bluuebunny/crossref_metadata_2025 huggingface dataset:
Motor simulation in verbal knowledge acquisition
Authors: Paulus Markus , Lindemann Oliver , Bekkering Harold
Published: September 2009

Recent research highlights the importance of motor processes for a wide range of cognitive functions such as object perception and language comprehension. It is unclear, however, whether the involvement of the motor system goes beyond the processing of information that is gathered through active action experiences and affects also the representation of knowledge acquired through verbal learning. We tested this prediction by varying the presence of motor interference (i.e., squeezing a ball vs. oddball detection task) while participants verbally acquired functional object knowledge and examined the effects on a subsequent object detection task. Results revealed that learning of functional object knowledge was only impaired when participants performed an effector-specific motor task while training. The present finding of an effector-specific motor interference effect on object learning demonstrates the crucial role of the motor system in the acquisition of novel object knowledge and provides support for an embodied account to perception and cognition.
Pseudoepidemic of Nontuberculous Mycobacteria in a Community Hospital
Authors: Mehta Jay B. , Kefri Maher , Soike David R.
Published: September 2009

Soon after our hospital instituted the BACTEC mycobacterial isolation system, the proportion of cultures positive for nontuberculous mycobacteria increased dramatically. After eliminating other possible sources of contamination, the BACTEC probe's sterilization time and temperature were increased, and the incidence of positive mycobacterial cultures returned to its former rate.
Ribotyping of Nosocomial Methicillin-Resistant Staphylococcus aureus Isolates From a Canadian Hospital
Authors: Nath Swapan K. , Shea Barb , Jackson Susan , Rotstein Coleman
Published: September 2009

Objective:

To evaluate the clonality of methicillin-resistant Staphylococcus aureus (MRSA) strains among hospitalized patients.

Setting:

University-affiliated, 465-bed tertiary-care teaching hospital with adjacent cancer clinic in Hamilton, Ontario, Canada.

Design:

Thirty-five colonized and 30 infected patients from January 2, 1992, through August 31, 1993, were investigated retrospectively. Analysis by restriction fragment-length polymorphisms of ribosomal RNA genes (ie, ribotyping) of 103 nosocomial isolates of MRSA from these 65 patients and of 25 selected unrelated strains was completed. Ribotyping results were compared with the phage typing data obtained prospectively during the course of prospective MRSA surveillance.

Results:

HindIII ribotyping was more discriminating than phage typing when epidemiologically unrelated strains were differentiated by these methods (19 different ribotypes versus 14 phage types; P< .005). Two early index cases were identified. Isolates from the index cases were two different strains, identified by ribotyping analysis as ribotype A (clonal group 1) and ribotype B (clonal group 2), respectively. These two ribotypes were not found when typing the unrelated control strains. Thirty-six colonized and infected patients (55%) had clonal group 1 isolates, and 20 (31%) had clonal group 2 isolates. These two clones emerged in the hospital in January and February 1992 and dominated the entire investigated period. There also were six patients with an additional clonal group (group 4) that emerged and disappeared in the second quarter of 1993.

Conclusions:

This study highlights the utility of ribotyping in investigating nosocomial MRSA. Three MRSA clones caused nosocomial colonization or infection in patients at this hospital. Two of these MRSA clones, once introduced, were maintained among our patients throughout the study period.
A Pseudoepidemic of Rhodotorula rubra: A Marker for Microbial Contamination of the Bronchoscope
Authors: Hagan Margaret E. , Klotz Stephen A. , Bartholomew William , Potter Lonna , Nelson Michael
Published: September 2009

Rhodotorula rubra was isolated from bronchoscopy specimens from 11 patients. An investigation of the bronchoscopy equipment and the bronchoscopy suite revealed contamination of the suction channel with R rubra, as well as potentially pathogenic bacteria. Disinfection control methods included gas sterilization of the bronchoscope and the institution of an alcohol and air flush through the suction channel to allow complete drying of the scope between each patient use. We have had no further isolates of R rubra from bronchoscopy specimens since these measures were instituted, and repeat cultures from the suction channel have been negative.
The Computer-Based Patient Record: The Role of the Hospital Epidemiologist
Authors: Classen David C. , Burke John P.
Published: September 2009

Despite advances in computers and software for data analysis, hospital epidemiologists still must use manual methods for data collection. To automate infection control surveillance fully, healthcare institutions need computerized medical records; however, very few institutions currently have such a system. Healthcare institutions appreciate the need for automation, but frequently do not see a clear path to the desired outcome. In this article, we outline the important issues that hospital epidemiologists must understand if they wish to help their institutions to computerize their medical records.
Tuberculosis Surveillance Practices in Long-Term Care Institutions
Authors: Naglie Gary , McArthur Margaret , Simor Andrew , Naus Monika , Cheung Angela , McGeer Allison
Published: September 2009

Objecitves:

To identify the tuberculosis (TB) skin-testing practices of long-term care facilities for the elderly in Toronto, Ontario.

Design:

A telephone survey using a 25-item questionnaire.

Setting:

Twenty-nine nursing homes (NHs) and 26 Homes for the Aged (HFAs) in metropolitan Toronto.

Results:

Thirty-one percent of facilities (17 of 55) had no formal tuberculin skin-testing program, including 52% of NHs (15 of 29) versus 8% of HFAs (2 of 26; P= 0.001). Ninety-two percent of HFAs (24 of 26) compared with 45% of NHs (13 of 29), obtained preadmission or admission skin-test status of residents (P= 0.0005). Annual testing was performed at 46% of HFAs (12 of 26) and 27% of NHs (8 of 29; P= 0.28). Of facilities that carried out any skin testing, 64% of HFAs (16 of 25) versus 32% of NHs (6 of 19) measured induration to establish test positivity (P=0.068). Fifty-two percent of HFAs (13 of 25), compared with 21% of NHs (4 of 19), recorded the actual size of induration in the patient record (P=0.085). Only 28% of HFAs (7 of 25) and 21% of NHs (4 of 19) correctly defined a positive tuberculin skin test.

Conclusions:

TB surveillance practices in long-term care institutions in Toronto are inadequate and often yield results that do not predict the risk of infection and cannot be used to investigate outbreaks. Tuberculin skin-testing practices were better at HFAs, which are subject to provincial legislation regarding TB surveillance, than at NHs, which are not subject to this legislation. Staff at HFAs and NHs require education regarding tuberculin skin-testing policies and procedures.
Impact of a Coordinated Tuberculosis Team in an Inner-City Hospital in New York City
Authors: Fazal Barkat A. , Telzak Edward E. , Blum Steve , Pollard Cathy L. , Bar Mordechai , Ernst Jerome A. , Turett Glenn S.
Published: September 2009

Objective:

To evaluate the impact of a coordinated approach for the isolation, diagnosis, and treatment of patients with tuberculosis.

Design:

Retrospective cohort study.

Setting:

Bronx-Lebanon Hospital Center, an inner-city hospital in the South Bronx, New York City.

Patients:

Patients with smear-positive, culture-confirmed pulmonary tuberculosis.

Interventions:

Institution of a coordinated tuberculosis team.

Results:

Admissions of 46 patients before and 39 patients after the formation of a tuberculosis team were reviewed. Before institution of the tuberculosis team, 35% of patients were isolated within 24 hours of presentation, 41% never were isolated, and the mean number of days patients were not isolated was 19. After implementation of the tuberculosis team, 59% of patients were isolated within 24 hours, only 5% were never isolated, and the mean number of days patients were not isolated was 3.5. These differences were statistically significant. There also was a corresponding decrease in length of hospitalization. In addition, there were noticeable improvements in patient and staff morale and attitudes.

Conclusions:

The tuberculosis team likely has decreased the risk of nosocomial tuberculosis transmission by increasing the proportion of infectious tuberculosis patients admitted into AFB isolation and by reducing (by 780) the number of days out of isolation while smear positive. There also were concomitant financial savings.
Respiratory Protection Standard: Comments on OSHA's Proposed Revision
Authors: Decker Michael D.
Published: September 2009

On November 15, 1994, the Occupational Safety and Health Administration (OSHA) published in the Federal Register (59:58884-58956) the draft of a proposed revision of the Respiratory Protection Standard. One of OSHA's oldest standards, the Respiratory Protection Standard defines the conduct of the employer (eg, hospital) with respect to respirator training, fit testing, medical examinations, use, storage, and so on. The proposed revision appears to have been drafted with no consideration for its effect on healthcare workers or the healthcare industry. SHEA has prepared the following comments to OSHA, which have been submitted to the docket and will be presented at public hearings later this month.
Prospective, Randomized Study of Ventilator-Associated Pneumonia in Patients With One Versus Three Ventilator Circuit Changes Per Week
Authors: Long Martha N. , Wickstrom Glenda , Grimes Anne , Benton Carol F. , Belcher Becky , Stamm Alan M.
Published: September 2009

Objective:

To assess the effect on the rate of ventilator-associated pneumonia (VAP) of decreasing the frequency of ventilator circuit changes from three times to once per week.

Design:

Prospective, randomized trial.

Setting:

Medical intensive care unit (MICU), a 12-bed, critical-care internal medicine unit, and neurosciences intensive care unit (NICU), a 21-bed, predominantly adult neurosurgical unit, of an urban university hospital.

Patients:

All 447 patients requiring mechanical ventilation during October 1992 through June 1993.

Intervention:

Patients were allocated randomly on the basis of permanent medical record numbers: those with odd numbers had circuits changed three times per week, those with even numbers once per week. Intensive-care-unit surveillance was conducted in accordance with definitions and methods of the National Nosocomial Infections Surveillance System.

Results:

In the MICU, the one-change-per-week group had a VAP rate of 7.3 per 1,000 ventilator days, versus 5.9 for the three-per-week group (P=.6). In the NICU, the one-change-per-week group had a rate of 12.2 per 1,000 ventilator days, versus 12.6 for the three-per-week group (P=.9). Considering patients in both units ventilated for no more than 7 days, the one-change-per-week group had a VAP rate of 5.9 per 1,000 ventilator days, versus 9.0 per 1,000 for the three-changes-per-week group (odds ratio [OR], 0.65; 95% confidence interval [CI95], 0.25 to 1.69). Including patients in the two units maintained on mechanical ventilation for more than 7 days, the one-change-perweek group had a VAP rate of 13.2 per 1,000 ventilator days, versus 9.6 per 1,000 for the three-changes-per-week group (OR, 1.37; CI95 0.71 to 2.65).

Conclusions:

Decreasing the frequency of ventilator circuit changes from three times to once per week had no adverse effect on the overall rate of VAP. Less frequent ventilator circuit changes may decrease the incidence of VAP among patients ventilated for no more than 1 week. However, the incidence of VAP may be higher among patients with once weekly circuit changes ventilated for more than 1 week.
Development of Mupirocin Resistance Among Methicillin-Resistant Staphylococcus aureus After Widespread Use of Nasal Mupirocin Ointment
Authors: Miller Mark A. , Dascal Andre , Portnoy Joseph , Mendelson Jack
Published: September 2009

All methicillin-resistant Staphylococcus aureus (MRSA) strains isolated from colonized or infected patients in a 625-bed public teaching hospital during an epidemic, and for 3 years thereafter, underwent susceptibility testing to mupirocin. Mupirocin resistance among MRSA increased markedly over this period (1990, 2.7%; 1991, 8.0%; 1992, 61.5%; 1993, 65%) in association with increased use of mupirocin ointment as an adjunct to infection control measures.
Clostridium difficile Contamination of Blood Pressure Cuffs: A Call for a Closer Look at Gloving Practices in the Era of Universal Precautions
Authors: Manian Farrin A. , Meyer Lynn , Jenne Joan
Published: September 2009

We report an outbreak of Clostridium difficile-associated diarrhea at our medical center following adoption of Universal Precautions. Environmental cultures revealed unexpected contamination of blood pressure cuffs at a rate similar to that for bedside commodes (10% and 11.5%, respectively). An obser vational sur vey revealed that healthcare workers in the patient care areas not infrequently failed to remove their potentially stool-contaminated gloves prior to touching clean surfaces, which might have contributed to contamination of blood pressure cuffs.
Mathematical Models in Decision Analysis
Authors: Tom Eric , Schulman Kevin A.
Published: September 2009

Decision analysis offers powerful techniques to understand and evaluate uncertain clinical situations better. Decision analytic models are appearing with increasing frequency in health policy planning, clinical information and decision-support computer systems, evaluations of clinical pathways, development of clinical practice or utilization review guidelines, and epidemiologic research. This article describes the structure, application, and limitations of the more popular decision analytic methods, including decision trees, Markov models, Monte Carlo simulation, survival and hazard functions, fuzzy logic, and sensitivity analysis. Understanding the nature of these methods will help readers to assess better the appropriateness of their use in published reports.
The Effect of High-Efficiency Particulate Air Respirator Design on Occupational Health: A Pilot Study Balancing Risks in the Real World
Authors: Eck Enid K. , Vannier Ann
Published: September 2009

Objectives:

To quantify specific factors believed to increase healthcare worker (HCW) risk for contaminated sharps injuries (eg, visibility, communication, and range of motion); to quantify the degree to which respirators of various designs impacted those same factors; and to assess HCW opinions about the suitability of selected respirators with respect to patient care and user compliance criteria.

Design:

Sharps injury data from seven hospitals were analyzed to determine the potential contribution of visibility, communication, and range of motion to reported injuries. Healthcare workers representing various clinical specialties and physical characteristics were examined at baseline and while wearing five different respirators to quantify the impact of respirator design on visibility, communication, and range of motion. Healthcare workers were inter viewed and completed a survey assessing each respirator.

Setting:

Hospital and ambulatory-care settings.

Participants:

Population-based and convenience sample.

Results:

Communication, visibility, and range of motion were found to affect contaminated sharps injuries significantly. Selected high-efficiency particulate air (HEPA) respirators were found to have a negative impact on each of these variables. Healthcare workers involved in the study also reported compliance criteria problems with selected HEPA respirators, which may effect implementation of respiratory precautions adversely.

Conclusion:

Current HEPA respirators, because of their design, potentially increase the risk of bloodborne pathogen exposure through sharps injuries. We conclude that mandating respirators without regard to the potential impact of their design to the sharps injuries may be counterproductive to HCW safety, because they may increase, rather than decrease, overall occupational risk to HCWs.
High Frequency of Pseudobacteremia at a University Hospital
Authors: Little J. Russell , Trovillion Ellen , Fraser Victoria
Published: September 2009

A prospective survey of all positive blood cultures was performed during a 6-month period at a 390-bed, tertiary-care teaching hospital in St Louis, Missouri. Data were collected from the clinical microbiology laboratory, medical records, and physicians caring for patients with positive blood cultures. Of 5,732 blood cultures, 261 (4.6%) were positive, and approximately half of these (51.3%) were categorized as false positive. Positive cultures were significantly more likely to be true positives if obtained from patients with malignancies or if they became positive within the first 48 hours of incubation.
Impact of Changes in Catheter Management on Infectious Complications Among Children With Central Venous Catheters
Authors: Lange Beverly J. , Weiman Marjorie , Feuer Eric J. , Jakobowski Diane , Bilodeau Julia , Stallings Virginia A. , Hirschl Ronald , Bell Louis M. , Harper James , Cnaan Avital
Published: September 2009

Objectives:

To characterize and enumerate central venous catheter (CVC)-related complications among children with chronic illnesses, and to reduce the complication rate through changes in CVC management and education.

Design:

A prospective obser vational study followed by an educational program and a nonrandomized inter ventional trial.

Setting:

The Children's Hospital of Philadelphia, a tertiary, pediatric facility.

Patients:

268 children with Broviac, Hickman, or Infusaport catheters in place during 58,290 catheter days.

Interventions:

Development and implementation of protocols for cleaning insertion site and hub, use of nonocclusive dressings, and manipulation of access; formal staff and parental education about protocols.

Results:

CVC-related infections fell from 4.58/1,000 catheter-days preinter vention to 3.83 postintervention (risk ratio [RR], 0.20; 95% confidence interval [CI95], 0.89-1.622; P=.25); exit-site infections fell from 0.58 to 0.11 (CI95, 1.22-45.64; P=.02); rates among infants on the surgical service fell from 15.46 to 6.67 (RR, 2.31; CI95, 1.10-4.30; P=.02).

Conclusions:

Education and changes in management protocols reduced the incidence of exit-site infections among all patients and reduced the overall infectious complication rate among the infants receiving parenteral nutrition on the surgical ser vice. Other interventions are needed to decrease further the infectious complications in these children
The Cost of Selected Tuberculosis Control Measures at Hospitals with a History of Mycobacterium Tuberculosis Outbreaks
Authors: Kellerman Scott , Tokars Jerome I. , Jarvis William R.
Published: September 2009

Objective:

To determine the cost of nonrespirator-related tuberculosis (TB) control measures at several hospitals, following publication of the Centers for Disease Control and Prevention (CDC)'s revised TB infection control guidelines.

Design:

Infection control (IC) and TB coordinators obtained cost information on tuberculin skin-test (TST) programs, addition of IC and employee health service (EHS) personnel, and the retrofit or new construction of environmental controls.

Setting:

Four hospitals with, and one community hospital without, prior nosocomial multidrug-resistant TB transmission.

Results:

During the study period, the TST program costs remained constant at four of five hospitals and increased at one hospital (median 1994 TST program cost: $5,568; range, $2,393-$44,902). Additional IC or EHS personnel were hired at four of five hospitals (median cost increase, $125,500; range, $63,000-$228,000). The median cost of new construction or new equipment purchases (ie, sputum induction booths, ultraviolet lights, or portable high-efficiency particulate air filters) at study hospitals was $163,000 (range, $45,000-$524,000) and $70,000 (range, $31,000-$93,000), respectively.

Conclusions:

Costs associated with implementing control measures similar to those recommended in the CDC TB IC guidelines varied widely by hospital. Engineering controls involved the largest capital outlay, but increases in personnel were the largest continuing cost. These costs represent improvements made to upgrade selected aspects of hospital TB control programs, not the cost of an optimal TB control program.
Effect of Treatment on Contagiousness of Patients With Active Pulmonary Tuberculosis
Authors: Menzies Dick
Published: September 2009

In view of the important consequences with regard to policies for respiratory isolation of hospitalized patients with active tuberculosis, the duration of contagiousness after initiation of effective therapy was reviewed. All relevant English-language literature was reviewed to identify in vitro, animal experimental, and epidemiological evidence regarding contagiousness of patients with active tuberculosis after initiation of therapy.

Based on in vitro evidence of numbers of tubercle bacilli initially present and rapidity of reduction with therapy, it can be predicted that patients whose respiratory secretions are initially smear-negative but culture-positive should no longer have viable bacilli detectable by culture within 2 weeks. Based on the same evidence, it can be predicted that, after 2 weeks of therapy, almost all smear-positive patients will remain culture-positive, and more than one half will remain smear-positive. There are few epidemiological studies of this issue, most of which have had major methodological weaknesses. None of the results from these studies can be considered relevant to the hospital environment, where the majority of workers are uninfected and patients are potentially immunocompromised.

Animal and in vitro evidence suggest that patients with active tuberculosis remain contagious at least 2 weeks after the initiation of therapy. Patients with smear-positive disease are likely to be contagious much longer. There is no relevant and valid epidemiological evidence regarding this issue.
Outbreak Among HIV-Infected Patients of Staphylococcus aureus Resistant to Cotrimoxazole and Methicillin
Authors: Alonso Roberto , Padilla Belen , Sánchez-Carrillo Carlos , Muñoz Patricia , Rodríguez-Creixems Marta , Bouza Emilio
Published: September 2009

Objective:

To describe an outbreak of trimethoprim-sulfamethoxazole (cotrimoxazole)–resistant and methicillin-resistant Staphylococcus aureus (CMRSA) in a unit housing patients infected with the human immunodeficiency virus (HIV).

Design:

Prospective study involving patients colonized or infected with CMRSA.

Patients:

15 hospitalized patients with cultures positive for CMRSA.

Methods:

Isolates of CMRSA were collected and characterized. Molecular typing of the epidemic strains was carried out after total DNA extraction by restriction endonuclease analysis and random amplification of polymorphic DNA.

Results:

The epidemic was brought under control with the reinforcement of nosocomial transmission measures and with systematic nasal decontamination with mupirocin of all patients admitted to the HIV unit. Molecular typing techniques showed the existence of two epidemic strains: strain A was present in the 12 patients admitted to the HIV unit and strain B in the remaining 3 patients hospitalized elsewhere.

Conclusions:

Cotrimoxazole may no longer be a reliable and effective alternative for glycopeptides in patients with infection caused by MRSA strains, and HIV units should be particularly alert for CMRSA strains.
Nosocomial Legionellosis Traced to a Contaminated Ice Machine
Authors: Graman Paul S. , Quinlan Gail A. , Rank June A.
Published: September 2009

Objective:

To investigate a case of nosocomial legionellosis, identify pathways of transmission, and effect control of the environmental source.

Design:

Case investigation and environmental culture surveillance.

Setting:

A 720-bed university teaching hospital.

Case Patient:

A ventilator-dependent 66-year-old male developed nosocomial pneumonia due to Legionella pneumophila serogroup 6 after 3 months in an intensive-care unit (ICU). The patient had no intake of potable water except for ice chips from an ice machine in the ICU.

Results:

Cultures revealed L pneumophila serogroup 6 in the ice (4.3 colony-forming units/mL) and ice machine cold water (too numerous to count). Cultures from adjacent hot and cold taps, plus taps located near the patient, all were negative; ice machines and cold water on seven other patient units also were negative. Only sterile water had been used for tube feedings, mouth care, suctioning, and ventilator humidification. Hospital hot water previously had been colonized with L pneumophila serogroup 6, but all surveillance water cultures had been negative since chlorination of the hot-water system began the previous year; cold-water cultures had never before grown Legionella.

The ice machine was disinfected with a 2-hour flush of 2.625% sodium hypochlorite. The supply line to the ice machine was replaced, and the cold-water pipe from the floor below was treated with 83 ppm sodium hypochlorite for 48 hours. All follow-up surveillance cultures of the ice machine remained negative through mid-1996. No additional cases of nosocomial legionellosis occurred.

Conclusions:

Ice machines may be reservoirs of L pneumophila in hospitals. Both ice and water dispensed from these machines may be contaminated, and nosocomial transmission may occur. Successful long-term decontamination and control can be accomplished with shock chlorination.
The Epidemiology of Hemorrhage Related to Cardiothoracic Operations
Authors: Herwaldt Loreen A. , Swartzendruber Sheri K. , Edmond Michael B. , Embrey Richard P. , Wilkerson Kim R. , Wenzel Richard P. , Perl Trish M.
Published: September 2009

Objective:

To define the epidemiology, risk factors, and unadjusted cost of hemorrhages related to cardiothoracic operations.

Study Design:

We conducted two case-control studies to evaluate the risk of hemorrhage following cardiothoracic operations. The definition of hemorrhage required one of the following: reoperation for bleeding, postoperative loss of greater than 800 mL of blood over 4 hours, or surgeon-diagnosed excessive intraoperative bleeding.

Setting:

The cardiothoracic surgery service of a university hospital.

Results:

Of 511 patients undergoing cardiothoracic operations, 93 (18%) met the definition of hemorrhage. In the first case-control study, 3 (14%) of 21 cases and 0 of 42 controls died (odds ratio [OR], 15.0; 95% confidence interval [CI95], 1.18-191.55). Compared with controls, cases received significantly more packed red blood cells intraoperatively (OR, 1.18/100 mL; CI95, 1.01-1.38), and significantly more platelets (OR, 3.26/100 mL; CI95, 1.47-7.26) and fresh frozen plasma (OR, 1.73/100 mL; CI95, 1.05-.84) in the intensive-care unit. Cases were more likely than controls to receive protamine postoperatively (OR, 3.74; CI95, 1.27-11.02). Previous sternotomy, preoperative aspirin or heparin, and preoperative laboratory values did not predict bleeding. The median unadjusted hospital cost was $3,458 higher for patients who suffered hemorrhage than for controls.

To decrease costs, hetastarch (acquisition cost $45/500 mL) was substituted for albumin (acquisition cost $76/100 mL) in the pump priming solution (estimated possible cost savings, $7,000-$53,000/year). Because hemorrhage rates increased subsequently, we conducted a second case-control study that identified patient age (P=.02) and use of greater than 5 mL/kg of hetastarch (OR, 1.82) as risk factors for hemorrhage. The cost of treating hemorrhages exceeded all estimates of possible cost savings ($7,000-$53,000 per year).

Conclusions:

Our definition of hemorrhage identified patients who required increased volumes of blood products and who had an increased crude mortality rate and a higher unadjusted cost of hospitalization. Patient age and hetastarch use were risk factors for hemorrhage. Efforts to save money by substituting less expensive products inadvertently may increase costs by increasing the probability of perioperative adverse events.
Stool Colonization of Healthcare Workers With Selected Resistant Bacteria
Authors: Carmeli Yehuda , Venkataraman Lata , DeGirolami Paola C. , Lichtenberg Deborah A. , Karchmer Adolf W. , Samore Matthew H.
Published: September 2009

We examined the carriage of selected resistant bacteria in the stools of healthcare workers who provided direct patient care. Neither vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, nor Clostridium difficile was recovered from the 55 stool specimens collected. A ceftazidime-resistant Citrobacter freundii was isolated from one specimen. We conclude that the stool of healthcare workers is colonized infrequently with these resistant organisms
Medical-Resource Use for Suspected Tuberculosis in a New York City Hospital
Authors: Griffiths Robert I. , Hyman Charles L. , McFarlane Samy I. , Saurina Guillermo R. , Anderson Jane E. , O'Brien Theodore , Popper Caroline , McGrath Margaret M. , Herbert Robert J. , Sierra Marcelino F.
Published: September 2009

Objective:

To compare resource use by diagnostic outcome among hospital admissions during which tuberculosis (TB) was suspected.

Design:

Retrospective study based on chart review and microbiology laboratory data.

Setting:

The department of medicine in a municipal hospital serving central Brooklyn, New York.

Participants:

We identified all adult admissions in 1993 during which TB was suspected. We assigned each admission to one of four mutually exclusive groups defined by the results of microbiological tests (acid-fast bacilli [AFB] smear and culture): culture-positive and smear-positive (C + S +); culture-positive and smear-negative (C + S−); culture-negative and smear-positive (C−S+); or culture-negative and smear-negative (C−S−). Each admission was divided into two separate periods to which the utilization of medical resources was assigned: the diagnostic and the postdiagnostic periods, which were separated by the date of receipt of the first definitive culture report.

Results:

Data on 519 admissions (93 C+S+; 57 C+S−; 30 C−S+; and 339 C−S−) were analyzed. Although C+S+ were more likely than other groups to have an admitting diagnosis of TB, approximately one quarter of the admissions without TB (C−S+, C−S−) were admitted with the principal diagnosis of TB. For the four groups, C+S+, C+S−, C−S+, and C−S−, the respective rates of TB isolation and anti-TB treatment, and median lengths of isolation were 98%, 87%, and 34 days; 74%, 74%, and 7 days; 83%, 83%, and 15 days; and 44%, 29%, and 0 days. During the diagnostic period, the rate and length of isolation were similar in the AFB-smear—positive groups (C+S+ and C−S+). We estimated that admissions without culture-proven TB (C−S+ and C−S−) accounted for 3,174 (36%) of the 8,712 days of TB isolation expended and for 65% of the 16,671 days of anti-TB treatment. The vast majority of this resource consumption (2,737 [86%] of 3,174 days of isolation) occurred during the diagnostic period before a definitive culture result was known.

Conclusions:

Our results suggest that prolonged diagnostic uncertainty and misclassification of cases due to false-positive and false-negative smears are associated with substantial medical-resource consumption. New diagnostic modalities that reduce the period of diagnostic uncertainty could reduce the utilization of resources later found to be unnecessary
An Observational Study of Hand Washing and Infection Control Practices by Healthcare Workers
Authors: Watanakunakorn Chatrchai , Wang Catherine , Hazy John
Published: September 2009

During a 6-week period, a medical student conducted an observational study of hand washing and infection control practices in a community teaching hospital. There was no difference in the prevalence of handwashing practices among the three work shifts. The prevalence of hand washing was higher in surgical (56.4%) and medical intensive-care units (39.2%) than in intermediate (30.0%) or general units (22.8%).
A Software Program to Calculate Goodman and Kruskal's Gamma: A Method to Monitor Surgical-Site Infection Rates
Authors: Wasser Thomas E.
Published: September 2009

Several studies have described a need for a valid statistical methodology to facilitate interhospital and intrahospital infection rates for their operative procedures. Physician awareness of postoperative surgical-site infection rates has been demonstrated as an effective means to reduce infection rates in both high- and low-risk surgical patients. This article presents a new software program that allows for simple data entry and provides results including the gamma statistic, sample size, variance, standard error, and Z value and P value of the gamma result. This software also provides a data interpretation table, allowing infectious disease department physicians or staff to determine if a significant relation exists between operative procedure infection rates and patient risk factors.
A Viral Gastroenteritis Outbreak Associated with Person-to-Person Spread Among Hospital Staff
Authors: Cáceres Victor M. , Kim David K. , Bresee Joseph S. , Horan John , Noel Jacqueline S. , Ando Tamie , Steed Connie J. , Weems J. John , Monroe Stephan S. , Gibson James J.
Published: September 2009

Objective:

To identify the etiologic agent and risk factors associated with a hospital ward outbreak of gastroenteritis.

Setting:

A regional referral hospital in upstate South Carolina.

Methods:

We reviewed patient charts, surveyed staff, and tested stool from acutely ill persons. A case was defined as diarrhea and vomiting in a staff member or patient from January 5 to 13, 1996.

Results:

The initial case occurred on January 5 in a staff nurse who subsequently was hospitalized on the ward and visited by many staff colleagues. The staff were at a significantly greater risk for gastroenteritis than were patients (28/89 [31%] vs 10/91 [11%]; relative risk [RR], 2.9; 95% confidence interval [CI95], 1.5-5.5). All 10 case-patients had been exposed to case-nurses (assigned nurses who were primary caretakers), and eight had documented exposure to case-nurses 1 to 2 days before their illness. Patients exposed to case-nurses had a significantly increased risk of illness (8/57 [14%] vs 0/32; RR, >4.5; CI95, undefined). Neither staff nor patients had significantly increased risk from food, water, ice, or exposure to case-patients. Electron microscopy identified small round-structured viruses (SRSVs) in nine of nine stool samples.

Conclusion:

This nosocomial outbreak of gastroenteritis was likely caused by SRSVs introduced by a staff member and spread via person-to-person transmission from and among staff. The potential for spread of SRSV-associated gastroenteritis from and among staff should be considered in developing strategies to prevent similar outbreaks in hospital settings
Influenza Immunization: Improving Compliance of Healthcare Workers
Authors: Harbarth Stephan , Siegrist Claire-Anne , Schira Jean-Claude , Wunderli Werner , Pittet Didier
Published: September 2009

OBJECTIVE: In spite of yearly recalls, influenza immunization rates of healthcare workers (HCWs) remained low (10%) at the University Hospitals of Geneva. This study was conducted to identify HCWs' reasons for rejection of immunization, to design specific intervention methods based on these reasons, and to evaluate the impact of such interventions.

METHODS: Three departments with high-risk patients (geriatrics, obstetrics, and pediatrics) were selected as main targets. Questionnaires were distributed in these units. Based on HCWs' perceptions, different intervention methods were designed and used either in these departments only (educational conferences, on-site availability of a vaccination nurse) or in the whole institution (posters, personal letters). Immunization rates were collected throughout the institution.

RESULTS: 797 completed questionnaires from 1,092 HCWs (73%) were returned. Major reasons for immunization rejection were confidence that their bodies' self-defense mechanisms would ward off infection (32%), perception of low exposure risk (23%), and doubts concerning vaccine efficacy (19%). The use of intervention methods designed to address these factors increased influenza immunization rates in the three targeted departments from 13% (95% confidence interval [CI95], 11.4-15.6) in 1995 and 1996 to 37% (CI95, 34.5-40.3) in the following season (P<.001). In all other departments, immunization rates rose from 9% (CI95, 8.5-10.3) to 23%% (CI95, 21.6-24.1; P<.001). Nurses were, and remained, more reluctant to be immunized compared to other HCWs.

CONCLUSIONS: Influenza immunization rates can be increased significantly by specific interventions based on local concerns of HCWs, among which educational conferences and the on-site availability of a vaccination nurse appeared important
Evidence for Person-to-Person Transmission of Candida lusitaniae in a Neonatal Intensive-Care Unit
Authors: Fowler Sandra L. , Rhoton Beth , Springer Shelley C. , Messer S.A. , Hollis Richard J. , Pfaller Michael A.
Published: September 2009

Candida lusitaniae is an increasingly important nosocomial bloodstream pathogen. Epidemiological investigation and molecular typing techniques identified three neonates infected with identical strains of C lusitaniae that were distinguished readily from epidemiologically unrelated strains from other locations in the hospital. The results of this study provide evidence for nosocomial transmission of C lusitaniae in a neonatal intensive-care unit and suggest that these infants are at increased risk for infection with this agent
Evaluating the Control of Tuberculosis Among Healthcare Workers: Adherence to CDC Guidelines of Three Urban Hospitals in California
Authors: Sutton Patrice M. , Nicas Mark , Reinisch Florence , Harrison Robert J.
Published: September 2009

OBJECTIVE:

To evaluate adherence to components of the Centers for Disease Control and Prevention (CDC) guidelines for preventing the transmission of Mycobacterium tuberculosis in healthcare facilities.

DESIGN:

Multihospital study using direct observation and a standardized questionnaire.

SETTING:

Three urban hospitals (two county hospitals and one private community hospital) in counties in California with a high number and incidence rate of tuberculosis (TB) cases.

MEASUREMENTS:

The ventilation performance of treatment and TB-patient isolation rooms was assessed. Questionnaire data regarding TB control policy and procedures were obtained through interviews with the person(s) responsible for each program component; review of written TB control plans, training, and educational materials; and attendance at hospital TB control meetings and trainings.

RESULTS:

Twenty-eight percent of isolation rooms tested (7/25) were under positive pressure; 83% of rooms tested (20/24) had six or more nominal air changes per hour (ACH), but supply air did not mix rapidly with room air. Therefore, the nominal ACH likely overestimated the effective ACH and the subsequent protection provided. In virtually all rooms tested (26/27), air potentially containing M tuberculosis aerosol moved toward, rather than away from likely worker locations. None of the hospitals regularly checked the performance of engineering controls. Only one hospital adhered to the CDC minimum requirements for respiratory protection. Training of healthcare workers generally was underutilized as a TB prevention measure. Hospitals did not provide comprehensive counseling regarding the need for healthcare workers to know their immune status and the risks associated with M tuberculosis infection in an immunocompromised individual. Employee representatives did not have a voice in TB-related decision making.

CONCLUSIONS:

Important aspects of day-to-day TB control practice did not conform to the written TB control policy. Subsequent to the identification of TB patients, healthcare workers at all three hospitals were potentially exposed to M tuberculosis aerosol due to breaches in negative-pressure isolation, the limitations of dilution ventilation, and the failure to maintain engineering controls and to implement respiratory protection controls fully These findings lend support to the Occupational Safety and Health Administration's policy presumption that, absent clear evidence to the contrary, newly acquired healthcare-worker M tuberculosis infections are work-related.
Cross-Contamination with Mycobacterium tuberculosis: An Epidemiological and Laboratory Investigation
Authors: Nivin Beth , Fujiwara Paula I. , Hannifin John , Kreiswirth Barry N.
Published: September 2009

OBJECTIVE:

To investigate possible cross-contamination of laboratory specimens, as suggested by an increased incidence of newly diagnosed patients with tuberculosis, many of whom had all negative smears for acid-fast bacilli and only one positive Mycobacterium tuberculosis culture referred to as “negative smears, one positive“ or NSOP.

METHODS:

Medical-record reviews were performed for all patients with NSOP results diagnosed at this facility within a 9-month period. Laboratory logbooks were reviewed for all isolates processed; DNA fingerprinting was performed on available isolates.

RESULTS:

Of 80 patients with NSOP results, 45 (56%) were found to have false-positive cultures resulting from laboratory contamination with H37Ra, an avirulent stock strain of Mycobacterium tuberculosis.

CONCLUSION:

Laboratory cross-contamination resulted in the false diagnosis of tuberculosis in at least 45 individuals. Use of the Mycobacteria Growth Indicator Tube may have contributed to these contamination incidents by detecting small numbers of contaminating mycobacteria that may not have been detected with less sensitive media.
Central Venous Catheters as a Source of Hemodialysis-Related Bacteremia
Authors: Taylor Geoffrey D. , McKenzie Margaret , Buchanan-Chell Maureen , Caballo Louise , Chui Linda , Kowalewska-Grochowska Kinga
Published: September 2009

Objective:

To describe investigations into an increase in hemodialysis-related bacteremia that occurred in our hospital in the first 6 months of 1996.

Setting:

Hemodialysis unit in a tertiary-care medical center.

Methods:

Prospective surveillance for hemodialysis bacteremia has been performed for several years. Cases that occurred in 1995 were compared to cases in the first 6 months of 1996. Unit data on dialysis runs and method of dialysis access were used to calculate rates. Nested polymerase chain reaction (PCR) was used to type 18 Staphylococcus aureus isolates from 1996. A case-control study comparing 80 randomly selected hemodialysis patients from 1995 and 1996 was performed to examine infection risk factors.

Results:

The hemodialysis bacteremia rate was 1.2 per 1,000 runs in 1995 and 2.8 per 1,000 in the first 6 months of 1996 (P=.0009). The 25 cases in 1995 and 32 in the first half of 1996 were similar in age, gender, means of vascular access, and micro-bial etiology. Central venous catheter (CVC) access accounted for >90% of cases in both time periods. S aureus was the most common microbial etiology (53% of the 1996 cases). PCR typing of S aureus isolates from 1996 demonstrated five different strains, the most common having six isolates. The use of CVCs as a means of vascular access abruptly increased in the unit in January 1996, from <30% of dialysis runs in 1995 to >40% in 1996 (P<.001), associated with structural changes in healthcare delivery in the region resulting in delays in performing surgical procedures, such as creation of vascular grafts and fistulae.

Conclusion:

A marked increase in hemodialysis bacteremia occurred in 1996, associated with increased reliance on CVCs for vascular access in hemodialysis patients during a period of healthcare restructuring.
Ipl1/Aurora B kinase coordinates synaptonemal complex disassembly with cell cycle progression and crossover formation in budding yeast meiosis
Authors: Jordan Philip , Copsey Alice , Newnham Louise , Kolar Elizabeth , Lichten Michael , Hoffmann Eva
Published: September 2009

Several protein kinases collaborate to orchestrate and integrate cellular and chromosomal events at the G2/M transition in both mitotic and meiotic cells. During the G2/M transition in meiosis, this includes the completion of crossover recombination, spindle formation, and synaptonemal complex (SC) breakdown. We identified Ipl1/Aurora B kinase as the main regulator of SC disassembly. Mutants lacking Ipl1 or its kinase activity assemble SCs with normal timing, but fail to dissociate the central element component Zip1, as well as its binding partner, Smt3/SUMO, from chromosomes in a timely fashion. Moreover, lack of Ipl1 activity causes delayed SC disassembly in a cdc5 as well as a CDC5-inducible ndt80 mutant. Crossover levels in the ipl1 mutant are similar to those observed in wild type, indicating that full SC disassembly is not a prerequisite for joint molecule resolution and subsequent crossover formation. Moreover, expression of meiosis I and meiosis II-specific B-type cyclins occur normally in ipl1 mutants, despite delayed formation of anaphase I spindles. These observations suggest that Ipl1 coordinates changes to meiotic chromosome structure with resolution of crossovers and cell cycle progression at the end of meiotic prophase.
Global Changes in the Transcript and Metabolic Profiles during Symbiotic Nitrogen Fixation in Phosphorus-Stressed Common Bean Plants
Authors: Hernández Georgina , Valdés-López Oswaldo , Ramírez Mario , Goffard Nicolas , Weiller Georg , Aparicio-Fabre Rosaura , Fuentes Sara Isabel , Erban Alexander , Kopka Joachim , Udvardi Michael K. , Vance Carroll P.
Published: September 2009

Phosphorus (P) deficiency is widespread in regions where the common bean (Phaseolus vulgaris), the most important legume for human consumption, is produced, and it is perhaps the factor that most limits nitrogen fixation. Global gene expression and metabolome approaches were used to investigate the responses of nodules from common bean plants inoculated with Rhizobium tropici CIAT899 grown under P-deficient and P-sufficient conditions. P-deficient inoculated plants showed drastic reduction in nodulation and nitrogenase activity as determined by acetylene reduction assay. Nodule transcript profiling was performed through hybridization of nylon filter arrays spotted with cDNAs, approximately 4,000 unigene set, from the nodule and P-deficient root library. A total of 459 genes, representing different biological processes according to updated annotation using the UniProt Knowledgebase database, showed significant differential expression in response to P: 59% of these were induced in P-deficient nodules. The expression platform for transcription factor genes based in quantitative reverse transcriptase-polymerase chain reaction revealed that 37 transcription factor genes were differentially expressed in P-deficient nodules and only one gene was repressed. Data from nontargeted metabolic profiles indicated that amino acids and other nitrogen metabolites were decreased, while organic and polyhydroxy acids were accumulated, in P-deficient nodules. Bioinformatics analyses using MapMan and PathExpress software tools, customized to common bean, were utilized for the analysis of global changes in gene expression that affected overall metabolism. Glycolysis and glycerolipid metabolism, and starch and Suc metabolism, were identified among the pathways significantly induced or repressed in P-deficient nodules, respectively.