated from fingernail samples taken from the ward housekeeper, who had a mild onychomycosis, and an asymptomatic nurse. Other potential reservoirs of C tropicalis were not identified among all the other infants or in the hospital environment. The six patients with C tropicalis fungemia were more likely to have received a larger number of antibiotics (4.0 versus 1.8, R<0.001) and to have been subjected to a longer duration of total parenteral nutrition (TPN) therapy (8.5 versus 2.67 days, P= 0.004) than the controls.

Conclusions:

The risk of fungemia in this outbreak can be attributed to a larger number of antibiotics and a longer period of TPN administered to the patients. Analysis of events suggests that the outbreak may have been the result of cross-infection between staff and patients.
Tetanus and Tetanus Immunization in Long-Term Care Facilities
Authors: Bentley David W. , Richardson James P.
Published: September 2009

Tetanus, one of the oldest diseases known to man, continues to exact a tremendous toll worldwide. While the incidence of tetanus has declined dramatically in the United States in this century, more than 50 cases are reported to the Centers for Disease Control and Prevention (CDC) each year. Two thirds of these cases are elderly patients. Some estimate that the actual number of cases may be two to four times greater than the number reported. The overall reported case fatality rate is about 20% to 30%, but is greater than 50% for those older than 60 years.
Molecular Epidemiology of Nosocomial Infection: Analysis of Chromosomal Restriction Fragment Patterns by Pulsed-Field Gel Electrophoresis
Authors: Barg Neil L. , Goering Richard V.
Published: September 2009

The epidemiological analysis of nosocomial pathogens is a subject of long-standing clinical interest. In recent years, molecular techniques have received increasing attention as a means of analyzing epidemiological interrelationships, thus leading to use of the term molecular epidemiology. Since chromosomal DNA represents a fundamental molecule of cellular identity, there has been particular interest in assessing chromosomal similarity as a measure of epidemiological relatedness.

One attractive approach has been to digest chromosomal DNA with restriction enzymes, resulting in a series of different sized fragments that form patterns when comparatively analyzed by agarose gel electrophoresis. In this context, differences in fragment patterns commonly are referred to as restriction-fragment length polymorphisms (RFLPs). Enzymes commonly used to cleave DNA typically recognize numerous sites within the bacterial chromosome. With such enzymes, restriction digestion of DNA from different bacterial isolates results in fragments that are too numerous to compare accurately after conventional agarose gel electrophoresis.