bluuebunny/crossref_metadata_2025 huggingface dataset:
Brief Report Possible Prevention of an Outbreak of Group A Streptococcal Infection by a Prospective Epidemiologic Approach
Authors: Denys Gerald A. , Palacas Jane T. , Lerner A. Martin
Published: August 2016

On May 17, 1984, a 67-year-old woman with endometrial carcinoma underwent an uneventful abdominal hysterectomy. Suddenly, 18 hours later she was in septic shock, short of breath, restless and oliguric. The wound appeared intact without erythema. Intraabdominal sepsis was postulated and the patient was given full dosages of intravenous cefotaxime, metronidazole and netilmicin. At 48 hours postoperative, the abdominal wound showed areas of necrosis and the patient died. The wound, peritoneal fluid, urine and blood yielded group A (β-hemolytic streptococci (Streptococcus pyogenes). Shortly before death, intravenous penicillin had been administered. An epidemiologic study was promptly initiated.
The Prevalence of Hepatitis B in Employees of Small, Rural Hospitals—Implications for Vaccine Administration
Authors: Martin David B. , Jannausch Marie , Skendzel Laurence P.
Published: August 2016

The Centers for Disease Control Advisory Committee on Immunization Practices has based recommendations for hepatitis B vaccine for hospital employees on studies done in large urban hospitals. Data on the prevalence of hepatitis B in employees of small hospitals have been lacking. We measured hepatitis B surface and core antibody in 422 employees of six small, rural hospitals who were exposed to blood. The overall prevalence among those “high-risk” employees was 5.5%. The highest prevalence was found in General Nursing, Intensive Care Nursing, Recovery Room, IV Therapy, Laboratory, and Respiratory Therapy, although differences were seen between hospitals. Results of such testing for individual hospitals may have a major impact on the cost-effectiveness of vaccination programs for their employees.
Topics in Clinical Microbiology Histopathologic Diagnosis of Fungal Diseases
Authors: Stratton Charles W. , O'Hare Michael
Published: August 2016

There has been a tremendous increase in the number of immunocompromised patients over the past few decades, which has resulted in an increased number of serious fungal infections. These infections frequently require an invasive procedure, such as bone, lung, or lymph node biopsy, in order to obtain tissue for diagnosis. Far too often the tissue obtained by such means is not optimally utilized. For example, the tissue may be placed in formalin without being appropriately cultured, or the incorrect choice of tissue stains may result in the pathogen either being missed or being incorrectly identified. Clearly, this problem should be addressed by both the pathologist and the clinician.
Increasing Handwashing in an Intensive Care Unit
Authors: Mayer Joni A. , Dubbert Patricia M. , Miller Mary , Burkett Paul A. , Chapman Stanley W.
Published: August 2016

The present study provides the first systematic evaluation of strategies for increasing handwashing of hospital staff. Nursing staff on two intensive care units (ICUs) were observed over a 3-month period. After baseline observations, two interventions were implemented on the experimental unit: 1) changing to an emollient handwashing agent, and 2) providing feedback to staff about the frequency of handwashing. Feedback focused on the previous day's handwashing following completed patient contacts, interrupted patient contacts, and critical procedures. No increase in handwashing was observed following introduction of the emollient soap. However, when feedback was provided on the experimental ICU, handwashing following completed patient contacts (the major dependent measure) increased to 92%, and was significantly higher than handwashing on the control unit. Follow-up observations suggested that compliance on the experimental unit appeared to return to baseline levels.
Serratia marcescensInfections
Authors: Acar Jacques F.
Published: August 2016

The recognition of serratia as an opportunistic human pathogen can be dated from 1959, when the microorganism entered the family ofEnterobacteriaceae,with features recognizable in the clinical laboratory and related to theKlebsiella/Enterobactergroup. Since then, physicians have been challenged to establish the significance of isolation of serratia from a clinical specimen.
Prevalence of Measles Antibodies in Hospital Personnel
Authors: Chou Teresa , Weil Diane , Arnow Paul M.
Published: August 2016

A community outbreak of measles prompted a serologic survey of personnel in a hospital serving that community. Two hundred sixty-six personnel, primarily physicians (129) and nurses (100), voluntarily participated. Serum specimens were initially tested by the immunofluorescent antibody and enzyme-linked immunosorbent assay (EIA) methods. Specimens with negative results by either test were further examined using the hemagglutination inhibition and plaque neutralization (PN) methods. If EIA and PN results were negative, an individual was considered susceptible. Only one of the 98 participants born during or after 1957 and none of the 168 participants born before 1957 were serosusceptible. The low rate of serosusceptibility, in contrast to previous studies of young adults, appears attributable to the sensitivity of the testing methods used. Based on our experience, institutions considering a measles serologic testing and immunization program should expect to identify very few serosusceptible personnel, even among those born during or after 1957.
Strict Versus Modified Isolation for Prevention of Nosocomial Transmission of Methicillin-ResistantStaphylococcus aureus
Authors: Ribner Bruce S. , Landry Martha N. , Gholson Gail L.
Published: August 2016

Patients colonized or infected with methicillin-resistantStaphylococcus aureus(MRSA) in a Surgical Intensive Care Unit and Surgical Intermediate Care Unit were placed either in Strict Isolation or cared for with modified isolation precautions. The assignment was determined by the unit in which they were hospitalized. Units were changed from one form of isolation to the other and served as their own controls.

Over a 4-month study period, the rate of MRSA transmission did not change when the type of isolation precautions were altered. The ratio of colonized to infected patients also remained constant. Infected patients were usually first detected by clinical specimens, while colonized patients were usually detected by surveillance cultures performed under the study protocol.

Following the study, all hospitalized patients with MRSA were placed in modified isolation precautions. Total new acquisitions of MRSA in the hospital have decreased over the subsequent 6-month period.
Infection Control and Employee Health: Marketing a Hepatitis B Vaccine Program
Authors: Valenti William M. , Haas Rose , Beideman Mary Ellen
Published: August 2016

Viral hepatitis B is one of the major concerns of today's healthcare workers. Of the 100,000 Americans infected each year, 5% to 10% of them are employed in healthcare professions. For every 500 identified high-risk personnel, as many as 50 could become infected with hepatitis B virus. Every hospital should have procedures in writing for pre- and post-exposure prevention of hepatitis B.
Hepatitis B Vaccine in Healthy Hospital Employees
Authors: Klotz S.A , Normand R. , Silberman R.
Published: August 2016

A low rate of seroconversion to hepatitis B vaccine is reported. This occurred in healthy hospital employees from two separate institutions. A total of 236 individuals were evaluated in this study and only 53% or 124 persons developed protective levels of antibody to hepatitis B surface antigen following a complete vaccine series. In one hospital, 30% of the vaccine recipients developed antibody but not to a protective level. Employees who received the entire series in the arm or in the arm and buttock (mixed) had a significantly greater number of responders than employees who received the entire series in the buttock (P<.05). Recipients aged 50 to 59 years had a significantly lower response rate to the vaccine (P<.05). There was no correlation with the vaccinee's sex or the timing of the second injection. Vaccine was noted to have frozen in one hospital and accounted for some loss of antigenicity. This failure to respond to the vaccine has necessitated the use of booster injections of vaccine and continued antibody monitoring.
Increasing Handwashing Compliance With More Accessible Sinks
Authors: Kaplan Lois M. , McGuckin Maryanne
Published: August 2016

The frequency of handwashing in two intensive care units (ICUs) was observed. Handwashing after direct contact with patients or their support equipment was recorded. The ratio of beds to sinks was 1:1 in the medical ICU and 4:1 in the surgical ICU. Surveillance of physicians, nurses, and other personnel demonstrated a greater frequency of handwashing by nurses (63%) compared with physicians (19%) and other personnel (25%). The nurses in the unit with one sink per bed had a significantly greater number of handwashes (76%) than those in the unit with fewer sinks (51%).
AIDS Update: HTLV-III Testing, Immune Globulins and Employees with AIDS
Authors: Valenti William M.
Published: August 2016

As we have become experienced in dealing with AIDS, we have learned that early concern over employees who refuse to care for patients with AIDS was merely the tip of the iceberg from the infection control standpoint. During the past 5 years, additional questions and concerns have been raised regarding employee health and AIDS. An interesting body of literature has emerged recently that discusses many of these current employee health issues. Some of these questions have been answered in major communications in The New England Journal of Medicine, the Journal of the American Medical Association, and The Lancet. Many other topics have been covered in short communications in letters to the editor in these same journals and in the CDC's Morbidity and Mortality Weekly Report (MMWR). When taken together, this writing presents a very clear picture of what is happening with AIDS in the health care arena. It is obvious that most of the concerns regarding AIDS in health care settings can be answered by taking a close look at the available epidemiologic data. It is important to remember that the decision-making process related to AIDS is easier if we try to separate the emotional issues surrounding the disease from the scientific data available.
When Should We Use Urine Cultures?
Authors: Stamm Walter E.
Published: August 2016

Medicine and infectious disease textbooks have traditionally advised physicians to obtain urine cultures routinely before the initiation of therapy for presumed urinary tract infection. In practice, however, many physicians treat patients empirically, without doing a culture, and a recent cost-effectiveness analysis has supported this approach, at least in selected patients. What, then, are trie pros and cons of diagnostic urine cultures, and in which situations does current evidence favor their use?
Methicillin-ResistantStaphylococcus aureus(MRSA): Risk and Outcome of Colonized vs. Infected Patients
Authors: Longfield Jenice N. , Townsend Timothy R. , Cruess David F. , Stephens Maureen , Bishop Catherine , Bolyard Elizabeth , Hutchinson Elsie
Published: August 2016

A retrospective study of 204 patients culture positive for methicillin-resistantStaphylococcus aureuscompared infected and colonized patients. Seventy-eight patients were colonized and never developed infection (C), 24 were colonized and subsequently infected (C➧I), and 102 patients had 1 or more nosocomial infections with MRSA at time of first culture (I). The most prevalent sites of infection were wound (26.5%) and bloodstream (20.7%), whereas the respiratory tract and surgical wounds were both frequent sites of colonization. Stepwise discriminant analysis found the most important factors in differentiating likelihood of colonization vs. infection were recent prior hospitalization, history of wound debridement, and number of invasive procedures. Ten percent of (C) died and 25.5% of (I) died. MRSA contributed to death in 57.6% of the (I) deaths (p<.05). These results underscore the importance of differentiating (C) vs. (I) in hospitals where MRSA is endemic so that early specific treatment may be initiated. Risk factors for infection should be discriminated from those for acquisition of the organism.
The Disinfectant Dilemma
Authors: Gurevich Inge
Published: August 2016

In a recent communication, the manufacturer of a glutaraldehyde-based disinfectant described several important discoveries that became apparent during a recent review of claims of their product. Such updating of materials is an ongoing quality assurance mechanism for many reputable manufacturers.

Manufacturer A maintains that the old Association of Official Analytical Chemists (AOAC) tuberculocidal testing procedure is prone to significant errors. Therefore, they developed a new, more reliable test (in their opinion), which has also been filed with the Environmental Protection Agency (EPA), and on which their new recommendations are based. Other manufacturers may use the old or new AOAC test methods to satisfy requirements of the EPA.
Methicillin-ResistantStaphylococcus aureus:Clinical and Laboratory Features
Authors: Aldridge Kenneth E.
Published: August 2016

Not long after the introduction of penicillin G for anti-staphylococcal therapy, penicillin G resistant strains of staphylococci were isolated and were found to produce penicillinase enzymes. In 1959 methicillin, a penicillinase resistant penicillin (PRP), was introduced in England for therapy of these strains. Within 2 years the first strains of methicillin-resistantStaphylococcus aureus(MRSA) were reported in that country. Subsequently, reports of MRSA infections throughout Europe appeared. Reports from Switzerland and Denmark indicated that 30% to 50% of all nosocomialS. aureusisolates and 40% of allS. aureusbacteremia isolates, respectively, were due to MRSA. Although sporadic reports of MRSA infections appeared in the US after 1960 the first documented outbreak of MRSA infections occurred at Boston City Hospital in 1968. Even today there is not a complete understanding of MRSA and its role in infectious diseases, however, a vast amount of information has accumulated and certain aspects of this information will be discussed.
Types of Disposable Medical Devices Reused in Hospitals
Authors: Mayhall C. Glen
Published: August 2016

Rising health care costs have prompted hospitals to turn to reprocessing and reuse of disposable devices as a cost-saving measure. The safety, efficacy, and cost benefit of such a practice are largely unknown. Classification schemata are presented as a means of categorizing the reasons for reprocessing and the types of adverse effects that may result from reprocessing and reuse. The very limited literature on reuse of disposable devices is reviewed. Examples of the categories of reprocessing and adverse effects are provided from a review of the experience with reprocessing and reuse at a university medical center. With the rising pressure for containment of health care costs, it is likely that this practice will expand further. The practice of reprocessing and reuse should be subjected to scientific study.
Significance of Nosocomial Infection Rates in the Era of DRGs
Authors: Fuchs Peter C. , Gustafson Marie E.
Published: August 2016

Nosocomial infection rates, as determined by either incidence or prevalence methods, are considered important data in infection control programs. Many factors besides infection control measures affect infection rates— eg, illness acuity of the patient population. However, there is evidence that when these factors remain constant, a lowering of the infection rate can be the result of infection control efforts. We wish to illustrate how a dramatic drop in infection rate may mislead infection control personnel into a false sense of accomplishment, when in reality it is an effect of changing medical practices.
Prevalence of Colonization with Antibiotic Resistant Gram-Negative Bacilli in a Nursing Home Care Unit: The Importance of Cross-Colonization as Documented by Plasmid Analysis
Authors: Shlaes David M. , Lehman Mary-Helen , Currie-McCumber Charlotte A. , Kim C.H. , Floyd Rachel
Published: August 2016

A prevalence study was carried out on a 100-bed Veterans Administration nursing home care unit to determine the extent of colonization with gentamicin-resistant gram-negative bacilli (GRGNB). Hand cultures of 12 employees and 17 environmental cultures were negative. Twenty-six of 86 (30%) patients were colonized with 49 GRGNB. Sixteen patients (19%) had urinary colonization. Multivariate analysis revealed significant associations between rectal or perineal colonization (P<0.01), and the presence of a urinary device (82% condom catheters) (P<0.05), with urinary colonization. The most common isolates wereProvidencia stuartii(20),Escherichia coli(nine) andKlebsiella pneumoniae(nine). Twenty-six of 49 isolates carried plasmids. Restriction endonuclease digestion of plasmid DNA was performed for 21. Cross-colonization, as defined by the presence of the identical species with the identical restriction endonuclease digestion profile of purified plasmid DNA found in different patients, was observed for eight of 21 (38%) strains. All were geographically clustered. No strains could transfer gentamicin-resistance by conjugation and only two plasmids could transform ourE colirecipient to gentamicin resistance. OneE coliplasmid was identical to twoCitrobacter freundiiplasmids and aP stuartiiplasmid isolated from three different patients. This 105 kb plasmid is conjugative and encodes resistance to ampicillin, carbenicillin, tetracycline, and sulfonamides. Thus, 57% of strains were cross-colonizing or contained identical R-plasmids. Southern hybridization using a 1 kb TEM-1 gene probe demonstrated sequences homologous to this probe in five of five nursing home plasmids examined. These data demonstrate the utility of plasmid analysis in epidemiologic typing of multiple species of Enterobacteriaceae, and suggest wide dissemination of R-plasmids bearing the TEM-1β-lactamase gene among gram-negative bacilli colonizing patients residing in our nursing home.
Prevention of Nosocomial Infections in Marrow Transplant Patients: A Prospective Randomized Comparison of Systemic Antibiotics Versus Granulocyte Transfusions
Authors: Petersen Finn B. , Buckner C.D. , Clift Reginald A. , Nelson Nira , Counts George W. , Meyers Joel D. , Thomas E.D.
Published: August 2016

One hundred twelve patients with hematologic malignancies underwent marrow transplantation from HLA-matched sibling donors and were randomized to receive either prophylactic granulocyte transfusions (PG, 67 patients) or prophylactic systemic antibiotics (PSA, 45 patients) as prophylaxis against nosocomial infections. Patients were treated in conventional hospital rooms and studied until day 100 post-transplant. For the entire study period, 26 patients (39%) in the PG group developed septicemia compared to 15 patients (33%) in the PSA group. Twenty-eight patients (42%) in the PG group developed local major infections compared to 19 patients (42%) in the PSA group. Ten patients (15%) in the PG group developed viral interstitial pneumonitis compared to 6 patients (13%) in the PSA group. None of these differences were statistically significant. There was no difference in the incidence of bacterial or fungal infections or viral interstitial pneumonitis between the two groups during the granulocytopenic or post-engraftment period. There was no difference in the incidence and severity of graft-versus-host-disease (GVHD). Inability to carry out the prophylaxis was frequent in the PG group, with complications necessitating discontinuance of transfusion in 24% of the recipients and 13% of the donors. The use of PG as an infection prophylaxis modality in marrow transplantation is not supported by this study, as it is difficult to carry out and because PG did not show any advantage over the use of PSA in preventing nosocomial infections.
Diarrheal Disease in the Hospitalized Patient
Authors: Gilligan Peter H.
Published: August 2016

In the past 15 years, our knowledge of the pathogenesis and etiologic agents of diarrheal disease has expanded rapidly. No longer is it scientifically appropriate or cost effective for the laboratory simply to culture a stool forSalmonellaandShigellaand to do a wet mount for amebae. Today we have a plethora of agents including, but not limited to,Campylobacter, Yersinia, Clostridium difficile, Escherichia coli, Aeromonas, Plesiomonas,vibrios, rotavirus, Norwalk agent,Giardia,andCryptosporidium,which have all been suggested to be agents of diarrheal disease. Given such a wide range of possibilities, what approaches should be taken to determine the etiologic agent of diarrheal disease in the hospitalized patient in an era of cost containment?
Wound Infection
Authors: Newsom William
Published: August 2016

Any consideration of infection following clean surgery, particularly cardiothoracic must include both exogenous and endogenous sources. The MRC Study on Hip Surgery presents a particular challenge. Although uncontrolled antibiotic prophylaxis reduced the infection rate almost as well as a laminar flow operating theater, further analysis of the data correlated the incidence of infection with the theater air counts and more significantly considered the sources ofStaphylococcus aureusinfections. Data on swabs from patient and theater staff at the time of surgery were available for 14 of the 28 patients who subsequently developed deep infections withS. aureus. Overall 25% of patients and 33% of staff were carriers. Bacteriophage typing revealed that 2 patients, 2 surgeons and 7 theater staff carried the infecting type at the time of the surgery. In two instances there was no correlation and in the last a member of the surgical staff on leave at the time carried the relevant strain. This at least provides a clue that exogenous infection can be important, and justifies attempts to clean the environment as well as the patient.
Skin as a Source for Hospital Infection
Authors: Noble William
Published: August 2016

The skin is itself the site of infection by many different bacteria. Dermatologists may see primary skin infection due toStaphylococcus aureus, beta hemolytic streptococci and a host of less common pathogens including gonococci, mycobacteria and even enterobacteriaceae, or secondary infection which is mostly staphylococcal in eczema or weighted toward Proteus and Pseudomonas in venous stasis ulcers. Geriatricians see a mixed microbial flora in decubitus ulcers while those who insert plastic prostheses, intravenous or abdominal catheters can expect infection with coagulase-negative or positive cocci.

The skin also forms a natural reservoir of organisms available to infect a variety of patients and it is with the skin as a reservoir that this article is concerned. The normal flora of the skin in healthy subjects is composed chiefly of coagulase-negative cocci and coryneforms with gram-negative bacilli chiefly, but not entirely, represented by Acinetobacter. Patients admitted to the hospital who are severely ill may become more heavily colonized by gram-negative bacilli while frank skin lesions constitute a more obvious source of potential pathogens.
Nosocomial Infection Prevalence, Risk and Control in Small Community and Rural Hospitals
Authors: Scheckler William E. , Peterson Patty J.
Published: August 2016

Between 1972 and 1973, Britt and colleagues conducted 1-day infection prevalence surveys in 18 hospitals each with fewer than 75 beds and all located in the rural intermountain west. The lessons learned from that study were incorporated into a book chapter entitled “Infection Control in Small Hospitals” by Dr. Britt. Since that study no substantial nor systematic review of nosocomial infections in small community or rural hospitals has been reported. A recent editorial in Infection Control posed four questions that still needed to be answered for the smaller (less than 100-bed) hospital:

1. Given the statistical realities of small hospitals, what types of surveillance methods—periodic prevalence surveys, general surveillance, focused surveillance, etc.—are the most reliable? Are any of them necessary?

2. Which of the many infection control practices recommended by the CDC, the Joint Commission on Accreditation of Hospitals, and others are applicable to small hospitals?

3. What resource sharing of existing expertise, from larger hospitals, health departments, groups such as the Association of Practitioners of Infection Control and the Society of Hospital Epidemiologists of America, and others can be developed for smaller hospitals in cost effective and realistic ways?

4. Should smaller hospitals be required to have the same type of multidisciplinary infection control committees required of larger hospitals or can the responsibilities of the committee be delegated to a smaller group such as one nurse and one staff physician?

The purpose of this report is to provide detailed infection control information obtained from 15 hospitals located in rural areas of Southwestern Wisconsin. This article will focus on data derived from an initial comprehensive prevalence survey that replicated the Britt study in the Wisconsin sites in 1983. Additional data were derived from ongoing bi-monthly prevalence studies done over 6 consecutive months in each of the 15 rural hospitals. Data from 6 months of ongoing comprehensive surveillance from each of the 15 hospitals and final conclusions from the project will be the subject of a subsequent paper.
In Vitro Activity of Cefixime and Six Other Agents Against Nosocomial Pathogens of the Enterobacteriaceae Family
Authors: Mulligan Maury E. , Kwok Y.Y.
Published: August 2016

Cefixime, a broad-spectrum, orally active cephalosporin, was more active in vitro than ampicillin, cefaclor, cephalothin, and trimethoprim/sulfamethoxazole against 194 nosocomial pathogens of the family Enterobacteriaceae. Activity was especially good against Klebsiella spp, Proteus spp, Serratia spp, and Providencia stuartii. Although gentamicin had equivalent or better activity against Citrobacter spp, Enterobacter spp, Escherichia coli, and Morganella morganii, all 23 of the gentamicin-resistant strains studied were susceptible to Cefixime. Isolates tested were from urinary tract infections, abdominal infections, wounds, vascular infections, and respiratory infections; they were sequentially collected nosocomial pathogens from a single institution. This orally active cephalosporin should be considered for therapy of a variety of nosocomial infections involving gram-negative bacillary pathogens.
The Incidence of Nosocomial Pneumonia Following Urgent Endotracheal Intubation
Authors: Lowy Franklin D. , Carlisle Penelope S. , Adams Audrey , Feiner Cheryl
Published: August 2016

The risk of nosocomial pneumonia following emergency or urgent endotracheal intubation was studied prospectively. Pneumonia developed in 35 of 78 (45%) patients within three days of intubation. No differences in age, sex, underlying illness, respiratory infection, or antibiotic use were found between those with or without pneumonia. There were also no differences in the frequency of complications occurring during intubation. Patients developing pneumonia tended to have the same organisms isolated from the sputum at the time of intubation and at the time of diagnosis of pneumonia (9 of 20 were identical, 5 differed by a single organism). Sputum cultures taken at the time of intubation were helpful in predicting the subsequent pathogens in patients who developed pneumonia. There were no differences in mortality between patients with (29%) and without (28%) pneumonia. Emergency endotracheal intubation appears to contribute to the overall incidence of nosocomial pneumonia.
Surgical Wound Infections: Prospective Study of 4,468 Clean Wounds
Authors: Gil-Egea M.J. , Pi-Sunyer M.T. , Verdaguer A. , Sanz F. , Sitges-Serra A. , Eleizegui L. Torre
Published: August 2016

A prospective four-year study on the infection rate of clean operative wounds is presented. From January 1982 to June 1985, a nurse epidemiologist and a medical team assessed 4,468 operative procedures, from the day of surgery to the patients' discharge from the hospital. The infection rate was 3.2%. A higher incidence of wound infection was detected in patients requiring emergency operations (5.1%), in drained wounds (5.4%), and in patients with conditions thought to predispose to infection, such as advanced cancer, hepatic cirrhosis, diabetes, nephrotic syndrome, previous splenectomy, and treatment with immunosuppressive drugs (7.8%). Age over 65 did not influence infection rates. There were up to tenfold differences in infection indices between surgeons performing the same clean procedures. The continued monitoring of clean wound infection rates allowed the early detection and control of infection outbreaks. Providing periodic information on infection rates to the different surgical services was associated with decreasing infection rates over time.
The Analysis of the Impact of a Mild, Low-iodine, Lotion Soap on the Reduction of Nosocomial Methicillin-ResistantStaphylococcus aureus:A New Opportunity for Surveillance by Objectives
Authors: Onesko Kim M. , Wienke Eugene C.
Published: August 2016

A significant unremitting increase in the incidence of nosocomial methicillin-resistantStaphylococcus aureus(MRSA) infections in a 500-bed acute care community teaching hospital prompted reevaluation of the efficacy of the infection control measures used. A well-accepted, low-iodine, antimicrobial soap was used to replace a liquid natural handsoap in two areas with the highest incidence of MRSA—the intensive care unit, and a medical division.

Over a two-year period, an analysis was made of the effect of soap replacement on nosocomial infections and pathogens. Soap changeover occurred at the midpoint of the two-year period. From year to year, the nosocomial MRSA rate decreased 80% (ttest,P=0.005). Other pathogens that demonstrated a dramatic decrease included methicillin-sensitiveStaphylococcus aureus(MSSA), infections where no pathogens were isolated, and various gram-negative infections. Categories of nosocomial infections that decreased included surgical wound infections, primary bacteremias, and respiratory tract infections. The overall nosocomial infection rate of the two combined areas decreased 21.5%, representing a year-to-year savings of $109,500. As a result, the decision was made to install the low-iodine hand-soap permanently at all sinks within the hospital.
Brief Report: Cytomegalovirus Infection in Pediatric House Officers: Susceptibility to and Rate of Primary Infection
Authors: Brady Michael T. , Demmler Gail J. , Anderson Donald C.
Published: August 2016

Hospital personnel, especially women in their child-bearing years, continue to express concern about the risk of acquiring cytomegalovirus (CMV) infection as a result of their occupation. Previous investigations of occupational risk of CMV infection have focused primarily on pediatric nursing personnel. However, assessment of the rate of CMV infection by other hospital personnel who have different clinical responsibilities and levels of patient contact cannot rely solely on the rates obtained for nursing personnel.
Cytomegalovirus
Authors: Sinnott John T. , Cancio Margarita R.
Published: August 2016

Cytomegalovirus (CMV) has emerged as an important cause of human illness. Infection with this common virus can result in asymptomatic infection, an acute “mononucleosis-like” illness, or congenital disease. It is capable of persisting in a latent state and reactivating at a later date. It can be transmitted by blood transfusion, organ transplantation, oral or genital contact, intrauterine infection, perinatal infection and perhaps casually by children in day care centers.

Historically, the first reports described “protozoan-like” cells in the organs of a fetus and a stillborn in 1904. In 1932, Farber reported the presence of inclusions in the nucleus and cytoplasm of cells in infants dying of various causes and coined the term cytomegalic inclusion disease. The urine was initially cultured in 1953 by Smith, and the subsequent development of serologic methods of diagnosis made its broad spectrum of disease more fully appreciated.
Use of Indwelling Urinary Tract Catheters in Swedish Hospitals
Authors: Burman Lars G. , Fryklund Birgitta , Nyström Bertil
Published: August 2016

In a survey of 67,774 patient days in 27 Swedish acute care hospitals, an indwelling urinary tract catheter (IUTC) was in place during 12% of patient days. There were marked differences between services (from 2% in rheumatology to 49% in urology), but also between hospitals for the same type of service (general surgery, internal medicine, gynecology, orthopaedic surgery) concerning proportion IUTC days, average duration of catheterization and the indications for IUTC use. The great local variation in IUTC usage for a particular service was usually not correlated with type of hospital (district, county, or regional/teaching), ie, with the mix of patients studied. We propose that the results mainly reflect a variable local impact of infection control and that a much more restrictive use of IUTCs is possible in many wards. This condition would imply a considerable potential for reducing the incidences of urinary tract infection and bacteremia and thus, mortality among hospitalized patients in Sweden.
Confounding and the Analysis of Multiple Variables in Hospital Epidemiology
Authors: Freeman Jonathan , Goldmann Donald A. , McGowan John E.
Published: August 2016

Most information in hospital epidemiology comes from observational studies of hospitalized patients rather than planned experiments, and in such observational studies the characteristics of study patients may vary widely, even within a single hospital. Any comparison between hospital populations will usually contain additional, unintended contrasts among patients with varying degrees of health. Adult patients, for example, may have vastly different underlying diseases, and infants may be of substantially different birth weights. We used both underlying disease and birth weight as indices of the basic severity of illness in order to adjust for confounding by differences in underlying disease in reanalyses of several published studies. We give an example in which differing birth weights among groups of infants compared artifactually double the apparent effect of nosocomial infections as a cause of mortality, and another example in which differing degrees of severity of underlying illness artifactually halve the apparent effect of appropriate antibiotics in preventing death from bacteremia with gram-negative bacilli. We describe simple intuitive methods based on stratification, adapted from chronic disease epidemiology, to remove confounding effects during analyses.
Infectious Complications of Acute Myocardial Infarction
Authors: Alkan Michael , Cristal Natalio , Paran Esther
Published: August 2016

Four cases of purulent complications in the heart following acute myocardial infarction are described. Fever occurred during the first week after coronary occlusion. In one case thrombophlebitis at an infusion site was followed by purulent pericarditis. One patient had an infected mural thrombus with peripheral septic embolic, and two suffered from streptococcal endocarditis. The association between these infections and recent acute myocardial infarction could be related to tissue necrosis and local thrombosis, but the increasing risk of bacteremia following invasive monitoring procedures in these patients is a risk factor that should not be ignored.
Multiply Antibiotic Resistant Gram-Negative Bacilli in a Long Term Care Facility A Case Control Study of Patient rick Factors and Prior Antibiotic Use
Authors: Muder Robert R , Brennen Carole , Drenning Stephanie D. , Stout Janet E. , Wagener Marilyn M.
Published: August 2016

Objective:

To determine the relation between prior exposure to specific antimicrobials and acquisition of gram-negative bacilli resistant to multiple ß-lactam and aminoglycoside antibiotics among long-term-care patients.

Design:

Case-control study. Cases were patients from whom multiply resistantEnterobacteriaceaeorPseudomonas aeruginosawere isolated; controls were patients from whom nonresistant bacteria of the same species were isolated. Prospectively defined risk factors included underlying illness, activity level, presence of decu-bitus ulcers, presence of indwelling devices, and prior exposure to specific antimicrobial agents. Resistant and control isolates ofP aeruginosawere compared using pulsed-field gel electrophoresis (PFGE) of genomic DNA after digestion withXbaI.

Setting:

390-bed long-term Veterans' Affairs facility.

Results:

We identified 35 patients with multiply resistantEnterobacteriaceaeand 24 patients with multiply resistantP aeruginosa. Of the resistantEnterobacteriaceae, 87% of isolates were resistant to piperacillin, 55% to ceftazidime, and 90% to gentamicin. Acquisition of multiply resistantEnterobacteriaceaewas associated with presence of decubitus ulcers (odds ratio [OR], 12.2; 95% confidence interval [CI95], 3.3-44.2;P=.0002) and prior receipt of ampicillm (OR, 13.7; CI95, 2.2-84;P=.005). Of resistant isolates ofP aeruginosa, 88% were resistant to piperacillin, 25% to ceftazidime, 42% to imipenem, and 67% to ciprofloxacin. Isolation of a multiply resistantP aeruginosawas associated with total days of antimicrobial exposure (OR, 1.07; CI95, 1.01-1.12;P=.011) and not with prior receipt of any individual agent. Eleven multiply resistant isolates shared a common PFGE pattern.

Conclusions:

In our long-term-care facility, acquisition of multiply resistantEnterobacteriaceaewas associated with the presence of decubitus ulcers and prior exposure to ampicillin. Acquisition of resistantP aeruginosawas associated with total antibiotic exposure. Molecular typing ofP aeruginosaisolates implicated patient-to-patient transmission of a limited number of resistant strains.
Seed-dispersal ecology of tropical montane forests
Authors: Chapman Hazel , Cordeiro Norbert J. , Dutton Paul , Wenny Dan , Kitamura Shumpei , Kaplin Beth , Melo Felipe P. L. , Lawes Michael J.
Published: August 2016

Seed-dispersal ecology in tropical montane forests (TMF) differs in some predictable ways from tropical lowland forests (TLF). Environmental, biogeographic and biotic factors together shape dispersal syndromes which in turn influence forest structure and community composition. Data on diaspore traits along five elevational gradients from forests in Thailand, the Philippines, Tanzania, Malawi and Nigeria showed that diaspore size decreases with increasing altitude, fleshy fruits remain the most common fruit type but the relative proportion of wind-dispersed diaspores increases with altitude. Probably corresponding to diaspore size decreasing with increasing elevation, we also provide evidence that avian body size and gape width decrease with increasing altitude. Among other notable changes in the frugivorous fauna across elevational gradients, we found quantitative evidence illustrating that the proportion of bird versus mammalian frugivores increases with altitude, while TMF primates decrease in diversity and density, and switch diets to include less fruit and more leaf proportionately. A paucity of studies on dispersal distance and seed shadows, the dispersal/predation balance and density-dependent mortality thwart much-needed conclusive comparisons of seed dispersal ecology between TMF and TLF, especially from understudied Asian forests. We examine the available evidence, reveal knowledge gaps and recommend research to enhance our understanding of seed dispersal ecology in tropical forests. This review demonstrates that seed dispersal is a more deterministic and important process in tropical montane forests than has been previously appreciated.
'The Scandalous Penton: A Biography of Brian Penton', Patrick Buckridge, 350 pages, St Lucia: University of Queensland Press, 1994, $34.95
Authors: Goodwin Ken
Published: August 2016

The Scandalous Penton: A Biography of Brian Penton, Patrick Buckridge, 350 pages, St Lucia: University of Queensland Press, 1994, $34.95
'A Migrant's Story: The Struggle and Success of an Italian-Australian', Osvaldo Bonutto, St Lucia: University of Queensland Press, 1994, 100 pages, $16.95
Authors: McMillan Warren
Published: August 2016

A Migrant's Story: The Struggle and Success of an Italian-Australian, Osvaldo Bonutto, St Lucia: University of Queensland Press, 1994, 100 pages, $16.95
Spirit of Place
Authors: Lee Christopher
Published: August 2016

No other town in Queensland is so well favoured by nature for combining these rare advantages. We have the healthiness of climate, the coolness of a fine English summer, the pure and rarefied air of a moderate elevation, which dwellers along the hot and humid coast so much desire. We have beauty of scenery in picturesque variety, with a panorama of rolling Downs and far-reaching plain … ours is the first town on the elevated Downs after rising from the close and exhausting atmosphere of the ‘littoral’ country.

So rhapsodised the editorial in the Toowoomba Chronicle on 14 June, 1890. From the nineteenth century the drop in temperature which greeted the traveller's ascent to the elevated tablelands of the Darling Downs was greeted as a sign of a more vitalising and health-giving climate than the sub-tropical humidity of the Brisbane coastal plain. Katie Hume in 1866 felt Toowoomba's air 'cool and English like … after the heat of Brisbane’, while the consumptive Walter Coote argued in 1887 that the Downs possessed ‘a climate as healthful and even invigorating as that of any place in the World’ (Hume 160, Coote 201). The Social-Darwinist connection between the moral character of a people and the temperature of their climate was a frequent theme of nineteenth century culture. The imperial triumphs of European civilisation were often explained by Europe's temperate climate, for the cooler the climate the more ‘civil’ the people are deemed to be (Spurr); and Europe's temperate climate was also an acknowledged cause of the reasoned moral restraint of the civilised colonial settler. Thus the celebration of Toowoomba's ‘European’ climate served to familiarise an alien Australian space as a place which would support European settlement.
War's End
Authors: Hall Robert A.
Published: August 2016

In the 20 years before the Second World War the frontier war dragged to a close in remote parts of north Australia with the 1926 Daly River massacre and the 1928 Coniston massacre. There was a rapid decline in the Aboriginal population, giving rise to the idea of the ‘dying race’ which had found policy expression in the State ‘Protection’ Acts. Aboriginal and Islander labour was exploited under scandalous rates of pay and conditions in the struggling north Australian beef industry and the pearling industry. In south east Australia, Aborigines endured repressive white control on government reserves and mission stations described by some historians as being little better than prison farms. A largely ineffectual Aboriginal political movement with a myriad of organisations, none of which had a pan-Aboriginal identity, struggled to make headway against white prejudice. Finally, in 1939, John McEwen's ‘assimilation policy’ was introduced and, though doomed to failure, it at least recognised that Aborigines had a place in Australia in the long term.
The Function of 'the tragic' in Henry Reynolds' Narratives of Contact History
Authors: Butt Beckett Louise
Published: August 2016

This paper discusses the ways in which ideas of ‘the tragic’ function in recent narratives of contact history in Australia. ‘Contact history’ is used here to refer to first and second generation contact between Aboriginal people and the European invaders in Australia in the eighteenth and nineteenth centuries, and I shall be primarily concerned with those historical narratives which attempt to ‘re-write’ history to include Aboriginal responses during this period. Within Australian historiography this project is said to have commenced in the 1970s, prompted by wider events in the Australian community such as the Aboriginal land rights movement (Curthoys 1983, 99). One of the best-known contributors to this project of inclusion has been Henry Reynolds, now the author of eight books dedicated to it. I shall be examining two of Reynolds' most recent contributions to this area: With the White People (1990) and The Fate of a Free People (1995). At the same time that Reynolds and other professional historians have engaged in this project, there has been an increasing body of work by Aboriginal writers — much of it classified as fiction rather than academic historiography — examining these same themes of initial contact and resistance to invasion. In order to clarify some of my arguments about the function of the tragic mode in Reynolds' work, I shall also discuss a recently published short story by the Aboriginal writer, Gerry Bostock.
'Wandjuk Marika: Life Story as told to Jennifer Isaacs'. Jo Robertson, St Lucia: University of Queensland Press, folio 176pp, 1995, $34.95
Authors: Robertson Jo
Published: August 2016

Wandjuk Marika: Life Story as told to Jennifer Isaacs. Jo Robertson, St Lucia: University of Queensland Press, folio 176pp, 1995, $34.95
Poems on Eggshells
Authors: Zurbrugg Nicholas
Published: August 2016

Patrick Buckridge conducted this interview with Nicholas Zurbrugg on 19 June, 1995. Nicholas taught in the Faculty of Humanities at Griffith University for 17 years. He departed in August to take up a position as Professor of English and Cultural Studies at Simon de Montfort University in the United Kingdom.
"Red Ted': The Life of E.G. Theodore', Ross Fitzgerald, 487 pages, St Lucia: University of Queensland Press, 1994, $29.95
Authors: Saunders Kay
Published: August 2016

‘Red Ted’: The Life of E.G. Theodore, Ross Fitzgerald, 487 pages, St Lucia: University of Queensland Press, 1994, $29.95
Tourism Development in Queensland and Hawaii
Authors: Van Fossen Anthony
Published: August 2016

This paper provides a comparative perspective on the development of tourism in Queensland through analysing the history of tourism in Hawaii. Both Queensland and Hawaii are heavily dependent on tourism, with the future of tourism being a constant focus of public debate in each case. Since Hawaii embarked on tourism development decades before Queensland, the history of Hawaiian tourism may present some important lessons for tourism in Queensland. Also, Hawaii is Queensland's most important competitor for the Japanese and emerging Asian markets (such as South Korea, Taiwan and mainland China) in sun-and-surf tourism.