bluuebunny/crossref_metadata_2025 huggingface dataset:
Neural responses to sanction threats in two-party economic exchange
Authors: Li Jian , Xiao Erte , Houser Daniel , Montague P. Read
Published: September 2009

Sanctions are used ubiquitously to enforce obedience to social norms. However, recent field studies and laboratory experiments have demonstrated that cooperation is sometimes reduced when incentives meant to promote prosocial decisions are added to the environment. Although various explanations for this effect have been suggested, the neural foundations of the effect have not been fully explored. Using a modified trust game, we found that trustees reciprocate relatively less when facing sanction threats, and that the presence of sanctions significantly reduces trustee's brain activities involved in social reward valuation [in the ventromedial prefrontal cortex (VMPFC), lateral orbitofrontal cortex, and amygdala] while it simultaneously increases brain activities in the parietal cortex, which has been implicated in rational decision making. Moreover, we found that neural activity in a trustee's VMPFC area predicts her future level of cooperation under both sanction and no-sanction conditions, and that this predictive activity can be dynamically modulated by the presence of a sanction threat.
Repression of DNA-binding dependent glucocorticoid receptor-mediated gene expression
Authors: Muzikar Katy A. , Nickols Nicholas G. , Dervan Peter B.
Published: September 2009

The glucocorticoid receptor (GR) affects the transcription of genes involved in diverse processes, including energy metabolism and the immune response, through DNA-binding dependent and independent mechanisms. The DNA-binding dependent mechanism occurs by direct binding of GR to glucocorticoid response elements (GREs) at regulatory regions of target genes. The DNA-binding independent mechanism involves binding of GR to transcription factors and coactivators that, in turn, contact DNA. A small molecule that competes with GR for binding to GREs could be expected to affect the DNA-dependent pathway selectively by interfering with the protein-DNA interface. We show that a DNA-binding polyamide that targets the consensus GRE sequence binds the glucocorticoid-induced zipper (
GILZ
) GRE, inhibits expression of
GILZ
and several other known GR target genes, and reduces GR occupancy at the
GILZ
promoter. Genome-wide expression analysis of the effects of this polyamide on a set of glucocorticoid-induced and -repressed genes could help to elucidate the mechanism of GR regulation for these genes.
The differential substitution of English /θ ð/ in French
Authors: Picard Marc
Published: September 2009

Summary

One of the most interesting problems in second-language (L2) phonology is how to account for differential substitution. This is the phenomenon by which speakers who lack a certain segment (sequence) in their first language (L1) may adopt alternative language-specific replacement strategies in the L2 they are attempting to acquire. It has recently been claimed by Weinberger (1997) that the reason why, for example, Japanese learners of English systematically replace English /θ ð/ by /s z/ while their Russian counterparts always substitute /t d/ is that fricatives are unspecified for the feature [continuant] in Japanese while in Russian, the stops constitute the default obstruents. What is argued here is that this analysis in terms of Underspecification Theory cannot possibly work in the case of European and Canadian French which evince an equally systematic differential substitution of /θ ð/ to /s z/ and /t d/ respectively even though they have an identical system of underlying obstuents. It is also suggested that a perception-based approach to the thorny problem of differential substitution would appear to be a much more promising avenue of research.
Automatic extraction of paraphrastic phrases from small-size corpora
Authors: Poibeau Thierry , Dutoit Dominique
Published: September 2009

This paper presents a versatile system intended to acquire paraphrastic phrases from a small-size representative corpus. In order to decrease the time spent on the elaboration of resources for NLP system (for example for Information Extraction), we suggest to use a knowledge acquisition module that helps extracting new information despite linguistic variation. This knowledge is semi-automatically derived from the text collection, in interaction with a large semantic network.
Improved Algorithms for Data-Gathering Time in Sensor Networks II: Ring, Tree, and Grid Topologies
Authors: Revah Yoram , Segal Michael
Published: September 2009

We address the problem of gathering information in sensor webs consisting of sensors nodes, wherein a round of communication sensor nodes have messages to be sent to a distant central node (called the base station) over the shortest path. There is a wide range of data gathering applications like target and hazard detection, environmental monitoring, battlefield surveillance, etc. Consequently, efficient data collection solutions are needed to improve the performance of the network. In this article, we take into account the fact that interference can occur at the reception of a message at the receiver sensor. In order to save redundant retransmissions and energy, we assume a known distribution of sources (each node wants to transmit at most one packet) and one common destination. We provide a number of scheduling algorithms jointly minimizing both the completion time and the average packet delivery time. We define our network model using directional antennas and consider Ring, Tree, and Grid Network (and its generality) topologies. All our algorithms run in low-polynomial time.
Seeing with ears: Sightless humans’ perception of dog bark provides a test for structural rules in vocal communication
Authors: Molnár Csaba , Pongrácz Péter , Miklósi ádám
Published: September 2009

Prerecorded family dog ( Canis familiaris) barks were played back to groups of congenitally sightless, sightless with prior visual experience, and sighted people (none of whom had ever owned a dog). We found that blind people without any previous canine visual experiences can categorize accurately various dog barks recorded in different contexts, and their results are very close to those of sighted people in characterizing the emotional content of barks. These findings suggest that humans can recognize some of the most important motivational states reflecting, for example, fear or aggression in a dog's bark without any visual experience. It is very likely that this result can be generalized to other mammalian species—that is, no visual experience of another individual is needed for recognizing some of the most important motivational states of the caller.
Controlling Vancomycin-Resistant Enterococci
Authors: Boyce John M. , Mermel Leonard A. , Zervos Marcus J. , Rice Louis B. , Potter-Bynoe Gail , Giorgio Christina , Medeiros Antone A.
Published: September 2009

After controlling an epidemic of vanB-type vancomycin-resistant Enterococcus faecium (VRE), we contained a subsequent vanA E faecium outbreak by using prospective laboratory-based surveillance, placing patients with VRE in private rooms, requiring the use of both gowns and gloves by all personnel entering the patients' rooms, and conducting prevalence surveys of patients on affected wards.
The Need for Surveillance for Antimicrobial Resistance
Authors: Lorian Victor
Published: September 2009

Currently, collection of bacterial susceptibility data is very incomplete; national or international susceptibility data simply do not exist. The large volume of scientific publications on this subject contributes to the perception that bacterial resistance to antimicrobials is extensive and growing. However, only a very few papers address the epidemiology of bacterial resistance. Those papers that do report quantitatively on this topic are from hospitals that are systematically different from hospitals that do not publish. No one can deny the existence and the importance of drug resistance, but the sensational reports from the media are grossly untrue. Multidrug-resistant bacteria affect an extremely small proportion of patients. Most antibiotics still are highly effective and cure the majority of infections. It is proposed that medical microbiology laboratories report their susceptibility data on eight common species that constitute 68.5% of all isolates. Such reports could be analyzed and published yearly.
Nosocomial Colonization and Its Impact on Hospital-Acquired Infections
Authors: Mayhall C. Glen
Published: September 2009

We are pleased to bring to our readership the contents of a symposium on nosocomial colonization held on January 14-16, 1994, in Clearwater, Florida, under the aegis of the University of South Florida College of Medicine and the National Foundation for Infectious Diseases.

The symposium was developed with the following goals: (1) to provide an up-to-date over view of the factors important in microbial colonization of human nonsterile surfaces or tissues, especially skin, nose, oropharynx, and gastrointestinal tract; (2) to provide an understanding of the impact of colonization upon the development of nosocomial infections; and (3) to provide an appreciation of how to control or manage colonization to prevent nosocomial infections.
Control of Methicillin-Resistant Staphylococcus aureus at a University Hospital: One Decade Later
Authors: Jernigan John A. , Clemence Mark A. , Stott Geraldine A. , Titus Maureen G. , Alexander Carolyn H. , Palumbo Carol M. , Farr Barry M.
Published: September 2009

Objective:

To investigate the cause of increasing rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection at a university hospital.

Design:

Review of data collected by prospective hospitalwide surveillance regarding rates of nosocomial MRSA colonization and infection.

Setting:

A 700-bed university hospital providing primary and tertiary care.

Patients:

Patients admitted to the hospital between 1986 and 1993 who were found to be infected or colonized with MRSA.

Main Outcome Measurement:

Rates of MRSA infection and colonization.

Results:

MRSA infection or colonization was identified in 399 patients (0.18%) admitted during the 8-year study. There was no correlation between the annual rates of MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) infections (P=.66). The frequency of both nosocomial and non-nosocomial cases increased significantly over the last 4 years of the study (P<.001 for trend). The ratio of patients who had acquired MRSA nosocomially to those admitted who already were infected or colonized decreased significantly during the study period (P=.002 for trend). There was a significant increase in the frequency of patients with MRSA being transferred from nursing homes and other chronic care facilities (P=.011). A cost-benefit analysis suggested that surveillance cultures of patients transferred from other healthcare facilities would save between $20,062 and $462,067 and prevent from 8 to 41 nosocomial infections.

Conclusions:

An increase in the incidence of nosocomial MRSA infection was associated with an increased frequency of transfer of colonized patients from nursing homes and other hospitals. The lack of correlation between rates of MRSA and MSSA infections suggested that MRSA infections significantly increased the overall rate of staphylococcal infection. Screening cultures of transfer patients from facilities with a high prevalence of MRSA may offer significant benefit by preventing nosocomial infections and reducing patient days spent in isolation.
Skin and Mucous Membrane Contacts With Blood During Surgical Procedures: Risk and Prevention
Authors: Tokars Jerome I. , Culver David H. , Mendelson Meryl H. , Sloan Edward P. , Farber Bruce F. , Fligner Denise J. , Chamberland Mary E. , Marcus Ruthanne , McKibben Penny S. , Bell David M.
Published: September 2009

Objective:

To study the epidemiology and preventability of blood contact with skin and mucous membranes during surgical procedures.

Design:

Observers present at 1,382 surgical procedures recorded information about the procedure, the personnel present, and the contacts that occurred.

Setting:

Four US teaching hospitals during 1990.

Participants:

Operating room personnel in five surgical specialties.

Main Outcome Measures:

Numbers and circumstances of contact between the patient's blood (or other infective fluids) and surgical personnel's mucous membranes (mucous membrane contacts) or skin (skin contacts, excluding percutaneous injuries).

Results:

A total of 1,069 skin (including 620 hand, 258 body, and 172 face) and 32 mucous membrane (all affecting eyes) contacts were observed. Surgeons sustained most contacts (19% had ≥1 skin contact and 0.5% had ≥1 mucous membrane-eye contact). Hand contacts were 72% lower among surgeons who double gloved, and face contacts were prevented reliably by face shields. Mucous membrane-eye contacts were significantly less frequent in surgeons wearing eyeglasses and were absent in surgeons wearing goggles or face shields. Among surgeons, risk factors for skin contact depended on the area of contact: hand contacts were associated most closely with procedure duration (adjusted odds ratio [OR], 9.4; ≥4 versus <1 hour); body contacts (arms, legs, and torso) with estimated blood losses (adjusted OR, 8.4; ≥1,000 versus <100 mL); and face contacts, with orthopedic service (adjusted OR, 7.5 compared with general surgery).

Conclusion:

Skin and mucous membrane contacts are preventable by appropriate barrier precautions, yet occur commonly during surgery. Surgeons who perform procedures similar to those included in this study should strongly consider double gloving, changing gloves routinely during surgery, or both.
The Risk of Infection Associated With Epidural Analgesia
Authors: Brooks Kathy , Pasero Chris , Hubbard Lex , Coghlan Raymond H
Published: September 2009

Four infections were identified among 4,832 patients receiving epidural analgesia (an attack rate of 0.08%). The infections involved cesarean-section patients and occurred within a 9-month period. Findings suggest that the risk of infection is decreased by maintaining a closed system for the duration of the analgesia course.
An Overview of Nosocomial Infection Control in Brazil
Authors: Pannuti Claudio S. , Grinbaum Renato S.
Published: September 2009

Brazil is the largest country in Latin America, with a population of 146 million people. The socioeconomic development and the distribution of population and health services varies widely within the country. There are approximately 1.2 million hospital admissions per month, 80% of them paid by a government healthcare program that follows the diagnosis-related groups (DRGs) model. The Ministry of Health has been trying to establish a nationwide nosocomial infection control program since 1983. Most Brazilian hospitals now have some kind of infection control activity, but only a few of them have complete programs. Infrastructural deficiencies, the scarcity of well-trained healthcare workers, and the widespread occurrence of multiresistant Staphylococcus aureus and gram-negative bacteria are some of the challenges faced by Brazilian hospitals in the control of nosocomial infection.
Infection Control in a Country with Annual Inflation of 3,600%
Authors: Wey Sergio B.
Published: September 2009

The economic crisis that has been seen worldwide affects developing countries such as Brazil even more severely. Worsening budget shortfalls for the healthcare system progressively threaten patient care. Infection control programs also are affected, and basic preventive policies are not implemented. Infection control practitioners face lack of equipment and poor microbiological support. In contrast, the motivation of the infection control people can be maintained through training courses, conferences, and meetings. Administrative support may be the most important single factor determining success in decreasing the infection control rate and should be (but is not always) provided, given that several infection control measures are cost effective.
Mupirocin Resistance: Clinical and Molecular Epidemiology
Authors: Bradley Suzanne F. , Ramsey Mary A. , Morton Teresa M. , Kauffman Carol A.
Published: September 2009

The antistaphylococcal activity of topical mupirocin has made it an attractive agent for the treatment of asymptomatic colonization with Staphylococcus aureus. Increasing use has been associated with the emergence of mupirocin resistance in staphyloccoci, and failure of therapy has been associated with the isolation of strains exhibiting high-level resistance (MIC >500 μg/mL). Fortunately, low-level mupirocin resistance (MIC <100 μg/mL) occurs most commanly. Because a novel gene encoding for mupirocin resistance resides in both low-level and high-level resistant strains, the emergence of low-level mupirocin resistance may not be as epidemiologically insignificant as previously thought.
The Impact of US-Style Infection Control Programs in an Asian Country
Authors: Leu Hsieh-Shong
Published: September 2009

The impact of US-style infection control programs is global. There are many Asian countries that have translated US-style infection control programs into their own programs, but reports of those efforts are rarely published in English. This article describes the development of infection control in Taiwan and the development of intensive infection surveillance and control programs in a pioneer acute-care medical center that has 3,000 beds. The article also discusses problems that have arisen in translation of US infection control practices.
Colonization and Infection With Methicillin-Resistant Staphylococcus aureus: Associated Factors and Eradication
Authors: Asensio Angel , Guerrero Antonio , Quereda Carmen , Lizán Maxima , Martinez-Ferrer Manuel
Published: September 2009

Objectives:

To identify characteristics associated with methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection, and to evaluate the efficacy of systemic and topical antimicrobials in the eradication of MRSA carriage among hospitalized patients.

Design:

A case-control study was done to identify associations. Odds ratios were estimated by unconditional multiple logistic regression. Cohort study was done to evaluate MRSA decolonization efficacy by an oral regimen. Patients infected or colonized with MRSA received a 5-day course of oral (166 mg/800 mg) trimethoprim-sulfametroxazole twice daily and 600 mg of rifampin once daily as decolonization treatment. The proportion of MRSA-free patients after decolonization treatment was determined. Persistence of clearing was estimated by the Kaplan-Meier method.

Setting:

Ramón y Cajal Hospital, a 1,249-bed, tertiary-care teaching hospital in Madrid, Spain.

Patients:

One hundred ninety-two patients with hospital-acquired MRSA infection/colonization and 195 MRSA-free random controls.

Results:

Six factors were associated independently with MRSA infection/colonization: age (every 10 years of age, odds ratio [OR]=1.3); ward (surgical, OR=1; medical, OR=3.1; intensive care unit, OR=60); previous hospitalization (OR=6.9); coma (OR=25.3); invasive procedures (each, OR=1.7); 3 or more weeks of hospitalization (OR=3.8). We failed to show antibiotic therapy to be an independent risk factor for MRSA hospital infection/colonization. Overall, MRSA eradication was 64.2% by day 2 to 9 after completion of treatment. Kaplan-Meier product limit survival analysis showed that the probability of remaining MRSA-free was 65.3% (SE=0.09) at 32 days after completion of treatment.

Conclusions:

The results offer a rationale for reduction of MRSA infection/colonization in the hospital by interventions aimed at early identification of patients at higher risk, at prompt discharge of patients, and at preventing dissemination while performing invasive procedures. They also provide estimates of antibiotic treatment efficacy to reduce the reservoir of MRSA in the hospital.
The Microbiology of Colonization, Including Techniques for Assessing and Measuring Colonization
Authors: Greene John N.
Published: September 2009

Organisms living on our external and internal body surfaces are the first contact for many potentially pathogenic invaders. Factors that alter this microenvironment include antibiotics, the host immunity, and the various diseases of man and their treatment. Predicting when colonization leads to infection remains an important challenge for every clinician. The maintenance and breakdown of colonization resistance by changes in the native microflora and the body's natural mucosal coating by various extrinsic and intrinsic factors is reviewed in this article. Quantitative culture methods developed to improve the predictive value of a given sampling technique (most notably with bronchoscopy) is presented. Besides improving diagnostic capabilities, quantitative cultures can be used successfully as an epidemiologic tool for some outbreak investigations.
High-Level Disinfection or “Sterilization” of Endoscopes?
Authors: Muscarella Lawrence Freed
Published: September 2009

Controversy has surrounded the use of liquid chemical germicides to reprocess medical instruments that are damaged by heat sterilization. A review of the literature was performed to assess and compare the efficacy of disinfection and sterilization processes. The results of this review demonstrate that high-level disinfection of thoroughly cleaned endoscopes is not associated with a higher infection rate than is “sterilization.” While there may be a theoretical distinction between the highest level of disinfection and sterilization, thorough cleaning eliminates clinical differences between the two. High-level disinfection is quick, effective, inexpensive, and recommended whenever heat sterilization is not feasible. A low-temperature sterilization process should be considered only if it is comparable in cost to disinfection or if it offers demonstrated advantages without damaging the instrument. Neither disinfection nor sterilization is likely to be effective if the instrument is not cleaned thoroughly after use.
Control of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive-Care Unit: Use of Intensive Microbiologic Surveillance and Mupirocin
Authors: Back Nancy A. , Linnemann Calvin C. , Staneck Joseph L. , Kotagal Uma R.
Published: September 2009

Objective:

To describe the epidemiology and the inter ventions used to control two methicillin-resistant Staphylococcus aureus (MRSA) epidemics involving 46 infants with two fatalities in a neonatal intensive care unit (NICU).

Setting:

A 50-bed, level III NICU in a university hospital.

Interventions:

After traditional interventions failed to stop the first epidemic, an intensive microbiologic surveillance (IMS) program was developed. Cultures were obtained on all infants each week, and those colonized with MRSA were isolated. When an infant was found to be colonized with MRSA, cultures immediately were obtained on all surrounding infants. This was continued until no MRSA-colonized infants were found in the area. During the first epidemic, mupirocin was used in an attempt to eradicate the organism from the unit.

Results:

All infants, colonized and noncolonized, and parents of and personnel working with colonized infants were treated simultaneously with 5 days of mupirocin. This failed to eradicate MRSA in colonized infants. The spread of MRSA ceased in the unit, but a second epidemic occurred 4 months later. This time, IMS alone was successful in quickly containing the epidemic, and MRSA disappeared from the unit after all colonized infants were discharged. Plasmid analysis demonstrated that the same strain was responsible for both outbreaks.

Conclusions:

IMS and isolation are effective in containing the spread of MRSA in an NICU. The use of mupirocin failed to eradicate the organism.
Total Cholesterol, HDL-Cholesterol, and Risk of Nosocomial Infection: A Prospective Study in Surgical Patients
Authors: Delgado-Rodríguez Miguel , Medina-Cuadros Marcelino , Martínez-Gallego Gabriel , Sillero-Arenas María
Published: September 2009

Objective:

To study the relationship between serum high-density lipoprotein cholesterol (HDL-C), total serum cholesterol, and nosocomial infection in patients undergoing general surgery.

Design:

Prospective cohort study, with an extended follow-up to 1 month after hospital discharge.

Setting:

The general surgery service of a tertiary hospital.

Main Outcome Measure:

Nosocomial infection, mainly surgical-site infection (SSI), urinary tract infection, respiratory tract infection (RTI), and bacteremia.

Patients:

1,267 surgery patients aged 10 to 92 years.

Results:

182 subjects acquired 194 nosocomial infections, a cumulative incidence of 14.5%; most (116, 62.3%) were postoperative wound infections. There was an increase in infection risk at low levels of HDL-C, and both low and high total cholesterol levels. After adjusting simultaneously for several confounders, including total cholesterol, low levels of HDL-C (≤20 mg/dL) yielded an odds ratio (OR) of 2.2 (95% confidence interval [CI95], 0.6-7.9) for SSI and an OR of 10.3 (CI95, 0.7-151.5) for RTI. Otherwise, no trend was observed between HDL-C levels and infection risk, and no increased risk of nosocomial infection was observed for HDL-C values in the range of 21 to 49 mg/dL. Serum cholesterol showed a U-shaped relationship with nosocomial infection risk. Both low levels (below 102 mg/dL) and high levels (above 290 mg/dL) of total cholesterol were associated with a higher risk of SSI (mainly those caused by gram-negative bacteria) and RTI in comparison with the reference group (139-261 mg/dL).

Conclusions:

Serum HDL-C and total cholesterol seem to be associated with the risk of nosocomial infection in surgical patients
Correlation Between Frequency of Tuberculosis and Compliance With Control Strategies
Authors: Roy Marie-Claude , Fredrickson Mary , Good Natalie L. , Hunter S. Ann , Nettleman Mary D.
Published: September 2009

Objective:

To determine if compliance with annual tuberculosis skin testing correlated with the number of cases of tuberculosis seen in patients and healthcare workers.

Design:

Survey using a written questionnaire.

Setting and Participants:

159 Veterans' Administration facilities.

Results:

Hospitals that reported that >80% of their healthcare workers received annual skin tests saw 12.7 patient cases per 10,000 admissions and 4.0 healthcare worker cases per 10,000 personnel. Facilities in which <20% of their healthcare workers were given annual skin tests saw 4.5 cases per 10,000 admissions and 1.6 cases in healthcare workers per 10,000 personnel (P<.001 for patients and P=.31 for healthcare workers). The ratio of the median number of patients placed in acid-fast bacilli (AFB) isolation to the median number of patients with confirmed tuberculosis was 12. There was no correlation of this ratio with the number of cases of tuberculosis in patients or healthcare workers seen in each facility.

Conclusion:

Compliance with annual tuberculosis skin testing was related directly to the rate of tuberculosis seen in patients. More standardized policies for placing patients in AFB isolation are needed to control for potentially costly variation among facilities. These measures should have highest priority in the control of tuberculosis in the healthcare setting, before implementing still more expensive interventions.
Use of Electrophoretic Karyotyping in the Evaluation of Candida Infections in a Neonatal Intensive-Care Unit
Authors: Vazquez Jose A. , Boikov Dina , Boikov Sergei G. , Dajani Adnan S.
Published: September 2009

Objective:

To evaluate a possible commonsource outbreak of Candida infections in the neonatal intensive-care unit. Systemic Candida infections increased from 6 to 11 cases (0.71 to 1.34 per 1,000 patient-days). In addition, Candida parapsilosis infections increased from 1 in 1992 to 10 in 1993.

Design and Setting:

Tertiary-care, teaching, pediatric institution with a 40-bed neonatal intensive-care unit (NICU). Clinical characteristics, associated conditions, and antimicrobial therapy were obtained from the medical records of all NICU patients with positive blood cultures for Candida during 1992 and 1993. Nineteen Candida isolates from 15 infants were studied retrospectively using contour-clamped homogeneous electric-field (CHEF) electrophoresis.

Results:

CHEF revealed eight karyotypes of C parapsilosis. Five isolates recovered from four patients shared one karyotype. The remaining isolates from seven infants all had distinctly different karyotypes.

Conclusions:

The evidence was insufficient to implicate a single source of infection, even though four patients in the same unit had identical strain types. However, identical strains of C parapsilosis were associated geographically, suggesting that nosocomial acquisition of C parapsilosis through indirect patient contact in the NICU was possible. The CHEF technique yields unique patterns that may be used to delineate clinical isolates and to study the molecular epidemiology of candidal infections.
The Evolution of the Surgical Mask: Filtering Efficiency Versus Effectiveness
Authors: Belkin Nathan L.
Published: September 2009

When originally introduced for use at the turn of the century, the primary function of the surgical mask was to prevent the migration of microorganisms residing in the nose and mouth of members of the operating team to the open wound of the patient. As technology developed new materials and designs, their filtering efficiencies gradually improved. However, there is no standard test method for assessing that capability, and its influence on the rates of surgical-wound infection has yet to be demonstrated. Quite to the contrary, both in-vitro and in-vivo studies indicate that a mask may not be universally necessary in today's surgical environment.
Isolation
Authors: Edmond Michael
Published: September 2009

Patients infected or colonized with certain microorganisms must be placed in isolation while hospitalized to prevent nosocomial transmission of these pathogens. Isolation systems enable healthcare workers to identify patients who need to be isolated and to institute the appropriate precautions. This article presents an overview of isolation precautions, emphasizing the latest guidelines from the Centers for Disease Control and Prevention.
Sentinel System for Nosocomial Infections in the Netherlands A Pilot Study
Authors: Severijnen A.J. , Verbrugh H.A. , Groot A.J. Mintjes-de , Vandenbroucke-Grauls C.M.J.E. , van Pelt W.
Published: September 2009

Objective:

To determine the feasibility of stan¬dardized surveillance of nosocomial infections (NI) in The Netherlands, using local data on patients with NI collected by infection control practitioners (ICPs) and denominator data on all patients under surveillance obtained from the Dutch National Medical Registry (LMR).

Design:

A prospective, multicenter study.

Setting:

Eight hospitals in the Utrecht region, and the National Institute of Public Health and the Environment.

Patients:

ICPs traced NI in gynecological and orthopedic patients for 9 to 16 months. Denominator data on all patients under surveillance were obtained from the LMR

Results:

Data from 8,922 patients were collected; the ICPs registered 470 patients with 526 N1. Overall, the NI incidence was 5.9 per 100 patients, or 6.3 per 1,000 patient days. Urinary tract infections (UTI) were most frequent (3.3%), followed by surgical-wound infections (SWI; 2.0%) and bloodborne infections (0.12%). The incidence of both SWI and UTI differed markedly between hospitals, only partially on account of differences in patient mix (age, type of operations), antibiotic prophylaxis, and intensity of tracing methods for NI. Delay in the availability of denominator data hampered the timely feedback of incidence figures.

Conclusions:

Surveillance of NI in a network of sentinel hospitals offered valuable information on the occurrence of NI and on factors influencing the incidence of NI. It revealed situations in which both NI surveillance and infection control methods in individual hospitals should be improved. Obtaining denominator data on all patients from electronically registered patient discharge data greatly reduces the workload of ICPs and enables surveillance on all types of NI (all body sites and all pathogens). For timely feedback, numerator and denominator data within hospitals must be linked.
Modeling the Spread of Resistant Nosocomial Pathogens in an Intensive-Care Unit
Authors: Sébille Véronique , Chevret Sylvie , Valleron Alain-Jacques
Published: September 2009

Objectives:

To show the value of mathematical modeling in simulating the spread of nosocomial pathogens in an intensive-care unit (ICU), to provide a framework for listing available knowledge; to predict the benefits of various control measures; and to supplement the epidemiological assessment of these measures.

Design:

Simulated outbreak of a nosocomial pathogen in an ICU, based on a deterministic compartmental model describing both person-to-person spread and indirect spread between patients through staff members.

Interventions:

Simulation of three typical colonization control measures: effective handwashing compliance among staff members, ICU antimicrobial policy, and curtailing ICU admission of colonized patients.

Results:

In controlling colonization, effective handwashing compliance reduced staff member colonization, but only moderately limited patient colonization unless the ICU was isolated strictly by curtailing the admission of colonized patients. The impact of antibiotic policy was very slight.

Conclusions:

In the field of nosocomial infection, mathematical modeling appears to be a valuable tool that can be used to evaluate the magnitude of the expected effects of control strategies and to guide the selection of the best randomized clinical trials to pursue.
Nosocomial Infections in Neonates Receiving Extracorporeal Membrane Oxygenation
Authors: Coffin Susan E. , Bell Louis M. , Manning MaryLou , Polin Richard
Published: September 2009

Objective:

To determine the incidence of, and risk factors for, nosocomial infections in neonates during and after treatment with extracorporeal membrane oxygenation (ECMO).

Design:

A retrospective cohort study of all infants treated with ECMO during a 4-year period.

Patients:

26 neonates experiencing 32 nosocomial infections, and 54 neonates with no nosocomial infections.

Setting:

A large, urban children's hospital.

Results:

30% of neonates treated with ECMO experienced at least one nosocomial infection. The rate of nosocomial infections was 10.3 per 1,000 patient-days. Risk factors significantly associated with nosocomial infection included duration of ECMO >7 days (mean, 12 vs 7 days; odds ratio [OR], 2.84; 95% confidence interval [CI95], 0.96-8.56); neonatal intensive care-unit stay >21 days (mean, 44 vs 19 days; OR, 8.73; CI95, 2.49-31.94); hospitalization >50 days (mean, 63 vs 29 days; OR, 5.44; CI95, 1.47-20.87); and surgical procedure before or during ECMO (46% vs 22%; OR, 4.58; CI95, 1.25 to 17.38).

Conclusions:

Nosocomial infections occurred in 30% of patients undergoing ECMO. Although nosocomial infections were not associated with an increase in mortality, hospitalization was prolonged.
Handwashing and Glove Use in a Long-Term–Care Facility
Authors: Thompson Betsy L. , Dwyer Diane M. , Ussery Xilla T. , Denman Susan , Vacek Pam , Schwartz Benjamin
Published: September 2009

Objectives:

To determine glove use and handwashing practices, the factors associated with infection control practices, and the frequency of potential microbial transmission in a long-term–care facility (LTCF).

Design:

Observational study of 230 staff-resident interactions in an LTCF. We recorded resident characteristics, type of activity, staff credentials, and movements of the staff member's hands, then used the LTCF's guidelines to judge appropriateness of glove use and handwashing.

Setting:

255-bed, university-based LTCF in Baltimore, Maryland.

Participants:

A systematic sample of staff-resident interactions.

Results:

Gloves were worn in 139 (82%) of 170 interactions when indicated, but changed appropriately in only 21 (16%) of 132. Hands were washed when needed before an interaction in 27%, during an interaction in 0%, and after an interaction in 63%. Gloves were less likely to be used when caring for residents with gastrostomy tubes compared with other residents (relative risk, 0.85; 95% confidence interval, 0.73-0.98). Guidelines were followed more frequently during wound care than during other activities. Microbial transmission potentially could have occurred in 158 (82%) of 193 evaluable interactions.

Conclusions:

We documented marked deficiencies in glove use and handwashing, demonstrated the possible impact of these deficiencies, and identified factors associated with inadequate handwashing and glove use. This information can be used in future educational and research efforts to improve infection control practices.
Hospital Epidemiologic Surveillance for Invasive Aspergillosis: Patient Demographics and the Utility of Antigen Detection
Authors: Patterson Jan Evans , Zidouh Ahmed , Miniter Peggy , Andriole Vincent T. , Patterson Thomas F.
Published: September 2009

Objective:

To monitor the epidemiology of invasive aspergillosis at a university hospital during a period of hospital construction. To compare the efficacy of active epidemiologic surveillance for invasive aspergillosis using Aspergillus cultures with the efficacy of surveillance using Aspergillus antigen detection.

Design:

A prospective surveillance study.

Setting:

An 850-bed, tertiary-care, university-based hospital.

Patients:

A convenience sample of 153 patients with Aspergillus antigen testing and culture.

Results:

24 cases were identified over a 12-month period; 7 were nosocomial, and 17 were community-acquired. Cases occurred primarily in patients with hematologic malignancy, but also occurred in patients with solid tumor, steroid treatment, cardiac transplant, and acquired immunodeficiency syndrome. Culture techniques identified only 14 (58%) of 24 cases, whereas Aspergillus antigen was positive in 19 (79%) of 24 cases tested. Epidemiological surveillance using either antigen or culture positivity detected 22 (92%) of 24 cases. In addition, antigen detection was 98% specific for the detection of aspergillosis, as compared to 91% for culture and 88% for antigen and culture combined.

Conclusions:

Hospital surveillance for aspergillosis should include determination of whether cases are nosocomial or community-acquired, because many may be the latter. Patients at risk for aspergillosis include patients without hematologic malignancies. Enhanced case detection occurred with active surveillance of patients considered to be at risk using both fungal serology and traditional microbiological techniques. Antigen detection was more sensitive and specific for the detection of invasive aspergillosis and may improve epidemiological surveillance for aspergillosis.
Nosocomial Exposure to Parvovirus B19: Low Risk of Transmission to Healthcare Workers
Authors: Ray Susan M. , Erdman Dean D. , Berschling Jeffrey D. , Cooper Joan E. , Török Thomas J. , Blumberg Henry M.
Published: September 2009

Objective:

To evaluate the risk of nosocomial transmission of parvovirus B19 (B19) infection to healthcare workers (HCWs) exposed to patients with transient aplastic crisis (TAC) caused by acute B19 infection.

Design:

Cohort study.

Setting:

1,000-bed, urban teaching hospital in Atlanta, Georgia.

Participants:

Eighty-seven exposed HCWs who cared for two patients with TAC prior to the time they were isolated and a comparison group of 88 unexposed HCWs from wards or clinics where the patients did not receive care.

Intervention:

Self-administered questionnaire on hospital contact with index patients, B19 community risk factors, and signs and symptoms suggestive of B19 disease. Serology for B19-specific IgM and IgG antibodies measured by antibody-capture enzyme-linked immunosorbent assay.

Results:

1 (3.1%) of the 32 nonimmune exposed HCWs had serologic evidence of recent B19 infection compared to 3 (8.1%) of the 37 nonimmune HCWs in the comparison group (P=.6). In a subgroup analysis of exposed HCWs who cared for index patients during the time when the virus load was expected to be greatest, a recent infection rate of 5.8% (1/17) was found among nonimmune HCWs.

Conclusions:

The finding of similar rates of recent infection in nonimmune exposed and unexposed HCWs suggests that transmission to HCWs did not occur, despite failure to place the patients in isolation at the onset of hospitalization.
Nosocomial Infections and Pseudoinfections From Contaminated Bronchoscopes: Two-Year Follow Up Using Molecular Markers
Authors: Blanc D.S. , Parret T. , Janin B. , Raselli P. , Francioli P.
Published: September 2009

During a 6-month period, two genetically distinct clones were isolated from 65% of patients with Pseudomonas aeruginosa isolated from bronchial specimens obtained during or after bronchoscopy. This epidemic was due to contamination of bronchoscopes by washing machines. After reintroduction of manual disinfection of endoscopes, a significant decrease in the incidence of the epidemic clones was observed, but the incidence of nonepidemic P aeruginosa did not change. The distinction between sporadic and epidemic cases was possible only with the use of a molecular typing method (ribotyping).
Outbreak Investigations
Authors: Beck-Sague Consuelo , Jarvis William R. , Martone William J.
Published: September 2009

Epidemic nosocomial infections are defined as hospital-acquired infections that represent an increase in incidence over expected rates. Epidemic-associated infections usually are clustered temporally or geographically, suggesting that the infections are from a common source or are secondary to increased person-to-person transmission. Epidemics are important, because they account for a substantial percentage of nosocomial infections. Furthermore, if infection control personnel thoroughly investigate outbreaks of nosocomial infections, they may identify new agents, reservoirs, or modes of transmission.
Possible Nosocomial Transmission of Psittacosis
Authors: Hughes Carolyn , Maharg Pat , Rosario Peter , Herrell Michael , Bratt Donna , Salgado Jose , Howard David
Published: September 2009

Objectives:

To investigate a cluster of seven pneumonia cases among persons exposed to a pet-shop worker hospitalized with psittacosis.

Design:

Epidemiological study of the outbreak, sero-diagnostic evaluation of exposed persons with pneumonia; and retrospective review of the pneumonia cases.

Setting:

450-bed teaching community hospital.

Participants:

Employees of the nursing unit where the patient with psittacosis was hospitalized.

Results:

The index case had laboratory and clinical evidence of psittacosis. Four of the seven exposed persons who developed pneumonia had serologic results that met criteria for a diagnosis of psittacosis, and three met criteria for Chlamydia pneumoniae infection, possibly reflecting cross-reactivity between the microimmunofluo-rescence assays for the two diseases. The epidemiological graph suggested a relationship between the index case and the cluster of pneumonias in exposed individuals.

Conclusions:

Psittacosis may have been transmitted person to person in a hospital setting.
Influenza Vaccination of Healthcare Workers
Authors: Nichol Kristin L. , Hauge Meri
Published: September 2009

Objective:

To assess factors associated with influenza vaccination of healthcare workers.

Design:

Cross-sectional survey.

Setting:

University-affiliated Veterans' Affairs medical center.

Participants:

Staff physicians and nurses employed by the medical center.

Methods:

A mailed, self-administered questionnaire.

Results:

The response rate was 38.0%. The mean age of the respondents was 43.6 years, 71.5% were females, and 26.2% were physicians. Nearly all of the practitioners had daily or weekly contact with elderly or high-risk patients. The influenza vaccination rate of the respondents was 61.2%. More than 50% of vaccine recipients indicated that avoiding illness, protecting patients, and being able to receive the vaccine conveniently and free of charge all were very important factors influencing their decisions to receive the vaccine. Avoiding illness was rated the most important factor by 58.8% of vaccine recipients. Among vaccine nonrecipients, concern about side effects was identified as a very important factor by 36.2% and as the most important factor by 30.9%.

Vaccine recipients were significantly more likely than were vaccine nonrecipients to indicate that influenza and its complications are very serious for high-risk patients. They also were more likely to report that the vaccine is very effective, that influenza vaccination is uncommonly associated with side effects, that healthcare workers' risk for contracting influenza is higher than the general public's risk, and that it is very important for healthcare workers to receive the vaccine to decrease risk for transmission to high-risk patients. After stepwise logistic regression, variables independently associated with receipt of vaccine were age, prior receipt of vaccine, being a physician, considering the vaccine to be very effective, believing that systemic side effects are uncommon, and indicating that it is very important for healthcare workers to receive vaccine for the protection of their patients.

Conclusion:

Many healthcare workers fail to receive influenza vaccine each year. Strategies to improve immunization levels should address concerns about vaccine safety and efficacy, barriers to vaccination including inconvenience and cost, and the reasons for targeting healthcare workers.
Negotiating With Administration—Or How to Get Paid for Doing Hospital Epidemiology
Authors: Deery H. Gunner
Published: September 2009

Many hospital administrators acknowledge the value of a hospital epidemiologist. However, many hospital epidemiologists are not being paid for their work. To eliminate this inequity, hospital epidemiologists must negotiate contractual relationships successfully with their hospitals or healthcare systems. This article reviews an approach to rectifying this problem that is based on practical experience.
The Risk of Peripheral Vein Phlebitis Associated With Chlorhexidine-Coated Catheters A Randomized, Double-Blind Trial
Authors: Sherertz Robert J. , Stephens Jeffrey L. , Marosok Randy D. , Carruth William A. , Rich H. Anne , Hampton Kenneth D. , Motsinger Sandy M. , Harris Lynnette C. , Scuderi Philip E. , Pappas James G. , Felton Steven C. , Solomon Donald D.
Published: September 2009

Objective:

To evaluate the risk of phlebitis associated with chlorhexidine-coated polyurethane catheters in peripheral veins.

Design:

A randomized, double-blinded trial comparing chlorhexidine-coated polyurethane catheters with uncoated polyurethane catheters.

Setting:

A university hospital.

Patients:

Adult medicine and surgery patients.

Interventions:

Certified registered nurse anesthetists or an infusion team consisting of nurses and physicians inserted the catheters. Catheter insertion sites were scored twice daily for evidence of phlebitis. At the time catheters were removed, a quantitative blood culture was performed, and catheters were sonicated for quantitative culture.

Results:

Of 221 evaluable catheters, phlebitis developed in 18 (17%) of 105 coated catheters, compared to 27 (23%) of 116 uncoated catheters (relative risk [RR], 0.74; 95% confidence interval [CI95], 0.43-1.26; P=.32). By survival analysis, chlorhexidine-coated catheters had a lower risk of phlebitis during the first 3 days (P=.06), but not when all catheters were considered in both patient groups (P=.31). In the absence of catheter colonization, the incidence of phlebitis was 21% (16/76) and 24% (20/86) for coated and uncoated catheters, respectively (P=.85), whereas in the presence of catheter colonization, the incidence of phlebitis was 14% (1/7) and 80% (4/5) for coated and uncoated catheters, respectively (RR, 0.18; CI95, 0.03-1.15; P=.07).

Conclusion:

The risk of phlebitis in the presence of catheter colonization was 82% lower for chlorhexidinecoated polyurethane catheters compared to otherwise identical uncoated catheters.