bluuebunny/crossref_metadata_2025 huggingface dataset:
Carmen 65 and the Arrangement of Catullus' Poetry
Authors: Block Elizabeth
Published: August 2016

While the metrical arrangement of the Catullan corpus has seemed to many scholars too artificial and inartistic to have been the poet's own choice, this opinion is now being challenged, in part because recent studies have shown that the collections could have been included in one roll, orLiber, and thus may be read as a single structure. Critics increasingly have sought the principles of organization in thematic correspondences or in the formation of ‘cycles’ within the three metrical groupings. Current studies have focused on the resonances in and among the groups, and on the function (and identification) of the first and last poems of each section and of the corpus as a whole.

Several scholars have suggested (although without unanimity in specifics, and for different reasons) that the three sections consist of poems 1-51, 61-64, and 65-116. Others (see Most, n. 3 below) argue that the long poems are arranged as a group, so that the corpus consists of the polymetrics, the long poems (61-68), and the short elegiacs (69-116). Any attempt to explain the arrangement of Catullus' poetry must address this controversy. One way to approach the problem is to examinec.65, the first poem in elegiac meter. While some studies note thatc.65 hints at a ‘new poetic consciousness in Catullus’ this richly textured piece is still dismissed as ‘merely a covering letter.’ The following discussion seeks to discover whether c. 65 does simply accompanyc.66, or whether, reflecting the themes and motifs of the preceding poetry, it implies an alteration in the poet's sensibility.
Romantic Love in Classical Times?
Authors: Rudd Niall
Published: August 2016

I start with four quotations: (1) ‘That all European poetry has come out of the Provençal poetry written in the twelfth century by the troubadours of Languedoc is now accepted on every side.’ [The writer is talking of love poetry.] (2) The passion and sorrow of love were an emotional discovery of the French troubadours and their successors.’ (3) ‘French poets in the eleventh century discovered or invented, or were the first to express, that romantic species of passion which English poets were still writing about in the nineteenth.’ (4) ‘The conception of romantic love which has dominated the literature, art, music, and to some extent the morality of modern Europe and America for many centuries is a medieval creation.’ Those words come from a Frenchman, a German, and Englishman and a Scot — namely Denis de Rougemont, E. R. Curtius, C. S. Lewis, and Gilbert Highet — a distinguished quartet, not lacking in knowledge or influence. The view they represent has met with little opposition and is, in fact, so widely held that it may be regarded as orthodox. The layman finds it all the easier to accept in that ‘romantic love’ is readily connected with the first definition of ‘romance’ given by theOxford English Dictionary, namely The vernacular language of France as opposed to Latin’.
From Force to Persuasion: Aeschylus' Oresteia as Cosmogonic Myth
Authors: Rabinowitz Nancy S.
Published: August 2016

Modern critics have done much interpretive work on theOresteia, ranging from specific studies of particular motifs (for example, of wind, music, nature, sacrifice) to the more synthetic studies of E. T. Owen, Anne Lebeck, and most recently, Michael Gagarin. The latter group has taken note of what may be called a superstructure in the plays, a moral framework which parallels the action of the trilogy. They have, of course, different visions of this structure. Thus, for example, Owen sees the subject of the plays as the creation of a ‘new spiritual order,’ while Lebeck describes the pattern as ‘movement from enigmatic utterance to clear statement, from riddle to solution.’

While these treatments are valuable to the student of the plays, the overriding question is still, ‘Why this structure and why these particular images?’ Owen and Lebeck, while undeniably correct in their analyses, are too general. It is possible to go further still, for the structure is more specific than a movement ‘from riddle to solution.’ Structure and image both, in fact, have their roots in the creation myth. Just as many rituals re-enact cosmogony to restore an interrupted order, Aeschylus, in order to achieve a sense of stability, builds on the religious response that a presentation of the myth evokes. It is no accident, then, that the patterns of light, wind, and nature imagery, all studied by separate scholars, are important in the creation myth; we can only fully understand these patterns when we uncover these roots.
Men and Gods in Euripides' Hippolytus
Authors: Luschnig C. A. E.
Published: August 2016

The relevancy of the appearances of the two goddesses, Aphrodite and Artemis, to the action, causation and characterization of the Hippolytus has long been debated. The rationalists' view is that they constitute a superficial and largely structural frame for the real, human drama, having little or nothing to do with what happens on the stage between epiphanies. Indeed, it is hard to deny that the human characters have a great deal to do with their own undoing. The divine nature of the catastrophe, on the other hand, prevents our rationalizing the superhuman element as outside the tragedy. If we include Poseidon in our Olympian cast of characters, it may be possible to find a relationship of the gods to the action of the play of another kind than a strictly causal one. It is the purpose of this paper to show that the characters and motivations of the persons of the drama both human and divine are so closely parallel that they form but a single frame of action within a dramatic structure that is so tight that barely an oimoi is superfluous. And surely two (or three) divinities have not been added for their appeal to the audience's love of the spectacular, or from a simple desire for balance.

In a recent article B. D. Frischer has observed that between the human and divine frames, as well as within each frame, the principle of concordia operates. He asserts, however, that the device of reenactment (which ‘harmonizes characters by showing them doing and saying the same things’, 87) functions within but not between frames. My contention is that in action and in character the human actors are like their gods, that their actions parallel those of their gods, that they try to impose on the situation a state of immutability that is not suited to the mortal condition, and that they impose upon themselves and each other an isolation which is very close to the gods' aloofness and anti-social existence. It is through the goddesses' statements and the implications of these statements when transferred to human relationships that we become aware of what is taking place at the human level.
Homer's Catalogue of Women
Authors: Northrup Mark D.
Published: August 2016

‘Son of Laertes, sprung from Zeus, Odysseus of many devices, no longer now remain unwilling in my house. But first you must complete another journey and come to the halls of Hades and dread Persephone to consult the shade of Theban Teiresias, the blind seer whose mind abides steadfast … and he will tell you the way and the measures of your path and your return, how you may go over the fish-laden deep.’ (Od. 10.488-493, 539 f.)

With these words Circe prepares Odysseus for his voyage to the land of the dead. Following the enchantress' instructions, he soon completes his mission: Teiresias is duly summoned, provides his information, then — at 11.151 — departs forever. But what of the rest of the book? Circe's words at the close of Book 10 have led us to expect none of the encounters which are described in 11.152-635, yet these occupy the greatest part of Odysseus' time among the shades. Particularly problematic has been the catalogue of women which extends from 225 through 332. Denys Page thought this passage an awkward interpolation, since the women who appear in it ‘have nothing whatever to do with Odysseus; he has nothing to say to them, and they have no motive for reciting to him their pedigrees … the episode is wholly irrelevant to Odysseus and his story; it is loosely attached and carelessly adapted to its surroundings …’ Shortly after Page published his views, however, T. B. L. Webster bluntly denied ‘all Page's strictures on [the passage's] quality’, suggesting that the list was genuine because it contained information which would have been ‘of extreme interest to the Ionian descendants of the Mycenaeans’; and W. B. Stanford restated his belief that the episode was authentic, noting again that it seemed an appropriately clever device by which Odysseus could entertain — and by so doing secure the favor of — Arete, the queen of the Phaeacians.
A Microbiologic Approach to the Investigation of Bacterial Nosocomial Infection Outbreaks
Authors: Goldmann Donald A. , Macone Ann B.
Published: August 2016

This article details the appropriate microbiologic support that is critical to the successful investigation of nosocomial infection problems. The infection control team must have ready access to microbiologic data, and the laboratory should retain epidemiologically relevant bacterial isolates. Investigation of epidemics is facilitated by precise identification of bacteria and careful antibiotic susceptibility testing. In some situations, biotyping, serotyping, phage typing, bacteriocin typing, and other specialized techniques may be required. Plasmid analysis may be useful in the investigation of nosocomial infection problems caused by antibiotic-resistant bacteria.
Surveillance in a Surgical Intensive Care Unit: Patient and Environment
Authors: McGuckin Maryanne B. , Kelsen Steven G.
Published: August 2016

Microbiologic surveillance of both the patients and the ambient environment of a surgical intensive care unit allowed us to relate the incidence of nosocomial respiratory tract infection to levels of airborne bacteria. Over the study period respiratory tract nosocomial infection rates varied from 0.7% to 17.0%, and nonrespiratory infection rates varied from 1.0% to 25.0%. Airborne bacteria counts during that time varied from 1.0 ± 0.8 S.E. CFU/ft3to 96.0 ± 6.8 S.E. CFU/ft3. There was a reasonably close correlation between airborne bacteria levels and the incidence of nosocomial pneumonia (r=0.81, p<0.05). Furthermore, there was a close correlation between a specific organism nosocomial infection rate and the number of colonies of that organism present in the air (r=0.88, p<0.05). In contrast, there was no significant relationship between airborne bacteria counts and nonrespiratory attack rates (r=0.60, p<0.05). If the bacteria traveled from the air to the patients, there appear to be at least three possible explanations for this significant relationship: (1) direct inoculation of the airway by the airborne bacteria; (2) inoculation of the airway by direct contact, which is related to the degree of “cleanliness” of the environment; and (3) an increased incidence of contaminated respiratory equipment and airway inoculation because of high counts of airborne bacteria. It is also possible that high bacterial air counts represent contamination of the air from patients with respiratory infections. Regardless of the pathway(s), surveillance of the ambient environment may prove to be a useful epidemiologic tool in the study and control of nosocomial respiratory tract infections in certain high-risk patient care areas.
Nosocomial Urinary Tract Infection: A Prospective Evaluation of 108 Catheterized Patients
Authors: Hartstein Alan I. , Garber Susan B. , Ward Thomas T. , Jones Stephen R. , Morthland Virginia H.
Published: August 2016

This study describes the evaluation of 108 patients who had indwelling urethral catheters for acute medical and surgical indications. Patients were evaluated daily, and cultures from bladders and drainage bags were obtained. Appropriateness for continuing catheterization was assessed using preset criteria. Twenty-five patients developed urinary tract infections. Exposure to antibiotics and a shorter duration of catheterization were the only factors that correlated significantly with a delayed onset or decreased prevalence of infection. Factors found to have insignificant effects included age, sex, maintenance of the closed system, underlying host disease status, catheter type, and reason for catheterization. No collection systems with one way valves were used, but significant colony counts in drainage bag urine preceded urinary tract infection in only two patients. Thirty-six percent of the total 562 catheter days were judged unnecessary. A major emphasis must be placed on prompt catheter removal if the prevalence of nosocomial urinary tract infections is to be reduced substantially in a cost-effective manner [Infect Control 1981; 2(5):380-386.]
The Control of Chagas' Disease in Mambai', Brazil: The Initial Phases
Authors: Marsden P.D.
Published: August 2016

The control of Chagas' disease depends on breaking contact between Man and vector organisms living in the house fabric; the primary method utilized is residual insecticide spraying of houses. Ministries of health in afflicted countries have elaborated standard procedures for such combat programs. The first two phases of such a program in Mambai', Goias', Brazil are described. In the third phase of vigilance, community participation is necessary to detect residual organism populations in houses. A house improvement scheme applied to houses with persistent infection, is recommended as being most practical at this time. [Infect Control 2(6):466-470, 1981.]
Federal Policy For Pneumococcal Immunization and Its Implementation in the Medicare Program
Authors: Riddiough Michael A.
Published: August 2016

The Congress has authorized the Medicare program to pay for the cost of pneumococcal vaccine and its administration. The history of this legislation demonstrates that chance and political considerations quite separate from the scientific issues on vaccination played an important role in the development of this policy. It demonstrates both the need for and the difficulty of achieving more effective coordination of the activities related to national policies on vaccines and immunization.
Increasing Occurrence of Methicillin-ResistantStaphylococcus aureusin the United States
Authors: Boyce John M. , Causey William A.
Published: August 2016

Although several outbreaks of methicillin-resistantStaphylococcus aureus(MRSA) infections have been reported in recent years, the geographic distribution and frequency of MRSA infections in American hospitals is unknown. We conducted a questionnaire survey to determine the magnitude of the problem. Data from 261 hospitals were included in the survey. MRSA were reported by 145 hospitals located in 36 states. Large hospitals reported these organisms significantly more often than small hospitals (p<.001). University hospitals reported MRSA more often than community or community-teaching hospitals (p<.001 and p<.005, respectively). The number of hospitals reporting MRSA increased from 24 in 1975 to 112 in 1980 (p<.001). Our data suggest that MRSA are widely distributed geographically and that the number of hospitals with these organisms has increased dramatically since 1975.
Nosocomial Infection in a High Risk Cohort: An Illustration of a Sampling Method
Authors: Chavigny Katherine Hill , Fischer Janet
Published: August 2016

Patients in two acute care university hospitals were entered into the study using the following method: twenty patients were selected each day from all floors/units in each hospital until the hospital communities had been surveyed only once. A total of 762 hospital patients were identified for the study, and the history of each patient was then abstracted from their charts. The data were analyzed as an historical cohort study design. The two hospital samples were compared to show the effects of the non-random sampling method using one hospital as a comparison group for the other. Expected associations between nosocomial infection and known risk factors were compared and contrasted between the hospitals using cumulative incidence rates and relative risk ratios. The average length of stay of the group of patients in each hospital was extended from a mean of ten days to a mean of 30 days. The only significant difference between the two hospital cohorts was an age effect. The advantages and disadvantages of this method for selecting a long staying cohort at high risk for nosocomial infection in acute care facilities are detailed.
The Source of Biliary Infections Associated with T-Tube Drainage
Authors: Agger William A. , Glasser James E. , Boyd William C. , Melby Neil
Published: August 2016

The purpose of this study was to determine the source of organisms responsible for biliary infection associated with T-tube placement. Two groups of patients who had had T-tubes placed following common bile duct exploration were studied. In one group of 34 patients, bacterial cultures were taken daily from the drainage bag and the lumen of the T-tube. In the second group of patients, paired daily bacterial cultures were taken from the T-tube lumen and the skin tract surrounding the T-tube. Results of the first group showed the drainage bag to be the initial site of infection in seven cases, with “descending” infection from the patient's skin occurring in 27 cases, 14 in whom the organism was initially present in the bile while in the other 13 the organism appeared later. In the second group, of 32 isolates only five were found extraluminally before they appeared within the lumen, these five being allStaphylococcus epidermidis.Thus the majority of bile infections occurring after T-tube placement were found to originate from the patient's own biliary tree or skin.
Endemic Resistance to Amikacin Among Hospital Isolates of Gram-Negative Bacilli: Implications for Therapy
Authors: Wormser Gary P. , Tatz Joseph , Donath Joseph
Published: August 2016

We reviewed the records of the microbiology laboratory of the Veterans Administration Medical Center, Bronx, New York in order to determine the prevalence, epidemiology and complete antibiotic susceptibility profile of amikacin-resistant aerobic and facultative gram-negative bacilli isolated from clinical specimens submitted for culture between January 1,1980 and May 1,1981. Of more than 5000 gram-negative rods isolated during this 16-month period, 2.8% were determined to be resistant to amikacin by the disc diffusion method. Eighty-eight of the amikacin-resistant organisms were unique isolates derived from cultures on 74 patients located throughout the hospital. Urine (51%) and sputum (27%) were the predominant sources of specimens yielding resistant strains. These organisms represented seven different genera of Enterobacteriaceae (58%) orPseudomonas aeruginosa(31%) and other glucose non-fermenting species (11%). Resistance to amikacin was usually associated with resistance to gentamicin, tobramycin and most of the other antimicrobials tested. Twenty percent of isolates were susceptible to only a single antimicrobial, and another 5% were resistant to every agent routinely tested. Although geographic clustering of a small number of amikacin-resistant organisms occurred twice (a strain ofProteus mirabilison the spinal cord injury service and a strain ofP. aeruginosaon one medical ward), the vast majority of isolations were consistent with a pattern of endemic resistance.
Nursing Care of the Immunosuppressed Patient
Authors: Crow Sue
Published: August 2016

The primary objectives of nurses caring for the immunosuppressed patient are to create a safe, peaceful environment and to promote the quality of the patient's life. Strengthening the patient's defense mechanisms is inherent in these nursing objectives, and the nurse must have certain competencies to reinforce these defense mechanisms. One competency is a thorough understanding of the immunosuppressed patient. The infection control practitioner (ICP) should assist the nurse in understanding what an immunosuppressed patient is, what his risk of infection is, what his reaction to infection might be, and what isolation practices are appropriate. Another necessary nursing skill is proficiency in patient assessment, not only when the patient is admitted, but on a continuous basis since the patient's status can change so rapidly.

Finally the nurse must have the ability to implement appropriate nursing measures. The nurse must use the principles of asepsis in all patient care activities, recognize risk factors of infection, and understand the importance of such details as proper nutrition, oral hygiene, and skin care. Psychological support is also an essential part of the nursing care plan.

Nursing care affects the well-being of the immunosuppressed patient and infection control practitioners have a role in ascertaining that nurses know how to treat such patients appropriately.
Creutzfeldt-Jakob Disease: Procedures for Handling Diagnostic and Research Materials
Authors: Bastian Frank O. , Jennings Roger A.
Published: August 2016

There is increasing concern in the medical community regarding the safe handling and storage of biological materials procured from patients with Creutzfeldt-Jakob disease (CJD). Neurosurgeons have refused to operate on CJD patients, pathologists have refused to do autopsies on CJD patients, and hospitals have discharged CJD patients without confirmation of their diagnoses. This attitude was exemplified in the case of a director of a pathology laboratory who was so concerned about the safety of his laboratory personnel that he proposed to incinerate his entire collection of CJD slides. This extreme example is typical of the hysteria common among medical colleagues regarding the safe handling of CJD biological materials.
Pharmacokinetics of Antimicrobial Agents
Authors: Norris Sandra M. , Spyker Daniel A.
Published: August 2016

The association between a target serum concentration and the therapeutic and toxic effects of most antiinfective agents is sufficiently established that we routinely use antibiotic blood levels as objective markers of therapy. Pharmacokinetics is the study of the time course of drug distribution throughout a biological system. Thus, we examine the effect of drug availability, distribution, metabolism, and clearance on drug concentration in various fluids and tissues. A principal goal is rational drug dosage selection and dosage adjustment. The use of mathematical expressions which characterize these metabolic processes enhances the clinician's ability to manipulate the dosage regimen to achieve and maintain a desired drug concentration at the site of action while minimizing toxicity. Knowledge of a drug's pharmacokinetic profile provides the basis for the design of a drug dosage regimen.
Nosocomial Endocarditis
Authors: Friedland Gerald , von Reyn C. Fordam , Levy Barry , Arbeit Robert , Dasse Priscilla , Crumpacker Clyde
Published: August 2016

We analyzed 14 cases of nosocomial infective endocarditis which occurred over a seven-year period at the Beth Israel Hospital in Boston, and compared them with 90 cases of community-acquired endocarditis. Patients with nosocomial endocarditis were older, more often female, and had a greater incidence of underlying valvular heart disease and bacteremia precipitating invasive procedures (93% v 50%, P < .05). Forty-three percent of patients had infection at the site of prosthetic valves or intracardiac prosthetic material. The disease carried a significantly higher mortality than community-acquired endocarditis (43% v 11%, P < .01). The clinical presentation was acute and the infecting organisms reflected the site of origin of bacteremia, with staphylococci from skin and enterococci from urinary sources. Half of the cases in this series may have been prevented by the application of currently recommended preventive and therapeutic practices. Nosocomial endocarditis occurs in a definable sub-population of hospitalized patients and is potentially preventable.
Klebsiella
Authors: Ristuccia Patricia A. , Cunha Burke A.
Published: August 2016

Belonging to the tribe Klebsielleae found in the family Enterobacteriaceae, the genus Klebsiella is the second most populous enteric genus found in the gastrointestinal tract of man. The genus Klebsiella is named after the late nineteenth century German microbiologist, Edwin Klebs, but the Klebsiella bacillus was for many years referred to as the Friedlander bacillus after being described by Carl Friedlander. The genus consists of four species, recognized by the Centers for Disease Control (CDC), and Bergey's Manual of Determinative Bacteriology, namely, K. pneumoniae (the type species), K. ozaenae, K. rhinoscleromatis, and K. oxytoca. K. pneumoniae is one of a few gram-negative rods that can cause a primary pneumonia.
Caring for the Infectious Patient: Risk Factors During Pregnancy
Authors: Gurevich Inge , Tafuro Patricia
Published: August 2016

Health care personnel are exposed to infectious diseases in the community as well as in the health care setting when they care for patients with transmissible conditions. Pregnant nurses, physicians and others face an additional risk—that of exposing their unborn children to some of these infections. Risk factors vary greatly between diseases and it is, therefore, important that each be evaluated and acted upon realistically. We will discuss and compare the risk of infections such as hepatitis, cytomegalovirus, tuberculosis, chickenpox, and others. With this knowledge, administrators and personnel involved will be able to make decisions about which patients should not be cared for by pregnant personnel, and which areas pose too high a risk for the mother and child so that a temporary transfer may be advisable. We address the multiplicity of preventive measures available for the prevention of maternal infections.
A Hospital Contingency Plan for Exotic Communicable Diseases
Authors: Campbell Beverly A. , Pequegnat M. Dorothy , Clayton Alastair J.
Published: August 2016

The exotic communicable diseases are highly virulent, transmissible, conditions which occur most often in tropical areas. Since the late 1960s, there have been occasions when these diseases have been exported to the US and Canada. Advance planning will facilitate the care of patients infected with these diseases in health care facilities. Hospitals should develop a contingency plan which addresses the management of patients that present themselves to the emergency department as well as patients diagnosed after admission. The plan should address such topics as the isolation room, protective clothing, disinfection of the environment and equipment as well as the management of waste and handling of corpses. A well thought out plan will prevent subsequent transmission of infection to attending personnel, other patients and the surrounding community.
Tuberculin (TB) Skin Testing After Exposure
Authors: Valenti William M.
Published: August 2016

Many employee health programs perform skin-tests on employees after exposure to pulmonary tuberculosis. This activity has become standard in employee health programs. The scenario in most health care facilities involves employees who are exposed to patients with active pulmonary tuberculosis. Many of these patients have active disease that is not detected during their hospitalization, and personnel are exposed unknowingly. The diagnosis of tuberculosis is often made after the patient is discharged which may result in contact tracing of exposed employees. This activity seems straightforward at first glance but is usually time-consuming and cumbersome. The first questions often asked are: what constitutes a dangerous patient and what is the definition of an exposure?
Antibody Response to Somatic Antigen ofSalmonella typhiin Areas Endemic and Non-Endemic for Typhoid Fever
Authors: Hirschl Alexander , Stanek Gerold , Rotter Manfred L. , Chau Pak Y. , Niemetz Adolf H.
Published: August 2016

In sera obtained between the 6th and the 30th day from 16 Austrian and 26 Hong Kong patients with culturally verified typhoid fever, agglutinating antibodies (microagglutination test) at significant titers were detected in 93% of the Austrian (median titer: 640) but in only 50% of the Hong Kong patients (median titer: 240). Similar results (93% and 54% positive sera respectively) were obtained for specific IgM as assessed by the enzyme-linked immunosorbent assay (ELISA) using lipopolysaccharide ofS. typhias antigen (median relative titer: 0.32 and 0.21 respectively). In contrast, specific IgG at significant concentrations were found in only 69% of the Austrian (median relative titer: 0.16) but 88% of the Hong Kong sera (median relative titer: 0.71). The (IgM-detecting) microagglutination test may be sufficiently diagnostic for typhoid fever in nonendemic areas such as Austria. In endemic regions like Hong Kong, however, tests indicative for early specific IgG are indispensable for serological diagnosis of the disease. The ELISA proved useful and is an example for such tests.
Eikenella corrodens
Authors: Stratton Charles W. , Decker Michael D.
Published: August 2016

It is thought that the first person to describe the organism subsequently known asEikenella corrodenswas Sverre Henriksen, who in 1948 reported the isolation of three gram-negative anaerobic rods with concentrically spreading colonies and a tendency to pit the agar. This corroding of the agar was seen most reliably with strain AJ, a nonmotile organism isolated from a perineal abscess. Two years later, Per Holm found that a gram-negative anaerobic organism resembling the influenza bacillus was often isolated from specimens of pus, examined for the presence of actinomycetes. Because of its appearance on blood agar, Holm proposed calling this organism the “corroding bacillus.” In 1958, Eiken studied 1,097 anaerobes isolated from 798 patients; of these, 61 corresponded in colony and microscopic morphology with the corroding bacillus.
The Efficacy of Several New Handwashing Agents for Removing Non-Transient Bacterial Flora from Hands
Authors: Morrison Allan J. , Gratz Jean , Cabezudo Ignacio , Wenzel Richard P.
Published: August 2016

Forty subjects participated in a study of four handwashing agents evaluated for their efficacy in removing non-transient bacteria: 70% isopropanol, 0.05% stabilized iodine, 4% chlorhexidine gluconate, and 1% para-chloro-meta-xylenol. Each subject performed a non-medicated handwash to remove transient flora. Afterwards, three consecutive experimental handwashes were performed using a 10-second contact time, and a fourth handwash employed a 1-minute contact time. Quantitative post-handwash cultures were obtained using the sterile bag technique incorporating an effective agent neutralizer. Significant mean log10reductions were documented for chlorhexidine gluconate, but only after the third (P=.05) and fourth (p=.004) handwash; however, the total log10reduction was less than 1.0 for any single agent.

Subsequently, three evaporative handwash agents, including 70% isopropanol, 0.5% chlorhexidine in 70% isopropanol, and a 60% isopropanol formulation containing evaporative retardants, were tested in 14 subjects. Contact time was prolonged to the point of evaporation prior to culturing. Four consecutive post-handwash cultures were obtained after performing a baseline pre-handwash culture. When compared with the other two evaporative agents, the 60% isopropanol formulation demonstrated significant mean log10reductions for each handwash (p ≤ .03), with a total log10 reduction of 2.9 over all four handwashes (p=.0001). The brief contact time incorporated in our handwashing technique reflects clinical usage patterns. The marked bacterial reduction demonstrated by the 60% isopropanol formulation warrants further study.
Nosocomial Infections in 15 Rural Wisconsin Hospitals—Results and Conclusions from 6 Months of Comprehensive Surveillance
Authors: Scheckler William E. , Peterson Patty J.
Published: August 2016

Fifteen rural Wisconsin acute care community hospitals with an average approved bed size of 55 and an average daily census of 28 patients participated in a nosocomial infection control project. Each hospital Infection Control Practitioner (ICP) was trained and conducted prospective nosocomial infection surveillance on all patients admitted to the hospital for 6 consecutive months between May 1,1984 and April 30, 1985. Two hundred twenty nosocomial infections were reported among 13,420 discharged patients for an incidence rate of 1.64 infections per 100 discharged patients. One hundred sixty-four patients had one nosocomial infection. Twenty-three patients had two or more. Infection rates were highest among gynecology— 4.9% and general surgery patients— 4.0%, and lowest among newborns—0.3% and pediatric patients—0%. 39.7% of the infections were of the urinary tract, 27.9% of surgical wounds, 16% pneumonia, and 1.4% primary bacteremia. The other infections were in seven additional sites. Risk factors associated with acquisition of infections included old age, urinary catheterization, and/or a surgical procedure. The overall nosocomial surgical wound infection incidence for inpatient procedures was 1.9%, with incidences of 0.4% for hernia repair, 1.3% for cholecystectomy, 3.3% for appendectomy, 4.0% for total abdominal hysterectomy, and 3.9% for cesarean sections; The incidence of nosocomial infections was 2.7 infections per 100 discharged patients age 65 years or over and 0.9 infections per 100 discharged patients less than 65 years. Two hundred thirty-six microorganisms were cultured from 175 of the infections. Staphylococcus aureus, coagulase-negative Staphylococcus, and Enterococcus were the most common gram-positive organisms. E. coli, Pseudomonas, Proteus, and Klebsiella were the most common gram-negative organisms cultured. The overall nosocomial infection incidence was much lower than reported rates for other groups of hospitals. These data have implications for the review and potential modification of complex guidelines and requirements for infection control in smaller rural hospitals.
A Hospital Cafeteria-Related Food-Borne Outbreak Due to Bacillus cereus: Unique Features
Authors: Baddour Larry M. , Gaia Shelia M. , Griffin Ronald , Hudson Richard
Published: August 2016

Although Bacillus cereus is a well-known cause of food-borne illness, hospital-related outbreaks of food-borne disease due to B. cereus have rarely been documented. We report a hospital employee cafeteria outbreak due to foods contaminated with B. cereus in which an outside caterer was employed to prepare the suspect meals. Data were collected from 249 of 291 employees who had eaten either of the two meals. With a mean incubation period of 12.5 hours, 64% (160 of 249) of employees manifested illness. Symptoms, which averaged 24.3 hours in duration, included diarrhea (96.3%), abdominal cramps (90%), nausea (50.6%), weakness (24.7%), and vomiting (13.8%). Eighty-seven employees sought medical attention, 84 of whom were seen in an emergency room. Although a significant difference was not demonstrated in food-specific attack rates, B. cereus was cultured from both rice and chicken items that were served at both meals. Sixty-three employees submitted stools for culture that grew no enteric pathogens, but none were examined for B. cereus. This food-borne outbreak demonstrates: (1) the need for hospital kitchen supervisors to ensure proper handling of food when outside caterers are employed; (2) that significant differences in food-specific attack rates may not be demonstrated in outbreaks, which may be related to several factors; and (3) the importance of notifying microbiology laboratory personnel when B. cereus is a suspect enteric pathogen, since many laboratories do not routinely attempt to identify this organism in stool specimens.
Selective Screening of Hospitalized Patients for the Presence of Asymptomatic Hepatitis B Virus Carriage: Predictability Based on Census Tract Data
Authors: Baddour Larry M. , Jennings Billy R. , Osborne Pamela T. , Rendtorff Robert C. , Moffatt Marge C. , Luther Ginger M. , Holcomb Jamie L.
Published: August 2016

Review of all hepatitis B surface antigen-positive patients reported to the county health department over the past 3 years showed that 60% of patients had been diagnosed at our hospital, which serves an inner city, predominantly black, indigent population. Sera from 524 adult patients admitted to the hospital were prospectively collected and tested for hepatitis B surface antigen, eight (1.5%) of which were antigen-positive. Census tract data allowed us to perform selective screening of sera from 95 other patients who were subsequently hospitalized and deemed “high risk” for hepatitis B infection. Nine of 95 (9.5%) selectively screened samples were positive for hepatitis B surface antigen, which represented a significantly higher rate of antigen carriage (P<0.0001) in hospitalized patients from “high risk” areas than that found in the general population screen. The methodology presented herein may be useful in providing a means of identifying hepatitis B surface antigen-positive patients from adult, urban, indigent care populations.
Nosocomial Dermatophytosis Caused by Microsporum canis in a Newborn Department
Authors: Mossovitch M. , Mossovitch B. , Alkan M.
Published: August 2016

Seven nurses working in a newborn unit were infested by Microsporum canis, involving the skin of the left forearm. One infant who was treated in the same unit suffered from a similar lesion on the occipital region. Transmission during bottle feeding was suspected. After the introduction of long sleeves for all nurses, no further cases occurred. Data collected on the nurses in the unit suggested that infection correlated with direct
exposure to infants.
Nosocomial Infection—The Irreducible Minimum
Authors: Ayliffe G.A.J.
Published: August 2016

Prevalence surveys in different countries have shown that about 1 in 10 hospitalized patients at any one time have acquired an infection and the incidence of infection is usually about 3% to 5%. Can this infection rate be significantly reduced and is there an irreducible minimum below which further reduction cannot be obtained? Cross-infection could probably be almost eliminated by the use of plastic isolators or life islands, and endogenous infections reduced by the wider and more rational prophylactic use of topical and systemic antimicrobial agents, and possibly a range of vaccines. However, the use of these techniques on all patients would clearly be impractical and too expensive for use in the foreseeable future. Excessive isolation techniques would have a detrimental psychological effect on many patients. In addition, failure to eradicate the organisms of the normal flora might be associated with more infections caused by antibiotic-resistant bacteria, fungi and viruses which would be more difficult to treat. Even if organisms could be eradicated, morbidity and mortality might not be correspondingly reduced. Priorities must therefore be set on the most effective use of staff and finances. These not only involve a consideration of infection, but all areas of clinical practice, eg, costs of cardiac transplants and provision of geriatric facilities. It therefore seems likely that little additional finance will be available for control of infection, other than possibly for transmissible infections with high mortality such as AIDS.
Systemic and Topical Antimicrobial Agents in the Prevention of Catheter-Associated Bacteriuria and its Consequences
Authors: Simpson Rosemary A.
Published: August 2016

Infection of the urinary tract is acknowledged to be the most common hospital infection, associated closely with the presence of an indwelling catheter. Patients are catheterized for a variety of reasons and for different periods of time, ranging from postoperative catheterization of a few days following urological surgery to the long-term catheterization over many months or years of patients who are unfit for operation, with spinal injuries or neuropathic bladders. The extent of the problem includes patients returning home infected, requiring catheterization before readmission to the hospital or needing nursing at home with a long-term catheter. The risks of infection and its complications as well as methods of control may differ between each group.

It is of fundamental importance to distinguish between patients who came to surgery with an existing infection and those with sterile preoperative urine. Other factors include recent previous catheterization and, importantly, the length of time the catheter is inserted. For the patient with sterile preoperative urine, postoperative bacteriuria seldom causes severe symptoms and can be treated with antibiotics or left to clear spontaneously after removal of the catheter. A minority of patients suffer consequences of their infection especially when bacteriuria starts before the catheter is removed postoperatively. Catheter removal often causes transient bacteremia, also induced by instrumentation or operation on infected urine, which may lead to serious complications, particularly of septicemia. In our experience in Bristol, about 1 in 4 patients admitted for urological surgery already has infected urine as defined by the presence of ≥105 bacteria/ml midstream urine or ≥=104 bacteria/ml catheter urine. Of those admitted with infected urine, 3 in 4 have a catheter already inserted compared with only 1 catheterized patient in 4 admitted to operation with sterile urine.
Endemic Emergence of Cephalosporin-Resistant Enterobacter: Relation to Prior Therapy
Authors: Weinstein Robert A.
Published: August 2016

The “second” and “third” generation cephalosporins offer striking antimicrobial activity against a wide spectrum of Enterobacteriaceae. Nevertheless, mutants resistant to these drugs have emerged in both laboratory and clinical settings. For example, before the commercial availability of the third-generation agents, we treated three cardiac surgery patients for Enterobacter mediastinitis with aminoglycosides and high doses of cefamandole. In two, initial treatment failed due to emergence of strains that were not only resistant to cefamandole, but also to then experimental third-generation drugs. Despite such reports and in vitro studies of the mechanisms of resistance, the frequency with which broad-spectrum cephalosporin resistance develops in clinical practice is not clear. To help delineate this problem, we have reviewed our hospital's experience with Enterobacter strains resistant to newer cephalosporins (using cefamandole and cefotaxime as prototypes) and the relation of resistant strains to cephalosporin use, with special attention to our cardiac surgery patients.
Emergence of Nosocomial Methicillin-ResistantStaphylococcus aureusand Therapy of Colonized Personnel during a Hospital-Wide Outbreak
Authors: Bacon Alfred E. , Jorgensen Karen A. , Wilson Kenneth H. , Kauffman Carol A.
Published: August 2016

At the Ann Arbor Veterans Administration Medical Center, 30 patients over a 6-month period became nosocomially infected or colonized by methicillin-resistantStaphylococcus aureus. Immediate institution of strict infection control measures, in conjunction with surveillance cultures of personnel and treatment of carriers, did not limit spread of the outbreak strain of MRSA. Multiple nonoutbreak strains, phenotypically exhibiting heteroresistance, were also uncovered. Thirteen hospital personnel were identified as MRSA carriers. Trimethoprim-sulfamethoxazole (TMP-SMX) and rifampin initially eradicated the carrier state, documented by anterior nares cultures in 13 courses of treatment in 11 employees. However, three employees were recolonized, one at one month, one at both one and four months, and one at four months. Treatment of the carrier state reservoir among personnel appeared to have no effect on the emergence and spread of nosocomial MRSA.
Variation in Methicillin-ResistantStaphylococcus aureusOccurrence by Geographic Location and Hospital Characteristics
Authors: Wakefield Douglas S. , Pfaller Michael , Massanari R. Michael , Hammons Glenn T.
Published: August 2016

A survey of 162 Veterans Administration Medical Center (VAMC) laboratories performing antimicrobial susceptibility testing was performed to determine variation in reported rates of methicillin-resistantStaphylococcus aureus(MRSA) isolation by geographic location and hospital characteristics. Of the 162 VAMC laboratories surveyed, 136 (84%) provided usable data. The percentage ofS aureusisolates reported as resistant to methicillin ranged from 0% to 52% with a mean value of 10% among the 136 survey respondents. MRSA were isolated in every VA Medical District and 96% of all respondent laboratories reported isolating at least one MRSA isolate during the preceding year. These data are considered an underestimate of the time MRSA rate in the VA system due to the fact that many laboratories failed to follow key methodologic guidelines for optimal detection of MRSA. A positive correlation was found between MRSA isolation rate and several measures of hospital size and activity including total beds, total admissions, and total antimicrobial susceptibility tests performed. Geographic clustering of MRSA isolation was observed with distinct areas of very high and very low percentages ofS aureusisolates reported as MRSA. The data suggest that the geographic distribution of MRSA within the VA system should be monitored closely for evidence of spread from areas with high-MRSA rates to areas of mid- or low-MRSA rates. Evidence of increased MRSA isolation within these areas may necessitate increased caution in patient referral and transfer patterns within the VA system.
Comparative Efficacy of Handwashing Agents against Cytomegalovirus
Authors: Faix Roger G.
Published: August 2016

Conscientious handwashing is often recommended as an important method for limiting transmission of cytomegalovirus (CMV) from infected individuals to health, education, and child care professionals. To assess the efficacy of handwashing, fingertips of radiation-sterilized latex gloves were inoculated with 0.2 mL of ten different CMV strains. Virus in each inoculum was quantitated by plaque assay. After five minutes, viral inocula were allowed to remain (control), or were washed away by dropwise application of 10 mL of distilled water (DI), 5 mL of 0.08% soap followed by 5 mL of DI, 5 mL of 0.01% Chlorhexidine gluconate followed by 5 mL of DI, or 5 mL of 0.025% povidone-iodine solution followed by 5 mL of DI. Separate glove fingertips were sampled 5, 15, 30, 60, 120 and 240 minutes after washing and cultured in duplicate for CMV. Similar studies were performed using human cadaver skin. Ordinary soap was as effective at preventing CMV recovery as other more expensive agents. For inocula with <5 log10pfu CMV/mL, washing with water alone was as effective as other agents. This was confirmed in similar studies with human hands using five CMV stains. Handwashing is probably an effective method for removing CMV from contaminated hands.
Bacterial Colonization in Humidifying Cascade Reservoirs After 24 and 48 Hours of Continuous Mechanical Ventilation
Authors: Goularte Theresa A. , Manning Marie , Craven Donald E.
Published: August 2016

We evaluated levels of bacterial colonization in the humidifying cascade reservoirs of 466 mechanical ventilators; 326 reservoirs were cultured after 24 hours and 140 were cultured after 48 hours of continuous mechanical ventilation. Bacterial colonization was absent in 284 (87.1%) of the humidifier reservoirs sampled at 24 hours and 125 (89.3%) of the reservoirs cultured at 48 hours. Levels of bacterial colonization in the remaining humidifiers were low (<100 organisms/mL). The median temperature recorded in the reservoir fluid of 30 different ventilators was 50°C (range 40° to 60°C). In vitro seeding of reservoir fluid at 50°C with 106 organisms/mL of four different species of nosocomial gram-negative bacilli andStaphylococcus aureusdemonstrated rapid killing of all five strains over a 6-hour incubation period, and no significant bacterial aerosols were detected. Rates and levels of bacteria in heated humidifier reservoirs are low and nosocomial pathogens survive poorly at the median reservoir temperature of 50°C. We conclude that the heated humidifier reservoir on a mechanical ventilator is an unlikely source of colonization or bacterial aerosols, and therefore it can be changed every 48 hours with the ventilator tubing.