bluuebunny/crossref_metadata_2025 huggingface dataset:
Brief Report: Tuberculin Testing, BCG in Pregnancy
Authors: Gillum Michael D. , Maki Dennis G.
Published: September 2009

The issue of tuberculin skin testing in pregnant health care workers of third-world ethnicity who may have previously received bacille Calmette-Guerin (BCG) immunization is complex and multifaceted. The relevant issues are:

• Is tuberculin skin testing safe in the pregnant female?

• Is tuberculin skin testing indicated in the pregnant female?

• Is tuberculin skin testing accurate and reliable in the pregnant female?

• Does previous BCG vaccination alter the diagnostic utility of tuberculin skin testing?

• Finally, is tuberculin skin testing safe in the BCG-immunized pregnant female?

Is tuberculin skin testing safe in the pregnant female?

When purified protein derivative (PPD) tuberculin is injected locally into the skin, most of it is removed within hours by lymphocytes. The remainder is engulfed by macrophages, and a mild brief local inflammatory reaction develops in both nonsensitive and hypersensitive patients. The reaction goes no further in the nonsen-sitized patient. In the sensitized patient-who has had Mycobacterium tuberculosis infection in the past-the area becomes heavily infiltrated by mononuclear cells, and an inflammatory reaction continues to increase for several days.
Butoconazole Nitrate
Authors: Tatum Demetris M. , Eggleston Mark
Published: September 2009

Imidazoles and their derivatives have been proven very effective in the treatment of fungal infections. Butoconazole nitrate is an important addition to this class of antifungal agents. It was introduced to the market in for the short-term management of vaginal infections caused by Candida species. It has high activity, against Candida albicans in vitro and is very effective clinically.

Butoconazole nitrate is an imidazole derivative with potent antifungal activity in vivo and in vitro (Figure). When synthesized, it exists as a racemic mixture in which both components are optical isomers and equally active.
The Trach Care™ Closed Tracheal Suction System: A New Medical Device to Permit Tracheal Suctioning Without Interruption of Ventilatory Assistance
Authors: Mayhall C. Glen
Published: September 2009

Many new medical devices have been introduced into the market over the last two decades with the aim of improving medical care. Recently, a new device, Trach Care’”, has been introduced by Ballard Medical Products. device has been designed to allow endotracheal suctioning of intubated patients on ventilatory support without having to disconnect the patient from the ventilator.

‘The Trach Care’” device has three major components. The T-piece is the component nearest the patient. It has a limb for connection to the endotracheal tube or tracheos-torny, a limb for connection to the ventilator, and a limb for introduction of the catheter. The remaining limb is covered by a plastic cap. On the limb through which the catheter is introduced, there is a port for infection of irrigation fluid. The second component is the catheter with its protective sheath. The third component, a control valve, is connected to the opposite end of the catheter and sheath. Opposite the insertion of the catheter on the control valve there is a port for connection to the wall suction tubing. When the control valve is opened, the vacuum from the wall suction tubing is applied to the catheter. The control valve may be locked in the “off position. When the Trach Care™ device is placed into the ventilator circuit, the trachea can be suctioned without interruption of ventilatory support.
Legal Comment, Part I: Basics of Liability Law
Authors: Hesson William W. , Thu Cynthia W.
Published: September 2009

This article, the first in a series that will explore the legal implications of hospital infection control, outlines the basic legal principles applicable to infection control. Future articles will discuss the issue of confidentiality and apply general principles to the specific issues surrounding AIDS.

In order to succeed in a medical malpractice action, the plaintiff must demonstrate by a preponderance of the evidence that: (1) the defendant(s) had a duty to act in a particular manner; (2) the defendant(s) negligently breached that duty; (3) the plaintiff suffered some “harm” or injury; and (4) the harm suffered by the plaintiff was causally related to the breach of duty.'

Physicians and hospitals have a duty, once a patient care provider relationship has been created, to provide care to the best of their skill, training, and experience.' A significant aspect of that duty for hospitals is the creation and maintenance of an environment that is safe from unnecessary risk of infection or harm.
Malassezia furfurSkin Colonization in Infancy
Authors: Bell Louis M. , Alpert Gershon , Slight Paula Horton , Campos Joseph M.
Published: September 2009

Malassezia furfur, a lipophilic yeast, has become recognized as a cause of sepsis in infants receiving parenteral fat emulsions via indwelling deep venous catheters. Colonization of infants' skin may be a prerequisite to colonization of the intravascular catheter and subsequent infection withM furfur. Three hundred ninety-three surveillance cultures were performed on 146 infants during their first 12 weeks of hospitalization in the intensive care unit (ICU) or the neonatal transitional unit (NTU). In addition, 47 full-term newborn infants and 38 healthy infants in the well-baby clinic were cultured. Colonization rates were greatest (48%) during the second month of hospitalization for the infants in the ICU/NTU group. In contrast, 0 of 47 newborn infants and 2 of 38 healthy infants were colonized. Prematurity and a prolonged length of stay were identified as risk factors for colonization.
Infection Rate for Single Lumen v Triple Lumen Subclavian Catheters
Authors: Yeung Carole , May John , Hughes Roger
Published: September 2009

An infection rate was calculated for all subclavian catheters inserted during a 12-month period. The overall, single lumen, and triple lumen infection rates were 1.7% (42/2,431), 0.4% (8/1,936), and 6.9% (34/495), respectively. After excluding single lumen catheters in patients in a surgical cardiovascular unit who appeared to have a decreased risk of infection, the overall, single lumen, and triple lumen rates were 3.7% (42/1,140), 1.2% (8/645), and 6.9% (34/495), respectively. Within this group, 11.8% (281237) of the catheters used for total parenteral nutrition (TPN) were infected, whereas 1.6% (14/903) of the non-TPN catheters were infected. Of patients receiving total parental nutrition through a triple lumen catheter, 14.5% (25/172) became infected, whereas 4.6% (3/65) of the patients receiving total parental nutrition through a single lumen catheter became infected. Single and triple lumen patient groups appeared comparable based on average age, death rate, immunosuppression, underlying disease, and duration of catheterization, but the risk of infection was approximately three times greater for patients receiving total parental nutrition through a triple lumen catheter.
Infection Control in Maryland Nursing Homes
Authors: Khabbaz Rima F. , Tenney James H.
Published: September 2009

We surveyed 53 randomly chosen Maryland nursing homes for infection control policies and practices. The majority had written infection control policies, an infection control committee, and a designated practitioner for infection control; in most facilities, however, the infection control practitioner had other major duties, spent little time on infection control, and had no specific training in the field. Thirty-four percent of homes in the survey performed routine environmental cultures, and more than half had insufficient or no isolation policies for infected decubiti and acute diarrhea. In general, the intensity of infection surveillance and the extent of infection control measures increased with the level of care provided, from domiciliary homes to homes providing chronic care. Employee health care fared generally well: 60% of homes offered influenza vaccine to employees and 66% had restriction policies for employees with upper respiratory infections. While the majority of homes offered the influenza vaccine to residents, acceptance of other vaccines recommended for the elderly was less widespread. We conclude that infection control efforts are made in most Maryland nursing homes; however, appropriate guidelines and more effort to educate nursing home personnel in proper infection control practices are badly needed.
A Survey of SHEA Members on Universal Precautions and HIV Screening
Authors: Miller Patti J. , Farr Barry M.
Published: September 2009

The Centers for Disease Control (CDC) have recommended that health care workers use appropriate barriers, referred to as universal precautions, to protect themselves against exposure to the blood and body fluids of all patients. The CDC has suggested that the use of universal precautions eliminates the need for the isolation category blood and body fluid precautions (BBFP). There has been discussion concerning the feasibility of applying these precautions to all patients. Tangential issues involving screening of all hospitalized patients and whether or not informed consent should be required before such testing occurs are also being debated.

The purpose of the current study was to survey those attending a meeting of The Society of Hospital Epidemiologists of America (SHEA) in October 1987 to determine their opinions on these issues and their hospitals' actual practices with regard to universal precautions, human immunodeficiency virus (HIV) screening, and informed consent.
Along the Data-Information Continuum: Pitfalls and Opportunities
Authors: Crede William B. , Hierholzer Walter J.
Published: September 2009

The need for accurate data concerning nosocomial infections has long been appreciated by infection control practitioners. Several major changes in the health delivery environment have highlighted for other care givers and managers the importance of, and indeed necessity of high-quality clinical and financial hospital information. Since 1983, the Medicare prospective payment system (PPS) has used the medical record discharge abstract as the hospital bill. This has created a need for more detailed clinical information in hospital information systems. In several states, all third-party reimbursers are using PPS variants, further strengthening this incentive. The “Agenda for Change” of the Joint Commission on Accreditation of Healthcare Organizations has created further pressure on hospitals to acquire information concerning the quality of care at their own facility, as well as comparative statistics from other facilities. Although trade journals extol the virtues of “good data sets,” and much academic study has been given to individual facets of data processing and handling, the practical aspects of hospital information opportunities and problems have been largely ignored. The purpose of this article is to discuss the nature of hospital data; to detail available sources of national, regional, and local hospital statistics; to delineate potential quality problems common to many types of hospital information; and to discuss difficulties with and solutions to some hospital data application problems.
Capnocytophaga
Authors: Sinnott John T. , Cullison James P. , Blanco Patricia Juarez
Published: September 2009

The genus Capnocytophaga includes three bacterial species: Capnocytophaga ochracea, Capnocytophaga sputigena, and Capnocytophaga gingivalis. Although occasionally found in soil and water, the predominant natural habitat of Capnocytophaga species is the human oropharynx. These organisms are also found throughout the human gastrointestinal tract as well as in the vagina. Initially implicated only in the pathogenesis of periodontal disease, Capnocytophaga has recently been recognized both as an opportunistic pathogen in the immunocompromised host and also as a pathogen associated with a variety of infections in the immunocompetent host. The protean manifestations of infection and the enlarging pathogenic spectrum of Capnocytophaga. disease mandate a high index of diagnostic suspicion on the part of the clinician.
The Israeli Study of Surgical Infections (ISSI): I. Methods for Developing a Standardized Surveillance System for a Multicenter Study of Surgical Infections
Authors: Simchen Elisheva , Wax Yohanan , Pevsner Bella , Erdal Mary , Michel Jacques , Modan Michaela , Rubinstein Eitan , Sacks Theodore , Shapiro Mervyn , Tevaglioglo Bilha
Published: September 2009

The postoperative wound infection experience in 11 Israeli hospitals was investigated with two objectives: (1) to utilize the variability among hospitals for a better understanding of the determinants of these infections, and (2) to present surgeons and infection control teams with information upon which they can take action. This article summarizes the methods that were applied to maximize the uniformity of information obtained from hospitals. (1) The same kind of patients were sampled in every hospital. (2) The data collection system was standardized, and analyzed for errors. The overall error rate was small (2%) but there were potential problem areas, such as missing information on underlying diagnoses (12%). Few errors (1%) were found in the nurses' observations of the wounds. (3) All wound infections were diagnosed in a uniform manner by convening a panel of four specialists at the central Israeli Study of Surgical Infections (ISSI) office. (4) The definition of infection that was finally chosen for this multicenter study had to be broadened to include, in addition to pus, “discharge other than pus,” because of the higher reliability among panel members. This definition was also clinically valid in terms of morbidity. (5) The rate of postdischarge infections was estimated and was not found to be related to the discharge policies in the various hospitals.
The Israeli Study of Surgical Infections (ISSI): II. Initial Comparisons Among Hospitals with Special Focus on Hernia Operations
Authors: Simchen Elisheva , Wax Yohanan , Pevsner Bella
Published: September 2009

In a study of 5,571 patients from the general surgery departments of 11 Israeli hospitals, the crude overall wound infection rates showed interhospital heterogeneity. The rates ranged from 6.3% to 12.4% (P(X2) = 0.039). Controlling for the different distributions of procedures performed in the various institutions did not reduce this variability. None of the hospitals had either consistently high or consistently low infection rates. A hospital could have low rates for one procedure and high rates for another. Therefore, the decision was made to proceed with procedure-specific analyses. This article details results of the analysis of 1,487 hernia operations. Four variables (old age, infection at another site, incarceration, and introduction of drains) accounted for almost all the differences in infection rates among the institutions. Of the four, presence of drains had the strongest association with infection (P derived from the logistic model <0.001). The risk was consistent in all hospitals and was unconfounded by other measurable factors. In contrast, the pattern of using drains seemed arbitrary and inconsistent, ranging from 9% of patients in one hospital to 41% in another. These findings were used as a basis for discussion with the surgical teams and for the initiation of a randomized clinical trial on the use of drains in hernia operations.
Surgical Complications Related to Insertion of Penile Prostheses with Emphasis on Infection and Cost
Authors: Goetz Angella , Yu Victor L. , O'Donnell Walter F.
Published: September 2009

We initiated a prospective study of penile prosthesis implant surgery to evaluate risk factors for infection and other complications. Twenty-one patients admitted for surgery or related complications were evaluated over a seven-month period. The two types of penile prostheses implanted were (1) inflatable and (2) semirigid. Nine of 21 patients (43%) developed postoperative complications. Although cephapirin and gentamicin were given prophylactically, four of nine patients had four wound infections and one case of pneumonia. One case of Bacteroides fragilis bacteremia was due to stool incontinency during surgery. In two of the wound infections, removal and reinsertion of the prosthesis was necessary. Other complications included hypotension during surgery, prosthesis malfunction and malposition, and urethral tears. There were no significant associations between infection and age, length of surgery, or type of prosthesis used. These complications contributed to prolonged hospital stay and readmission (87 extra days for the infected patients at a cost of $44,000). Antibiotic costs to treat the infections totaled $1,900. Prospective evaluation by infection control practitioners of various elective surgeries can be useful in quantitating the complication rate and targeting patients at risk, with the goal of minimizing hospital costs.
Cost-Effective Eradication of an Outbreak of Methicillin-Resistant Staphylococcus aureus in a Community Teaching Hospital
Authors: Rao Nalini , Jacobs Sharon , Joyce Linda
Published: September 2009

During an eight-month period, 25 hospitalized patients became infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA) in a 464-bed acute care, medical-surgical teaching hospital. There were only five cases during the eight months prior to the outbreak period (P < 0.0001). Initial measures, including category-specific isolation and education, did not limit the spread of the outbreak of a strain of MRSA. This prompted institution of additional measures including (1) strict isolation of all infected and colonized cases; (2) prospective microbiological surveillance to detect additional cases; (3) multiple site cultures of identified cases to determine the extent of colonization; (4) employee and environment surveillance; (5) antibiotic decolonization of patients and employees; and (6) educational efforts. The highest number of personnel carriers were noted in one of the critical care units where most of the cases occurred. The decolonization protocol was 100% effective for personnel carriers. The incidence of nosocomial cases of MRSA fell to zero in the five months following the implementation of the strategy. The cost of the entire eradication process was approximately half that of treating a single MRSA bacteremia.
Eradication of Low-Level Methicillin-Resistant Staphylococcus aureus Skin Colonization with Topical Mupirocin
Authors: Denning David W. , Haiduven-Griffiths Donna
Published: September 2009

Methicillin-resistant Staphylococcus aureus (MKSA) infections have become a major problem in many US hospitals in the last ten years.‘,’ Attempts to solve the problem have been hampered by many factors. One of these factors is the difficulty in eradicating the organism from colonized sites and thereby removing one of the reservoirs of endemicity. Another complicating factor is the lack of consistency in the published literature regarding what constitutes eradication and, therefore, when it is appropriate to discontinue isolation of patients or work restrictions of personnel. Even the decisions regarding when and how often to culture personnel remain difficult to define.” Finally, although the Australian experience illustrated an environmental component to an MRSA outbreak, the role of the environment in MRSA infections remains unclear. The following report describes the measures utilized to eradicate low-level MRSA skin colonization in a long-term psychiatric patient and illustrates several problems of-long-term MRSA carriage in institutionalized patients.
Susceptibility Testing Today: Myth, Reality, and New Direction
Authors: Stratton Charles W.
Published: September 2009

Recent concerns about the clinical relevance of susceptibility testing echo those expressed previously by a number of authors.’-” These concerns are well founded and are perhaps even more important today because of the proliferation of new antibiotics and the changes in reimbursement philosophy.” Ultimately, the question becomes that raised by David Greenwood: “In vitro veritas?” The following discussion will review the role of susceptibility testing in clinical medicine with emphasis on myth versus reality. In addition, new directions for susceptibility testing that promise increased clinical relevance will be covered.
Legal Comment, Part 2: Confidentiality: A Legal Cornerstone in Infection Control Programs
Authors: Hesson William W. , Thu Cynthia W.
Published: September 2009

This is the second in a series of articles addressing legal issues in infection control. The first article (Infect Control Hosp Epidemiol 1988: 9(3):127-129) discussed the basic elements of liability law as it relates to infection control in the hospital setting. This article will focus on confidentiality in the infection control process.

Infection monitoring and control, as it occurs in most hospital settings, depends on ready access to relevant information, careful evaluation of the data, and appropriate communication of conclusions and recommendations. Equally obvious, however, is the risk associated with free-floating information of this significance. Infection control programs produce a multitude of documents that are of potential interest to outsiders such as fellow staff members, other health care institutions, and attorneys. Without specific attention to mechanisms for protecting its confidentiality, information gathered in the infection control process may well become available to some or all of those interested parties.
General Design and Analysis Questions
Authors: Woolson Robert F. , McNutt Louise-Anne
Published: September 2009

Much of clinical and hospital epidemiology involves the identification and enumeration of cases or the comparison of case frequencies between two or more groups of interest. Because both of these activities involve the use of statistics, it is important to pay careful attention to biostatistical issues involved in the collection and the analysis of such data.

In this article, the first in a series of biostatistical papers, we discuss some general issues that are important in the design, analysis, and interpretation of clinical epidemiologic data. Subsequent papers in this series will deal with specific methods of analysis, examples of these methods of analysis, and limitations and interpretations of the methods.
Nosocomial Respiratory Tract Colonization and Infection with Aminoglycoside-Resistant Acinetobacter calcoaceticus var anitratus: Epidemiologic Characteristics and Clinical Significance
Authors: Peacock James E. , Sorrell LuAnne , Sottile Frank D. , Price Loraine E. , Rutala William A.
Published: September 2009

During the period July 1983 through December 1984, aminoglycoside-resistant Acinetobacter calcoaceticus var anitratus (ACA) were isolated from 98 patients in a university hospital. Eighty-seven percent of patients (85/98) acquired aminoglycoside-resistant ACA in the intensive care unit (ICU) and 92% (90198) of all initial isolates were from sputum. ICU patients with respiratory colonization/infection with aminoglycoside-resistant ACA were compared with matched ICU controls with other gram-negative rods in sputum. Compared with controls, the duration of ICU stay prior to colonization/infection with aminoglycoside-resistant ACA was significantly longer for cases (14.7 days υ 5.9 days, P = 0.002). Although exposures to devices and procedures were not significantly different for the two groups, cases received respiratory therapy significantly longer than did controls (14.7 days υ 6.6 days, P = 0.006). Prior to isolation of aminoglycoside-resistant ACA in sputum, cases received more cephalosporins than did controls (1.9 υ 1.2, P = 0.018); aminoglycoside usage in the two groups was comparable but cases tended to have received aminoglycoside for longer durations before colonization/infection than had controls (9.0 days υ 6.1 days, P = 0.08). Following sputum isolation of ACA, 6 of 22 cases developed ACA bacteremia compared with bacteremia in 2 of 22 controls. We conclude that factors predisposing to colonization/infection with aminoglycoside-resistant ACA were extended ICU care, prolonged respiratory therapy, and prior therapy with cephalosporins and aminoglycoside. In addition, ACA may be a more common cause of secondary bacteremia than previously appreciated.
Description of Case-Mix Adjusters by the Severity of Illness Working Group of The Society of Hospital Epidemiologists of America (SHEA)
Authors: Gross Peter A. , Beyt B. Eugene , Decker Michael D. , Garibaldi Richard A. , Hierholzer Walter J. , Jarvis William R. , Larson Elaine , Simmons Bryan , Scheckler William E. , Harkavy Lorraine M.
Published: September 2009

Hospitals, insurance companies, and federal and state governments are increasingly concerned about reducing patient cost expenditures while maintaining high quality patient care. One method of reducing expenditures has been to tie hospital reimbursement with a prospective payment system based on diagnosis-related groups (DRGs). However, reimbursement under the DRG system is not acceptable for all patients in all hospitals because it is neither an accurate predictor of costs nor of clinical outcome. This deficiency poses significant problems for hospitals because DRGs are used nationwide as the prospective payment system for inpatients covered by Medicare. Several case-mix adjusters have been proposed to modify DRGs to improve their accuracy in predicting costs and outcome. We reviewed five of the most widely available indices: Acute Physiologic and Chronic Health Evaluation (APACHE II), Coded Disease Staging, Computerized Severity Index (CSI), Medical Illness Severity Group System (MEDISGROUPS), and Patient Management Categories (PMC). Recommendations for the use of a single case-mix adjuster cannot be made at this time because all indices have not been compared in sufficiently diverse settings and because some are better predictors of costs while others are better predictors of clinical outcome. Hospital epidemiologists and other infection control practitioners should be informed about these indices and their potential applications as they expand their role beyond infection control problems to issues concerning cost containment, quality assurance, and reimbursement.
Introduction of a Plasmid Encoding the OHIO-l β -Lactamase to an Intermediate Care Ward by Patient Transfer
Authors: Shlaes David M. , Currie-McCumber Charlotte A. , Lehman Mary-Helen
Published: September 2009

A prospective study of 147 intermediate care ward (ICW) patients for acquisition of gentamicin-resistant Enterobacteriaceae (GRE) was carried out. Fifty (34%) were colonized or infected with one or more strains of GRE. Fifteen of these patients and one nurse were colonized with 22 strains (including ten species) of GRE bearing identical 60 kb plasmids encoding a novel β-lactamase determinant, OHIO-l and ANT (2“). Analysis of the time course of colonized patients on the ICW revealed one probable episode of cross-transmission. Five colonized patients had been residing in the ICW from one to four months prior to study initiation. Eight patients were admitted to the ICW from other hospital areas already colonized and one additional patient acquired colonization on the ICW from an unknown source. Thus, eight of ten patients admitted to the ICW during the prospective study were already colonized on admission to the ICW. To control this level of colonization it would therefore be necessary to direct efforts at limiting admission of colonized patients or attempting to eliminate the strain from persistently colonized patients, rather than trying to limit transmission within the ward.
Handwashing, Semmelweis, and Chlorine
Authors: Beck William C.
Published: September 2009

When I went to medical school, I was taught that asepsis had its beginnings with Oliver Wendell Holmes, Lord Joseph Lister, and Ignaz Semmelweis. Holmes introduced the concept that puerperal sepsis was spread from patient to patient by physicians. Lister developed the concept that surgical infection was of bacterial origin. Semmelweis proved that childbed fever was transmitted on the contaminated hands of the attendant. In 1846 he effectively used a chloride as an antiseptic for the first time.

Moreover, Semmelweis, on hearing of the death of Professor Kolletschka following a finger pinprick by a scalpel that had been used in an autopsy, noted that the symptoms and outcome were identical to puerperal sepsis. Thus, he established that “cadaverous particles” had lethal potential.
Bacillus Species
Authors: Weber David J. , Rutala William A.
Published: September 2009

The genus Bacillus is a diverse group of gram-positive, spore-forming aerobic bacilli. B anthracis, the agent of anthrax, is primarily an animal pathogen but is capable of causing human infection, most commonly of the skin or lungs. B cereus, a well-recognized cause of gastroenteritis, may occasionally cause epidemics in health institutions. Both B cereus and other Bacillus species are increasingly recognized as opportunistic pathogens in the hospitalized patient. This report is intended as a comprehensive review of the bacteriology, clinical features, and therapy of Bacillus spp infections. Nosocomial epidemics and transmission will be highlighted.
Receiver Operator Characteristic (ROC) Curves
Authors: Nettleman Mary D.
Published: September 2009

The goal of diagnostic testing is to identify patients with a particular disease. Often, it is just as important that the test not mistakenly identify healthy persons as having disease. For example, a new test for the acquired immunodeficiency syndrome (AIDS) might identify 99.99% of all patients infected with the human immunodeficiency virus (HIV). However, if the test is positive in large numbers of persons who are not infected, its usefulness may be overshadowed by the harm caused by false positive results.
Bacillus Species Pseudomeningitis
Authors: Lettau Ludwig A. , Benjamin Dean , Cantrell H. Furman , Potts David W. , Boggs J. Michael
Published: September 2009

A cluster of cerebrospinal fluid Gram's stains showing gram-positive bacilli and of cerebrospinal fluid cultures growing Bacillus species in a large community teaching hospital prompted an epidemiologic and microbiologic investigation. Pseudomeningitis was suspected and confirmed when cultures of uninoculated commercial trypticase soy broth with 5% Fildes enrichment grew Bacillus species. Secondary contamination of the pipettes used for inoculation accounted for the positive cerebrospinal fluid Gram's stains. The costs of this pseudo-outbreak included unnecessary antibiotic therapy, lumbar punctures, and hospitalization. Such adverse effects can be minimized by increased physician awareness of pseudoinfections and by prompt investigation of such occurrences.
An Epidemic of Adenovirus 7a Infection in a Neonatal Nursery: Course, Morbidity, and Management
Authors: Finn Adam , Anday Endla , Talbot George H.
Published: September 2009

An epidemic of adenovirus 7a in our neonatal intensive care nursery and intermediate care nursery in July and August 1987 caused the death of two patients. Significant symptomatic infection possibly due to the virus occurred in nine patients, ten staff, and three parents, of whom three patients, three staff, and one parent were positive by culture. As a direct consequence of the outbreak, 58 staff days of work were lost; the intensive care nursery had to be closed to admissions for 19 days and the intermediate care nursery for 14 days. Seventeen newborns were transferred to other hospitals and four mothers were sent elsewhere for delivery. Control measures, which included cohorting of patients, use of gloves, gowns and goggles, and exclusion of symptomatic staff from the unit, appeared effective. Rapid immunofluorescence testing of virological specimens was of little use in monitoring the outbreak, largely because of poor specimen quality. This outbreak further underlines the ease of transmission and high morbidity of neonatal adenovirus infection.
Nosocomial Infection in Adult Patients with Sickle Cell Anemia
Authors: Crowe Helen M. , Lichtenberg Deborah A. , Craven Donald E.
Published: September 2009

Although the vulnerability of patients with sickle cell disease to infection with encapsulated organisms is well recognized, nosocomial transmission of infection has not been studied in this population. We describe eight serious, nosocomially transmitted infections in four adult patients hospitalized for complications of sickle cell disease, which led to death in one patient and prolonged hospital stays in three others. Although we have not surveyed all patients with sickle cell disease for rates of nosocomial infection, the cases presented suggest that these patients may be at increased risk. Risk can be reduced if health care workers are especially vigilant in adhering to handwashing and other infection control measures when caring for these patients. Additionally, we recommend that a patient with sickle cell disease not share a room with a patient known to have or suspected of having a nosocomial or community-acquired infectious disease.
Safe and Cost-Effective Cleaning of Pressure-Monitoring Transducers
Authors: Platt Richard , Lehr John L. , Marino Susan , Munoz Alvaro , Nash Barbara , Raemer Daniel B.
Published: September 2009

The CDC category I recommendation for high-level disinfection of pressure-monitoring transducers between uses imposes substantial costs. This practice has not been shown to be useful when disposable transducer domes are used. A prospective, randomized, double-blind study assessed the consequences of wiping transducers with alcohol between uses rather than sterilizing with ethylene oxide. We studied 5,197 transducer courses with disposable domes involving 2,202 patients in intensive care units during 15 months. There was no significant difference between the two treatment regimens in the risk of positive cultures of fluids from monitored lines, of cultures of cannula tips or of a positive blood culture. We conclude that under normal conditions, ie, in the absence of a cluster of transducer-related bacteremias, wiping transducers with alcohol between uses is sufficient when disposable domes are used.
Do Antibiotic Combinations Prevent the Emergence of Resistant Organisms?
Authors: Craig William A.
Published: September 2009

Antibiotic combinations are often used in the therapy of infectious diseases to broaden the antibacterial spectrum and to enhance antimicrobial activity. Another potential reason for combination therapy is to reduce or prevent the emergence of resistant organisms during therapy. Antituberculous chemotherapy provides a classic example in which drug combinations have successfully prevented the emergence of drug-resistant organisms and improved clinical outcome. The purpose of this brief report is to review the success of combination therapy in preventing resistance in more common bacterial infections.

The emergence of resistance during single-drug therapy is a well-documented clinical phenomenon, especially with the broad-spectrum ß-lactams against gram-negative bacilli. As with Mycobacterium tuberculosis, the resistant organisms are generally thought to be naturally occurring mutants selected by drug exposure. Because mutation frequencies appear to vary from 10-6 to 10-8, it is not surprising that emergence of resistant organisms observed clinically occurs primarily at sites of high organism density, such as the respiratory and urinary tracts.
Statistical Analysis of 2 × 2 Tables
Authors: McNutt Louise-Anne , Woolson Robert F.
Published: September 2009

Clinical epidemiologic studies often focus on the identification of risk factors associated with hospital-acquired infections and the subsequent effects of preventive measures. Two study designs commonly used are the prospective design and the retrospective design. Both of these designs and the associated data collection issues were defined and discussed in the first article of this series. This article reviews the statistical analysis for a dichotomous risk factor and the presence or absence of a given disease for unmatched data. We focus our attention primarily on the unmatched prospective study, although we present formulae for the retrospective study as well.
Epidemic of Serratia marcescens Bacteremia and Meningitis in a Neonatal Unit in Mexico City
Authors: Zaidi Mussaret , Sifuentes José , Bobadilla Miriam , Moncada David , de León Samuel Ponce
Published: September 2009

A case-control study was conducted on an epidemic of bacteremia and meningitis caused bySerratia marcescensin the neonatal intensive care unit and special care nursery of a general hospital in Mexico City, Mexico. A 19.9% incidence of bacteremia and meningitis was recorded in contrast to 1.4% and 3.7% during pre-epidemic and postepidemic periods; a 69% mortality rate was observed. Peripheral IV catheters and the use of mixed IV fluids prepared in the wards were the major risk factors (P< 0.001). Rectal and nasopharyngeal cultures were positive in 68% of asymptomatic neonates and hand cultures were positive in 16.7% of personnel. Strains were resistant to all aminoglycosides and broad-spectrum penicillins, and belonged to the A5/8 bio-group. Containment of this outbreak was difficult because of failure to identify colonized infants early in the epidemic and because of persistent carriage ofS marcescensby personnel. Comparisons between this hospital and tertiary care centers in Mexico suggest that in developing countries nosocomial infections could be of greater magnitude in secondary than in tertiary level centers.
Urinary Tract Infection Following Instrumentation for Urodynamic Testing
Authors: Hamill Richard J. , Wright Charles E. , Andres Nita , Koza Maureen A.
Published: September 2009

After identifying a temporal cluster of urinary tract infections in patients who had undergone urodynamic procedures, we examined the techniques within the urodynamic laboratory and retrospectively reviewed charts of all 155 patients tested in the previous six months. The rate of acquired urinary tract infections was 18.7%. Risk factors for infection included undergoing cystometrograms and being subject to the first procedure performed in a day. Technical errors in the performance of the urodynamic studies included failure to completely disassemble the apparatus upon completion of a procedure, failure to use sterile components, and lapses in aseptic technique. Bacteria implicated in the outbreak were isolated from tubing, transducers, and flush solutions. After the institution of appropriate technique, all patients tested in the subsequent six months were followed. The rate of acquired urinary tract infection dropped to 5%. Urodynamic apparatus should be completely disassembled following the completion of a procedure; reassembly using sterile components should occur immediately prior to the next procedure; aseptic technique should be maintained; and patients should undergo routine urine screening before a procedure. Surveillance of urodynamic procedures may reveal correctable flaws in technique.
Regulation of Topical Antimicrobials: History, Status and Future Perspective
Authors: Bruch Mary K. , Larson Elaine
Published: September 2009

Antimicrobial agents used as disinfectants and antiseptics are increasing in epidemiologic importance. The regulation of topical antiseptics has ranged from nonexistent, lax and confusing to inclusion in the Food and Drug Administration (FDA) over-the-counter (OTC) review of drug ingredients. This article simplifies the complex history, current status and future possibilities for the hospital use of topical antiseptic products.
The High Rate of Blood Donor Exposure for Critically III Neonates
Authors: Donowitz Leigh G. , Turner Ronald B. , Searcy Mary Ann M. , Luban Naomi L.C. , Hendley J. Owen
Published: September 2009

The purpose of this study was to determine the number and volume of red blood cell (RBC) transfusions and the number of donors a newborn is exposed to during his or her newborn intensive care unit (NICU) stay. On one day at the Medical University of South Carolina (MUSC) and two days at the University of Virginia Hospital (UVH) all babies who had or were receiving RBCs comprised the study group. Patient records were reviewed at discharge. Fifty-two (70%) of the 75 NICU babies had or were receiving RBCs and were enrolled. The average number of RBC transfusions was nine (range 1 to 28, median 7) and the average transfusion volume was 16.5 ml (range 5 to 60) for a total volume of 148 ml transfused during a NICU stay. Each baby was exposed to an average of 6.9 donors (range 1 to 25, median 6.5). The practice of splitting RBC packs to share among different infants and of giving multiple small volume transfusions maximizes donor exposure and transfusion-related infectious risks in this population.
Pseudoepidemic of Rhodotorula rubra in Patients Undergoing Fiberoptic Bronchoscopy
Authors: Hoffmann Karen K. , Weber David J. , Rutala William A.
Published: September 2009

Between March and June 1988, Rhodotorula rubra was isolated from the bronchial washings of 30 of 56 (54%) patients undergoing bronchoscopy at a North Carolina community hospital. Pulmonary disease consistent with invasive fungal pneumonia was not apparent for any patient. Repeat sputum cultures were performed on 11 patients, none of whom were positive for R rubra. Investigation revealed fungal contamination of two brushes used to clean the bronchoscope channels and one positive sample of the tub water used to test the integrity of the bronchoscope prior to cleaning and disinfection. Control measures instituted were high-level disinfection of all equipment used to clean the bronchoscopes, including the brushes, complete air drying of the bronchoscopes before storing and storage of equipment in closed cabinets. An additional case one month after instituting these measures prompted the addition of a final 70% ethyl alcohol rinse of the bronchoscopes immediately prior to storage. Over a six-month period no additional cases have been identified.

Despite published disinfection guidelines, pseudoepidemics and infections from contaminated equipment continue to appear. This pseudoepidemic investigation revealed a site for contaminating bronchoscopes that has not been previously reported, the inner cannula cleaning brushes. This emphasizes the need for stringent adherence to recommended cleaning and disinfection guidelines.
Evaluation of a New Method of Detection of Nosocomial Infection in the Pediatric Intensive Care Unit: The Infection Control Sentinel Sheet System
Authors: Ford-Jones E.L. , Mindorff C.M. , Pollock E. , Milner R. , Bohn D. , Edmonds J. , Barker G. , Gold R.
Published: September 2009

To improve the efficiency of nosocomial infection detection, a highly structured system combining initial reporting by the bedside night nurse of symptoms possibly related to infection with follow-up by the infection control nurse (ICN) was developed: The Infection Control Sentinel Sheet System (ICSSS).

Between July 1, 1987 and February 28, 1988, a prospective comparison of results obtained through ICSSS and daily bedside observation/chart review by a full-time trained intensivist was undertaken in the pediatric intensive care unit (PICU). Ratios of nosocomial infections and nosocomially-infected patients were 15.8 and 7.0 respectively among 685 admissions; included are seven infections identified only through the ICSSS so that the “gold standard” became an amalgamation of the two systems. The sensitivity for detection of nosocomially-infected patients by bedside observation/chart review and ICSSS was 100% and 87% respectively. The sensitivity for detection of standard infections (blood, wound and urine) was 88% and 85% respectively. The sensitivity for detection of nosocomial infections at all sites was 94% and 72% respectively. Missed infections were minor (e.g., drain, skin, eye), required physician diagnosis (e.g., pneumonia), were not requested on the sentinel sheet (SS) (e.g., otitis media), related to follow-up of deceased patients or were minor misclassifications or failures to associate with device (e.g., central-line related). Daily PICU surveillance by the ICN required only 20 minutes a day. The ICSSS appears highly promising and has many unmeasured benefits.
Outcome Measurements in Decision Analysis: Life Versus Quality of Life
Authors: Nettleman Mary D.
Published: September 2009

Life expectancy has been the most popular outcome measurement for decision analyses. The effectiveness, or utility, of a strategy is expressed in years of life gained over a baseline state. This is particularly useful from a public health standpoint when a fixed budget must be used to serve a diverse population. For example, should money be spent on influenza vaccination programs or cholesterol screening? A decision analysis to answer this question might use cost per year of life gained as the primary outcome. Essentially, the public health provider is seeking to minimize cost while maximizing life expectancy. Strategies could be ordered and priority given according to rank.
Evaluation of Rigid Container Systems for Sterilization
Authors: Ryan Peggy
Published: September 2009

The packaging of surgical instruments, medical devices and procedure trays for sterilization is indeed important. There are three choices for packaging.

The first two methods use traditional over-wrap packaging, with either reusable flat wraps of muslin or tightly woven textiles, or one of several types of nonwoven disposable wraps. Reusable wrappers must be monitored by labor-intensive inspection, delinting and frequent patching, and are easily contaminated. In addition, disposable wraps can develop tears and holes compromising the sterility of the contents. Thus, both reusable and disposable wrappers have drawbacks.
An Early Historical Perspective on the FDA's Regulation of OTC Drugs
Authors: Bruch Mary K. , Larson Elaine
Published: September 2009

From a variety of contacts with hospital infection control personnel, it has become clear to us that the historical perspective about and internal workings of the Food and Drug Administration (FDA) are confusing and deserve clarification. The accompanying article in this issue (“Regulation of Topical Antimicrobials: History, Current Status and Future Perspective,” pp. 505-508) details the regulation of topical antimicrobial drugs administered by the FDA. We believe it is necessary to provide a special context for this article.
Epidemic Keratoconjunctivitis in a University Medical Center Ophthalmology Clinic; Need for Re-evaluation of the Design and Disinfection of Instruments
Authors: Koo Denise , Bouvier Brenda , Wesley Michele , Courtright Paul , Reingold Arthur
Published: September 2009

During the period from early December 1987 to late January 1988, an outbreak of epidemic keratoconjunctivitis (EKG) caused by adenovirus type 8 occurred at a university medical center eye clinic. A telephone survey of patients revealed an attack rate of 17% among patients seen during the epidemic period. A case-control study demonstrated that development of EKC was associated with exposure to pneumotonometry and to three caregivers. After controlling for exposure to pneumo-tonometry, however, only exposure to one caregiver was significantly associated with risk of the disease. On January 19, 1988, after recognition of the outbreak, the eye clinic instituted additional infection control measures. A survey of patients seen the following week showed a substantial decrease in the attack rate (1.9%). Before these control measures were implemented, clinic personnel had followed the manufacturer's recommendations and disinfected pneumotonometer tips with 70% isopropyl alcohol, fearing that other disinfectants would corrode the instrument metal. Isopropyl alcohol, shown to have limited activity against adenovirus in vitro, also was being used to “disinfect” pneumotonometer tips between uses at six other area eye clinics polled by telephone. The results of this study demonstrate the need for changes in the design and manufacture of equipment used in the eye clinic.