bluuebunny/crossref_metadata_2025 huggingface dataset:
Molecular Epidemiology of Serratia marcescens Outbreaks in Two Neonatal Intensive Care Units
Authors: Milisavljevic Vladana , Wu Fann , Larson Elaine , Rubenstein David , Ross Barbara , Drusin Lewis M. , Della-Latta Phyllis , Saiman Lisa
Published: April 2006

Objective:

Serratia marcescens can cause serious infections in patients in neonatal intensive care units (NICUs), including sepsis, pneumonia, urinary tract infection, and conjunctivitis. We report the utility of genetic fingerprinting to identify, investigate, and control two distinct outbreaks of S. marcescens.

Design:

An epidemiologic investigation was performed to control two clusters of S. marcescens infections and to determine possible routes of transmission. Molecular typing by pulsed-field gel electrophoresis determined the relatedness of S. marcescens strains recovered from neonates, the environment, and the hands of healthcare workers (HCWs).

Setting:

Two geographically distinct level III-IV NICUs (NICU A and NICU B) in two university-affiliated teaching hospitals in New York City.

Results:

In NICU A, one major clone, “F,” was detected among isolates recovered from four neonates and the hands of one HCW. A second predominant clone, “A,” was recovered from four sink drains and one rectal surveillance culture from an asymptomatic neonate. In NICU B, four neonates were infected with clone “D,” and three sink drains harbored clone “H.” The attributable mortality rate from bloodstream infections was 60% (3 of 5 infants). The antimicrobial susceptibilities of clone F strains varied for amikacin, cefepime, and piperacillin/tazobactam.

Conclusions:

S. marcescens causes significant morbidity and mortality in preterm neonates. Cross-transmission via transient hand carriage of a HCW appeared to be the probable route of transmission in NICU A. Sinks did not harbor the outbreak strains. Antimicrobial susceptibility patterns did not prove to be an accurate predictor of strain relatedness for S. marcescens.
Handwashing Program for the Prevention of Nosocomial Infections in a Neonatal Intensive Care Unit
Authors: Won Sau-Pin , Chou Hung-Chieh , Hsieh Wu-Shiun , Chen Chien-Yi , Huang Shio-Min , Tsou Kuo-Inn , Tsao Po-Nien
Published: April 2006

Objective:

To evaluate the effects of a hand hygiene program on compliance with hand hygiene and the rate of nosocomial infections in a neonatal intensive care unit (NICU).

Design:

Open trial.

Setting:

A level-III NICU in a teaching hospital.

Participants:

Nurses, physicians, and other healthcare workers in the NICU.

Interventions:

A multimodal campaign for hand hygiene promotion was conducted beginning in September 1998. This program consisted of formal lectures, written instructions and posted reminders regarding hand hygiene and proper handwashing techniques, covert observation, financial incentives, and regular group feedback on compliance. Surveillance of handwashing compliance and nosocomial infections before and during the program was analyzed.

Results:

Overall compliance with hand hygiene improved from 43% at baseline to 80% during the promotion program. The rate of nosocomial infections decreased from 15.13 to 10.69 per 1,000 patient-days (P = .003) with improved handwashing compliance. In particular, respiratory tract infections decreased from 3.35 to 1.06 per 1,000 patient-days during the handwashing campaign (P = .002). Furthermore, the correlation between nosocomial infection of the respiratory tract and handwashing compliance also reached statistical significance (r = -0.385; P = .014).

Conclusions:

Improved compliance with handwashing was associated with a significant decrease in overall rates of nosocomial infection and respiratory infections in particular. Washing hands is a simple, economical, and effective method for preventing nosocomial infections in the NICU
Survey of Knowledge, Beliefs, and Practices of Neonatal Intensive Care Unit Healthcare Workers Regarding Nosocomial Infections, Central Venous Catheter Care, and Hand Hygiene
Authors: Kennedy Allison M. , Elward Alexis M. , Fraser Victoria J.
Published: April 2006

Objective:

To assess the knowledge, beliefs, and practices of neonatal intensive care unit (NICU) healthcare workers (HCWs).

Design:

Self-administered survey.

Setting:

A 55-bed NICU.

Participants:

NICU HCWs (N = 215).

Results:

The response rate was 68%. Ninety-two percent knew central venous catheters (CVCs) should be capped, clamped, or connected to running fluids at all times. Ninety-five percent knew when to change gloves. Thirty-one percent knew the recommended duration for handwashing. Most HCWs believed sterile technique in CVC care (96%), gloves (91%), and handwashing (99%) prevent nosocomial infection (NI). Sixty-seven percent used sterile barriers to insert CVCs, 76% reported wearing gloves, 81% reported routine handwashing, 35% knew that bacterial hand counts are higher with rings, 30% knew that long fingernails are associated with higher gram-negative bacterial hand contamination, and 35% knew that artificial fingernails are associated with higher gram-negative bacterial hand contamination. Most (93%) believed HCWs can affect outcomes of patients with NIs. Fewer believed rings (40%), artificial fingernails (61%), and long fingernails (48%) play a role in NIs, or that policies concerning number of rings (50%), cutting fingernails (35%), or prohibiting artificial fingernails (47%) would prevent NIs. Sixty-one percent of HCWs regularly wore at least one ring to work, 56% wore their fingernails shorter than the fingertip, and 8% wore artificial fingernails.

Conclusions:

A disconnect existed between CVC knowledge and beliefs and practice. HCWs did not know the relationship between bacterial hand counts and rings and fingernails, and did not believe rings or long or artificial fingernails increased the risk of NIs.
Pattern of Culture-Proven Neonatal Sepsis in a District General Hospital in the United Kingdom
Authors: Haque Khalid N. , Khan M. Ajaz , Kerry Sally , Stephenson Jim , Woods Gretta
Published: April 2006

Objective:

To determine the incidence, clinical characteristics, and risk factors associated with the first culture-proven episode of sepsis among neonates in a neonatal intensive care unit (NICU).

Setting:

Level-II NICU in the United Kingdom.

Patients:

Neonates with their first culture-proven sepsis between January 1, 1996, and December 31, 2000.

Methods:

Demographic data were obtained from the NICU database and chart review. Sepsis was considered early (EOS; < 72 hours old) or late (LOS; > 72 hours old). Data were also collected on potential risk factors.

Results:

Among 14,767 live births, 1,612 (11%) neonates were admitted to the NICU during the study period. Nine hundred eight were screened for sepsis. One hundred twenty-four had at least one positive culture (overall sepsis rate of 8.4 per 1,000 live births [1%] or 77 per 1,000 NICU admissions). Twenty-four neonates had EOS and 100 had LOS. Coagulase-negative staphylococci (CoNS) and group B Streptococcus were the most frequent organisms causing EOS, whereas CoNS and Escherichia coli most frequently caused LOS. Birth before 30 weeks' gestation and birth weight less than 1,500 g were risk factors for sepsis. Resuscitation at birth was the leading risk factor for EOS and respiratory support prior to sepsis, presence of a central or peripheral catheter, and total parenteral nutrition were leading risk factors for LOS.

Conclusions:

A strong inverse relationship existed between gestational age of 30 weeks or younger and birth weight of 1,500 g or less and LOS. Resuscitation and indwelling intravenous catheters were also risk factors.
Prevalence of Nosocomial Infections in Swiss Children's Hospitals
Authors: Mühlemann Kathrin , Franzini Christine , Aebi Christoph , Berger Christoph , Nadal David , Stähelin Jody , Gnehm Hanspeter , Posfay-Barbe Klara , Gervaix Alain , Sax Hugo , Heininger Ulrich , Bonhoeffer Jan , Eich Gerhard , Kind Christian , Petignat Christiane , Scalfaro Pietro
Published: April 2006

Objective:

To acquire data on pediatric nosocomial infections (NIs), which are associated with substantial morbidity and mortality and for which data are scarce.

Design:

Prevalence survey and evaluation of a new comorbidity index.

Setting:

Seven Swiss pediatric hospitals.

Patients:

Those hospitalized for at least 24 hours in a medical, surgical, intensive care, or intermediate care ward.

Results:

Thirty-five NIs were observed among 520 patients (6.7%; range per hospital, 1.4% to 11.8%). Bacteremia was most frequent (2.5 per 100 patients), followed by urinary tract infection (1.3 per 100 patients) and surgical-site infection (1.1 per 100 patients; 3.2 per 100 patients undergoing surgery). The median duration until the onset of infection was 19 days. Independent risk factors for NI were age between 1 and 12 months, a comorbidity score of 2 or greater, and a urinary catheter. Among surgical patients, an American Society of Anesthesiologists (ASA) score of 2 or greater was associated with any type of NI (P = .03). Enterobacteriaceae were the most frequent cause of NI, followed by coagulase-negative staphylococci; viruses were rarely the cause.

Conclusions:

This national prevalence survey yielded valuable information about the rate and risk factors of pediatric NI. A new comorbidity score showed promising performance. ASA score may be a predictor of NI. The season in which a prevalence survey is conducted must be considered, as this determines whether seasonal viral infections are observed. Periodic prevalence surveys are a simple and cost-effective method for assessing NI and comparing rates among pediatric hospitals.
Healthcare-Associated Infections Among Neonates in Brazil
Authors: Pessoa-Silva Carmem Lúcia , Richtmann Rosana , Calil Roseli , Santos Rosana Maria Rangel , Costa Maria Luiza M. , Frota Ana Cristina Cisne , Wey Sergio Barsanti
Published: April 2006

Objective:

To describe the epidemiology of healthcare-associated infections (HAIs) among neonates.

Design:

Prospective surveillance of HAIs was conducted during 2 years. Infections beginning within 48 hours of birth were defined as HAIs of maternal origin. Death occurring during an active episode of HAI was considered related to HAI.

Setting:

Seven neonatal units located in three Brazilian cities.

Patients:

All admitted neonates were included and observed until discharge.

Results:

Twenty-two percent of 4,878 neonates had at least one HAI. The overall incidence density was 24.9 per 1,000 patient-days, and 28.1% of all HAIs were maternally acquired. HAI rates ranged from 12.3% in the group with a birth weight (BW) of more than 2,500 g to 51.9% in the group with a BW of 1,000 g or less. The main HAIs were bloodstream infection (BSI) and pneumonia. Coagulase-negative staphylococci, Enterobacter species, Staphylococcus aureus, and Klebsiella pneumoniae were the main pathogens. Forty percent of all deaths were related to HAI. Central venous catheter (CVC)-associated BSIs per 1,000 CVC-days ranged from 17.3 (BW, 1,501 to 2,500 g; device utilization [DU], 0.11) to 34.9 (BW, ≤ 1,000 g; DU, 34.92). Ventilator-associated pneumonia per 1,000 ventilator-days ranged from 7.0 (BW, ≤ 1,000 g; DU, 0.34) to 9.2 (BW, 1,001 to 1,500 g; DU, 0.14).

Conclusions:

The high proportion of HAIs of maternal origin highlights perinatal care issues in Brazil and the need to improve the diagnosis of neonatal HAIs. The very low BW group and device-associated infections should be priorities for prevention strategies in this population.
Pediatric Risk of Mortality and Hospital Infection
Authors: Arantes Aglai , Carvalho Eduardo da Silva , Medeiros Eduardo A. S. , Farhat Calil Kairalla , Mantese Orlando Cesar
Published: April 2006

We studied the association of Pediatric Risk of Mortality scores with nosocomial infections among 341 critically ill patients admitted to a pediatric intensive care unit between June 1998 and December 2000. Through stepwise logistic regression analysis, the best predictors for nosocomial infections were device utilization ratio, antimicrobial therapy, and length of stay.
Survey of Tuberculin Skin Test Positivity Among Israeli Pediatric Hospital Workers
Authors: Finkelstein Yaron , Elenberg Henia , Chodick Gabriel , Hoffer Vered , Shalit Itamar , Garty Ben-Zion
Published: April 2006

Tuberculin skin test (TST) was performed in 374 healthcare workers. TST results of induration of 10 mm or more and 20 mm or more were noted in 44.9% and 10.4%, respectively. Positive TST (> 10 mm) was found to be significantly associated with age, country of origin, and duration of employment.
Three Surveillance Strategies for Vancomycin-Resistant Enterococci in Hospitalized Patients: Detection of Colonization Efficiency and a Cost-Effectiveness Model
Authors: Lee Todd A. , Hacek Donna M. , Stroupe Kevin T. , Collins Susan M. , Peterson Lance R.
Published: April 2006

Objective:

To evaluate the cost-effectiveness and detection sensitivity associated with three active surveillance strategies for the identification of patients harboring vancomycin-resistant enterococci (VRE) to determine which is the most medically and economically useful.

Design:

Culture for VRE from 200 consecutive stool specimens submitted forClostridium difficileculture. Following this, risk factors were assessed for patients whose culture yielded VRE, and a cost-effectiveness evaluation was performed using a decision analytic model with a probabilistic analysis.

Setting:

A 688-bed, tertiary-care facility in Chicago, Illinois, with approximately 39,000 annual admissions, 7,000 newborn deliveries, 56,000 emergency department visits, and 115,000 home care and 265,000 outpatient visits.

Subjects:

All stool specimens submitted to the clinical microbiology laboratory forC. difficileculture from hospital inpatients.

Results:

From 200 stool samples submitted forC. difficiletesting, we identified 5 patients with VRE in non-high-risk areas not screened as part of our routine patient surveillance. Medical record review revealed that all 5 had been hospitalized within the prior 2 years. Three of 5 had a history of renal impairment. The strategy that would involve screening the greatest number of patients (all those with a history of hospital admission in the prior 2 years) resulted in highest screening cost per patient admitted ($2.48), lower per patient admission costs ($480), and the best survival rates.

Conclusion:

An expanded VRE surveillance program that encompassed all patients hospitalized within the prior 2 years was a cost-effective screening strategy compared with a more traditional one focused on high-risk units.
A Pilot Study of Antibiotic Cycling in the Community Hospital Setting
Authors: Bruno-Murtha Lou Ann , Brusch John , Bor David , Li Wenjun , Zucker Deborah
Published: April 2006

Objective:

To assess the feasibility of a quarterly antibiotic cycling program at two community hospitals and to evaluate its safety and impact on antibiotic use, expenditures, and resistance.

Design:

Nonrandomized, longitudinal cohort study.

Setting:

Two community hospitals, one teaching and one non-teaching.

Patients:

Adult medical and surgical inpatients requiring empiric antibiotic therapy.

Intervention:

We developed and implemented a treatment protocol for the empiric therapy of common infections. Between July 2000 and June 2002, antibiotics were cycled quarterly; quinolones, beta-lactam–inhibitor combinations, and cephalosporins were used. Protocol adherence, adverse drug events, nosocomial infections, antibiotic use and expenditures, resistance among clinical isolates, and length of stay were assessed during eight quarters.

Results:

Physicians adhered to the protocol for more than 96% of 2,494 eligible patients. No increases in nosocomial infections or adverse drug events were attributed to the cycling protocol. Antibiotic acquisition costs increased 31%; there was a 14.7% increase in antibiotic use. Length of stay declined by 1 day. Quarterly variability in the prevalence of vancomycin-resistant enterococci and ceftazidime resistance among combined gram-negative organisms were noted.

Conclusions:

Implementation of an antibiotic cycling program is feasible in a community hospital setting. No adverse safety concerns were identified. Antibiotic cycling was more expensive, partly due to an increase in antibiotic use to optimize initial empiric therapy. Quarterly antibiogram patterns suggested that antibiotic cycling may have impacted resistance, although the small number of isolates precluded statistical analysis. Further assessment of this approach is necessary to determine its relationship to antimicrobial resistance.
Clinical Epidemiology of Ciprofloxacin Resistance and Its Relationship to Broad-Spectrum Cephalosporin Resistance in Bloodstream Infections Caused by Enterobacter Species
Authors: Kang Cheol-In , Kim Sung-Han , Park Wan Beom , Lee Ki-Deok , Kim Hong-Bin , Kim Eui-Chong , Oh Myoung-don , Choe Kang-Won
Published: April 2006

Objectives:

To evaluate the clinical features of ciprofloxacin-resistant Enterobacter bacteremia and to examine the risk factors for ciprofloxacin resistance in Enterobacter species isolates causing bacteremia.

Design:

A case-control study.

Setting:

A 1,500-bed, tertiary-care university hospital and referral center.

Patients:

All patients older than 16 years with Enterobacter species isolated from blood were enrolled. The medical records of 183 patients with clinically significant Enterobacter bacteremia from January 1998 to December 2002 were identified. We compared patients with bacteremia caused by ciprofloxacin-susceptible isolates with patients with bacteremia caused by ciprofloxacin-resistant isolates.

Results:

Twenty-three (12.6%) of the patients had bacteremia caused by isolates resistant to ciprofloxacin. There were no significant differences in age, gender, underlying diseases, primary site of infection, or Acute Physiology and Chronic Health Evaluation II score between the ciprofloxacin-resistant and the ciprofloxacin-susceptible groups. Broad-spectrum cephalosporin resistance, defined as resistance to cefotaxime or ceftazidime in vitro, was detected in 21 (91.3%) of 23 ciprofloxacin-resistant isolates compared with 65 (40.6%) of 160 ciprofloxacin-susceptible isolates (P < .001). Multivariate analysis revealed that independent risk factors for ciprofloxacin resistance were the prior receipt of fluoroquinolones (P < .001) and broad-spectrum cephalosporin resistance (P < .001).

Conclusions:

In Enterobacter species isolates causing bacteremia, ciprofloxacin resistance was closely associated with the prior receipt of fluoroquinolones and broad-spectrum cephalosporin resistance. The close relationship between ciprofloxacin resistance and broad-spectrum cephalosporin resistance is particularly troublesome because it severely restricts the therapeutic options for Enterobacter species infection.
Assessment of Knowledge, Attitudes, and Practices Regarding Isolation Precautions Among Iranian Healthcare Workers
Authors: Askarian Mehrdad , Mirzaei Kamran , Mundy Linda M. , McLaws Mary-Louise
Published: April 2006

We conducted a survey of 1,048 healthcare workers (HCWs) at 8 Iranian hospitals regarding knowledge, attitudes, and practices related to isolation precautions. We found 75% below acceptable safety levels. Routine handwashing before and after glove use was reported by fewer than half of the HCWs.
Nosocomial Acquisition of Methicillin-ResistantStaphylococcus aureusDuring an Outbreak of Severe Acute Respiratory Syndrome
Authors: Poutanen Susan M. , Vearncombe Mary , McGeer Allison J. , Gardam Michael , Large Grant , Simor Andrew E.
Published: April 2006

Objective:

The four hospitals assessed in this study use active surveillance cultures for methicillin-resistantStaphylococcus aureus(MRSA) and contact precautions for MRSA-positive patients as part of routine infection control practices. The objective of this study was to determine whether nosocomial acquisition of MRSA decreased in these hospitals during an outbreak of severe acute respiratory syndrome (SARS) when barrier precautions were routinely used for all patients.

Design:

Retrospective cohort study.

Setting:

Three tertiary-care hospitals (a 1,100-bed hospital; a 500-bed hospital; and an 823-bed hospital) and a 430-bed community hospital, each located in Toronto, Ontario, Canada.

Patients:

All admitted patients were included.

Results:

The nosocomial rate of MRSA in all four hospitals combined during the SARS outbreak (3.7 per 10,000 patient-days) was not significantly different from that before (4.7 per 10,000 patient-days) or after (3.4 per 10,000 patient-days) the outbreak (P= .30 andP= .76, respectively). The nosocomial rate of MRSA after the outbreak was significantly lower than that before the outbreak (P= .003). Inappropriate reuse of gloves and gowns and failure to wash hands between patients on non-SARS wards were observed during the outbreak. Increased attention was paid to infection control education following the outbreak.

Conclusions:

Inappropriate reuse of gloves and gowns and failure to wash hands between patients may have contributed to transmission of MRSA during the SARS outbreak. Attention should be paid to training healthcare workers regarding the appropriate use of precautions as a means to protect themselves and patients.
Epidemiology and Clonality of Methicillin-Resistant and Methicillin-SusceptibleStaphylococcus aureusCausing Bacteremia in a Tertiary-Care Hospital in Spain
Authors: Chaves Fernando , García-Martínez Jesus , Miguel Sonia de , Sanz Francisca , Otero Joaquín R.
Published: April 2006

Objectives:

To describe the relative proportions of nosocomial and community-onsetStaphylococcus aureusbacteremia at our institution and the epidemiologic characteristics and clonal diversity ofS. aureusisolates, as determined by pulsed-field gel electrophoresis (PFGE) and antimicrobial resistance patterns.

Design:

Retrospective cohort study of all cases ofS. aureusbacteremia between October 2001 and October 2002.

Setting:

A 1,300-bed, tertiary-care hospital.

Results:

One hundred sixty-two unique episodes ofS. aureusbacteremia were identified. Forty-three cases (26.5%) were caused by methicillin-resistantS. aureus(MRSA). Most cases ofS. aureusbacteremia, whether MRSA or methicillin susceptible (MSSA), were nosocomial in origin (77.2%) or were otherwise associated with the healthcare system (16%). Only 11 (6.8%) of the cases (all MSSA) were strictly community acquired. Thirty-five unique macrorestriction patterns were identified among the 154 isolates that were typed by PFGE. Four major genotypes were defined among the isolates of MRSA, with 36 (85.7%) represented by a single PFGE type. Of the isolates within this major clone, all (100%) were ciprofloxacin resistant and 77.8% were erythromycin resistant. In contrast, the 112 isolates of MSSA comprised 31 different PFGE types, 3 of which represented 42.9% of all MSSA isolates and were associated with both nosocomial and community-onset bacteremia.

Conclusions:

Most cases ofS. aureusbacteremia in our healthcare region are nosocomial in origin or are acquired through contact with the healthcare system and are thus potentially preventable. To preclude dissemination of pathogenic clones, it is therefore necessary to redouble preventive measures in both the hospital and the community.
Detection and Treatment of Antibiotic-Resistant Bacterial Carriage in a Surgical Intensive Care Unit: A 6-Year Prospective Survey
Authors: Troché Gilles , Toly Luc-Marie , Guibert Michèle , Zazzo Jean-Fabien
Published: April 2006

Objective:

To describe, during a 6-year period, multidrug-resistant bacterial carriage in an intensive care unit (ICU).

Design:

Prospective survey of 2,235 ICU patients with methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-E).

Setting:

A surgical ICU in a tertiary-care teaching hospital.

Patients:

All admitted patients.

Interventions:

Nasal and rectal swabs were performed at admission and weekly thereafter. There was nasal application of mupirocin for MRSA carriers and selective digestive decontamination with local antibiotics for ESBL-E carriers.

Results:

The swab compliance rate was 82% at admission and 51% during ICU stay. The rates of MRSA carriage or infection were 4.2 new cases per 100 admissions and 7.9 cases per 1,000 patient-days during ICU stay. The rates of ESBL-E carriage or infection were 0.4 new case per 100 admissions and 3.9 cases per 1,000 patient-days during ICU stay. Importation of MRSA increased significantly over time from 3.2 new cases per 100 admissions during the first 3 years to 5.5 during the last 3 years. The rate of ICU-acquired ESBL-E decreased from 5.5 cases per 1,000 patient-days during the first 3 years to 1.9 cases during the last 3 years. Nasal and digestive decontamination had low efficacy in eradicating carriage.

Conclusions:

MRSA remained poorly controlled throughout the hospital and was not just a problem in the ICU. MRSA thus requires more effective measures throughout the hospital. ESBL-E was mainly an ICU pathogen and our approach resulted in a clear decrease in the rate of acquisition in the ICU over time.
Healthcare-AssociatedStaphylococcus aureusBacteremia and the Risk for Methicillin Resistance: Is the Centers for Disease Control and Prevention Definition for Community-Acquired Bacteremia Still Appropriate?
Authors: Lesens Olivier , Hansmann Yves , Brannigan Eimar , Hopkins Susan , Meyer Pierre , O'Connel Brian , Prévost Gilles , Bergin Colm , Christmann Daniel
Published: April 2006

Objective:

To evaluate a new classification for bloodstream infections that differentiates hospital acquired, healthcare associated, and community acquired in patients with blood cultures positive forStaphylococcus aureus.

Design:

Prospective, observational study.

Setting:

Three tertiary-care, university-affiliated hospitals in Dublin, Ireland, and Strasbourg, France.

Patients:

Two hundred thirty consecutive patients older than 18 years with blood cultures positive forS. aureus.

Methods:

S. aureusbacteremia (SAB) was defined as hospital acquired if the first positive blood culture was performed more than 48 hours after admission. Other SABs were classified as healthcare associated or community acquired according to the definition proposed by Friedman et al. When available, strains of methicillin-resistantStaphylococcus aureus(MRSA) were analyzed by pulsed-field gel electrophoresis (PFGE).

Results:

Eighty-two patients were considered as having community-acquired bacteremia according to the Centers for Disease Control and Prevention (CDC) classification. Of these 82 patients, 56% (46) had healthcare-associated SAB. MRSA prevalence was similar in patients with hospital-acquired and healthcare-associated SAB (41% vs 33%;P> .05), but significantly lower in the group with community-acquired SAB (11%;P< .03). PFGE of MRSA strains showed that most community-acquired and healthcare-associated MRSA strains were similar to hospital-acquired MRSA strains. On multivariate analysis, Friedman's classification was more effective than the CDC classification for predicting MRSA.

Conclusion:

These results support the call for a new classification for community-acquired bacteremia that would account for healthcare received outside the hospital by patients with SAB.
Clustering of Multiple Endemic Strains of Methicillin-ResistantStaphylococcus aureusin a Nursing Home: An 8-Year Study
Authors: Drinka Paul J. , Stemper Mary E. , Gauerke Cathy D. , Miller Janice E. , Goodman Brian M. , Reed Kurt D.
Published: April 2006

PFGE was performed on residents' first clinical MRSA isolate (n = 94) during 8 years. Sixty-one percent of the isolates were clustered in time (P< .05) and space (P< .05) (ie, 2 separate statistically significant tests). Isolates from individual units were genetically related, with only the occasional unrelated isolate.
A Norovirus Gastroenteritis Epidemic in a Long-Term–Care Facility
Authors: Cooper Elizabeth , Blarney Stephen
Published: April 2006

Background:

In Victoria, Australia, from July to December 2002, 126 outbreaks of viral and suspected viral gastroenteritis were reported in healthcare institutions. Norovirus was found to account for at least 77 of the 126 outbreaks.

Methods:

In October 2002, the infection control unit investigated an outbreak of acute gastroenteritis on three wards in a 500-bed, long-term-care facility in Melbourne, Victoria, Australia. Cohorting and other infection control measures were initiated.

Results:

The outbreak was controlled 32 days after the first symptoms of acute gastroenteritis were identified. Fifty-two patients and 11 staf f members were affected. Norovirus genotype 2 was detected on two of the three wards. Norovirus was not isolated in the third ward but was suspected to be the causative organism.

Conclusions:

Outbreaks of viral gastroenteritis can cause significant morbidity in a long-term-care facility, affecting both patients and staff. In addition, the transmission of viral pathogens can be well established before there is recognition of an outbreak.
Impact of an Outbreak of Norovirus Infection on Hospital Resources
Authors: Zingg Walter , Colombo Carlo , Jucker Thomas , Bossart Walter , Ruef Christian
Published: April 2006

Objective:

To describe a nosocomial norovirus outbreak, its management, and its financial impact on hospital resources.

Design:

A matched case-control study and microbiological investigation.

Methods:

We compared 16 patients with norovirus infection with control-patients matched by age, gender, disease category, and length of stay. Bed occupancy-days during the peak incidence period of the outbreak were compared with the corresponding periods in 2001 and 2002. Expenses due to increased workload were calculated based on a measuring system that records time spent for nursing care per patient per day.

Results:

The attack rates were 13.9% among patients and 29.5% among healthcare workers. The median number of occupied beds was significantly lower due to bed closure during the peak incidence in 2003 (29) compared with the median number of occupied beds in 2001 and 2002 combined (42.5). Based on this difference and a daily charge of $562.50 per patient, we calculated a revenue loss of S37.968. Additional expenses totaled $10,300 for increased nursing care. Extra costs for microbiological diagnosis totaled $2,707. Lost productivity costs due to healthcare workers on sick leave totaled $12,807. The expenses for work by the infection control team totaled $1,408. The financial impact of this outbreak on hospital resources comprising loss of revenue and extra costs for microbiological diagnosis but without lost productivity costs, increased nursing care, and expenses for the infection control team totaled $40,675.

Conclusions:

Nosocomial norovirus outbreaks result in significant loss of revenue and increased use of resources. Bed closures had a greater impact on hospital resources than increased need for nursing care.
Evaluation of the Impact of the Source (Patient Versus Staff) on Nosocomial Norovirus Outbreak Severity
Authors: Mattner Frauke , Mattner Lutz , Borck Hans Ulrich , Gastmeier Petra
Published: April 2006

Objective:

To study the dependence of infection risk and outbreak size on the type of index case (ie, patient or staff).

Methods:

Nosocomial outbreaks were reviewed and categorized into those started by patients and those started by staff. Infection risks and outbreak sizes were evaluated taking into account the index case category.

Results:

Of the 30 nosocomial outbreaks of norovirus with person-to-person transmission, 20 (67%) involved patients as the index cases. Patient-indexed outbreaks affected significantly more patients than did staff-indexed outbreaks (difference in means, 16.25; 95% confidence interval [CI95], 5.1 to 27.0). For the numbers of affected staff, no dependence on the index case category was detectable (difference in means, -1.05; CI95, -9.0 to 6.9). For patients exposed during patient-indexed outbreaks, the risk of acquiring a norovirus infection was approximately 4.8 times as high as the corresponding risk for patients exposed during staff-indexed outbreaks (odds ratio [OR], 4.79; CI95,1.82 to 8.28). The infection risk for exposed staff during patient-indexed outbreaks was approximately 1.5 times as high as the corresponding risk during staff-indexed outbreaks (OR, 1.51; CI95, 0.92 to 2.49).

Conclusions:

Patient-indexed norovirus outbreaks generally affect more patients than do staff-indexed outbreaks. Staff appear to be similarly affected by both outbreak index category groups. This study demonstrates the importance of obtaining complete outbreak data, including the index case classification as staff or patient, during norovirus outbreak investigations. Such information may be useful for further targeting prevention measures.
Impact of Nosocomial Infection on Cost of Illness and Length of Stay in Intensive Care Units
Authors: Chen Yin-Yin , Chou Yi-Chang , Chou Pesus
Published: April 2006

Objective:

Economic evaluation has become increasingly important in healthcare and infection control. This study evaluated the impact of nosocomial infections on cost of illness and length of stay (LOS) in intensive care units (ICUs).

Design:

A retrospective cohort study.

Setting:

Medical, surgical, and mixed medical and surgical ICUs in a tertiary-care referral medical center.

Patients:

Patients admitted to adult ICUs between October 2001 and June 2002 were eligible for the study.

Methods:

Estimates of the cost and LOS for patients who acquired a nosocomial infection were computed using a stratified analysis and regression approach.

Results:

During the study period, 778 patients were admitted to the ICUs. Total costs for patients with and without nosocomial infections (median cost, $10,354 and $3,985, respectively) were significantly different (P < .05). The costs stratified by infection site (median differences from $4,687 to $7,365) and primary diagnosis (median differences from $5,585 to $16,507) were also significantly different (P < .05) except for surgical-site infection. After covariates were adjusted for in the multiple linear regression, nosocomial infection increased the total costs by $3,306 per patient and increased the LOS by 18.2 days per patient (P < .001). Each additional day spent in the ICU increased the cost per patient by $353 (P < .001).

Conclusions:

Nosocomial infections are associated with increased cost of illness and LOS. Prevention of nosocomial infections should reduce direct costs and decrease the LOS.
Effect of Pressure Ulcers on Length of Hospital Stay
Authors: Graves Nicholas , Birrell Frances , Whitby Michael
Published: April 2006

Objective:

To identify the independent effect of pressure ulcers on excess length of stay and control for all observable factors that may also contribute to excess length of stay. Hospitalized patients who develop a pressure ulcer during their hospital stay are at a greater risk for increased length of stay as compared with patients who do not.

Design:

Cross-sectional, observational study.

Setting:

Tertiary-care referral and teaching hospital in Australia.

Patients:

Two thousand hospitalized patients 18 years and older who had a minimum stay in the hospital of 1 night and admission to selected clinical units.

Methods:

Two thousand participants were randomly selected from 4,500 patients enrolled in a prospective survey conducted between October 2002 and January 2003. Quantile median robust regression was used to assess risk factors for excess length of hospital stay.

Results:

Having a pressure ulcer resulted in a median excess length of stay of 4.31 days. Twenty other variables were statistically significant at the 5% level in the final model.

Conclusions:

Pressure ulcers make a significant independent contribution to excess length of hospitalization beyond what might be expected based on admission diagnosis. However, our estimates were substantially lower than those currently used to make predictions of the economic costs of pressure ulcers; existing estimates may overstate the true economic cost.
Knowledge of Standard and Isolation Precautions in a Large Teaching Hospital
Authors: Sax Hugo , Perneger Thomas , Hugonnet Stéphane , Herrault Pascale , Chraïti Marie-Noëlle , Pittet Didier
Published: April 2006

Objective:

To assess the level of knowledge regarding and attitudes toward standard and isolation precautions among healthcare workers in a hospital.

Method:

A confidential, self-administered questionnaire survey was conducted in a random sample of 1,500 nurses and 500 physicians in a large teaching hospital.

Results:

A total of 1,241 questionnaires were returned (response rate, 62%). The median age of respondents was 39 years; 71.9% were women and 21.2% had senior staff status. One-fourth had previously participated in specific training regarding transmission precautions for pathogens conducted by the infection control team. More than half (55.9%) gave correct answers to 10 or more of the 13 knowledge-type questions. The following reasons for noncompliance with guidelines were judged as “very important”: lack of knowledge (47%); lack of time (42%); forget-Mness (39%); and lack of means (28%). For physicians and healthcare workers in a senior position, lack of time and lack of means were significantly less important (P < .0005). On multivariate linear regression, knowledge was independently associated with exposure to training sessions (coefficient, 0.33; 95% confidence interval, 0.08 to 0.57; P = .009) and less professional experience (coefficient per increasing professional experience, -0.024; 95% confidence interval, -0.035 to -0.012; P < .0005).

Conclusions:

Despite a training effort targeting opinion leaders, knowledge of transmission precautions for pathogens remained insufficient. Nevertheless, specific training proved to be the major determinant of “good knowledge”.
Surveillance and Infection Control in an Intensive Care Unit
Authors: Orsi Giovanni Battista , Raponi Massimiliano , Franchi Cristiana , Rocco Monica , Mancini Carlo , Venditti Mario
Published: April 2006

Objective:

To evaluate the effect of an infection control program on the incidence of hospital-acquired infection (HAI) and associated mortality.

Design:

Prospective study.

Setting:

A 2,000-bed, university-affiliated hospital in Italy.

Patients:

All patients admitted to the general intensive care unit (ICU) for more than 48 hours between January 2000 and December 2001.

Methods:

The infection control team (ICT) collected data on the following from all patients: demographics, origin, diagnosis, severity score, underlying diseases, invasive procedures, HAI, isolated microorganisms, and antibiotic susceptibility.

Interventions:

Regular ICT surveillance meetings were held with ICU personnel. Criteria for invasive procedures, particularly central venous catheters (CVCs), were modified. ICU care was restricted to a team of specialist physicians and nurses and ICU antimicrobial therapy policies were modified.

Results:

Five hundred thirty-seven patients were included in the study (279 during 2000 and 258 in 2001). Between 2000 and 2001, CVC exposure (82.8% vs 71.3%; P < .05) and mechanical ventilation duration (11.2 vs 9.6 days) decreased. The HAI rate decreased from 28.7% in 2000 to 21.3% in 2001 (P < .05). The crude mortality rate decreased from 41.2% in 2000 to 32.9% in 2001 (P < .05). The most commonly isolated microorganisms were nonfermentative gram-negative organisms and staphylococci (particularly MRSA). Mortality was associated with infection (relative risk, 2.11; 95% confidence interval, 1.72-2.59; P <.05).

Conclusion:

Routine surveillance for HAI, coupled with new measures to prevent infections and a revised policy for antimicrobial therapy, was associated with a reduction in ICU HAIs and mortality.
Impact of Severity of Illness Bias and Control Group Misclassification Bias in Case-Control Studies of Antimicrobial-Resistant Organisms
Authors: Harris Anthony D. , Carmeli Yehuda , Samore Matthew H. , Kaye Keith S. , Perencevich Eli
Published: April 2006

Background:

Case-control studies often analyze risk factors for antibiotic resistance. Recently published articles have illustrated that randomly selected control-patients may be preferable to those with the susceptible phenotype of the organism. A possible methodologic problem with randomly selected control-patients is potential bias due to control group misclassification. This occurs if some control-patients did not have clinical cultures performed and thus might have been unidentified case-patients. If this bias exists, these studies might be expected to report lower odds ratios (ORs) because control-patients would be more like case-patients.

Objective:

To analyze potential biases that might arise due to control group misclassification and potentially larger selection biases that may be introduced if control-patients are required to have at least one clinical culture.

Patients:

One hundred twenty case-patients, 770 control-patients in group 1, and 510 control-patients in group 2.

Methods:

Two case-control studies. Case-patients had clinical cultures positive for imipenem-resistant Pseudomonas aeruginosa. The first group of control-patients were random. The second group of control-patients were identical to those in group 1 except being required to have at least one clinical culture.

Results:

Univariate analyses showed higher ORs for case-patients versus control-patients in group 1 (imipenem [OR, 12.5], piperacillin-tazobactam [OR, 3.7], and vancomycin [OR, 4.7]) as compared with case-patients versus control-patients in group 2 (imipenem [OR, 8.0], piperacillin-tazobactam [OR, 2.5], and vancomycin [OR, 3.0]).

Conclusion:

Requiring control-patients to have at least one clinical culture introduces a selection bias likely because it eliminates patients with less severe illness.
The Case-Case-Control Study Design: Addressing the Limitations of Risk Factor Studies for Antimicrobial Resistance
Authors: Kaye Keith S. , Harris Anthony D. , Samore Matthew , Carmeli Yehuda
Published: April 2006

Objective:

There are significant limitations of the standard case-control study design for identifying risk factors for resistant organisms. The objective of this study was to develop a study design to overcome these limitations.

Design:

Theoretical analysis of different types of study designs that can be used in risk factor studies for resistant organisms.

Results:

We developed the case-case-control study design, which uses two separate case-control analyses within a single study. The first analysis compares patients infected with resistant bacteria (resistant cases) with control-patients without infection caused by the target organism, who are therefore representative of the source population; and the second analysis compares patients infected with the susceptible phenotype of the target organism (susceptible cases) with the same controlpatients without infection caused by the target organism. These two analyses provide risk models for (1) isolation of the resistant phenotype of the target organism as compared with the source population and (2) isolation of the susceptible phenotype of the organism as compared with the source population. When these two risk models are compared and contrasted, risk factors specifically associated with isolation of the resistant phenotype can be identified.

Conclusions:

The case-case-control study design is an effective method for identifying risk factors for antimicrobial-resistant pathogens. Although the case-case-control study design has limitations, it is, in our opinion, more informative and less flawed than the standard case-control study design.
Isolation of Infectious Cystic Fibrosis Patients: Results of a Systematic Review
Authors: Vonberg Ralf-Peter , Gastmeier Petra
Published: April 2006

Objective:

Respiratory tract infections significantly contribute to morbidity and mortality among cystic fibrosis (CF) patients. Therefore, pathogen transmission needs to be prevented. There are several guidelines for the care of CF patients, but no transparent systematic literature review has been published.

Methods:

We conducted a systematic literature review (January 1966 to September 2004) dealing with segregation of CF patients colonized withBurkholderia cepaciaspecies,Pandoraeaspecies,Pseudomonas aeruginosa, Stenotrophomonas maltophilia,orAlcaligenesspecies. Quality of studies was evaluated by taking patient population size, existence of control-patients, patient randomization, diagnostic approach, and bacteria typing methods into account.

Results:

One hundred ninety-nine studies were found. Evidence and quality of 102 publications were evaluated. In 99 publications, recommendations concerning segregation measures for infectious CF patients were determined including a total of 11,576 patients. No randomized, controlled trials had been conducted. Fifty of 56 authors strongly recommended isolation of CF patients infected withB. cepaciaorPandoraeaspecies. In 31 of 39 studies, interpatient spread ofPseudomonas aeruginosawas documented or had been brought to an end by isolation of patients. Only five studies had addressed S.maltophiliaorAlcaligenesspecies.

Conclusions:

Patients colonized withB. cepaciaorPandoraeaspecies are to be separated from noncolonized patients in single rooms. Patients harboring multidrug-resistantPseudomonas aeruginosa, S. maltophilia,orAlcaligenesspecies may not share a room with immunocompromised patients, in intensive care units, or with other CF patients anywhere in the hospital.
Evaluation of Policies Regarding Physicians Infected With Blood-Borne Pathogens
Authors: Ng Cherie , Swartzberg John
Published: April 2006

Objective:

Formulating an effective approach to preventing surgeon-to-patient transmission of blood-borne pathogens has been controversial. The objective of our study was to evaluate current community hospital policies, if any, regarding restrictions on surgeons (general surgeons and obstetricians and gynecologists) infected with blood-borne pathogens operating on patients.

Design:

A survey on hospital policies regarding surgeons infected with blood-borne pathogens was sent to infection control officers at Northern California community hospitals (n = 113).

Results:

Forty-five hospitals responded to the survey. Of these, only 6 (13.3%) had a policy. Of the 39 (86.7%) that did not have a policy, only 3 hospitals were planning on implementing one.

Conclusions:

Many community hospitals are uninterested in instituting a policy regarding the practice of surgeons infected with blood-borne pathogens. Possible reasons include the lack of concern on the individual level, difficulty in defining exposure-prone procedures, and the nature of the relationship between medical staff and community hospitals.
Prerequisite Programs and Food Hygiene in Hospitals: Food Safety Knowledge and Practices of Food Service Staff in Ankara, Turkey
Authors: Bas Murat , Temel Mehtap Akçil , Ersun Azmi Safak , Kivanç Gökhan
Published: April 2006

Our objective was to determine food safety practices related to prerequisite program implementation in hospital food services in Turkey. Staff often lack basic food hygiene knowledge. Problems of implementing HACCP and prerequisite programs in hospitals include lack of food hygiene management training, lack of financial resources, and inadequate equipment and environment.