bluuebunny/crossref_metadata_2025 huggingface dataset:
An Outbreak of Gram-Negative Bacteremia in Hemodialysis Patients Traced to Hemodialysis Machine Waste Drain Ports
Authors: Wang Susan A. , Levine Rachel B. , Carson Loretta A. , Arduino Matthew J. , Killar Teresa , Grillo F. Gregory , Pearson Michele L. , Jarvis William R.
Published: February 2006

Objective:

To investigate an outbreak of gram-negative bacteremias at a hemodialysis center (December 1, 1996-January 31, 1997).

Design:

Retrospective cohort study. Reviewed infection control practices and maintenance and disinfection procedures for the water system and dialysis machines. Performed cultures of the water and dialysis machines, including the waste-handling option (WHO), a drain port designed to dispose of saline used to flush the dialyzer before patient use. Compared isolates by pulsed-field gel electrophoresis.

Setting:

A hemodialysis center in Maryland.

Results:

94 patients received dialysis on 27 machines; 10 (11%) of the patients had gram-negative bacteremias. Pathogens causing these infections wereEnterobacter cloacae(n=6),Pseudomonas aeruginosa(n=4), andEscherichia coli(n=2); two patients had polymicrobial bacteremia. Factors associated with development of gram-negative bacteremias were receiving dialysis via a central venous catheter (CVC) rather than via an arterio-venous shunt (all 10 infected patients had CVCs compared to 31 of 84 uninfected patients, relative risk [RR] undefined;P<.001) or dialysis on any of three particular dialysis machines (7 of 10 infected patients were exposed to the three machines compared to 20 of 84 uninfected patients, RR=5.8;P=.005).E cloacae, P aeruginosa, or both organisms were grown from cultures obtained from several dialysis machines. WHO valves, which prevent backflow from the drain to dialysis bloodlines, were faulty in 8 (31%) of 26 machines, including 2 of 3 machines epidemiologically linked to case-patients. Pulsed-field gel electrophoresis patterns of available dialysis machine and patientE cloacaeisolates were identical.

Conclusions:

Our study suggests that WHO ports with incompetent valves and resultant backflow were a source of cross-contamination of dialysis bloodlines and patients' CVCs. Replacement of faulty WHO valves and enhanced disinfection of dialysis machines terminated the outbreak.
A Canadian Survey of Prophylactic Antibiotic Use Among Hip-Fracture Patients
Authors: Zoutman Dick , Chau Laurence , Watterson James , Mackenzie Thomas , Djurfeldt Marina
Published: February 2006

Objective:

To study how surgical prophylactic antibiotics (SPAs) were utilized in the perioperative management of surgery for hip fractures.

Design:

Retrospective chart review of randomly selected medical records.

Setting:

Twenty-two hospitals (teaching, nonteaching, community, and large urban referral centers) from across Canada.

Patients:

Patients admitted in 1990 with a diagnosis of hip fracture.

Methods:

Complete medical records of 438 patients were examined; 352 cases who underwent surgical repair of a fractured hip with insertion of prosthetic material were included in analysis. Perioperative SPA use was assessed by abstracting the agent(s) chosen, dosages, time given with respect to the incision, and duration of postoperative use. Fourteen patient and process-of-care variables related to SPA were examined.

Results:

247 (70%) of 352 cases did not receive a dose of SPA 2 hours preoperatively. Ten percent of preoperative SPA was administered either too early or during the procedure. In 91 (39%) of 231 cases receiving SPA the first dose was not administered until the end of the procedure. Preoperative SPA consisted of a parenteral first-generation cephalosporin for 94% of cases. SPAs were continued more than 24 hours postoperatively in 78% of cases.

Lack of a written order for SPA, being a nonteaching hospital, and shorter duration of surgical procedure were predictive of failure to receive SPA in an effective manner.

Conclusions:

Most hip-fracture-surgery patients did not receive effective antibiotic prophylaxis as required to prevent serious wound infections. This important variable can be included for surveillance, so that corrective measures can be taken to assure effective prophylactic antibiotic administration.
Usefulness of Pulsed-Field Gel Electrophoresis in Assessing Nosocomial Transmission of Pertussis
Authors: Nouvellon Michèle , Gehanno Jean-François , Pestel-Caron Martine , Weber Christian , Lemeland Jean-François , Guiso Nicole
Published: February 2006

During a 2-week period, three infants with a cough lasting at least 8 days with whoops, were admitted to the pediatric unit; Bordetella pertussis was isolated from nasopharyngeal aspirates collected from the three infants. Approximately 1 week later, a nurse working on the same unit developed influenza-like symptoms followed by whooping cough; B pertussis was isolated. Isolates from the nurse and from one of the infants were shown to be indistinguishable by pulsed-field gel electrophoresis. These data demonstrate that B pertussis transmission to healthcare workers is possible and emphasize the need to use respiratory protection devices (Droplet Precautions) for healthcare workers having close contact with infected children.
A Case-Control Study to Detect Modifiable Risk Factors for Colonization With Vancomycin-Resistant Enterococci
Authors: Loeb Mark , Salama Suzette , Armstrong-Evans Maxine , Capretta Gina , Olde Jan
Published: February 2006

A case-control study was conducted to determine the modifiable risk factors associated with vancomycin-resistant Enterococcus (VRE) colonization during a hospital outbreak. Cephalosporin use was identified as the only independent risk factor (odds ratio, 13.8; 95% confidence interval, 2.5-76.3; P=.01). Nursing work-load intensity was not associated with VRE colonization in this study.
Infection Control Programs in Long-Term-Care Facilities: Structure and Process
Authors: Goldrick Barbara A.
Published: February 2006

Due to the rapid transfer of patients from the acute-care setting, the intensity of nursing care among residents in long-term-care facilities (LTCFs) has increased, transforming today's LTCFs into subacute healthcare facilities. Given the increased risk of infection among residents in LTCFs and the associated morbidity and mortality, evaluation of infection control programs in skilled nursing LTCFs is warranted. This article addresses the current structure and process of infection control programs in skilled nursing LTCFs.
staffTRAK-TB: Software for Surveillance of Tuberculosis Infection in Healthcare Workers
Authors: Burwen Dale R. , Seawright M. Franklin
Published: February 2006

The Centers for Disease Control and Prevention (CDC) recommends periodic tuberculin skin testing of healthcare workers with potential exposure to Mycobacterium tuberculosis. However, many healthcare facilities have neither a system to identify workers due for their skin test nor a means of analyzing aggregate data. To illustrate some of the complexities involved in tuberculin skin test (TST) tracking and analysis, and how these might be addressed, this report describes a software package called staffTRAK-TB, developed by the CDC to facilitate surveillance of tuberculosis infection in healthcare workers. staffTRAK-TB records data for each healthcare worker, including demographic information, occupation, work location, multiple TST results, and results of evaluations to determine if clinically active tuberculosis is present. Programmed reports include lists of workers due and overdue for skin tests, and skin test conversion rates by occupation or worksite. Standardization of types of occupations and locations allows data from multiple facilities to be aggregated and compared. Data transfer to the CDC can be performed via floppy diskettes. staffTRAK-TB illustrates important issues in software structure, standardization of occupation and work-location information, relevant data items, and reports and analyses that would be useful in practice. Developing software that adequately addresses the epidemiological issues is complex, and the lessons learned may serve as a model for hospital epidemiologists, infection control personnel, occupational health personnel, and computer programmers considering software development in this area or trying to optimize their facility's TST surveillance.
Satellite Videoconferencing for Healthcare Workers: Audience Characteristics and the Importance of Continuing Education Credits
Authors: Chen Ii-Lun , Eckhardt Joseph N. , Sinkowitz-Cochran Ronda L. , Jarvis William R.
Published: February 2006

To assess the opinions of healthcare workers (HCWs) about a satellite videoconference as a means of earning continuing education credit, a telephone survey was conducted in September 1998, 1 month after a live interactive satellite video-conference on antimicrobial use and resistance. There were 180 registered sites in 45 states surveyed, representing 1,589 viewers: 764 nurses (48.1%), 201 physicians (12.6%), and 624 other HCWs (39.3%). Continuing education credit was requested by 51% of nurses, 31% of physicians, and 27% of all other HCWs. Although preferred learning formats varied, 70% of respondents said it was important to offer continuing education credit. Furthermore, 31% of the respondents stated that the video-conference influenced institutional strategies. We concluded that satellite videoconferences are a method to reach audiences around the world efficiently and effectively, provide the latest information, facilitate interaction, and meet some of the demand for continuing education credit for HCWs.
Persistence ofLegionella Pneumophilain a Hospital's Water System: A 13-Year Survey
Authors: Rangel-Frausto M. Sigfrido , Rhomberg Paul , Hollis Richard J. , Pfaller Michael A. , Wenzel Richard P. , Helms Charles M. , Herwaldt Loreen A.
Published: February 2006

Objective:

To describe the molecular epidemiology ofLegionella pneumophilainfections in the University of Iowa Hospitals and Clinics (UIHC).

Design:

Molecular epidemiological study using pulsed-field gel electrophoresis (PFGE).

Setting:

A large university teaching hospital.

Isolates:

All surviving isolates obtained from culture-proven nosocomialL pneumophilainfections and all surviving isolates obtained from the University of Iowa Hospital and Clinics' water supply between 1981 and 1993.

Results:

Thirty-three isolates from culture-proven nosocomial cases ofL pneumophilapneumonia were available for typing. PFGE of genomic DNA from the clinical isolates identified six different strains. However, only strain C (16 cases) and strain D (13 cases) caused more than 1 case. Strain C caused clusters of nosocomial infection in 1981, 1986, and 1993 and also caused 4 sporadic cases. Strain D caused a cluster in 1987 and 1988 plus 4 sporadic cases. Of the six strains causing clinical infections, only strains C and D were identified in water samples. PFGE identified three strains in the water supply, of which strains C and D caused clinical disease and also persisted in the water supply during most of the study period.

Conclusion:

Specific strains ofL pneumophilacan colonize hospital water supplies and cause nosocomial infections over long periods of time.
Hospital Characteristics Associated With Colonization of Water Systems byLegionellaand Risk of Nosocomial Legionnaires' Disease: A Cohort Study of 15 Hospitals
Authors: Kool Jacob L. , Bergmire-Sweat David , Butler Jay C. , Brown Ellen W. , Peabody Deborah J. , Massi Daniel S. , Carpenter Joseph C. , Pruckler Janet M. , Benson Robert F. , Fields Barry S.
Published: February 2006

Objective:

To investigate an increase in reports of legionnaires' disease by multiple hospitals in San Antonio, Texas, and to study risk factors for nosocomial transmission of legionnaires' disease and determinants forLegionellacolonization of hospital hot-water systems.

Setting:

The 16 largest hospitals in the cities of San Antonio, Temple, and Austin, Texas.

Design:

Review of laboratory databases to identify patients with legionnaires' disease in the 3 years prior to the investigation and to determine the number of diagnostic tests forLegionellaperformed; measurement of hot-water temperature and chlorine concentration and culture of potable water forLegionella. Exact univariate calculations, Poisson regression, and linear regression were used to determine factors associated with water-system colonization and transmission ofLegionella.

Results:

Twelve cases of nosocomial legionnaires' disease were identified; eight of these occurred in 1996. The rise in cases occurred shortly after physicians started requestingLegionellaurinary antigen tests. Hospitals that frequently usedLegionellaurinary antigen tests tended to detect more cases of legionnaires' disease.Legionellawas isolated from the water systems of 11 of 12 hospitals in San Antonio; the 12th had just experienced an outbreak of legionnaires' disease and had implemented control measures. Nosocomial legionellosis cases probably occurred in 5 hospitals. The number of nosocomial legionnaires' disease cases in each hospital correlated better with the proportion of water-system sites that tested positive forLegionella (P=.07) than with the concentration ofLegionellabacteria in water samples (P=.23). Hospitals in municipalities where the water treatment plant used monochloramine as a residual disinfectant (n=4) and the hospital that had implemented control measures wereLegionella-free. The hot-water systems of all other hospitals (n=11) were colonized withLegionella. These were all supplied with municipal drinking water that contained free chlorine as a residual disinfectant. In these contaminated hospitals, the proportion of sites testing positive was inversely correlated with free residual chlorine concentration (P=.01). In all hospitals, hot-water temperatures were too low to inhibitLegionellagrowth.

Conclusions:

The increase in reporting of nosocomial legionnaires' disease was attributable to increased use of urinary antigen tests; prior cases may have gone unrecognized. Risk of legionnaires' disease in hospital patients was better predicted by the proportion of water-system sites testing positive forLegionellathan by the measured concentration ofLegionellabacteria. Use of monochloramine by municipalities for residual drinking water disinfection may help prevent legionnaires' disease.
The Impact of Multifocused Interventions on Sharps Injury Rates at an Acute-Care Hospital
Authors: Gershon Robyn R.M. , Pearse Lisa , Grimes Martha , Flanagan Patricia A. , Vlahov David
Published: February 2006

Objective:

To determine the impact of a multifocused interventional program on sharps injury rates.

Design:

Sharps injury data were collected prospectively over a 9-year period (1990-1998). Pre- and postinterventional rates were compared after the implementation of sharps injury prevention interventions, which consisted of administrative, work-practice, and engineering controls (ie, the introduction of an anti-needlestick intravenous catheter and a new sharps disposal system).

Setting:

Sharps injury data were collected from healthcare workers employed by a mid-sized, acute-care community hospital.

Results:

Preinterventional annual sharps injury incidence rates decreased significantly from 82 sharps injuries/1,000 worked full-time-equivalent employees (WFTE) to 24 sharps injuries/1,000 WFTE employees postintervention (P<.0001), representing a 70% decline in incidence rate overall. Over the course of the study, the incidence rate for sharps injuries related to intravenous lines declined by 93%, hollow-bore needlesticks decreased by 75%, and non-hollow-bore injuries decreased by 25%.

Conclusion:

The implementation of a multifocused interventional program led to a significant and sustained decrease in the overall rate of sharps injuries in hospital-based healthcare workers.
The Effect of Blood on the Antiviral Activity of Sodium Hypochlorite, a Phenolic, and a Quaternary Ammonium Compound
Authors: Weber David J. , Barbee Susan L. , Sobsey Mark D. , Rutala William A
Published: February 2006

Objective:

To assess the virucidal activity of three disinfectants (sodium hypochlorite, a phenolic, and a quaternary ammonium compound) in the presence and absence of blood.

Methods:

Disinfectants at varying concentrations (hypochlorite: 5,000, 500, or 50 ppm; phenolic: 1:10 or 1:128 dilution; quaternary ammonium compound: 1:10 or 1:128 dilution) were added to either saline or whole blood (final concentration, 80% or 20% blood) and mixed. Test organisms included an attenuated vaccine strain of poliovirus type 1 (prototype for relatively resistant hydrophilic viruses) and herpes simplex virus (HSV) type 1 (prototype for relatively susceptible lipophilic viruses). Virus was added to create a viral-blood suspension. Viral survival was tested at room temperature at the following times: 0, 15 seconds, 30 seconds, 1 minute, 2 minutes, 5 minutes, and 10 minutes. A neutralizer stopped the reaction, and virus was assayed using a plaque technique.

Results:

In the absence of blood, complete inactivation of HSV was achieved within 30 seconds with 5,000 (1:10 dilution of bleach) and 500 (1:100 dilution of bleach) ppm chlorine, 1:10 and 1:128 diluted phenolic (use dilution), and 1:10 and 1:128 diluted quaternary ammonium compound (use dilution). In the presence of 80% blood, only 5,000 ppm hypochlorite, 1:10 phenolic, and 1:10 or 1:128 quaternary ammonium compound were effective. In the absence of blood, complete inactivation of polio was achieved within 30 seconds by 5,000 and 500 ppm chlorine and 1:10 quaternary ammonium compound. In the presence of 80% blood, no solution tested was capable of completely inactivating poliovirus within 10 minutes.

Conclusions:

Our data suggest that, in the absence of visible blood, environmental surfaces may be disinfected with a diluted hypochlorite solution (1:10 or 1:100), a phenolic, or a quaternary ammonium compound. Based on our studies using HSV, which has similar susceptibilities to disinfectants as human immunodeficiency virus (HIV), phenolics at their use dilution and 1:100 diluted hypochlorite are unlikely to inactivate HIV or hepatitis B virus reliably in the presence of blood. Hypochlorite at a final concentration of 5,000 ppm (1:10 dilution) should be used to decontaminate blood spills, but, even after decontamination, care should be used to avoid sharps injuries.
Emergence of Vancomycin-Resistant Enterococci at a University Hospital in Taiwan: Persistence of Multiple Species and Multiple Clones
Authors: Hsueh Po-Ren , Teng Lee-Jene , Pan Hui-Ju , Chen Yu-Chi , Wang Li-Hua , Chang Shan-Chwen , Ho Shen-Wu , Luh Kwen-Tay
Published: February 2006

Objectives:

To describe the epidemiology of vancomycin-resistant enterococci (VRE) in a university hospital in Taipei, Taiwan.

Design:

Retrospective review over a 27-month period, from March 1996 to May 1998.

Setting:

A tertiary-care teaching hospital in Taiwan.

Participants:

Patients with VRE isolated from any body site.

Methods:

Patients were identified through hospital microbiology and infection control records. Patient charts were reviewed for clinical and epidemiology data, including age, gender, previous hospital admissions, underlying diseases, types of infection, and recent antibiotic use. VRE isolates were characterized by their typical biochemical reactions, cellular fatty acid profiles, and the presence ofvangenes. Antibiotypes using the E-test and randomly amplified polymorphic DNA (RAPD) patterns of these isolates were used to determine the clonality.

Results:

Twenty-five isolates of VRE recovered from 12 patients were identified. One patient with a perianal abscess had 12 isolates of VRE (4Enterococcus faecalis, 7Enterococcus faecium, and 1Enterococcus casseliflavus) recovered from perianal lesions. Among 3 patients who were hospitalized in the same room, 1 had a community-acquired cellulitis over the left leg caused byE faecalis, and the other 2 patients both had anal colonization with 2 isolates ofE faecalis. The other 8 patients had 1E faecalisisolate each from various clinical specimens. All isolates possessed vanA resistance phenotype andvanAgenes. Different antibiotypes and RAPD patterns of the isolates from different patients excluded the possibility of nosocomial spread at the hospital.

Conclusions:

Multiple species of VRE (E faecalis, E faecium, andE casseliflavus) and multiple clones ofE faeciumcould colonize or infect hospitalized patients. In addition, clones of VRE can persist long-term in patients' lower gastrointestinal tracts. These results extend our knowledge of the coexistence and the persistence of multiple species and multiple clones of VRE in hospitalized patients.
Selecting Respirators for Control of Worker Exposure to Infectious Aerosols
Authors: McCullough Nicole Vars , Brosseau Lisa M.
Published: February 2006

A method for selecting respirators for protection in infectious aerosol environments was developed, building on a procedure used to choose respiratory protection for environments containing nonbiological contaminants. Modifications in the traditional respirator selection method are proposed for situations where information on occupational exposure limits, toxicity, and airborne concentrations is absent. Toxicity is determined from risk rankings proposed by a variety of organizations. The nature of the activity allows assessment of source generation, which is combined with room volume and airflow to obtain a ranking of airborne concentration. Finally, concentration and toxicity ranks determine a minimum assigned protection factor, which corresponds to a respirator class. Case studies are presented to illustrate the proposed decision logic. For each situation, the procedure yielded choices that were both protective and reasonable. These results suggest that the procedure will be applicable to a variety of settings for a range of infectious organisms.
The Prevalence of Colonization With Vancomycin-Resistant Enterococcus at a Veterans' Affairs Institution
Authors: Tokars Jerome I. , Satake Sachiko , Rimland David , Carson Loretta , Miller Elaine R. , Killum Edna , Sinkowitz-Cochran Ronda L. , Arduino Matthew J. , Tenover Fred C. , Marston Barbara , Jarvis William R.
Published: February 2006

Objective:

To study vancomycin-resistantEnterococcus(VRE) prevalence, risk factors, and clustering among hospital inpatients.

Design:

Rectal-swab prevalence culture survey conducted from February 5 to March 22,1996.

Setting:

The Veterans' Affairs Medical Center, Atlanta, Georgia.

Patients:

Hospital (medical and surgical) inpatients.

Results:

The overall VRE prevalence was 29% (42/147 patients). The VRE prevalence was 52% (38/73 patients) among patients who had received at least one of six specific antimicrobials during the preceding 120 days, compared with only 5% (4/74) among those who had not received the antimicrobials (relative risk, 9.6;P<.001). The longer the period (up to 120 days) during which antimicrobial use was studied, the more closely VRE status was predicted. Among 67 hospital patients in 28 multibed rooms, clustering of VRE among current roommates was not found.

Conclusions:

At this hospital with relatively high VRE prevalence, VRE colonization was related to antibiotic use but not to roommate VRE status. In hospitals with a similar VRE epidemiology, obtaining cultures from roommates of VRE-positive patients may not be as efficient a strategy for identifying VRE-colonized patients as obtaining screening cultures from patients who have received antimicrobials.
Management of a Sabiá Virus-Infected Patient in a US Hospital
Authors: Armstrong Lori R. , Dembry Louise-Marie , Rainey Petrie M. , Russi Mark B. , Khan Ali S. , Fischer Steven H. , Edberg Stephen C. , Ksiazek Thomas G. , Rollin Pierre E. , Peters C.J.
Published: February 2006

Objective:

To describe the hospital precautions used to isolate a Sabiá virus (arenavirus: Arenaviridae)-infected patient in a US hospital and to protect hospital staff and visitors.

Design:

Investigation of a single case of arenavirus laboratory-acquired infection and associated case-contacts.

Setting:

A 900-bed, tertiary-care, university-affiliated medical center.

Patients or other Participants:

The case-patient became ill with Sabiá virus infection. The case-contacts consisted of healthcare workers, coworkers, friends, and relatives of the case-patient.

Intervention:

Enhanced isolation precautions for treatment of a viral hemorrhagic fever (VHF) patient were implemented in the clinical laboratory and patient-care setting to prevent nosocomial transmission. The enhanced precautions included preventing aerosol spread of the virus from the patient or his clinical specimens. All case-contacts were tested for Sabiá virus antibodies and monitored for signs and symptoms of early disease.

Results:

No cases of secondary infection occurred among 142 case-contacts.

Conclusions:

With the frequency of worldwide travel, patients with VHF can be admitted to a local hospital at any time in the United States. The use of enhanced isolation precautions for VHF appeared to be effective in preventing secondary cases by limiting the number of contacts and promoting proper handling of laboratory specimens. Patients with VHF can be managed safely in a local hospital setting, provided that appropriate precautions are planned and implemented.
Epidemiology of Device-Associated Infections Related to a Long-Term Implantable Vascular Access Device
Authors: Sotir Mark J. , Lewis Curtis , Bisher Edward W. , Ray Susan M. , Soucie J. Michael , Blumberg Henry M.
Published: February 2006

Objective:

To examine risk factors for, and determine the incidence of, device-associated infections among patients with an implantable vascular access device.

Setting:

Grady Health System, including a 1,000-bed, inner-city, public, teaching hospital and human immunodeficiency virus (HIV), oncology, and sickle cell clinics in Atlanta, Georgia.

Patients:

123 consecutive patients who received a PASPort implantable venous access device between January 1 and June 30, 1995.

Design:

Retrospective cohort study with follow-up ≥1 year following device implantation.

Results:

Underlying illnesses included HIV infection in 66 patients (median CD4 count, 24.4 cells/mm3), malignancy in 51, and sickle cell disease in 6. Mean age of patients was 43.7 years, 50% were male, and 74% were black. Thirty-one (25%) of 123 patients developed a primary or device-associated bloodstream infection (BSI), and 3 of the 31 patients experienced two separate episodes of infection. The overall rate of infection was 1.23 primary BSIs per 1,000 device days. Patients with cancer had a lower rate of infection than those with HIV infection, but the difference was not statistically significant (0.96 vs 1.50 BSIs/1,000 device days; relative risk, 0.58; 95% confidence interval, 0.27-1.26). Subgroup analysis of patients with different malignancies indicated that infection rates differed according to type of cancer, and there was a trend for heterogeneity across the different cancer strata (P=.06). Gram-positive pathogens accounted for 60% of the pathogens recovered. Six (19%) of 31 patients who developed an infection did so within the first 14 days after implantation. In 11 (32%) of the 34 BSIs, the port required removal; two patient deaths were attributed to device-associated bacteremias (0.072 deaths/ 1,000 device days).

Conclusions:

Approximately one fourth of patients who had a vascular access device implanted developed a primary BSI, but the overall infection rate (per 1,000 device days) was relatively low, even among those with HIV infection. Primary BSI rates in patients with vascular access devices appeared to differ according to the specific underlying illness.
Long-Lasting Contamination of a Vitrectomy Apparatus With Serratia marcescens
Authors: Kappstein Ines , Schneider Christian M. , Grundmann Hajo , Scholz Regina , Janknecht Peter
Published: February 2006

Objective:

To investigate the contamination of a vitrectomy apparatus withSerratia marcescens.

Design:

Descriptive microbiological and molecular environmental study.

Setting:

An 1,800-bed university hospital.

Results:

S marcescenswas found inside the vitrectomy apparatus at the pressure transducer. Molecular typing by randomly amplified polymorphic DNA-automated laser flourescence analysis and pulsed-field gel electrophoresis identified a single pattern for all strains isolated from the apparatus. Surprisingly, the contaminating strain was identical to two strains ofS marcescensisolated nearly 2 years earlier from two patients who were involved in a small outbreak of acute postoperative endophthalmitis following cataract surgery at another hospital. The emergency vitrectomies in these patients were performed at our hospital with the same apparatus that was found to be contaminated 2 years later.

Conclusion:

Performing a systematic environmental search for the assumed bacterial reservoir within the system of the vitrectomy apparatus finally made it possible to find and eliminate the nidus for the gram-negative rod. Molecular typing demonstrated that all isolates belonged to a single genotype, and revealed unexpectedly a link to two vitrectomies performed 2 years earlier. The data support the hypothesis that the source of the contamination was one of these patients, and thus contamination of the apparatus was present for almost 2 years.
Investigation of a Nosocomial Outbreak Due toSerratia marcescensin a Maternity Hospital
Authors: Berthelot Philippe , Grattard Florence , Amerger Colette , Frery Marie-Claude , Lucht Frédéric , Pozzetto Bruno , Fargier Philippe
Published: February 2006

Objectives:

To investigate an outbreak ofSerratia marcescensin a maternity hospital (November 1994 to May 1995).

Design:

Retrospective analysis of epidemiological data and prospective study of systematic bacteriological samples from patients and environment, with genotyping of strains by arbitrarily primed polymerase chain reaction.

Setting:

A private maternity hospital, Saint-Etienne, France.

Results:

In the neonatal unit, 1 newborn developed a bacteremia, and 36 were colonized in stools with Smarcescens.As the colonization of some newborns was shown to occur only a few hours after delivery, the inquiry was extended to other maternity wards, where 8 babies and 4 mothers were found to be colonized. Environmental sampling led to the isolation of Smarcescensfrom a bottle of enteral feed additive in the neonatal unit and from the transducers of two internal tocographs in the delivery rooms. The genotyping of 27 strains showed two different profiles: a major epidemic profile shared by 22 strains (18 from babies of the neonatal unit, 2 from babies of other units, and 2 from breast milk) and another profile shared by 5 strains (2 from transducers of internal tocographs, 2 from babies, and 1 from a mother). The strain isolated from lipid enteral feeding was not available for typing. Although this source of contamination was removed soon from the neonatal unit, the outbreak stopped only when infection control measures were reinforced in the delivery rooms, including the nonreuse of internal tocographs.

Conclusions:

In delivery rooms, the quality of hygiene needs to be as high as in surgery rooms to prevent nosocomial colonization or infection of neonates at birth.
Bloodstream Infections in a Neonatal Intensive-Care Unit: 12 Years' Experience With an Antibiotic Control Program
Authors: Cordero Leandro , Sananes Mercedes , Ayers Leona W.
Published: February 2006

Objective:

To assess the prevalence of gram-positive coccal (GPC), gram-negative bacillary (GNB), and fungal bloodstream infections (BSIs) during a 12-year period in which a consistent antibiotic treatment protocol was in place; to evaluate the efficacy of these antibiotic policies in relation to treatment, to the emergence of bacterial or fungal resistance, and to the occurrence of infection outbreaks or epidemics.

Study Design:

Case series.

Methods:

Demographic, clinical, and bacteriological information from 363 infants born during 1986 through 1991 and 1992 through 1997 who developed 433 blood-culture-proven BSIs was analyzed. Early-onset BSIs were defined as those infections discovered within 48 hours of birth, and late-onset BSIs as those that occurred thereafter. Suspected early-onset BSIs were treated with ampicillin and gentamicin, and suspected late-onset BSIs with vancomycin and gentamicin. Antibiotics were changed on the basis of organism antimicrobial susceptibility.

Results:

Early-onset BSIs were noted in 52 of 21,336 live births and 40 of 20,402 live births during 1986 through 1991 and 1992 through 1997, respectively. GPC (83% due to group B streptococcus [GBS]) accounted for approximately one half of early-onset BSI cases and GNB (68%Enterobacteriaceae)for the remainder. Early-onset GBS declined from 24 to 11 cases (P=.04) and late-onset BSI increased from 111 to 230 cases (P<.01) from the first to the last study period. Sixty-eight percent of late-onset BSIs were due to GPC (primarily coagulase-negativeStaphylococcus), 18% to GNB, and 14% to fungus. Over the study period,Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, andPseudomonas aeruginosaisolated from the newborn intensive-care unit (unlike those strains from other hospital units) remained fully susceptible to ceftazidime and gentamicin. Although the hospitalwide prevalence of methicillin-resistantStaphylococcus aureusincreased, all 17 newborn BSI cases were due to methicillin-sensitive strains. Prevalence of methicillin-resistant coagulase-negativeStaphylococcusincreased, although all strains remained vancomycin-susceptible, as did the 16Enterococcus faecalisisolates. All fungi recovered (from 48 patients) were susceptible to amphotericin.

Conclusion:

We observed a decrease in the prevalence of early-onset BSIs due to GBS and an increase in late-onset BSIs due to GPC, GNB, and fungi. The combination of ampicillin and gentamicin for suspected early-onset BSIs and vancomycin and gentamicin for late-onset BSIs has been successful for treatment of individual patients without the occurrence of infection outbreaks or the emergence of resistance. Controlled antibiotic programs and periodic evaluations based on individual unit and not on hospitalwide antibiograms are advisable.
An Outbreak of Acute Gastroenteritis in a Geriatric Long-Term–Care Facility: Combined Application of Epidemiological and Molecular Diagnostic Methods
Authors: Marx Arthur , Shay David K. , Noel Jacqueline S. , Brage Carol , Bresee Joseph S. , Lipsky Sherry , Monroe Stephan S. , Ando Tamie , Humphrey Charles D. , Alexander E. Russell , Glass Roger I.
Published: February 2006

Objective:

To assess possible transmission modes of, and risk factors for, gastroenteritis associated with Norwalk-like viruses (NLVs) in a geriatric long-term-care facility.

Methods:

During a prolonged outbreak of acute gastroenteritis, epidemiological data on illness among residents and employees were collected in conjunction with stool, vomitus, and environmental specimens for viral testing. NLVs were identified by electron microscopy in stool and vomitus specimens, and further characterized by reverse-transcriptase polymerase chain reaction and nucleotide sequencing. Potential risk factors were examined through medical-record review, personal interview, and a self-administered questionnaire sent to all employees.

Results:

During the outbreak period, 52 (57%) of 91 residents and 34 (35%) of 90 employees developed acute gastroenteritis. Four case-residents were hospitalized; three residents died at the facility shortly after onset of illness. A point source was not identified; no association between food or water consumption and gastroenteritis was identified. A single NLV strain genetically related to Toronto virus was the only pathogen identified. Residents were at significantly higher risk of gastroenteritis if they were physically debilitated (relative risk [RR], 3.5; 95% confidence interval [CI95], 1.0-12.9), as were employees exposed to residents with acute gastroenteritis (RR, 2.6; CI95, 1.1-6.5) or ill household members (RR, 2.3; CI95, 1.4-3.6). Adherence to infection control measures among the nursing staff may have reduced the risk of gastroenteritis, but the reduction did not reach statistical significance.

Conclusions:

In the absence of evidence for food-borne or waterborne transmission, NLVs likely spread among residents and employees of a long-term-care facility through person-to-person or airborne droplet transmission. Rapid notification of local health officials, collection of clinical specimens, and institution of infection control measures are necessary if viral gastroenteritis transmission is to be limited in institutional settings
Enterococcal Bacteremia: Risk Factors for Vancomycin Resistance and Predictors of Mortality
Authors: Lautenbach Ebbing , Bilker Warren B. , Brennan Patrick J.
Published: February 2006

Objective:

To identify risk factors for vancomycin resistance and mortality in enterococcal bacteremia.

Design:

Historical cohort study.

Setting:

A large academic medical center with a high prevalence of vancomycin-resistant enterococci (VRE).

Patients:

Two hundred sixty patients with enterococcal bacteremia, of whom 72 (28%) had VRE.

Results:

Independent risk factors for infection with VRE were the mean number of antibiotic days (P<.001), renal insufficiency (P<.001), mean days of vancomycin use (P=.005), and neutropenia (P=.013). A trend toward a significant association between metronidazole use and VRE also was noted (P=.068). Mortality was attributable to the bacteremia in 96 patients (37%). Severity of illness (P<.001) and age (P=.020) were independent risk factors for mortality. Vancomycin resistance was not, however, an independent predictor of mortality.

Conclusion:

These results suggest that restrictions on antibiotic use, particularly in patients with renal insufficiency and neutropenia, may help to combat the rising incidence of VRE. Although patients with VRE bacteremia demonstrated higher mortality rates than patients with infection due to susceptible isolates, vancomycin resistance was not an independent predictor of mortality in these patients and likely serves more as a marker of underlying severity of illness.
Trends in Compliance With the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis Among New Jersey Hospitals, 1989 to 1996
Authors: Manangan Lilia P. , Collazo Edgar R. , Tokars Jerome , Paul Sindy , Jarvis William R.
Published: February 2006

Objective:

To determine trends in compliance with the guidelines for preventing the transmission ofMycobacterium tuberculosisin healthcare facilities among New Jersey hospitals from 1989 through 1996.

Design:

A voluntary questionnaire was sent to all 96 New Jersey hospitals in 1992. The 53 that responded were resurveyed in 1996.

Results:

Of the 96 hospitals surveyed in 1992, 53 (55%) returned a completed questionnaire; 33 (64%) were community, nonteaching hospitals. In 1991, patients with tuberculosis (TB) were admitted at 38 (72%) of 53 hospitals, and from 1989 through 1991, patients with multidrug-resistant (MDR) TB were admitted at 15 (29%) of 52 hospitals. Twenty-nine (57%) of 51 reported having rooms meeting the Centers for Disease Control and Prevention (CDC) criteria for acid-fast bacilli (AFB) isolation. A nonfltted surgical mask was used as a respiratory protective device by healthcare workers (HCWs) at 28 (55%) of 51 hospitals. Attending physicians were included in tuberculin skin-testing (TST) programs at 5 (11%) of 45 hospitals. In the 1996 resurvey, 48 (94%) of 53 surveyed hospitals returned a completed questionnaire; 34 (81%) of 42 had TB patient admissions, and 4 (9%) of 43 had MDR TB patient admissions in 1996. Forty-five (96%) of 47 reported having rooms that met CDC criteria for AFB isolation. N95 respiratory devices were used by HCWs at 45 (94%) of 48 hospitals. Attending physicians were included in the TST programs at 22 (54%) of 41 hospitals.

Conclusion:

New Jersey hospitals have made improvements in availability of AFB isolation rooms, use of proper respiratory protective devices, and expansion of TST programs for HCWs from 1989 through 1996.
Lack of Transmission of Vancomycin-Resistant Enterococci in Three Long-Term–Care Facilities
Authors: Greenaway Christina A. , Miller Mark A.
Published: February 2006

Three patients colonized with vancomycin-resistant Enterococcus were admitted to one or more of three long-term-care facilities. Six point-prevalence surveys revealed no transmission of vancomycin-resistant Enterococcus after a total of 234 days of exposure during which moderately strict infection control measures were implemented. Four of 116 environmental cultures were positive.
Hospital Water Supply as a Source of Disseminated Mycobacterium fortuitum Infection in a Leukemia Patient
Authors: Kauppinen Juha , Nousiainen Tapio , Jantunen Esa , Mattila Rauni , Katila Marja-Leena
Published: February 2006

Nosocomial acquisition ofMycobacterium fortuitumled to a disseminated infection in a leukemia patient. A linkage to shower-head water was supported by molecular typing of clinical and environmental isolates. Contamination of the hospital water system with microbes that are relatively resistant to common sanitation processes poses an increased risk of infection to neutropenic patients.
Bacteremia Due to Persistent Strains of Coagulase-Negative Staphylococci in a Neonatal Intensive-Care Unit
Authors: Sung Lillian , Ramotar Karam , Samson Lindy M. , Toye Baldwin
Published: February 2006

This retrospective case-control study was performed to determine risk factors for bacteremia due to persistent coagulase-negative staphylococci in our neonatal intensive-care unit. Enteral nutrition and the presence of a nasogastric tube were identified as possible risk factors for coagulase-negative staphylococcal bacteremia involving one of the persistent strains.
Outbreak of Methicillin-Resistant Staphylococcus aureus in a German Tertiary-Care Hospital
Authors: Rüchel Reinhard , Mergeryan Hamparsum , Boger Olga , Langefeld Christiane , Witte Wolfgang
Published: February 2006

A biphasic outbreak of methicillin-resistantStaphylococcus aureusin intensive-care units of a German tertiary-care hospital afflicted 89 patients within 4 years. The spread of the outbreak most likely was facilitated by the contamination of mobile radiograph equipment. The outbreak was controlled by measures of hospital hygiene.
Varicella Serological Status of Healthcare Workers as a Guide to Whom to Test or Immunize
Authors: Brunell Philip Alfred , Wood David
Published: February 2006

Only 1.6% of 1,331 hospital workers were seronegative for varicella-zoster virus (VZV), including 8.7% of those with a negative history and 0.5% of those with a positive history. Seronegativity was inversely related to age but unrelated to job category, exposure at work to VZV, country of origin, race, or gender.
Issues in the Management of Resistant Bacteria in Long-Term–Care Facilities
Authors: Bradley Suzanne F.
Published: February 2006

The prevalence of antibiotic-resistant bacteria in the long-term–care setting and the risk to nursing home residents is still unknown. Few studies have been done in community-based nursing homes, and most have focused on colonization rather than infection rates. Concerns about methicillin-resistantStaphylococcus aureusand vancomycin-resistant enterococci have been expressed most often, while relatively scant attention has been paid to the problem of antibiotic resistance in gram-negative bacilli. Antibiotic resistance precautions need to be developed for nursing homes that are simple, effective, inexpensive, and recognize the unique rehabilitative and long-term custodial missions of chronic-care facilities.
Attributable Morbidity and Mortality of Catheter-Related Septicemia in Critically Ill Patients: a Matched, Risk-Adjusted, Cohort Study
Authors: Soufir Lilia , Timsit Jean-François , Mahe Cédric , Carlet Jean , Regnier Bernard , Chevret Sylvie
Published: February 2006

Objective:

To determine the attributable risk of death due to catheter-related septicemia (CRS) in critically ill patients when taking into account severity of illness during the intensive-care unit (ICU) stay but before CRS.

Design:

Pairwise-matched (1:2) exposed-unexposed study.

Setting:

10-bed medical-surgical ICU and an 18-bed medical ICU.

Patients:

Patients admitted to either ICU between January 1, 1990, and December 31, 1995, were eligible. Exposed patients were defined as patients with CRS; unexposed controls were selected according to matching variables.

Methods:

Matching variables were diagnosis at ICU admission, length of central catheterization before the infection, McCabe Score, Simplified Acute Physiologic Score (SAPS) II at admission, age, and gender. Severity scores (SAPS II, Organ System Failure Score, Organ Dysfunction and Infection Score, and Logistic Organ Dysfunction System) were calculated four times for each patient: the day of ICU admission, the day of CRS onset, and 3 and 7 days before CRS. Matching was successful for 38 exposed patients. Statistical analysis was based on nonparametric tests for epidemiological data and on Cox's models for the exposed-unexposed study, with adjustment on matching variables and prognostic factors of mortality.

Results:

CRS complicated 1.17 per 100 ICU admissions during the study period. Twenty (53%) of the CRS cases were associated with septic shock. CRS was associated with a 28% increase in SAPS II. Crude ICU mortality rates from exposed and unexposed patients were 50% and 21%, respectively. CRS remained associated with mortality even when adjusted on other prognostic factors at ICU admission (relative risk [RR], 2.01; 95% confidence interval [CI95], 1.08-3.73; P=.03). However, after adjustment on severity scores calculated between ICU admission and 1 week before CRS, the increased mortality was no longer significant (RR, 1.41; CI95, 0.76-2.61; P=.27).

Conclusion:

CRS is associated with subsequent morbidity and mortality in the ICU, even when adjusted on severity factors at ICU admission. However, after adjustment on severity factors during the ICU stay and before the event, there was only a trend toward CRS-attributable mortality. The evolution of patient severity should be taken into account when evaluating excess mortality induced by nosocomial events in ICU patients.