bluuebunny/crossref_metadata_2025 huggingface dataset:
What is Leaky Can be Risky: A Study of the Integrity of Hospital Gloves
Authors: Yangco Bienvenido G. , Yangco Nathaniel F.
Published: September 2009

One thousand six-hundred and eighteen medical gloves were tested to determine whether, with current increased demands, these gloves are of high quality, i.e., free of leaks. The risk of exposure to potentially infected fluids when using leaky gloves was also estimated. Using a four-stage leak test, no significant difference was found between 64 of 790 (8.1%, range 0% to 44.4%) unsterile latex gloves and 11 of 210 (5.2%, range 1.7% to 21.7%) unsterile vinyl gloves (p=.21). Sterile surgical gloves (7 of 618, 1.13% [range 0% to 3%]) had fewer leaks compared to unsterile latex and vinyl gloves combined p<.OOOl). The safranin test was positive in 27 of 28 (96.4%) leaky gloves tested, indicating a high risk of exposure to potentially infected fluids when leaky gloves are used. Because of these findings, elements of “universal precautions” such as changing gloves after each patient contact and good handwashing after using gloves should be carefully observed. There is a need for the Food and Drug Administration to establish more stringent guidelines for manufacturing gloves and to verify compliance with these guidelines.
Microbial Contamination of Arterial Infusions Used for Hemodynamic Monitoring: A Randomized Trial of Contamination with Sampling Through Conventional Stopcocks versus a Novel Closed System
Authors: Crow Sue , Conrad Steven A. , Chaney-Rowell Cynthia , King John W.
Published: September 2009

Arterial catheters are now commonly used to monitor blood pressure and obtain blood samples for arterial blood gas and other laboratory determinations. Stopcocks inserted into the pressure monitoring circuit have been the primary means of obtaining blood from arterial catheters. However, these stopcock systems have been associated with nosocomial contamination and bacteremias. Because of the problems of bacterial contamination and blood wasting with the stopcock sampling systems, we compared the frequency and extent of contamination of external sampling ports and the monitoring tubing fluid in stopcocks with that of a novel closed needle-sampling system (Lab-Site, Migada Ltd, Rehovot, Israel), incorporated into pressure monitoring tubing (Abbott Laboratories Inc., North Chicago, Illinois). We found that use of the novel sampling system resulted in significantly fewer episodes of internal bacterial contamination of the arterial monitoring line (7%) than did the use of a stopcock system (61%). External contamination of the sampling port was also lower in the novel system (8%) than in the stopcock system (37%). This suggests that the closed system may reduce the risk of nosocomial infections in patients requiring arterial pressure monitoring.
Therapy of Bacterial Meningitis: Principles and Practice
Authors: Tunkel Allan R. , Scheld W. Michael
Published: September 2009

Since the advent of antimicrobial therapy, bacterial meningitis has changed from a disease with an almost uniformly fatal course to one in which the majority of patients now survive. The mortality rates for the three most common etiologic agents in bacterial meningitis, Hemophilus influenzae, Neisseria meningitidis and Streptococcus pneumoniae, were 6%, 10.3%, and 26.3%, respectively, in the United States from 1978 to 1981. Morbidity, however, primarily in the form of neurologic sequelae, continues to be a problem in children and adults surviving bacterial meningitis. This article focuses on the principles and practice of therapy in bacterial meningitis, highlighting the experience with new antimicrobial agents and the utility of adjunctive therapy.
Cryptosporidium Species
Authors: Zygmunt Deborah J.
Published: September 2009

Protozoans of genus Cryptosporidium cause infections of the mucosal epithelium of a variety of animals, including humans. Infections by these coccidian parasites were once considered rare in animals. In humans, infections were thought to be the result of an opportunistic occurrence in immunosuppressed persons. Recently however, the concept of this intracellular protozoan parasite has changed markedly in that this parasite is now thought to be an important cause of widespread gastrointestinal (GI) illness commonly seen in several species, including humans. Infections in animals are common in newborn livestock and often are fatal. At least one species of this protozoan genus may cause mild to severe diarrhea in immunocompetent humans; this diarrheal illness may last from several days to a month or more. In immunosuppressed persons seen with acquired immunodeficiency syndrome (AIDS), cryptosporidiosis may cause a prolonged life-threatening diarrheal illness.” Recent descriptions of respiratory and biliary infections by Cryptosporidium species demonstrate that this parasite is not confined to the GI tract of immunosuppressed persons. Unfortunately, antiprotozoan therapy for cryptosporidiosis is ineffective. Persons with normal host defenses or those with restored immune balance are able to control the infection.
Transmission and Control of Methicillin-Resistant Staphylococcus aureus in a Skilled Nursing Facility
Authors: Thomas J. Conley , Bridge Janis , Waterman Stephen , Vogt Jacqueline , Kilman Liga , Hancock Gary
Published: September 2009

Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly frequent in both acute care facilities (ACFs) and skilled nursing facilities (SNFs). Admissions to SNFs from ACFs with endemic MRSA are one likely source of infection in SNFs. The occurrence of MRSA in SNFs and the relative roles of ACFs and SNFs in MRSA transmission have not been well characterized. We conducted an epidemiologic investigation in an SNF reporting a high incidence of MRSA cases and found that the prevalence of MRSA exceeded that reported in acute care settings. Fifteen (9.1%) of the 164 residents were colonized or infected with MRSA. Risk factors for MRSA identified through a prevalence case-control study were nasogastric intubation (odds ratio = 5.5; 95% confidence interval = 1.2, 26.4), antibiotic therapy (OR= 3.9; CI = 1.2, 13.0), and hospitalization in an acute care facility within the previous six months (OR = 2.9; CI = 0.9, 9.7). During a three-month period, 6 of 100 new admissions were MRSA-positive; all positive patients were from ACFs. Five new cases also emerged from previously MRSA-negative residents. SNF residents are often discharged to ACFs. Transmission of MRSA within the SNF and the transfer of patients to ACFs increases the reservoir of potentially infective patients and the potential for MRSA infections in ACFs. Modest control measures, including targeted surveillance culturing and cohorting of colonized residents, may minimize MRSA transmission in the SNF and decrease the reservoir of MRSA in the community.
Coagulase-Negative Staphylococcal Infections in Vascular Surgery: Epidemiology and Pathogenesis
Authors: Edmiston Charles E. , Schmitt David D. , Seabrook Gary R.
Published: September 2009

Staphylococcal infection of a vascular prosthesis is a relatively uncommon complication of peripheral vascular surgery; however, these infections and their sequelae can be catastrophic. The majority of prosthetic graft infections are caused by mucin-producing strains of Staphylococcus epidermidis, which express varying degrees of adherence to the synthetic substrates. Studies have demonstrated that the components and construction characteristics of the graft, implantation site, administration of antimicrobial agents, and endogenous microbial flora are all identifiable risk factors in vascular graft infections. Mucin production, a known virulence factor, has recently been shown to occur in endogenous coagulase-negative staphylococci (CNS) at the time of hospital admission. While mucin production plays an important role in the persistence of graft infections, there is no evidence that suggests a relationship between mucin and antimicrobial resistance.

Identifying characteristics of (CNS) graft infections may include a draining wound sinus, poor graft incorporation, a perigraft exudate or a pseu-doaneurysm at the anastomotic site. The occult nature of these infections, in which the patient is often asymptomatic, makes diagnosis and treatment difficult. The graft or graft exudate may be negative when routine culture methods are employed. The recognition of CNS graft infections requires a high index of suspicion and the treatment of these infections requires understanding of the pathogenic process, individualized surgical management, and the judicious use of antimicrobial agents.
Brief Report: Blood Contamination of Medical Records
Authors: Wormser Gary P. , Medure-Collins Rosemary , Mack Lynda
Published: September 2009

The epidemic of human immunodeficiency virus (HIV) infection has provided a major impetus to strengthen infection control practices in health care and laboratory settings. The widespread nature of blood contamination in the hospital environment, however, is often underappreciated. In this study, we evaluated the frequency and origin of blood contamination of medical records.
Brief Report: Primary and Recurrent Herpes Simplex Infection in a Pediatric Nurse Resulting from a Human Bite
Authors: Fuortes Laurence , Melson Enrico
Published: September 2009

A case of primary and recurrent herpes simplex virus (HSV) infection resulting from a bite wound' occurring in a pediatric nurse is presented. HSV infection as an occupational hazard among hospital, personnel is briefly reviewed.

Herpes simplex virus occurring as herpes whitlow is a well-known hazard among dentists and dental technicians. There is one report in the literature of a large series of nurses in a neurosurgical unit contracting herpetic whitlow. There is one case in the literature of a physician contracting primary herpes simplex infection from mouth-to-mouth resuscitation of a patient with herpes simplex pneumonia. Three days after performing mouth-to-mouth resuscitation, the physician developed painful papulovesicular lesions over the beard area, which subsequently ulcerated and crusted. One year after the resuscitation, the physician experienced cervical lymphadenop-and a recurrence of herpetic lesions in the same areas as the original infection. We report a case of primary and recurrent herpes simplex type 1 infection with disabling causalgia in a licensed practical nurse resulting from a bite wound received from a child hospitalized with pneumonia.
Analysis of Matched Samples
Authors: Woolson Robert F. , McNutt Louise-Anne
Published: September 2009

Introduction in order to study the association between disease status (eg, nosocomial infection) and some exposure variable (eg, number of days on urinary catheter), it is often necessary to take into account other variables that may influence either the disease status or the exposure variable. For example, Freeman et al described a retrospective (in their terminology “case-referent”) study of a neonatal population. In this study, cases of nosocomial infection are selected in addition to corresponding control individuals who did not experience a nosocomial infection. All patients were selected from a neonatal intensive care unit, and the goal was to study the role of umbilical artery catheterization and its association with nosocomial infection. As noted by Freeman et al, this is a complex question because the risk of nosocomial infection might reasonably depend not only on the duration of catheterization, but also on the birth weight of the infant.
Shigellosis Occurring in Newborn Nursery Staff
Authors: Beers Lorraine M. , Burke Timothy L. , Martin David B.
Published: September 2009

Shigellosis is uncommon in the newborn nursery. We describe a case of Shigella sonnei gastroenteritis occurring in a newborn. Three of 32 health care providers caring for the infant acquired shigellosis. The neonate probably acquired the infection from its mother via vertical transmission. All six members of the infant's family had gastroenteritis and two siblings had stool cultures positive for Shigella. Transmission of Shigella in the newborn nursery is potentially great. Emphasis on handwashing and glove use, aggressive case finding, notification of contacts, and a liberal “forced paid sick time” policy may halt the spread.
Proteeae Groin Skin Carriage in Ambulatory Geriatric Outpatients
Authors: Ehrenkranz N. Joel , Eckert Debra G. , Alfonso Blanca C. , Moskowitz Lee B.
Published: September 2009

Aerobic gram-negative bacillus (AGNB) groin skin carriage was prospectively studied in ambulatory geriatric outpatients: 42 from three nursing homes and 44 from private homes. Initially, 12 (28.6%) Proteeae carriers were in the former group and 3 (6.8%) were in the latter (P =0.01). At one year, 6 of 7 surviving nursing home carriers remained Proteeae carriers while none from private homes remained carriers (P =0.007). The annual prevalence of Proteeae carriage was 14 (33.3%) in nursing homes and 4 (9.1%) in private homes (P =0.008); of non-Proteeae AGNB carriage, the annual prevalence was 2 (4.8%) and 4 (11.4%), respectively. Nursing home subjects had similar initial health characteristics; however, by one year, 5 of 12 carriers in contrast to 3 of 30 noncarriers were dead of chronic disease (P =0.03). These nursing homes included persons with chronic diseases that apparently facilitated Proteeae carriage. Urethral catheters, skin ulcers, and recent antibiotics were not factors.
Proteeae Groin Skin Carriage Among Nursing Home Resident—Resistance to Antiseptics
Authors: Eckert Debra G. , Ehrenkranz N. Joel , Alfonso Blanca C. , Moskowitz Lee B.
Published: September 2009

Proteeae carriage was evaluated in groin skin carriers following vigorous antiseptic application. Three Proteus mirabilis carriers were treated with 60% isopropyl alcohol or 4% chlorhexidine, observed to prevent skin contact, and then recultured; at four and eight hours P mirabilis numbers remained undiminished. Ten Proteeae carriers received a series of nine body baths with soap, chlorhexidine, and 0.75% povidone-iodine plus three cefazolin injections over 16 to 34 days; cumulative treatments failed to clear seven carriers. Within three months, all were again carriers. Proteeae carriers also had affinity for groin carriage of various aerobic gram-negative bacilli (AGNB) including cefazolin-resistant strains. In seven subjects, more than one AGNB species were recovered shortly after applying an antiseptic. Proteeae groin skin carriage appears to reflect a major change in the nature of resident bacteria on intact groin skin.
The Importance of Nosocomial Transmission of Measles in the Propagation of a Community Outbreak
Authors: Raad Issam I. , Sherertz Robert J. , Rains Caroline S. , Cusick Janet L. , Fauerbach Loretta L. , Reuman Peter D. , Belcuore Tom R.
Published: September 2009

In late January 1985, a measles outbreak occurred at a community hospital in Columbia county, Florida. The outbreak spread throughout the county and to two neighboring counties (Alachua and Marion), resulting in 79 cases with a 29% hospitalization rate. Hospitals represented the site with the highest frequency of transmission. At the Alachua county hospitals, where strict respiratory isolation measures were taken, no secondary cases occurred among hospitalized patients. Two independent risk factors existed for hospitalization: measles exposure in a hospital setting (P <0.05) and nonvaccination (P <0.00l). Of the total measles cases, 24% were under the age of 16 months and 47% of those aged 16 months or older had a history of appropriate vaccination. Columbia county, which experienced 86% of the cases, had a 5% frequency of unvaccinated students compared to 0.6% frequency at Alachua (P <0.00l) where only 10% of the cases occurred. This outbreak demonstrates the role of uncontrolled nosocomial transmission of measles in the propagation of a community outbreak.
Infection Control and Hospital Hygiene in Belgium
Authors: Reybrouck Gerald , Mertens Raf
Published: September 2009

In 1972 the Council of Europe, in which most of the Western European countries are represented, adopted a resolution aimed at the improvement of hospital hygiene and the promotion of the prevention of nosocomial infections. The member states were invited to take the required measures, but each country was free to implement the resolution according to its own needs and particularities. In Belgium, the first legal regulations were issued in 1974—every hospital was obliged to set up a committee for hospital hygiene.

Although similar regulations were issued in most other member states. the actual infection control policies adopted can vary. This article highlights some of the particularities for Belgium.
Chlamydia Species Strain TWAR
Authors: Sinnott John T. , Himelright Inga
Published: September 2009

The chlamydia have long been recognized as ubiquitous pathogens capable of producing a wide spectrum of disease both in children and in adults. Common infections caused by this pathogen include pneumonia in infants, trachoma in children, and genital tract disease in adults. While neonatal chlamydial pneumonia is commonly described, chlamydial pneumonia in adults is less commonly recognized and was originally associated only with exposure to psittacine birds. Instances of person-to-person transmission of a chlamydial pneumonia were first identified in San Francisco in 1941. The organism isolated was a chlamydia-like agent with glycogen-staining characteristics unlike those of the well-studied avian chlamydia but much more difficult to maintain in culture. This finding lapsed into obscurity until 1965, when a chlamydial organism again demonstrating a Chlamydia psittaci-like staining pattern was isolated from a Taiwanese child in a trachoma study. This isolate was eventually named TW183. It was not until 1983, however, when a patient with atypical pneumonia was found to be infected with a similar pathogen, dubbed AR39, that the question of prevalence was raised. As the behavior of these isolates was characterized in Grayston's laboratory, it became apparent that they represented a novel human pathogen and the name TWAR (Taiwan acute respiratory agent) was adopted. Subsequent epidemiologic studies of this agent have shown broad exposure over a wide geographic distribution with almost 40% of tested populations showing serologic evidence of exposure.
AIDS: Risk of HIV Infection to Health Care Workers
Authors: Schaffner William
Published: September 2009

Dr. Jaffe presented an update on the risk of HIV infection to health care workers. He noted that information has come from three sources: 1) analysis of national AIDS surveillance data: 2) prospective studies of injuries and exposures of health care workers: and 3) anecdotal reports.

The national AIDS surveillance data indicate that 5% of reported AIDS cases occur in health care workers; health care workers represent 5.7% of the US workforce. By itself, this would suggest that employment as a health care worker is not associated with a disproportionately large risk of AIDS. The health care workers with AIDS have an age and sex distribution that is similar to that of all AIDS patients; the health care workers with AIDS are more likely to be white, however. The health care workers with AIDS are more likely to he homosexual/bisexual men (73%) than are all AIDS patients (62%); conversely, they are less likely to admit to intravenous drug use.
AIDS: Serologic Testing for the Human Immunodeficiency Virus—To Screen or Not to Screen
Authors: Maki Dennis G.
Published: September 2009

The world pandemic of acquired immunodeficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV) is now in its eighth year and may represent the most serious infectious disease threat to world health in modern history. We now have the capability to diagnose HIV infection very accurately by simple serologic means. However, there has been great reluctance in this country to use serologic testing on a wide scale as a weapon in the war against AIDS. It is hard to believe that when serologic testing first became available, there was controversy as to whether blood donors should be routinely screened.
AIDS: Understanding the Pathogenesis of HIV Infection
Authors: Goldmann Donald A. , Zuck Thomas E.
Published: September 2009

It has been little more than four years since the human immunodeficiency virus (HIV) was definitively associated with acquired immunodeficiency syndrome (AIDS). Although a few holdouts still insist that the true cause of AIDS has not yet been found, an over whelming body of evidence indicates that a retrovirus is responsible. The human retroviruses can be classified into transforming retroviruses (HTLV-I and HTLV-II) and cytopathic retroviruses (HIV-I and HIV-Y). As their name suggests, the cytopathic viruses rapidly lyse cells, but it is now clear that they do not lyse all of the cell types that they infect. Many T4 helper cells, which have an abundance of CD4 receptors on their surface, are destroyed following infection. However, HIV does not kill other cell types, such as macrophages, so readily, but rather persists either productively or latently within them. In this fashion, the virus persists in the host generally for the life of the individual.
Expanding Roles of Hospital Epidemiology: Pharmacoepidemiology
Authors: Burke John p. , Tilson Hugh H. , Platt Richard
Published: September 2009

In the past few years, several hospital epidemiology programs in the United States have developed the capacity to monitor drug usage in hospitalized patients. This activity has been stimulated by a Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) mandate to monitor antimicrobial agents and also by the emergence of technology for automated medical record linkage. There is a growing recognition that these methods to link computerized pharmacy records and discharge diagnoses can be used to identify “signals” for side effects and toxicities of all drugs and not only just for antimicrobial agents. In addition, clinical trials designed to detect occurrences of adverse experiences with commonly used antimicrobials have led some hospital epidemiologists to seek collaboration with experts in the methodologies for study of drug usage and drug effects, i.e., pharmacoepidemiologists.
Expanding Roles of Hospital Epidemiology: Severity of Illness Indicators
Authors: Gross Peter A.
Published: September 2009

In recent years we have all been distressed by reports in the popular press of inaccurate hospital mortality data. We have been concerned when quality assurance programs attempt to compare infection rates among surgeons without adjusting for the differences in underlying illnesses of their patients. A similar concern arises when infection rates are compared among hospitals. And university hospital administrators have been concerned by the inadequate reimbursement given to referral hospitals compared with community hospitals.

Congress has mandated that the Health Care Financing Administration (HCFA) adopt a severity adjuster for DRGs (Diagnosis Related Groups), the basis of Medicare's prospective payment system. A number of states are close to mandating the use of severity adjusters. These states include New Jersey, Colorado, Pennsylvania, Iowa and Washington. Finally, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is developing severity-adjusted clinical indicators to assess the quality of care.

Dr. William Scheckler, when he was the president of the Society of Hospital Epidemiologists of America (SHEA), had the foresight to set up a task force so that SHEA could develop a position on the severity of illness indicators. The findings of the task force have been published previously in this journal (see volume 9, number 7, pp 309–316).
Expanding Role of Hospital Epidemiology: Employee Health—Chemical Exposure in the Health Care Setting
Authors: Rutala William A. , Hamory Bruce H.
Published: September 2009

Health care workers are exposed to a vast array of health and safety hazards, unsurpassed by any other service industry and perhaps unequaled by industry in general. These hazards include exposure to biological agents, physical agents, stress, injury and chemical agents.

The hospital environment abounds with hazardous chemical agents. A hospital survey conducted by the National Institute for Occupational Safety and Health (NIOSH) found at least 135 chemicals recognized as carcinogens, teratogens, mutagens, or which have some combination of these effects in humans or animals. Another 179 chemicals found in hospitals are primary irritants of the skin or eyes. Although employee risks associated with chemicals have been neglected all too frequently, attention finally is being directed to assessing and reducing these risks. Among the toxic substances that present health hazards to health care providers are disinfecting and sterilizing compounds, chemotherapeutic agents and anesthetic gases.
Infection Control: New Problem Organisms for Infection Control
Authors: McGowan John E.
Published: September 2009

The use of glycoprotein G (gG) from the herpes simplex virus has made possible an immunoprecipitation test that distinguishes prior infection with herpesvirus type 1 (HSV-I), herpesvirus type 2 (HSV-2) or both. The test is more sensitive than previously available tests. A national study employing this new immunologic test suggests great differences in prevalence of antibodies to each of these two viruses at different ages in different ethnic groups. For example, in the 20-to 25-year age group, about 5% of Caucasians have antibody to HSV-2, while the frequency of antibody to HSV-2 in blacks is about four times that high. This study also suggests a higher prevalence of HSV infection in the population of women of childbearing age than was previously estimated with less sensitive testing methods. Since HSV disease in newborns is closely related to the frequency of herpes simplex infection in the mother, estimates of the likelihood of nosocomial infection with HSV in newborns must take these new data into account. The specificity of the new test was not discussed.
Infection Control: Opportunistic Fungal Infections—The Increasing Importance of Candida Species
Authors: Pfaller Michael A.
Published: September 2009

Opportunistic fungal infections increasingly are becoming important causes of morbidity and mortality in the hospitalized patient. In addition to the well-known pathogenic fungi such as the Zygomycetes and Aspergillus spp, serious infections are being reported with increasing frequency due to Fusarium spp, dematiacious fungi and other usually “nonpathogenic” fungi. Recent data, however, suggest that Candida spp are emerging as one of the major nosocomial pathogens in both seriously ill immunocompetent and immunocompromised patients. Given the importance of Candida spp as opportunistic fungal pathogens, this summary will focus on newer clinical and epidemiologic observations of nosocomial candidiasis.
Infection Control: The Immunocompromised Host
Authors: Young Lowell S.
Published: September 2009

I have two major concerns about the immunocompromised host field in 1989. The first relates to the tremendous impact that acquired immunodeficiency syndrome (AIDS) has had on nosocomial infections and the management of hospitalized patients. It is a major consideration in screening patients for organ transplants. Concern about AIDS influences all aspects of blood transfusion therapy.

The second concern relates to the increasing demand for expensive technologically-oriented procedures involved in the management of immunocompromised hosts. I believe the demand for these approaches is irresistible and adds to the mounting problems that hospitals face in containing basic costs. Since there is a finite dollar available for medical expenses, 1 see these demands exacerbating the rationing of medical resources.
The Future of Hospital Epidemiology
Authors: Kunin Calvin M.
Published: September 2009

It is not difficult to predict the future of hospital epidemiology. It will become increasingly important. The need to prevent and control hospital-acquired infections and to protect the staff from communicable diseases will grow. Hospitals will continue to be filled with patients, life-prolonging technical advances will continue to be introduced, resistance will emerge to the new antimicrobial agents, the number of patients with acquired immunodeficiency syndrome (AIDS) will increase and the population will continue to age. Concomitant increases in costs and demands for accountability and for quality assurance will occur (Table 1).

The future for practitioners of hospital epidemiology is less assured. We will have to continue to convince hospital administrators that we are more than “bean counters” engaged mainly in surveillance. We must assure them that the benefits of our work justify the costs of maintaining effective infection control units and that we are dedicated to prevention and control.
Satellite Infection Control Committees within the Hospital: Decentralizing for Action
Authors: Ford-Jones E.L. , Mindorff C.M. , Gold R.
Published: September 2009

The contemporary infection control program, whether independent or fully integrated into a hospital-wide quality assurance (QA) program, has a very broad scope including surveillance, outbreak management, education, policy/procedure development, environmental/construction surveillance, program evaluation and research (Table). The greatest problem organizing an infection control program has been identified as integration of its components so as to establish supervision and feedback among its participants, with the purpose of achieving steady progress.

Programs have historically been “centralized” with the hospital epidemiologist, infection control practitioner and hospital infection control committee responsible directly or indirectly for the maintenance of the system.’
New Insights on the Genetic Basis for Resistance
Authors: Stratton Charles W.
Published: September 2009

One of the more important aspects of nosocomial infections is that they often are caused by bacterial strains resistant to many antimicrobial agents. Despite over 50 years in the development and use of a wide variety of antibiotics, bacterial resistance mechanisms have not been defeated and are playing an increasingly important role in the therapy of infections.

The mechanisms of bacterial resistance, moreover, are constantly changing, but our understanding of these resistance mechanisms at a molecular level is rapidly increasing.” Yet importantly, a detailed knowledge and understanding of the genetic basis for bacterial resistance is of great importance for the proper evaluation and control of nosocomial infections caused by resistant pathogens. The purpose of this discussion is to provide insights into the genetic basis for bacterial resistance and to describe some newer mechanisms of bacterial resistance that influence the therapeutic approach to nosocomial infections.
Surgeon-Specific Wound Surveillance: The Family or the Bean Counters?
Authors: Crow Sue , Bryan Charles S.
Published: September 2009

I generally associate the “product commentary” section of this journal with such things as urethral catheters, vascular access devices and antiseptic solutions. Hence, the invitation to write about surgical wound surveillance seemed at first inappropriate. However, the gathering storm over who will supervise wound surveillance involves our own unique product: infection control data. My task is to address concerns common to all business enterprises:

▪ What is the demand?

▪ What does the consumer want?

▪ Who should be the chief executive officer?

▪ What should be our current strategy?

More than 70 years ago, it was shown that making surgeons aware of infection rates can lower their incidence.’ It is now customary to cite a series of studies suggesting that surgeon-specific rate reporting lowers the incidence of postoperative wound infection. First, Cruse and Foord correlated this practice with a lowering of the infection rate from 2.6% to 0.6%. Next, Condon et al. and then Olson et al. reported similar successes. Finally, data from the Centers for Disease Control's SENIC project indicated that two factors clearly correlated with reduced wound infection rates: 1) strong surveillance and control programs; and 2) the presence of an effective infection control physician.” Having both elements in place reduced the infection rate by 41% or 35% for low-risk or high-risk patients, respectively. Having surveillance alone reduced the infection rate by 19% for low-risk patients and 20% for high-risk patients. These findings made the case for wound surveillance seem ironclad.
Enterobacter sakazakii Infections in Neonates Associated with Intrinsic Contamination of a Powdered Infant Formula
Authors: Simmons Bryan P. , Gelfand Michael S. , Haas Michael , Metts Linda , Ferguson John
Published: September 2009

We report an outbreak of Enterobacter sakazakii infection and colonization in neonates related to an infant formula contaminated during the manufacturing process. The outbreak occurred in a 2O-bed neonatal intensive care unit during a six-week period in 1988, and involved a total of four infants. Three infants had sepsis and three had bloody diarrhea; all patients responded to intravenous antibiotics and recovered without complications. The E sakazakii isolated from the formula had the same plasmid and multilocus enzyme profile as those isolated from patients. This outbreak demonstrates the significance of commercially contaminated formulas and emphasizes the need to limit contamination and multiplication of bacteria in enteral formulas.
Investigation of a Streptococcus viridans Pseudobacteremia Epidemic at a University Teaching Hospital
Authors: Church Deirdre L. , Bryant Heather E.
Published: September 2009

For several months in 1986, an outbreak of Streptococcus viridans pseudobacteremia occurred at a large teaching hospital. All sources of laboratory blood culture contamination were excluded. A retrospective epidemiological study indicated that one phlebotomist, “P,” collected a disproportionate number of the positive blood cultures. Further comparison of the paired blood culture results from the three months when the incidence was highest revealed a good concordance of results among all other phlebotomists (Kappa = 0.5), while P's results concurred with others less frequently than would be expected even by chance (Kappa < 0.0). Clinical follow-up showed that P did not routinely wear gloves while drawing blood and had eczema of the hands. Skin scrapings from the hands, right index finger/fingernail grew predominantly S viridans species that were compatible with those recovered from contaminated blood cultures. This epidemic demonstrated the need for early detection of this source as a cause of nosocomial pseudobacteremia.
On Using Microcomputers in Statistical Analysis
Authors: Lachenbruch Peter A.
Published: September 2009

Over several years, I have used microcomputers for most of my statistical analyses. This article is a summary of some of my preferences and thoughts from this experience. Some of the ideas expressed here, of course, are distillations and re-expressions of the thoughts of others.

When you use a microcomputer for your analyses, you assume all the roles traditionally associated with a computer center. You are responsible for the purchase of your machines, supplies and program selection. One problem that may arise is that you may not have a program you need or it may not exist in a version for your computer. If this is the case, you must either find a program that does the job you want or move the data set to a different computer. This problem is less severe now than it was a few years ago because many major statistical packages are available.
Staphylococcus aureus Nasal Colonization in a Nursing Home: Eradication With Mupirocin
Authors: Cederna Jean E. , Terpenning Margaret S. , Ensberg Mark , Bradley Suzanne F. , Kauffman Carol A.
Published: September 2009

Recent reports have emphasized an increase in both infection and colonization with methicillin-resistant Staphylococcus aureus (MRSA) in institutionalized older patients. We studied whether or not local treatment with mupirocinointment could eliminate nasal colonization with S aureus. A total of 102 patients in a Veterans Administration nursing home were screened for S aureus nasal colonization. Thirty-nine patients (38.2%) were colonized, 18 with methicillin-sensitive Saureus (MSSA) and 21 with MRSA. Almost half of all colonized patients were in the most dependent functional category and there was a significant association of MRSA colonization, but not MSSA colonization, with poor functional status. Colonized patients were treated with mupirocin ointment applied to the anterior nares twice daily for seven days. After treatment, MSSA persisted in only two patients and MRSA in only one patient; thus, nasal colonization was eliminated in 91.4% of colonized patients. At one month and two months follow-up, 11 patients became transiently recolonized and three became persistently recolonized with S aureus. Mupirocin was well tolerated with no side effects noted. Mupirocin ointment may be useful in controlling nasal colonization with S aureus in the nursing home setting.
Effectiveness of Simple Measures to Control an Outbreak of Nosocomial Methicillin-Resistant Staphylococcus aureus Infections in an Intensive Care Unit
Authors: Guiguet M. , Rekacewicz C. , Leclercq B. , Brun Y. , Escudier B. , Andremont A.
Published: September 2009

Between June 1985 and March 1986, 14 cases of severe nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection, including septicemia, were observed in the intensive care unit (ICU) of a 400-bed cancer reference center. Simple control measures including contact isolation of colonized patients and reinforcement of handwashing practices among personnel were followed by a sharp decrease in the rate of infection and colonization. An epidemiological investigation showed that a single serophage variant MRSA strain was involved; peak incidence of infection was 17 per 100 ICU patient discharges; the index case was identified as a patient admitted from another hospital and the epidemic strain was then transmitted from patient-to-patient in the ICU; risk factors for acquiring infection were length of prior hospitalization, invasive procedures and number of antibiotic treatments; dissemination of the strain to other wards was only anecdotal. These results stress the effectiveness of simple measures to control outbreaks of MRSA nosocomial infections even in immunocompromised cancer patients.
Nosocomial Outbreak of Systemic Candidosis Associated With Parenteral Nutrition
Authors: Moro Maria Luisa , Maffei Claudio , Manso Esther , Morace Giulia , Polonelli Luciano , Biavasco Francesca
Published: September 2009

Eight patients in two surgical units developed systemic candidosis during a 40-day period from June 5 to July 13, 1987 (in five cases Candida albicans was identified). Three of them died. All cases belonged to a group of 27 patients receiving parenteral nutrition (PN), while among the 108 patients who did not receive PN, no cases were observed (p = .000001). Candida was cultured from two PN bags administered to the cases. A specialized nutrition nurse was responsible for the PN compounding and for maintaining administration sets in the two wards involved.

An epidemiological investigation in which 19 uninfected patients who had had PN were used as controls, showed no significant difference between cases and controls except that lipids were more frequently added to bags administered to cases (p = .0005). Furthermore, the bags administered to cases contained a higher average number of multidose constituents (p = .0008) when the comparison was focused on the two days before the onset of symptoms.Given the favorable medium provided by lipids, even a low level contamination of PN solutions during compounding and/or administration could have been responsible for the outbreak. The finding of a more frequent exposure of cases to multidose vials suggests, although not conclusively, that an extrinsic contamination occurred during compounding. Six isolates of C albicans were available from four cases. C albicans was cultured from the pharyngeal swabs of two physicians and three nurses, including the specialized nutrition nurse. According to DNA restriction pattern analysis, a single strain was responsible for all the cases of systemic candidosis, with only the specialized nutrition nurse harboring the same strain. DNA fingerprinting provided a reliable system for typing C albicans strains. This was the first outbreak of C albicans systemic infection associated with PN.
Surveillance for Quality Assessment: II. Surveillance for Noninfectious Processes: Back to Basics
Authors: McGeer Allison , Crede William , Hierholzer Walter J.
Published: September 2009

The first article in this series reviewed the type of surveillance currently used by most of the infection surveillance and control programs in acute care hospitals in the United States. Five components were identified as critical to the widespread acceptance and continuing success of this surveillance methodology: targeting of events (diseases); early development of standardized definitions; wide acceptance of the criteria for these definitions; advocacy, leadership and education in methodology; and a high level of effectiveness in program practice. Using the framework of these key components, this article will discuss the potential for the application of similar methodology to noninfectious nosocomial adverse events and explore some current successes and problems associated with surveillance for such events.
Tuberculosis in Long-Term Care Facilities
Authors: Bentley David W.
Published: September 2009

Persons age 65 and over constitute the largest reservoir of Mycobacterium tuberculosis infection in the United States today. During 1987, 6,150 tuberculosis cases were reported among this high-risk group. These cases represent 27% of the total US tuberculosis morbidity, although this age group constitutes only 12% of the US population. Tuberculosis case rates in the United States are higher among the elderly (20.6 per 100,000) than among all other age groups (average 9.3 per 100,000).

More Americans live in nursing homes than in any other type of residential institution; on any given day approximately 5% of all elderly persons are living in a nursing home. Elderly nursing home residents are at greater risk for tuberculosis than elderly persons living in the community. In a Centers for Disease Control (CDC)-sponsored survey of 15,379 routinely-reported tuberculosis cases from 29 states, 8% of the 4,919 cases that occurred among elderly persons occurred among residents of nursing homes. The incidence of tuberculosis among nursing home residents was 39.2 per 100,000 person years, whereas the incidence of tuberculosis among elderly persons living in the community was 21.5 per 100,000. The observed rate of tuberculosis among nursing home employees was three times the rate expected in employed adults of similar age, race and sex (CDC, unpublished data).
Hepatitis B Immunoprophylaxis: Developing a Cost-Effective Program in the Hospital Setting
Authors: Lanphear Bruce P.
Published: September 2009

There are several goals of a hepatitis B immunoprophylaxis program. Prevention of clinical disease and carrier status in healthcare workers (HCW) is the primary goal. In addition, the uncommon incidence of staff transmitting hepatitis B infection (HBV) to patients should not continue with available methods of prevention. The prevention of disease is not only desirable from a public health standpoint, it is also needed to protect health centers from liability that may result from the occurrence of preventable diseases of occupational origin, such as HBV.
Variation in Risk for Falls by Clinical Department: Implications for Prevention
Authors: Rohde Judith M. , Myers Ann H. , Vlahov David
Published: September 2009

To examine rates of falls and injuries by clinical department, a retrospective analysis was performed of 874 inpatient falls during a one-year period in a 1,000-bed acute-care hospital. Incident reports were reviewed, and for those patients injured, medical records were abstracted. Fall rates were calculated by age, sex and service using total patient days as the denominator.

During 1983, 874 falls occurred during 282,713 adult patient days (31/104 days). Fall rates were significantly higher (odds ratio = 2.12; 95% confidence interval [CI]: 1.84, 2.45) in the neuroscience and psychiatry departments (53/104 days) compared with other adult services combined (25/104 days); this difference persisted after direct adjustment for age. Differences by clinical department persisted throughout four additional years of surveillance, although fall rates for the oncology service increased. Injuries following falls occurred among 200 (22.8%) patients.

These data indicate that falls are not random events, and that falls and injury prevention programs can be more appropriately focused by consideration of clinical department.
Persistence of Antibody in Healthcare Workers Vaccinated Against Hepatitis B
Authors: Street Alan C. , Weddle Teresa Z. , Thomann Wayne R. , Lundberg Ellen W. , Jackson George W. , Hamilton John D.
Published: September 2009

A cross-sectional serological survey was undertaken in 82 randomly selected high-risk healthcare workers previously vaccinated with the hepatitis B vaccine. The study design allowed for the identification and testing for hepatitis B surface antibody in equal numbers of employees in six-month intervals up to five years after vaccination. The results showed a consistent decline in antibody level with time, and an increasing proportion of participants with antibody levels below the commonly accepted protective level of ≥10 S/N (sample counts/negative control counts) radioimmunoassay units. The percent of vaccinees whose S/N ratio was greater than 10 fell from 10% at one year, to 25% at two years, to over 50% at four years. Based on these figures, as well as the financial costs of hepatitis B in employees and the predictability of booster immunization, it was possible to assess the cost benefit of a hospital policy for reimmunization. At our institution, a strategy of revaccination at fixed intervals could save up to $200,000 over a ten-year period if revaccination was not offered and vaccine efficacy declined. The information obtained should help determine the need for revaccination and the advantages and disadvantages of alternative revaccination strategies.
Plasmid DNA Fingerprinting of Acinetobacter calcoaceticus Subspecies anitratus From Intubated and Mechanically Ventilated Patients
Authors: Hartstein Alan I. , Morthland Virginia H. , Rourke J. William , Freeman Joan , Garber Susan , Sykes Renee , Rashad Abdel L.
Published: September 2009

Forty-three intubated and mechanically ventilated patients in five intensive care units (ICUs) of one hospital developed respiratory colonization or infection with Acinetobacter calcoaceticus subspecies anitratus over a 16-month interval. Neither the frequency nor rate of A anitratus isolation exceeded the hospital endemic norms. Single isolates from 34 of the patients were subtyped by plasmid DNA analysis, two biotyping systems and antimicrobial susceptibility to 24 drugs. Plasmid DNA fingerprints were distinct in 18 isolates (they differed from each other and all others), similar in two and identical or similar in ten. The latter group of isolates were recovered from patients in four ICUs. Reproducibility of biotyping was poor. Neither biotyping nor antimicrobial susceptibility were successful in identifying sameness among the group isolates nor differences among other isolates. We conclude that plasmid DNA fingerprinting should be used to assess the possibility of multiple patient transmissions of the same A anitratus strain in the absence of an obvious outbreak.