bluuebunny/crossref_metadata_2025 huggingface dataset:
Successful Control of Hepatitis B Surface Antigenemia in a Dialysis Unit Without Geographic or Machine Isolation
Authors: Ostrower Victor S. , Lifschitz Meyer D. , Craven Philip C. , Williams Dwight M.
Published: August 2016

Persistent hepatitis B infections among patients and frequent new hepatitis B infections among both patients and staff were a major problem in our dialysis unit during its first two and one-half years of operation. During this time the mean quarterly rate of conversion to HBsAg positivity among patients ranged from 0-60% (mean 12%); in staff it ranged from 0-13%. Control efforts, including strict temporal isolation, improved sanitary measures, and use of parallel plate dialyzers without geographic or machine isolation, were begun late in 1976. After a four-month lag, new HBsAg conversions ceased among the 30 patients and staff at risk, despite continued dialysis of eight HBsAg-positive patients (at least four of whom were HBeAg-positive). Over the succeeding three years the conversion rate was zero in both patients and staff. This experience suggests that conservative control measures without geographic separation of patients may be sufficient to control an established outbreak of hemodi-alysis-related hepatitis B. Controlled prospective trials of this hypothesis are warranted.
High Cost Nosocomial Infections
Authors: Pinner Robert W. , Haley Robert W. , Blumenstein Brent A. , Schaberg Dennis R. , Allmen Stephen D. Von , McGowan John E.
Published: August 2016

The average charge per patient due to nosocomial infection for 215 nosocomial infections in 183 study patients was $693. These costs, however, were concentrated in very few patients; 5% of patients accounted for nearly one-third of total charges. The 10% of patients with highest nosocomial infection costs were patients on Medical or Surgical services; these services were utilized in 71% of patients with nosocomial infection and accounted for 86% of the attributable charges. Among the 22 most costly infections, 17 occurred in surgical wounds and lower respiratory tract. Although these sites accounted for 46% of the infections, they resulted in 77% of the total nosocomial infection charges. Patients with a primary diagnosis of injury had particularly costly infections. Combined analysis of these variables revealed two groups for whom nosocomial infections were especially costly: surgical patients who acquired wound infections after injuries, and medical patients with lower respiratory infections.
Pneumococcal Infections and Pneumococcal Vaccine: An Update
Authors: Rytel Michael W.
Published: August 2016

Pneumococcal pneumonia continues to be an important disease in terms of prevalence, morbidity and mortality. With the discovery of penicillin and its wide clinical use, the overall mortality of pneumococcal pneumonia has been significantly reduced, but problems remain. These include: 1) death rate is uninfluenced by the antibiotic in the first five days of illness; 2) death rate in certain high risk groups and in patients infectecd with type 3 pneumococcus exceeds 25%; and 3) penicillin resistant strains of pneumococci have emerged. Because of these and other considerations, a modern 14-valent pneumococcal vaccine has been developed by Robert Austrian and his co-workers. The vaccine has been found to be immunogenic and effective in a number of populations studied. Additional efficacy studies are needed, however, particularly in certain high risk groups, such as the elderly and immunocompromised patients.
Injection Site Abscesses Caused by Mycobacterium Chelonei
Authors: Gremillion David H. , Mursch Sara B. , Lerner Charles J.
Published: August 2016

Subcutaneous abscesses occurred at hip and deltoid injection sites in 13 student nurse assistants following practice injections.Mycobacterium cheloneiwas isolated from three cases and was the presumptive pathogen in other temporally clustered cases with similar clinical findings. A 1,000 cc bottle of 0.9 N saline used as a source for practice injection solution was the apparent source of the organism.

Presenting findings included tenderness (7), swelling (7), fever (3), adenopathy (1) and weight loss (1). All cases were characterized by long incubation periods (6 to 16 weeks) and delayed resolution (mean 8.8 months), and required surgical drainage or wedge excision for therapy. Antituberculous therapy was administered in three cases. Complications were limited to scarring in seven cases with keloid formation in two and persistent pain in three cases. This outbreak reinforces the importance of penetrating trauma in this cutaneous mycobacterial infection and emphasizes the emergence of this organism as an important nosocomial pathogen.
A Prospective Study of Infectious Diseases Following Bone Marrow Transplantation: Emergence ofAspergillusandCytomegalovirusas the Major Causes of Mortality
Authors: Peterson Phillip K. , McGlave Philip , Ramsay Norma K.C. , Rhame Frank , Cohen Eve , Perry Guy S. , Goldman Anne I. , Kersey John
Published: August 2016

We performed a prospective study of infections following bone marrow transplantation in 50 patients treated for aplastic anemia or hematologic malignancy. Early, continuous prophylaxis with trimethoprim/sulfamethoxazole and oral nystatin, and empiric intravenous antimicrobial therapy during febrile granulocytopenic episodes were standard treatment for all patients. The use of trimethoprim/sulfamethoxazole did not appear to adversely affect donor marrow engraftment. Serious gram-negative bacillary and systemicCandidainfections were uncommon. Although gram-positive bacterial infections were frequent, they were rarely associated with mortality. Aspergillosis emerged as the single most important infection, contributing to the death of nine patients. Cytomegalovirus diseases developed in 13 patients, seven of whom died. Patient age and chronic myelogenous leukemia were risk factors for the development of fatal infections. This study demonstrates that although certain serious infections can be controlled, there is a critical need for effective measures to prevent and treat aspergillosis and cytomegalovirus disease in these seriously compromised hosts.
Nafcillin Resistant Staphylococcus Aureus A Possible Community Origin
Authors: Hamoudi Ayser C. , Palmer Robert N. , King Timothy L
Published: August 2016

An increased incidence in nafcillin (semisynthetic penicillins) resistantStaphylococcus aureus(SR-SA), which peaked in January 1980, was noted in Columbus Children's Hospital (CCH), Columbus, Ohio. To investigate the source of this outbreak, we reviewed the susceptibility patterns ofS. aureusstrains isolated at CCH for a 12-month period (July 1979 to June 1980). A total of 773 isolates from 706 patients were investigated with a total of 40 patients colonized or infected with SR-SA, approximately 25% of which were diagnosed in the ambulatory clinics. These patients did not have any apparent previous contact with the inpatient unit or inpatient personnel. Eight nosocomial infections were also uncovered. The first appeared in December 1979. Our studies suggested that some SR-SA isolates may have originated in the community and these organisms may not be exclusive to the hospital environment, as was felt to be the case previously. We also determined that the baseline incidence for our hospital of SR-SA was approximately 2% of total S.aureusisolates. Only 35% of the SR-SA demonstrated resistance to multiple antibiotics. This report indicates that community and nosocomial 5.aureusisolates should be monitored for nafcillin resistance. Vancomycin susceptibility should be tested on all isolates and reported for SR-SA in life-threatening infections.
Surgical Scrub and Skin Disinfection
Authors: Ayliffe Graham A.J.
Published: August 2016

The role of pre-operative disinfection of the surgeon's hands and the skin of the operative site in the prevention of wound infection remains uncertain. The normal resident skin flora, consisting mainly of coagulase-negative staphylococci and aerobic and anaerobic diphtheroids, is an uncommon cause of infection except in prosthetic operations.Staphylococcus aureusis rarely a resident on normal skin other than the perineum, and is mostly present on the hands as a transient acquired from the nose. Nevertheless, it seems rational to kill or remove all transients on the hands of the surgeon and reduce residents to low levels.

Surgical skin disinfection is usually assessed by measuring the reduction in organisms on the hands immediately after disinfection, after repeated applications of the disinfectant and after wearing gloves for two to three hours. The hands are commonly sampled in a bowl or plastic bag containing Ringer's or a similar solution and relevant neutralizers, or by the use of glove washings. A standardized technique is necessary to provide a statistical comparison between agents. Antiseptic detergents, chlorhexidine or povidone iodine show immediate reductions in bacterial counts of 70% to 80%, increasing to 99% after repeated application. Hexachloraphene and triclosan detergents show a lower immediate reduction but a good residual effect. Seventy percent ethyl or 60% propyl alcohol, with or without an antiseptic, show an immediate reduction of over 95%, and in excess of 99% on repeated application. Residual levels of organisms tend to be lower after repeated alcohol treatment than following the use of antiseptic detergents. A two to three-minute application of the antiseptic to the hands, without a scrubbing brush, is commonly recommended in the UK, but possibly in routine surgery an application time of 30 seconds is sufficient, killing or removing transients and superficial residents.
The Cost Implications of Clean Air Systems and Antibiotic Prophylaxis in Operations for Total Joint Replacement
Authors: Lidwell O.M.
Published: August 2016

The effect on sepsis of the use of prophylactic antibiotics and measures for reducing the level of airborne contamination in the operating room has been related to the costs of these measures and of dealing with a septic joint. While antibiotic prophylaxis is the most cost effective, the benefits that may be obtained from the introduction of cleaner air also appear to be worthwhile, even when considered solely in terms of hospital costs.
The Episomatic Test System and Its Application to Test Disinfectants
Authors: Weuffen W. , Kramer A.
Published: August 2016

Disinfectants come into contact with humans in two principal ways. First, they have involuntary contact with the skin and mucous membranes and are inhaled during the course of normal work. Second, they are applied purposefully directly to the skin and mucous membranes. This applies also to other chemicals in the hospital (eg, detergents), with the long-term danger being much greater for hospital personnel than for the patients.
Legal Aspects of Antibiotic Audit
Authors: Nottebart Harry C.
Published: August 2016

In first examining the legal aspects of an antibiotic audit, it might be well to consider the legal basis or reason to do such an audit.

A hospital may be compelled to act in certain ways in order to comply with standards based on:

1. Federal laws

2. State laws, particularly those on hospital licensure.

3. Joint Commission on Accreditation of Hospitals (JCAH) standards if the hospital is JCAH accredited.

4. The hospital's own bylaws, rules and regulations, and policies and procedures.

5. Certain actions are also based on duties perceived from reading opinions in lawsuits. This even may be reflected in changes in the hospital's bylaws, rules and regulations, or policies and procedures.
Employee Health and the Infection Control Practitioner—Why Bother?
Authors: Valenti William M.
Published: August 2016

The hospital is a unique workplace in terms of the infectious hazards it presents to its employees. Traditionally, infection control programs have focused on various aspects of infection control in patients. However, infections constitute a risk for health care workers, a fact which emphasizes the importance of infection control input into the employee health program. Many health care facilities and most regulatory agencies recognize the importance of infection control in health care workers. However, infection control programs have had varying degrees of influence in occupational health matters. As the discipline of infection control has grown and become more sophisticated, the subdiscipline of employee health has also begun to grow and emerge with a data base of its own. Many infection control conferences, symposia, and meetings now have a session or two related to employee health. Perhaps even more important is the CDC Guideline for Infection Control in Hospital Personnel, written by a CDC panel as part of its guidelines series. It will be responsible for drawing attention to employee health issues as they relate to infection control and should help solidify the discipline. The guideline will also provide opinions and answers to many questions regarding infection control and employee health.
A Potential Infection Hazard Associated with the Use of Disposable Saline Vials
Authors: Rutala William A. , Stiegel Marsha M. , Sarubbi Felix A.
Published: August 2016

Nosocomial respiratory tract infections have occasionally been associated with contaminated respiratory therapy devices and techniques. In the past two years, our hospital purchased disposable saline squeeze vials for use during suctioning of intubated patients. These vials have a cap which must be flipped or twisted-off by the user before the contents can be instilled into the patient's respiratory tract. We observed use of this item in our intensive care units (ICU) and studied the potential for contamination. ICU nurses use ungloved hand(s) to flip or twist-off squeeze vial cups resulting in skin contact with the vial opening. Cultures of nurses' hands and squeeze vial contents were obtained in the ICU where 24 nurses opened 92 vials in the manner previously described. Twenty-three percent of vial contents were contaminated and cultures revealed S. epidermidis, S. aureus, Streptococcus viridans and enterococcus. On six occasions, organisms recovered from vial contents were believed to be identical to organisms isolated from the hands of the nurse who opened the vial. When nurses used care in removing the saline vial cap, cultures of vial contents were sterile.
Hospital-Acquired Infections in Intensive Care Unit Patients An Overview with Emphasis on Epidemics
Authors: Wenzel Richard P , Thompson Robert L. , Landry Sandra M. , Russell Brenda S. , Miller Patti J. , de Leon Samuel Ponce , Miller Grayson B.
Published: August 2016

Surveillance activities for the detection of nosocomial infections at the University of Virginia Hospital (Charlottesville, Virginia) and at hospitals participating in the Virginia Statewide Infection Control Program have focused on outbreaks and device-related infections which are potentially preventable. Eleven outbreaks of nosocomial infections were identified at the University of Virginia Hospital between January 1, 1978 and December 31, 1982 (9.8 outbreaks/100,000 admissions). Ten of the 11 were centered in critical care units. The 269 patients involved in the epidemics represented 0.2% of all hospital admissions and 3.7% of all patients who developed nosocomial infections. Eight of the 11 outbreaks involved infection of the bloodstream, and the 90 patients who developed a bloodstream infection as part of an epidemic represented 8% of all patients with nosocomial bloodstream infections identified during the five-year study period. The reservoir of the 11 outbreaks involved devices (5), contaminated cocaine (1), probable blood products (1), other patients (3), and nursing personnel (1). Forty-one percent of all nosocomial bloodstream infections and 41% of all nosocomial pneumonias occurred in intensive care units (ICUs).

In 38 hospitals in the state of Virginia with ICUs and practitioners who voluntarily reported surveillance data between June 1,1980 and May 31,1982, there were 264,757 patients admitted and a crude infection rate of 3%. Of note is that 1,867 of the 7,407 nosocomial infections (25%) occurred in the ICU patients. Several factors point to a compelling argument that the highest priority in infection control resources be assigned to the prevention and control of ICU infections: ICU patients often have serious device-related infections and may be identified as high risk prior to infection. Furthermore, they are at risk of being infected as part of a major outbreak. Such characteristics define a population of hospitalized patients, many of whose infections are preventable.
Optimal Design/Personnel for Control of Intensive Care Unit Infection
Authors: Nyström Bertil
Published: August 2016

Apart from the special mechanisms for spread of IV device and respiratory equipment-related infections, the mechanisms for spread of infections in the intensive care unit (ICU) are no different from other areas of the hospital. Control of transmission must emphasize the necessity of blocking the contact and airborne routes of spread.

Hand disinfection with an alcoholic preparation and the use of patient-bound gowns for all direct patient contact are efficient measures against contact spread of infections.

Airborne spread is best reduced by nursing patients in one-patient rooms with doors closed. A substantial part of the beds should be in such rooms. However, they are of little value if basic barrier nursing techniques are neglected. An ante-room to the one-patient room is practical for hand disinfection, gowning, etc., and if ventilated, offers added protection against airborne spread.

Barriers against transmission of microorganisms must be created between patient rooms. Since basic barrier nursing techniques are the determining factors for infection control, the need for adequate numbers of well-trained and well-educated staff cannot be overestimated.
Increased Antimicrobial Resistance of Pathogenic Coagulase-Negative Staphylococci From Blood Cultures (1961–1981)
Authors: Flournoy D.J.
Published: August 2016

Coagulase-negative staphylococci (CONS) have only recently gained notoriety as pathogens. Several reports have established their pathogenicity in bacterial endocarditis, prosthetic heart valve endocarditis, intraventricular shunts for treatment of hydrocephalus and intravenous catheters. One difficult decision for physicians is determining whether a particular CONS isolate is pathogenic or contaminant. The differentiation of pathogenic and contaminant CONS has recently been noted, but further studies are needed to aid in this differentiation. Data on antimicrobial susceptibilities of positive blood culture isolates were recently compiled at this institution. This report compares antimicrobial susceptibilities of pathogenic and contaminant CONS and Staphylococcus aureus blood culture isolates from 1961-1981 at this institution.
Staphylococcus epidermidis Bacteremia Associated With Vascular Catheters: An Important Cause of Febrile Morbidity in Hospitalized Patients
Authors: Sattler Fred R. , Foderaro Janet B. , Aber Robert C.
Published: August 2016

Seventeen episodes of persistent Staphylococcus epidermidis bacteremia (one to nine days) occurred in 16 patients with vascular catheters during a 26-month period. Cases were statistically more likely to have a longer hospitalization (54 v 7.6 days, p < .0005), longer duration of antibiotic therapy (22 v 2.5 days, p = .002), presence of a central venous pressure (CVP) catheter (14 v 2, p < 3 × 10-8), and presence of an arterial catheter (4 v 1, p = 0.037) than randomly selected hospitalized patients matched for age, sex, and date of admission. However, when cases were compared with similarly matched non-bacteremic patients having CVP catheters, these characteristics were not significantly different in the two groups. Furthermore, exposure to total parenteral nutrition (TPN) and duration of TPN were not significantly different between cases and controls. Hence, the presence of a CVP catheter appeared to be the major risk factor for 5. epidermidis bacteremia. In 16 episodes, patients had temperature > 38.6°C without another identifiable cause, and the average white cell count for the case group was 19,400/mm. Seven patients also had diaphoresis, confusion, hypotension, or oliguria. Temperatures returned to normal in 13 within 24 hours after catheter removal, and all patients were afebrile and symptom-free within 72 hours. Thus, vascular catheter-associated S. epidermidis bacteremia was an important case of febrile morbidity in these patients.
Epidemic Bullous Impetigo in a Nursery Due to a Nasal Carrier ofStaphylococcus aureus:Role of Epidemiology and Control Measures
Authors: Nakashima Allyn K. , Allen James R. , Martone William J. , Plikaytis Brian D. , Storer Beth , Cook Larry M. , Wright Stephen P.
Published: August 2016

From September 14, 1981 to February 28, 1982, an epidemic of bullous impetigo caused by a penicillin/tetracycline resistant strain ofStaphylococcus aureus,phage type 3A/3C, occurred in a newborn nursery in Louisville, Kentucky. Twenty of 1,181 (1.7%) infants at risk developed disease during the six-month epidemic period. Clinically all case-infants had bullous impetigo skin lesions. One infant developed staphylococcal septicemia. No infant died. An epidemiologic investigation identified a nurse as having significantly greater contact with case-infants than control-infants (p=0.0013). She was also found to be a nasal carrier of the epidemic strain. Infection control measures appeared to decrease infant-to-infant transmission via the hands of non-colonized nurses, but did not affect transmission from the nurse carrying the epidemic strain to infants. No cases of bullous impetigo have occurred since this nurse was temporarily removed from the nursery for treatment.
Results of a Survey of Ventilator Circuit Practices in the United States
Authors: Craven Donald E. , Connolly Michael G. , Goularte Theresa A.
Published: August 2016

The responses to a survey of ventilator circuit practices published in Infection Control are shown in the Table. The majority of 249 individuals who responded were located in community hospitals or community teaching hospitals of 100 to 500 beds. Most of the hospitals changed ventilator circuits (tubing humidifying cascades and swivel adapters) every 24 hours or less. Interestingly, 30.1% of the hospitals indicated that “self-study” was used to determine the time interval of ventilator circuit changes. Our 1982 study of contamination in mechanical ventilators at 24 and 48 hours confirmed earlier observations that mechanical ventilators with cascade humidifiers do not generate small particle aerosols.
The Cephalosporin Antibiotic Agents — II. First- and Second-Generation Agents
Authors: Marsh T. Donald
Published: August 2016

The first article in this series discussed the cephalosporin antibiotic agents as a class, including the similarities in their structure, antimicrobial action, and toxicity. Part II focuses on the difference between commercially available first- and second-“generation” agents.

The cephalosporins are classified using various criteria, including vulnerability to beta-lactamase hydrolysis and antibacterial activity. The latter classification is based on the in vitro activity of the individual agents, with each succeeding “generation” possessing a greater spectrum of activity than the previous generation(s).
The Efficacy of Antibiotic Prophylaxis in the Prevention of Post-Cesarean Section Endometritis
Authors: Donowitz Leigh Grossman , Norris Sandra M.
Published: August 2016

Endometritis is an infectious complication in 9% to 65% of patients delivered by cesarean section. The risk of developing endometritis is greater in the high-risk emergent patient as compared to routine repeat abdominal deliveries. This study describes the incidence of endometritis following cesarean section delivery in different patient groups at the University of Virginia Hospital during a 1-year period and reviews the literature on the efficacy and risks of prophylactic antibiotics in this setting. Of patients not receiving antibiotic prophylaxis, 11 (<1%) of 1,461 normal spontaneous vaginal delivery patients, 7 (16.7%) of 42 repeat and 39 (29.8%) of 131 emergent cesarean section patients developed endometritis. This contrasts to none of the 24 emergent patients who received antibiotic prophylaxis. The literature review shows multiple prospective well-designed and executed studies that demonstrate reliable decreases in the incidence of endometritis with short course antibiotic prophylaxis. Our conclusion is that short course antibiotic prophylaxis is a safe, reproducible, cost-effective and indicated method of reducing the incidence of this costly and serious postoperative infection.
Update on AIDS
Authors: Valenti William M.
Published: August 2016

Recent advances in our knowledge of the Acquired Immune Deficiency Syndrome (AIDS) could have a major impact on practitioners in both infection control and employee health. The discovery that a retrovirus, the human T-cell leukemia virus (HTLV-III) is the cause of AIDS could be used to help health care workers better understand this disease. Those of us who are trying to provide our employees with up-to-date information on AIDS should use this new information to help employees understand the nature of the disease, its transmissibility and non-transmissibility. Now that the disease can be linked to a specific agent, employees may find AIDS to be much less mysterious. The retrovirus link is a major step forward in understanding this disease and may eventually lead to more effective treatment and possibly a vaccine. Our knowledge continues to evolve in much the same way as our understanding of Legionnaires' Disease and Toxic Shock Syndrome.

The Acquired Immune Deficiency Syndrome (AIDS) was discussed extensively at recent infectious diseases meetings in Washington, D.C. The results of original research conducted by investigators at the National Institutes of Health (NIH), Centers for Disease Control (CDC), Pasteur Institute in Paris, and medical centers throughout the world were presented at the meetings. A number of issues have been clarified and the pieces of the puzzle are starting to come together.
EnterobacterMediastinitis Following Cardiac Surgery
Authors: Palmer Darwin L. , Kuritsky Joel N. , Lapham Sandra C. , King Rosalie M. , Akl Bechara F.
Published: August 2016

Eight cases of sternal/mediastinal infection due to Enterobacter species were seen in postoperative cardiac patients during 1980 to 1981. The attack rate was 14.5% (8/55), compared to 3.7% (2/54) for an identical period in 1979 to 1980 (p<0.05). Cases varied in severity from fulminant, acute bacteremic infections (one death) to less severe wound infection. Late complications or recurrences were not seen. There was a hospital-wide increase, relative to all other gram-negative bacillary isolates, inEnterobacterlaboratory isolations, but no increased rate of infection in any other specific surgical condition.

No personnel, materials, or techniques were associated with the outbreak, and all but two environmental cultures were negative. Case-control analysis suggested that surgical complications and prophylactic cephalosporins were associated with infection. Prospectively, an additional 85 cardiac surgery patients had increasedEnterobacterskin/wound colonization following perioperative prophylaxis with cephalosporin antibiotics. After introduction of barrier isolation and restriction of contacts no further mediastinitis occurred in 100 subsequent cardiac surgery patients. This study indicates thatEnterobactermay be major pathogens causing post-cardiac-surgery infection not prevented by cephalosporin prophylaxis.
Prevention and Control of Tuberculosis
Authors: Valenti William M.
Published: August 2016

One activity of most employee health programs is a tuberculosis control program. No two programs will be exactly the same since many of the components of this program are controversial. Each should be tailored to the needs of the individual health care facility. In general, there are two components of a program for tuberculin skin testing of employees:

1. Skin testing prior to exposure.

2. Skin testing after exposure.
An Outbreak of Invasive Aspergillosis Among Allogeneic Bone Marrow Transplants: A Case-Control Study
Authors: Rotstein Coleman , Cummings K. Michael , Tidings John , Killion Kathleen , Powell Eileen , Gustafson Tracy L. , Higby Donald
Published: August 2016

Between April 1982 and March 1983,10 of 26 (38.4%) allogeneic bone marrow transplant recipients housed on a newly opened bone marrow transplant unit developed invasive aspergillosis. By contrast, between September 1977 and March 1982, only 3 of 46 (6%) transplant recipients developed invasive aspergillosis. A case-control study to identify host factors related toAspergillusinfection found that aspergillosis was more common in patients with chronic myelogenous leukemia and aplastic anemia, older patients, patients having cytomegalovirus disease, patients who experienced prolonged granulocytopenia, patients conditioned with ara-C (100-200 mg/day), and patients who received longer duration of antimicrobial therapy. A series of logistic regression analyses revealed that underlying disease was the single best predictor ofAspergillusinfection. This study demonstrates that underlying disease is an important risk factor for aspergillosis and that special measures may be warranted when transplanting certain patients.
Infection Control Considerations for In Vitro Fertilization and Embryo Transfer Programs
Authors: Axelrod Peter , Talbot George H.
Published: August 2016

In vitro fertilization and embryo transfer (IVF-ET) is a process in which human ova are obtained by laparoscopic ovarian follicular puncture, fertilized in vitro by capacitated donor sperm, and introduced transcervically into the uterus. The prospective mother's ovarian cycle is usually stimulated with either clomiphene citrate, human menopausal gonadotropin, or both, so that multiple aspiratable follicles are produced. Follicular development is monitored by ultrasound and by serial serum or urine estrogen determinations. When adequate follicular development has been achieved, a pre-ovulatory dose of human chorionic gonadotropin is administered.
Herpes Simplex Virus
Authors: Simmons Bryan P. , Gelfand Michael S.
Published: August 2016

Herpes simplex virus (HSV) causes a variety of illnesses in th e community and hospital settings (Table). Nosocomial infections with this virus may result from: 1) reactivation of latent infection, especially in patients whose immune systems are compromised; 2) spread from mother to infant; 3) spread from patients to hospital personnel; 4) spread from hospital personnel to patients; and 5) cross-infection among patients. The latter two possibilities seem to occur infrequently but merit some discussion because of the serious implications of such infections.
Bubbling Humidifiers Produce Microaerosols Which Can Carry Bacteria
Authors: Rhame Frank S. , Streifel Andrew , McComb Carter , Boyle Mike
Published: August 2016

It is widely held that bubbling humidifiers do not produce microaerosols, although prior studies have resulted in conflicting evidence. We have studied this phenomenon in a clean room using an airborne particle counter and samplers for airborne bacteria. At gas flow rates between 10 and 80 L/min, a Cascade 1 humidifier produced between 460 and 999 water droplets/L humidified gas. Total water volume aerosolized was approximately 10-8ml/L humidified gas. Seventy-three percent of the particles had diameters between 1 and 5 microns. With the reservoir containing 6.4 × 106P. aeruginosa/ml, it produced between 2 and 9P. aeruginosa/Lhumidified gas. Most of the bacteria were in particles of a size likely to be deposited in the lung. This bacterial carryover was between 20 and 150 times the amount predicted by multiplication of the water volume aerosolized times the concentration of bacteria in the humidifier reservoir. An Air Life humidifier produced fewer particles which were also of a size likely to be deposited in the lung and, when the reservoir containedP. aeruginosa, it aerosolized bacteria. Wick-type humidifiers did not produce detectable aerosol or bacterial carry-over. Although the clinical significance of these findings has not been established, they provide a rationale for the CDC recommendations for procedures designed to keep bubbling humidifier reservoir water uncontaminated.
Infection Control in Pulmonary Function Laboratories
Authors: Tablan Ofelia C. , Williams Walter W. , Martone William J.
Published: August 2016

The role of the pulmonary function (PF) laboratory and PF testing equipment in the transmission of infections has not been established. Although microorganisms have been cultured from parts of in-use pulmonary function testing equipment, a relationship between equipment contamination and transmission of infection or colonization has not been documented. Nosocomial outbreaks of respiratory infections, eg, influenza, tuberculosis, and legionellosis have been described, but transmission of the microorganisms has not been shown to be more likely in the PF laboratory or with PF testing equipment than in other areas in the hospital or with other hospital equipment. Unlike nebulizers, which have been implicated in epidemic and endemic nosocomial gram-negative bacterial infections, PF machines do not generate aerosols. PF testing equipment is thus built without provision for easy machine disassembly and disinfection, except for parts that routinely come in contact with mucous membranes or secretions (eg, mouthpieces, valves, and some tubings).
The Risks of Transmission of the HTLV-III and Hepatitis B Virus in the Hospital
Authors: Shanson David
Published: August 2016

In the hospital, both HTLV-III and hepatitis B virus are most likely to spread via infected blood or contaminated blood products. A summary of the main factors affecting spread of these viruses and some observations made at the author's hospital in central London, will be discussed here.

AIDS was first recognized in Britain in 1981 and up to August 1985 there were 206 confirmed cases of AIDS with 114 deaths. The majority of patients with AIDS have been male homosexuals and less than 15% of the cases occurred outside of London. By August 1985 over 10,000 cases of AIDS had been reported in the US and it is clear by comparison that the current epidemic in Britain is in its early stages. Only a minority of London homosexuals have been infected. It is possible that an aggressive public health campaign could slow the course of the epidemic. Measures needed would include an increase in education, publicity, facilities for HTLV-III antibody tests, trained social workers and counseling on a massive scale. In the meantime the number of hospitalized patients with known HTLV-III infections has increased considerably during the last 2 years in certain hospitals in London (Figure 1). Approximately 33% of homosexuals attending sexually transmitted diseases (STD) clinics in London have serological evidence of HTLV-III infection. A few hospitals in central London have seen most of the patients with known HTLV-III or hepatitis B infections mainly because of the concentrations of homosexuals, drug addicts or other “risk groups” in the local catchment areas of these hospitals. A small number of hospitals in London and elsewhere in Britain have special hemophiliac centers and currently these centers have generally noted that more than 50% of their hemophiliac patients already have serological evidence of HTLV-III infection. Recent reports have documented the rate of increase of HTLV-III infections in British hemophiliac patients. During the last few years in London less than 10% of male homosexuals known to have HTLV-III infection and less than 1% of infected hemophiliac patients have developed AIDS.
The Management of Health Care Workers' Accidental Parenteral Exposures to Biological Specimens of HIV Seropositive Individuals
Authors: Kuhls Thomas L. , Cherry James D.
Published: August 2016

Because of the similarities in the spread of hepatitis B virus and the human immunodeficiency virus (HIV), health officials have been concerned about the acquisition of HIV infection by health care workers. This concern has led to numerous cross-sectional and prospective cohort studies during the last 3 years to evaluate the risks involved. The risk of occupationally acquired HIV infection has been shown to be considerably less than that of hepatitis B virus infection, however needlestick transmission has occurred.
Effect of Long-term Storage on Sterile Status of Devices in Surgical Packs
Authors: Klapes N. Ariene , Greene Velvl W. , Langholz Ann C. , Hunstiger Cindy
Published: August 2016

We investigated the effect of the following on the sterile integrity of surgical packs: four wrapping materials (two-ply reusable, nonbarrier wovens, both new and previously used; disposable, barrier nonwovens; and polypropylene peel pouches), dustcovers, two storage locations, and storage times ranging from 2 to 50 weeks. Two hundred sixty-three packs containing stainless steel coupons were prepared, wrapped, sterilized, and stored. Half of the packs were dustcovered prior to storage. At monthly intervals for a year, packs of each type were opened in a laminar flow hood, and the coupons inoculated into trypticase soy broth. The coupon contamination probabilities were 0.019 for reusable, woven packs; 0.017 for disposable, nonwoven packs; and 0.016 for peel pouches. These differences were not significant. The probability of finding a contaminated coupon in any pack after 50 weeks was 0.018. No trend toward increased probability of contamination over time was observed for any of the pack types studied.
The Importance of Surveillance Stool Cultures During Periods of Severe Neutropenia
Authors: Wells Carol L. , Ferrieri Patricia , Weisdorf Daniel J. , Rhame Frank S.
Published: August 2016

The correlation of fecal gram-negative bacilli (GNB), neutropenia, and bacteremia was studied in 45 bone marrow transplant recipients. Weekly stool cultures were prospectively monitored for GNB resistant to routine prophylactic and empiric antimicrobial agents. Seven cases of GNB bacteremia occurred in 45 patients described as follows. Twenty-three patients had no fecal or blood GNB. Fifteen patients had fecal GNB and no blood GNB; three of these latter patients had ≤50/mm3 circulating white blood cells (WBC) at the time of isolation of fecal GNB but two of the three were concurrently receiving appropriate empiric antibiotics. Two patients had blood GNB but no fecal GNB: one patient had a trimethoprim/sulfamethoxazole (TMP-SMZ)-sensitive isolate that would not be detectable in the feces by our methodology and one patient had feces analyzed only after the bacteremic event. Five patients had fecal GNB and blood GNB: one of these patients did not have a fecal sample analyzed prior to bacteremia but the remaining four patients had the same species/antibiogram of GNB isolated from the feces two to three days prior to the detection of bacteremia. Thus, the fecal GNB could have been used to predict the antibiogram of the subsequent blood GNB. In addition, all four of these latter bacteremic patients had ≤50/mm3 circulating WBC at the time of documented fecal GNB. Thus, bone marrow transplant recipients with fecal GNB coupled with severe neutropenia (≤50/mm3 circulating WBC) were more likely to develop bacteremia (P<0.02) than were those with fecal GNB and ≤50/mm3 circulating WBC.
Staphylococcus aureusMediastinitis: Prognostic Usefulness of an Early Medicosurgical Therapy
Authors: Voiriot Pascal , Marcoux J. André , Duperval Raymond , Teijeira Javier
Published: August 2016

Six cases of acuteStaphylococcus aureusmediastinitis after median sternotomy were reported. Five resulted from an asymptomatic disseminator of 5aureuspresent in the operating room. Each case was characterized by an acute bacteremic phase, occurring after a mean interval of 8.2 ± 1.7 days after the surgical procedure; within 24 to 36 hours all patients had a temperature above 39°C, toxic appearance, and marked leukocytosis. Pericicatricial inflammation was moderate, instability of the sternum was present in only two patients, and chest roentgenogram was not helpful in making an early diagnosis. No risk factor for mediasinitis in connection with the perioperative or postoperative periods was noted in cases compared with a control group of 103 patients. All strains ofS aureuswere susceptible in vitro to the antibiotic regimen used in prophylaxis. All patients underwent early surgical reopening of the mediastinum within 47 ± 15 hours after the first sign of acute mediastinitis. Mediastinal debridement and continuous irrigation-suction with dilute povidone-iodine solution were associated with intravenous antistaphylococcal therapy for a period of four to six weeks. All patients survived and no recurrence was observed, a finding we think due to early diagnosis and aggressive medicosurgical therapy.
Staphylococcus aureusColonization and Infection After Discharge from a Term Newborn Nursery
Authors: Wang Elaine E.L. , Elder Diane , Mishkel Norma
Published: August 2016

During a 6-month period, term infants underwent nasal and umbilical swabbing within 96 hours of delivery and again at 1 to 18 (mean 3.8) weeks after discharge. Swabs were inoculated onto horse blood agar and allS aureusisolates were phage typed. Two hundred three infants were enrolled and follow-up was obtained for 181 (89%). Thirty-two of 181 (17.6%) were initially colonized, of whom 12 (37.5%) were colonized on follow-up. Thirty-two of 181 became colonized subsequent to hospital discharge. No single phage type predominated. Twenty-five patients were diagnosed to have clinical illness—omphalitis (11), conjunctivitis (10), and pustulosis (5). Six of these were colonized with 5 aureus initially, although organisms of the same phage type were not recovered from cultures obtained at the time of clinical illness. There was no significant difference in the rate of infections in colonized (19%) versus noncolonized (12%) infants. In five patients whereS aureuswas recovered at the time of symptoms, all organisms were acquired subsequent to discharge. We conclude that nursery colonization withS aureusdid not lead to clinical illness, and clinical illnesse s previously ascribed toS aureusfrequently occur in the absence of these bacteria.
A Hepatitis B Vaccination Program in a Community Teaching Hospital
Authors: Tong Myron J. , Howard Ann M. , Schatz Gary C. , Kane Mark A. , Roskamp Deborah A. , Co Ruth L. , Boone Cissy
Published: August 2016

Prior to offering the hepatitis B (HB) vaccine, a prescreen for hepatitis B virus (HBV) antibodies was conducted in a 565 bed hospital in Pasadena, California. Antibodies to the hepatitis B virus were detected in 14.5% of 1,745 employees tested. There was a significantly higher prevalence in those with a previous history of hepatitis, blood transfusions, exposure to nee-dlesticks, number of years in the same occupation, and in the same hospital work area. Employees of Asian extraction (33.3%) and blacks (23.1%) had a higher prevalence of antibodies to the hepatitis B virus than Hispanics (13.7%) and whites (10.2%). Anti-HBs was detected in 92.6% of 865 employees who received three doses of the hepatitis B vaccine. Only 28.6% of nonresponders receiving a fourth dose of hepatitis B vaccine produced anti-HBs. The nonresponders to the HB vaccine were older (average age 64.9 years) when compared to the responders (average age 37.5 years), and more males failed to produce anti-HBs after vaccination than females. Hepatitis B vaccination of the majority of individuals with either “low level” anti-HBs alone or anti-HBc alone did not elicit an anamnestic response after one dose of vaccine, implying that these “low level” antibodies are nonspecific and do not represent antiviral antibodies. Adverse reactions to the hepatitis B vaccine were minor and included a flulike syndrome, sore arm, and rash and swelling at the injection site. The reasons for nonparticipation were obtained from 179 individuals, and the main issue was concern about safety of the hepatitis B vaccine.
Review of the 4-Quinolones
Authors: Eggleston Mark , Park Soon-Young
Published: August 2016

Improvements in antimicrobial activity and pharmacokinetics have moved the 4-quinolones into the forefront of antibiotic research. The 4-quinolones are analogues of nalidixic acid, and there are presently at least six agents in this group under investigation in the United States. It is difficult to generalize their clinical usefulness, since these agents exhibit different pharmacokinetic profiles, antimicrobial activity (with varied minimum inhibitory concentrations among similar organisms), and dosage regimens.

The 4-quinolones are potential therapeutic alternatives for infections caused by a variety of organisms. They include: Neisseria gonorrhoeae; Pseudomonas aeruginosa; Haemophilus influenzae; Staphylococcus aureus; common enteric pathogens (salmonella, shigella, Campylobacter, etc); and intracellular bacteria (legionella, chlamydia, mycobacteria, etc).

Clinical efficacy has been demonstrated in urinary tract infections, respiratory tract infections, and sexually transmitted diseases. Future studies will undoubtedly demonstrate effectiveness in numerous additional infectious processes.

The purpose of this article is to compare the 4-quinolones in regards to pharmacokinetics and spectrum of activity and review the clinical studies involving these agents.
Protein Fingerprinting for the Determination of Relatedness inAcinetobacter calcoaceticussubspecies anitratus Isolated from Patients in a Surgical Intensive Care Unit
Authors: Mortensen Joel E. , LaRocco Mark T. , Steiner Bret , Ribner Bruce
Published: August 2016

The use of protein fingerprinting for the establishment of relatedness among isolates ofAcinetobacter calcoaceticussubspeciesanitratus, isolated from patients in a surgical intensive care unit was examined. Poly-acrylamide gel electrophoresis was used to analyze the cellular proteins from whole cell lysates of 14 intensive care unitA calcoaceticussubspeciesanitratusisolates and 11 control strains. Antimicrobial susceptibilities and plasmid profiles were also determined for all isolates. All intensive care unitA calcoaceticussubspeciesanitratusisolates exhibited identical cellular protein fingerprints, no detectable plasmids, and minimum inhibitory concentrations within ±1 log2dilution of the mode value for each of the antimicrobial agents tested. The other clinical isolates demonstrated a range of antimicrobial susceptibilities, various numbers and sizes of plasmids, and distinctly different protein fingerprints. These data indicate that protein fingerprinting may be useful as an epidemiologic tool inA calcoaceticussubspeciesanitratusoutbreaks and this method deserves further study.
The Antiseptic Efficacy of Chlorxylenol-Containing vs. Chlorhexidine Gluconate-Containing Surgical Scrub Preparations
Authors: Soulsby M.E. , Barnett J.B. , Maddox S.
Published: August 2016

The studies described here evaluate the efficacy of the chlorxylenol-containing surgical scrub formulations against the Chlorhexidine gluconate-containing formulations using the Glove Juice Test, as recommended by the FDA's panel to develop guidelines for the study of antiseptic agents. Similar reports from the literature evaluating the relative efficacies of the iodophor-containing and the hexachlorophene-containing formulations are cited. Results fail to detect any significant differences in the efficacy of these two preparations, each significantly reducing the bacterial flora on the hands as indicated by immediate post-wash colony counts, and each demonstrating the continuing ability to significantly reduce bacterial growth with continued regular use.
Outbreak ofBurkholderia cepaciain the Adult Intensive Care Unit Traced to Contaminated Indigo-Carmine Dye
Authors: Gravel Denise , Sample Mary Lu , Ramotar Karam , Toye Baldwin , Oxley Cathy , Garber Gary
Published: August 2016

We report an unusual cluster ofBurkholderia cepaciain patients. Environmental cultures identified indigo-carmine dye used in enteral feeding as the reservoir. Compared with the controls, the cases were significantly more likely to have received tube feedings tinted with this dye. This outbreak was terminated with the removal of the dye from hospital inventory.