bluuebunny/crossref_metadata_2025 huggingface dataset:
An Operating Surveillance System of Surgical-Site Infections in The Netherlands: Results of the PREZIES National Surveillance Network
Authors: Geubbels Eveline L.P.E. , Groot A. Joke Mintjes-de , Berg Jan Maarten J. van den , de Boer Annette S.
Published: February 2006

Objectives:

To describe the results of the first year of the Dutch national surveillance of surgical-site infections (SSIs) and risk factors, which aims to implement a standardized surveillance system in a network of Dutch hospitals, to collect comparable data on SSIs to serve as a reference, and to provide a basic infrastructure for further intervention research.

Design:

Prospective multicenter cohort study.

Setting:

Acute-care hospitals in The Netherlands from June 1996 to May 1997.

Results:

38 hospitals participated, with a slight overrepresentation of larger hospitals. Following a total of 18,063 operations, 562 SSIs occurred, of which 198 were deep. Multivariate analysis of pooled procedures shows that age, preoperative length of stay, wound contamination class, anesthesia score, and duration of surgery were independent risk factors for SSI. When analyzed by procedure, the relative importance of these risk factors changed. Bacteriological documentation was available for 56% of the SSIs; 35% of all isolates were Staphylococcus aureus. Multiple regression analysis computed the mean extra postoperative length of stay associated with SSI to be 8.2 days.

Conclusion:

The first year of national surveillance has shown that it is feasible to collect comparable data on SSI, which are already used for education, policy, and decision making in the network of participating hospitals. This gives room to effectuate the next aim, namely to use the network as an infrastructure for intervention research. Multivariate analysis shows that feedback on a procedure-specific level is important.
Nasal Carriage of Staphylococcus aureus: Is a Major Risk Factor for Surgical-Site Infections in Orthopedic Surgery
Authors: Kalmeijer Mathijs D. , Nieuwland-Bollen Ella van , Bogaers-Hofman Diane , Baere Gerard A.J. de , Kluytmans Jan A.J.W.
Published: February 2006

Objective:

To determine the relative importance of different risk factors for the development of surgical-site infections (SSIs) in orthopedic surgery with prosthetic implants.

Design:

In a cohort of 272 patients, the following possible risk factors were studied: age, gender, method of hair removal, duration of operation, surgeon, underlying illness, and nasal carriage of Staphylococcus aureus. Infections were recorded following the Centers for Disease Control criteria. The relation between risk factors and SSI was tested in univariate and multiple logistic regression analysis.

Setting:

Community hospital in Breda, The Netherlands.

Results:

18 (6.6%) of 272 patients experienced SSI: 11 superficial and 7 deep SSI. These infections led in three cases to removal of the prosthesis and caused 286 extra days in hospital. The main causative pathogen was S aureus. In multiple logistic regression analysis, the following factors were independent risk factors for the development of SSI: high-level nasal carriage of S aureus (P=.04), male gender (P=.005), and surgeon 1 (P=.006). The only independent risk factor for SSI with S aureus was high-level nasal carriage of S aureus (P=.002).

Conclusion:

High-level nasal carriage of S aureus was the most important and only significant independent risk factor for developing SSI with S aureus.
Identifying Outliers of Antibiotic Usage in Prevalence Studies on Nosocomial Infections
Authors: Gastmeier Petra , Sohr Dorit , Forster Dietmar , Schulgen Gabriele , Schumacher Martin , Daschner Franz , Rüden Henning
Published: February 2006

Objective:

To investigate whether the correlation between patients' antibiotic treatment (yes/no) and patients' infections (yes/no) in each hospital department, described by Pearson's correlation coefficient (ρ) for binary data as a measure for adequate use of antibiotics, is an appropriate quality indicator.

Design:

Comparison of the results of repeated prevalence studies in different hospitals with the data of a national prevalence study, comparing the hospital (ρ) and reference (ρNIDHP[Nosokomiale Infektionen in Deutschland: Erfassung und Prävention]) correlation coefficients for “use of antibiotics/ presence of infections.”

Setting:

The data of 5,377 surgical patients were separated from the total data of a national prevalence study in 72 representative hospitals to create a reference correlation coefficient (ρNIDEP) with a reference range. Nine additional prevalence studies, involving a total of 4,984 patients, were repeatedly performed in the surgical departments of 8 other hospitals during a 12-month period, whereby the correlation coefficients ρn for every prevalence investigation were determined.

Results:

In the national prevalence study, 15.3% of the surgical patients received antibiotics on the study day. Surgical patients had a 3.8% prevalence of nosocomial infections and a 7.0% prevalence of community-acquired infections. Pearson's correlation coefficient ρNIDEP for correlation between patients' binary data use of antibiotics and presence of infection was 0.62. To compare the correlation coefficient of each department with the appropriate reference range, the coefficients of the single departments were plotted against the number of patients; in these plots, three lines indicated the value ρNIDEP and the upper and lower reference ranges, depending on the number of patients. Seven of eight surgical departments investigated during the repeated prevalence studies were found to be within the reference range, near the reference value, in the majority of prevalence studies; only one of the departments was identified as an outlier as regards antibiotic use.

Conclusion:

The correlation between patients' antibiotic treatment (yes/no) and patients' infections (yes/no) in hospitals or departments, as described by Pearson's correlation coefficient ρ for binary data with a definitive reference range depending on the number of patients, is useful for quality management in identifying the overall necessity for evaluating the indications for antibiotic use in one's own hospital.
Nosocomial Malaria From Contamination of a Multidose Heparin Container With Blood
Authors: Al-Saigul Abdullah M. , Fontaine Robert E. , Haddad Qais
Published: February 2006

A girl developed Plasmodium falciparum malaria in Riyadh, Saudi Arabia, a non-malarious area. Twelve to 18 days before onset, she had been hospitalized for asthma on the same ward as three malaria patients. The only link between the malaria patients and the asthma patient was a multidose heparin container used to fill syringes for use on heparin locks and intravenous devices. Contamination of the heparin with blood occurred on at least one occasion when a needle had been left in place through the septum of this container and was used to refill a used syringe.
Nosocomial Bacteremia in HIV Patients: The Role of Peripheral Venous Catheters
Authors: Lambotte Olivier , Lucet Jean-Christophe , Fleury Laurent , Joly-Guillou Marie-Laure , Bouvet Elisabeth
Published: February 2006

A retrospective case-control study compared 40 human immunodeficiency virus (HIV)-infected patients with 43 nosocomial bacteremias (NB) to 77 HIV-infected patients without NB. Presence of a peripheral venous catheter (PVC) was associated with occurrence of NB and was significantly more frequent in NB without an identified source. PVCs probably are an underestimated source of NB in HIV-infected patients.
Efficacy of a Washer-Pasteurizer for Disinfection of Respiratory-Care Equipment
Authors: Rutala William A. , Weber David J. , Gergen Maria F. , Gratta Albert R.
Published: February 2006

We evaluated the efficacy of a commercial washer-pasteurizer. Carriers were inoculated with 104 to 106 test organisms and pasteurized at 170°F for 30 minutes. Pasteurization eliminated all test organisms with the exception of Bacillus subtilis spores. Pasteurization appears efficacious for the disinfection of respiratory-care equipment and could result in a cost savings of approximately $30,000 per year.
Nosocomial Candida guilliermondii Fungemia in Cancer Patients
Authors: Mardani Masoud , Hanna Hend A. , Girgawy Essam , Raad Issam
Published: February 2006

From 1988 to 1998, we identified nine patients with Candida guilliermondii fungemia. Four of the five patients with nosocomial infection died, while all of the non-nosocomial cases survived, even though one half of them (2/4) did not receive any treatment Nosocomial C guilliermondii fungemia is often associated with poor outcome despite aggressive antifungal therapy.
Compliance With National Recommendations for Tuberculosis Screening and Immunization of Healthcare Workers in a Children's Hospital
Authors: Bratcher Denise F. , Stover Beth H. , Lane Natalie E. , Paul Ronald I.
Published: February 2006

Physicians and clinical employees at a children's hospital were surveyed to compare their tuberculosis (TB) screening and immunization statuses. Failure to offer screening and immunization services to non-employee physicians was associated with lower rates of reported immunity to several vaccine-preventable diseases and with markedly lower rates of TB screening.
Risk Factors for Nosocomial Infections in a Critically Ill Pediatric Population: A 25-Month Prospective Cohort Study
Authors: Gilio Alfredo E. , Stape Adalberto , Pereira Crésio R. , Cardoso Maria Fátima S. , Silva Claudia V. , Troster Eduardo J.
Published: February 2006

We studied risk factors for nosocomial infections among 500 critically ill children who were admitted to a pediatric intensive care unit from August 1994 through August 1996 and who were prospectively followed until death, transfer, or discharge. Age, gender, postoperative state, length of stay, device-utilization ratio, pediatric risk of mortality score, and total parenteral nutrition were the risk factors studied. Through multivariate analysis, we identified three independent risk factors for nosocomial infection: device-utilization ratio (odds ratio [OR], 1.6; 95% confidence interval [CI95], 1.10-2.34), total parenteral nutrition (OR, 2.5; CI95, 1.05-5.81) and length of stay (OR, 1.7; CI95, 1.31-2.21).
Control of Occupational Hepatitis B Among Healthcare Workers in the Czech Republic, 1982 to 1995
Authors: Helcl Jaroslav , Cástková Jitka , Benes Cestmir , Novotna Lenka , Sepkowitz Kent A , DeHovitz Jack A.
Published: February 2006

Occupational hepatitis B remains a threat to healthcare workers (HCWs) worldwide, even with availability of an effective vaccine. Despite limited resources for public health, the Czech Republic instituted a mandatory vaccination program for HCWs in 1983. Annual incidence rates of acute hepatitis B were followed prospectively through 1995. Despite giving vaccine intradermally from 1983 to 1989 and intramuscularly as half dose from 1990 to 1995, rates of occupational hepatitis B decreased dramatically, from 177 cases per 100,000 workers in 1982 (before program initiated) to 17 cases per 100,000 in 1995. Among high-risk workers, the effect was even more dramatic (from 587 to 23 per 100,000). We conclude that strong public-health leadership led to control of occupational hepatitis B among HCWs in the Czech Republic, despite limited resources that precluded administering full-dose intramuscular vaccine for much of the program. Application of a similar program should be considered for other countries in regions that currently do not have a hepatitis B vaccination program.
SHEA Conference on Antimicrobial Resistance
Authors: Gerding Dale N. , Martone William J.
Published: February 2006

Antimicrobial resistance is an increasing problem in healthcare institutions and in the community. Public concern about resistance is also increasing. The issue is broad and complex and not readily addressed by government, industry, or professional societies alone. On October 29-30,1998,19 representatives of various professional societies and governmental agencies met under the auspices of the Society for Healthcare Epidemiology of America (SHEA) at Brook Lodge Conference Center in Augusta, Michigan. The purpose of the meeting was to discuss the current status of antimicrobial resistance in the United States and Canada, including present society and governmental efforts to address the problem. Representatives exchanged experiences through presentations and discussions on the first day, then on the second day held a brainstorming session to address future needs and priorities in addressing the resistance problem. It was agreed that a national coordinated effort was needed. As part of this national effort, representatives called for the creation of a National Coalition on Antibiotic Resistance (NCAR) to combat antibiotic resistance through education, research, prevention, and advocacy. Priorities for NCAR were focused in four areas: (1) education of the public and professionals; (2) support of basic and applied research; (3) provision of an information resource and clearinghouse; and (4) advocacy initiatives. At the recommendation of the SHEA Board, discussions with the National Foundation for Infectious Diseases for the joint development of NCAR have begun.
Scheduled Replacement of Central Venous Catheters Is Not Necessary
Authors: Timsit Jean-François
Published: February 2006

Although half of intensivists routinely replace their central venous catheters (CVCs), this practice is not supported by data from randomized control studies or by pathophysiology of CVC infection. The daily risk of CVC infection is considered to be a constant; the risk of catheter infection is directly related to the duration of catheter insertion. Consequently, the routine change of the catheter is able to decrease the number of infections per catheter but not to modify the number of infections per day of catheter insertion. This assertion is supported by evidence-based medicine: scheduled replacement every 3 or 7 days has not been shown to alter the infectious risks of CVCs in randomized studies or a meta-analysis.

Moreover, routine replacement at a new site exposes the patient to an increased risk of mechanical complications. The overall rate of mechanical complications per catheter inserted is approximately 3%. Guidewire exchange of the catheters may reduce the risk of mechanical complications, but unfortunately is associated with a higher rate of catheter colonization and catheter-related bacteremia. Routine replacement of CVCs is not necessary.
Improving Compliance With Hand Hygiene in Hospitals
Authors: Pittet Didier
Published: February 2006

Hand hygiene prevents cross-infection in hospitals, but compliance with recommended instructions often is poor among healthcare workers. Although some previous interventions to improve compliance have been successful, none has achieved lasting improvement. This article reviews reported barriers to appropriate hand hygiene and factors associated with poor compliance.

Easy access to hand hygiene in a timely fashion and the availability of skin-care lotion both appear to be necessary pre-requisites for appropriate hand-hygiene behavior. In particular, in high-demand situations, hand rub with an alcohol-based solution appears to be the only alternative that allows a decent compliance. The hand-hygiene compliance level does not rely on individual factors alone, and the same can be said for its promotion. Because of the complexity of the process of change, it is not surprising that solo interventions often fail, and multimodal, multidisciplinary strategies are necessary. A framework that includes parameters to be considered for hand-hygiene promotion is proposed, based on epidemiologically driven evidence and review of the current knowledge. Strategies for promotion in hospitals should include reasons for noncompliance with recommendations at individual, group, and institutional levels. Potential tools for change should address each of these elements and consider their interactivity.
Antibiotic Use in Developing Countries
Authors: Istúriz Raúl E. , Carbon Claude
Published: February 2006

Antimicrobials have been used successfully for over 6 decades, but genes expressing resistance to them have emerged in strains of bacteria and have disseminated through the global ecosystem to reach infecting microorganisms, produce disease, and seriously interfere with therapy, allowing infections to progress and kill despite antibiotic administration. The upsurge in prevalence of such resistance genes in the bacterial population that colonize and infect humans involves two processes, emergence and dissemination, in both of which there have been contributions from the developing world, where resistance is common and increasing. The emergence of pneumococcal isolates noted in Papua New Guinea and later in South Africa that 1 decade later spread to most of the world and the intercontinental spread between the United States and Venezuela of a new gentamicin resistance gene carried on an epidemic plasmid are examples of the ability of bacteria to travel freely, without regard to borders. Complex societal issues such as the misuse of antibiotics by physicians, pharmacists, and the public; the suboptimal quality of the drugs (emergence); and conditions such as crowding, lack of hygiene, poor or nonexistent hospital infection control practices, or insufficient surveillance (dissemination) play a largely unmeasured role that requires study and solutions. In the meantime, we may intervene to delay the emergence of resistance and to limit its spread by promoting the judicious use of antibiotics both at the local level as well as from multinational organized cooperative efforts. Education and improvement of surveillance and socioeconomic conditions are integral parts of any solution strategy.
Toward New Biomaterials
Authors: Montdargent Béatrice , Letourneur Didier
Published: February 2006

Polymers are widely used for a large range of medical devices used as biomaterials on a temporary, intermittent, and long-term basis. It is now well accepted that the initial rapid adsorption of proteins to polymeric surfaces affects the performance of these biomaterials. However, protein adsorption to a polymer surface can be modulated by an appropriate design of the interface. Extensive study has shown that these interactions can be minimized by coating with a highly hydrated layer (hydrogel), by grafting on the surface different biomolecules, or by creating domains with chemical functions (charges, hydrophilic groups). Our laboratory has investigated the latter approach over the past 2 decades, in particular the synthesis and the biological activities of polymers to improve the biocompatibility of blood-contacting devices. These soluble and insoluble polymers were obtained by chemical substitution of macromolecular chains with suitable groups able to develop specific interactions with biological components. Applied to compatibility with the blood and the immune systems, this concept has been extended to interactions of polymeric biomaterials with eukaryotic and prokaryotic cells. The design of new biomaterials with low bacterial attachment is thus under intensive study. After a brief overview of current trends in the surface modifications of biocompatible materials, we will describe how biospecific polymers can be obtained and review our recent results on the inhibition of bacterial adhesion using one type of functionalized polymer obtained by random substitution. This strategy, applied to existing or new materials, seems promising for the limitation of biomaterial-associated infections.
An Outbreak of Influenza A in a Neonatal Intensive Care Unit
Authors: Cunney Robert J. , Bialachowski Anne , Thornley Diane , Smaill Fiona M. , Pennie Ross A.
Published: February 2006

Objectives:

Investigation of an outbreak of influenza A in a neonatal intensive care unit (NICU) with examination of risk factors for infection and outcomes.

Design:

Retrospective cohort study of infants admitted to the unit during the outbreak period. Prospective survey of NICU staff and mothers of infants in the cohort study.

Setting:

Level III nursery in a university-affiliated tertiary referral center.

Results:

Nineteen infants in the NICU were infected with influenza A. There were six symptomatic cases and one death who had evidence of virus-associated hemophagocytic syndrome at autopsy. Amantadine prophylaxis was offered to the NICU staff, and amantadine therapy was given to five of the six symptomatic infants. Mechanical ventilation, gestational age, birth weight, Clinical Risk Index for Babies score, and twin pregnancy were associated with acquisition of influenza A on univariate analysis. Mechanical ventilation (odds ratio [OR], 6.2;P=.02) and twin pregnancy (OR, 7.0;P=.04) remained as significant risk factors for infection on multiple logistic regression analysis. Only 15% of respondents to the NICU staff survey were vaccinated against influenza. There was no association between a history of an influenza-like illness during pregnancy and acquisition of influenza A by infants of mothers who responded to the maternal survey (OR, 0.91;P=1.0).

Conclusions:

Influenza A is an important pathogen in the neonatal population and is readily transmissible in the NICU setting.
A Heterogeneous Outbreak ofEnterobacter cloacae and Serratia marcescensInfections in a Surgical Intensive Care Unit
Authors: Dorsey Grant , Borneo Hena T. , Sun Sumi J. , Wells Jennifer , Steele Lynn , Howland Kathryn , Perdreau-Remington Francoise , Bangsberg David R.
Published: February 2006

Objective:

To investigate an outbreak of invasive disease due toEnterobacter cloacaeandSerratia marcescensin a surgical intensive care unit (ICU).

Design:

Pulsed-field gel electrophoresis (PFGE) analysis of restriction fragments was used to characterize the outbreak isolate genotypes. A retrospective cohort study of surgical ICU patients was conducted to identify risk factors associated with invasive disease. Unit staffing data were analyzed to compare staffing levels during the outbreak to those prior to and following the outbreak.

Setting:

An urban hospital in San Francisco, California.

Patients:

During the outbreak period, December 1997 through January 1998, there were 52 patients with a minimum ICU stay of ≥72 hours. Of these, 10 patients fit our case definition of recovery ofE cloacaeorS marcescensfrom a sterile site.

Results:

PFGE analysis revealed a highly heterogeneous population of isolates. Bivariate analysis of patient-related risk factors revealed duration of central lines, respiratory colonization, being a burn patient, and the use of gentamicin or nafcillin to be significantly associated with invasive disease. Both respiratory colonization and duration of central lines remained statistically significant in a multivariate analysis. Staffing data suggested a temporal correlation between understaffing and the outbreak period.

Conclusions:

Molecular epidemiological techniques provided a rapid means of ruling out a point source or significant cross-contamination as modes of transmission. In this setting, patient-related risk factors, such as respiratory colonization and duration of central lines, may provide a focus for heightened surveillance, infection control measures, and empirical therapy during outbreaks caused by common nosocomial pathogens. In addition, understaffing of nurses may have played a role in this outbreak, highlighting the importance of monitoring staffing levels.
A Pseudo-Outbreak ofAureobasidiumSpecies Lower Respiratory Tract Infections Caused by Reuse of Single-Use Stopcocks During Bronchoscopy
Authors: Wilson Stephen J. , Everts Richard J. , Kirkland Kathryn B. , Sexton Daniel J.
Published: February 2006

Objective:

To investigate and control an apparent outbreak of lower respiratory tract infections due to Aureobasidium species.

Design:

Outbreak investigation.

Setting:

University-affiliated medical center.

Patients:

Nine patients who underwent bronchoscopy between June and August 1998.

Results:

Ten bronchoalveolar lavage (BAL) fluid cultures from nine patients grewAureobasidiumspecies during the outbreak period; whereas, respiratory specimens from only two patients grewAureobasidiumspecies during the preceding 6 years. No patient was judged to have true infection due toAureobasidiumspecies either before or after bronchoscopy. Nine of the 10 bronchoscopies that yieldedAureobasidiumspecies were performed in the outpatient bronchoscopy suite. TheAureobasidiumisolates were not associated with any one bronchoscope. Observation of bronchoscopy procedure revealed that plastic stopcocks labeled for single use were reused on different patients during BAL. There was no record of how many times each stopcock was being reused. After each use, the stopcocks were placed in an automated disinfection machine designed for bronchoscopes. Culture of the stopcocks after they had been “disinfected” yielded a heavy growth ofAureobasidiumspecies, while culture of fluid from the automated disinfection machine was negative. Reuse of the stopcocks was halted, and, during the following 6-month period,Aureobasidiumspecies were not isolated from any BAL specimen.

Conclusions:

Reuse of medical equipment labeled for single use is potentially hazardous, especially if no quality control system is in place to monitor sterility and function after reprocessing.
Cleaning of Blood-Contaminated Reprocessed Angiographic Catheters and Spinal Needles
Authors: Penna Thereza Christina Vessoni , Ferraz Carlos Augusto M.
Published: February 2006

Objectives:

To evaluate the efficacy of a multistep cleaning method using a cleaner and a chemical disinfectant on blood-contaminated angiographic catheters and spinal needles intended to be sterilized by hydrogen peroxide gas plasma.

Method:

A mixture of radiopaque iodine contrast, bovine blood (plus ethylenediaminetetraacetic acid), and a suspension of Bacillus subtilis spores was used to simulate catheterization and needle use. The mixture was a 1:1 proportion of contrast and blood, inoculated so that there was a final concentration of B subtilis spores of 1.0×106 colony-forming units (CFU)/mL. The inoculated devices were cleaned using a hydrogen peroxide solution at a concentration of 1.5±0.5 percent by weight, followed by distilled water with enzymatic detergent. After drying, the devices were sterilized with hydrogen peroxide gas plasma.

Results:

The initial B subtilis spore concentration inoculated into catheters and needles varied from 2.12×104 to 2.74×107 CFU/mL. The residual load of B subtilis spores after cleaning varied from zero (no count) to a maximum of 200 CFU/device. The multistep cleaning procedure was responsible for an average 5-log10 reduction of B subtilis spores in the catheter and needle lumens.

Conclusions:

The hydrogen peroxide and enzymatic detergent aqueous solutions were shown to be efficacious when used as part of a multistep cleaning method. The low level of microbial contamination prior to sterilization with hydrogen peroxide gas plasma assured that the intended sterility assurance level was reached.
Pathogenic Organisms Associated with Artificial Fingernails Worn by Healthcare Workers
Authors: Hedderwick Sara A. , McNeil Shelly A. , Lyons Michael J. , Kauffman Carol A.
Published: February 2006

Objective:

To determine differences in the identity and quantity of microbial flora from healthcare workers (HCWs) wearing artificial nails compared with control HCWs with native nails.

Design:

Two separate studies were undertaken. In study 1, 12 HCWs who did not normally wear artificial nails wore polished artificial nails on their nondominant hand for 15 days. Identity and quantity of microflora were compared between the artificial nails and the polished native nails of the other hand. In study 2, the microbial flora of the nails of 30 HCWs who wore permanent acrylic artificial nails were compared with that of control HCWs who had native nails. In both studies, nail surfaces were swabbed and subungual debris was collected to obtain material for culture.Staphylococcus aureus, gram-negative bacilli, enterococci, and yeasts were considered to be potential pathogens. All organisms were identified and quantified.

Results:

In study 1, potential pathogens were isolated from more samples obtained from artificial nails than native nails (92% vs 62%;P<.001). Colonization of artificial nails increased over time; by day 15, 71% of cultures yielded a pathogen compared with 21% on day 1 (P=.004). A significantly greater quantity of organisms (expressed as mean log10colony-forming units ± standard deviation) was isolated from the subungual area than the nail surface; this was noted for both artificial (5.0±1.4 vs 4.1 ±1.0;P<.001) and native nails (4.9±1.3 vs 3.7±0.8;P<.001). More organisms were found on the surface of artificial nails than native nails (P=.008), but there were no differences noted in the quantities of organisms isolated from the subungual areas. In study 2, HCWs wearing artificial nails were more likely to have a pathogen isolated than controls (87% vs 43%;P=.001). More HCWs with artificial nails had gram-negative bacilli (47% vs 17%;P=.03) and yeasts (50% vs 13%;P=.006) than control HCWs. However, the quantities of organisms isolated from HCWs wearing artificial nails and controls did not differ.

Conclusions:

Artificial fingernails were more likely to harbor pathogens, especially gram-negative bacilli and yeasts, than native nails. The longer artificial nails were worn, the more likely that a pathogen was isolated. Current recommendations restricting artificial fingernails in certain healthcare settings appear justified.
Nosocomial Infections in Combined Medical-Surgical Intensive Care Units in the United States
Authors: Richards Michael J. , Edwards Jonathan R. , Culver David H. , Gaynes Robert P. ,   National Nosocomial Infections Surveillance System
Published: February 2006

Objective:

To describe the epidemiology of nosocomial infections in combined medical-surgical (MS) intensive care units (ICUs) participating in the National Nosocomial Infection Surveillance (NNIS) System.

Design:

Analysis of surveillance data on 498,998 patients with 1,554,070 patient-days, collected between 1992 and 1998 from 205 MS ICUs following the NNIS Intensive Care Unit protocol, representing 152 participating NNIS hospitals in the United States.

Results:

Infections at three major sites represented 68% of all reported infections (nosocomial pneumonia, 31%; urinary tract infections (UTIs), 23%; and primary bloodstream infections (BSIs), 14%: 83% of episodes of nosocomial pneumonia were associated with mechanical ventilation, 97% of UTIs occurred in catheterized patients, and 87% of primary BSIs in patients with a central line. In patients with primary BSIs, coagulase-negative staphylococci (39%) were the most common pathogens reported; Staphylococcus aureus (12%) was as frequently reported as enterococci (11%). Coagulase-negative staphylococcal BSIs were increasingly reported over the 6 years, but no increase was seen in candidemia or enterococcal bacteremia. In patients with pneumonia, S aureus (17%) was the most frequently reported isolate. Of reported isolates, 59% were gram-negative bacilli. In patients with UTIs, Escherichia coli (19%) was the most frequently reported isolate. Of reported isolates, 31% were fungi. In patients with surgical-site infections, Enterococcus (17%) was the single most frequently reported pathogen. Device-associated nosocomial infection rates for BSIs, pneumonia, and UTIs did not correlate with length of ICU stay, hospital bed size, number of beds in die ICU, or season. Combined MS ICUs in major teaching hospitals had higher device-associated infection rates compared to all other hospitals with combined medical-surgical units.

Conclusions:

Nosocomial infections in MS ICUs at the most frequent infection sites (bloodstream, urinary, and respiratory tract) almost always were associated with use of an invasive device. Device-associated infection rates were die best available comparative rates between combined MS ICUs, but the distribution of device-associated rates should be stratified by a hospital's major teaching affiliation status.
Prevalence and Determinants of Fecal Colonization with Vancomycin-ResistantEnterococcusin Hospitalized Patients in The Netherlands
Authors: Braak Nicole van den , Ott Alewijn , van Belkum Alex , Kluytmans Jan A.J.W. , Koeleman Johannes G.M. , Spanjaard Lodewijk , Voss Andreas , Weersink Annemarie J.L. , Vandenbroucke-Grauls Christina M.J.E. , Buiting Anton G.M. , Verbrugh Henri A. , Endtz Hubert P.
Published: February 2006

Objective:

To determine the prevalence and determinants of fecal carriage of vancomycin-resistant enterococci (VRE) in intensive care unit (ICU), hematology-oncology, and hemodialysis patients in The Netherlands.

Design:

Descriptive, multicenter study, with yearly 1-week point-prevalence assessments between 1995 and 1998.

Population:

All patients hospitalized on the testing days in ICUs and hematology-oncology wards in nine hospitals in The Netherlands were included.

Methods:

Rectal swabs obtained from 1,112 patients were screened for enterococci in a selective broth and subcultured on selective media with and without 6 mg/L vancomycin. Resistance genotypes were determined by polymerase chain reaction. Further characterization of VRE strains was done by pulsed-field gel electrophoresis (PFGE). We studied possible determinants of VRE colonization with a logistic regression analysis model. Determinants analyzed included gender, age, and log-transformed length of prior hospital stay.

Results:

The results showed that 614 (55%) of 1,112 patients were colonized with vancomycin-sensitive enterococci, and 15 (1.4%) of 1,112 carried VRE. No increase in VRE colonization was observed from 1995 to 1998. Eleven strains were identified asEnterococcus faeciumand four asEnterococcus faecalis. AllE faeciumand oneE faecaliscarried thevanAgene; the otherE faecalisstrains harbored thevanBgene. PFGE revealed that threevanBVRE isolated from patients hospitalized in one single ICU were related, suggesting nosocomial transmission. Though higher age seemed associated with VRE colonization, exclusion of patients with the nosocomial strain from the regression analysis decreased this relation to nonsignificant. Duration of hospital stay was not associated with VRE colonization.

Conclusion:

VRE colonization in Dutch hospitals is an infrequent phenomenon. Although nosocomial spread occurs, most observed cases were unrelated, which suggests the possibility of VRE acquisition from outside the hospital. Prolonged hospital stay, age, and gender proved unrelated to VRE colonization.
Epidemiology of Nosocomial Outbreaks: 14-Year Experience at a Tertiary-Care Center
Authors: Ostrosky-Zeichner Luis , Baez-Martinez Rosa , Rangel-Frausto M. Sigfrido , Ponce-de-León Samuel
Published: February 2006

Twelve nosocomial outbreaks over 14 years at a tertiary-care center in Mexico are described. Overall mortality was 25.8%, one half due to pneumonia. The most common organism was Pseudomonas aeruginosa. Incidence was three outbreaks per 10,000 discharges; outbreak-related infections comprised 1.56% of all nosocomial infections. Incidence in the intensive care unit was 10-fold higher.
A Pilot Study on Infection Control in 10 Randomly Selected European Hospitals: Results of a Questionnaire Survey
Authors: Beaujean Desirée J.M.A. , Weersink Annemarie J.L. , Troelstra Annet , Verhoef Jan
Published: February 2006

We describe and compare the organization of infection control and some infection control practices in 10 hospitals in seven different European countries. Great differences were observed. By evaluating infection control and hygiene practices in different European centers, areas of prime importance for the development of a European infection control standard may be defined.
Outbreak of Vancomycin-Resistant Enterococci in a Burn Unit
Authors: Falk Pamela S. , Winnike Janice , Woodmansee Carta , Desai M. , Mayhall C. Glen
Published: February 2006

Objective:

To investigate and control an outbreak of colonization and infection caused by vancomycin-resistant enterococci (VRE) in a burn intensive care unit (BICU).

Design:

Epidemiological investigation, including multiple point-prevalence culture surveys of patients and environment, cultures from hands of healthcare workers (HCWs), pulsed-field gel electrophoresis (PFGE) typing of patient and environmental isolates, case-control study, and institution and monitoring of control measures.

Setting:

BICU in an 800-bed university medical center in Galveston, Texas.

Results:

Between June 6, 1996, and July 14, 1997, 21 patients were colonized by VRE, and 4 of these patients developed bacteremia. Of 2,844 environmental cultures, 338 (11.9%) were positive, but all hand cultures from HCWs were negative. PFGE typing indicated that the outbreak was clonal, with VRE isolates from patients differing by ≤4 bands from the index case. Thirteen of 14 environmental isolates varied by ≤4 bands from the pattern of the index case. A case-control study analyzed by exact logistic regression identified diarrhea (odds ratio [OR], 43.9; 95% confidence interval [CI95], 5.5-infinity;P=.0001) and administration of an antacid (OR, 24.2; CI95,2.9-infinity;P=.002) as independent risk factors for acquisition of VRE. During a 5-week period in October and November 1996, all patient and 317 environmental cultures were negative for VRE. The outbreak recurred from a contaminated electrocardiogram lead that had not been identified during the prior 5 weeks. VRE were finally eradicated from the BICU in July 1997, using barrier isolation and a very aggressive environmental decontamination program.

Conclusions:

A VRE outbreak in a BICU over 13 months was caused by a single clone. After apparent eradication of VRE from a BICU, recrudescence of the outbreak occurred, evidently from a small inapparent source of environmental contamination. Changes in gastrointestinal (GI) tract function (motility) and administration of medications, other than antibiotics, that have an effect on the GI tract may increase the risk of GI tract colonization by VRE in burn patients. Application of barrier isolation and an aggressive environmental decontamination program can eradicate VRE from a burn population.
An Outbreak ofAcinetobacter baumannii:The Importance of Cross-Transmission
Authors: D'Agata Erika M.C. , Thayer Valerie , Schaffner William
Published: February 2006

Objective:

To investigate an outbreak of nosocomial infections due to multidrug-resistant (MDR)Acinetobacter baumanniiand to analyze the contribution of cross-transmission in the rise in infection rates.

Design:

Epidemiological investigation; molecular typing using pulsed-field gel electrophoresis (PFGE); matched case-control study to identify risk factors for infection.

Setting:

A 34-bed surgical intensive care unit at a tertiary-care hospital.

Patients:

Eighteen patients who developed MDRA baumanniinosocomial infection were matched to 36 patients who were admitted to the same surgical intensive care unit (SICU) room and did not develop an infection during the outbreak period.

Results:

Prior to the outbreak, the baseline attack rate of MDRA baumanniinosocomial infections was 3 per 100 patients per month. From February 1 through March 22, 1998, the attack rate rose to 16 per 100 patients per month, with a total of 18 infections. All isolates had indistinguishable PFGE patterns. Seventy environmental cultures were negative for MDRA baumannii. Following intense infection control education, the attack rate decreased to 4 per 100 patients per month. By conditional logistic regression, cases were exposed to a significantly higher number of patients with MDRA baumanniiinfections compared to controls (odds ratio, 1.1; 95% confidence interval, 1.01-1.2;P=.02), even after adjusting for length of SICU admission and exposure to antibiotics and invasive devices.

Conclusion:

Cross-transmission between patients contributed to the rise in rates of MDRA baumanniiinfections. A common environmental source was not detected.
Bloodborne Viral Infections in Patients Attending an Emergency Room in Mexico City: Estimate of Seroconversion Probability in Healthcare Workers After an Occupational Exposure
Authors: Kato-Maeda Midori , Ponce-de-León Samuel , Sifuentes-Osornio Jose , Rangel-Frausto M. Sigfrido , Calva-Mercado Juan , Infante-Suarez Lourdes , Villareal Fernando Morales , Ponce-de-León Sergio
Published: February 2006

The frequency of hepatitis C (HCV), hepatitis B (HBV), human immunodeficiency virus (HIV), and human T-cell lymphotropic virus (HTLV) I/II was determined in the emergency room of a teaching hospital. Of 909 patients, 19% had at least one infection; 7.8% had HCV, 6.9% HBV, 3.3% HIV, and 2.8% HTLV I/II. The probability that a healthcare worker would have an accident with an infected patient and seroconvert was 4.99 to 24.9 per 100,000 venipunctures for HBV, 5.6 to 8.4 for HCV, and 0.12-0.16 for HIV in our emergency room.
Long-Term Control ofLegionellaSpecies in Potable Water After a Nosocomial Legionellosis Outbreak in an Intensive Care Unit
Authors: Borau Joseph , Czap Ryan T. , Strellrecht Kathleen A. , Venezia Richard A.
Published: February 2006

Environmental and patient-care control measures were initiated in response to an outbreak of legionellosis in an intensive care unit in 1992. The measures included maintaining elevated potable hot-water temperatures following superheating and using sterile water for administrations through nasogastric tubes.Legionellaspecies remained below detectable levels in the potable hot-water system upon reevaluation in 1999. Nosocomial cases of legionellosis have not been reported since the outbreak.
Prevalence of Nasal Colonization With Methicillin-Resistant Staphylococcus aureus in Selected Patient Populations
Authors: Price Margaret F. , Carlini Maria , Houston Susan , Gentry Layne O.
Published: February 2006

Methicillin-resistant Staphylococcus aureus nasal colonization was investigated in patients arriving for elective cardiovascular surgery, renal patients admitted for arteriovenous graft surgery, and patients transferred to our hospital from other institutions. Renal patients were significantly more likely to be colonized and represent a potential source of MRSA to our institution.
Physician Preferences for Educational Media
Authors: Smith Theresa L. , Sinkowitz-Cochran Ronda L. , Jarvis William R.
Published: February 2006

Background:

Although educational media have expanded in variety, information on physicians' preferences for types of educational media remains limited.

Method:

An assessment form was distributed to 14 medical societies evaluating their members' medical education media preferences and society antimicrobial-resistance educational offerings.

Results:

These 14 medical societies represent 349,685 physicians. All supported educational offerings, most frequently as professional meetings, followed by audiotapes, computer programs, Internet sites, or print-based self-study materials. Only 5 (36%) societies had measured how many members used their educational offerings. Eight (57%) societies had made antimicrobial resistance an educational priority for their medical societies. Antimicrobial treatment was the most commonly offered educational topic on antimicrobial resistance.

Conclusions:

These 14 medical societies help to educate over one half the practicing US physicians. However, less than one half of the societies knew how many of their members used the educational materials they offered, or how their members would prefer to obtain medical education. Understanding how physicians want to obtain medical information potentially could improve the delivery of medical knowledge to physicians.
Tuberculosis in Long-Term–Care Facilities
Authors: Smith Philip W. , Rajagopalan Shobita , Yoshikawa Thomas T.
Published: February 2006

The geriatric population represents the largest reservoir ofMycobacterium tuberculosisinfection in developed nations, including the United States. Tuberculosis (TB) case rates in the United States are highest for this age group compared with other age categories. The subtle clinical manifestations of TB in the elderly often can pose potential diagnostic dilemmas and therapeutic challenges, resulting in increased morbidity and mortality in this age group; this treatable infection unfortunately often is detected only at autopsy. Compared with their community-dwelling counterparts, the institutionalized elderly are at a greater risk both for reactivation of latent TB and for the acquisition of new TB infection. Prevention and control of TB in facilities providing long-term care to the elderly thus cannot be overemphasized.
The Microbial Genetics of Antibiotic Cycling
Authors: John Joseph F. , Rice Louis B.
Published: February 2006

Cycling of currently available antibiotics to reduce resistance is an attractive concept. For cycling strategies to be successful, their implementation must have a demonstrable impact on the prevalence of resistance determinants already dispersed throughout the hospital and associated healthcare facilities. While antibiotic use in hospitals clearly constitutes a stimulus for the emergence of resistance, it is by no means the only important factor. The incorporation of resistance determinants into potentially stable genetic structures, including bacteriophages, plasmids, transposons, and the more newly discovered movable elements termedintegronsandgene cassettes,forces some degree of skepticism about the potential for such strategies in institutions where resistance determinants are already prevalent. In particular, the expanding role of integrons may pose an ultimate threat to formulary manipulations such as cycling. Despite these concerns, the crisis posed by antimicrobial resistance warrants investigation of any strategy with the potential for reducing the prevalence of resistance. Over the next decade, new studies with carefully designed outcomes should determine the utility of antibiotic cycling as one control measure for nosocomial resistance.
Antibiotic Cycling and Marketing Into the 21st Century: A Perspective From the Pharmaceutical Industry
Authors: Lavin Bruce S.
Published: February 2006

Before the development of the first antimicrobial agents, bacteria already had demonstrated an ability to adapt to stress in the environment, resulting in the development of resistance that often makes the prevailing antibiotic treatment ineffective. The response to antimicrobial resistance in the medical community has been to use new or alternative antibiotics not previously used against the resistant bacteria. The pharmaceutical industry has responded to the resistance problem by producing newer antibiotics, either as modifications of currently existing compounds or as combinations of compounds that may inhibit or bypass the bacterial resistance mechanisms. The development of new antibiotics is a lengthy and costly process. To be successful, the pharmaceutical industry must anticipate the changing needs of the medical community, as well as the dynamic process of antimicrobial resistance. The marketing of new antimicrobial agents must be adaptable to the potential environmental pressures that induce bacterial resistance in order to ensure the longevity of the agents.