bluuebunny/crossref_metadata_2025 huggingface dataset:
Daily Meatal Care for Prevention of Catheter-Associated Bacteriuria Results Using Frequent Applications of Polyantibiotic Cream
Authors: Classen David C. , Larsen Robert A. , Burke John P. , Alling David W. , Stevens Lane E.
Published: September 2009

Objective:

To determine the efficacy of meatal treatment with a polyantibiotic cream in the prevention of bacteriuria during transurethral bladder catheterization.

Design:

Randomized controlled trial.

Setting:

Community teaching hospital.

Intervention:

Adult patients who underwent closed urinary catheter drainage for short and intermediate durations (two to 30 days).

Intervention:

Polyantibiotic cream containing polymyxin B sulfate, neomycin sulfate, and gramicidin was applied to the urethral meatus-catheter interface three times daily from the first day of catheterization until bacteriuria was found. The onset of bacteriuria was defined as the day the colonizing species first achieved a colony count of >1000 colonies/ml. Patients randomized to the control group received routine meatal care with cleansing of the meatal surface during daily bathing.

Results:

Among 2,923 patients who were randomly allocated to receive either the protocol meatal care or routine care, the evaluable study population consisted of 747 patients who were nonbacteriuric and who remained catheterized for more than two days. Overall, 26 (6.8%) of 383 patients given the polyantibiotic treatment acquired bacteriuria, as compared to 37 (10.1%) of 364 patients not given this treatment (p = .167). A Cox proportional hazards regression analysis showed that, among putative risk factors including lack of meatal care, only female gender, a meatal swab culture yielding gram-negative rods or enterococci, and lack of antibiotic use during catheterization were independently associated with the development of bacteriuria.

Conclusions:

The adverse effect of meatal care noted in earlier studies of a disinfectant ointment applied twice daily was not found in this study of an antimicrobial preparation in a cream vehicle applied three times daily. However, the results do not support meatal care as an efficacious method to prevent catheter-associated bacteriuria in all patients.
Application of Multilocus Enzyme Electrophoresis to Epidemiologic Investigations of Xanthomonas Maltophilia
Authors: Schable Barbara , Villarino Margarita E. , Favero Martin S. , Miller J. Michael
Published: September 2009

Objective:

To test the utility of a newly developed multilocus enzyme electrophoresis typing method for Xanthomonas maltophilia.

Design:

Isolates were first screened by slide agglutination, which served as the standard to characterize the outbreak strains. All isolates were then subjected to multilocus enzyme elec-trophoresis and the results analyzed based on epidemiological data.

Setting:

This outbreak occurred in a shock-trauma intensive care unit of a large general community hospital.

Patients:

Patients admitted to the shock-trauma intensive care unit who had X maltophilia isolated from any site > 24 hours after admission met the case definition. Specimens from patients who fit the case definition were characterized, as were specimens from other patients that were used as controls for nonoutbreak isolates. Environmental samples were also evaluated for X maltophilia.

Results:

Most of the 64 isolates received during this outbreak were serotype 10, and when they were subjected to multilocus enzyme electro-phoresis, one electrophoretic type predominated and correlated to most outbreak isolates. Unrelated isolates of serotype 10 from other institutions all exhibited unique electrophoretic types.

Conclusion:

Application of multilocus enzyme electrophoresis to X maltophilia outbreaks is a valuable addition to the characterization of suspected outbreak strains.
Effect of Educational Programs, Rigid Sharps Containers, and Universal Precautions on Reported Needlestick Injuries in Healthcare Workers
Authors: Linnemann Calvin C. , Cannon Constance , DeRonde Martha , Lanphear Bruce
Published: September 2009

Objective:

To evaluate the effect of infection control programs on reported needlestick injuries in a general hospital.

Design:

Surveillance of all reported needlestick injuries at the University of Cincinnati Hospital was maintained by the infection control department for five years, from 1985 through 1989. Data on individual workers were collected, tabulated on a monthly basis, and reviewed continually to monitor trends in injuries. During this time, the effects of each of three new infection control programs on reported injuries were evaluated sequentially.

Setting:

A 700-bed general hospital that serves as the main teaching hospital of the University of cincinnati.

Participants:

All employees of University Hospital who reported to personnel health for management of needlestick injuries.

Interventions:

In 1986, an educational program to prevent injuries was initiated and continued throughout the surveillance period. In 1987, rigid sharps disposal containers were placed in all hospital rooms. In 1988, universal precautions were introduced with an intensive inservice.

Results:

Surveillance identified 1,602 needlestick injuries (320/year) or 104/1 ,000/ year. After the educational program began, reported injuries increased rather than decreased, and this was attributed to increased reporting. Subsequently, after installation of the new disposal containers, reported injuries returned to the levels seen prior to the educational program, but recapping injuries showed a significant decrease from 63/year to 30, or 20/1,000/year to 10. This decrease was observed in nurses but not in other healthcare workers. After universal precautions were instituted, total injuries increased slightly, but recapping injuries remained at 50% of the levels reported prior to the use of rigid sharps disposal containers.

Conclusions:

The three infection control programs failed to produce a major reduction in reported needlestick injuries, except for a decrease in recapping injuries associated with the placement of rigid sharps disposal containers in all patient rooms. These observations indicate that new approaches are needed to reduce needlestick injuries.
Needlestick Injury: Impact of a Recapping Device and an Associated Education Program
Authors: Whitby Michael , Stead Pat , Najman Jake M.
Published: September 2009

Objective:

To determine the impact of the introduction of a plastic shield-shaped device (Needleguard, Biosafe, Auckland, New Zealand) and education program designed to allow safer recapping, on recorded rates of needlestick injury.

Design:

A before-after trial with a two-year duration of follow-up.

Setting:

Tertiary referral hospital.

Participants:

Nursing and other hospital personnel.

Results:

Prospectively collected baseline data, together with the results of an anonymous questionnaire of 25% of the hospital nursing staff, defined a reported needlestick injury rate of 6.9 per hundred full-time nursing staff per year. In the pre-intervention period, there were 6.7 needlestick injuries per 100 nursing staff members per year reported. This increased to 15.4 (p<.0001) needlestick injuries per 100 nursing staff members per year after the intervention. An anonymous survey undertaken at both time periods suggests that the apparent increase in officially reported needlestick injuries is due to an increase in the willingness of nurses to now report previously unreported needlestick injuries.

Conclusions:

The impact of the safety device and education program was the more accurate reporting of needlestick injuries; many nursing staff continued to resheath needles contrary to hospital policy. Many staff simply did not use the newly designed safety device. Approaches to improving compliance with such safety devices are considered.
A Survey of Nosocomial Respiratory Viral Infections in a Children's Hospital: Occult Respiratory Infection in Patients Admitted During an Epidemic Season
Authors: Goldwater Paul N. , Martin A. James , Ryan Brownwyn , Morris Sylvia , Thompson Jill , Kok T.W. , Burrell Christopher J.
Published: September 2009

Objective:

To define the extent of shedding of respiratory viruses and Mycoplasma pneumoniae among a population of pediatric patients admitted to the hospital during a winter epidemic period and to identify nosocomial infections within this population.

Design:

An open, prospective survey of patients admitted to three wards (General Medical, Respiratory Infectious, and Infectious Diseases) of a pediatric hospital during a defined three-month period.

Patients:

All patients with medical, respiratory, and infectious conditions admitted to three wards of the Adelaide Children's Hospital had nasopharyngeal aspirations performed at the time of admission with the purpose of documenting viral and M pneumoniae shedding. Patients were monitored daily for the development of symptoms of respiratory infection or new symptoms of respiratory disease. Such patients underwent a further nasopharyngeal aspiration for the purpose of diagnosing hospital-acquired infection.

Results:

Nasopharyngeal aspirations were obtained from 601 patients. Forty-seven percent of asymptomatic patients were positive for a respiratory virus or M pneumoniae, and 61% of patients with respiratory symptoms were also positive. Gastroenteritis patients shed viruses in 66% of cases. Respiratory symptoms were initially overlooked by admitting physicians but subsequently identified in 110 cases, and 46% of these were found to be positive for a respiratory virus or M pneumoniae. There were 18 possible hospital acquired infections among the 293 initially virus-negative patients. Multiple isolates were obtained from a substantial number of patients, especially those with respiratory symptoms.

Conclusions:

A substantial proportion of all patients admitted to a pediatric hospital during winter represent a potential source of infection, and strict infection control measures should be enacted to limit the spread of these infections.
Surveillance for Quality Assessment: IV. Surveillance Using a Hospital Information System
Authors: Classen David C. , Burke John F! , Pestotnik Stanley L. , Evans R. Scott , Stevens Lane E.
Published: September 2009

The first two articles in this series outlined the widespread use of hospital surveillance for infection control programs and the potential use of surveillance for monitoring noninfectious nosocomial events. The third article focused on quality indicators as potential targets for hospital surveillance. Surveillance has been defined as the collection, collation, analysis, and dissemination of data. Several methods have been developed to perform this task in hospitals; the traditional method includes collection of data through extensive chart review, a very time- and labor-intensive process. Computerized methods have been developed for hospital surveillance: several personal computer-based programs in infection control are available, including NOSO 3 (Epi Systematics, Inc., Ft. Myers, Florida) and AICE (ICPA, Inc., Austin, Texas). In addition, the Centers for Disease Control (CDC) offer an IDEAS software program to facilitate collection of hospital data for inclusion in the National Nosocomial Infection Surveillance System. These systems offer added efficiencies in the analysis of data, but not in the collection of data. As surveillance in hospitals is expanded from infection control to other areas, more efficient means of data collection will be essential. The development and implementation of comprehensive hospital information systems offer the potential for improving, enlarging, and conducting more efficient hospital-wide surveillance. This article will review the hospital surveillance programs conducted with a hospital information system currently in use at LDS Hospital in Salt Lake City, Utah.
Antibiotic Resistance in Long-Term Care Facilities
Authors: John Joseph F. , Ribner Bruce S.
Published: September 2009

Long-term care facilities are comprised of a heterogeneous group of institutions caring for residential patients over prolonged periods of time. Included as long-term care facilities in this review are private and Veterans' Affairs (VA) nursing homes, rehabilitation centers, institutions for the developmentally disabled, and hospital wards for both long-term and intermediate care. Patients in long-term care facilities incur bacterial infections at a prevalence of 10% to 16%. These infections usually are caused by common bacterial pathogens that invade the compromised host residing within a complex physical environment. The high prevalence of institutional infections leads, in turn, to the need for multiple courses of antimicrobials or for hospitalization. This process selects strains more resistant to antibiotics, which are then available for repeated dispersal in the long-term care facility.
Disinfection Practices for Endoscopes and Other Semicritical Items
Authors: Rutala William A. , Clontz Eva P. , Weber David J. , Hoffmann Karen K.
Published: September 2009

Objective:

To determine the disinfection practices employed by North Carolina hospitals for endoscopes and other semicritical patient care items and to discuss minimally acceptable disinfection procedures for these items.

Design:

A survey questionnaire was mailed to all North Carolina hospitals to identity their disinfection practices, and a literature review was conducted to ascertain studies that evaluated disinfection techniques for certain semicritical items.

Participants:

Questionnaires were returned by 107 of 167 (64%) North Carolina acute-care hospitals.

Results:

Most hospitals (91%) used a glutaraldehyde-based disinfectant (59%, 2% glutaraldehyde; 29%, 0.13% glutaraldehyde-0.44% phenol-0.08% phenate; 3%, either); half (51%) of the hospitals immersed the endoscope into disinfectant for >20 minutes, but 44% immersed for <10 minutes; nearly all hospitals (97%) disinfected endoscopes at room temperature. Hospitals rinsed the endoscope with sterile water (16%), tap water (54%), tap water followed by alcohol rinse (27%), or other (2%); 58% of the hospitals treated endoscopes from patients infected with human immunodeficiency virus (HIV), hepatitis B virus (HBV), or Mycobacterium tuberculosis differently (81%, ethylene oxide [ETO] sterilization; 10%, increased exposure time; 10%, other). Twenty percent of the hospitals used an automated washer for processing endoscopic instruments. Rigid endoscopes (e.g., arthroscopes, laparoscopes) were primarily high-level disinfected (57%), ET0 sterilized (17%), or either (13%). The disinfection strategies for other semicritical items (e.g., applanation tonometers, cryosurgical instruments, and diaphragm fitting rings) were highly variable for the responding hospitals.

Conclusions:

This survey indicated the presence of a wide variety of practices for handling semicritical patient care items, many of which are inconsistent with current recommendations. To help establish minimally acceptable disinfection procedures for some patient care instruments (e.g., arthroscopes, laparoscopes, tonometers), the scientific literature was reviewed and recommendations were made.
Investigations of Intrinsic Pseudomonas cepacia Contamination in Commercially Manufactured Povidone-Iodine
Authors: Anderson Roger L. , Vess Robert W. , Carr Janice H. , Bond Walter W. , Panlilio Adelisa L. , Favero Martin S.
Published: September 2009

Objective:

Laboratory investigations were initiated with a povidone-iodine antiseptic solution that was intrinsically contaminated with Pseudomonas cepacia. These investigations were helpful in understanding the microbicidal and chemical properties of iodophor solutions and the mechanism by which P cepacia can survive in iodine-containing antiseptics.

Design:

Included in these studies were: prolonged survival of P cepacia; available and free iodine determinations; microbial challenge studies; and scanning electron microscopic examination of contaminated antiseptic.

Results:

P cepacia survived in this iodophor antiseptic up to 68 weeks from the date of manufacture. A uniform concentration of 1% available iodine was found in all lots of povidone-iodine tested as specified on the product label, but free iodine (I,) values varied greatly. Low free iodine levels of 0.23 to 0.46 ppm were associated with the contaminated lot of povidone-iodine. Solutions of povidone-iodine with varying levels of free iodine were rapidly microbicidal when challenged with cells of P cepacia derived from culture broth and washed or adapted to growth in water. P cepacia cells taken directly from contaminated povidone-iodine survived for significantly longer periods of time. Large numbers of P cepacia were found embedded in extracellular material and among strands of glycocalyx between cells as shown by scanning electron microscopy.

Conclusions:

The physical thickness of cellular and extracellular material that forms on surfaces could protect embedded organisms from the microbicidal action of disinfectants and antiseptics and subsequently allow for extended microbial survival times. Manufacturers should be aware that distribution piping surfaces colonized with bacteria may be a source of product contamination and resistant organisms.
Epidemiology of Isolation Precautions
Authors: Pettinger Ann , Nettleman Mary D.
Published: September 2009

Objective:

To investigate compliance with isolation precautions.

Design:

A prospective observational study carried out during ten weeks of 1989. Participants were unaware of the study.

Setting:

The isolation bay of a 24-bed surgical intensive care unit in a 900-bed university tertiary care facility.

Participants:

Study participants included any healthcare worker or visitor entering the patient room during designated 15-minute intervals.

Results:

We observed 467 subjects entering patient rooms. Compliance with strict isolation (65%) was better than with wound/skin (40%) or excretion/secretion (36%) isolation (p<.01). Visitors were more compliant than healthcare workers (88% versus 41%; p<.01). Spending more time in the room was associated with improved compliance (p<.01). Compliance was higher for subjects entering with a group compared with those entering alone (51% versus 41%; p<.05). The compliance rate for nurses improved as the nurse/patient ratio improved (p= .14). Compliance was independent of severity of illness. Multivariate analysis revealed that the amount of time spent in the room, being a visitor, and use of strict isolation were independent predictors of compliance.

Conclusions:

Noncompliance was wide-spread. When increased demands are placed on the time of physicians and nurses in the name of cost containment, unperceived consequences, such as those resulting from decreased compliance, must be considered.
Listeria
Authors: Klein Natalie C. , Schoch Paul E. , Cunha Burke A.
Published: September 2009

Infections with Listeria monocytogenes have been increasing in incidence over the last decade. Listeria species are found widely in the environment, frequently isolated from the soil, water, sewage, and from a variety of wild and domestic animals. Outbreaks of human listeriosis have been linked to contaminated coleslaw, milk, and other dairy products. Since Listeria is an intracellular pathogen, it is not surprising that the majority of symptomatic cases have occurred in individuals receiving immunosup pressive therapy, or with some defect in their cell-mediated immune system.
Monitoring and Evaluation
Authors: Decker Michael D.
Published: September 2009

The development of this section of Infection Control and Hospital Epidemiology was stimulated by the opportunity and the need to expand the activities of those practicing epidemiology in the hospital “beyond nosocomial infections to the rates, distributions, preventive measures, and cost benefit studies of all adverse events in patients.” Some of the most compelling opportunities to do so involve the hospital's quality assessment (QA) and utilization review (UR) activities.

The hospital can reap considerable benefits from the involvement of an epidemiologist in the QA/UR program. Assistance in study design, sampling techniques, data management, and statistically sound analysis can be invaluable. Furthermore, in the process of providing consultation, the epidemiologist is training the QA staff in the epidemiologic approach to data. Involvement of an epidemiologist (particularly a physician epidemiologist) in the QA program can increase the confidence of the medical staff in the validity of the data presented to them and enhance their willingness to act in response.

Although QA programs must be responsive to the requirements of many external entities, for the majority of hospitals, the most detailed and demanding applicable standards are those set by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and published annually in the Accrediting Manual for Hospitals. Fundamental to many of these standards is the process known as “monitoring and evaluation.”
Risk Factors for the Development of Clostridium difficile-Associated Diarrhea During a Hospital Outbreak
Authors: Thibault Alain , Miller Mark A. , Gaese Christina
Published: September 2009

Objective:

To evaluate the risk factors associated with a nosocomial outbreak of Clostridium difficile-associated diarrhea.

Design:

Case-control study with two control groups.

Setting:

University-affiliated urban hospital.

Patients:

A convenience sample of 26 patients was chosen out of a total of 78 hospitalized patients with C difficile-associated diarrhea, defined as the presence of diarrhea and a positive C difficile cytotoxin assay or stool culture. Twenty-six controls were matched for age, gender, ward, and date of admission; 18 additional controls were matched to surgical patients for date and ward of admission, as well as for the type of surgical procedure performed.

Results:

Significant risk factors for the development of C difficile-associated diarrhea were gastrointestinal surgery (exposure odds ratio [EOR] = 7.9, p= .004, 95% confidence interval [CI]= 1.9, 35), use of neomycin (EOR= 15.6, p=.012, 95% CI=1.7, 92), clindamycin (EOR=15.6, p=.005, 95% CI=1.7, 92), metronidazole (EOR=5.7,p=.02,95%CI= 1.4, 25), and excess antibiotic use (mean number of antibiotics = 4.2 versus 1.4, p<.00005). The presence of systemic disease and the use of antacids or immunosuppressive drugs were similar in cases and controls. In surgical patients, no specific antibiotic could be linked to C difficile-associated diarrhea because of uniform perioperative antibiotic use. There was a significant difference in the number of antibiotics administered to cases and controls (mean = 3.1 versus 1.9, p< .005).

Conclusions:

The results suggest that control of nosocomial C difficile-associated diarrhea may be attained by minimizing the administration of antibiotics, avoidance of high-risk antibiotics, and having a high index of suspicion of C difficile-associated diarrhea in patients who develop diarrhea after gastrointestinal surgery. Perioperative administration of metronidazole, when given with other antibiotics, failed to protect against the development of C difficile-associated diarrhea.
Hospital-Acquired Diarrhea in Adults: A Prospective Case-Controlled Study in Mexico
Authors: Zaidi Mussaret , de Leon Samuel Ponce , Ortiz Rosa Maria , de Leon Sergio Ponce , Calva Juan J. , Ruiz-Palacios Guillermo , Camorlinga Margarita , Cervantes Luz Elena , Ojeda Francisco
Published: September 2009

Objective:

To know the incidence, etiology, risk factors, morbidity, and mortality of nosocomial diarrhea in adults.

Design:

Nested case-control study, matched by service, length of stay, date of admission, and presence of leukopenia and/or the acquired immunodeficiency syndrome (AIDS). Cases were those who developed nosocomial diarrhea. Controls were those who did not develop nosocomial diarrhea during a comparative period nor during the next ten days. Stool samples were processed in search for parasites, yeasts, bacteria, and rotavirus.

Setting:

Third-level referral center, in Mexico City, Mexico, for general internal medicine and surgical problems.

Patients:

Eligible subjects were all new admissions to the hospital from November 1987 to September 1988. Reasons for exclusion were presence of chronic diarrheal disease or melena. There were 115 cases and 111 controls.

Results:

Overall risk of acquiring nosocomial diarrhea was 5.5%, or 1.8 episodes per 100 patient-weeks. A potential pathogen was found in 59%. Yeasts and Entamoeba histolytica were the most frequently isolated pathogens. Mortality in cases was 18%, as compared with 5% in controls (p<.01). Multivariate analysis showed enteral feeding, recent enemas, presence of Candida species, use of antacids/Hz-blockers, and presence of nasogastric tubes as significant risk factors for nosocomial diarrhea.

Conclusions:

Diarrhea is a common complication in hospitalized patients. It occurs more often than previously suspected and is linked with a substantial mortality, The spectrum of etiologic agents is different from that reported in pediatric hospitals. Given that nosocomial diarrhea may constitute, at least, a marker of severity of illness, it should receive more attention in general hospitals.
Policy for Managing a Community Infectious Disease Outbreak
Authors: Frace Ruth M. , Jahre Jeffrey A.
Published: September 2009

Objective:

To identify guidelines for the management of an infectious disease emergency.

Setting:

In February 1990, the discovery of hepatitis A in three foodhandlers prompted city and state health officials to offer mass immunization to residents of several counties in eastern Pennsylvania. In an attempt to facilitate the immunization effort, local hospitals were asked to establish and staff clinics to supplement the efforts of the health bureaus.

Results:

Over a four-week period, combined efforts resulted in approximately 10,000 people receiving immunization with immune serum globulin (IgG).

Conclusions:

This was one of several infectious disease emergencies the community has faced in the recent past. Recognizing that future incidents of this nature are likely to occur, one 435-bed community teaching hospital devised an infectious disease emergency policy that allows for rapid deployment of personnel and services in the event of an infectious disease outbreak.
Biological Warfare and Infection Control
Authors: Nettleman Mary D.
Published: September 2009

Though biological weapons were outlawed in 1925 by the Geneva Convention and though research, development, and stockpiling of such weapons were forbidden by the Biological Weapons Convention in 1972, the threat of biological warfare has not been eradicated. A wide variety of agents have been considered as possible weapons. In addition to their devastating effect on the battlefield, some have potential for nosocomial spread in US hospitals that care for victims of biological warfare. The following is a brief review of the history of germ warfare, a description of selected agents under consideration, and a discussion of the potential impact of biological weapons on hospital infection control.

Biological warfare has been attempted many times in past centuries and is not a concept unique to the war in the Persian Gulf. Poisoning wells by throwing dead bodies into them was not uncommon in the Middle Ages. During the 14th century conflict in Crimea, plague victims were catapulted into the besieged city of Kaffa by the Tartar army. Whether aided by this or not, plague soon broke out and the city surrendered. Escaping citizens and returning soldiers soon spread the disease to much of Europe. In another example, blankets from smallpox victims were considered as potential weapons against American Indians by British colonial commanders in the 18th century. More recently, Japan purportedly investigated biological weapons to spread plague, cholera, yellow fever, and anthrax during World War II. Attempts in earlier centuries usually were unsuccessful due to the lack of knowledge about disease vectors and etiological agents. Only with the advent of modern microbiological techniques has intentional biological warfare been possible on an organized and vast scale.
Problems Resulting from Multiple Tests
Authors: Burmeister Leon F.
Published: September 2009

The consequences of multiple tests within a study have received much attention in recent years. In spite of many detailed considerations, there remains controversy concerning the seriousness of these consequences.

To appreciate fully the arguments that abound in this controversy, it is necessary to be aware of several different definitions of errors that can occur in hypothesis testing. The definitions of Type I error (rejection of a true null hypothesis) and Type II error (failure to reject a false null hypothesis) remain basic. Consider initially the Type I error, which receives the major emphasis of arguments concerning the effects of multiple testing. Its usual definition is based on the fact that for a single variable and a single comparison, there is a probability (α) that the hypothesis of no effect erroneously can be rejected. If all studies consisted of only one variable and if only one comparison were of interest (for example, only two treatments or two groups were studied), there would be no multiple testing controversy. Of course, few, if any, studies are so limited in their intent. Thus, the consequences of multiple testing apply to nearly all studies.
Pentamidine: A Review
Authors: Wispelwey Brian , Pearson Richard D.
Published: September 2009

With the advent of the acquired immunodeficiency syndrome (AIDS), the therapeutic importance of pentamidine isethionate has increased greatly. This review summarizes the pharmacology, clinical experience in the treatment ofPneumocystiscarinii pneumonia, and toxicity of pentamidine. Data are conflicting as to whether pentamidine is more or less effective than trimethoprim-sulfamethoxazole (TMP-SX) for the treatment ofP cariniipneumonia in individuals with AIDS, but due to its toxicity and expense, it is considered as second-line therapy forPcarinii pneumonia by many authorities. Hypoglycemia has been encountered in up to 27%, and nephrotoxicity in 25%, of treatment courses with pentamidine. In an attempt to circumvent the toxicities associated with parenteral administration, aerosolized delivery has been evaluated for both therapy and prevention ofP cariniipneumonia. Aerosolized pentamidine, on the basis of early clinical results, convenience, and low toxicity, is being used extensively to preventP cariniipneumonia in individuals at high risk. Relapses occur, however, and pneumothorax may be more common in those using this form of prophylaxis. Aerosolized pentamidine should not be used as sole therapy for acuteP cariniipneumonia.
Serial Survey of Methicillin-Resistant Staphylococcus aureus Nasal Carriage Among Residents in a Nursing Home
Authors: Hsu Clement C.S.
Published: September 2009

Objective:

To study the natural course of nasal colonization by methicillin-resistant Staphylococcus aureus (MRSA) among residents in a nursing home.

Design:

A cohort study with eight surveys of nasal cultures over 15 months.

Setting:

A community nursing home in Chicago, Illinois.

Participants:

Between 117 and 129 residents of the nursing home in each survey.

Results:

MRSA carriers were present throughout the study period. On the average, 24.4% (range: 17.1% to 34.2%) of the residents carried S aureus, and 35.3% (range: 20% to 62.5%) of the isolates were methicillin resistant at each survey. The carrier state was persistent or transient and was affected little by a roommate's carrier status. Approximately 70% to 80% of residents who were bedridden or who had decubitus ulcers or foreign bodies carried MRSA at least once during the study period. Residents' prior hospitalization was not associated with MRSA carriage.

Conclusion:

This study demonstrated that MRSA was perpetuated in the nursing home by persistently or intermittently colonizing debilitated residents who required more intensive nursing care and that the prior hospitalization of the residents was not an important cause of its perpetuation. (Infect Control Hosp Epidemiol. 1991;12:416-421.)
Clinical Significance of Neutropenia in Patients With Human Immunodeficiency Virus Infection
Authors: Farber Bruce F. , Lesser Martin , Kaplan Mark H. , Woltmann Jeanine , Napolitano Barbara , Armellino Donna
Published: September 2009

Objective:

To determine the incidence of infection in human immunodeficiency virus (HIV)-infected patients during periods of neutropenia and non-neutropenia. To compare the infection rates in patients with HIV disease to those in a group hospitalized with neutropenia and hematologic malignancy.

Design:

Prospective observational study conducted between December 1985 and December 1987 at a university teaching hospital. Thirty patients with documented acquired immunodeficiency syndrome (AIDS) and absolute T-helper cells <200 mm/mm3. All patients had a period of non-neutropenia following a neutropenic period (neutrophils <1000 cells/mm3).

Results:

The rate of first infection during neutropenic and non-neutropenic periods for opportunistic infection and nonopportunistic infections were compared. There were no differences between infection rates for the two time periods for both types of infections. A subgroup of patient care days in which non-neutropenic days followed neutropenic days also was studied to eliminate selection bias. In this group, a comparison of infection rates also revealed no difference between neutropenic and non-neutropenic periods. An alternate analysis of the time until first infection during periods of neutropenia or non- neutropenia was done using the Kaplan-Meier product limit method. There was a longer infection-free period for the neutropenic group for opportunistic infections, but it was not statistically significant (p<.1). In addition, we compared HIV-infected patients with a group of 37 patients with neutropenia from hematologic malignancy. There was a significantly higher rate of all infections, particularly bacteremias (p<.001), in the group of patients with hematologic malignancies when compared with all subsets of patients with HIV disease.

Conclusion:

We conclude that patientswith HIV disease and modest neutropenia do not have an increased risk of bacterial infection. The incidence of all infections is significantly greater in patients with neutropenia secondary to hematologic malignancy, (Infect Control Hosp Epidemiol. 1991;12:429-434.)
Efficacy of Glove Combinations in Reducing Cell Culture Infection After Glove Puncture With Needles Contaminated With Human Immunodeficiency Virus Type 1
Authors: Johnson Gregory K. , Nolan Timothy , Wuh Hank C. , Robinson William S.
Published: September 2009

Objective:

To study the effect of various latex and treated glove combinations in reducing the frequency of human immunodeficiency virus (HIV) infection of tissue culture cells after puncture by surgical needles contaminated with infectious human immunodeficiency virus type 1 (HIV 1).

Design:

One, two, or three layers of sterile latex glove material, or two latex layers with intermediate cotton or Kevlar (with or without the virucidal compound nonoxynol-9) were used to cover 24-well cell culture dishes containing MT2 cells in cell culture medium. Surgical needles wet with cell culture medium containing HIV- 1 (HTLV IIIA strain) were passed through the glove materials into the culture medium in the wells of the culture dishes. The culture medium in each well was then assayed biweekly for HIV-1 p24 antigen as a test for infection of cells in the well.

Results:

The rate of HIV-1 infection of cell cultures after glove puncture was greater than 90% with a single latex surgical glove barrier, 23% to 60% with double or triple layers of latex gloves, less than 8% with an intermediate cotton glove impregnated with 4% nonoxynol-9, 6% with an intermediate Kevlar glove, and 0% with an intermediate Kevlar glove impregnated with non-oxynol-9.

Conclusions:

An intermediate glove of Kevlar or of Kevlar or cotton impregnated with virucidal compound nonoxynol-9 between standard latex gloves may improve surgical glove safety, compared with latex gloves alone with respect to needlestick transmission of HIV 1. The experimental model used may permit rapid investigation of other glove systems as barriers to the transfer of infectious agents through gloves by needlestick. (Infect Control Hosp Epidemiol. 1991;12:435-438.)
The Hospital Epidemiologist in Long-Term Care: Practical Considerations
Authors: Mylotte Joseph M.
Published: September 2009

Infection control practices in long-term care facilities have been the subject of an increasing number of reports in the past few years. A recent review by Smith in this series outlined important problems regarding infection surveillance in long-term care facilities including: the lack of standard definitions of infection and the difficulty of applying Centers for Disease Control (CDC) definitions in long-term care facilities: the lack of a consensus on the best approach to infection surveillance in long-term care facilities; the lack of full-time commitment to infection control among long-term care facilities; and the lack of risk stratification of patients. For reasons mentioned previously, the effective solution to these problems will require the input of hospital-based infection control professionals. It would be ideal if, prior to this effort, these professionals could gain some experience regarding the important differences between the long-term care facility and the acute hospital setting.

In this article, the observations of a hospital epidemiologist who has consulted for several years with long-term care facilities will be discussed. Specifically, I will deal with experiences and problems I have dealt with in long-term care facilities that were either new to me or variations of hospital-based experience.
Expected Costs of Implementing a Mandatory Human Immunodeficiency Virus and Hepatitis B Virus Testing and Restriction Program for Healthcare Workers Performing Invasive Procedures
Authors: Gerber-ding Julie Louise
Published: September 2009

Healthcare personnel injured by needles or other sharps contaminated with blood from infected patients are at risk for infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV), and other bloodborne pathogens.’ When such injuries also result in blood contamination of a patient's wound, mucous membrane, or skin lesion, transmission of infection in the opposite direction, from provider to patient, may occur.

Although HBV transmission from HBeAg- positive providers to patients during invasive procedures where the opportunity for injury and contamination coexists was documented as early as 1974, the hazard was not deemed large enough to warrant widespread changes in infection control practices or mandatory testing. Recent reports suggesting that HIV infection in three patients of a dentist with acquired immunodeficiency syndrome (AIDS) were acquired in the dental office have had a much more dramatic impact.
Bactericidal Action of Modulated Ultraviolet Light on Six Groups of Salmonella
Authors: Bank H.L. , John J.F. , Atkins L.M. , Schmehl M.K. , Dratch R.J.
Published: September 2009

Previous studies on the bactericidal effects of ultraviolet (UV) lamps have focused on the effects of specific wavelengths and the time and intensity of exposure. Virtually all of these studies have used continuous wave UV. Exposure to UV can induce abnormal ion flow or increased membrane permeability, or it can depolarize the membrane, induce DNA, RNA, and protein alterations, and inhibit oxidative phosphorylation. Any periodic alteration in the modulation of the intensity alters the biological effectiveness. If the waveform and pulse repetition rate are chosen carefully, the bactericidal effects of the UV light may be greatly enhanced.

We tested a prototype UV-C lamp modulated by a series of complex waveforms designed to enhance bactericidal activity. These experiments evaluated the effectiveness of the modulated WC in a series of in vitro experiments on six serogroups of Salmonella.
Lyme Borreliosis
Authors: Holt Douglas A. , Pattani Namrata J. , Sinnott John T. , Bradley Elizabeth
Published: September 2009

Lyme borreliosis (also known as Lyme disease) has become the most commonly reported tick-transmitted disease in the United States.’ The diverse clinical manifestations of the disease make diagnosis difficult, but Lyme borreliosis is quite responsive to treatment if recognized in the early stages.

In the early part of the century, Afzelius in Sweden and Lipschutz in Austria described a distinctive skin lesion, erythema chronicum migrans (ECM), which developed at the site of a previous tick bite. Later, Garin and Bujadoux in France, Hellerström in Sweden, and Bannwarth in Germany described the association of ECM with neurological diseases, including neuropathies, radiculopathies, and cranial nerve palsies. Lyme disease was first recognized as a separate syndrome in the United States by Dr. Allen Steere and his colleagues in 1976, after a homemaker, MS Polly Murray, brought an outbreak of arthritis to their attention. Epidemiological studies of this unusual geographical clustering of children in Lyme, Connecticut, who were thought to have juvenile rheumatoid arthritis, suggested another process. The illness was eventually found to be caused by a vectorborne spirochete,Borrelia burgdorferi, which is capable of infecting the cardiovascular, dermatologic, neurologic, and musculoskeletal systems.
Microbial Growth and Endotoxin Production in the Intravenous Anesthetic Propofol
Authors: Arduino Matthew J. , Bland Lee A. , McAllister Sigrid K. , Aguero Sonia M. , Villarino Margarita E. , McNeil Michael M. , Jarvis William R. , Favero Martin S.
Published: September 2009

Objective:

In this study, we measured microbial growth and endotoxin production in the intravenous anesthetic propofol using 10 different microbial strains; 6 isolated from outbreak cases and 4 from laboratory stock cultures.

Design:

In each trial, endotoxin-free glass tubes containing 10 ml propofol were inoculated with 10°-103 CFU/ml of the test organism and incubated at 30°C for 72 hours.

Setting:

In May and June 1990, the Centers for Disease Control received reports of 5 outbreaks in 5 states of postsurgical patient infections and/or pyrogenic reactions. Epidemiologic and laboratory investigations implicated extrinsic contamination of an intravenous anesthetic, propofol, as the probable source of these outbreaks.

Results:

After 24 hours, 9 of the 10 cultures increased in viable counts by 3 to 6 logs. At least 1 ng/ml of endotoxin was produced within 24 hours by Escherichia coli, Enterobacter cloacae, and Acinetobacter calcoaceticus subspecies anitratus.

Conclusions:

Propofol can support rapid microbial growth and endotoxin production. To avoid infectious complications, scrupulous aseptic technique should be used when preparing or administering this anesthetic.
Migration to Rural Areas by HIV Patients Impact on HIV-Related Healthcare Use
Authors: Davis Kristine , Stapleton Jack
Published: September 2009

Objective:

To evaluate the impact of patient migration on human immunodeficiency virus (HIV)-related healthcare use in a rural setting.

Design:

Data were collected on all patients seeking medical care related to HIV infection at The University of Iowa HIV/acquired immunodeficiency syndrome (AIDS) clinic. Information was collected related to patient care, stage of illness, prior and current residence, and clinic and hospital use.

Setting:

An outpatient clinic in a university hospital offering primary and consultative medical care for persons with HIV infection.

Patients:

All patients scheduled into clinic reported a previous positive HIV serologic test.

Results:

Forty-five percent (81 of 181) of patients reported moving to Iowa, yet no more than 11% (n = 20) moved out of the state during the same period of observation. Of patients meeting the centers for Disease control criteria for AIDS, 24% were diagnosed prior to moving to Iowa (18 of 74). Twenty-seven percent of AIDS-related inpatient days of hospitalization and 19% of AIDS-related outpatient clinic visits were used by persons diagnosed in another state. Lifetime charges totalled for eight patients ranged from $24,873 to $232,556, with a mean of $109,934.

Conclusions:

A substantial portion of HIV related healthcare in our rural area was used by individuals who had migrated to or back to Iowa. Further understanding of the reasons for and the extent of HIV patient migration to rural areas is needed.
Complications Associated With Central Venous Catheters Inserted in Critically III Neonates
Authors: Hruszkewycz Victoria , Holtrop Paul C. , Batton Daniel G. , Morden Robert S. , Gibson Peter , Band Jeffrey D.
Published: September 2009

Objective:

To assess the incidence and spectrum of complications associated with central venous catheter (CVC) placement in the critically ill infant.

Design:

A prospective study of all babies hospitalized in a neonatal intensive care unit (NICU) from January 1989 to December 1989. Potential risk factors associated with infection were evaluated by a case-control comparison.

Setting:

Conducted at a university-affiliated, tertiary care community hospital.

Patients:

Neonates requiring intensive care and a central venous catheter. Controls consisted of noninfected babies.

Results:

Of 263 critically ill neonates, only 13 (4.9%) required a CVC insertion. Seventeen CVCs were placed in these 13 neonates for a total duration of 600 days (median, 32 days/cannula). Fifteen (88%) of these cannulas had one or more complications during its catheter life including dislodgement or leakage (53%), occlusion or thrombosis (47%), infections (29%), or minor bleeding (12%). Five babies (29%) developed 6 episodes of bloodstream infection including 3 sporadic cases due to Staphylococcus epidermidis and a cluster of fungemia due to Malassezia furfur associated with lipid emulsion therapy Infants with a CVC-associated infection were a younger gestational age (24 weeks versus 32 weeks, p=.04) and weighed less at birth (580 g versus 1285 g, p =.02). The overall rate of bloodstream infection was one episode per 100 days of catheter use.

Conclusions:

CVCs may be lifesaving to a critically ill neonate, but complications occur frequently Use must be restricted to infants in whom alternate delivery routes of intravenous therapy or support are otherwise unavailable.
Cholera, Travel, and Infection Control
Authors: Nettleman Mary D.
Published: September 2009

Recent outbreaks of cholera in South America and a handful of imported cases in the United States have transformed the disease from a third-world curiosity to an important issue for our daily American newspapers. Although cholera often is considered one of the classic plagues of humankind, we now know that the disease can be contained with modern sanitation and that, with proper hydration, mortality rates are less than 1%. The role of epidemiologists and infection control practitioners should be to provide information, reassure the public, and prevent harmful attempts at infection control based on “cholera hysteria.”

It is surprising to realize that cholera is a relative newcomer to the global pestilence scene. In fact, pandemics were not reported before the 18th century..’ As cholera spread from Asia to Europe, panic outran the disease and was exacerbated by futile attempts to limit the epidemic. Cholera victims were placed in strict quarantine, and their houses were burned. In some instances, military troops encircled towns or fortified borders in a vain attempt to confine the disease. Public officials would deny that cholera had invaded their cities until the graveyards were filled with indisputable evidence. In the early 1800s, during the height of the epidemic in the United States, 1,000 people died daily in Philadelphia, Pennsylvania, alone.2 Virtually all those deaths could have been prevented with proper rehydration and replacement of electrolytes.