bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk Assessment for Surgical-Site Infections in Orthopedic Patients
Authors: Boer Annette S. de , Groot A. Joke Mintjes-de , Severijnen Antonius J. , van den Berg Jan Maarten J. , van Pelt Wilfrid
Published: February 2006

Objective:

To assess the relative importance of risk factors for surgical-site infections (SSIs) in orthopedic patients and thereby determine which risk factors to monitor in the national surveillance of SSI in The Netherlands.

Design:

Reanalysis of data on SSI and associated risk factors from two surveillance projects on nosocomial infections, carried out in 1992 and 1993 in The Netherlands: Project Surveillance Nosocomial Infections in the region of Utrecht (PSZU) and the first Project Surveillance Surgical Wound Infections (SWIFT-1). Odds ratios (ORs) were calculated for age, gender, preoperative stay, and the number of operations. In addition, in PSZU, other nosocomial infections, and, in SWIFT-1, prophylactic antibiotics, acute surgery, and wound contamination were studied.

Participants:

The study was confined to hospitalized orthopedic patients (PSZU, 4,872; SWIFT-1, 6,437).

Results:

In PSZU, the following ORs were significant in a multivariate model: age 0-44 years, 1.0; 45-64 years, 1.6; 65-74 years, 4.7; and 75-99 years, 6.0. For a preoperative stay over 4 days, the OR was 3.3 (95% confidence interval [CI95], 2.5-4.0), and for multiple surgery, 2.5 (CI95, 1.9-3.0). For females, the OR was 0.8 (not significant). The same model applied to SWIFT-1 gave similar ORs. Adjustment for additional nosocomial infections (PSZU) decreased the ORs for ages over 65 years remarkably. The OR for additional nosocomial infections in patients under 65 years of age was 15.6 (CI95, 4.3-57.4). Adjustment for prophylactic antibiotics, acute surgery, and wound-contamination class (SWIFT-1) did not influence the ORs of the original model, but showed that wound-contamination class was an important risk factor.

Conclusions:

Age, additional nosocomial infections, wound-contamination class, preoperative stay, and the number of operations were identified as important risk factors for SSI in Dutch orthopedic patients.
A Survey of Methods Used to Detect Nosocomial Legionellosis Among Participants in the National Nosocomial Infections Surveillance System
Authors: Fiore Anthony E. , Butler Jay C. , Emori T. Grace , Gaynes Robert P.
Published: February 2006

Objective:

To help define the scope of nosocomial legionnaire's disease (LD) and to assess use of recommended diagnostic methods and transmission control practices.

Methods:

We surveyed 253 hospitals participating in the National Nosocomial Infections Surveillance (NNIS) System. The anonymous survey included questions about episodes of nosocomial LD, environmental sampling practices, maintenance of hospital water systems, and diagnostic techniques.

Results:

Of 192 hospitals that responded, 29% reported at least one episode of nosocomial ID from 1990 through 1996, and 61% of these reported at least two episodes. Of 79 hospitals with transplant programs, 42% reported nosocomial LD, compared with 20% of hospitals without transplant programs. Environmental sampling had been conducted by 55% of hospitals, including 79% of those reporting nosocomial LD.Legionellawere isolated in 34% that sampled potable water and 19% that sampled cooling system reservoirs. Supplemental potable-water decontamination systems were installed in 20% of hospitals. Only 19% routinely performed testing for legionellosis among patients at high risk for nosocomial LD.

Conclusions:

Nosocomial LD is relatively common among NNIS hospitals, especially those performing organ transplants. Environmental sampling forLegionellais a common practice among NNIS hospitals, andLegionellaoften are isolated from sampled hospital cooling towers and hospital potable-water systems. Hospitals have responded to suspected nosocomial LD infection with a variety of water sampling and control strategies; some have not attempted to sample or decontaminate water systems despite identified transmission.
Nosocomial Tuberculosis Exposure in an Outpatient Setting Evaluation of Patients Exposed to Healthcare Providers With Tuberculosis
Authors: Bock Naomi N. , Sotir Mark J. , Parrott Patricia L. , Blumberg Henry M.
Published: February 2006

Objective:

To evaluate the risk of tuberculosis (TB) transmission to patients potentially exposed to two healthcare providers who worked in outpatient settings for several weeks prior to being diagnosed with acid-fast bacilli smear-positive pulmonary TB.

Design:

Potentially exposed patients were notified by letter and television reports of the recommended evaluation for TB infection or disease and availability of free screening at the hospital. Prevalence of infection in the screened patients and the incidence rate of TB over the subsequent 2 years were compared to those of a control group of unexposed outpatients.

Setting:

An urban inner-city hospital.

Patients:

1,905 patients with potential exposure to the ill healthcare workers; 487 (25%) presented for evaluation. Controls consisted of 951 unexposed patients.

Results:

361 potentially exposed patients had their tuberculin test read; 97 (27%) had a purified protein derivative ≥10 mm. In the comparison group, 148 (25%) of 600 with test readings had a ≥10-mm reaction (risk ratio, 1.18; 95% confidence interval, 0.86-1.60). In multivariate analysis, male gender, non-white race, and older age were significantly associated with a positive tuberculin test; exposure was not. No TB cases were identified during screening. Two years after the exposure, 7 TB cases had been reported to the state registry among 1,905 potentially exposed patients (184 cases/100,000 person-years) versus 4 cases in the comparison group of 951 (210 cases/100,000 person-years).

Conclusions:

Evaluation of patients exposed to health-care workers with TB disease in ambulatory settings of an inner-city hospital revealed no evidence of transmission ofMycobacterium tuberculosisdue to the exposure.
Effect of Zidovudine Postexposure Prophylaxis on the Development of HIV-Specific Cytotoxic T-Lymphocyte Responses in HIV-Exposed Healthcare Workers
Authors: D'Amico Ronnie , Pinto Ligia A. , Meyer Peter , Landay Alan L. , Harris Alan A. , Clerici Mario , Berzofsky Jay A. , Shearer Gene M. , Kessler Harold A.
Published: February 2006

We evaluated the effects of zidovudine postexposure prophylaxis (PEP) on the development of human immunodeficiency virus (HIV) envelope-specific cytotoxic T-lymphocyte responses in 20 healthcare workers with occupational exposures to HIV. Seven healthcare workers were treated with zidovudine PER Only 1 of 7 treated, versus 6 of 13 not treated, developed an HIV envelope-specific cytotoxic T-lymphocyte response. These data suggest that zidovudine abrogated HIV-specific cytotoxic T-lymphocyte responses. HIV-specific cytotoxic T-lymphocyte responses may be useful as a surrogate marker of HIV replication in the evaluation of new regimens for PEP of occupational HIV exposures.
Occupational Exposure and Voluntary Human Immunodeficiency Virus Testing: A Survey of Maryland Hospitals
Authors: Solomon Liza , Thompson Charlotte , Squiers Linda , Wulff Karen , Benjamin Georges
Published: February 2006

A survey was conducted to estimate how often healthcare providers were exposed to patients' blood and the percentage of incidents in which patients agreed to human immunodeficiency virus (HIV) testing. Data from 38 hospitals with 53,508 employees revealed 2,244 exposures. Of 1,732 requests for information regarding the HIV status of the source patient, only 77 (6%) resulted in the patient's refusal to consent to an HIV test.
Implementation of a Practical Antibiotic Policy in the Czech Republic
Authors: Kolár Milan , Látal Tomás
Published: February 2006

We describe the antibiotic control policy at the Faculty Hospital in Olomouc, Czech Republic. Practical examples of successful implementation of the policy are provided.
Implementation of an Interactive Computer-Assisted Infection Monitoring Program at the Bedside
Authors: Heininger Alexandra , Niemetz Adolf H. , Keim Martin , Fretschner Reinhold , Döring Gerd , Unertl Klaus
Published: February 2006

A new computer-assisted infection monitoring (CAI) software program has been developed for use in an intensive-care unit (ICU). By means of an interactive dialogue with physicians at the bedside, infection diagnoses and therapeutic decisions were recorded prospectively during a 3-month test period. By linking epidemiological data with information about therapeutic decisions, CAI could assess the quality of the therapeutic decisions. Antibiotics chosen empirically before the availability of any culture results, matched the antibiotic susceptibility patterns of the subsequently identified pathogens in 74% of the cases. Therapy chosen in collaboration with the computer after the pathogen was known, but before sensitivity results were available, corresponded with the eventual antibiograms of the microorganisms in 90% of the cases. Data analysis by CAI allowed us to assess critically the diagnostic and therapeutic habits in our ICU. Using the query-by-example method, CAI automatically calculated device-associated infection rates.
The Presterilization Microbial Load on Used Medical Devices and the Effectiveness of Hydrogen Peroxide Gas Plasma AgainstBacillus SubtilisSpores
Authors: Penna Thereza Christina Vessoni , Ferraz Carlos Augusto M. , Cassola Maria Águida
Published: February 2006

Objectives:

To determine the microbial load found on used critical medical devices (5 spinal anesthesia needles, 21 catheters, and 28 sheaths) prior to sterilization and to evaluate the effectiveness of hydrogen peroxide gas plasma against inoculatedBacillus subtilisvargiobigii(American Type Culture Collection 9372) spores.

Methods:

Membrane filter and pour-plate methods were applied to estimate total microbial loads (aerobic and anaerobic, mesophilic and thermophilic, vegetative and spore forms). Spinal anesthesia needles (102 units) and sheath components (61 units) were inoculated with a suspension ofB subtilisspores. After drying, the devices were sterilized with hydrogen peroxide gas plasma.

Results:

Higher counts of aerobic, mesophilic, and fungal organisms were recovered when the drying period was insufficient. Anaerobic spores were not found in any analyzed presterilization items. The hydrogen peroxide gas plasma effected a 5 to 7 log10-fold reduction inB subtilisspore counts in well-dried needles and sheath components.

Conclusions:

The success of hydrogen peroxide gas plasma sterilization depends mostly on educating the staff to assure well-cleaned and dried reusable medical devices, allowing penetration of the hydrogen peroxide gas plasma into the critical points of the items and providing a reduction in organisms.
Screening High-Risk Patients for Methicillin-ResistantStaphylococcus Aureuson Admission to the Hospital Is It Cost Effective?
Authors: Papia Giuseppe , Louie Marie , Tralla Arnold , Johnson Claudette , Collins Veronica , Simor Andrew E.
Published: February 2006

Objectives:

To determine the cost-effectiveness of a policy of screening high-risk patients for methicillin-resistantStaphylococcus aureus(MRSA) colonization on admission to hospital.

Setting:

980-bed university-affiliated tertiary-care hospital.

Patients:

Between June 1996 and May 1997, patients directly transferred from another hospital or nursing home, or who had been hospitalized in the previous 3 months, were screened for MRSA within 72 hours of hospital admission.

Design:

Nasal, perineal, and wound swabs were obtained for MRSA screening using standard laboratory methods. Laboratory and nursing costs associated with screening patients for MRSA on admission to hospital were calculated. The costs associated with the implementation of recommended infection control measures for patients with MRSA also were determined.

Results:

3,673 specimens were obtained from 1,743 patients. MRSA was found on admission in 23 patients (1.3%), representing 36% of the 64 patients with MRSA identified in the hospital during the year. MRSA-colonized patients were more likely to have been transferred from a nursing home (odds ratio [OR], 6.4;P=.04) or to have had a previous history of MRSA colonization (OR, 13.1;P=.05). Laboratory and nursing costs were found to be $8.34 per specimen, for a total cost of $30,632 during the year. The average cost of implementing recommended infection control measures for patients colonized with MRSA was approximately $5,235 per patient.

Conclusion:

If early identification of MRSA in colonized patients prevents nosocomial transmission of the organism to as few as six new patients, the screening program would save money.
Methicillin-ResistantStaphylococcus Aureusin French Hospitals: A 2-Month Survey in 43 Hospitals, 1995
Authors:   The Hôpital Propre II Study Group
Published: February 2006

Objective:

To estimate the incidence of methicillin-resistantStaphylococcus aureus(MRSA) in patients hospitalized in French public hospitals.

Design:

A 2-month survey that included 163,573 patients and 140,114 admissions.

Setting and Patients:

Forty-three public or public-affiliated hospitals throughout France, including 12 university-affiliated hospitals. Information was recorded on all patients having MRSA recovered from culture of any clinical sample.

Results:

The overall median incidence rate (per 1,000 admissions) of clinically detected MRSA was 5.9 (range, 1.8-15.8); median rates were similar in hospitals affiliated or not affiliated to universities (6.4 and 5.9, respectively). Smaller unaffiliated hospitals (<500 beds) had higher MRSA incidence rates (mean, 7.2) than larger (>500 beds) unaffiliated hospitals or university hospitals (mean, 6.7 and 6.1, respectively). The incidence density (per 1,000 patient-days) of MRSA was higher in intensive-care units [ICUs] 2.39/1,000) than in surgical (0.80/1,000) and medical (0.70/1,000) wards, respectively; comparable rates were recorded in rehabilitation units (0.67/1,000), whereas in long-term-stay units, the incidence density of MRSA was 0.27/1,000 patient-days. Of 958 MRSA isolates, 660 (69%) also were resistant to all aminoglycosides. In 411 (43%) of 958 patients, the MRSA isolate was considered imported (ie, first recovered within 72 hours of the patient's admission to the unit). More than one half (53%) of imported cases were transfer patients from other hospitals, and 17% originated from ICUs.

Conclusion:

MRSA is extensive in French hospitals. All categories of hospitals are involved to a similar extent, and there is intense circulation of patients colonized or infected with MRSA between units and hospitals. Containment of MRSA would mandate increasing resources devoted to infection control, especially in smaller hospitals, and control programs should involve notification of carriers and screening of patients at risk of MRSA carriage on admission to detect carriers and to implement isolation precautions rapidly.
Long-Term Central Venous Catheter Infection in HIV-infected and Cancer Patients: A Multicenter Cohort Study
Authors: Astagneau Pascal , Maugat Sylvie , Tran-Minh Tuan , Douard Marie-Cécile , Longuet Pascale , Maslo Caroline , Parte Régis , Macrez Annick , Brücker Gilles
Published: February 2006

Objectives:

To evaluate and compare the risk of long-term central venous catheter (CVC) infection in human immunodeficiency virus (HIV)-infected and cancer patients.

Design:

Prospective multicenter cohort study based on active surveillance of long-term CVC manipulations and patient outcome over a 6-month period.

Setting:

Services of infectious diseases and oncology of 12 university hospitals in Paris, France.

Participants:

In 1995, all HIV and cancer patients with solid malignancy were included at the time of long-term CVC implantation.

Results:

Overall, 31.6% of long-term CVC infections were identified in 32% of 201 HIV and 5% of 255 cancer patients. Most were associated with bacteremia, most commonly coagulase-negative staphylococci. The long-term CVC time-related infection risk was greater in HIV than in cancer patients (3.78 vs 0.39 infections per 1,000 long-term CVC days; P<.001). The independent risk factors of long-term CVC infection were as follows: in HIV patients, frequency of long-term CVC handling and neutropenia; in cancer patients, poor Karnofsky performance status; in both HIV and cancer patients, recent history of bacterial infection. The risk of long-term CVC infection was similar for tunneled catheters and venous access ports in each population.

Conclusions:

Prevention of long-term CVC infection should focus first on better sterile precautions while handling long-term CVC, especially in HIV patients who have frequent and daily use of the long-term CVC.
Seroconversion Rates in Healthcare Workers Using a Latex Agglutination Assay After Varicella Virus Vaccination
Authors: Weinstock David M. , Rogers Maureen , Lim Suzanne , Eagan Janet , Sepkowitz Kent A.
Published: February 2006

Objectives:

To determine the seroconversion rate after varicella immunization of healthcare workers (HCWs) and the effect of seroconversion rate on current cost-based recommendations for universal vaccination.

Methods:

A voluntary vaccination program for HCWs was performed at a tertiary-care cancer center in New York City. A commercial latex agglutination assay was used to test postvaccination antibody response. Costs for vaccination and postvaccination serological testing were compared to potential costs of postexposure employee furloughs.

Results:

Of 263 seronegative HCWs, 96 (36.5%) began the vaccine program. Thirty-nine HCWs received only one dose of vaccine. Seven returned for follow-up antibody testing, of whom 4 were seropositive. Of the 57 HCWs who received two doses, 38 returned for follow-up serology. Thirty-one (81.6%) HCWs were seropositive for varicella-zoster virus antibodies, and seven HCWs (18.4%) remained seronegative. Total cost of vaccination for all 263 seronegative HCWs was estimated and compared to the cost of varicella-related furloughs at our institution.

Conclusions:

We found a considerably lower rate of vaccine-induced seroconversion at our hospital compared to that of the published literature. Despite this finding, universal varicella vaccination remained an extremely cost-effective alternative to the furloughing of exposed, seronegative HCWs. Projected hospital savings exceeded $53,000 in the first year after vaccination alone.
Sporicidal Activity of a New Low-Temperature Sterilization Technology: The Sterrad 50 Sterilizer
Authors: Rutala William A. , Gergen Maria F. , Weber David J.
Published: February 2006

This study was undertaken to evaluate the efficacy of a new low-temperature sterilization system that recently has been cleared by the Food and Drug Administration, the Sterrad 50. Flat stainless steel carriers were inoculated with approximately 106 Bacillus stearothermophilus spores. These carriers were placed aseptically in the middle of 40-cm–long stainless steel-lumened test units of varying diameters (1 mm, 2 mm, and 3 mm). After inoculation, the test units were processed in the Sterrad 50. After sterilization, the carriers were assayed for growth of the B stearothermophilus spores. Our data demonstrated that the Sterrad 50 was highly effective in killing the B stearothermophilus spores (no positive carriers with 30 tests of each lumen-diameter test unit). The Sterrad 50 is likely to be clinically useful for the sterilization of heat-sensitive medical equipment.
Results of a Comprehensive Infection Control Program for Reducing Surgical-Site Infections in Coronary Artery Bypass Surgery
Authors: McConkey Samuel J. , L'Ecuyer Paul B. , Murphy Denise M. , Leet Terry L. , Sundt Thoralf M. , Fraser Victoria J.
Published: February 2006

Objective:

To evaluate the efficacy of a comprehensive infection control program on the reduction of surgical-site infections (SSIs) following coronary artery bypass graft (CABG) surgery.

Design:

Prospective cohort study.

Setting:

1,000-bed tertiary-care hospital.

Patients:

Persons undergoing CABG with or without concomitant valve surgery from April 1991 through December 1994.

Interventions:

Prospective surveillance, quarterly reporting of SSI rates, chlorhexidene showers, discontinuation of shaving, administration of antibiotic prophylaxis in the holding area, elimination of ice baths for cooling of cardioplegia solution, limitation of operating room traffic, minimization of flash sterilization, and elimination of postoperative tap-water wound bathing for 96 hours. Logistic regression models were fitted to assess infection rates over time, adjusting for severity of illness, surgeon, patient characteristics, and type of surgery.

Results:

2,231 procedures were performed. A reduction in infection rates was noted at all sites. The rate of deep chest infections decreased from 2.6% in 1991 to 1.6% in 1994. Over the same period, the rate of leg infections decreased from 6.8% to 2.7%, and of all SSI from 12.4% to 8.9%. The adjusted odds ratio (OR) for all SSIs for the end of 1994 compared to December 31,1991, was 0.37 (95% confidence interval [CI95], 0.22-0.63). For deep chest and mediastinal infections, the adjusted OR comparing the same period was 0.69 (CI95, 0.28-1.71).

Conclusions:

We observed significant reductions in SSI rates of deep and superficial sites in CABG surgery following implementation of a comprehensive infection control program. These differences remained significant when adjusted for potential confounding covariables
Nosocomial Pertussis in Healthcare Workers From a Pediatric Emergency Unit in France
Authors: Gehanno Jean-François , Pestel-Caron Martine , Nouvellon Michèle , Caillard Jean-François
Published: February 2006

Objective:

After pertussis was diagnosed in July 1997 in a 55-year-old nurse (case) from a pediatric emergency unit who had a respiratory illness and paroxysmal cough for 5 weeks, an epidemiological investigation was initiated to determine if other healthcare workers (HCWs) from the same unit also had pertussis.

Design:

Interviews were conducted to assess symptoms occurring in the previous months. Two sera were collected 2 to 3 months apart for 59 of 61 HCWs of the unit. The IgG response to pertussis toxin was determined using Western blot assay.

Setting:

Pediatric emergency unit (61 HCWs) of a 2,500-bed university hospital.

Results:

There was a total of 10 (5 confirmed and 5 probable) cases of pertussis identified in this outbreak. Nine HCWs (15%) had results suggesting recent or acute pertussis. To avoid transmission to patients and other HCWs, all HCWs with cough were treated for 14 days with erythromycin, and those having acute cough were given a 5-day sick leave. Despite these measures, a new acute pertussis case was identified in a 41-year-old nurse, with a positive culture from nasopharyngeal aspirates. Thus, all HCWs in the unit were prescribed spiramycin for 10 days to prevent any further spread of pertussis.

Conclusion:

Pertussis should be considered a threat to HCWs who are in contact with children. For HCWs, diagnosis of pertussis should be made on a clinical basis, giving greater importance to sensitivity of diagnosis criteria, and on early bacterial identification by culture of the organism or by polymerase chain reaction.

Recommendations:

In case of pertussis in an HCW, all staff in the unit who have had unprotected and intensive contact with that person should be provided with macrolide treatment to stop any transmission to colleagues and to young patients. Furthermore, the possibility of providing these HCWs with acellular pertussis vaccines warrants further investigation.
Two Consecutive Outbreaks ofStenotrophomonas Maltophilia (Xanthomonas Maltophilia)in an Intensive-care Unit Defined by Restriction Fragment-Length Polymorphism Typing
Authors: Alfieri Nancy , Ramotar Karam , Armstrong Pamela , Spornitz Mary E. , Ross Glenda , Winnick James , Cook D. Roy
Published: February 2006

Objective:

To investigate and control consecutive outbreaks ofStenotrophomonas maltophiliainfections in intensive-care–unit (ICU) patients.

Design:

Epidemiological investigation; restriction fragment-length polymorphism typing by pulsed-field gel electrophoresis (PFGE) of genomic DNA of outbreak strains; institution of infection control measures to limit spread.

Setting:

The medical-surgical ICU in an 800-bed tertiary-care center in Calgary, Alberta, Canada.

Results:

S maltophiliawas recovered from 14 ICU patients (12 infected, 2 colonized) between February 1993 and February 1994. Ten of the 14 patient isolates and 1 environmental isolate were available for PFGE typing. Patient isolates from 6 of the first 10 patients were identical. Isolates from the next 3 of 4 patients and an isolate recovered from a ventilator being used by a patient not infected withS maltophiliaalso were identical, but different from the first 6. The ventilator isolate was temporally associated with the latter 4 patients.

Conclusion:

Molecular typing allowed us to determine that there were two separate consecutiveS maltophiliaoutbreaks rather than a single protracted outbreak. Recovery ofS maltophiliafrom patient ventilators and an in-line suction catheter suggests that the organism may have been spread by cross-contamination from contaminated equipment or from an environmental source.
Vancomycin in Oregon: Who's Using It and Why
Authors: Cieslak Paul R. , Strausbaugh Larry J. , Fleming David W. , Ling Julia M.
Published: February 2006

Objective:

To determine the proportion of vancomycin orders that are appropriate according to national guidelines and to identify targets for educational messages.

Design:

Population-based study of vancomycin use in Oregon during a 3-week period. Survey of pharmacists, prospective flagging of vancomycin orders, and data abstraction from patient charts using standardized forms.

Setting:

Nonpsychiatric hospitals in Oregon.

Results:

Four (6%) of the 66 Oregon hospitals had pharmacy restrictions on initial vancomycin orders. Sixty-four (97%) of the hospitals participated in the study of indications for use; 293 vancomycin orders were reported; 3.8 courses were initiated per 1,000 patient-days. Indications for use were determined for 266 (91%); of these, 159 (60%) were deemed appropriate. Of uses for prophylaxis, empirical treatment of suspected gram-positive infection, and treatment of documented gram-positive infection, 57%, 56%, and 65%, respectively, were appropriate. Of hospitals with <250, 251-475, and >475 licensed beds, 65%, 58%, and 57% of vancomycin orders were appropriate. No single medical specialty accounted for >16% of inappropriate vancomycin use.

Conclusions:

Vancomycin was used inappropriately by physicians of many different specialties, in hospitals of all sizes, and in sundry clinical situations. The problem of inappropriate vancomycin use does not lend itself to solution by educational strategies targeted at specific subgroups; restrictions by hospital pharmacies may be required.
Varicella-Zoster Screening and Management Programs in Healthcare Facilities in Canada
Authors: Lussier Nathalie , Weiss Karl , Laverdière Michel
Published: February 2006

A 24-question survey on varicella-zoster screening programs and control measures for varicella-zoster infections was sent to 170 Canadian healthcare facilities. The results indicated that 60% of Canadian healthcare facilities have well-established preemployment varicella-zoster screening programs for healthcare workers. Overall, 30% of healthcare facilities impose work restrictions for susceptible healthcare workers, 49% use negative-pressure rooms for varicella-zoster management, and 28% have a policy to discharge susceptible exposed patients. Large variations exist among Canadian healthcare facilities in their varicella-zoster infection control policies.
Nosocomial Meningococcemia in a Physician
Authors: Gehanno Jean-François , Kohen-Couderc Laure , Lemeland Jean-François , Leroy Jacques
Published: February 2006

We report the case of a pediatrician who developed meningococcal meningitis after performing endotracheal intubation without protection on a child who was suspected of having meningoencephalitis. This case emphasizes the necessity for healthcare workers who perform high-risk procedures to use personal protection devices (ie, respirators and protective goggles). Unprotected healthcare workers with high exposure toNeisseria meningitidisshould receive chemoprophylaxis.
The Emergence of Resistant Strains of Acinetobacter baumannii: Clinical and Infection Control Implications
Authors: Dy Marie Eve , Nord Jill A. , LaBombardi Vincent J. , Kislak Jay W.
Published: February 2006

A prospective study was undertaken to determine colonization rates, susceptibility profiles, and outcomes in patients with clinical isolates of Acinetobacter baumannii. Fifty percent of patients became colonized with A baumannii, and 29% of these patients had clinical and colonizing isolates with discordant susceptibility profiles, without apparent relation to antibiotic use. Barrier infection control measures are necessary to prevent nosocomial transmission.
Infection Control in Gene Therapy
Authors: Evans Martin E. , Lesnaw Judith A.
Published: February 2006

Gene therapy is now being studied for the treatment of a wide variety of acquired and inherited diseases. Viruses used as vectors for gene transfer include retroviruses, adenoviruses, vaccinia viruses, adeno-associated viruses, and herpesviruses. These vectors, developed in the laboratory and in animal studies, are now being introduced into the clinical arena. Infection control practitioners will be involved invariably in reviewing the use of these agents in their clinics and hospitals. This review summarizes key aspects of the more common vectors and makes recommendations for infection control.
Outbreak ofEnterobacter cloacaeRelated to Understaffing, Overcrowding, and Poor Hygiene Practices
Authors: Harbarth Stephan , Sudre Philippe , Dharan Sasi , Cadenas Mercedes , Pittet Didier
Published: February 2006

Objective:

To determine the cause and mode of transmission of a cluster of infections due toEnterobacter cloacae.

Design and Setting:

Retrospective cohort study in a neonatal intensive-care unit (NICU) from December 1996 to January 1997; environmental and laboratory investigations.

Subjects:

60 infants hospitalized in the NICU during the outbreak period.

Main Outcome Measures:

Odds ratios (OR) linkingE cloacaecolonization or infection and various exposures. All availableE cloacaeisolates were typed and characterized by contour-clamped homogenous electric-field electrophoresis to confirm possible cross-transmission.

Results:

Of eight case-patients, two had bacteremia; one, pneumonia; one, soft-tissue infection; and four, respiratory colonization. Infants weighing <2,000 g and born before week 33 of gestation were more likely to become cases (P<.001). Multivariate analysis indicated that the use of multidose vials was independently associated withE cloacaecarriage (OR, 16.3; 95% confidence interval [CI95], 1.8-∞P=011). Molecular studies demonstrated three epidemic clones. Cross-transmission was facilitated by understaffing and overcrowding (up to 25 neonates in a unit designed for 15), with an increased risk ofE cloacaecarriage during the outbreak compared to periods without understaffing and overcrowding (relative risk, 5.97; CI95, 2.2-16.4). Concurrent observation of healthcare worker (HCW) handwashing practices indicated poor compliance. The outbreak was terminated after decrease of work load, increase of hand antisepsis, and reinforcement of single-dose medication.

Conclusions:

Several factors caused and aggravated this outbreak: (1) introduction ofE cloacaeinto the NICU, likely by two previously colonized infants; (2) further transmission by HCWs' hands, facilitated by substantial overcrowding and understaffing in the unit; (3) possible contamination of multidose vials withE cloacae.Overcrowding and understaffing in periods of increased work load may result in outbreaks of nosocomial infections and should be avoided.
Tuberculosis in Hemodialysis Patients in New Jersey: A Statewide Study
Authors: Simon Teresa A. , Paul Sindy , Wartenberg Daniel , Tokars Jerome I.
Published: February 2006

Objective:

To study the incidence of tuberculosis (TB), tuberculin skin testing (TST) practices, and infection control practices at outpatient hemodialysis centers.

Design:

Mail surveys performed in December 1994 and 1995.

Main Outcome Measures:

The numbers of patients with incident active TB during 1994 and 1995, TST policies during 1994, and TB infection control policies in 1994.

Setting:

All outpatient dialysis centers in New Jersey.

Patients or Participants:

Healthcare workers and patients in dialysis centers in New Jersey.

Results:

Of 47 centers, 41 provided information on TST and TB infection control policies and practices. TSTs were performed on newly hired healthcare workers at all 41 centers and on established workers at 39 centers. In contrast, only 1 center reported performing TSTs on hemodialysis patients; 5 other centers reported screening of patients for TB using chest radiographs. Active TB was reported in 3 of 4,550 chronic hemodialysis patients in 1994 (rate, 66/100,000 patient-years) and in 4 of 4,831 patients in 1995 (rate, 83/100,000 patient-years). Both rates were several times higher than the rate in the New Jersey general population during this period (10.7-10.8/100,000).

Conclusion:

Although based on small numbers of patients with TB, we found a relatively high incidence of TB among hemodialysis patients in New Jersey. Most centers reported performing TSTs on workers but not on patients. These results suggest the need for improved TB screening and infection control precautions at outpatient dialysis centers.
Costs and Benefits of Measures to Prevent Needlestick Injuries in a University Hospital
Authors: Roudot-Thoraval Françoise , Montagne Olivier , Schaeffer Annette , Dubreuil-Lemaire Marie-Laure , Hachard Danièle , Durand-Zaleski Isabelle
Published: February 2006

Objective:

To document the costs and the benefits (both in terms of costs averted and of injuries averted) of education sessions and replacement of phlebotomy devices to ensure that needle recapping did not take place.

Design:

The percentage of recapped needles and the rate of needlestick injuries were evaluated in 1990 and 1997, from a survey of transparent rigid containers in the wards and at the bedside and from a prospective register of all injuries in the workplace. Costs were computed from the viewpoint of the hospital. Positive costs were those of education and purchase of safer phlebotomy devices; negative costs were the prophylactic treatments and follow-up averted by the reduction in injuries.

Setting:

A 1,050-bed tertiary-care university hospital in the Paris region.

Results:

Between the two periods, the proportion of needles seen in the containers that had been recapped was reduced from 10% to 2%. In 1990, 127 needlestick (12.7/100,000 needles) and 52 recapping injuries were reported versus 62 (6.4/100,000 needles) and 22 in 1996 and 1997. When the rates were related to the actual number of patients, the reduction was 76 injuries per year. The total cost of information and preventive measures was $325,927 per year. The cost-effectiveness was $4,000 per injury prevented.

Conclusion:

Although preventive measures taken to ensure reduction of needlestick injuries appear to have been effective (75% reduction in recapping and 50% reduction in injuries), the cost of the safety program was high.
Preventing Central Venous Catheter-Related Infection in a Surgical Intensive-Care Unit
Authors: Bijma Rens , Girbes Armand R. , Kleijer Dick J. , Zwaveling Jan H.
Published: February 2006

The cumulative effect of five measures (introduction of hand disinfection with alcohol, a new type of dressing, a one-bag system for parenteral nutrition, a new intravenous connection device, and surveillance by an infection control practitioner) on central venous catheter colonization and bacteremia was studied. Colonization was significantly reduced (P<.025); the decrease in bacteremia was not statistically significant.
Nosocomial Infections Caused by Multiresistant Pseudomonas aeruginosa
Authors: Arruda Erico A.G. , Marinho Ivan S. , Boulos Marcos , Sinto Sumiko I. , Caiaffa F Helio H. , Mendes Caio M. , Oplustil Carmen P. , Sader Helio , Levy Carlos E. , Levin Anna S.
Published: February 2006

A case-control study was done to evaluate factors associated with nosocomial infections by multiresistant Pseudomonas aeruginosa (MRPA). Results showed that MRPA was associated with the use of immunosuppressive and antimicrobial drugs. Five typing methods indicated that the MRPA infections were due to multiple strains rather than a single strain.
Healthcare Worker Compliance With Nosocomial Tuberculosis Control Policies
Authors: LoBue Philip , Catanzaro Antonino
Published: February 2006

To determine compliance with nosocomial tuberculosis control measures, 541 healthcare worker observations were made for 52 patients placed in respiratory isolation. Sixty-four total violations were noted, of which 45% occurred in physicians in training. Overall compliance with tuberculosis control measures appeared to be good, but additional educational efforts are warranted.
Bacterial Contamination of Hospital Physicians' Stethoscopes
Authors: Bernard Louis , Kereveur Anne , Durand Dominique , Gonot Jeanne , Goldstein Fred , Mainardi Jean Luc , Acar Joseph , Carlet Jean
Published: February 2006

Because stethoscopes might be potential vectors of nosocomial infections, this study, conducted in a 450-bed general hospital, was devised to evaluate the bacterial contamination of stethoscopes; bacterial survival on stethoscope membranes; the kinetics of the bacterial load on stethoscope membranes during clinical use; and the efficacy of 70% alcohol or liquid soap for membrane disinfection. Among the 355 stethoscopes tested, 234 carried ≥2 different bacterial species; 31 carried potentially pathogenic bacteria. Although some bacteria deposited onto membranes could survive 6 to 18 hours, none survived after disinfection.
Prevention of Influenza in Long-Term–Care Facilities
Authors: Bradley Suzanne F. ,   Long-Term–Care Committee of the Society for Healthcare Epidemiology of America
Published: February 2006

Influenza is a frequent cause of epidemic and endemic respiratory illness in long-term-care facilities (LTCFs), resulting in considerable morbidity and mortality. Detection of influenza outbreaks in this setting can be difficult, because the clinical presentation in older adults is atypical and other pathogens also cause influenza-like illness (ILI) during the influenza season. Use of the standard case definition for influenza has not been effective in detecting episodes in residents of LTCFs. Alternative case-definitions that reflect the atypical presentation of influenza in this population have been recommended but not validated. The use of rapid tests for the detection of influenza in conjunction with more sensitive case definitions of ILI may lead to the earlier detection of influenza outbreaks in LTCFs, earlier initiation of infection control measures, and reduction in transmission.

The definition of outbreak, eg, the number of episodes of ILI or episodes of confirmed influenza A that would result in the initiation of antiviral chemoprophylaxis, remains controversial in this setting. The use of newer antivirals could limit the side effects seen in older adults in LTCFs. However, annual vaccination of residents and staff remains the most effective way to prevent the introduction of influenza A or influenza B into LTCFs. In addition, vaccination of LTCF residents reduces rates of illness and pneumonia due to influenza, as well as cardiopulmonary exacerbation, hospitalization, and death.
Cholesterol Is Required for Efficient Endoplasmic Reticulum-to-Golgi Transport of Secretory Membrane Proteins
Authors: Ridsdale Andrew , Denis Maxime , Gougeon Pierre-Yves , Ngsee Johnny K. , Presley John F. , Zha Xiaohui
Published: February 2006

Although cholesterol is synthesized in the endoplasmic reticulum (ER), compared with other cellular membranes, ER membrane has low cholesterol (3–6%). Most of the molecular machinery that regulates cellular cholesterol homeostasis also resides in the ER. Little is known about how cholesterol itself affects the ER membrane. Here, we demonstrate that acute cholesterol depletion in ER membranes impairs ER-to-Golgi transport of secretory membrane proteins. Cholesterol depletion is achieved by a brief inhibition of cholesterol synthesis with statins in cells grown in cholesterol-depleted medium. We provide evidence that secretory membrane proteins vesicular stomatitis virus glycoprotein and scavenger receptor A failed to be efficiently transported from the ER upon cholesterol depletion. Fluorescence photobleaching recovery experiments indicated that cholesterol depletion by statins leads to a severe loss of lateral mobility on the ER membrane of these transmembrane proteins, but not loss of mobility of proteins in the ER lumen. This impaired lateral mobility is correlated with impaired ER-to-Golgi transport. These results provide evidence for the first time that cholesterol is required in the ER membrane to maintain mobility of membrane proteins and thus protein secretion.
Structured polychotomous machine diagnosis of multiple cancer types using gene expression
Authors: Koo Ja-Yong , Sohn Insuk , Kim Sujong , Lee Jae Won
Published: February 2006

Motivation: The problem of class prediction has received a tremendous amount of attention in the literature recently. In the context of DNA microarrays, where the task is to classify and predict the diagnostic category of a sample on the basis of its gene expression profile, a problem of particular importance is the diagnosis of cancer type based on microarray data. One method of classification which has been very successful in cancer diagnosis is the support vector machine (SVM). The latter has been shown (through simulations) to be superior in comparison with other methods, such as classical discriminant analysis, however, SVM suffers from the drawback that the solution is implicit and therefore is difficult to interpret. In order to remedy this difficulty, an analysis of variance decomposition using structured kernels is proposed and is referred to as the structured polychotomous machine. This technique utilizes Newton–Raphson to find estimates of coefficients followed by the Rao and Wald tests, respectively, for addition and deletion of import vectors.

Results: The proposed method is applied to microarray data and simulation data. The major breakthrough of our method is efficiency in that only a minimal number of genes that accurately predict the classes are selected. It has been verified that the selected genes serve as legitimate markers for cancer classification from a biological point of view.

Availability: All source codes used are available on request from the authors.

Contact:  jykoo@korea.ac.kr
PROFbval: predict flexible and rigid residues in proteins
Authors: Schlessinger Avner , Yachdav Guy , Rost Burkhard
Published: February 2006

Summary: The mobility of a residue on the protein surface is closely linked to its function. The identification of extremely rigid or flexible surface residues can therefore contribute information crucial for solving the complex problem of identifying functionally important residues in proteins. Mobility is commonly measured by B-value data from high-resolution three-dimensional X-ray structures. Few methods predict B-values from sequence. Here, we present PROFbval, the first web server to predict normalized B-values from amino acid sequence. The server handles amino acid sequences (or alignments) as input and outputs normalized B-value and two-state (flexible/rigid) predictions. The server also assigns a reliability index for each prediction. For example, PROFbval correctly identifies residues in active sites on the surface of enzymes as particularly rigid.

Availability:  

Contact:  profbval@rostlab.org

Supplementary information: Supplementary data are available at Bioinformatics online.
Detection of gene copy number changes in CGH microarrays using a spatially correlated mixture model
Authors: Broët Philippe , Richardson Sylvia
Published: February 2006

Motivation: Comparative genomic hybridization array experiments that investigate gene copy number changes present new challenges for statistical analysis and call for methods that incorporate spatial dependence between sequences along the chromosome. For this purpose, we propose a novel method called CGHmix. It is based on a spatially structured mixture model with three states corresponding to genomic sequences that are either unmodified, deleted or amplified. Inference is performed in a Bayesian framework. From the output, posterior probabilities of belonging to each of the three states are estimated for each genomic sequence and used to classify them.

Results: Using simulated data, CGHmix is validated and compared with both a conventional unstructured mixture model and with a recently proposed data mining method. We demonstrate the good performance of CGHmix for classifying copy number changes. In Addition, the method provides a good estimate of the false discovery rate. We also present the analysis of a cancer related dataset.

Supplementary information:  

Contact:  broet@vjf.inserm.fr
A deterministic motif finding algorithm with application to the human genome
Authors: Hon Lawrence S , Jain Ajay N
Published: February 2006

Motivation: We present a novel algorithm, MaMF, for identifying transcription factor (TF) binding site motifs. The method is deterministic and depends on an indexing technique to optimize the search process. On common yeast datasets, MaMF performs competitively with other methods. We also present results on a challenging group of eight sets of human genes known to be responsive to a diverse group of TFs. In every case, MaMF finds the annotated motif among the top scoring putative motifs. We compared MaMF against other motif finders on a larger human group of 21 gene sets and found that MaMF performs better than other algorithms. We analyzed the remaining high scoring motifs and show that many correspond to other TFs that are known to co-occur with the annotated TF motifs. The significant and frequent presence of co-occurring transcription factor binding sites explains in part the difficulty of human motif finding. MaMF is a very fast algorithm, suitable for application to large numbers of interesting gene sets.

Availability: The software is available for academic research use free of charge by email request.

Contact:  ajain@jainlab.org

Supplemental information: Data comprising the benchmarks used in the paper may be downloaded from .
Herbal Medicine Research in Taiwan *Appropriate person among the authors to be in contact for any further information on the status of CHM research in Taiwan and for opportunities to study and conduct research in the field of TCM in Taiwan
Authors: Kaphle Krishna , Wu Leang-Shin , Yang Nai-Yen Jack , Lin Jen-Hsou
Published: February 2006

Of all the countries in the world, why did you choose Taiwan to pursue your study? It is a question that I (comments of the first author) have answered a thousand times. My first visit to a laboratory at National Taiwan University opened my eyes to the possibilities of herbal medicine research, especially in the area of veterinary medicine. It became my ambition to link the knowledge of Traditional Chinese Medicine (TCM) and Ayurveda from the Indian subcontinent and their integration with other systems of medicine, including Western medicine (WM), to achieve the concept of Sustainable Medicine, firstly for animals and then for humans. The Ministry of Economic Affairs (MOEA) has implemented a technology development program to quickly establish the key technologies, and this is a moment of opportunity for Taiwan′s traditional herbal medicine industry to upgrade and transform itself. This paper, initially intended to be a student′s narration, has evolved into a multi‐author treatise on the present state and likely future scenario of herbal medicine research in Taiwan.