bluuebunny/crossref_metadata_2025 huggingface dataset:
Hospital- and Community-Based Surveillance of Methicillin-Resistant Staphylococcus aureus: Previous Hospitalization is the Major Risk Factor
Authors: Warshawsky Bryna , Hussain Zafar , Gregson Daniel B. , Alder Robert , Austin Marilyn , Bruckschwaiger Debra , Chagla Abdul H. , Daley Jackie , Duhaime Cam , McGhie Kathy , Pollett Graham , Potters Harriet , Schiedel Lorraine
Published: February 2006

Objective:

The purpose of the study was to determine the incidence and risk factors for the acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in our community.

Design:

This study used a cross-sectional design to assess patients colonized or infected with MRSA.

Patients:

The study population consisted of residents of London, Ontario, Canada, who were identified as MRSA-positive for the first time in 1997.

Setting:

All acute- and chronic-care hospitals, long-term healthcare facilities, and community physicians' offices in the city of London participated in the study.

Main Outcome Measure:

Incidence of MRSA in the community, risk factors for acquisition, especially previous hospitalization over a defined period, and strain type were evaluated.

Results:

In 1997, 331 residents of London were newly identified as MRSA-positive, representing an annual incidence of 100/100,000 persons (95% confidence interval, 88.8-110.7). Thirty-one (9.4%) individuals were not healthcare-facility patients in the previous month, and 11 (3.3%), 10 (3.0%), and 6 (1.8%) individuals had no such contact in the previous 3, 6, and 12 months, respectively. One hundred seventy-seven strains, including five of the isolates from patients with no healthcare-facility contact in the previous year, were typed. One hundred sixty (90.3%) of these isolates, including all typed strains from patients with no healthcare facility contact, belonged to a single clone.

Conclusion:

These findings demonstrate that the incidence of MRSA is higher than previously reported and that hospital contact is the single most important risk factor for the acquisition of MRSA in our community. Screening for MRSA in previously hospitalized patients at the time of hospitalization may reduce nosocomial spread and indirectly reduce the incidence of MRSA in the community.
“Colonization Pressure” and Risk of Acquisition of Methicillin-Resistant Staphylococcus aureus in a Medical Intensive Care Unit
Authors: Merrer Jacques , Santoli François , Vecchi Corinne Appéré-De , Tran Beatrice , De Jonghe Bernard , Outin Hervé
Published: February 2006

Objective:

To determine the roles of “colonization pressure,” work load or patient severity in patient acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in intensive care units (ICUs).

Design:

Prospectively collected data from October 1996 through December 1998.

Setting:

A 12-bed medical ICU in a university-affiliated general hospital.

Patients:

Patients with risk factors for MRSA admitted to the ICU were screened within 72 hours of admission and weekly thereafter. MRSA was considered imported if detected during the first 72 hours of admission and nosocomial if detected only thereafter. Three screening strategies were used on admission during three consecutive periods.

Interventions:

The unit of time chosen for measurements was the week. Weekly colonization pressure (WCP) was defined as the number of MRSA-carrier patient-days/total number of patient-days. Patient severity (number of deaths, Simplified Acute Physiologic Score [SAPS] II), work load (number of admissions. Omega score), and colonization pressure (number of MRSA carriers at the time of admission, WCP) were compared with the number of MRSA-nosocomial cases during the following week.

Results:

Of the 1,016 patients admitted over 116 weeks, 691 (68%) were screened. MRSA was imported in 91 (8.9%) admitted patients (13.1% of screened patients) and nosocomial in 46 (4.5%). The number of MRSA-nosocomial cases was correlated to the SAPS II (P=.007), the Omega 3 score (P=.007), the number of MRSA-imported cases (P=.01), WCP (P<.0001), and the screening period (P<.0001). In multivariate analysis, WCP was the only independent predictive factor for MRSA acquisition (P=.0002). Above 30% of WCP, the risk of acquisition of MRSA was approximately fivefold times higher (relative risk, 4.9;95% confidence interval, 1.2-19.9; P<.0001).

Conclusion:

Acquisition of MRSA in ICU patients is strongly and independently influenced by colonization pressure.
Zanamivir Use During Transmission of Amantadine-Resistant Influenza A in a Nursing Home
Authors: Lee Christine , Loeb Mark , Phillips Anne , Nesbitt Judy , Smith Karen , Fearon Margaret , McArthur Margaret A. , Mazzulli Tony , Li Yan , McGeer Allison
Published: February 2006

Objective:

To describe the use of zanamivir during an influenza A outbreak.

Population:

Residents of a 176-bed long-term-care facility for the elderly in Newmarket, Ontario, Canada, 90% of whom received influenza vaccine in the fall of 1998.

Outbreak:

When respiratory illness due to influenza A was confirmed, infection control measures and amantadine prophylaxis were initiated. Despite these measures, transmission of influenza A continued.

Intervention:

Zanamivir inhalations, 10 mg daily for prophylaxis and 10 mg twice daily for treatment of influenza.

Results:

There were 13 definite and 66 probable outbreak-associated cases of influenza A. Twelve (15%) cases developed pneumonia, 7 (9%) were hospitalized, and 2 (2.6%) died. All 12 culture-positive cases yielded influenza A/Sydney/H3N2/05/97-like virus, a 1998/99 vaccine component. The three isolates obtained prior to the initiation of amantadine were amantadine-susceptible; all nine obtained after prophylaxis was instituted were amantadine-resistant. One hundred twenty-nine (92%) of 140 residents who were offered zanamivir accepted it and were able to attempt inhalations. Of these 129, 78% (100) had no difficulty in complying with inhalations. Difficulty with inhalations was associated with decreased functional and mental status. Fifteen (58%) of 26 residents fully dependent in activities of daily living had difficulty compared to 14 (14%) of 100 others (P<.001). Twenty-two (45%) of 49 residents not oriented to person, place, or time had difficulty compared to 7 (10%) of 77 others (P<001). In the 2 weeks after zanamivir prophylaxis, only 2 new cases of respiratory illness occurred, neither confirmed as influenza. No side effects were identified in 128 zanamivir-treated residents.

Conclusion:

A minority of nursing home residents have difficulty following instructions for zanamivir inhalations. Zanamivir was well tolerated, and its use was temporally associated with termination of an outbreak that amantadine had failed to control.
The Nature and Frequency of Blood Contacts Among Home Healthcare Workers
Authors: Beltrami Elise M. , McArthur Margaret A. , McGeer Allison , Armstrong-Evans Maxine , Lyons Demie , Chamberland Mary E. , Cardo Denise M.
Published: February 2006

Objective:

To estimate the frequency of, and assess risk factors for, percutaneous, mucous membrane, and cutaneous blood contacts sustained by healthcare workers (HCWs) during the delivery of infusion therapy and the performance of procedures involving sharp instruments in the home setting.

Design:

Prospective surveillance of percutaneous, mucous membrane, and cutaneous blood contacts.

Setting:

Eleven home healthcare agencies in the United States and Canada from August 1996 through June 1997.

Participants:

HCWs who provided home infusion therapy or performed procedures using hollow-bore needles and other sharp instruments in the home setting.

Methods:

Each participating worker recorded information about the procedures performed and blood contacts experienced during each of his or her home visits for a 2- to 4-week period using standard questionnaires. HCWs also completed questionnaires regarding job duties, reporting of previous occupational blood contacts, and their use of protective barriers in the home setting.

Results:

Participating HCWs provided information about 33,606 home visits. A total of 19,164 procedures were performed during 14,744 procedure visits. Fifty-three blood contacts occurred during these visits, for a blood-contact rate of 2.8 blood contacts per 1,000 procedures and 0.6 percutaneous injuries per 1,000 procedures with needles or lancets. Gloves were worn for 52%, masks for 5%, gowns for 3%, and protective glasses or goggles for 2% of all procedure visits. HCWs used barriers for 53% of visits during which at least 1 procedure was performed and for 27% of other visits.

Conclusions:

HCWs involved in home health care are at risk for blood contact. Infection control barrier use was low in our study. The majority of skin contacts could have been prevented by glove use.
Reality Check: How Should We Control Antimicrobial Use? Current Practices and Controversies
Authors: Coignard Bruno , Siegel Jane D. , Weinstein Robert A. , Sohn Annette H. , Sinkowitz-Cochran Ronda L. , Jarvis William R.
Published: February 2006

The infectious diseases community shares a wide consensus about the need for control of antimicrobial use. However, current practices toward this goal remain controversial. This “Reality Check” session assessed attendees of the 4th Decennial Conference regarding their knowledge and practices about control of antimicrobial use in hospitals.
Outbreak of Infections in a Greek University Hospital Involving a Single Clone of High-Level Aminoglycoside-ResistantEnterococcus faecalis
Authors: Pournaras Spyros , Tsakris Athanassios , Kaufmann Mary E. , Douboyas John , Antoniadis Antonios
Published: February 2006

Among 145Enterococcus faecalisisolates recovered during a 15-month period (April 1997-June 1998) in AHEPA University Hospital, Thessaloniki, Greece, 94 (65%) exhibited high-level resistance to gentamicin or streptomycin and 61 (42%) to both aminoglycosides; 73% of the high-level aminoglycoside-resistantE faecalisisolates belonged to a single clone carrying the geneaac(6')-Ie-aph(2”)-Ia. These findings differ from those of other regions, where high-level aminoglycoside-resistance genes are dispersed into genetically unrelated strains.
A Prolonged Outbreak ofPseudomonas Aeruginosain a Neonatal Intensive Care Unit Did Staff Fingernails Play a Role in Disease Transmission?
Authors: Moolenaar Ronald L. , Crutcher J. Michael , Joaquin Venusto H. San , Sewell Lucille V. , Hutwagner Lori C. , Carson Loretta A. , Robison Denise A. , Smithee Lauri M.K. , Jarvis William R.
Published: February 2006

Objectives:

To describe an outbreak ofPseudomonas aeruginosabloodstream infection (BSD and endotracheal tube (ETT) colonization in a neonatal intensive care unit (NICU), determine risk factors for infection, and make preventive recommendations.

Design:

A 15-month cohort study followed by a case-control study with an environmental survey and molecular typing of available isolates using pulsed-field gel electrophoresis.

Setting and Patients:

Neonates in the NICU of a university-affiliated children's hospital.

Interventions:

Improved hand washing and restriction of use of long or artificial fingernails.

Results:

Of 439 neonates admitted during the study period, 46 (10.5%) acquiredP aeruginosa; 16 (35%) of those died. Fifteen (75%) of 20 patients for whom isolates were genotyped had genotype A and 3 (15%) had genotype B. Of 104 healthcare workers (HCWs) from whom hand cultures were obtained,P aeruginosawas isolated from three nurses. Cultures from nurses A-1 and A-2 grew genotype A and cultures from nurse B grew genotype B. Nurse A-1 had long natural fingernails, nurse B had long artificial fingernails, and nurse A-2 had short natural fingernails. On multivariate logistic regression analysis, exposure to nurse A-l and exposure to nurse B were each independently associated with acquiring a BSI or ETT colonization withP aeruginosa, but other variables, including exposure to nurse A-2, were not.

Conclusion:

Epidemiological evidence demonstrated an association between acquiringP aeruginosaand exposure to two nurses. Genetic and environmental evidence supported that association and suggested, but did not prove, a possible role for long or artificial fingernails in the colonization of HCWs' hands withP aeruginosa. Requiring short natural fingernails in NICUs is a reasonable policy that might reduce the incidence of hospital-acquired infections.
Standardized Surveillance of Hemodialysis Vascular Access Infections 18-Month Experience at an Outpatient, Multifacility Hemodialysis Center
Authors: Stevenson Kurt B. , Adcox Michael J. , Mallea Michael C. , Narasimhan Nagraj , Wagnild Jon P.
Published: February 2006

Objective:

To develop a standardized surveillance system for monitoring hemodialysis vascular-access infections in order to compare infection rates between outpatient sites and to assess the effectiveness of infection control interventions.

Design:

Prospective descriptive analysis of incidence infection rates.

Setting:

An outpatient hemodialysis center with facilities in Idaho and Oregon.

Patients:

All outpatients receiving chronic outpatient hemodialysis.

Results:

There were 38,096 hemodialysis sessions (31,603 via permanent fistulae or grafts, 5,060 via permanent tunneled central catheters, and 1,433 via temporary catheters) during an 18-month study period in 1997 to 1998. We identified 176 total infections, for a rate of 4.62/1,000 dialysis sessions (ds). Of the 176, 80 involved permanent fistulae or grafts (2.53/1,000 ds), 69 involved permanent tunneled central catheter infections (13.64/1,000 ds), and 27 involved temporary catheter infections (18.84/1,000 ds). There were 35 bloodstream infections (0.92/1,000 ds) and 10 episodes of clinical sepsis (0.26 /1,000 ds). One hundred thirty-one vascular-site infections without bacteremia were identified (3.44/1,000 ds), including 65 permanent fistulae or graft infections (2.06/1,000 ds), 42 permanent tunneled central catheter infections (8.3/1,000 ds), and 24 temporary catheter infections (16.75/1,000 ds).

Conclusions:

Infection rates were highest among temporary catheters and lowest among permanent native arteriovenous fistulae or synthetic grafts. This represents the first report of extensive incidence data on hemodialysis vascular access infections and represents a standardized surveillance and data-collection system that could be implemented in hemodialysis facilities to allow for reliable data comparison and benchmarking.
Prevalence of Hepatitis C Antibodies in a Large Sample of Belgian Healthcare Workers
Authors: Moens Guido , Vranckx Robert , De Greef Liesbeth , Jacques Pierre
Published: February 2006

Objective:

To assess the risk of hepatitis C virus (HCV) infection among Belgian (Flemish) healthcare workers.

Design:

A seroprevalence survey of HCV IgG antibodies.

Setting and Participants:

A systematic sample of 5,064 employees from 22 general hospitals in Flanders and Brussels, Belgium, was tested at the annual occupational medical examination. Together with demographic and occupational data, information was collected on the frequency of blood contact, needlestick injuries, and medical and surgical history. The blood samples were tested using the third-generation Abbott Screen Kit test, with confirmation by Matrix, LIA, and an in-house polymerase chain reaction and the Quantiplex-HCV b-DNA test.

Results:

21 persons were found to be positive for HCV markers. The overall prevalence was 0.41% (95% confidence interval [CI95], 0.24-0.59). A statistically significant association was found with a history of blood transfusion (odds ratio [OR], 4.14; CI95, 1.67-10.31) and with history of a clinically apparent hepatitis (OR, 3.98; CI95,1.60-9.90). Although the ORs for the frequency of blood contact were slightly elevated (between 1.17 and 2.73), this association was not significant. Moreover, a history of needlestick injuries showed a nonsignificant OR of 1.28 (CI95, 0.53-3.09), and no statistically significant difference was found with a variety of duties and tasks. The ORs for potential occupational risk factors were adjusted according to age, gender, antecedents, and other confounders using a logistic regression analysis. Based on this procedure, the ORs decreased slightly.

Conclusions:

Flemish healthcare workers showed a lower HCV seropositivity than is seen in the general population; a history of blood transfusion and of clinically apparent hepatitis was most strongly associated with the presence of HCV markers. We concluded that employees in Flemish regional general hospitals are not at an overall increased risk for HCV infection, although occasional transmission through percutaneous injuries is possible, and prevention therefore remains imperative.
Determining the Significance of Coagulase-Negative Staphylococci Isolated From Blood Cultures at a Community Hospital A Role for Species and Strain Identification
Authors: Kim Soon-Duck , McDonald L. Clifford , Jarvis William R. , McAllister Sigrid K. , Jerris Robert , Carson Loretta A. , Miller J. Michael
Published: February 2006

Objectives:

To determine the degree to which species identification or strain relatedness assessment of successive blood culture isolates of coagulase-negative staphylococci (CNS) may improve the clinical diagnosis of bloodstream infection (BSI).

Setting:

400-bed community hospital.

Design:

Prospective laboratory survey during which all CNS blood culture isolates obtained between mid-August 1996 and mid-February 1997 (study period) were saved and later identified to the species level; selected isolates were genotyped using pulsed-field gel electrophoresis at the Centers for Disease Control and Prevention (CDC). Retrospective review of medical records of 37 patients with multiple cultures positive for CNS.

Results:

During the study period, 171 patients had blood cultures positive for CNS; 130 had single positive cultures and 41 had ≥2 positive cultures. Of these 41, 23 (62%) were from patients with signs and symptoms of BSI according to CDC surveillance definitions. Species identification and strain clonality of CNS isolates from patients with ≥2 positives revealed 3 (13%) of the 23 patients did not have a consistent CNS species, and another 3 (13%) did not have a consistent genotype in the ≥2 positive cultures, suggesting that CNS from these patients probably were contaminants. Thus, species identification and strain clonality assessment reduced by 27% the number of patients with BSI diagnosed based on the presence of symptoms and ≥2 positive blood cultures.

Conclusions:

Routine species identification and selected strain genotyping of CNS may reduce the misinterpretation of probable contaminants among patients with ≥2 positive blood cultures.
Nosocomial Transmission of Tuberculosis (TB) Associated With Care of an Infant With Peritoneal TB
Authors: Matlow Anne G. , Harrison Alanna , Monteath Anne , Roach Peggy , Balfe J. Williamson
Published: February 2006

Nosocomial transmission of tuberculosis (TB) after exposure to infected peritoneal fluid has not been described. We report the exposure of 111 healthcare workers to infected dialysate from an infant with TB peritonitis. Two (5%) of 39 primary-care nurses, but no doctors or environmental service workers, had apparent tuberculin skin test conversions, raising the concern that patients with peritoneal TB may be a source for nosocomial transmission of TB.
Nosocomial Infections in Pediatric Patients A European, Multicenter Prospective Study
Authors: Raymond Josette , Aujard Yannick ,   European Study Group
Published: February 2006

Objectives.

To determine the site and bacterial epidemiology of nosocomial infections (NIs) in children.

Design:

6-month prospective study with periodic chart review during hospitalization using a uniform prospective questionnaire in each unit, analyzed at a coordinating center.

Setting:

20 units in eight European countries: 5 pediatric intensive care units (PICUs), 7 neonatal units, 2 hematology-oncology units, 8 general pediatric units.

Participants:

All children hospitalized during the study period with an NI according to Centers for Disease Control and Prevention criteria.

Results:

The overall incidence of NI was 2.5%, ranging from 1% in general pediatric units to 23.6% in PICUs. Bacteria were responsible for 68% (gram-negative bacilli, 37%; gram-positive cocci, 31%),Candidafor 9%, and viruses for 22% of cases. The proportion of lower respiratory tract infections was 13% in general pediatric units and 53% in PICUs. Bloodstream infections were most frequent in neonatal units (71% of NIs) and were associated with a central venous catheter in 66% of cases. Coagulase-negativeStaphylococcus(CNS) was the main pathogen. Eleven percent of NI were urinary tract infections. Gastrointestinal infections were most commonly viral and accounted for 76% of NIs in general pediatric units.

The prevalence of antimicrobial resistance depended on the type of unit. The highest rates were observed in PICUs: 26.3% ofStaphylococcus aureusand 89% of CNS were methicillin-resistant, and 37.5% ofKlebsiella pneumoniaehad an extended-spectrum β-lactamase. Mortality due to NI was 10% in PICUs and 17% in neonatal units.

Conclusions:

We found large differences in NI frequency and microbial epidemiology in this European study. Viruses were the main pathogens in general pediatrics units. Catheter-related sepsis and CNS were frequent in newborns. A high frequency of multiresistant bacteria was observed in some units. Clinical monitoring of NIs and bacterial resistance profiles are required in all pediatric units.
Comparison of Higher-Dose Intradermal Hepatitis B Vaccination to Standard Intramuscular Vaccination of Healthcare Workers
Authors: Henderson Elizabeth A. , Louie Thomas J. , Ramotar Karam , Ledgerwood Donna , Hope Karen Myrthu , Kennedy Agnes
Published: February 2006

Objective.

To compare the immunogenicity of hepatitis B vaccine administered via intradermal (ID) versus intramuscular (IM) route.

Methods:

Subjects chose either to specify the route of immunization or to undergo random allocation to vaccination by the ID (0.15 mL) or the IM (1.0 mL) route. Yeast-derived recombinant hepatitis B vaccine was given at 0, 30, and 180 days. Hepatitis B surface antibody (HBsAb) and hepatitis B core antibody (HBcAb) were measured by microparticle enzyme immunoassay.

Results:

763 subjects were enrolled. Baseline screening identified 65 subjects (8%) who were positive for HBsAb or HBcAb. Vaccination was completed by 590 (85%) of 698 enrollees (370 ID, 220 IM). Seroconversion rates (geometric mean titers [GMT]>0 IU/mL HBsAb) for those vaccinated ID were 99% and 96% for screening at 9 months and 1 year post-vaccination, respectively; subjects vaccinated intramuscularly had similar rates of 95% and 96%. Seropositivity rates (GMT ≥ 10 IU/mL HBsAb) showed a similar pattern, with 95%, 92%, and 73% at 9 months and 1 and 2 years, respectively, for those vaccinated ID, and 94%, 93%, and 81% for those having IM vaccination. GMT for HBsAb was significantly higher for individuals vaccinated IM than for those vaccinated ID (P<.0001). The GMT ratio for the IM and ID routes decreased over time, being 9.3 at 9 months, 7.8 at 1 year, and 5.9 at 2 years. An unanticipated side effect of intradermal vaccination was skin discoloration at injection sites, which persisted for at least 2 years postvaccination. Two thirds (112/166) of respondents reported that they would have selected the ID route despite the discoloration.

Conclusions:

Higher-dose ID vaccination (3 vs 1 μg per injection) uses one sixth of the dose required for standard IM vaccination. It is a cost-effective way to vaccinate populations against hepatitis B virus, but the long-term efficacy of the ID route must still be investigated.
Evidence of Delays in Transferring Patients With Methicillin-Resistant Staphylococcus aureus or Vancomycin-Resistant Enterococcus to Long-Term–Care Facilities
Authors: Bryce Elizabeth A. , Tiffin Shelley M. , Isaac-Renton Judith L. , Wright Charles J.
Published: February 2006

This retrospective case-control study examined whether there was a difference in length of time awaiting long-term-care lacement for patients identified as having methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus compared to controls. Thirty-nine patients with methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus waited for placement an average of 61 days longer than controls (P<.0002). The average number of requests for placement was 2.5 compared to 1.7 for controls (P=.015).
The Incidence and Risk Factors of Ventilator-Associated Pneumonia in a Riyadh Hospital
Authors: Memish Ziad A. , Cunningham Gwen , Oni Gbolahan A. , Djazmati W.
Published: February 2006

We report the incidence of, and risk factors for, ventilator-associated pneumonia (VAP) at the King Fahad National Guard Hospital. Of the 202 patients studied, 41 (25.2%) had VAP The incidence density was 16.8/1,000 person-days of ventilation. Variables significantly associated with VAP were serious injury from motor-vehicle accident, enteral feeding, and length of ventilation. The avoidance of unnecessary enteral nutrition could help to reduce VAP.
O2 in Y2K Not An Airtight Case
Authors: Lee James T.
Published: February 2006

During a bitterly cold Minnesota weekend, I holed up at home with two dogs and hot tea while reading and rereading the paper that “everyone is talking about.” The findings of Grief and coworkers now have received world-wide exposure. In consequence, anesthesiologists, surgeons, and infection control workers may be pondering how soon to start “putting everybody on 80% oxygen in the OR and recovery room.” The article is not perfect—it has some warts—yet it may stimulate timely reconsideration of four intertwined topics: the difficulty of detecting an incremental infection prevention effect in a clinical trial; the importance of designing such a trial so that the control-group treatment represents current best practice; the bittersweet vagaries of inductive inference that are inescapable whenever we generalize to our practices (non-research conditions) techniques reported from clinical trials (research conditions); and the absence of logical rules of engagement to follow at our own hospitals when a new infection control gimmick or gadget arrives on the scene.

Of course, I have already submitted my e-mail letter to the editor of the New England Journal of Medicine. What I could not cover within the 400-word limit of that forum inspired this essay.

The apparent effect of only a few hours' supplemental oxygen administration for colorectal surgical-incision infection prevention was astounding. The 50% reduction in infection risk seems almost too good to be true. There is a seductive charm when a single, simple, relatively cheap and safe process change gives that much outcome improvement.
How to Survey Nosocomial Infections
Authors: Gastmeier Petra , Sohr Dorit , Just Heinz-Michael , Nassauer Alfred , Daschner Franz , Rüden Henning
Published: February 2006

Many surveillance methods for nosocomial infections (NIs) have been put forward in the literature, and all have their advantages and disadvantages. Different surveillance methods are useful, depending on whether the objective of surveillance is only to increase sensitivity to infection control problems and to identify areas with possible infection control problems; to confirm a possible infection control problem through comparison with other units or departments; or to use surveillance data for identifying the sources of infections. Furthermore, time effectiveness is a major point in selecting the most appropriate method, particularly the method for case identification. In units or departments with a high level of NI, even highly time-consuming surveillance methods may be ultimately time-effective; in units or departments with a lower level of NI, the time-effectiveness depends on the time necessary for case identification. Close liaison with staff in the units is a sine qua non for the success of all surveillance activities
The Clinical and Economic Consequences of Nosocomial Central Venous Catheter-Related Infection: Are Antimicrobial Catheters Useful?
Authors: Saint Sanjay , Veenstra David L. , Lipsky Benjamin A.
Published: February 2006

Central venous catheters (CVCs) are essential for many hospitalized patients, but they are associated with important infectious complications. Recent studies have indicated that CVCs coated with antimicrobial agents reduce the incidence of catheter-related bloodstream infection (CR BSI). To estimate the clinical and economic consequences of short-term central venous catheter-related infection and the potential usefulness of antimicrobial-coated catheters, we reviewed and synthesized the available relevant literature. Statistical pooling was used to estimate the incidence of both catheter colonization and CR BSI. The attributable mortality of CR BSI was also evaluated. In addition, the economic consequences of both local and systemic catheter-related infection was estimated from literature reports that used micro-costing and other techniques.

Among patients in whom standard, noncoated CVCs are in place for an average of 8 days, 24.7% are expected to develop catheter colonization (95% confidence interval [CI95], 22.0%-27.5%). Approximately 5.2% (CI953.9%-6.5%) will develop CR BSI. The attributable mortality of CR BSI remains unclear, but recent studies are consistent with a range from 4% to 20%. An episode of local catheter-related infection leads to an additional cost of approximately $400, whereas the additional cost of CR BSI ranges from approximately $6,005 to $9,738. Formal economic analyses indicate that CVCs coated with antibacterial agents (such as chlorhexidine-silver sulfadiazine or minocycline-rifampin) likely reduce infectious complications, yielding economic advantages. In light of the substantial clinical and economic burden of catheter-related infection, hospital personnel should adopt proven cost-effective methods to reduce this common and important nosocomial complication.
Control of Antibiotic Use in the Community: The Danish Experience
Authors: Sørensen Thomas Lund , Monnet Dominique
Published: February 2006

The selection pressure for antibacterial resistance in the community might not be as high as in hospitals. However, it is generally accepted that it is in the primary healthcare sector that one can achieve the greatest decrease in the total use of antimicrobials. There are significant differences in the overall use of antimicrobials among European countries. On average, 80% to 90% of the total antibiotic use in each country takes place in the primary healthcare sector. Surveillance of the use of antimicrobials is the core for planning interventions and monitoring their effect. These interventions may be implemented for either political, economic, or professional reasons. Often, but not always, political interventions are governmental, and professional interventions are recommendations from professional associations. Examples of interventions at different levels in the Danish healthcare system, from the general practitioner to legislation by the government, will be presented together with their effect on the use of antimicrobials.
Potential Dissemination of Antibiotic Resistance Genes From Transgenic Plants to Microorganisms
Authors: Bertolla Franck , Kay Elisabeth , Simonet Pascal
Published: February 2006

Evidence that genes were transferred during evolution from plants to bacteria was obtained from nucleotide and protein sequence analyses. However, the extent of such transfers among phylogenetically distant organisms is limited by various factors, including those related to complexity of the environment and those endogenous to the bacteria, designed to prevent a drift of the genome integrity. The goal of this article is to give an overview of the potentials and limits of natural interkingdom gene transfers, with a particular focus on prokaryote originating sequences fitting the nuclear genome of transgenic plants.
Methicillin-ResistantStaphylococcus aureusin the Community: New Battlefronts, or Are the Battles Lost?
Authors: Cookson Barry David
Published: February 2006

Methicillin-resistantStaphylococcus aureus(MRSA) is an important cause of nosocomial infections worldwide. Interpretation of community MRSA trends is problematical, in that the term is ill-defined, and related data are difficult to put into context. There are four relevant battlefronts, all of interest to risk assessment and prevention. These comprise the following: the issues relating to an increasing pool of patients with MRSA discharged from hospitals into the community; MRSA spreading to patients in nursing and residential homes; and MRSA spreading from patients and healthcare workers to others in the community. There are often difficulties in determining whether the fourth issue, MRSA arising apparently de novo in the community, is in fact due to one of these other fronts. All these battlefronts are important and not yet lost. However, we must agree on definitions and design-appropriate surveillance strategies, so that we can best inform prevention and control activities to contain these emerged or emerging problems.
Reasons for Noncompliance With Infection Control Guidelines
Authors: Farr Barry M.
Published: February 2006

Concern frequently is voiced about individuals not complying with guidelines intended to prevent spread of antibiotic-resistant pathogens from patient to patient, but institutional decisions to ignore Centers for Disease Control and Prevention guidelines recommending detection and isolation of colonized patients also have contributed greatly to the increasing rate of infections due to these pathogens. This is so because colonized patients are the main reservoir for spread, and barrier precautions prevent spread much more effectively than Standard Precautions. Providing effective leadership and changing this culture of noncompliance must begin with the infection control team believing that spread is both important and preventable.
Skin Irritation and Dryness Associated With Two Hand-Hygiene Regimens: Soap-and-Water Hand Washing Versus Hand Antisepsis With an Alcoholic Hand Gel
Authors: Boyce John M. , Kelliher Susan , Vallande Nancy
Published: February 2006

Objective:

To compare the frequency of skin irritation and dryness associated with using an alcoholic–hand-gel regimen for hand antisepsis versus using soap and water for hand washing.

Design:

Prospective randomized trial with crossover design. Irritation and dryness of nurses' hands were evaluated by self-assessment and by visual assessment by a study nurse. Epidermal water content of the dorsal surface of nurses' hands was estimated by measuring electrical capacitance of the skin.

Setting:

Miriam Hospital, a 200-bed university-affiliated teaching hospital.

Participants:

Thirty-two nurses working on three hospital wards participated in the trial, which lasted 6 weeks.

Results:

Self-assessment scores of skin irritation and dryness decreased slightly during the 2 weeks when nurses used the alcoholic–hand-gel regimen (mean baseline score, 2.72; mean final score, 2.0; P=.08) but increased substantially during the 2 weeks when nurses used soap and water (mean baseline score, 2.0; mean final score, 4.8; P<.0001). Visual assessment scores by the study nurse of skin irritation and dryness did not change significantly when the alcoholic–hand-gel regimen was used (mean baseline and final scores were both 0.55), but scores increased substantially when nurses used soap and water (baseline score, 0.59; mean final score, 1.21; P=.05). Epidermal water content of the dorsal surface of nurses' hands changed little when the alcoholic–hand-gel regimen was used (mean ± standard deviation baseline electrical capacitance reading, 24.8±6.8; mean final reading, 25.7±7.3), but decreased significantly (skin became dryer) with soap-and-water hand washing (mean baseline, 25.9±7.5; mean final reading, 20.5±5.4; P=.0003).

Conclusions:

Hand antisepsis with an alcoholic–hand-gel regimen was well tolerated and did not result in skin irritation and dryness of nurses' hands. In contrast, skin irritation and dryness increased significantly when nurses washed their hands with the unmedicated soap product available in the hospital. Newer alcoholic hand gels that are tolerated better than soap may be more acceptable to staff and may lead to improved hand-hygiene practices.
Association of Antibiotic Utilization Measures and Control of Multiple-Drug Resistance inKlebsiella pneumoniae
Authors: Patterson Jan E. , Hardin Thomas C. , Kelly Cindy A. , Garcia Rosa C. , Jorgensen James H.
Published: February 2006

Objective:

To study the association of antibiotic-utilization measures and control of multidrug-resistant (MDR)Klebsiella pneumoniaeafter emergence in two hospitals in our medical center.

Design and Setting:

Rates of MDRK pneumoniaeat two hospitals were compared before and after acute interventions, including emphasis on Contact Precautions and education in antibiotic utilization. Antipseudomonal β-lactam antibiotic use was measured before and after the interventions at both hospitals. Pulsed-field gel electrophoresis of whole cell DNA was used as a marker of strain identity.

Results:

Clonal strain dissemination was the major mechanism of emergence at hospital A; emergence was polyclonal at hospital B. Antibiotic-utilization interventions at both institutions included physician education regarding the association of ceftazidime use and MDRK pneumoniae. At hospital A, ceftazidime use decreased from 4,301 g in the preintervention period, to 1,248 g in the postintervention period. Piperacillin-tazobactam use increased from 12,455 g to 17,464 g. Ceftazidime resistance in Kpneumoniae decreased from 110 (22%) of 503 isolates to 61 (15%) of 407 isolates (P<.05); piperacillin-tazobactam resistance decreased from 181 (36%) of 503 to 77 (19%) of 407 isolates (P<.05). At hospital B, ceftazidime use decreased from 6,533 g in the preintervention period to 4,792 g in the postintervention period. Piperacillin-tazobactam use increased from 58,691 g to 67,027 g. Ceftazidime resistance inK pneumoniaedecreased from 42 (10%) of 415 isolates to 19 (5%) of 383 isolates (P<.05). Piperacillin-tazobactam resistance decreased from 91 (22%) of 415 isolates to 54 (14%) of 383 isolates (P<.05). Follow-up data showed continued decrease in piperacillin-tazobactam resistance despite increased use at both hospitals.

Conclusions:

Antibiotic-use measures may be particularly important for control of MDRK pneumoniae, whether emergence is clonal or polyclonal.
The Epidemiology of Mupirocin Resistance Among Methicillin-ResistantStaphylococcus aureusat a Veterans' Affairs Hospital
Authors: Vasquez Jose E. , Walker Elaine S. , Franzus Bettylene W. , Overbay Barbara K. , Reagan David R. , Sarubbi Felix A.
Published: February 2006

Objective:

To describe the clinical and molecular epidemiology of mupirocin-resistant (MR) and mupirocin-susceptible (MS) methicillin-resistantStaphylococcus aureus(MRSA) at a Veterans' Affairs hospital and to assess risk factors associated with the acquisition of MR MRSA.

Design:

All clinical MRSA isolates for the period October 1990 through March 1995 underwent susceptibility testing to mupirocin. Mupirocin resistance trends were measured, and MS MRSA and MR MRSA isolates underwent typing by pulsed-field gel electrophoresis (PFGE). A retrospective case-control study was conducted to evaluate risk factors for having MR versus MS MRSA.

Setting:

The James H. Quillen Veterans' Affairs Medical Center in Mountain Home, Tennessee, included a 324-bed acute-care hospital, a 120-bed nursing home, and a 525-bed domiciliary. Colonizations and infections with MRSA were endemic, and mupirocin ointment was commonly used.

Patients:

Inpatients and outpatients at the facility.

Results:

MS MRSA was recovered from 506 patients and MR MRSA from 126. Among MR MRSA isolates, 58% showed low-level mupirocin resistance (minimum inhibitory concentration [MIC] ≥4 to 256 μg/mL), and 42% showed high-level mupirocin resistance (MIC ≥512 μg/mL). A significant increase (P=.002) in the number of high-level MR isolates occurred during the 1993 to 1995 period. A case-control study showed that presence of a decubitus ulcer correlated with high-level resistant isolates (P<.05). The distribution of PFGE patterns did not differ for MR and MS MRSA.

Conclusions:

Use of mupirocin ointment in a program aimed at managing endemic MRSA infection or colonization resulted in a significant increase in the recovery of high-level MR MRSA isolates. These isolates appeared to emerge from our existing MRSA pool. A case-control study provided few clues concerning patients likely to harbor MR MRSA We confirmed the position that the extended use of mupirocin ointment should be avoided in settings where MRSA is endemic.
Neonatal Group B Streptococcal Disease: How Infection Control Teams Can Contribute to Prevention Efforts
Authors: Strausbaugh Larry J. , Pinner Robert W. , Schrag Stephanie J. , Whitney Cynthia G. , Schuchat Anne
Published: February 2006

Group B streptococcal (GBS) disease is a leading cause of morbidity and mortality among newborns. Many cases of newborn GBS disease can be prevented by the administration of intrapartum antibiotic prophylaxis. Current consensus guidelines for prevention of perinatal GBS disease have led to substantial declines in the incidence of GBS disease occurring in newborns <7 days of age (early-onset disease). Despite declines in the incidence of early-onset disease, approximately 20% of pregnant women are colonized with GBS at the time of labor and thus have the risk of transmitting the bacteria to their newborns. Consequently, continued and improved implementation of prevention efforts is essential. Infection control teams can contribute uniquely to prevention of perinatal GBS disease by serving as hospital champions of GBS disease prevention. In particular, teams can coordinate with administration and staff to encourage establishment and effective implementation of GBS prevention policies; facilitate improved laboratory processing of prenatal GBS screening specimens; monitor any adverse consequences of increased use of intrapartum antibiotics within the hospital; and investigate GBS cases that occur to determine whether they could have been prevented. By spearheading efforts to improve implementation of perinatal GBS disease prevention at the hospital level, hospital epidemiologists and infection control practitioners can play an important role in reducing the burden of early-onset GBS disease.
Activity of an Alcohol-Based Hand Gel Against Human Adeno-, Rhino-, and Rotaviruses Using the Fingerpad Method
Authors: Sattar Syed A. , Abebe Makonnen , Bueti Angela J. , Jampani Hanuman , Newman Jerry , Hua Steven
Published: February 2006

Objective:

To assess the activity against three non-enveloped viruses (an adeno-, a rhino- and a rotavirus) of a gel containing 60% ethanol, using experimentally contaminated thumb- and fingerpads of 12 panelists, as per standard procedure E-1838-96 of the American Society of Testing and Materials.

Design:

Each digit received 10 μL of the test virus suspension. The inocuLum from the thumbs was eluted immediately with 990 μL of Earle's balanced salt solution (EBSS) to assess the amount of virus on each digit (0-minute control). The inoculum on the fingers was allowed to dry (20-25 minutes), and virus was eluted from two fingerpads to determine the loss in virus infectivity upon drying (baseline titer). Then the dried inoculum on randomly selected fingers was exposed to 1 mL of the test product or standard hard water (200-ppm calcium carbonate) for 20 seconds. The virus remaining was eluted with 1 mL of EBSS, titrated to determine the amounts eliminated, and compared to the baseline titer.

Results:

Each digit received at least 104 plaque-forming units of virus in 10 μL The amounts of adeno-, rhino-, and rotaviruses surviving the drying were 30%, 75%, and 42%, respectively. The product reduced the infectivity titers of the three viruses by 3 to >4 log10when compared to a reduction of ≤ 1 log10for the hard-water rinse.

Conclusion:

The level of virus reduction by gel was statistically significantly higher than that seen with the water control. Evidence for such activity against non-enveloped viruses supports further investigation of the benefits of this product.
Antimicrobial Use in Long-Term–Care Facilities
Authors: Nicolle Lindsay E. , Bentley David W. , Garibaldi Richard , Neuhaus Ellen G. , Smith Philip W. ,   SHEA Long-Term–Care Committee
Published: February 2006

There is intense antimicrobial use in long-term-care facilities (LTCFs), and studies repeatedly document that much of this use is inappropriate. The current crisis in antimicrobial resistance, which encompasses the LTCF, heightens concerns of antimicrobial use. Attempts to improve antimicrobial use in the LTCF are complicated by characteristics of the patient population, limited availability of diagnostic tests, and the virtual absence of relevant clinical trials. This position paper recommends approaches to management of common infections in LTCF patients and proposes minimal standards for an anti-microbial review program. In developing these recommendations, the position paper acknowledges the unique aspects of provision of care in the LTCF.
Use of Spoligotype Analysis to Detect Laboratory Cross-Contamination
Authors: Nivin Beth , Driscoll Jeffrey , Glaser Tom , Bifani Pablo , Munsiff Sonal
Published: February 2006

Spoligotype analysis identified false-positive isolates ofMycobacterium tuberculosiscaused by laboratory cross-contamination. Spoligotyping is faster, is less expensive than DNA fingerprinting, and can be used with a variety of media. Patients were reevaluated and had medications discontinued as a result of this investigation. Months of unnecessary patient follow-up and treatment were avoided.
Transient Detection of Plasma HIV-1 RNA During Postexposure Prophylaxis
Authors: Puro Vincenzo , Calcagno Giuseppe , Anselmo Marco , Benvenuto Gisella , Trabattoni Daria , Clerici Mario , Ippolito Giuseppe
Published: February 2006

Transient plasma human immunodeficiency virus (HIV) copies were detected by nucleic-acid sequence-based amplification during combination antiretroviral prophylaxis in a healthcare worker who reported a percutaneous injury from a stylet and who remained HIV-antibody-negative. An HIV-specific T-helper response, assessed by interleukin-2 production, was observed when tested at 13 months following the exposure.
Nosocomial Infections in a New Medical Center, Turkey
Authors: Durmaz Bengül , Durmaz Riza , Otlu Bariş , Sönmez Emine
Published: February 2006

Nosocomial infection was found in 255 (2.5%) of 10,164 inpatients in a new medical center with a 310-bed capacity. The infection rate was 12.5% in the intensive care unit, 9.5% in neurology, 5.5% in general surgery, and 4.0% in orthopedics. Rates in the other services were lower. Hospital-acquired infections in our medical center frequently involved multiply resistant Enterobacteriaceae and staphylococci.