bluuebunny/crossref_metadata_2025 huggingface dataset:
The Association of Diabetes and Glucose Control With Surgical-Site Infections Among Cardiothoracic Surgery Patients
Authors: Latham Robert , Lancaster Ava D. , Covington Janet F. , Pirolo John S. , Thomas Clarence S.
Published: February 2006

Objective:

To assess the importance of diabetes, diabetes control, hyperglycemia, and previously undiagnosed diabetes in the development of surgical-site infections (SSIs) among cardiothoracic surgery patients.

Setting:

A 540-bed tertiary-care university-affiliated hospital.

Design:

Prospective cohort and case-control studies.

Patients:

All patients having cardiothoracic surgery between November 1998 and September 1999 were eligible for participation. One thousand patients had preoperative hemoglobin Ale determinations. Seventy-four patients with SSIs were identified.

Results:

Diabetes (odd ratio [OR], 2.76;P<.001) and postoperative hyperglycemia (OR, 2.02;P=.007) were independently associated with development of SSIs. Among known diabetics, elevated hemoglobin Ale values were not associated with a statistically significantly increased risk of infection; the mean Ale value was 8.44% among those with infections compared with 7.80% for those without (P=.09). Forty-two (6%) of 700 patients without prior diabetes history had evidence of undiagnosed diabetes; their infection rate was comparable to that of known diabetics (3/42 [796] vs 17/300 [6%];P=.72). An additional 30% of nondiabetics had elevated hemoglobin Ale determinations or perioperative hyperglycemia.

Conclusions:

Postoperative hyperglycemia and previously undiagnosed diabetes are associated with development of SSIs among cardiothoracic surgery patients. Screening for diabetes and hyperglycemia among patients having cardiothoracic surgery may be warranted to prevent postoperative and chronic complications of this metabolic abnormality.
Risk Factors for Surgical-Site Infections Following Cesarean Section
Authors: Killian Carol A. , Graffunder Eileen M. , Vinciguerra Timothy J. , Venezia Richard A.
Published: February 2006

Objective:

To identify risk factors associated with surgical-site infections (SSIs) following cesarean sections.

Design:

Prospective cohort study.

Setting:

High-risk obstetrics and neonatal tertiary-care center in upstate New York.

Patients:

Population-based sample of 765 patients who underwent cesarean sections at our facility during 6-month periods each year from 1996 through 1998.

Methods:

Prospective surgical-site surveillance was conducted using methodology of the National Nosocomial Infections Surveillance System. Infections were identified during admission, within 30 days following the cesarean section, by read-mission to the hospital or by a postdischarge survey.

Results:

Multiple logistic-regression analysis identified four factors independently associated with an increased risk of SSI following cesarean section: absence of antibiotic prophylaxis (odds ratio [OR], 2.63; 95% confidence interval [CI95], 1.50-4.6;P=.008); surgery time (OR, 1.01; CI95, 1.00-1.02;P=.04); <7 prenatal visits (OR, 3.99; CI95, 1.74-9.15;P=.001); and hours of ruptured membranes (OR, 1.02; CI95,1.01-1.03;P=.04).

Patients given antibiotic prophylaxis had significantly lower infection rates than patients who did not receive antibiotic prophylaxis (F=02), whether or not active labor or ruptured membranes were present.

Conclusion:

Among the variables identified as risk factors for SSI, only two have the possibility to be changed through interventions. Antibiotic prophylaxis would benefit all cesarean patients regardless of active labor or ruptured membranes and would decrease morbidity and length of stay. Women's healthcare professionals also must continue to encourage pregnant women to start prenatal visits early in the pregnancy and to maintain scheduled visits throughout the pregnancy to prevent perinatal complications, including postoperative infection.
An Outbreak of Coagulase-Negative Staphylococcal Surgical-Site Infections Following Aortic Valve Replacement
Authors: Lark Rebecca L. , VanderHyde Kristi , Deeb G. Michael , Dietrich Steve , Massey Jeffrey P. , Chenoweth Carol
Published: February 2006

Objectives:

To determine the cause of a coagulase-negative staphylococcal outbreak and to identify risk factors for surgical-site infections among patients following Medtronic Freestyle bioprosthesis implantation.

Design:

Retrospective case-control study.

Setting:

An 800-bed university referral center.

Patients:

The cohort of 64 patients undergoing Freestyle valve replacement from September 1998 to December 1998.

Results:

Seven patients developed infection (10.9% vs 1.1% during the preceding 8 months), including two with mediastinals and five with endocarditis. There were no statistically significant differences between cases and controls with respect to age, gender, weight, underlying illness, preoperative hospital stay, duration of surgery, time on bypass, central venous catheter duration, National Nosocomial Infection Surveillance risk index, New York Heart Association class, albumin, or antibiotic prophylaxis. However, only three cases were documented to have received vancomycin prophylaxis. Of all staff evaluated, only surgical resident A was significantly associated with infection (odds ratio, 7.68; 95% confidence interval, 1.3-44.1;P=.02) Pulsed-field gel electrophoresis patterns onStaphylococcus epidermidisisolates from four of the six cases were identical. These cases were performed on different days. Surgical resident A was the only staff member present in the operating room for all cases caused by the epidemic strain. This Sepidermidisstrain, however, was not isolated from operating room staff.

Conclusion:

A surgical resident was significantly associated with infection. However, the cause of this outbreak was likely multifactorial. Changes occurring during the investigation included institution of vancomycin as routine prophylaxis and modification of surgical technique, which contributed to the resolution of the outbreak.
Risk Factors for Colonization With Vancomycin-Resistant Enterococci in a Melbourne Hospital
Authors: MacIntyre C. Raina , Empson Marianne , Boardman Claire , Sindhusake Doungkamol , Lokan Julie , Brown Graham V.
Published: February 2006

Objective:

To determine risk factors for colonization with vancomycin-resistant enterococci (VRE) in a hospital outbreak.

Design:

Outbreak investigation and case-control study.

Setting:

A referral teaching hospital in Melbourne, Australia.

Participants:

Cases were inpatients colonized (with or without clinical disease) with VRE between July 26 and November 28, 1998; controls were hospitalized patients without VRE.

Methods:

Five cases of VRE were identified between July 26 and November 8, 1998, by growth of VRE from various sites. Active case finding by cultures of rectal swabs from patients surveyed in wards was commenced on July 26, after the first isolate of VRE.

Results:

There were 19 cases and 66 controls. All the VRE identified werevanB, and all wereEnterococcus faecium.One molecular type predominated (18/19 cases). In a logistic-regression model, being on the same ward as a VRE case was the highest risk factor (odds ratio [OR], 82; 95% confidence interval [CI95], 5.7-1,176;P=.001). Having more than five antibiotics (OR 11.9; CI95, 1.1-129.6;P<.05), use of metronidazole (OR 10.9; CI95, 1.7-69.8;P=.01), and being a medical patient (OR 8.1; CI95,1.4-47.6;P<.05) also were significant. Intensive care unit admission was associated with decreased risk (OR, 0.1; CI95, 0.01-0.8;P<.05).

Conclusion:

Our findings are consistent with an acute hospital outbreak. Monitoring and control of antibiotic use, particularly metronidazole, may reduce VRE in our hospital. Ongoing surveillance and staff education also are necessary.
In Vitro and In Vivo Efficacy of Catheters Impregnated With Antiseptics or Antibiotics: Evaluation of the Risk of Bacterial Resistance to the Antimicrobials in the Catheters
Authors: Sampath Lester A. , Tambe Suhas M. , Modak Shanta M.
Published: February 2006

Objective:

To compare the efficacy of a new antiseptic catheter containing silver sulfadiazine and chlorhexidine on the external surface and chlorhexidine in the lumens to an antibiotic catheter impregnated with minocycline and rifampin on its external and luminal surfaces.

Design:

Experimental trial.

Methods:

Antimicrobial spectrum of catheters was determined by zones of inhibition. Resistance to luminal colonization was tested in vitro by locking catheter lumens withStaphylococcus epidermidisorStaphylococcus aureusculture after 7 days of perfusion. In vitro development of resistance to the antiseptic or antibiotic combination used in catheters was investigated. In vivo efficacy was tested (rat subcutaneous model) by challenge with sensitive or antibiotic-resistant bacteria.

Results:

Antiseptic and antibiotic catheters exhibited broad-spectrum action. However, antibiotic catheters were not effective againstCandidaspecies andPseudomonas aeruginosa.Both catheters prevented luminal colonization. Compared to controls, both test catheters resisted colonization when challenged withS aureus7 and 14 days' postimplant (P<.05).

Repeated in vitro exposure ofS epidermidisculture to the antibiotic and antiseptic combinations led to small increases in the minimum inhibitory concentration (15 times and 2 times, respectively). Unlike the antibiotic catheter, the in vitro and in vivo activity of the antiseptic catheter was unaffected by the resistance profile of the test organism. Antiseptic catheters were more effective than antibiotic catheters in preventing colonization by rifampin-resistantS epidermidisin vivo (P<.05).

Conclusions:

Antiseptic and antibiotic catheters exhibit similar efficacy; however, when challenged with a rifampin-resistant strain, the antibiotic catheter appeared to be more susceptible to colonization than the antiseptic device.
Appropriateness of Use of Indwelling Urinary Catheters in Patients Admitted to the Medical Service
Authors: Munasinghe Rajika L. , Yazdani Habeeb , Siddique Mohamed , Hafeez Wasif
Published: February 2006

Of 836 medical admissions evaluated over a 1-month period, 89 (10.7%) had a urinary catheter placed within 24 hours; 34 placements (38%) had no justifiable indication. Risk for inappropriate catheterization was independent of age, gender, functional status, and mental status at admission. Preventive measures should focus on increasing awareness among healthcare providers.
Transmission of Hepatitis C in a Pharmacologic Study
Authors: Saginur Raphael , Nixon Judith , Devries Barbara , Bruce Natalie , Carruthers Christopher , Scully Linda , Berger Rachel , Leech Judy , Nicolle Lindsay , Mackenzie Andrew
Published: February 2006

Objective:

To describe an outbreak of hepatitis C in a clinical research study.

Design:

Observational study.

Setting:

Tertiary-care hospital.

Patients:

Healthcare workers who volunteered to be subjects in a study of the metabolic effects of inhaled and oral corticosteroids who were unwittingly exposed to hepatitis C virus (HCV).

Methods:

Epidemiological investigation and serological analyses.

Results:

One chronic carrier of HCV was identified. Four fellow workers volunteering in the studies became infected with HCV, with 96% homology among strains. There was no evidence of spread from infected healthcare workers to patients on whom they had performed arterial punctures (2 of 214 positive, unrelated to each other and to the outbreak strain).

Conclusion:

Infection control standards in clinical research must be maintained vigorously to prevent transmission of blood-borne pathogens such as HCV.
Environmental Contamination by Multidrug-ResistantAcinetobacter baumanniiin an Intensive Care Unit
Authors: Levin Anna S. , Gobara Satiko , Mendes Caio M.F. , Cursino M. Rosa , Sinto Sumiko
Published: February 2006

Contamination in an intensive care unit caused by mul-tidrug-resistantAcinetobacter baumanniicomplex (MRAB)-colo-nized patients was evaluated using environmental and patient cultures. MRAB occurred in 21% of patients' cultures, 2.1% of 513 areas surrounding MRAB-patients, and one of 372 common areas. No transmission to other patients occurred. Barrier precautions and ethanol disinfection may prevent dissemination.
Nasal Carriage ofStaphylococcus aureusAmong Patients Receiving Allergen-Injection Immunotherapy: Associated Factors and Quantitative Nasal Cultures
Authors: Bassetti Stefano , Dunagan Donnie P. , D'Agostino Ralph B. , Sherertz Robert J.
Published: February 2006

Objective:

To compare the prevalence of nasalStaphylococcus aureuscarriage among outpatients receiving allergen-injection immunotherapy with the prevalence among healthy controls and to determine predictors of nasalS aureuscarriage.

Design:

Survey.

Setting:

Allergy clinic of a university hospital.

Participants:

A volunteer sample consisting of 45 outpatients undergoing desensitization therapy and 84 first- and second-year medical students.

Results:

The nasalS aureuscarriage rate was significantly higher among patients (46.7%) than among students (26.2%;P=.019). In a multivariate model adjusted for age and gender, the presence of atopic dermatitis or eczema was the only independent predictor of nasal Saureuscarriage (odds ratio [OR], 4.4; 95% confidence interval [CI95], 1.2-16.0;P=.02). The only other participant characteristic associated with nasalS aureuscarriage was immunotherapy with allergen injections (OR, 1.98; CI95, 0.7-6.0), but this association did not reach statistical significance (P=.23). The probability of nasalS aureuscarriage was 88.9% for patients receiving allergen injections and having atopic dermatitis or eczema, and 36.1% for patients receiving allergen injections without atopic dermatitis or eczema.

Conclusions:

Patients undergoing desensitization have a higher nasal carriage rate ofS aureus.However, factors other than the regular use of needles, and in particular abnormalities related to the atopic constitution of these patients, may predispose this population forS aureuscarriage.
Azithromycin Prophylaxis During a Hospitalwide Outbreak of a Pertussis-Like Illness
Authors: Martinez Shay M. , Kemper Carol A. , Haiduven Donna , Cody Sara H. , Deresinski Stanley C.
Published: February 2006

A questionnaire regarding tolerability and adherence was administered for 5 days to hospital employees who received azithromycin prophylaxis during a hospitalwide outbreak of a pertussis-like illness. Analysis of the 239 responses from those having received prophylactic azithromycin determined that it was well tolerated and accounted for a minimal loss of days worked; 81.5% were fully adherent with the regimen.
Nosocomial Infections in Geriatric Long-Term-Care and Rehabilitation Facilities: Exploration in the Development of a Risk Index for Epidemiological Surveillance
Authors: Golliot Franck , Astagneau Pascal , Cassou Bernard , Okra Nicole , Rothan-Tondeur Monique , Brücker Gilles
Published: February 2006

Objective:

To compute a risk index for nosocomial infection (NI) surveillance in geriatric long-term-care facilities (LTCFs) and rehabilitation facilities.

Design:

Analysis of data collected during the French national prevalence survey on NIs conducted in 1996. Risk indices were constructed based on the patient case-mix defined according to risk factors for NIs identified in the elderly.

Setting:

248 geriatric units in 77 hospitals located in northern France.

Participants:

All hospital inpatients on the day of the survey were included.

Results:

Data from 11,254 patients were recorded. The overall rate of infected patients was 9.9%. Urinary tract, respiratory tract, and skin were the most common infection sites in both rehabilitation facilities and LTCFs. Eleven risk indices, categorizing patients in 3 to 7 levels of increasing NI risk, ranging from 2.7% to 36.2%, were obtained. Indices offered risk adjustment according to NI rate stratification and clinical relevance of risk factors such as indwelling devices, open bedsores, swallowing disorders, sphincter incontinence, lack of mobility, immunodeficiency, or rehabilitation activity.

Conclusion:

The optimal index should be tailored to the strategy selected for NI surveillance in geriatric facilities in view of available financial and human resources.
Factors Associated With Tuberculin Reactivity in Two General Hospitals in Mexico
Authors: García-García María de Lourdes , Jiménez-Corona Aida , Jiménez-Corona María Eugenia , Ferreyra-Reyes Leticia , Martínez Kenneth , Rivera-Chavira Blanca , Martínez-Tapia María Elena , Valenzuela-Miramontes Emilio , Palacios-Martínez Manuel , Juárez-Sandino Luis , Valdespino-Gómez José Luis
Published: February 2006

Objective:

To identify risk factors associated with tuberculin reactivity in healthcare workers (HCWs).

Design:

Cross-sectional survey of tuberculin reactivity (2 TU of purified protein derivative (PPD) RT23, using the Mantoux two-step test).

Setting:

Two general hospitals located in a region with a high prevalence of tuberculosis and high bacille Calmette-Guérin (BCG) coverage.

Participants:

Volunteer sample of HCWs.

Results:

605 HCWs were recruited: 71.2% female; mean age, 36.4 (standard deviation [SD], 8.2) years; 48.9% nurses, 10.4% physicians, 26.8% administrative personnel; mean time of employment, 10.9 (SD, 6.7) years. PPD reactivity (≥10 mm) was found in 390 (64.5%). Multivariate analysis revealed an association of tuberculin reactivity with occupational exposure in the hospital: participation in autopsies (odds ratio [OR], 9.3; 95% confidence interval [CI95], 2.1-40.5; P=.003.), more than 1 year of employment (OR, 2.4; CI95, 1.1-5.0; P=.02), work in the emergency or radiology departments (OR, 2.0; CI95,1.03-3.81; P=.04), being physicians or nurses (OR, 1.5; CI95, 1.04-2.11; P=.03), age (OR, 1.04; CI95, 1.02-1.07 per year of age; P<.001), and BCG scar (OR, 2.1; CI95, 1.2-3.4; P=.005).

Conclusions:

Although the studied population has a high baseline prevalence of tuberculosis infection and high coverage of BCG vaccination, nosocomial risk factors associated with PPD reactivity were identified as professional risks; strict early preventive measures must be implemented accordingly.
Effectiveness of Hand-Cleansing Agents for Removing Methicillin-Resistant Staphylococcus aureus From Contaminated Hands
Authors: Guilhermetti Marcio , Hernandes Silvio Evandro Daniel , Fukushigue Yoshiaki , Garcia Lourdes Botelho , Cardoso Celso Luíz
Published: February 2006

Objective:

The effectiveness of hand-cleansing agents in removing a hospital strain of methicillin-resistantStaphylococcus aureusfrom artificially contaminated hands of five volunteers was studied.

Design:

The products used were plain liquid soap, ethyl alcohol 70% (by weight), 10% povidone-iodine liquid soap (PVP-I), and chlorhexidine gluconate (4%) detergent. The experiments were performed using a Latin square statistical design, with two 5×4 randomized blocks. The removal rates ofS aureuscells from contaminated fingertips were estimated by analysis of variance, the response variable being the log10reduction factor (RF), ie, log10of the initial counts minus log10of the final counts. In the first and second blocks, the fingertips of the volunteers were contaminated in mean with 3.76 log10colony-forming units ([CFU] light-contamination hand) and 6.82 log10CFU (heavy-contamination hand), respectively.

Results:

In the first block, there were significant differences between treatments (P<.05). The 10% PVP-I (RF, 3.76) and 70% ethyl alcohol (RF, 3.51) had significantly higher removal rates than plain liquid soap (RF, 1.96) and 4% chlorhexidine (RF, 1.91). In the second block, 10% PVP-I (RF, 4.39) and 70% ethyl alcohol (RF, 3.27) also were significantly more effective than plain liquid soap (RF, 1.77) and 4% chlorhexidine (RF, 1.37;P<.05). Plain liquid soap was significantly more effective than chlorhexidine (4%) detergent.

Conclusions:

The results suggest that 10% PVP-I and 70% ethyl alcohol may be the most effective hand-cleansing agents for removing methicillin-resistantS aureusstrain from either lightly or heavily contaminated hands.
Reality Check: Should We Try to Detect and Isolate Vancomycin-Resistant Enterococci Patients?
Authors: Ostrowsky Belinda , Steinberg James T. , Farr Barry , Sohn Annette H. , Sinkowitz-Cochran Ronda L. , Jarvis William R.
Published: February 2006

Antimicrobial resistance, including vancomycin resistance in enterococci (VRE), is a growing problem in healthcare facilities. This “Reality Check” session focused on the question of whether we should try to detect and isolate patients colonized or infected with VRE.
Optimal Frequency of Changing Intravenous Administration Sets: Is It Safe to Prolong Use Beyond 72 Hours?
Authors: Raad Issam , Hanna Hend A. , Awad Abeer , Alrahwan Amin , Bivins Carol , Khan Asma , Richardson Deborah , Umphrey Jan L. , Whimbey Estella , Mansour Georganne
Published: February 2006

Objective:

To determine the safety and cost-effectiveness of replacing the intravenous (TV) tubing sets in hospitalized patients at 4- to 7-day intervals instead of every 72 hours.

Design:

Prospective, randomized study of infusion-related contamination associated with changing IV tubing sets within 3 days versus within 4 to 7 days of placement.

Setting:

A tertiary university cancer center.

Patients and Methods:

Cancer patients requiring IV infusion therapy were randomized to have the IV tubing sets replaced within 3 days (280 patients) or within 4 to 7 days of placement (232 patients). Demographic, microbiological, and infusion-related data were collected for all participants. The main outcome measures were infusion- or catheter-related contamination or colonization of IV tubing, determined by quantitative cultures of the infusate, and infusion- or catheter-related bloodstream infection (BSI), determined by quantitative culture of the infusate in association with blood cultures in febrile patients.

Results:

The two groups were comparable in terms of patient and catheter characteristics and the agents given through the IV tubing. Intent-to-treat analysis demonstrated a higher level of tubing colonization in the 4- to 7-day group versus the 3-day group (median, 145 vs 50 colony-forming units;P=.02). In addition, there were three episodes of possible infusion-related BSIs, all of which occurred in the 4- to 7-day group (P=.09). However, when the 84 patients who received total parenteral nutrition, blood transfusions, or interleukin-2 through the IV tubing were excluded, the two groups had a comparable rate of colonization (0.4% vs 0.5%), with no catheter- or infusion-related BSIs in either group.

Conclusion:

In patients at low risk for infection from infusion- or catheter-related infection who are not receiving total parenteral nutrition, blood transfusions, or interleukin-2, delaying the replacement of IV tubing up to 7 days may be safe, as well as cost-effective.
A Hospital Epidemic of Vancomycin-Resistant Enterococcus Risk Factors and Control
Authors: Byers Karin E. , Anglim Anne M. , Anneski Cynthia J. , Germanson Teresa P. , Gold Howard S. , Durbin Lisa J. , Simonton Barbara M. , Farr Barry M.
Published: February 2006

Abstbact

Objective:

To determine risk factors for vancomycin-resistantEnterococcus(VRE) colonization during a hospital outbreak and to evaluate Centers for Disease Control and Prevention (CDC)-recommended control measures.

Design:

Epidemiological study involving prospective identification of colonization and a case-control study.

Setting:

A university hospital.

Participants:

Patients on eight wards involved in outbreak from late 1994 through early 1995.

Methods:

Cases were matched by ward and culture date with up to two controls. Risk factors were evaluated with four multivariate models using conditional logistic regression. The first evaluated proximity to other VRE patients and isolation status. The second evaluated proximity to unisolated VRE cases and three variables independently predictive after adjustment for proximity. The third evaluated seven significant univariate predictors in addition to proximity to unisolated VRE in backward, stepwise logistic regression. The fourth assessed proximity to VRE with all other variables collected, clustered in a principal components analysis. Pulsed-field gel electrophoresis was performed to assess clonality of two outbreak strains.

Results:

The incidence of transmission declined significantly after CDC guidelines were implemented. Proximity to unisolated VRE cases during the prior week was a significant predictor of acquisition in each of four multivariate models. Other significant risk factors in multivariate models included a history of major trauma and treatment with metronidazole. Pulsed-field gel electrophoresis confirmed the clonality of two outbreak strains.

Conclusions:

VRE was transmitted between patients during a hospital epidemic, with proximity to previously unisolated VRE patients being an important risk factor. Weekly surveillance cultures and contact isolation of colonized patients significantly reduced spread.
Surveillance of Nosocomial Infections in Icus: Is Postdischarge Surveillance Indispensable?
Authors: Geffers Christine , Gastmeier Petra , Bräuer Helga , Daschner Franz , Rüden Henning
Published: February 2006

Objective:

To determine how many infections are missed if the postdischarge surveillance (PDS) follow-up of intensive care unit (ICU) patients that is required by the National Nosocomial Infection Surveillance System method is not done.

Design:

ICU patients were followed up and surveillance results with PDS (gold standard) and without PDS were compared.

Setting:

Surgical or interdisciplinary ICUs in eight German acute-care hospitals.

Patients:

All 1,857 patients within a 6-month period in the participating ICUs (a total of 9,129 ICU-patient–days).

Results:

Without PDS, 45 urinary tract infections (UTIs) were diagnosed, compared with 53 with PDS; thus, 15% of the UTIs were missed if no postdischarge follow-up was performed. Three nosocomial pneumonias (4%) and one bloodstream infection (8%) also were missed if surveillance was carried out without PDS. A total of 198 nosocomial infections (NIs) were recorded with PDS, compared to 175 NIs without PDS. Approximately 12% of all ICU-associated NIs were missed if no follow-up was done.

Conclusions:

Since it is very time-consuming to follow patients after their transfer from the ICU, we do not perform a postdischarge follow-up of patients in the course of routine surveillance.
Risk of Exposure to Bloodborne Infection for Italian Healthcare Workers, by Job Category and Work Area
Authors: Puro Vincenzo , De Carli Gabriella , Petrosillo Nicola , Ippolito Giuseppe ,   Studio Italiano Rischio Occupazionale da HIV Group
Published: February 2006

Objective:

To analyze the rate of occupational exposure to blood and body fluids from all sources and specifically from human immunodeficiency virus (HIV)-infected sources among hospital workers, by job category and work area.

Design:

Multicenter prospective study. Occupational exposure data (numerator) and full-time equivalents ([FTEs] denominator) were collected over a 5-year period (1994-1998) and analyzed.

Setting:

18 Italian urban acute-care hospitals with infectious disease units.

Results:

A total of 10,988 percutaneous and 3,361 mucocutaneous exposures were reported. The highest rate of percutaneous exposure per 100 FTEs was observed among general surgery (11%) and general medicine (10.6%) nurses, the lowest among infectious diseases (1.1%) and laboratory (1%) physicians. The highest rates of mucocutaneous exposure were observed among midwives (5.3%) and dialysis nurses (4.7%), the lowest among pathologists (0%). Inadequate sharps disposal and the prevalence of sharps in the working unit influence the risk to housekeepers. The highest combined HIV exposure rates were observed among nurses (7.8%) and physicians (1.9%) working in infectious disease units. The highest rates of high-risk percutaneous exposures per 100 FTE were again observed in nurses regardless of work area, but this risk was higher in medical areas than in surgery (odds ratio, 2.1; 95% confidence interval, 1.9-2.5; P<.0001).

Conclusion:

Exposure risk is related to job tasks, as well as to the type and complexity of care provided in different areas, whereas HIV exposure risk mainly relates to the prevalence of HIV-infected patients in a specific area. The number of accident-prone procedures, especially those involving the use of hollow-bore needles, performed by job category influence the rate of exposure with high risk of infection. Job- and area-specific exposure rates permit monitoring of the effectiveness of targeted interventions and control measures over time.
Suitability of the NNIS Index for Estimating Surgical-Site Infection Risk at a Small University Hospital in Brazil
Authors: Campos Maria Léa , Cipriano Zulmira Miotello , Freitas Paulo Fontoura
Published: February 2006

Objectives:

To detect the occurrence of surgical-site infection (SSI) in our study sample, using the traditional variables of the National Nosocomial Infection Surveillance (NNIS) index with a locally modified cut-off point for the “T time” defining length of surgical procedure; to compare the modified and the traditional NNIS index under the hypothesis that a cut-off point discriminating procedures of short and long duration, based upon the actual experience of the study sample, can adequately predict the risk of SSI.

Design:

A retrospective chart review of 9,322 patients undergoing surgical procedures in the period January 1993 to December 1998.

Setting:

A small university hospital (UH) in southern Brazil.

Results:

The composite index using the local sample procedure-duration cut-off point (UH-index) performed better than any of the individual components of the composite index (anesthesia risk index and surgical-wound class [SWC]). The UH-index also predicted adequately the risk of SSI when compared to the traditional NNIS index, particularly when stratifying by SWC.

Conclusions:

A modified NNIS index, using the sample cut-off point, can adequately predict the risk of SSI in a given population. Further studies are needed to compare and validate the NNIS index of risk for populations other than those of the NNIS-participating hospitals. Larger samples using different hospitals with similar characteristics are needed to investigate the risk of SSI associated with specific operations.
Persistence of Immunity to Varicella-Zoster Virus After Vaccination of Healthcare Workers
Authors: Saiman Lisa , LaRussa Philip , Steinberg Sharon P. , Zhou Juyan , Baron Keren , Whittier Susan , Della-Latta Phyllis , Gershon Anne A.
Published: February 2006

Objective:

Varicella-zoster virus (VZV) vaccine is recommended to protect susceptible healthcare workers (HCWs) from serious disease and to prevent nosocomial spread of VZV. We evaluated clinical outcomes and serological responses in HCWs after immunization with live attenuated VZV vaccine.

Design:

Vaccinees were immunized from 1979 to 1998 during VZV vaccine trials, as well as after licensure, and followed prospectively for 1 month to 20.6 (mean 4.6) years after vaccination. Sera were tested by fluorescent antibody to membrane antigen (FAMA), latex agglutination (LA), and enzyme-linked immunoassay (EIA) to detect VZV-specific antibodies.

Study Participants:

The median age of the 120 HCWs was 26 years; 51 (42%) were males.

Interventions:

Ninety eight (82%) of these study subjects received vaccine prepared by Merck and 22 (18%) by SmithKline Beecham; 25, 81, and 14 vaccinees received one dose, two doses, and three doses, respectively.

Results:

The crude attack rate was 10%; 12 of 120 HCWs developed chickenpox 6 months to 8.4 years after vaccination. The attack rates following household and hospital exposures were 18% (4/22) and 8% (6/72), respectively. All resulting illness was mild to moderate (mean 40 vesicles). Seroconversion after vaccination was documented by FAMA in 96% of HCWs, although 31% lost detectable antibodies. Compared with FAMA, LA and EIA were 82% and 74% sensitive and 94% and 89% specific, respectively.

Conclusions:

The VZV vaccine effectively protected HCWs from varicella, particularly from serious disease. Currently available serological tests are not optimal, and improved assays are needed.
Antibiotic Resistance Is a Major Risk Factor for Epidemic Behavior ofAcinetobacter baumannii
Authors: Koeleman Johannes G.M. , van der Bijl Madelon W. , Stoof Jeroen , Vandenbroucke-Grauls Christina M.J.E. , Savelkoul Paul H.M.
Published: February 2006

Objective:

To study the presence of bacterial factors in clinical isolates ofAcinetobacterspecies in order to identify markers of epidemic potential.

Design:

Case-control study.

Methods:

Forty-six isolates ofAcinetobacterspecies, including 23 epidemic and 23 sporadic strains from different outbreaks in nine European countries, were compared for the presence of the following factors: hemagglutination, presence of capsules and fimbriae, binding to salivary mucins, resistance to drying, and antibiogram typing. Genotyping of all strains was performed by amplified fragment-length polymorphism (AFLP).

Results:

All outbreak strains except two (91%) were identified asAcinetobacter baumannii. Binding to salivary mucins and resistance to antibiotics were significantly associated with epidemic behavior. Antibiogram typing showed clustering of predominantlyA baumanniistrains within one group, and these strains were significantly more resistant to antibiotics than sporadic strains. AFLP genotyping revealed a great heterogeneity among the different EuropeanAcinetobacterstrains. Cluster analysis of AFLP fingerprints showed several small clusters of differentA baumanniioutbreak strains. AFLP genotyping could not identify a common epidemic marker within the strains studied.

Conclusions:

Antibiogram typing can be used in routine clinical laboratories as a screening method to recognize potentially epidemicA baumanniistrains. Several other factors were found, both in different outbreaks as well as in sporadicAcinetobacterisolates. These characteristics were unable to predict epidemic behavior and therefore cannot be used as discriminative epidemic markers. AFLP genotyping demonstrated no common clonal origin of European epidemicA baumanniistrains. This indicates that any clinicalA baumanniiisolate with resistance to multiple antibiotics can be a potential nosocomial outbreak strain.
Outbreak ofSerratia marcescensInfection in a Neonatal Intensive Care Unit
Authors: Prasad G.A. , Jones Paula G. , Michaels Jacqueline , Garland Jeffery S. , Shivpuri Chandra R.
Published: February 2006

We report an outbreak ofSerratia marcescensinfection in the neonatal intensive care unit of a community hospital. The outbreak involved eight neonates, (five infected and three colonized), one of whom died. Pulsed-field gel electrophoresis confirmed that all isolates were identical strains. Cohorting and isolation of the infected neonates helped to control the outbreak. No environmental source of infection was found.
Routes and Sources ofStaphylococcus aureusTransmitted to the Surgical Wound During Cardiothoracic Surgery Possibility of Preventing Wound Contamination by Use of Special Scrub Suits
Authors: Tammelin Ann , Hambræus Anna , Ståhle Elisabeth
Published: February 2006

Objectives:

To trace the routes of transmission and sources ofStaphylococcus aureusfound in the surgical wound during cardiothoracic surgery and to investigate the possibility of reducing wound contamination, with regard to total counts of bacteria andS aureus, by wearing special scrub suits.

Methods:

A total of 65 elective operations for coronary artery bypass graft with or without concomitant valve replacement were investigated. All staff present in the operating room wore conventional scrub suits during 33 operations and special scrub suits during 32 operations. Bacteriological samples were taken from the hands of the scrubbed team after surgical scrub but before putting on sterile gowns and gloves and from the patients' skin (incisional area of sternum and vein harvesting area of legs) after preoperative skin preparation with chlorhexidine gluconate. Air samples were taken during operations. Bacteriological samples also were taken from the subcutaneous walls of the surgical wound just before closing the wound. Total counts of bacteria on sternal skin and wound walls (colony-forming units [CFUs//cm2) were calculated, as well as total counts of bacteria in the air (CFUs/m3). Strains ofS aureusrecovered from the different sampling sites were compared by pulsed-field gel electrophoresis (PFGE).

Results:

Special scrub suits significantly reduced total counts of bacteria in air compared to conventional scrub suits (P=.002). The number of air samples in whichS aureuswas found was significantly reduced by special scrub suits compared with conventional scrub suits (P=.016; relative risk, 4.4; 95% confidence interval [CI95], 1.3-14.9]). By use of PFGE, it was possible to identify two cases of possible airborne transmission ofS aureuswhen wearing conventional scrub suits, whereas no case was found when wearing special scrub suits. When exposed to airborneS aureus, the concomitant sternal carriage ofS aureuswas a risk factor for havingS aureusin the wound.

Conclusions:

Use of tightly woven special scrub suits reduces the dispersal of total counts of bacteria and ofS aureusfrom staff in the operating room, thus possibly reducing the risk of airborne contamination of surgical wounds. The importance of careful preoperative disinfection of the patient's skin should be stressed.
Anesthesia-Associated Carbon Monoxide Exposures Among Surgical Patients
Authors: Pearson Michele L. , Levine William C. , Finton Robert J. , Ingram Charles T. , Gay Kathleen B. , Tapelband Gerda , Smith J. David , Jarvis William R.
Published: February 2006

Objective:

To estimate the extent of, and evaluate risk factors for, elevated carboxyhemoglobin levels among patients undergoing general anesthesia and to identify the source of carbon monoxide.

Design:

Matched case-control study to measure carboxyhemoglobin levels.

Setting:

Large academic medical center.

Participants:

45 surgical patients who underwent general anesthesia.

Results:

Case-patients were more likely than controls to undergo surgery on Monday or Tuesday (10/15 vs 7/30; matched odds ratio [mOR], 7.7; 95% confidence interval [CI95], 1.8-34; P=.01), in one particular room (7/15 vs 4/30; mOR, 8.5; CI95, 1.5-48; P=.03) or in a room that was idle for ≥24 hours (11/15 vs 1/30; mOR, 95.5; CI95, 8.0-1,138; P≤.001). In a multivariate model, only rooms, and hence the anesthesia equipment, that were idle for ≥24 hours were independently associated with elevated intraoperative carboxyhemoglobin levels (OR, 22.4; CI95, 1.5-338; P=.025). Moreover, peak carboxyhemoglobin levels were correlated with the length of time that the room was idle (r=0.7; CI95, 0.3-0.9). Carbon monoxide was detected in the anesthesia machine outflow during one case-procedure. No contamination of anesthesia gas supplies or CO2 absorbents was found.

Conclusions:

Carbon monoxide may accumulate in anesthesia circuits left idle for ≥24 hours as a result of a chemical interaction between CO2-absorbent granules and anesthetic gases. Patients administered anesthesia through such circuits may be at increased risk for elevated carboxyhemoglobin levels during surgery or the early postoperative period.
Do New Surgeons Have Higher Surgical-Site Infection Rates?
Authors: Wurtz Rebecca , Wittrock Beth , Lavin Mary Alice , Zawacki Anne
Published: February 2006

We compared class I surgical-site infection (SSI) rates for new and experienced surgeons. Data showed that new surgeons in two surgical subspecialties associated with higher baseline SSI rates had rates higher than their experienced colleagues. They took longer in the operating room (OR), but did not operate on sicker patients. As the surgeons gained more experience (as measured by cumulative cases), their OR times and SSI rates decreased toward their colleagues'. New surgeons who perform infection-prone surgery may have higher SSI rates than more experienced colleagues until they gain experience. A new surgeon's SSI rate could be one factor considered in assessing competence.
Burkholderia cepaciaLower Respiratory Tract Infection Associated With Exposure to a Respiratory Therapist
Authors: Ramsey Alan H. , Skonieczny Patrice , Coolidge Diane T. , Kurzynski Terry A. , Proctor Mary E. , Davis Jeffrey P.
Published: February 2006

Objective:

To investigate and control a nosocomial outbreak ofBurkholderia cepacialower respiratory tract infection.

Design:

Outbreak investigation and case-control study.

Setting:

A 260-bed community hospital.

Patients:

Participants were mechanically ventilated intensive care patients without cystic fibrosis. A case was defined as a hospitalized patient with a sputum culture positive forB cepaciabetween January 1 and November 6, 1998.

Methods:

Respiratory therapy infection control policies and practices were reviewed; laboratory and environmental studies and a retrospective case-control study were conducted. Case-patients were matched with control-patients on age, gender, diagnosis, and type of intensive care unit.

Results:

Nine case-patients were identified;B cepacialikely caused pneumonia in seven and colonization in two. Two respiratory therapy practices probably contributed to the transmission ofB cepacia:multidose albuterol vials were used among several patients, and nebulizer assemblies often were not dried between uses.B cepaciawas grown from cultures of three previously opened multidose vials; pulsed-field gel electrophoresis patterns ofB cepaciafrom seven case-patients and two multidose vials were indistinguishable. Case-patients had longer durations of heated humidified mechanical ventilation (mean, 9.8 days vs 4.4 days;P=.03) and were more likely to have exposure to one particular respiratory therapist than controls (odds ratio, undefined; 95% confidence interval, 4.7-∞P=.001). The association with the respiratory therapist, a temporary employee, persisted after controlling for duration of heated humidified ventilation. No newB cepaciainfections were identified after control measures were implemented.

Conclusions:

B cepaciaprobably was transmitted among patients through use of extrinsically contaminated multidose albuterol vials. Respiratory therapy departments must pay close attention to infection control practices, particularly among new or temporary staff.
Costs and Savings Associated With Infection Control Measures That Reduced Transmission of Vancomycin-Resistant Enterococci in an Endemic Setting
Authors: Montecalvo Marisa A. , Jarvis William R. , Uman Jane , Shay David K. , Petrullo Coleen , Horowitz Harold W. , Wormser Gary P.
Published: February 2006

Objective:

To determine the costs and savings of a 15-component infection control program that reduced transmission of vancomycin-resistant enterococci (VRE) in an endemic setting.

Design:

Evaluation of costs and savings, using historical control data.

Setting:

Adult oncology unit of a 650-bed hospital.

Participants:

Patients with leukemia, lymphoma, and solid tumors, excluding bone marrow transplant recipients.

Methods:

Costs and savings with estimated ranges were calculated. Excess length of stay (LOS) associated with VRE bloodstream infection (BSI) was determined by matching VRE BSI patients with VRE-negative patients by oncology diagnosis. Differences in LOS between the matched groups were evaluated using a mixed-effect analysis of variance linear-regression model.

Results:

The cost of enhanced infection control strategies for 1 year was $116,515. VRE BSI was associated with an increased LOS of 13.7 days. The savings associated with fewer VRE BSI ($123,081), fewer patients with VRE colonization ($2,755), and reductions in antimicrobial use ($179,997) totaled $305,833. Estimated ranges of costs and savings for enhanced infection control strategies were $97,939 to $148,883 for costs and $271,531 to $421,461 for savings.

Conclusion:

The net savings due to enhanced infection control strategies for 1 year was $189,318. Estimates suggest that these strategies would be cost-beneficial for hospital units where the number of patients with VRE BSI is at least see to nine patients per year or if the savings from fewer VRE BSI patients in combination with decreased antimicrobial use equalled $100,000 to $150,000 per year.
Use and Efficacy of Tuberculosis Infection Control Practices at Hospitals With Previous Outbreaks of Multidrug-Resistant Tuberculosis
Authors: Tokars Jerome I. , McKinley George F. , Otten Joan , Woodley Charles , Sordillo Emilia M. , Caldwell Joan , Liss Catherine M. , Gilligan Mary Ellen , Diem Lois , Onorato Ida M. , Jarvis William R.
Published: February 2006

Objective:

To evaluate the implementation and efficacy of selected Centers for Disease Control and Prevention guidelines for preventing spread ofMycobacterium tuberculosis.

Design:

Analysis of prospective observational data.

Setting:

Two medical centers where outbreaks of multidrug-resistant tuberculosis (TB) had occurred.

Participants:

All hospital inpatients who had active TB or who were placed in TB isolation and healthcare workers who were assigned to selected wards on which TB patients were treated.

Methods:

During 1995 to 1997, study personnel prospectively recorded information on patients who had TB or were in TB isolation, performed observations of TB isolation rooms, and recorded tuberculin skin-test results of healthcare workers. Genetic typing ofM tuberculosisisolates was performed by restriction fragment-length polymorphism analysis.

Results:

We found that only 8.6% of patients placed in TB isolation proved to have TB; yet, 19% of patients with pulmonary TB were not isolated on the first day of hospital admission. Specimens were ordered for acid-fast bacillus smear and results received promptly, and most TB isolation rooms were under negative pressure. Among persons entering TB isolation rooms, 44.2% to 97.1% used an appropriate (particulate, high-efficiency particulate air or N95) respirator, depending on the hospital and year; others entering the rooms used a surgical mask or nothing. We did not find evidence of transmission of TB among healthcare workers (based on tuberculin skin-test results) or patients (based on epidemiological investigation and genetic typing).

Conclusions:

We found problems in implementation of some TB infection control measures, but no evidence of healthcare-associated transmission, possibly in part because of limitations in the number of patients and workers studied. Similar evaluations should be performed at hospitals treating TB patients to find inadequacies and guide improvements in infection control.