bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Surgical-Site Infections in the 1990s: Attributable Mortality, Excess Length of Hospitalization, And Extra Costs
Authors: Kirkland Kathryn B. , Briggs Jane P , Trivette Sharon L. , Wilkinson William E. , Sexton Daniel J.
Published: February 2006

Objective:

To determine mortality, morbidity, and costs attributable to surgical-site infections (SSIs) in the 1990s.

Design:

A matched follow-up study of a cohort of patients with SSI, matched one-to-one with patients without SSI.

Setting:

A 415-bed community hospital.

Study Population:

255 pairs of patients with and without SSI were matched on age, procedure, National Nosocomial Infection Surveillance System risk index, date of surgery, and surgeon.

Outcome Measures:

Mortality, excess length of hospitalization, and extra direct costs attributable to SSI; relative risk for intensive care unit (ICU) admission and for readmission to the hospital.

Results:

Of the 255 pairs, 20 infected patients (7.8%) and 9 uninfected patients (3.5%) died during the postoperative hospitalization (relative risk [RR], 2.2; 95% confidence interval [CI95], 1.14.5). Seventy-four infected patients (29%) and 46 uninfected patients (18%) required ICU admission (RR, 1.6; CI95,1.3-2.0). The median length of hospitalization was 11 days for infected patients and 6 days for uninfected patients. The extra hospital stay attributable to SSI was 6.5 days (CI95, 5-8 days). The median direct costs of hospitalization were $7,531 for infected patients and $3,844 for uninfected patients. The excess direct costs attributable to SSI were $3,089 (CI95, $2,139-$4,163). Among the 229 pairs who survived the initial hospitalization, 94 infected patients (41%) and 17 uninfected patients (7%) required readmission to the hospital within 30 days of discharge (RR, 5.5; CI95, 4.0-7.7). When the second hospitalization was included, the total excess hospitalization and direct costs attributable to SSI were 12 days and $5,038, respectively.

Conclusions:

In the 1990s, patients who develop SSI have longer and costlier hospitalizations than patients who do not develop such infections. They are twice as likely to die, 60% more likely to spend time in an ICU, and more than five times more likely to be readmitted to the hospital. Programs that reduce the incidence of SSI can substantially decrease morbidity and mortality and reduce the economic burden for patients and hospitals.
Outbreak ofStenotrophomonas maltophiliaBacteremia Among Patients Undergoing Bone Marrow Transplantation: Association With Faulty Replacement of Handwashing Soap
Authors: Klausner Jeffrey D. , Zukerman Carol , Limaye Ajit P. , Corey Lawrence
Published: February 2006

Using molecular typing methods, we confirmed an outbreak ofStenotrophomonas maltophiliaamong bone marrow transplant patients. The likely source was a healthcare worker who may have washed with moisturizer instead of soap between patients. Hospital epidemiologists need to go beyond antibiograms when evaluating outbreaks and be vigilant about all aspects of hand washing.
Mortality Following Isolation of Various Respiratory Viruses in Nursing Home Residents
Authors: Drinka Paul J. , Gravenstein Stefan , Langer Elizabeth , Krause Peggy , Shult Peter
Published: February 2006

Objective:

To compare mortality following isolation of influenza A to mortality following isolation of other respiratory viruses in a nursing home.

Setting:

The Wisconsin Veterans Home, a 688-bed skilled nursing facility for veterans and their spouses.

Participants:

All residents with respiratory viral isolates obtained between 1988 and 1999.

Design:

Thirty-day mortality was determined following each culture-proven illness.

Results:

Thirty-day mortality following isolation of viral respiratory pathogens was 4.7% (15/322) for influenza A 5.4% (7/129) for influenza B; 6.1% (3/49) for parainfluenza type 1; 0% (0/26) for parainfluenza types 2,3, and 4; 0% (0/26) for respiratory syncytial virus (RSV); and 1.6% (1/61) for rhinovirus.

Conclusions:

Mortality following isolation of certain other respiratory viruses may be comparable to that following influenza A (although influenza A mortality might be higher without vaccination and antiviral agents). The use of uniform secretion precautions for all viral respiratory illness deserves consideration in nursing homes.
Evidence of NosocomialStenotrophomonas MaltophiliaCross-Infection in a Neonatology Unit Analyzed by Three Molecular Typing Methods
Authors: de Viedma Darío García , Marín Mercedes , Cercenado Emilia , Alonso Roberto , Rodríguez-Créixems Marta , Bouza Emilio
Published: February 2006

Objective:

To characterize the epidemiological relationships amongStenotrophomonas maltophiliaisolates in the neonatology unit of our institution over a 4-month period in which an increased number of isolates was observed.

Setting:

The neonatology ward in a 2,000-bed university hospital in Madrid, Spain.

Design:

A retrospective molecular epidemiological analysis using three different typing methods, arbitrarily primed polymerase chain reaction (PCR), pulsed-field gel electrophoresis, and enterobacterial repetitive intergenic consensus-PCR, was performed with 11 isolates obtained from seven neonates over a 4-month period. Presumed unrelated isolates also were included as controls. A similarity dendrogram was obtained, to analyze the genetic relatedness among the isolates.

Results:

All isolates from the neonates, except one, showed a remarkably high homology among their typing patterns for the three methods assayed and clustered in the relatedness dendrogram at 96% similarity. The unrelated strains selected as controls were unclustered. The index case was considered to be a newborn who had anS maltophiliaisolate from a culture drawn on the day of admission to the neonatology unit and which was included in the clustered similarity group.

Conclusions:

Such a high genetic similarity among the isolates, together with the presence of an index case who had been colonized or infected byS maltophiliabefore arrival at our institution, constitutes the first evidence of nosocomial cross-transmission of this microorganism.
The Emergence of Decreased Susceptibility to Vancomycin in Staphylococcus epidermidis
Authors: Garrett Denise O. , Jochimsen Elise , Murfitt Kate , Hill Bertha , McAllister Sigrid , Nelson Pat , Spera Richard V. , Sall Richard K. , Tenover Fred C. , Johnston Judy , Zimmer Barbara , Jarvis William R.
Published: February 2006

Background:

Coagulase-negative staphylococci (CNS) are the major cause of nosocomial bloodstream infection. Emergence of vancomycin resistance among CNS is a serious public health concern, because CNS usually are multidrug-resistant, and glycopeptide antibiotics, among which only vancomycin is available in the United States, are the only remaining effective therapy. In this report, we describe the first bloodstream infection in the United States associated with aStaphylococcus epidermidisstrain with decreased susceptibility to vancomycin.

Methods:

We reviewed the hospital's microbiology records for all CNS strains, reviewed the patient's medical and laboratory records, and obtained all available CNS isolates with decreased susceptibility to vancomycin. Blood cultures were processed and CNS isolates identified by using standard methods; antimicrobial susceptibility was determined by using minimum inhibitory concentration (MIC) and disk-diffusion methods. Nares cultures were obtained from exposed healthcare workers (HCWs) to identify possible colonization by CNS with decreased susceptibility to vancomycin.

Results:

The bloodstream infection by anS epidermidisstrain with decreased susceptibility to vancomycin occurred in a 49-year-old woman with carcinoma. She had two blood cultures positive for CNS; both isolates wereS epidermidis. Although susceptible to vancomycin by the disk-diffusion method (16-17 mm), the isolates were intermediate by MIC (8-6 μg/mL). The patient had received an extended course of vancomycin therapy; she died of her underlying disease. No HCW was colonized by CNS with decreased susceptibility to vancomycin.

Conclusions:

This is the first report in the United States of bloodstream infection dueto S epidermidiswith decreased susceptibility to vancomycin. Contact precautions likely played a role in preventing nosocomial transmission of this strain, and disk-diffusion methods may be inadequate to detect CNS with decreased susceptibility to vancomycin.
Surgical-Site Complications Associated With a Morphine Nerve Paste Used for Postoperative Pain Control After Laminectomy
Authors: Kramer Michael H. , Mangram Alicia J. , Pearson Michele L. , Jarvis William R.
Published: February 2006

Objective:

To identify risk factors that might explain a sudden increase in the rate of surgical-site complications following laminectomy.

Design:

Retrospective cohort study.

Patients and Setting:

Patients who underwent laminectomy at a 120-bed hospital from August 1 through October 15, 1996 (the epidemic period). A case-patient was defined as a patient with postoperative surgical-site complications (surgical-site drainage, edema, or swelling) requiring surgical debridement.

Results:

Of the 148 patients who underwent a laminectomy during the epidemic period, 17 (11%) met our case definition. The rate of postoperative surgical debridement was 7.6-fold higher during the epidemic period than the preceding 19-month period (17/148 vs 15/995,P<.001). Development of surgical-site complications was associated with intraoperative receipt of morphine nerve paste (relative risk [RR], 11;P<.001), preoperative shaving by nurses rather than surgeons (RR, 6.6;P=.006), procedures done by a certain surgeon (RR, 3.1;P=.022), or receipt of iodine rather than povidone-iodine for preoperative skin antisepsis (RR, 5.1;P=.002). In multivariate analysis, only receipt of morphine nerve paste remained as a risk factor (RR, 18;P=.011). The paste was used to control postoperative pain and was applied directly to exposed dura and surrounding tissues. At the time of surgical debridement (median, 24 days postsurgery), the original surgical sites showed residual paste and a lack of healing. Ten of 16 cultures from surgical sites were positive; all but three grew skin commensals. Histological examination of surgical specimens showed a foreign-body reaction, but no marked acute inflammation.

Conclusions:

The intraoperative use of morphine nerve paste may delay wound healing and increase postoperative morbidity. When new products are introduced, standardized protocols should be developed for their use, and systematic surveillance should be done to monitor for potential adverse outcomes.
Evaluation of the SENIC Risk Index in a Spanish University Hospital
Authors: Valls Victoria , Díez Manuel , Ena Javier , Gutiérrez Alberto , Gómez-Herruz Peña , Martín Antonio , Gónzalez-Palacios Rosario , Granell Javier
Published: February 2006

Objective:

To assess the performance of the Study of the Efficacy of Nosocomial Infection Control (SENIC) risk index for the evaluation of the risk of surgical-site infection (SSI) in a country other than the United States, having a different health system.

Setting:

350-bed university hospital in Spain belonging to the National Health System (Insalud).

Design:

Observational cohort study of 1,019 patients who underwent consecutive surgery from January to December 1992. Surgical-infection risk factors assessed by the traditional wound-classification system (clean, clean-contaminated, contaminated, and dirty-infected wound) and by the SENIC risk index (length of intervention more than 2 hours, more than three discharge diagnoses, abdominal surgery, and contaminated or dirty-infected wound) were compared by forward logistic regression.

Results:

The SENIC risk index showed a greater ability to predict SSI than the traditional wound-classification system. The study carried out in our institution reproduced the estimators provided by the SENIC study in the United States. The SENIC risk index provided a stepwise increase in SSI rates, according to the number of factors present, for every traditional wound-classification group. In the case of clean wounds, the incidence of surgical infection (per 100 interventions) increased (1.5, 2.4, 5.3, and 50;P<.001) for patients having from zero to three risk factors of the SENIC risk index.

Conclusions:

This study shows that the SENIC risk index results are reproducible, and the index can be used to compare rates of wound infection across countries with different health systems than the United States.
Evaluation of a Handwashing Intervention to Reduce Respiratory Illness Rates in Senior Day-Care Centers
Authors: Falsey Ann R. , Criddle Mary M. , Kolassa John E. , McCann Robert M. , Brower Christine A. , Hall William J.
Published: February 2006

To decrease respiratory infections in senior day care, staff were educated on viral transmission and the value of hand washing. Fanny packs with alcohol foam supplemented hand washing and were alternated monthly between centers. Infection rates were unchanged with alcohol foam use. The intervention year's infection rate was significantly lower than the previous 3 years, suggesting a benefit of education.
Regional Dissemination and Control of Epidemic Methicillin-Resistant Staphylococcus aureus
Authors: Nicolle Lindsay E. , Dyck Brenda , Thompson Genevieve , Roman Susan , Kabani Amin , Plourde Pierre , Fast Margaret , Embil John ,   Manitoba Chapter of CHICA-Canada
Published: February 2006

A methicillin-resistantStaphylococcus aureus(MRSA) strain introduced into the largest tertiary-care teaching hospital in Manitoba in 1993 led to a sustained outbreak with secondary outbreaks at one community hospital, two large long-term-care facilities, and nosocomial transmission at a second teaching hospital. Control measures were consistent at each institution and were coordinated on a province-wide basis. MRSA is not currently endemic in any facility in the province.
Nosocomial Infections With Ceftazidime-Resistant Pseudomonas aeruginosa: Risk Factors and Outcome
Authors: Lee Sai-Cheong , Fung Chang-Phone , Liu Peter Yuk-Fong , Wang Tzu-Chien , See Lai-Chu , Lee Ning , Chen Shu-Chu , Shieh Wen-Bin
Published: February 2006

Prospective studies were conducted for nosocomialPseudomonas aeruginosainfections from February 1, 1994, to October 30,1995. Of 97P aeruginosaisolates from 97 patients, 35 were resistant to ceftazidime. Logistic regression revealed previous cephalosporin or piperacillin use as independent risk factors for nosocomial ceftazidime-resistantP aeruginosainfection. Pulsed-field gel electrophoresis revealed that four nosocomial ceftazidime-resistantP aeruginosainfections were caused by cross-infection, probably through medical personnel.
Survival of Mycobacteria on N95 Personal Respirators
Authors: Reponen Tiina A. , Wang Zheng , Willeke Klaus , Grinshpun Sergey A.
Published: February 2006

Objectives:

The overall aim of this study was to investigate the survival and possible growth of Mycobacterium tuberculosis simulant bacteria on respirator filters.

Methods:

Mycobacterium smegmatis was used as a biochemical simulant for M tuberculosis. Bacterial survival was tested on National Institute for Occupational Safety and Health-certified N95 respirators from three manufacturers. The first experiments simulated one-time respirator use and subsequent storage for 1 to 9 days under ideal conditions for the growth of mycobacteria: 37°C and 85% relative humidity. The bacteria were loaded on the respirator filters under three different nutritional conditions: in the absence of nutrients; in the presence of human saliva (simulating conditions when the respirator is worn); and in the presence of nutrient broth (for ideal growth potential). The subsequent experiments simulated respirator wear for 2 hours under medium workload conditions at a breathing rate of 56 L/min.

Results:

It was found that M smegmatis did not grow on the tested respirators, even when the respirators were stored at temperature, humidity, and nutrition conditions most favorable for microbial growth. However, these bacteria could survive on respirators for up to 3 days during storage. The culturability of M smegmatis was not affected by airflow that simulated the breathing rate associated with medium work-load conditions for 2 hours.

Conclusions:

This study shows that M tuberculosis surrogate bacteria collected on a respirator are not able to grow and are able to survive only in ideal (ie, not clinically relevant) conditions. Based on these experiments, we conclude that M tuberculosis is unlikely ever to become an infectious problem in the air again, once it is removed by a respirator.
Guideline for Prevention of Surgical Site Infection, 1999
Authors: Mangram Alicia J. , Horan Teresa C. , Pearson Michele L. , Silver Leah Christine , Jarvis William R. ,   The Hospital Infection Control Practices Advisory Committee
Published: February 2006

The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention (CDC)'s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.

Part I, “Surgical Site Infection: An Overview,” describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis.
Control of Transmission of Vancomycin-Resistant Enterococcus faecium in a Long-Term–Care Facility
Authors: Armstrong-Evans Maxine , Litt Margaret , McArthur Margaret A. , Willey Barbara , Cann Darlene , Liska Susan , Nusinowitz Sidney , Gould Richard , Blacklock Anna , Low Donald E. , McGeer Allison
Published: February 2006

Objectives:

To describe the investigation and control of transmission of vancomycin-resistant enterococci (VRE) in a residential long-term-care (LTC) setting.

Outbreak Investigation:

A strain of vancomycin-resistantEnterococcus faeciumnot previously isolated in Ontario colonized five residents of a 254-bed LTC facility in Toronto. The index case was identified when VRE was isolated from a urine culture taken after admission to a local hospital. Screening of rectal swabs from all 235 residents identified four others who were colonized with the same strain ofE faecium.

Control Measures:

Colonized residents were cohorted. VRE precautions were established as follows: gown and gloves for resident contact, restriction of contact between colonized and noncolonized residents, no sharing of personal equipment, and daily double-cleaning of residents' rooms and wheelchairs.

Outcome:

Two colonized residents died of causes unrelated to VRE. Although bacitracin therapy (75,000 units four times a day X 14 days) failed to eradicate carriage in two of three surviving residents, both cleared their carriage within 7 weeks. Repeat rectal swabs from 224 residents (91%) 2 months after isolation precautions were discontinued and from 125 residents (51%) 9 months later identified no new cases. Total cost of investigation and control was $12,061 (Canadian).

Conclusion:

VRE may be transmitted in LTC facilities, and colonized LTC residents could become important VRE reservoirs. Control of VRE transmission in LTC facilities can be achieved even with limited resources.
The Mycobactericidal Efficacy of Ortho-Phthalaldehyde and the Comparative Resistances of Mycobacterium bovis, Mycobacterium terrae, and Mycobacterium chelonae
Authors: Gregory Adam W. , Schaalje G. Bruce , Smart Jonathan D. , Robison Richard A.
Published: February 2006

Objectives:

To assess the mycobactericidal efficacy of an agent relatively new to disinfection, ortho-phthalaldehyde (OPA) and to compare the resistances of threeMycobacteriumspecies.Mycobacterium bovis(strain BCG) was compared withMycobacterium chelonaeandMycobacterium terraeto investigate the feasibility of using either of the latter two species in tuberculocidal testing.M chelonae(a rapid grower) andM terrae(an intermediate grower) both grow faster and are less virulent thanM bovis(a slow grower).

Design:

The quantitative suspension protocol specified by the Environmental Protection Agency (EPA), the Tuberculocidal Activity Test Method (EPA test), was used throughout this study. Standard suspensions of all three species were prepared in a similar manner. Two suspensions ofM bovis,created in different laboratories, were used. These were tested against two concentrations of alkaline glutaraldehyde to provide reference data. Two concentrations of OPA were evaluated against all mycobacterial test suspensions. Four replicates of each organism-disinfectant combination were performed.

Results:

Results were assessed by analysis of variance.M terraewas significantly more resistant to 0.05% OPA than eitherM bovisorM chelonae.At 0.21% OPA,M terraewas slightly more susceptible than one test suspension ofM bovis,but not significantly different from the other.M chelonaewas significantly less resistant than the other species at both OPA concentrations. At their respective minimum effective concentration, OPA achieved a 6-log10 reduction ofM bovisin nearly one sixth the time required by glutaraldehyde (5.5 minutes vs 32 minutes).

Conclusions:

These data, along with other recent studies, lend support to the idea thatM terraemay be a suitable test organism for use in the tuberculocidal efficacy testing of disinfectants. They also confirm the relatively rapid tuberculocidal activity of OPA.
Occupational Injuries and Exposures Among Canadian Dentists: The Results of a National Survey
Authors: McCarthy Gillian M. , Koval John J. , MacDonald John K.
Published: February 2006

Objectives:

To measure the frequency of occupational exposures reported by dentists in Canada and to identify factors associated with occupational exposure.

Design:

A national mailed survey of a stratified random sample of 6,444 dentists with three follow-up attempts. Weighted data were analyzed usingttests, analysis of variance, and multiple logistic regression.

Results:

The response rate was approximately 66%. Occupational exposures, percutaneous injuries, and mucous membrane exposures in the last year were reported by 67%, 62%, and 29% of respondents, respectively. Fewer than 1% reported exposure to human immunodeficiency virus or hepatitis B virus (HBV). Respondents reported means of 1.5 mucous membrane and 3.0 percutaneous exposures per year. HBV immunization was reported by 91% of dentists, but of these 28% reported no post-immunization serology. Other reports of suboptimal compliance included use of a postexposure protocol by only 41% and HBV vaccination of all assistants or of hygienists by 74% and 77% of respondents, respectively. Factors associated with percutaneous exposure included non-use of postexposure protocol or puncture-proof containers for sharps disposal, treating ⩾20 patients per day, and male gender. Risk factors for mucous membrane exposure included non-use of eye protection or masks.

Conclusion:

This study provides evidence of the protective effect of puncture-proof containers, eye protection, and masks and raises concerns related to HBV post-immunization serology and postexposure protocols. To reduce risk of infection, educational interventions are required to improve compliance with Universal Precautions, with emphasis on comprehensive HBV immunization and post-immunization serology, the use of barriers, puncture-proof containers for sharps disposal, and postexposure protocols.
Agrobacterium radiobacter as a Cause of Pseudobacteremia
Authors: Rogues Anne-Marie , Sarlangue Jean , de Barbeyrac Bertille , Doerman Henri-Pierre , Helmer Catherine , Labadie Jean-Claude , Delfeau Christine , Sandler Boris , Bebear Christiane , Gachie Jean-Pierre
Published: February 2006

Agrobacterium radiobacterwas isolated from 15 blood cultures collected from 15 newborns. Contamination of blood cultures was suspected because, in most cases, the babies' illnesses seemed incompatible with infection.A radiobacterwas isolated from citrated tubes used for clotting-factor studies. Review of venipuncture technique revealed that occasionally the coagulation study tubes were being inoculated before the blood-culture bottles. This investigation demonstrated how an environmental source coupled with faulty technique caused a cluster of false-positive blood cultures.
Changing Heat and Moisture Exchangers Every 48 Hours Does Not Increase the Incidence of Nosocomial Pneumonia
Authors: Daumal Françoise , Colpart Eric , Manoury Benoît , Mariani Mercedès , Daumal Marc
Published: February 2006

This prospective study was conducted to evaluate the risk of nosocomial pneumonia when changing heat and moisture exchangers every 48 hours in 1996 instead of every 24 hours in 1995 for patients needing continuous mechanical ventilation. Medical and surgical patients in the two periods did not differ in terms of demographic characteristics and markers of acute or underlying illnesses. The incidence density of nosocomial pneumonia was not different in the two groups. Extended heat and moisture exchanger use reduces circuit manipulation and cost.
Bacitracin Versus Mupirocin for Staphylococcus aureus Nasal Colonization
Authors: Soto Norberto E. , Vaghjimal Ashok , Stahl-Avicolli Annette , Protic John R. , Lutwick Larry I. , Chapnick Edward K.
Published: February 2006

We performed a randomized prospective study of 5-day treatment with topical mupirocin or bacitracin for the elimination ofStaphylococcus aureusnasal colonization in healthcare workers (HCWs). Nasal cultures were obtained from 141 HCWs, 37 (26%) of whom showed Saureus.After 72 to 96 hours of treatment, the organism was eradicated in 15 (94%) of 16 by mupirocin and in 8 (44%) of 18 by bacitracin (P=.0031). Similar efficacy was demonstrated at 30 days. Mupirocin may be more effective than bacitracin for eradication of Saureusin healthy HCWs.
Infected Pressure Ulcers in the Long-Term–Care Facility
Authors: Smith Philip W. , Black Joyce M. , Black Steven B.
Published: February 2006

Pressure ulcers occur with some frequency in the elderly, debilitated population in long-term–care facilities. Pressure ulcers cause morbidity and mortality and, by virtue of breaking the integumentary barrier, predispose to skin and soft-tissue infections. The latter often are deep and require lengthy medical and surgical therapy. Prevention depends on avoidance of pressure, as well as providing adequate nutrition and meticulous skin care.
Nosocomial Methicillin-Resistant and Methicillin-SusceptibleStaphylococcus AureusPrimary Bacteremia: At What Costs?
Authors: Abramson Murray A. , Sexton Daniel J.
Published: February 2006

Objective:

To determine the attributable hospital stay and costs for nosocomial methicillin-sensitive Staphylococcus aureus (MSSA) and methicillin-resistantS aureus(MRSA) primary bloodstream infections (BSIs).

Design:

Pairwise-matched (1:1) nested case-control study.

Setting:

University-based tertiary-care medical center.

Patients:

Patients admitted between December 1993 and March 1995 were eligible. Cases were defined as patients with a primary nosocomialS aureusBSI; controls were selected according to a priori matching criteria.

Measurements:

Length of hospital stay and total and variable direct costs of hospitalization.

Results:

The median hospital stay attributable to primary nosocomial MSSA BSI was 4 days, compared with 12 days for MRSA (P=.023). Attributable median total cost for MSSA primary nosocomial BSIs was $9,661 versus $27,083 for MRSA nosocomial infections (P=.043).

Conclusion:

Nosocomial primary BSI due toS aureussignificantly prolongs the hospital stay. Primary nosocomial BSIs due to MRSA result in an approximate threefold increase in direct cost, compared with those due to MSSA.
Vancomycin Use in a University Medical Center: Effect of a Vancomycin Continuation Form
Authors: Evans Martin E. , Millheim Eric T. , Rapp Robert P.
Published: February 2006

Objective:

To examine the impact of a new policy to ensure appropriate use of vancomycin in a 461-bed tertiary-care hospital.

Design:

We instituted a policy that allowed physicians to prescribe vancomycin but that required them to complete a vancomycin continuation form and document that use conformed to Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines if they wished to continue the drug beyond 72 hours. Vancomycin was stopped automatically at 72 hours if use was not consistent with guidelines, if an infectious diseases consultant did not approve the drug, or if the form was not completed. A pharmacist and infectious diseases specialist monitored use of vancomycin prospectively and interacted with prescribers when indicated. Educational efforts were limited to printing the HICPAC guidelines on the form and providing information about the policy in a newsletter. Patterns of prescribing and the economic impact of the form were evaluated over a 6-month period.

Results:

Only 29% to 48% of vancomycin orders initially met HICPAC guidelines, but 77% to 96% of use was appropriate after 72 hours when the form was used. Inappropriate surgical prophylaxis, empirical therapy of intensive-care unit and transplant patients, and therapy for inadequately documented coagulase-negative staphylococcal infections remained problems. Vancomycin use fell from a mean of 136 (±52) g/1,000 patient days in the 12 months before the form to 78 (±22) g/1,000 patient days in the 9 months after institution of the form (P<.05). Net vancomycin acquisition costs and costs of ordering vancomycin serum levels fell by $357 and $19 per 1,000 patient days, respectively (P<.05). This represented annualized saving of approximately $47,000 in drug and monitoring costs. No adverse patient outcomes were seen as a result of the program.

Conclusions:

A vancomycin continuation form can decrease inappropriate vancomycin use and may save money. Additional educational efforts may be required to increase compliance with HICPAC guidelines during initial prescribing.
Treatment of aLegionella pneumophila-Colonized Water Distribution System Using Copper-Silver Ionization and Continuous Chlorination
Authors: Biurrun Amaya , Caballero Luis , Pelaz Carmen , León Elena , Gago Alberto
Published: February 2006

The detection in April 1997 of a case of nosocomial legionellosis in our hospital led to the discovery that both our hot- and cold-water circuits were heavily colonized withLegionella pneumophila. Conventional methods for eradication of the organisms were unsuccessful, so a copper-silver (Cu-Ag) ionization system and a continuous chlorination system were installed. Five months later, the number of colonized sites decreased from an initial 58.3% to 16.7%.
Monitoring Rotavirus Environmental Contamination in a Pediatric Unit Using Polymerase Chain Reaction
Authors: Soule Hervé , Genoulaz Odile , Gratacap-Cavallier Bénédicte , Mallaret Marie Reine , Morand Patrice , François Patrice , Bin Dominique Luu Duc , Charvier Agnés , Bost-Bru Cécile , Seigneurin Jean-Marie
Published: February 2006

Rotavirus environmental contamination in a pediatric unit was investigated. Surfaces were swabbed, then viruses eluted, ultracentrifuged, and detected by polymerase chain reaction (PCR) amplification. Of 55 samples, 25 (46%) tested positive. Rotavirus RNA was more prevalent on surfaces in direct contact with children (thermometers and play mats) than on other environmental surfaces (washbasins, door handles, etc). PCR has proved useful for monitoring rotavirus environmental contamination.
Evaluation of a Disinfection Procedure for Hysteroscopes Contaminated by Hepatitis C Virus
Authors: Sartor Catherine , Charrel Remi Nicolas , Lamballerie Xavier de , Sambuc Roland , Micco Philippe De , Boubli Leon
Published: February 2006

We assessed the ability of a standard disinfection procedure to eliminate hepatitis C virus (HCV) from the air-water channel of hysteroscopes. The residual HCV RNA remaining after the disinfection procedure was measured by polymerase chain reaction. When correctly applied to hysteroscopes, the standard disinfection procedure was sufficient to eliminate the risk of HCV transmission.
Perioperative Antibiotic Prophylaxis in Spanish Hospitals: Results of a Questionnaire Survey
Authors: Codina Carles , Trilla Antoni , Riera Nuria , Tuset Montserrat , Carne Xavier , Ribas Josep , Asenjo Miguel-Angel ,   Hospital Pharmacy Antimicrobial Prophylaxis Study Group
Published: February 2006

A questionnaire survey was sent to a random sample of the Spanish network of National Health System public acute-care hospitals. Of responding institutions (representing 25% of Spanish hospital beds), nearly 75% had active surveillance programs for the prevention and control of surgical-site infections (SSIs), but only 20% performed postdischarge surveillance. Overall, perioperative antibiotic prophylaxis (PAP) was used in 84% of all surgical procedures. For 77% of procedures, there were written guidelines for the choice and use of PAR Cefazolin was the most commonly used antibiotic (38%). Duration of PAP was shorter than 24 hours in 75% of procedures, and only a single dose was given in 52% of procedures. PAP was commonly used in breast (52%) and inguinal hernia repair (69%) procedures, as well as in laparoscopic abdominal surgery (86%). In summary, the use of PAP in Spanish hospitals is adequate, but improvements can be made in the frequency of prolonged PAP and in the use of broad-spectrum antibiotics. Surveillance systems for SSI, including postdischarge follow-up, also should be improved.
A Randomized Trial of 72- Versus 24-Hour Intravenous Tubing Set Changes in Newborns Receiving Lipid Therapy
Authors: Matlow Anne G. , Kitai Ian , Kirpalani Haresh , Chapman Nicola H. , Corey Mary , Perlman Max , Pencharz Paul , Jewell Sue , Phillips-Gordon Cindy , Summerbell Richard , Ford-Jones E. Lee
Published: February 2006

Objective:

To compare the microbial contamination rate of infusate in the intravenous tubing of newborns receiving lipid therapy, replacing the intravenous delivery system at 72-hour versus 24-hour intervals.

Design:

Infants requiring intravenous lipid therapy were randomly assigned to have intravenous sets changed on a 72- or a 24-hour schedule, in a 3:1 ratio, in order to compare the infusate contamination rates in an equivalent number of tubing sets.

Setting:

A 35-bed, teaching, referral, neonatal intensive-care unit (NICU).

Participants:

All neonates admitted to the NICU for whom intravenous lipid was ordered.

Methods:

Patients were randomized in pharmacy, on receipt of the order for intravenous lipid therapy, to either 72- or 24-hour administration set changes, and followed until 1 week after discontinuation of lipids or discharge from the NICU. Microbial contamination of the infusate was assessed in both groups at the time of administration set changes. Contamination rates were analyzed separately for the lipid and amino acid-glucose tubing sets. Patient charts were reviewed for clinical and epidemiological data, including birth weight, gestational age, gender, age at start of lipid therapy, duration of parenteral nutrition, and type of intravenous access.

Results:

During the study period, 1,101 and 1,112 sets were sampled in the 72- and 24-hour groups, respectively. Microbial contamination rates were higher in die 72-hour group than the 24-hour group for lipid infusions (39/1,101 [3.54%] vs 15/1,112 [1.35%];P=.001) and for amino acid infusions (12/1,093 [1.10%] vs 4/1,103 [0.36%];P=.076). Logistic regression analysis controlling for birth weight, gestational age, and type of venous access showed that only the tubing change interval was significanfly associated with lipid set contaminations (odds ratio, 2.69;P=.0013). The rate of blood cultures ordered was higher in die 72-versus the 24-hour group (6.11 vs 4.99 per 100 patient days of total parenteral nutrition;P=.017), and a higher proportion of infants randomized to the 72-hour group died (8% vs 4%;P=.05), although the excess deaths could not clearly be attributed to bacteremia.

Conclusion:

Microbial contamination of infusion sets is significantiy more frequent with 72- than witii 24-hour set changes in neonates receiving lipid solutions. This may be associated with an increased mortality rate.
Influenza Vaccination in Long-Term–Care Facilities: Structuring Programs for Success
Authors: McArthur Margaret A. , Simor Andrew E. , Campbell Beverly , McGeer Allison
Published: February 2006

Objectives:

To determine which influenza vaccination program characteristics were associated with high resident vaccination rates in Canadian long-term–care facilities (LTCFs).

Design:

A cross-sectional survey consisting of a mailed questionnaire conducted in spring 1991.

Participants:

All 1,520 Canadian LTCFs for the elderly with at least 25 beds.

Results:

The mean overall influenza vaccination rate in the 1,270 (84%) responding facilities was 79%. In multivariate analysis, the variables significantly associated with increased vaccination rates were: a single nonphysician staff person organizing the program, having more program aspects covered by written policies, the offering of vaccine to all residents, a policy of obtaining consent on admission that was durable for future years rather than repeating consent annually, and automatically administering vaccine to residents whose guardians could not be contacted for consent. Any encouragement to staff to be vaccinated had a significant impact on staff vaccination rates.

Conclusion:

Well-organized influenza vaccination programs increase the influenza vaccination rates of residents in Canadian LTCFs. Facilities need to develop resident vaccination programs further and to focus on vaccinating staff.
Efficacy of Prevention by High-Efficiency Particulate Air Filtration or Laminar Airflow Against Aspergillus Airborne Contamination During Hospital Renovation
Authors: Cornet Muriel , Levy Vincent , Fleury Laurent , Lortholary Jacques , Barquins Sandrine , Coureul Marie-Hélène , Deliere Elisabeth , Zittoun Robert , Brücker Gilles , Bouvet Anne
Published: February 2006

Objective:

To evaluate efficacy of laminar airflow facilities plus high-efficiency particulate air (HEPA) filtration and HEPA filtration alone in preventing environmentalAspergilluscontamination during hospital renovation. To show the usefulness of environmental surveillance to facilitate protection of patients at risk for invasive pulmonary aspergillosis.

Design:

Prospective sampling of air and surfaces forAspergillusconidia during 2-year period.

Setting:

A hematological department adjacent to building renovation at a university hospital.

Results:

1,047 air samples and 1,178 surface samples were collected from January 1996 to December 1997. Significantly more air samples were positive forAspergillusspecies during the period of building renovation than during the periods before and after renovation in a unit without a protected air supply adjacent to the building work area (51.5% vs 31.7%; odds ratio [OR], 2.3; 95% confidence interval [CI95, 1.4-3.7;P<.001). A major increase in the frequency of positive air samples was also found in another adjacent unit that was protected with HEPA filtration alone (from 1.8% to 47.5%; OR, 48.9; CI95,12-229;P<10-7). In addition, in this unit, the mean count ofAspergillusconidia in positive air samples increased significantly during construction (4 colony-forming units [CFU]/m3to 24.7 CFU/m3;P=.04) and the proportion of positive surface samples showed a significant increase during renovation (from 0.4% to 9.7%; OR, 28.3; CI95, 3.4-623;P=104). However, none of 142 air samples collected during renovation in the area protected with laminar airflow plus HEPA filtration showedAspergillusconidia. In a unit distant from the building renovation site, the results of air and surface samples were not affected by renovation.

Conclusion:

This study showed a strong association between building renovation and an increase in environmentalAspergilluscontamination. Results confirmed the high efficacy of laminar airflow plus HEPA filtration and a high air-change rate. Although filtration with HEPA was effective during normal conditions, it alone was unable to prevent the rise ofAspergilluscontamination related to building renovation. This study emphasized the necessity of an environmental survey of airborne contamination related to construction, to facilitate prevention of nosocomial aspergillosis outbreaks. A standardized protocol for aerobiological surveillance is needed.
Controlling Varicella in the Healthcare Setting: Barriers to Varicella Vaccination Among Healthcare Workers
Authors: Qureshi Mahmooda , Gordon Steven M. , Yen-Lieberman Belinda , Litaker David G.
Published: February 2006

We surveyed healthcare workers to determine factors that may influence acceptance of varicella-zoster virus vaccine. Of 2,801 workers tested, 90 were susceptible to varicella; of workers offered vaccination, 68% accepted. Workers providing direct patient care were 3.7-fold more likely than other workers to accept VZV vaccination (P=.04).
A Pseudoepidemic of Postoperative Scleritis Due to Misdiagnosis
Authors: Burwen Dale R. , Margo Curtis E. , McNeil Michael M. , Brown June M. , Tapelband Gerda , Jenkins Robert B. , Jarvis William R.
Published: February 2006

Objective:

To describe a pseudoepidemic of infectious scleritis following eye surgery.

Methods:

Retrospective cohort study with selected procedural and laboratory investigations.

Results:

Twenty-one patients with postoperative scleritis were identified during a 2-month outbreak. Neither an infectious etiology nor a causative pre-, intra-, or postoperative exposure was found. The clinical findings, when carefully reviewed, were consistent with poor surgical-wound closure.

Conclusions:

The art of clinical diagnosis involves the subjective interpretation of clinical history, physical findings, and laboratory results. A repeated error in the interpretation of clinical findings can simulate an outbreak of disease. Clinicians may be reluctant to concede misdiagnosis
Breakthrough Varicella Infection in a Healthcare Worker Despite Immunity After Varicella Vaccination
Authors: Wurtz Rebecca , Check Irene J.
Published: February 2006

Although varicella vaccination is recommended for varicella-susceptible healthcare workers (HCWs), breakthrough infection after vaccination is not unusual, especially following household exposures. We report breakthrough varicella in a vaccinated HCW and review the data on breakthrough infection and concerns for the healthcare setting.
A Decade of Prevalence Surveys in a Tertiary-Care Center: Trends in Nosocomial Infection Rates, Device Utilization, and Patient Acuity
Authors: Weinstein Jeffrey W. , Mazon Dorothy , Pantelick Elizabeth , Reagan-Cirincione Patricia , Dembry Louise M. , Hierholzer Walter J.
Published: February 2006

Objective:

To evaluate the usefulness of repeated prevalence surveys to determine trends in the rates of nosocomial infections and to detect changes in risk factors (eg, use of invasive devices) associated with nosocomial infections.

Patients And Methods:

Ten annual prevalence surveys were conducted by trained infection control practitioners between 1985 and 1995 for acute-care patients on the medical, surgical, pediatric, and obstetric-gynecologic services at a 900-bed, tertiary-care, teaching hospital with 750 acute-care beds. The same methods of chart review and concurrent reporting from nursing, the microbiology and clinical laboratory, and the pharmacy were used each year to collect data on the prevalence of nosocomial infections, invasive-device utilization, and abnormal laboratory indicators. Although data were collected on a single day, a period-prevalence study approach was used, because charts were reviewed for any infection data occurring within the 7 days prior to the survey.

Results:

The hospital census for acute-care patients, as measured by the prevalence surveys, declined sharply over the 10 years, from 673 to 575 patients (P=.02). However, the medical service census increased from 150 to 188 patients (P=.01). During the same period, there was a significant decrease in the mean length of stay, from 7.3 to 6.0 days (P=.01), and a concomitant increase in the mean diagnosis-related-group case-mix index, from 1.03 to 1.24 (P=.001). Overall, nosocomial infection rates remained unchanged over the study period (mean of 9.85 infections per 100 patients), but rates of nosocomial bloodstream infection increased from 0.0% in 1985 to 2.3% in 1995 (P=.05). Nosocomial infection rates were significantly higher on the medical and surgical services than on other services (P<.001). Utilization rates increased significantly for Foley catheters (9.0% to 16.0%, P=.002) and ventilators (5.0% to 8.0%, P=.05).

Conclusions:

Despite apparent increases in the severity of illness of our patients, overall rates of nosocomial infection remained stable during a decade of study. Rates of nosocomial bloodstream infection increased, in parallel with National Nosocomial Infection Surveillance System data. We found repeated prevalence surveys to be useful in following trends and rates of infection, device utilization, and abnormal laboratory values among patients at our institution. Such methodologies can be valuable and low-cost components of a comprehensive infection surveillance, prevention, and control program and other potential quality-improvement initiatives, because they enable better annual planning of departmental strategies to meet hospital needs
Prospective Evaluation of a Hospital Epidemiologist's Activities at a European Tertiary-Care Medical Center
Authors: Ruef Christian
Published: February 2006

Objective:

Assessment of the distribution of tasks and consultations provided by the hospital epidemiologist (HE) at University Hospital of Zurich (UHZ).

Design:

Prospective collection of data on hospital epidemiology consultations over a 3-year period (1995-1997). Time spent per consultation and activities of infection control practitioners were not recorded.

Setting:

A 1,040-bed tertiary-care university hospital in Zurich, Switzerland.

Results:

Between January 1, 1995, and December 31, 1997, the HE received 1,660 requests for consultation. Advice or action was sought in the following areas: epidemiology (27.5% of requests); quality assurance, including antibiotic utilization and technology assessment (24.8%); infection control and practice guidelines (22.5%); disinfection and sterilization (11.6%); clinical infectious diseases (13.4%). During 1997, 35% of epidemiology consults were related to methicillin-resistant Staphylococcus aureus and 5.8% to tuberculosis. Public or private hospitals not affiliated with UHZ requested 40% of all consults.

Conclusions:

This study shows that HEs are involved in many different activities. Only 27.5% of hospital epidemiology consultations were directly related to issues of epidemiology. Practical knowledge of the methodologies for continuous quality improvement and assessment of various new technologies is important for HEs. The results of this study may be useful in discussions between HEs and administrators about allocation of resources or issues of reimbursement.