bluuebunny/crossref_metadata_2025 huggingface dataset:
Accidental Blood Contact During Orthopedic Surgical Procedures
Authors: Folin Ann C. , Nordström Gun M.
Published: September 2009

A questionnaire study was carried out of all orthopedic surgical procedures in the operating rooms of a teaching hospital over an 8-week period to describe the frequency and circumstances of accidental blood contact. Blood exposure occurred in 11% of the procedures. Contamination of intact skin was the most common incident (79%); percutaneous injury occurred in 13%. The majority of the incidents were believed to be preventable.
Skin Testing for Tuberculosis in University Teaching Hospitals—Is There a Problem?
Authors: Mabon Barbara L. , Ciardi Beth , Nouri Kathi , Ruben Frederick L.
Published: September 2009

We performed four annual audits of tuberculin tests performed on hospitalized patients at a university teaching hospital complex. Each audit assessed if tests were performed and read correctly. House staff performed skin testing in years 1 to 3. Despite inter ventions of teaching and then of written instructions on skin testing, performance was poor. When testing was turned over in year 4 to trained infection control practitioners, performance approached 100%. We conclude that university teaching hospitals should assess skin-testing performance
Vancomycin-Resistant Enterococci in Stool Specimens Submitted for Clostridium difficile Cytotoxin Assay
Authors: Rafferty Mary Ellen , McCormick Malkanthie I. , Bopp Lawrence H. , Baltch Aldona L. , George Mary , Smith Raymond P. , Rheal Carol , Ritz William , Schoonmaker Diana
Published: September 2009

The prevalence of, and clinical risk factors associated with, vancomycin-resistant enterococcal colonization were investigated in patients suspected of having Clostridium difficile infection. Stools submitted for C difficile cytotoxin testing were screened for vancomycin-resistant enterococci (VRE). Isolates were speciated and characterized further by antibiotic susceptibility testing, DNA fingerprinting, and DNA:DNA hybridization for detection of specific vancomycin resistance genes. Of the 79 evaluable patients identified during a 3-month period, 16.5% were VRE-positive. The VRE isolates were genetically heterogeneous, although all carried the vanA gene. DNA fingerprinting data suggest that patient-to-patient transmission occurred, implicating colonized patients as potential reser voirs for VRE transmission. A positive C difficile cytotoxin assay and diabetes mellitus were the only identifiable risk factors associated with VRE colonization. Patients at risk for C difficile infection therefore may serve as reser voirs for VRE.
Activity of Disinfectants Against Vancomycin-Resistant Enterococcus faecium
Authors: Saurina Guillermo , Landman David , Quale John M.
Published: September 2009

Vancomycin-resistant enterococci (VRE) often contaminate the hospital environment. We examined the activity of commonly used disinfectants against eight strains of VRE, using a quantitative suspension test method. Isopropyl alcohol and sodium hypochlorite were highly effective. Hydrogen peroxide was ineffective for all strains. After 10 minutes of incubation (the manufacturers' recommended time of exposure), three phenolic and three quaternary ammonium compounds also were highly effective. After 3 minutes of exposure, however, occasional failures did occur. With the exception of 3% hydrogen peroxide, most disinfectants appear to be active against VRE.
Management of Healthcare Workers Infected With Hepatitis B Virus, Hepatitis C Virus, Human Immunodeficiency Virus, or Other Bloodborne Pathogens
Authors:   AIDS/TB Committee of the Society for Healthcare Epidemiology of America
Published: September 2009

This article provides the current recommendations of the Society for Healthcare Epidemiology of America (SHEA) regarding the management of healthcare workers infected with hepatitis B virus (HBV), hepatitis C virus (HCV), or the human immunodeficiency virus (HIV). For the reasons cited in the article, SHEA now maintains that separate virus-specific management strategies are appropriate for healthcare workers who are infected with these unrelated viruses. SHEA emphasizes the use of appropriate infection control procedures to minimize exposure of patients or providers to blood, emphasizes that transfers of blood from patients to providers and from providers to patients should be avoided, and argues that infected health-care workers should not be prohibited from participating in patient-care activities solely on the basis of their blood-borne pathogen infection. SHEA recommends that hepatitis B e-antigen–positive healthcare workers routinely should double glove and should not perform those activities that have been identified epidemiologically as associated with a risk for provider-to-patient HBV transmission despite the use of appropriate infection control procedures. SHEA also recommends that HCV- and HIV-infected providers use double gloving for procedures, but recommends that these providers not be excluded from any aspect of patient care unless epidemiologically incriminated in the transmission of these infections despite adequate precautions. SHEA argues for comprehensive education concerning bloodborne pathogens for all healthcare providers and trainees and against mandatory pathogen-specific educational requirements for infected providers. SHEA recommends against specific competence-monitoring procedures directed at these healthcare workers infected with bloodborne pathogens, arguing for managing infected providers in the context of a comprehensive approach to the management of all impaired providers. SHEA emphasizes the importance of worker privacy and medical confidentiality. SHEA emphasizes the importance of offering employees who have disabilities reasonable accommodation for their disabilities. The article discusses exposure management in detail and, in general, recommends adherence to existing guidelines for managing exposures to these agents. Finally, SHEA recommends against routine mandatory testing of providers. Specific details and the rationale for these recommendations are included in the body of the article.
Intramural and Extramural Communication
Authors: Herwaldt Loreen A. , Lettau Ludwig A.
Published: September 2009

Effective communication with hospital administrators, with medical staff, with the media, and with peers in healthcare epidemiology is a vital skill for hospital epidemiologists. This article will describe a number of practical ways to improve such communication based on the author's experience, on inter views with senior SHEA members, and on relevant articles from the literature.
Susceptibility of Antibiotic-Susceptible and Antibiotic-Resistant Hospital Bacteria to Disinfectants
Authors: Rutala William A. , Stiegel Marsha M. , Sarubbi Felix A. , Weber David J.
Published: September 2009

Objective:

To evaluate whether hospital strains of antibiotic-resistant bacteria exhibited altered susceptibility to disinfectants.

Design:

Antibiotic-susceptible bacteria were obtained from American Type Culture Collection: Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Klebsiella pneumoniae, Salmonella choleraesuis, and Pseudomonas aeruginosa. Hospital strains of antibiotic-resistant bacteria were obtained from clinical isolates, including: S aureus, S epidermidis, E coli, Enterococcus species, K pneumoniae, and P aeruginosa. The Association of Official Analytical Chemist's use-dilution method was used to test these 12 strains of 7 bacterial pathogens for their susceptibility to a phenol and a quaternary ammonium compound. For five pathogens, we tested a susceptible and a more resistant strain in 20 comparative trials (5 pathogens, 2 disinfectants, 2 dilutions per disinfectant).

Results:

In our 20 comparative trials, the antibiotic-resistant strains exhibited an increased resistance to the disinfectant in only a single instance.

Conclusions:

Our data demonstrate that the development of antibiotic resistance does not appear to be correlated to increased resistance to disinfectants.
Nosocomial Transmission of Human Immunodeficiency Virus and Subsequent Transmission of Multidrug-Resistant Tuberculosis in a Healthcare Worker
Authors: Ridzon Renée , Kenyon Thomas , Luskin-Hawk Roberta , Schultz Carol , Valway Sarah , Onorato Ida M.
Published: September 2009

A phlebotomist with nosocomially acquired human immunodeficiency virus infection developed tuberculosis 10 months after exposure to multidrug-resistant Mycobacterium tuberculosis during a nosocomial outbreak. Healthcare workers with immunosuppression are at increased risk of tuberculosis if infected and, if exposed, should be considered for preventive therapy regardless of tuberculin skin-test status.
Derivation and Validation of a Pulmonary Tuberculosis Prediction Model
Authors: Mylotte Joseph M. , Rodgers Jeanne , Fassl Maureen , Seibel Kathleen , Vacanti Angela
Published: September 2009

Objective:

To describe the derivation and validation of a pulmonary tuberculosis (TB) prediction model that would enable early discontinuation of unnecessary respiratory isolation.

Design:

Patients placed in isolation for suspected pulmonary TB were studied retrospectively (derivation cohort) and prospectively (validation cohort). Independent predictors of pulmonary TB in the derivation cohort (January 1992-March 1994) were identified by retrospective analysis. Predictors in the model were assigned weights on the basis of the results of the multivariate analysis in order to quantitate the risk of TB in an individual patient. The prospective validation consisted of application of the model to patients placed in isolation during the period April 1994 to June 1995. The predictability of the model in the derivation and validation cohorts was evaluated using receiver operating characteristics (ROC), curve analysis, and calculation of the area under the ROC curve (AUC).

Setting:

A university-affiliated, urban, public hospital with a large population of prison inmates and patients with human immunodeficiency virus infection.

Interventions:

Prospective application of the prediction model to patients placed in isolation during the validation period.

Results:

Four factors were found to be independent predictors of pulmonary TB among 296 isolation episodes in the derivation cohort: positive acid-fast sputum smear (odds ratio [OR], 5.8; 95% confidence interval [CI95], 3.0-11.0; weight=3 points), localized chest radiograph findings (OR, 2.5; CI95,1.3-4.9; weight=2 points), residence in a correctional facility (OR, 2.3; CI95, 1.2-4.4; weight=2 points), and history of weight loss (OR, 1.8; CI95, 1.0-3.2; weight=1 point). Infection control practitioners applied the model prospectively to 220 isolation episodes. The mean (土SE) AUCs of the ROC curve for the derivation and validation cohorts were not significantly different (.86±.04 vs.86±.07; P=.90). There was a significant decline in the mean duration of isolation from the onset of an automatic TB isolation policy in August 1992 to the end of the study (P=.045 by analysis of variance).

Conclusions:

A pulmonary TB prediction model was derived and validated prospectively in a hospital with a moderately high prevalence of TB. The model quantitated the risk of TB in an individual patient and aided infection control practitioners and primary-care physicians in their decisions to discontinue isolation during the validation period. Utilization of the model was responsible, in part, for a decrease in the mean duration of isolation during the study period. Although the model may not have general applicability due to the uniqueness of the patient population studied, this study illustrates how prediction models can be developed and used effectively to deal with a clinical problem.
Tuberculin Skin Testing of Hospitalized Patients
Authors: Woeltje Keith F. , Kilo Charles M. , Johnson Krista , Primack Jonathon , Fraser Victoria J.
Published: September 2009

Objectives:

We sought to define the prevalence of tuberculin skin test (TST) positivity in a group of newly hospitalized patients, to identify risk factors for positive tests, and to examine the impact of testing on infection control practices.

Design:

Unblinded cohort study over 5 days in July 1992.

Setting:

A 1,000-bed university-affiliated hospital.

Patients:

All patients admitted (excluding obstetric patients and newborns) were interviewed. Patients without a history of tuberculosis (TB) or a positive TST were offered a TST with Candida and tetanus controls.

Results:

Of 346 patients offered the test, 21 (6%) had a prior history of TB or a positive TST, and 36 (10%) declined to participate; 279 of the remaining 289 completed the study. Anergy was demonstrated in 94 (33.7%) of 279 patients. New positive TSTs were identified in 19 (10.3%) of 185 nonanergic patients. Of the 19 TST-positive patients, 6 (32%) had infiltrates on chest radiographs and were evaluated for active TB. One patient was treated empirically for active TB, and five received isoniazid prophylaxis. Risk factors for a new positive TST included age (odds ratio [OR], 1.56 per decade of life; P=.021), African American race (OR, 4.81; P=.008), alcohol abuse (OR, 5.53; P=.005), and peptic ulcer disease (OR, 4.53; P=.017). Risk factors for anergy included admission to a surgical service (OR, 2.1; P=.006), current use of steroids (OR, 2.65; P=.005), and human immunodeficiency virus (HIV) infection (OR, undefined; P=.034).

Conclusions:

Despite a high rate of anergy, routine tuberculin skin testing identified a substantial number of patients with TB infection who might otherwise have gone unrecognized.
Reduction in Tuberculin Skin-Test Conversions Among Medical House Staff Associated with Improved Tuberculosis Infection Control Practices
Authors: Bangsberg David R. , Crowley Kathleen , Moss Andrew , Dobkin Jay F. , McGregor Carlton , Neu Harold C.
Published: September 2009

Objective:

To assess the efficacy of an infection control program as measured by tuberculin skin-test (TST) conversion rates in medical house staff.

Design:

Observational study.

Setting:

University-based hospital in New York City serving a large indigent population.

Participants:

Medical house staff.

Interventions:

TST conversions were measured every 6 months in medical house staff from June 1992 to June 1994. Compliance with the isolation policy was measured by identifying room locations 24 hours after admission of patients who had Mycobacterium tuberculosis recovered from respiratory specimens.

Results:

The TST conversion rate decreased from 5.8 to 0, 2.3, and 0 per 100 person years of exposure in successive 6-month periods. The estimated annual TST conversion rate among interns fell from 7 per 100 person years in June 1992 to 0 per 100 person years in June 1993 and 0 per 100 person years in June 1994 (P=.029). The proportion of patients with pulmonary tuberculosis who were isolated in negative-pressure rooms increased from 38% to 75% over the study period (P=.01).

Conclusion:

Development of a multifaceted infection control program can decrease the risk of nosocomial tuberculosis infection in medical house staff.
Hospital Outbreak of Norwalk-Like Virus
Authors: Russo Philip L. , Spelman Denis W. , Harrington Glenys A. , Jenney Adam W.J. , Gunesekere Ishara C. , Wright Peter J. , Doultree Jennifer C. , Marshall John A.
Published: September 2009

An outbreak of gastroenteritis caused by Norwalk-like virus occurred in two areas of the hospital: area 1, consisting of three adjacent and interconnected wards, with mostly elderly patients; and area 2, an acute ward in a separate building with elderly patients. In area 1, 40 patients and 20 staff were affected; in area 2, 18 patients and 14 staff were affected. Infection control measures were instituted in consultation with the government health authority. These measures did not appear to affect the course of the outbreak, but may have prevented spread to other wards.
Bleeding After Cardiovascular Surgery Caused by Detergent Residues in Laparotomy Sponges
Authors: Geiss Heinrich K. , Schmitt Judith , Frank Stefan C.
Published: September 2009

On 2 successive days in July 1994, six patients who underwent coronary artery bypass grafting developed postoperative bleeding requiring reexploration. The cause was the use of reprocessed laparotomy sponges with retained detergents, inducing a bleeding disorder.
Primary Prevention and Rubella Immunity: Overlooked Issues in the Outpatient Obstetric Setting
Authors: Schoenhoff Deborah D. , Lane Timothy W. , Hansen Charles J.
Published: September 2009

Objective:

To determine the knowledge of rubella immune status among practicing obstetrician-gynecologists in the United States and of rubella immunity policies covering healthcare workers in the obstetric-care office setting.

Design:

Mailed survey questionnaire, August through December 1994.

Setting:

Physicians from multiple-practice sites including private office, public institution, university or teaching hospital, and closed panel health maintenance organization settings.

Participants:

3,302 practicing obstetrician-gynecologists, chosen by a systematic random sample from the AMA national physician database.

Main Outcome Measures:

Participants were defined as rubella immune if they reported knowledge of prior rubella vaccination or positive antibody titer. Knowledge of a policy for documenting rubella immunity among employees in the office-based practice setting also was assessed.

Results:

Questionnaires were returned from 50% (1,666) of the 3,302 surveyed, and 96% (1,599) were evaluable. Approximately 20% (304/1,599) of the responding obstetrician-gynecologists did not have knowledge of documented rubella immunity, and the majority of office-based practices did not require documentation of rubella immunity in the following groups: physicians, 66% (723/1,094); office nurses, 62% (666/1,070); and other office staff, 69% (728/1,063). Sixty-two percent (993/1,599) of responding physicians had individual rubella serologies performed, with 916 known to be positive, 53 reported negative, and 24 reported unknown. Fifty-seven percent (918/1,599) reported receiving monovalent rubella vaccine or trivalent measles-mumps-rubella vaccine. Multiple logistic regression analysis revealed the following to be independent predictors of positive immune status among respondents: female gender (odds ratio [OR], 2.4; 95% confidence interval [CI95], 1.8-3.1), medical school graduation since 1980 (OR, 2.6; CI95, 2.0-3.3), providing obstetric or fertility services (OR, 1.5; CI95, 1.2-1.9), and group practice setting ≥5 physicians; OR, 1.2; CI95, 1.1-14).

Conclusions:

Nationally, nearly one of every five practicing obstetricians may not have documented rubella immunity, and the majority of office-based practices have no system for assuring such immunity. Rubella immunity should extend beyond the hospital setting, with consideration for requiring rubella immunity as a condition for employment. Methods for effective implementation and documentation of current guidelines need to be addressed, particularly in the office setting.
An Evaluation of the AbTox Plazlyte Sterilization System
Authors: Bryce E.A. , Chia E. , Logelin G. , Smith J.A.
Published: September 2009

Objective:

To evaluate the efficacy of the AbTox Plazlyte Sterilization System against selected microbial species using inoculated carriers and surgical instruments.

Setting:

The microbiology laboratory of a 700-bed adult tertiary-care hospital.

Design:

The study was conducted in two phases. In phase 1, microorganisms were inoculated to various metal, paper, plastic, and glass carriers, as well as surgical equipment, and processed in cycle II of the AbTox sterilizer. Phase 2 compared AbTox cycle III with ethylene oxide sterilization using stainless steel washers, penicylinders, and surgical equipment. In both phases, cultures of equipment and carriers were obtained after processing. The phenotypic profiles and antibiograms of positive cultures were compared to the original inoculate to rule out the possibility of contamination.

Results:

Of a total of 350 paper carriers, 375 metal washers, and 234 pieces of equipment processed in cycle II and using trypticase soy broth as the inoculating medium, 123 metal washers (32%) and 8 instruments (3%) failed to be sterilized. Similar failures were noted with cycle III. The presence of either salt or protein adversely affected the system's ability to sterilize in either cycle.

Conclusion:

Further studies are needed to evaluate the extent to which salt or organic material compromise low-temperature gas-plasma sterilization. Meanwhile, users should exercise caution and use care in the cleaning of instruments that will be processed in the plasma-based sterilization technologies
Use of an Estimation Method to Derive an Appropriate Denominator to Calculate Central Venous Catheter-Associated Bloodstream Infection Rates
Authors: Cookson Susan Temporado , Ihrig Melanie , O'Mara Edward M. , Hartstein Alan I. , Jarvis William R.
Published: September 2009

An outbreak investigation was conducted to determine if an increase in bloodstream infections (BSIs) in patients with central venous catheters (CVC) had occurred. Because other methods of obtaining CVC days were not feasible, we used an estimation method based on a random 5% sample of medical records to determine the proportion of days that a CVC was present for each of three patient units. This calculated ratio was used to estimate the total CVC days for each unit. A cohort study was conducted in which the BSI rates before and during needleless device use were compared. This article describes the methods used to calculate this estimated denominator and discusses the need for such a denominator to be used by infection control practitioners when prospective collection of CVC days is not possible.
Infection Control in the Outpatient Setting
Authors: Herwaldt Loreen A. , Smith Shanon D. , Carter Cheryl D.
Published: September 2009

This article discusses aspects of ambulatory care that increase the difficulty of practicing infection control in this setting or that require infection control staff to use different methods than they would use in the inpatient setting. The article reviews basic infection control precautions that apply to the outpatient setting in general and specific precautions that apply to dialysis centers and physical therapy programs. The article also describes outbreaks that have occurred in the outpatient setting, defines the deficiencies in infection control practice that caused the outbreaks, and discusses methods to prevent transmission of pathogens in the outpatient setting.
Evaluation of a Room for Tuberculosis Patient Isolation Using Theatrical Fog
Authors: Gershey Edward L. , Reiman James , Wood William , Party Esmeralda
Published: September 2009

Objective:

To develop a method to evaluate directional airflow patterns, air dilution, and air mixing in facilities where tuberculosis patients are seen.

Design:

A tuberculosis patient isolation room was evaluated by analyzing pressure differential between the room and the corridor and by using theatrical fog to visualize room air movement and impact of dilution and exchange, as well as air capture and displacement. Tracer gas was compared to fog results and used to calculate air exchange rates.

Setting:

A small research hospital.

Results:

By adding theatrical fog to the patient room at several locations, we quickly learned that most of the air entering the room through the transom and around the door to the corridor was exhausted through the three exhaust vents. Little air appeared to move toward the exhaust fan.

For comparison and to confirm the room air exchange rate, tracer gas was distributed and sampled. The kinetics of decay were very similar whether the tracer gas and room air were mixed during sampling or not.

Conclusions:

The fog procedure allowed good visual confirmation of air mixing and airflow patterns and provided quantitative data for evaluating the efficacy of air capture and displacement or dilution and exchange
Does Clinical Experience Affect Medical Students' Knowledge, Attitudes, and Compliance With Universal Precautions?
Authors: Jeffe Donna B. , Mutha Sunita , Kim Lynn E. , Evanoff Bradley A. , L'Ecuyer Paul B. , Fraser Victoria J.
Published: September 2009

Objective:

To investigate differences in second-, third-, and fourth-year medical students' knowledge of bloodborne pathogen exposure risks, as well as their attitudes toward, and intentions to comply with, Universal Precautions (UP).

Design:

Cross-sectional survey.

Participants And Setting:

Surveys about students' knowledge, attitudes, and intentions to comply with UP were completed by 111 second-year (preclinical), 80 third-year, and 60 fourth-year medical students at Washington University School of Medicine in the spring of 1996.

Results:

Preclinical students knew more than clinical students about the efficacy of hepatitis B vaccine, use of antiretroviral therapy after occupational exposure to human immunodeficiency virus, and nonvaccinated healthcare workers' risk of infection from needlestick injuries (P<.001). Students' perceived risk of occupational exposure to bloodborne pathogens and attitudes toward hepatitis B vaccine did not differ, but preclinical students agreed more strongly that they should double glove for all invasive procedures with sharps (P<.001). Clinical students agreed more strongly with reporting only high-risk needlestick injuries (P = .057) and with rationalizations against using UP (P = .008). Preclinical students more frequently reported contemplating or preparing to comply with double gloving, wearing protective eyewear, reporting all exposures, and safely disposing of sharps, whereas students with clinical experience were more likely to report compliance. Clinical students also were more likely to report having “no plans” to practice the first three of these precautions (P<.001).

Conclusions:

Differences in knowledge, attitudes, and intentions to comply with UP between students with and without clinical experience may have important implications for the timing and content of interventions designed to improve compliance with UP.
Clinical Effectiveness of Low-Temperature Sterilization Technologies
Authors: Rutala William A. , Weber David J.
Published: September 2009

The elimination of chlorofluorocarbons by the Clean Air Act has led to the development of alternative technologies for low-temperature sterilization in the healthcare setting, including 100% ethylene oxide, ethylene oxide with other stabilizing gases, immersion in peracetic acid, and gas plasmas. The ideal sterilant does not exist, and infection control professionals should understand the advantages and disadvantages of these processes. However, when combined with adherence to standard cleaning protocols, the available data suggest that the currently available Food and Drug Administration-cleared low-temperature sterilization technologies can inactivate a clinically relevant inoculum of highly resistant organisms
Risk Factors for Death in Patients With Candidemia
Authors: Nucci Marcio , Colombo Arnaldo L. , Silveira Fernanda , Richtmann Rosana , Salomão Reinaldo , Branchini Maria Luiza , Spector Nelson
Published: September 2009

Objective:

To analyze possible risk factors for death among patients with nosocomial candidemia. To identify risk factors for death in patients with candidemia, we analyzed demographic, clinical, and microbiological data.

Setting:

Six tertiary hospitals in Brazil.

Patients:

A cohort of 145 patients with candidemia.

Design:

26 possible risk factors for death, including age, underlying disease, signs of deep-seated infection, neutropenia, number of positive blood cultures, removal of a central venous catheter, etiologic agent of the candidemia, susceptibility pattern of the isolate to amphotericin B, and antifungal treatment were evaluated by univariate stepwise logistic regression analysis.

Results:

Non-albicans species accounted for 63.4% of the candidemias. Risk factors for death in univariate analysis were older age, catheter retention, poor performance status, candidemia due to species other than Candida parapsilosis, hypotension, candidemia due to species other than Candida parapsilosis, and no antifungal treatment. In multivariate analysis, older age and non-removal of a central venous catheter were the only factors associated with an increased risk for death.

Conclusions:

These data suggest that patients with candidemia and a central venous catheter should have the catheter removed.
Streptococcus pneumoniae Transmission in Chronic-Care Facilities: Description of an Outbreak and Review of Management Strategies
Authors: Sheppard Donald C. , Bartlett Kathleen A. , Lampiris Harry W.
Published: September 2009

We report an outbreak of invasive Streptococcus pneumoniae disease in a chronic-care facility with a documented immunization rate of only 2.5%. We describe and discuss the infection control strategies used in prevention and management of such outbreaks, highlighting the role of immunization and presumptive chemotherapy.
Colonization With Pseudomonas aeruginosa in Patients Developing Ventilator-Associated Pneumonia
Authors: Bergmans Dennis C.J.J. , Bonten Marc J.M. , Stobberingh Ellen E. , van Tiel Frank H. , van der Geest Siebe , de Leeuw Peter W. , Gaillard Carlo A.
Published: September 2009

To determine routes of colonization and genotypic variation of Pseudomonas aeruginosa leading to ventilator-associated pneumonia, colonization of the rectum, stomach, oropharynx, and trachea was studied chronologically in 10 patients. Ninety-one isolates of P aeruginosa were genotyped; seven different genotypes were identified. Patients developing ventilator-associated pneumonia caused by P aeruginosa were colonized at multiple body sites and may be colonized with multiple genotypes. The upper respiratory tract is the predominant initial site of colonization with P aeruginosa (Infect Control Hosp Epidemiol 1998;19:853-855).
An Outbreak of Bacillus Species in a Cancer Hospital
Authors: Thuler Luiz Claudio Santos , Velasco Eduardo , Martins Carlos Alberto de Souza , de Faria Lúcia Maria Dias , da Fonseca Nereida Proença , Dias Leda Maria de Castro , Gonçalves Vania Maria da Silva e Castro
Published: September 2009

Bacillus species were recovered from the blood cultures of 39 oncology patients over 14 weeks. A matched case-control study showed a strong association of Bacillus species bacteremia with use of calcium gluconate solution (odds ratio=25.0) and of central venous lines (odds ratio=8.8). Stopping use of the implicated calcium gluconate vials controlled the outbreak.
Caveats Regarding the Use of Control Charts
Authors: Humble Charles
Published: September 2009

Control charts are essential tools in the statistical process control armamentarium. Although designed for ease of use in highly structured production settings, they are in fact quite complex in nature; their proper use depends on numerous conditions that may not be clear to newer users. This article briefly contrasts the use of control charts in production and healthcare settings and highlights common sources of problems among novice users. These include misunderstandings of the type of data being charted, non-independence of samples, the influence of natural cycles, ignoring known special influences, overlooking clear signals that a process is out of control, and calculating control limits before adequate data are available.
Low Risk for Tuberculosis in a Regional Pediatric Hospital: Nine-Year Study of Community Rates and the Mandatory Employee Tuberculin Skin-Test Program
Authors: Christie Celia D.C. , Constantinou Panayiota , Marx Mary L. , Willke Mary Jane , Marot Kathleen , Mendez Fernando L. , Donovan James , Thole Julia
Published: September 2009

Objective:

To assess the risk of Mycobacterium tuberculosis infection and disease among patients and workers in a regional pediatric hospital.

Design:

Descriptive epidemiological study of the mandatory tuberculin skin testing program of hospital employees at hire and during annual reevaluation, pediatric patients with tuberculosis (TB), efficacy of hospital infection control measures, and community rates of TB.

Setting:

361-bed, university, pediatric hospital serving Cincinnati (1.7 million population).

Results:

During 1986 through 1994, 2,275 to 4,356 employees were compliant with Mantoux skin testing and screening each year. This represented >97% of the population who were eligible for screening. The cumulative rate of M tuberculosis infection from a previous positive tuberculin skin test was 10% to 12% per year during 1986 through 1994. Among new Mantoux skin-test converters in employees at annual reevaluation, the risk of TB infection was 0.3% in 1993 and 1994. There were no active cases of TB identified during new employee screening or annual reevaluation. Of 62 new Mantoux skin-test converters in 9 years, 23% were foreign-born, 13% were Asian, 23% were African American, 11% received the bacillus of Calmette-Guerin vaccine, and 60% had direct patient care or indirect patient contact. A cluster of five converters occurred in a department with no patient care or contact. Mantoux conversion rates were 1.9 per 1,000 employee patient-care or contact-years and 2.2 per 1,000 employee non-patient-contact years. Twenty pediatric patients with active TB were identified during 1991 to 1994, with ≤6 cases per year, placing this hospital in the low-risk category for M tuberculosis disease. Three children with pulmonary TB were admitted without immediate respiratory isolation, possibly exposing 9 patients and 42 employees; none converted their Mantoux skin tests on retesting. Rates of active TB in Cincinnati were stable during the period (eg, 8/100,000 population in 1994).

Conclusions:

Despite intense active surveillance among thousands of hospital employees with >97% annual compliance, tuberculin conversion rates were low, and no cases of active TB were identified during 9 years of follow-up. There was no evidence of transmission of M tuberculosis from infected patients to employees during uncontrolled exposures. Rates of TB in the community were low. These data suggest that rigorous application of the Centers for Disease Control and Prevention guidelines and Occupation Safety and Health Administration regulations for preventing nosocomial TB in pediatric hospitals may be excessive and costly. Special provisions should be made for pediatric hospitals with a proven low risk of transmission of M tuberculosis
Risk Factors Associated With the Acquisition of Amikacin-Resistant Gram-Negative Bacilli in Central New Jersey Hospitals
Authors: Jessop Amy B , John Joseph F. , Paul Sindy M.
Published: September 2009

A case-control study was performed in central New Jersey hospitals to evaluate the potential patient factors associated with the acquisition of amikacin-resistant gram-negative bacilli (ARGNB).

Univariate analysis revealed an association between numerous patient factors, and multivariate analysis revealed four factors to be associated independently with ARGNB: the number of hospital admissions during the prior year, previous aminoglycoside exposure, intubation, and intensive–care–unit admission
In Support of Bacillus of Calmette and Guérin for Healthcare Workers
Authors: Jenney Adam W.J. , Spelman Denis W.
Published: September 2009

Although widely used outside the United States, bacillus of Calmette and Guerin (BCG) immunization generally is given scant consideration in the US literature. We believe that the recent resurgence of tuberculosis, including multidrug-resistant tuberculosis, is a compelling argument for the use of BCG in healthcare workers and that BCG given to those at risk of exposure could be more effective than routine tuberculin skin testing and isoniazid prophylaxis.
Use of Antibiotic Exposure to Detect Postoperative Infections
Authors: Yokoe Deborah S. , Shapiro Mervyn , Simchen Elisheva , Platt Richard
Published: September 2009

OBJECTIVE: To assess the utility of postoperative antibiotic exposure as an indicator of postoperative infection after coronary artery bypass graft surgery.

DESIGN: We determined an optimal antibiotic exposure threshold by creating receiver operating characteristic curves.

SETTING: Tertiary healthcare institution (United States); national sample (Israel).

PATIENTS: 5,887 patients undergoing coronary artery bypass graft surgery.

RESULTS: Postoperative antibiotic exposure with at least 9 days between the first and last dates of antibiotic administration, excluding the first postoperative day, had a sensitivity of 95% (261/276) and specificity of 85% (3,944/4,628) for identifying surgical-site infection, using as a gold standard surgical-site infections identified by conventional prospective surveillance or extrapolated from review of a sample of medical records. In contrast, using the same gold standard for surgical-site infections, the sensitivity of routine prospective surveillance alone was only 60%. The predictive value positive of the defined antibiotic exposure was 28% (261/945) for surgical-site infection and 60% (563/945) for any nosocomial infection. In the Israeli cohort, the sensitivity was 87% (74/85) and the specificity was 82% (735/898).

CONCLUSION: Antibiotic exposure of sufficient duration and timing was more sensitive than conventional methods in detecting nosocomial infection and required substantially less effort to collect. Although the predictive value positive for surgical-site infection was only moderate, the majority of individuals identified this way had a nosocomial infection
Stability and Bactericidal Activity of Chlorine Solutions
Authors: Rutala William A. , Cole Eugene C. , Thomann Charlotte A. , Weber David J.
Published: September 2009

OBJECTIVES: To determine the stability of sodium hypochlorite (diluted household bleach) when stored for 30 days in various types of containers and to determine the efficacy of low concentrations of free available chlorine to inactivate test bacteria.

DESIGN: Laboratory-based study. Solutions of standard household bleach were prepared using tap water or sterile distilled water at dilutions of 1:100, 1:50, and 1:5. Chlorine concentrations were measured, and then the solutions were placed into five polyethylene containers and left at room temperature (20°C) under various conditions (translucent containers with light exposure and with or without air; brown opaque container without light or air exposure). Samples for chlorine and pH determinations were taken at time 0 and on days 7, 14, 21, 30, and 40. Bactericidal activity of chlorine solutions was assessed using the Association of Official Analytical Chemists Use-Dilution Method. Test bacteria included Pseudomonas aeruginosa, Staphylococcus aureus, and Salmonella choleraesuis.

RESULTS: Chlorine concentrations at 30 days varied from the 40% to 50% range for 1:50 or 1:100 dilutions stored in containers other than closed brown containers to 83% to 85% for the 1:5 dilution stored in closed but non-opaque containers to 97% to 100% for 1:50 or 1:5 solutions stored in closed brown containers. The lowest concentration of sodium hypochlorite solution that reliably inactivated all the test organisms was 100 ppm.

CONCLUSIONS: These data suggest that chlorine solutions do not need to be prepared fresh daily, as is recommended currently, and the lowest concentration of chlorine that reliably inactivates S aureus, S choleraesuis, and P aeruginosa is 100 ppm
Reduction in Vancomycin-Resistant Enterococcus and Clostridium Difficile Infections Following Change to Tympanic Thermometers
Authors: Brooks Steven , Khan Ashraf , Stoica Dorin , Griffith Jennylyn , Friedeman Les , Mukherji Rajat , Hameed Rizwanullah , Schupf Nicole
Published: September 2009

OBJECTIVE: To contain a nosocomial outbreak of vancomycin-resistant Enterococcus (VRE).

DESIGN: Intervention study, with comparison of incidence rates before and after intervention to assess whether changes in incidence followed the intervention and were greater than expected based on trends observed before the intervention.

SETTING: A 343-bed acute-care hospital serving a predominantly elderly population referred from nursing homes, as well as patients admitted from the community.

METHODS: Interventions strategies were tested on three high-risk nursing stations. These included enhanced environmental sanitation; intensive staff retraining in Universal Precautions, body substance isolation, and proper use of gloves; and the use of tympanic thermometers to avoid possible rectal or oral VRE transmission during temperature taking.

RESULTS: Nosocomial VRE infections were reduced by 48% 9 months after switching to tympanic thermometers; incidence of Clostridium difficile infections also was reduced. As a result, tympanic thermometers were introduced facilitywide; additional observation for 20 months showed a risk reduction of 60% for VRE and 40% for C difficile.

CONCLUSION: Cross-transmission of VRE and C difficile during temperature taking may result in bowel colonization, placing the patient at increased risk for infection. This risk may be reduced by the use of tympanic thermometers
Nursing Home Infection Control: A Status Report
Authors: Smith Philip W.
Published: September 2009

Infection control in the long-term–care facility has expanded substantially since “Topics in Long-Term Care” debuted in this journal in 1989. This section has been on hiatus, but now, after a 4-year lag, resumes its exploration of these topics.

In the first article, endemic and epidemic infections in long-term care are discussed and compared to nosocomial infections in the hospital. The basic elements of an infection control program in this setting, as well as the recent advances in the field, are reviewed
Frequency of Percutaneous Injuries Requiring Postexposure Prophylaxis for Occupational Exposure to Human Immunodeficiency Virus
Authors: Sistrom Maria Gilson , Coyner Betty Joe , Gwaltney Jack M. , Farr Barry M.
Published: September 2009

New recommendations regarding prophylaxis of healthcare workers exposed to human immunodeficiency virus (HIV) prompted us to examine the frequency and nature of percutaneous injuries at this hospital. Four previously defined risk factors for transmission of HIV were evaluated. Between 1993 and 1995, 1,070 percutaneous injuries were reported, including 11 in which the source patient had acquired immunodeficiency syndrome (AIDS). Five of these injuries involved at least one risk factor for transmission. No source patient was found to have AIDS as a result of testing following exposure. We conclude that high-risk injuries are infrequent and that postexposure prophylaxis will not increase costs greatly at this medical center.
Improving Influenza Immunization Among Healthcare Workers
Authors: Begue Rodolfo E. , Gee Sheilah Q.
Published: September 2009

A survey among hospital personnel regarding influenza vaccination (response rates 44% and 80% for vaccinated and unvaccinated subjects, respectively) identified fear of side effects as the main reason for refusing vaccination, whereas a convenient vaccination schedule fostered participation.
High Rates of Discitis Following Surgery for Prolapsed Intervertebral Discs at a Hospital in Pakistan
Authors: Siddiqui Amna R. , Luby Stephen P.
Published: September 2009

OBJECTIVES:

To confirm the presence of an outbreak of postoperative infections following laminectomy and to determine the infection rate after interventions were instituted.

DESIGN:

Retrospective cohort study. Medical records were reviewed, personnel interviewed, and premises examined.

SETTING:

Surgical unit of hospital A in Pakistan.

SUBJECTS:

Patients who had surgical laminectomy between January 1993 and July 1994.

INTERVENTION:

Instructive program for nursing and medical staff in December 1993.

RESULTS:

From January to December 1993, 6 (15%) of 41 laminectomy patients developed postoperative discitis. The risk of discitis varied significantly by surgeon (P=.016); patients who had one particular surgeon, surgeon A, were nine times more likely to develop postoperative infections than patients who did not have surgeon A. Patients were not consistently cleaned or shaved before coming to the operating room, and personnel moved back and forth between the operation theater and other parts of the hospital without changing their gowns or slippers. After the instructional intervention, between January and July 1994, 2 (6%) of 31 laminectomy patients developed postoperative discitis, a rate not significantly lower than in the preceding 12 months (P=.45). Overall, from January 1993 through July 1994, female patients were more likely to develop discitis than males (31% vs 7%; relative risk, 4.4; 95% confidence interval, 1.3-15.6; P<.032).

CONCLUSION:

Endemic conditions require that laminectomy at hospital A be limited to those situations where the benefits of the surgery exceed the considerable risk of postoperative discitis.
The Costs of Healthcare Worker Respiratory Protection and Fit-Testing Programs
Authors: Kellerman Scott E. , Tokars Jerome I. , Jarvis William R.
Published: September 2009

Objective:

We studied hospital costs associated with healthcare worker (HCW) respiratory protection and respirator fit-testing programs recommended by the Centers for Disease Control and Prevention (CDC) and mandated by the Occupational Safety and Health Administration to decrease nosocomial or occupational Mycobacterium tuberculosis (TB).

Design:

The number and cost of high-efficiency particulate air (HEPA)-filter and dust-mist (DM) respirators for 1989 to 1994 were obtained from study hospital purchasing departments, and the costs of HCW fit-testing and education programs for 1994 were estimated from information provided by infection control practitioners. Costs of N-class respirator programs were estimated for study hospitals using retrospective cost analysis and an observational study.

Setting:

Four urban hospitals with, and one rural community hospital without, documented nosocomial or occupational transmission of multidrug-resistant TB.

Results:

During the study period, four of five hospitals introduced HEPA and DM respirators and respirator education and fit-testing programs. Median costs in 1994 were $83,900 (range, $2,000-$223,000) for respirators and $17,187 (range, $8,736-$26,175) for respiratory fit-testing programs. The projected median annual cost of N95 respirators was $62,023 (range, $270-$422,526).

Conclusions:

Compliance with CDC TB guidelines may require a substantial investment. However, outlays for respirators and education and fit-testing programs are more reasonable than would be suggested by analyses that estimated the costs of preventing one case of nosocomial TB