bluuebunny/crossref_metadata_2025 huggingface dataset:
Recommendations for Preventing the Spread of Vancomycin Resistance
Authors:   Hospital Infection Control Practices Advisory Committee (HICPAC)
Published: September 2009

A rapid increase in the incidence of infection and colonization with vancomycin-resistant enterococci (WE) has been reported from U.S. hospitals in the last 5 years. This increase poses several problems, including: a) the lack of available antimicrobials for therapy of infections due to VRE, since most VRE are also resistant to multiple other drugs, e.g., aminoglycosides and ampicillin, previously used for the treatment of infections due to these organisms, and b) the possibility that the vancomycin resistance genes present in VRE may be transferred to other gram-positive microorganisms such as Staphylococcus aureus.

An increased risk of VRE infection and colonization has been associated with previous vancomycin and/or multi-antimicrobial therapy, severe underlying disease or immuno-suppression, and intra-abdominal surgery. Because enterococci can be found in the normal gastrointestinal or female genital tract, most enterococcal infections have been attributed to endogenous sources within the individual patient. However, recent reports of outbreaks and endemic infections due to enterococci, including VRE, have shown that patient-to-patient transmission of the microorganisms can occur either via direct contact or indirectly via hands of personnel or contaminated patientcare equipment or environmental surfaces.

Prevention and control of the spread of vancomycin resistance will require coordinated, concerted effort from various departments of the hospital, and can only be achieved if each of the following elements is addressed: 1) prudent vancomycin use by clinicians, 2) education of hospital staff regarding the problem of vancomycin resistance, 3) early detection and prompt reporting of van-comycin resistance in enterococci and other gram-positive microorganisms by the hospital microbiology laboratory, and 4) immediate implementation of appropriate infection-control measures to prevent person-to-person transmission of VRE.
Occupational Risk of Human Immunodeficiency Virus, Hepatitis B Virus, and Hepatitis C Virus Infections Among Funeral Service Practitioners in Maryland
Authors: Gershon Robyn R. M. , Vlahov David , Farzadegan Homayoon , Alter Miriam J.
Published: September 2009

Objective:

To estimate the risk of exposure and infection with bloodborne pathogens, a seroepidemiologic survey was conducted among funeral service practitioners (FSPs) in Maryland.

Method:

Of 262 members of the Maryland State Funeral Directors Association, 130 (49%) volunteered to participate in the study. In addition to a brief questionnaire, designed to assess both occupational and non-occupational risk factors for bloodborne pathogen infection, participants were screened for markers of human immunodeficiency virus (HIV), hepatitis C virus (HCV), and past hepatitis B virus (HBV). Titers for antibodies to hepatitis B surface antigen (anti-HBs) also were examined and compared with history of hepatitis B vaccination.

Results:

Seroprevalence for HIV, HBV, and HCV infection was 0.8%, 4.6%, and 0%, respectively. Nearly 19% of participants reported at least one bloodborne exposure in the past 6 months. The one HIV infection and all but two of the HBV infections were correlated with well-established non-occupational risk behaviors. Disposable gloves were worn by 96%, and eating, drinking, or smoking during embalming were infrequent. Sixty-one percent of FSPs reported having received one or more doses of hepatitis B vaccine at some time in the past. Of those who reported having received all three doses of vaccine, 67% had adequate titers to hepatitis B surface antibody, the marker of protection related to vaccination.

Conclusion:

Compared with prior studies of FSPs, this study found a low rate of occupational exposures and a high rate of hepatitis B vaccination, suggesting improved compliance with recommendations for preventing transmission of bloodborne pathogens in the workplace.
An Outbreak of Handscrubbing-Related Surgical Site Infections in Vascular Surgical Procedures
Authors: Grinbaum Renato S. , de Mendonça Joao Silva , Cardo Denise M.
Published: September 2009

Objective:

To investigate an outbreak of surgical site infections (SSI) in a vascular surgery unit.

Setting:

A 60-bed unit of vascular surgery, where surgeons performed an average of 30 operations per month at the Hospital do Servidor Público Estadual, a 1,000-bed tertiary care hospital in São Paulo, Brazil.

Design:

We included in the case group nine patients who had limb amputations or arterial reconstructions, October 16 through 23, 1992. We included in the control group patients whose operations were performed within 30 days of the outbreak period. Control patients were matched for sex and type of operation.

Results:

Six of 9 case patients experienced SSI, as compared with 3 of 18 control patients (P= .026) and 28 of 244 patients in the pre-epidemic period (P= .0002). Risk factors were identical for case and control groups. Factors assessed were American Society of Anesthesiology (ASA) status, duration of surgery, wound class, emergency status, remote site infections, preoperative length of stay, use of prophylactic antibiotics, and underlying diseases. Possible common sources also were analyzed. No differences were observed concerning hair removal, preoperative shower, wound dressing, and surgical team present in the operating room. During the outbreak period, the operating room was not provided with povidone-iodine, used in our hospital for skin cleansing and handscrubbing. Surgeons from all departments, including vascular surgery, used 2% iodine with 70% alcohol for skin cleansing. Surgeons from other departments used this iodine solution for handscrubbing, but the vascular surgeons used plain soap for handscrubbing. No increases in SSI rates were reported in other services. Comparison of case and control groups for handscrubbing was statistically significant (P<.00001). After reinstitution of povidone-iodine, only one SSI was diagnosed in 13 vascular procedures.

Conclusions:

Although we could not demonstrate definitely that scrubbing with plain soap was related to SSI, we found a strong suggestion of this association
Conjunctivitis in a Long-Term Care Facility
Authors: Boustcha E. , Nicolle L. E.
Published: September 2009

Objective:

To determine the prevalence, incidence, and etiology of conjunctivitis in residents of a long-term care facility.

Design:

Prospective surveillance of episodes of conjunctivitis during two 6-month periods.

Setting:

Three-building, 319-bed, multipurpose, long-term care facility including units for personal care, chronic care, palliative care, rehabilitation, respiratory rehabilitation, and chronic ventilator patients.

Results:

The incidence of conjunctivitis on different units varied from 0.6 to 3.5 per 1,000 patient-days. One building had a significantly higher rate of acute conjunctivitis and, within that facility, the most highly impaired patients had significantly more disease. Patients with chronic conjunctivitis generally were admitted with conjunctivitis; institutionally acquired conjunctivitis proceeding to chronic conjunctivitis seldom was observed except on the chronic ventilator unit. Residents with chronic conjunctivitis were significantly more likely to have a diagnosis of glaucoma, ectropion, or entropion. Potential bacterial pathogens were isolated from 3 (21%) of 14 and 24 (38%) of 69 acute episodes for which cultures were available in the two study periods. Staphylococcus aureus was the most frequent pathogen isolated. Empiric therapy was usually with topical sodium sulamyd or gentamicin, with substantial interphysician variability in prescribing patterns. Symptom duration did not differ for episodes which did or did not receive topical antimicrobials.

Conclusion:

Conjunctivitis is common in this facility and occurs with increased frequency in more highly impaired residents. Most episodes may not be due to bacterial infection. Further study of optimal management approaches to conjunctivitis is necessary
Characterization of Nosocomial Strains of Enterobacter aerogenes by Arbitrarily Primed-PCR Analysis and Ribotyping
Authors: Grattard Florence , Pozzetto Bruno , Tabard Lionel , Petit Marianne , Ros Alain , Gaudin Odette G.
Published: September 2009

Objective:

To study the spread of strains of Enterobacter aerogenes in our hospital in 1992 and 1993 by using two genotypic markers, and to evaluate these methods for the epidemiological investigation of this species.

Design:

Ribotyping (using two endonucleases) and arbitrarily primed (AP)-PCR (using two different 10-mer primers) were applied to the epidemiological typing of clinical strains of E aerogenes isolated from hospitalized patients.

Setting and Patients:

The intensive care unit (ICU; 5 patients, 13 isolates), nephrology units (3 patients, 5 isolates), and surgery units (2 patients, 2 isolates) of the university hospital of Saint-Etienne (France).

Results:

Eight epidemiologically unrelated isolates, chosen as controls, exhibited distinct profiles, both by AP-PCR and ribotyping. Two clones of E aerogenes circulated in the ICU; both were isolated successively from samples of a single patient who stayed in the unit for almost 1 year. A third clone was recovered from patients of surgery units. A fourth clone was shown to have infected patients of nephrology units.

Conclusions:

Ribotyping and AP-PCR appear to be reliable methods for typing E aerogenes strains implicated in nosocomial infection. The spread of independent clones of E aerogenes in different units of our hospital in 1992 and 1993 was demonstrated by both methods. This study emphasizes the need to choose the endonucleases or primers with care to obtain high discriminatory results in genotypic investigations.
An Introduction to Utility Measurement in Health Care
Authors: Ferguson Beryl M. , Keown Paul A.
Published: September 2009

Key decisions regarding the introduction and optimal use of health technologies often are made on an ad hoc basis. Quantitative information on effectiveness, if incorporated into the decision-making process, would establish a reasoned and defensible basis for the introduction and optimal use of therapeutic technologies. Utility measures provide a single summary score of effectiveness which, when combined with cost information, permits the calculation of cost-utility ratios for alternative technologies. A number of techniques have been developed to elicit utilities, including standard gamble, time trade-off, rating scales, the Quality of Well-Being Scale, and the Health Utility Index. No single method has been accepted yet as the gold standard. Selection therefore must be guided by the specific objectives of the assessment.
Molecular Epidemiology of Methicillin-Resistant Staphyloccocus aureus at a Low-Incidence Hospital over a 4-Year Period
Authors: Lugeon Catherine , Blanc Dominique S. , Wenger Aline , Francioli Patrick
Published: September 2009

Objective:

To study the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) over a prolonged period of time with the aid of a molecular typing method (ribotyping).

Setting:

A 1,000-bed tertiary university medical center.

Patients and Methods:

Defined epidemiological data were recorded for all patients culture-positive for MRSA between 1989 and 1992. Ribotyping of MRSA strains was performed using three restriction enzymes: EcoRv, HindHI, and KpnI.

Results:

From 1989 to 1992, MRSA was isolated from clinical specimens in 98 patients and from surveillance cultures in 27 patients. Among the 122 isolates available for typing, 26 different ribotypes were identified. In 20% of the cases, MRSA was community-acquired, and a third of these patients never had been hospitalized previously. Nine ribotypes were responsible for more than one case (2 to 64 patients); 17 appeared only once. Epidemiological data correlated with ribotyping results revealed 14 epidemiologic clusters involving six different ribotypes, whereas only three outbreaks were suspected initially. The median follow-up after the last isolation of a given ribotype was 14 months (range, 1 to 42) for clusters and 25 months (range, 1 to 46) for ribotypes that appeared only once. During clusters, only 16% of the cases occurred after the implementation of control measures in the ward (breakthrough cases).

Conclusions:

The high diversity of MRSA strains observed over 4 years suggested that new strains were introduced continuously in our hospital. Furthermore, that 17 ribotypes were isolated only once, that breakthrough cases represented only 16% of the cases in clusters, and that the follow-up duration after the last isolation of a given ribotype was more than 14 months suggest that infection control measures were effective in limiting the nosocomial spread of MRSA over a prolonged period of time.
Impact of the Bloodborne Pathogens Standard on Vaccination of Healthcare Workers with Hepatitis B Vaccine
Authors: Agerton Tracy B. , Mahoney Francis J. , Polish Louis B. , Shapiro Craig N.
Published: September 2009

Objectives:

To evaluate the impact of Occupational Safety and Health Administration (OSHA) regulations on the vaccination of healthcare workers (HCWs), to assess interpretation of these regulations, and to evaluate changes in hospital vaccination policies.

Design:

Between June 1, 1992, and August 15, 1992, a telephone survey was conducted among 150 hospitals selected randomly from participants in the American Hospital Association 1991 annual survey.

Results:

Of the 150 hospitals, 96 (64%) provided information on hepatitis B vaccination coverage of their employees. Of the 103,419 employees in these hospitals, 77,302 (75%) were eligible to receive the hepatitis B vaccine, and 38,850 (51%) of these were vaccinated completely (had received 3 doses of vaccine). Following issuance of the final regulations, 73% of hospitals reported greater employee acceptance of hepatitis B vaccine, and hospitals were more likely to offer hepatitis B vaccine to maintenance workers, security personnel, dietary staff, and clerical personnel. Seventy-five hospitals (59%) reported conducting postvaccination serologic testing on all hospital employees, 12 (8%) as a result of OSHA regulations. Twenty-three hospitals (16%) reported administering routine booster doses of hepatitis B vaccine at 3, 5, or 7 years.

Conclusions:

The new OSHA standard resulted in a greater awareness of risk for HBV infection among HCWs and an increase in the number of HCWs receiving hepatitis B vaccine; however, vaccination coverage remained suboptimal. Postvaccination serologic testing of employees with negligible risk and the routine administration of vaccine booster doses may be diverting resources and preventing comprehensive coverage of high-risk employees.
The Malcolm Baldrige National Quality Award: Implications and Uses for Healthcare Organizations
Authors: Gaucher Ellen , Kratochwill Eric
Published: September 2009

Whatever your line of business, chances are the rate of change you are experiencing is outrunning your organization's ability to keep up. This environment challenges business leaders to redesign their enterprises using revolutionary change strategies. Evolutionary change processes that were successful in the past are ineffective in the competitive global marketplace. However, several viewpoints for organizational redesign exist. For example, noted author Peter Senge believes in the importance of creating a learning organization. He argues that an “organization doesn't start out great, it learns to be great. Learning organizations are those where people continually expand their capacity to create the results they truly desire, where new expansive patterns of thinking are nurtured, where collective organization is set free, and where people are continually learning to learn together.”l Senge describes those organizations that will excel in the future as those that discover how to tap people's commitment and capacity to learn at all levels in the organization. In times of rapid change, employees' ability to analyze work processes and to improve them can be the difference between organizational success and failure. Many organizations accept this theory but have difficulty determining how to create a learning organization through empowering and energizing the work force.
An Approach to the Evaluation of Quality Indicators of the Outcome of Care in Hospitalized Patients, With a Focus on Nosocomial Infection Indicators
Authors:   The Quality Indicator Study Group
Published: September 2009

The Quality Indicator Study Group was created by the governing boards of three national professional organizations that have interest and experience in epidemiology, nosocomial infection control and prevention, and quality of care improvement. The Study Group has reviewed the existing literature concerning quality indicators (QIs), interviewed experts in the field, and focused on how best to evaluate such indicators, with an emphasis on nosocomial infection indicators as a paradigm for all QIs. In this report, we review pertinent issues and, where possible, provide specific advice on how to evaluate QIs and QI systems.
Application of CQI Tools to the Reduction in Risk of Needlestick Injury
Authors: Burnett Leslie , Chesher Doug
Published: September 2009

Objective:

To reduce the risk of needlestick injuries to laboratory workers.

Design:

Continuous Quality Improvement (CQI) tools were applied to data collected on the number of blood gas syringes that arrived in the laboratory with needles still attached and to the reasons for these occurrences.

Setting:

A clinical chemistry department within a 900-bed tertiary referral university teaching hospital.

Participants:

Clinical chemistry laboratory staff and medical staff responsible for sending syringes with needles still attached.

Interventions:

Changing to a preheparinized blood gas syringe that included a syringe cap within the packaging.

Results:

Fivefold reduction in the number of syringes arriving in the laboratory with needles still attached.

Conclusion:

The risk of needlestick injury to laboratory workers can be reduced by provision to clinical staff of preheparinized blood gas syringes that include a syringe cap within the packaging. The techniques of CQI provide powerful tools for the identification, solving, and monitoring of safety-related issues within the healthcare environment.
Subclavian Hemodialysis Catheter Infections: A Prospective, Randomized Trial of an Attachable Silver-impregnated Cuff for Prevention of Catheter-related Infections
Authors: Dahlberg Philip J. , Agger William A. , Singer James R. , Yutuc Wilfrido R. , Newcomer Kermit L. , Schaper Ana , Rooney Brenda L.
Published: September 2009

Objective:

To determine if an attachable silver-impregnated cuff is effective in reducing subclavian hemodialysis catheter-related infections.

Design:

Prospective, randomized, nonblinded study.

Setting:

Community teaching hospital.

Patients:

One hundred one acute and chronic renal failure patients requiring subclavian venipuncture and catheterization. After randomization, 47 patients underwent subclavian catheterization with a silver-impregnated cuff (Ag-CC), and 54 patients had routine catheter (RC) placements.

Measurements:

Multiple presumed predictor variables for catheter-related infections, exit site infection rate, bacteremia rates, and semiquantitative cultures of all catheters.

Results:

There were no significant differences between the AG-CC and the RC groups for catheter colonization, exit site infection, catheter sepsis, any catheter-related infections, or the incidence of infections within the first 7 or 14 days. Although the differences did not achieve statistical significance, the RC group was more likely to experience catheter colonization (20.4% versus 14.9%) and exit site infection (5.6% versus 2.1%). However, the RC group contained nearly twice as many intensive care (ICU) patients (44% versus 23%; P=.027), and ICU subjects were twice as likely to acquire catheter infection (P<.002).

Conclusions:

Although the sample size was insufficient to exclude Type 2 errors, it appears that the attachable silver-impregnated cuff did not reduce subclavian catheter-related infections in our patient population.
Developing Policies and Guidelines
Authors: Brennan Patrick J. , Abrutyn Elias
Published: September 2009

Practice guidelines are proliferating in the era of managed care. Hospital epidemiologists frequently are asked to author guidelines for infection control. The greatest challenge in the process is not writing the guidelines but implementing them. This article offers practical advice on which topic to select and on how to develop and implement guidelines.
The Certification Board of Infection Control, Inc
Authors: Pirwitz Sandy
Published: September 2009

The Certification Board of Infection Control, Inc (CBIC), was created in 1981 by the Association for Professionals in Infection Control and Epidemiology, Inc, for the sole purpose of developing and administering an examination by which competent infection control professionals could become certified. This independent, voluntary board is multidisciplinary, representing all levels of professionals in the field of infection control, as well as a consumer member. CBIC certification is the only recognized certification for infection control professionals. Since the first examination was administered in 1983, over 3,000 persons have attained infection control certification (CIC) status and are permitted to use the CIC credential.
Special Update on Healthcare Reform From The White House
Authors: Rasco Carol H.
Published: September 2009

Today, I want to touch on four different areas that I think will be of interest to you. I am going to talk about healthcare reform, quality management research within the Clinton Administration, efforts to fight on-the-job infection of healthcare workers, and the President's Childhood Immunization Initiative.
42 CFR Part 84: Respiratory Protective Devices Implications for Tuberculosis Protection
Authors: Rosenstock Linda
Published: September 2009

This final rule was made available to the public at the Government Printing Office in Washington, DC, on June 2, 1995. It was published in the Federal Register on June 8, 1995, in Part II of that issue (60 FR 110:30336). This rule addresses the National Institute for Occupational Safety and Health (NIOSH) and Department of Labor/Mine Safety and Health Administration (MSHA) certification requirements for respiratory protective devices. Specifically, the rule replaces MSHA regulations at 30 CFR Part 11 with new public health regulations at 42 CFR Part 84, while also upgrading testing requirements for particulate filters. Concurrent with NIOSH publication of this new rule, MSHA published a final rule to remove existing regulations at 30 CFR Part 11, which are made obsolete by this final rule. NIOSH now will have exclusive authority for testing and certification of respirators with the exception of certain mine emergency devices, which will continue to be jointly certified by NIOSH and MSHA.
The Effect of Respirator Training on the Ability of Healthcare Workers to Pass a Qualitative Fit Test
Authors: Hannum Donna , Cycan Kerrie , Jones Linda , Stewart Melinda , Morris Steve , Markowitz Sheldon M. , Wong Edward S.
Published: September 2009

Objectives:

To determine the effect of different methods of training on the ability of hospital workers to wear respirators and pass a qualitative fit test, and to compare the direct cost of the training.

Design:

179 hospital employees were recruited for study and were stratified into three groups based on the type of training they received in the use of respirators. Employees in Group A received one-on-one training by the hospital's industrial hygienist and were fit tested as part of this training. Employees in Group B received classroom instruction and demonstration by infection control nurses in the proper use of respirators, but were not fit tested as part of training. Employees in Group C received no formal training. Each participant in our study underwent a subsequent qualitative fit test using irritant smoke to check for the employee's ability to adjust correctly the fit and seal of the respirator. The direct cost of each method of training was determined by accounting for the cost of trainers and the cost of employee-hours lost during training.

Setting:

775-bed Veterans' Affairs hospital.

Results:

94% of Group A participants (49 of 52) passed the qualitative fit test, compared to 91% of Group B participants (58 of 64) and 79% of Group C participants (50 of 63; P=.036, 2 × 3 chi-square). Group A had a significantly higher pass rate than Group C (P=.043), but Group B did not differ significantly from Group A or Group C. Location or professional status did not affect pass rate, but prior experience wearing respirators did. When the study groups were compared after stratifying for prior experience, we found no difference in pass rates, except when Groups A and B (those with any training) were combined and compared with Group C (107 of 116 versus 50 of 63, P=.05, Mantel-Haenszel chi-square).

We estimate that the method of training involving individual instruction followed by fit testing took 20 minutes per employee to complete, compared to 10 minutes per six employee class for the method of classroom demonstration. The difference in direct cost between the two methods, applied to the training of 1,200 employees at our hospital, would be approximately $19,000 per year.

Conclusion:

Our study indicates that training in the proper use of respirators is important, but the method of training may not be, as the two methods we evaluated were nearly equivalent in their pass rates on fit testing (94% versus 91%). Fit testing as part of training may have enhanced the performance of our participants marginally, but was more time consuming and accounted for most of the excess cost.
Staphylococcus epidermidis Catheter-Related Infections in a Short-Bowel Patient. Persistence of a Single Strain Over a Two-Year Period
Authors: Voss Andreas , Melchers Willem J.G. , Bijl Diana , Hoogkamp-Korstanje Jacomina A.A. , Meis Jacques F.G.M.
Published: September 2009

We report the case of a patient with short-bowel syndrome, who lost multiple central venous devices over the course of 2 years while treating his catheter-related septicemia. Genotyping proved that all infectious episodes were caused by a single genotype of a Staphylococcus epidermidis strain, persisting over time
Attitudes, Practices, and Infection Risks of Hemophilia Treatment Center Nurses Who Teach Infection Control for the Home
Authors: Lobato Mark N. , Hannan Judith , Simonds R.J. , Riske Brenda , Evatt Bruce L.
Published: September 2009

Objective:

To examine the practices toward infection control training and to assess the attitudes about, and risks for, exposures to blood among hemophilia treatment center (HTC) nurses who teach home infusion therapy (HIT).

Design and Population:

Written and telephone interview surveys of the 153 nurses who teach HIT at federally funded HTCs.

Main Outcome Measures:

Hemophilia treatment center nurses' teaching practices and infection control messages taught, and frequency of exposures to blood.

Results:

The response rate to the written nurses' survey was 60% and to the telephone interview 88%. Nurses taught patients a median of three HIT sessions totaling 4 hours of instruction. Reevaluation of patients' HIT practices took place every 6 months by 22% and every 12 months by 59% of nurses. Nurses frequently reported teaching proper use of a sharps disposal container (99%) and gloves (93%), but less often reported teaching patients to wash hands after infusions (26%) and to report needlestick injuries to HTCs (11%). The respondents identified several barriers to effective infection control as it is practiced in the home by patients. Although at least 30% of HTC nurses recalled having had percutaneous exposure to blood, they considered their risk for hepatitis B infection low but greater than for infection with the human immunodeficiency virus (HIV).

Conclusions:

While some important infection control messages are stressed during HIT teaching, others may be underemphasized. Failure to instruct patients about all infection control precautions may be related to nurse educators' perception of low to moderate personal risk for hepatitis B and HIV infection. Patients receiving HIT, and those who assist them, need to be fully aware of, and to have reinforced periodically, universal infection control strategies in the home.
Three-Year Outbreak of Pseudobacteremia With Burkholderia cepacia Traced to a Contaminated Blood Gas Analyzer
Authors: Gravel-Tropper Denise , Sample Mary Lee , Oxley Catherine , Toye Baldwin , Woods Donald E. , Garber Gary E.
Published: September 2009

Between November 1990 and June 1993, Burkholderia cepacia was isolated from the blood cultures of 13 neonates born at the Ottawa General Hospital. Eight of the 13 neonates appeared symptomatic, and only 4 were treated with appropriate antimicrobial therapy, but all improved clinically. In August 1993, the blood gas analyzer in the neonatal intensive-care unit was found to be contaminated heavily with B cepacia. Eight available patient isolates were identical to the isolates recovered from the blood gas analyzer by ribotyping analysis. Infection control measures were implemented to prevent future contamination of the analyzer, and no further cases have been identified.
An Outbreak of Burkholderia cepacia Lower Respiratory Tract Infection Associated With Contaminated Albuterol Nebulization Solution
Authors: Reboli A.C. , Koshinski R. , Arias K. , Marks-Austin K. , Stieritz D. , Stull T.L.
Published: September 2009

An outbreak of Burkholderia cepacia lower respiratory tract colonization and infection occurred in the adult intensive-care units in various geographic locations throughout our hospital. Forty-four patients became colonized or infected over an 11-month period, whereas B cepacia had been isolated from only 13 patients in the preceding 48 months. Environmental cultures revealed the source to be extrinsically contaminated albuterol nebulization solution. Polymerase chain reaction-ribotyping confirmed the genetic relatedness of the B cepacia patient isolates and the contaminated albuterol. After extensive infection control training for the respiratory therapy staff, including attention to nebulization technique, washing and drying the nebulizer cup, and good handwashing, there have not been any new cases.
Surveillance for Infections Associated With Vascular Catheters
Authors: Sherertz Robert J.
Published: September 2009

Intravascular devices are the source of most primary bloodstream infections. Unfortunately, there are few studies that demonstrate how surveillance for catheter-related infection should be done. This article attempts to provide infection control personnel with information necessary to develop such surveillance.
Management of Healthcare Workers With Pharyngitis or Suspected Streptococcal Infections
Authors: Weber David Jay , Rutala William A. , Denny Floyd W.
Published: September 2009

The group A streptococcus may cause pharyngitis, rheumatic fever, streptococcal toxic shock syndrome, and serious skin and soft-tissue infections. More than 50 nosocomial outbreaks have been reported since 1966. For this reason, healthcare facilities should develop policies for the diagnosis and treatment of symptomatic hospital employees, and for the recognition and management of potential outbreaks. The clinical diagnosis of streptococcal pharyngitis is unreliable. Rapid streptococcal tests may be used for initial screening, but a negative rapid test should be confirmed with a properly obtained culture. Penicillin remains the treatment of choice, but new alternatives now include a 5-day course of either azithromycin or cefpodoxime.
Pediatric Primary Gram-Negative Nosocomial Bacteremia: A Possible Relationship With Infusate Contamination
Authors: Macías-Hernández Alejandro E. , Hernández-Ramos Isabel , Muñoz-Barrett Juan M. , Vargas-Salado Enrique , Guerrero-Martínez Francisco J. , Medina-Valdovinos Humberto , Hernández-Hernández Jesus , Ponce-de-León-Rosales Samuel
Published: September 2009

Objective: To evaluate the potential contribution of “extrinsic” contamination of intravenous fluids in hospital bacteremia and infection.

Design: Prospective cross-sectional survey of infusate contamination, December 1992 to December 1993.

Setting: A pediatric department (1,500 admissions per year) in a general, urban teaching hospital, serving low-income patients.

Samples and Patients: Infusate samples (0.5 to 1.0 mL) from the injection port used by the staff were taken for cultures from all febrile or septic patients in hospital wards. At least four samples were taken each day; if no febrile or septic patients were available, other patients were sampled at convenience.

Results: A 6.8% positive culture rate (87 contaminates in 1,277 infusates) was obtained, without significant differences among the wards. Gram-negative organisms were recovered from 56 samples (62.9%), mainly of the tribe Klebsielleae (56.1%). Coagulase-negative staphylococci were isolated in 30 samples (33.7%). There was no significant difference between the febrile-septic group and the asymptomatic group in the rate of infusate contamination (P=.59). In eight patients, the same organisms were recovered from infusate and blood culture. The overall bacteremia rate was 2.5 per 100 discharges.

Conclusions: Compared to previous reports, higher infusate contamination rates and different organisms (mainly gram-negative) were observed. In hospitals of underdeveloped countries, nosocomial infection control frequently is disregarded. Infusate contamination may be common and could lead to gram-negative bacteremia. In such settings, it seems advisable to perform surveillance studies to identify infusate contamination, because a single infusate contamination could be a signal for an epidemic.
Control of Endemic Glycopeptide-Resistant Enterococci
Authors: Dembry Louise M. , Uzokwe Keke , Zervos Marcus J.
Published: September 2009

Objective: To evaluate the epidemiology of, and control measures for, vancomycin-resistant Enterococcus (VRE) in a renal unit.

Design: A 3-month, prospective, prevalence culture survey of patients on a 24-bed renal unit.

Setting: A 975-bed community teaching hospital.

Patients: Patients admitted to the renal unit over a 3-month period. Patients identified with VRE were each matched with four patients without VRE isolated over the study period.

Interventions/Control Measures: Resistant-organism barrier precautions. To eradicate carriage of VRE, two patients with VRE stool colonization were treated with 5 days of oral doxycycline (100 mg twice per day) and rifampin (300 mg/day).

Results: Seven patients with VRE (8 isolates) were identified. Five isolates were Enterococcus faecium (vancomycin MIC=16 to 256 μg/mL), two were Enterococcus faecalis (MICs=16 and 124 μg/mL), and one was Enterococcus gallinarum (MIC=8.0 μg/mL). Eradication of carriage with VRE was accomplished in two patients treated with doxycycline and rifampin. In the final 30 days of the culture survey and at 9 months, there were no further patients with VRE identified.

Conclusions: Resistant-organism precautions and elimination of patient carriage may be useful measures for controlling the spread of low-prevalence endemic vancomycin-resistant Enterococcus.
Nosocomial Infections in Spain: Results of Five Nationwide Serial Prevalence Surveys (EPINE Project, 1990–1994)
Authors: Vaqué Josep , Rosselló José , Trilla Antoni , Monge Vicente , García-Caballero Juan , Arribas José L. , Blasco Pedro , Sáenz-Domínguez José R. , Albero Inma , Calbo Francisco , Barrio Josep , Herruzo Rafael , Sáenz-González Carmen , Arévalo José M. ,   EPINE Working Group
Published: September 2009

Objective: To determine trends in rates of nosocomial infections in Spanish hospitals.

Design: Prospective prevalence studies, performed yearly from 1990 through 1994.

Setting: A convenience sample of acute-care Spanish hospitals.

Participants and Patients: The number of hospitals and patients included were as follows: 1990, 125 hospitals and 38,489 patients; 1991, 136 and 42,185; 1992, 163 and 44,343; 1993, 171 and 46,983; 1994, 186 and 49,689. A core sample of 74 hospitals, which participated in all five surveys and included a mean of 23,871 patients per year, was analyzed separately.

Results: The overall prevalence rate of patients with nosocomial infections in the five studies was as follows: 1990, 8.5%; 1991, 7.8%; 1992, 7.3%; 1993, 7.1%; and 1994, 7.2%. The prevalence rate of patients with nosocomial infection in the core sample of 74 hospitals was 8.9%, 8.0%, 7.4%, 7.6%, and 7.6%, respectively (test for trend, P=.0001). Patients admitted to intensive care units had a 22.8% prevalence rate of nosocomial infection in 1994. The most common nosocomial infections by primary site were urinary tract infection and surgical site infections, followed by respiratory tract infections and bacteremia. More than 60% of all infections were supported by a microbiological diagnosis.

Conclusions: The EPINE project provides a uniform tool for performing limited surveillance of nosocomial infections in most Spanish acute-care hospitals. Its use helps to spread an accepted set of definitions and methods for nosocomial infection control in the Spanish healthcare system. The surveys indicate that the prevalence of nosocomial infections has been reduced over the last 5 years in a core sample of Spanish hospitals.
Vancomycin Use in a University Medical Center: Comparison With Hospital Infection Control Practices Advisory Committee Guidelines
Authors: Evans Martin E. , Kortas Kenneth J.
Published: September 2009

Objective: To compare actual vancomycin use in a hospital with the guidelines proposed by the Hospital Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention.

Design: One-month prospective survey of all patients given vancomycin. Data were collected from patient and laboratory records and discussions with prescribing physicians.

Setting: Four hundred sixty-one–bed tertiary-care university hospital.

Results: Only 35% of the 101 vancomycin orders written during the audit were consistent with HICPAC guidelines. Twenty-eight patients were begun on vancomycin for the treatment of documented infections due to β-lactam–resistant gram-positive bacteria or because preliminary culture results suggested such bacteria were present. Seven methicillin-resistant Staphylococcus aureus, two ampicillin-resistant enterococci, and 10 coagulase-negative staphylococci were recovered. Vancomycin use was judged inappropriate in 66 patients. The drug was used empirically without obtaining appropriate cultures (44 patients), as surgical prophylaxis (6 patients), for primary treatment of antibiotic-associated colitis (3 patients), for convenience in a hemodialysis patient (1 patient), or for other reasons not recommended by HICPAC (12 patients).

Conclusions: Vancomycin use in our teaching center often was inconsistent with HICPAC guidelines. Information from the audit will be useful for designing strategies to improve vancomycin use.
Control of Construction-Associated Nosocomial Aspergillosis in an Antiquated Hematology Unit
Authors: Loo Vivian G. , Bertrand Céline , Dixon Catherine , Vityé Debbie , DeSalis Beverley , McLean A.P.H. , Brox Alan , Robson Hugh G.
Published: September 2009

Objective: To determine the incidence of aspergillosis in patients with leukemia or bone marrow transplants during a construction-associated outbreak, and the effect of an environmental control program for Aspergillus.

Design: Clinical, microbiological, and pathological records were reviewed retrospectively once the outbreak was appreciated, and prospectively thereafter, to determine the presence or absence of aspergillosis and duration of neutropenia.

Setting: A university tertiary-care center with a single designated hematology-oncology unit.

Patients: From January 1988 to September 1993, there were 141 patients with leukemia or bone marrow transplants identified as being neutropenic during 231 admissions to this specialized unit.

Interventions: Installation of wall-mounted portable high-efficiency particulate air (HEPA)-filter air purifiers, application of copper-8-quinolinolate–formulated paint, replacement of perforated ceiling tiles with nonperforated type, sealing of all windows, replacement of horizontal, dust-accumulating blinds with vinyl, opaque, roller shades, and systematic and regular cleaning of surfaces.

Results: Thirty-six cases of nosocomial aspergillosis were diagnosed during this period. The incidence density (ID) in the preconstruction period was 3.18 per 1,000 days at risk. During construction activity—before the implementation of a control strategy—the ID increased dramatically to 9.88 per 1,000 days at risk. With infection control measures implemented and continued construction work, the ID decreased to 2.91 per 1,000 days at risk, comparable to the preconstruction baseline rate.

Conclusions: An environmental control strategy incorporating widely available technology may have played an important role in controlling this outbreak of construction-associated invasive aspergillosis.
Primary Cutaneous Aspergillosis: Case Report and Review of the Literature
Authors: Larkin Julie A. , Greene John N. , Sandin Ramon L. , Houston Sally H.
Published: September 2009

Primary cutaneous aspergillosis is an uncommon entity that may occur in immunosuppressed hosts, usually resulting from contact with contaminated medical devices used in patient care. The infection spreads locally with subsequent skin necrosis due to angioinvasion and thrombosis. We report primary cutaneous aspergillosis following contact with contaminated gauze, and we review the relevant literature.
Nosocomial Infection Due to Vibrio cholerae in Two Referral Hospitals in Guatemala
Authors: Hernández Jaime E. , Mejía Carlos R. , Cazali Iris L. , Arathoon Eduardo G.
Published: September 2009

We report nosocomial infection with Vibrio cholerae 01, in four seriously ill individuals and one infant in Guatemala. Nosocomial cholera occurs in developing countries in Latin America and should be suspected in hospitalized patients with diarrhea, especially during community outbreaks, in order to institute appropriate diagnostic, therapeutic, and control measures.
Trends in the Prevalence of Methicillin-Resistant Staphylococcus aureus Associated With Discontinuation of an Isolation Policy
Authors: Fazal Barkat A. , Telzak Edward E. , Blum Steve , Turett Glenn S. , Petersen-Fitzpatrick Frances E. , Lorian Victor
Published: September 2009

The number of patients with methicillin-resistant Staphylococcus aureus (MRSA) before and after discontinuing placement of patients into private rooms was determined. The mean monthly number of patients with MRSA decreased from 34 to 22, and the proportion of S aureus isolates that were MRSA decreased from 34% to 20%. We found no evidence that failure to isolate patients with MRSA resulted in an increased prevalence of MRSA.
Risk Factors for Ventilator-Associated Pneumonia in Surgical Intensive-Care–Unit Patients
Authors: Beck-Sague Consuelo M. , Sinkowitz Ronda L. , Chinn Raymond Y. , Vargo Judy , Kaler Wendy , Jarvis William R.
Published: September 2009

Patients admitted during the study period to the Sharp Memorial Hospital intensive-care units who required mechanical ventilation were followed prospectively; 15 (10.4%) of 145 acquired ventilator-associated pneumonia (VAP). Duration of prior oral or nasal intubation and H2 receptor antagonists use were longer among patients who developed VAP than among those who did not. Prior cefazolin use was associated with a higher rate of VAP (11 of 63 [17%] versus 4 of 82 [5%], P=.01).
Disinfection and Sterilization of Patient-Care Items
Authors: Herwaldt Loreen A. , Rutala William A.
Published: September 2009

This article provides recommendations on the preferred method for disinfection and sterilization of patient-care items based on the intended use of the item (ie, critical, semicritical, noncritical). The chemical disinfectants recommended for patient-care items and instruments include glutaraldehyde, hydrogen peroxide, peracetic acid, sodium hypochlorite, alcohol, iodophors, phenolics, and quaternary ammonium compounds. The choice of disinfectant, concentration, and exposure time is based on the risk of infection associated with the use of the item. The sterilization methods briefly discussed include steam sterilization, ethylene oxide, dry heat, and the new low-temperature sterilization technologies. When properly used, these disinfection and sterilization processes can ensure the safe use of invasive and noninvasive medical devices. However, this requires strict adherence to current cleaning, disinfection, and sterilization guidelines.
Comparison of a Rapid Readout Biological Indicator for Steam Sterilization With Four Conventional Biological Indicators and Five Chemical Indicators
Authors: Rutala William A. , Jones Suzanne M. , Weber David J.
Published: September 2009

Objective: In this study, we compare a new biological indicator that provides results within 3 hours with four conventional, 48-hour biological indicators and five chemical indicators.

Design: Biological indicators tested included the conventional Attest 1262, Proof Plus, Assert, and Biosign, and the new Attest 1292 Rapid Readout biological indicator. Chemical indicators tested included Comply, Propper, Chemdi, Sterigage, and Thermalog S. Spore survival following 121°C in a gravity displacement sterilizer was measured by media color change after incubation for 24 and 48 hours at 56°C for the conventional biological indicators, fluorescence at 3 hours for the Attest 1292 Rapid Readout biological indicator, and color change for the chemical indicators. Each exposure time was replicated 12 times with five samples of each indicator per run (ie, 60 replicates per indicator).

Results: At 48 hours, the conventional biological indicators Attest 1262, Proof Plus, Assert, and Biosign showed 100%, 95%, 88%, and 93% spore survival at 5 minutes' exposure; 0%, 0%, 0%, and 8% at 10 minutes; and all showed 0% survival at 15 minutes' exposure. Following a 3hour incubation, the Attest 1292 Rapid Readout biological indicator showed fluorescence at 100%, 72%, and 0% at 5, 10, and 15 minutes, respectively. The chemical indicators Comply, Propper, Chemdi, Sterigage, and Thermalog S revealed sterilization failure rates of 100%, 100%, 100%, 100%, and 100% at 5 minutes' exposure; 0%, 0%, 0%, 92%, and 100% at 10 minutes; and, 0%, 0%, 0%, 3%, and 27% at 15 minutes' exposure, respectively.

Conclusions: The sensitivity of the Attest 1292 Rapid Readout biological indicator parallels that of conventional biological indicators. These data suggest that a 3hour rapid readout biological indicator is equivalent to a standard 48-hour biological indicator. Some chemical indicators (eg, Thermalog S) failed to indicate adequate sterilization at 15 minutes' exposure. These chemical indicators have the potential of causing unnecessary recall of adequately sterilized items.