bluuebunny/crossref_metadata_2025 huggingface dataset:
Observations Relating to an Inter-Hospital Outbreak of Methicillin-Resistant Staphylococcus aureus: Role of Antimicrobial Therapy in Infection Control
Authors: Ward Thomas T. , Winn Rick E. , Hartstein Alan I. , Sewell David L.
Published: August 2016

Clinical, bacteriologie, epidemiologic and hospital infection-control observations related to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus are described. The outbreak involved 66 patients at the University of Oregon Health Sciences Center (UOHSC) and its closely affiliated VA hospital, the Portland VA Medical Center (PVAMC). No environmental source of infection was identified; person-to-person transmission was most likely responsible for its spread. Surveillance cultures demonstrated nasal colonization in house staff and nursing personnel at both hospitals. Inter-hospital transfer of infection was, in all likelihood, achieved via nasal carriage by a single physician. Case-control analysis indicated a significantly increased risk (p < 0.05) of acquisition of infection related to age, number of days hospitalized, severity of underlying disease and number of invasive procedures. Prior antibiotic receipt was a significant risk factor when analyzed by univariate analysis (p < 0.01), but, in contrast to previous studies, this was not a significant risk factor (p > 0.05) when related variables were controlled by multivariate analysis. Prevention of spread of infection by routine infection control measures was less effective at PVAMC than at UOHSC. Patients at PVAMC were significantly older and had longer durations of hospitalization (p < 0.05). Antimicrobial therapy of colonized patients and personnel appeared to assist in the control of the outbreak at PVAMC. Antimicrobial therapy with topical bacitracin and oral rifampin, alone or in combination with oral trimethoprim-sulfamethoxazole, was effective in eliminating colonization with methicillin-resistant S. aureus. [Infect Control 1981; 2(6):453-459.]
Klebsiella pneumoniaePseudobacteremia Due to Cross-Contamination of A Radiometric Blood Culture Analyzer
Authors: Greenhood Gary P. , Highsmith Anita K. , Allen James R. , Causey William A. , West C. Michael , Dixon Richard E.
Published: August 2016

Blood isolates from 13 patients in one hospital were positive forKlebsiella pneumoniaeover a two-week period. Vials of potassium chloride used in intravenous fluid admixture initially were suspected of being contaminated and thus causing the problem. However, a comparison of patients who had blood cultures positive forK. pneumoniaewith control patients who had blood cultures negative for this organism during the same period identified no common features that would explain the increase inK. pneumoniaeblood isolates. Careful evaluation of laboratory data suggested that six of the 13 culture-positive patients had probable pseudobacteremia, an explanation that would account for the increase in isolates above the endemic level of trueK. pneumoniaebacteremia in the hospital. Epidemiologic data suggested that cross-contamination of adjacent and non-adjacent blood culture vials on the radiometric blood culture analyzer was the cause of pseudobacteremia;K. pneumoniaeserotyping data supported this hypothesis. A mocktrial using the analyzer demonstrated that cross-contamination of non-adjacent vials by the sampling needles could occur. Changing the sampling needles of the analyzer daily, in accordance with the manufacturer's recommendations, prevented further episodes of pseudobacteremia from the analyzer. [Infect Control 1981; 2(6):460-465.]
Nursery Epidemic Due to Multiply-ResistantKlebsiella pneumoniae: Epidemiologic Setting and Impact on Perinatal Health Care Delivery
Authors: McKee Kelly T. , Cotton Robert B. , Stratton Charles W. , Lavely Gail B. , Wright Peter F. , Shenai Jayant P. , Evans Martin E. , Melly M. Ann , Farmer J.J. , Karzon David T. , Schaffner William
Published: August 2016

Gram-negative bacilli frequently cause epidemics in high-risk newborn intensive care units. Recently, an epidemic caused by a multiply-resistantK. pneumoniae, serotype 21, occurred in the Vanderbilt University intensive care nursery. The background of this outbreak included an increasing endemic nosocomial sepsis rate, operation of the facility in excess of rated capacity, and increasingly inadequate nurse-to-patient staffing ratios. The epidemic lasted 11 weeks; 26 (12%) of the 232 infants at risk in the unit became colonized. Five infants developed systemic illness and one died. Cohorting, reinforcement of strict handwashing and isolation procedures, and closure of the unit to outborn admissions resulted in rapid termination of the outbreak. Followup studies performed on infants colonized with the epidemic bacterium demonstrated persistent fecal shedding up to 13 months following discharge from the hospital. This epidemic had a detrimental influence on high-risk newborn and obstetric health care delivery in an area encompassing portions of three states. Under a system of progressively more sophisticated referral units, nosocomial infections occurring at a tertiary center can have an impact on other hospitals within the network.
Cost Effectiveness and Cost Benefit of Vaccination Against Pneumococcal Pneumonia. Implications for Clinical Practice
Authors: Willems Jane Sisk
Published: August 2016

The economic techniques of cost-effectiveness and cost-benefit analysis have provided useful insights into the potential advantages of vaccination against pneumococcal pneumonia. They suggest that the cost of vaccinating persons 65 years and older and perhaps younger persons with high risk conditions would be reasonable when compared with the cost of treatment for pneumococcal pneumonia. These findings, together with other considerations, may guide physicians and health care policymakers in deciding which individuals might be expected to benefit from pneumococcal vaccination.
Hospital-Based Pneumococcal Immunization: The Epidemiologic Rationale and Its Implementation
Authors: Fedson David S.
Published: August 2016

Many patients hospitalized for or dying of pneumococcal bacteremia have been discharged from a hospital with in the previous five years. In addition to age and underlying medical condition, previous hospital care, particularly for high risk conditions, is a useful marker for identifying individuals who are destined to develop serious pneumococcal infections. Relatively few patients, especially those with high risk conditions, would need to receive pneumococcal vaccine at the time of hospital discharge to prevent, within the next five years, each subsequent readmission or death from pneumococcal pneumonia. Although pneumococcal vaccine has not been widely used in the hospital setting, there are sound epidemiologic reasons to expect that organized programs for vaccine delivery in hospitals would be an effective approach to preventing many serious pneumococcal infections.
Pneumococcal Immunization: Policy Development and Implementation from the ACIP Perspective
Authors: Dull H. Bruce
Published: August 2016

The Advisory Committee on Immunization Practices (ACIP) of the U.S. Public Health Service is responsible for making recommendations on the use of new vaccines and periodically revising those for established vaccines. Recommendations for pneumococcal vaccine were first issued in 1978 and revised in 1981. The changes which appear in the revision reflect the continuing maturation of the Committee's judgment on the vaccine and are a good example of the process by which the ACIP develops its recommendations on national immunization practices.
An Evaluation of Daily Bacteriologic Monitoring to Identify Preventable Episodes of Catheter-Associated Urinary Tract Infection
Authors: Garibaldi Richard A. , Mooney Barbara R. , Epstein Beverly J. , Britt Michael R.
Published: August 2016

We evaluated the efficacy of a daily bacteriologic monitoring program for preventing symptomatic urinary tract infections (UTI) in hospitalized patients with temporary indwelling urethral catheters. We identified 99 instances in which bacteriuria was present at the time of catheter insertion among 1,140 catheterizations. Of those, 62 patients were asymptomatic and 37 patients had fever or symptoms attributable to UTI. Of the 37 symptomatic episodes, only 14 developed symptoms 24 hours or more after the first culture and might be considered potentially preventable.

We also identified 76 episodes of acquired bacteriuria among 608 catheterizations that were initially non-bacteriuric in which at least two cultures were available. Of these 76 patients, 51 (67%) remained asymptomatic throughout their period of hospitalization. Of the 25 patients who developed symptomatic infections, only ten were potentially preventable.

In all, only 24 symptomatic episodes among 1,140 catheterizations (2%) occurred 24 hours or more after colonization was first detected and might be considered potentially preventable. Our data suggest that routine daily bacteriologic monitoring of urine from all catheterized patients is not an efficient way to decrease the incidence of symptomatic, catheter-associated UTI.
Guideline for Prevention of Surgical Wound Infections
Authors: Simmons Bryan P.
Published: August 2016

Patients who undergo a surgical operation are at high risk of having one or more nosocomial infections. These infections develop in more surgical patients (8%) than in any other patient group, and about 70% of all nosocomial infections throughout the hospital develop in patients who have an operation. Most infections in surgical patients, however, are not related to the wound but to instrumentation of the urinary and respiratory tracts. Thus, personnel who take care of these patients should be aware of measures to prevent nosocomial infections at all sites. Moreover, to prevent surgical wound infections, personnel who perform the operation must take the lead in instituting prevention measures, because the most important measures involve use of good surgical technique and are not easily instituted simply by making changes in hospital policy.
Presumed Autoclave Failure Due to False-Positive Spore Strip Tests
Authors: Gurevich Inge , Holmes Joyce E. , Cunha Burke A.
Published: August 2016

The sterilizing processes in autoclaves and ethylene oxide sterilizers are challenged on a regular basis with a controlled inoculum of spores from two Bacillus species. Within a two-day period in March 1980, the seven autoclaves at this 550-bed hospital appeared to have failed in their function of killing spores on 18 out of 46 test strips. A shut-down of the autoclaves and a massive investigation failed to identify any mechanical, physical, or human failures. However, after 48 hours, it was found that the broth used as growth medium contained a contaminant, Bacillus coagulans, that resulted in broth turbidity at 55°C. Incubating an uninoculated tube of trypticase soy broth (TSB) for quality control at 55°C in addition to the usual 37°C quality check is a recommended safeguard against such occurrences.
Nosocomial Infections Decade-Specific Risk
Authors: Gross Peter A. , Rapuano Christopher , Adrignolo Anthony , Shaw Barbara
Published: August 2016

Although the elderly are thought to be at increased risk for acquiring nosocomial infections (NIs), the degree of risk has not been carefully quantified. We determined the decade-specific risks of NIs. The rate was constant at approximately 10 per 1,000 discharged patients from birth to 40 to 49 years. Thereafter the rate rose logarithmically and peaked at greater than 100 per 1,000 discharges after 70 years. Of all NIs, 64% occurred after 60 years of age. Yet, this elderly group made up only 23% of hospitalized patients. In conclusion, while the elderly comprise a small fraction of hospitalized patients, they account for the majority of nosocomial infections.
An Outbreak of Gentamicin-ResistantEnterobacter cloacaeInfections in a Pediatric Intensive Care Unit
Authors: Anderson Edwin L. , Hieber J. Patrick
Published: August 2016

The intensive care unit at Children's Medical Center in Dallas is a medical-surgical unit that cares for pediatric patients of all ages. In 1978 an outbreak of infections occurred that was caused by a gentamicin-resistant strain ofEnterobacter cloacae. Thirty of the 34 patients involved in the outbreak were neonates. Six patients developed bacteremia, five of them neonates. The neonates who became infected were significantly smaller (> 1500 g) and more premature (< 35 weeks) than control patients. Neonates with bacteremia had a significantly higher incidence of congenital anomalies. In a multi-specialty pediatric intensive care unit newborn infants were the group of patients at high risk for nosocomial infection.
Nursery Salmonellosis Delayed Recognition Due to Unusually Long Incubation Period
Authors: Seals Jerry E. , Parrott Patricia L. , McGowan John E. , Feldman Roger A.
Published: August 2016

A nursery outbreak of diarrheal illness caused bySalmonella nienstedteninitially involved seven infants cared for in one nursery; secondary infection subsequently affected one infant cared for in the same nursery as well as four other infants. Recognition of the outbreak was delayed due to an unusually long incubation period. The period from last known exposure to onset of diarrhea ranged from two to 18 days, with a median of ten days. The prolonged incubation period may have resulted from a low inoculum of the organism, from a previously unknown characteristic ofSalmonella nienstedten, or may be an age-specific response. Hospital infection control personnel should be aware that nosocomial cases of salmonellosis may have a longer incubation period than has been previously recognized.
Acinetobacter
Authors: Stratton Charles W. , Ristuccia Patricia A. , Cunha Burke A.
Published: August 2016

Found in the family Neisseriaceae, the genus Acinetobacter is large and contains many species formerly classified as Mima, Herellea, Moraxella, Bacterium, Achromobacter, and even Pseudomonas. Currently, onlyAcinetobacter calcoaceticusis recognized inBergey's Manual. The phenotypic variability of this species,A. calcoaceticus, is explained on the basis of four biotypes. The biotypes are classed according to their hemolytic activity, production of gelatinase, ability to grow on Salmonella-Shigella (SS) agar, and production of acid from glucose. The two most clinically important and frequently encountered biotypes areA. calcoaceticusvar.anitratusandA. calcoaceticusvar.lwoffi. The other biotypes areA. calcoaceticusvar.haemolyticusandA. calcoaceticusvar.alcaligenes. Although they are not very virulent organisms, infections due to Acinetobacter species have been associated with a wide variety of nosocomial infections. Most infections involve patients with compromised host defenses. Acinetobacter has been associated with a variety of diseases including septicemia, with indwelling intravenous catheters as the suspected portal of entry; bacteriuria, usually associated with the presence of an indwelling bladder catheter; and pneumonias affecting those severely debilitated individuals who have undergone major surgery or trauma. Respiratory support equipment has been found to serve as a source or reservoir for these organisms. Most nosocomial colonizations and infections due toA. calcoaceticusare due to theanitratus variety.
Practical Aspects for Cost Reduction in Hospital Infection Control
Authors: Daschner F.D.
Published: August 2016

Nosocomial infections consume a significant amount of the total hospital budget. This article describes some practical aspects for cost reduction in hospital infection control. Within one year total savings of 91.000 DM* could be achieved by discontinuing unnecessary disinfection procedures. Within six years 2,27 million DM could be saved by discontinuing unnecessary infection control procedures or employing cheaper methods. Of the total antibiotic costs 25% can be reduced by certain measures.
An Outbreak of Gentamicin-ResistantKlebsiella pneumoniae:Analysis of Control Measures
Authors: Saravolatz Louis D. , Arking Lucille , Pohlod Donald , Fisher Evelyn J. , Borer Robert
Published: August 2016

In April 1978, a strain of gentamicin-resistantKlebsiella pneumoniae(GRK) was introduced into the neonatal intensive care unit of Henry Ford Hospital. An additional ten cases of GRK occurred over the subsequent 16 months and intestinal colonization occurred in up to 91% of admissions per month. All GRK were susceptible to amikacin and were capsular serotype 19. Though hand contamination of hospital personnel with GRK was documented, increased handwashing practices did not reduce colonization rates of neonates with the epidemic strain. Intestinal carriage persisted for up to ten months and could not be eradicated by administering oral colistin sulfate. Discontinuation of gentamicin and utilization of amikacin were associated with a significant reduction in colonization with GRK (p< 0.05). However, the only control measure that prevented both new cases and colonization with the epidemic strain was the utilization of a strict cohort system.
Comments on the CDC Guideline for Employee Health
Authors: Valenti William M.
Published: August 2016

A number of resources are available to individuals who are interested in employee health and infection control. These resources can be useful to individuals whose employee health programs are just starting or to those whose programs are well-established.

The most comprehensive document to date is the Employee Health Guidelines published by the Centers for Disease Control. This is perhaps the most comprehensive and thorough document published to date. It is current, reflects the state of the art in employee health, and should provide employee health and infection control practitioners with a wealth of useful information that is practical and clinically relevant.
Summary of the International Workshop National Laws and Guidelines for Control of Infections
Authors: Nyström Bertil , Reber Hans , Weuffen Wolfgang , Schaffner William
Published: August 2016

By way of introduction, Dr. Nyström described the hospital system in Sweden which is organized in a pyramidal fashion within each county. The largest hospital in each county contains a Department of Clinical Microbiology and the organization of hospital infection control activities follows this county structure.

An infection control unit is located within the clinical microbiology laboratory of the major county hospital. The head of the unit, the hospital epidemiologist, is usually a specialist in clinical microbiology with medical training. The epidemiologist has an infection control committee consisting of clinicians of various specialties, especially surgeons. There are usually two infection control nurses per county (now approximately 1 nurse/3000 beds with an eventual goal of 1 nurse/1000 to 1500 beds). The nurses advise the ward staff in all the county hospitals. There are only some 50 infection control nurses in Sweden; financial restrictions curtail the development of infection control activities.
Serratia MarcescensMeningitis Associated With a Contaminated Benzalkonium Chloride Solution
Authors: Sautter Robert L. , Mattman L.H. , Legaspi Ruben C.
Published: August 2016

Serratia marcescensis recognized as an important and potentially hazardous nosocomial pathogen. The organism has been implicated here as the first reported case ofS. marcescensmeningitis associated with skin disinfection. A quaternary ammonium compound (QAC—Benzalkonium Chloride), was used to sterilize the skin prior to injection in a physician's office. Epidemiological studies were initiated. Six spray bottles containing disinfectant, the opened stock bottle of QAC, and an unopened bottle of disinfectant were all cultured.S. marcescenswas noted growing in the spray bottles as well as in the opened stock bottle. Anti-biograms of the patient and epidemiological isolates are essentially the same. It is our contention as well as that of the Centers for Disease Control that an appropriate skin disinfectant such as Tincture of Chlorhexidine, Iodophors, or Tincture of Iodine should be used, and that physicians performing surgical techniques in the office be aware of the potential hazard of contamination. The consequences of nosocomial infection with resistant organisms warrant every precaution by health care professionals.
Disposable Suction Canisters
Authors: Crow Sue
Published: August 2016

The purpose of suctioning is to remove unwanted materials from a body cavity. Th e waste material is mixed with air in the suctioning tubing and drawn into a collection receptacle (canister). After the liquid and air enter the canister, the liquid drops into the canister and the air is discarded into the vacuum system. The vacuum system may be a central or a portable system.
The Pharmacology of Aminoglycosides: II. Distinctions Among the Agents
Authors: Geller Robert J. , Norris Sandra M.
Published: August 2016

The first paper in this series dealt with the similarities among the aminocyclitol agents. In the following discussion, we will emphasize the differences among the commercially available aminoglycosides, highlighting the pharmacokinetic and toxicologic data affecting their rational use.
Analysis of Hospital Infection Surveillance Data
Authors: Birnbaum David
Published: August 2016

How often infection rates should be calculated and how large a change is required for “significance” are pertinent questions in nosocomial infection surveillance programs. A method is presented which establishes outbreak threshold infection frequencies. Comparison is direct and immediate: computation of rates or use of electronic data processing is not required. We have validated this method, using computer systems, by comparing the distributions of mean weekly incidence and prevalence statistics for each ward by nosocomial infection site in an acute care general hospital against both our theoretical outbreak threshold limits and the distribution of proven infection outbreaks. Sensitive and specific distinction between random variation or sporadic cross-infection and true persisting outbreaks requiring intervention is obtained. This approach provides a simple and timely alternative to intuitive after-the-fact interpretation of infection patterns which is applicable to infection surveillance and cost-effective infection control in hospitals of all sizes.
Ethylene Oxide Environmental Monitors
Authors: Samuels Thomas M.
Published: August 2016

Implementing a cost-effective and meaningful ethylene oxide (EtO) environmental monitoring program is more than purchasing an EtO sensitive device and placing it in the department or on an employee. First, the responsible person involved in such a program must have some general knowledge of analytical procedures and methods. Second, the individual should possess an understanding of the various types of equipment that are available and their limitations. Third, and perhaps most importantly, there must be a good thorough understanding of ethylene oxide and the principles of environmental monitoring as it relates to employee exposure. Even if the hospital or department decides to contract with an outside vendor to perform these services, the responsible individual must be involved with the provider from the inception of the program. All too often, departmental managers enter into an ethylene oxide exposure monitoring program with little thought to where, when, or how to monitor. The key to any ethylene oxide exposure monitoring program has to be the measurement of the extent of employee exposure. Once this is established, the monitoring program can be developed.
A Perspective on Controlling Vaccine-Preventable Diseases Among Children in Liberia
Authors: Weeks R. Mark
Published: August 2016

In 1978 the Ministry of Health and Social Welfare in Liberia embarked on a major initiative to expand immunization activity countrywide. During its early development, the Expanded Program on Immunization (EPI) experienced the realities of establishing an immunization program in a developing country, including the high costs of maintaining mobile operations and a network of kerosene refrigerators. To improve vaccination coverage with diminishing resources, the Program recently began to place greater emphasis on integrating immunization activities into the existing infrastructure of hospitals, clinics, and health posts. Although the EPI goal and objectives, which in retrospect were highly ambitious, have not yet been achieved, it is possible to immunize effectively the children and women of Liberia. Effective vaccination coverage can be achieved by developing local strategies, coordinating resources, and most importantly, involving the community. International organizations must support such efforts by continuing to supplement essential supplies and by promoting research to develop vaccines that are more heat-stable and immunogenic.
Multiple-Dose Vials: Persistence of Bacterial Contaminants and Infection Control Implications
Authors: Longfield Robert N. , Smith L. Patrick , Longfield Jenice N. , Coberly Jacqueline , Cruess David
Published: August 2016

Due to sporadic infections attributed to contaminated multiple-dose medication vials (MDV), some authorities have suggested discarding all MDV within 24 hours. We inoculated 11 commonly used medications with suspensions of 10 bacterial species previously associated with contaminated parenteral solutions and determined microbial persistence at both room and refrigerator temperature. At 22°C, atropine, curare, folic acid, NPH insulin and triamcinolone did not allow microbial persistence beyond 4 hours. Lidocaine and heparin were sterile by 24 hours. Regular insulin, immune serum globulin, and myochrysine allowed persistence for up to 7 days. At 4°C, bacterial persistence was significantly prolonged for all medications including those MDV requiring refrigeration. No organisms proliferated; however,F. meningosepticumandP. maltophiliawere particularly persistent at both temperatures. The risk of persistent MDV contamination appears to be dependent upon specific pharmaceutical, microbe and storage temperature interactions. Recommendations for the refrigeration of MDV medications may require reevaluation on a product-by-product basis.
Hospital Usage of Parenteral Antimicrobial Agents: A Gradated Utilization Review and Cost Containment Program
Authors: Pelletier Lawrence L.
Published: August 2016

Forty percent to 60% of antimicrobial agents administered in hospitals without effective antimicrobial review and control programs are not needed. Excessive use of antimicrobial agents in the hospital promotes colonization of patients with resistant organisms, needlessly exposes them to the risk of an adverse drug reaction, and increases the cost of care. A gradated antimicrobial utilization review program is presented that determines hospital usage, develops guidelines for appropriate cost-effective drug administration, provides several options for implementation, and monitors outcome so that measures can be modified for specific situations. The techniques used are basic epidemiologic measures currently used to assess hospital infections.
70% Alcohol Disinfection of Transducer Heads: Experimental Trials
Authors: Talbot George H. , Skros Maureen , Provencher Mary
Published: August 2016

We investigated the feasibility of transducer head disinfection with 70% alcohol wipes. In the initial trial, nine gas-sterilized transducers were inoculated with an estimated 5 × 106 organisms of a clinical isolate of Enterobacter cloacae, mimicking a contaminated fluid couple. A sterile disposable transducer dome was attached to each transducer. The units were allowed to sit for 24 hours at room temperature; the domes were then removed. Three transducer heads were cultured prior to disinfection to ensure that viable organisms remained. Each transducer head was wiped clean with a single alcohol wipe, allowed to dry, and then cultured. All nine cultures showed growth of E. cloacae. A second series of trials with 54 transducers employed an identical protocol, except that each transducer head received not one, but two, applications of alcohol. In addition to E. cloacae (26 runs), Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans were employed in nine, nine and ten runs, respectively. Cultures of 53 of 54 transducer heads showed no growth; the single positive culture was attributed to an error in technique. These preliminary results suggest that the double-alcohol-wipe technique may be an easy, cost-effective, alternative or supplemental method of transducer head disinfection. However, we do not advocate routine implementation of this technique in patient care settings until clinical trials confirm its safety and efficacy.
A Comparison of Pneumonia Caused by Gentamicin, Methicillin-Resistant and Gentamicin, Methicillin-SensitiveStaphylococcus aureus: Epidemiologic and Clinical Studies
Authors: Lentino Joseph R. , Hennein Hani , Krause Sally , Pappas Sharon , Fuller Gail , Schaaff Doris , DiCostanzo Mary Beth
Published: August 2016

We investigated an outbreak of nosocomial pneumonia due to gentamicin, methicillin-resistantStaphylococcus aureus(GMRSA). We compared the predisposing factors for pneunomia due to GMRSA to those for pneumonia due to gentamicin, methicillin-sensitiveStaphylococcus aureus(GMSSA). Seventeen of 29 patients with staphylococcal pneumonia were infected with GMRSA. Risk factors and associated diseases which selected for infection with GMRSA as opposed to GMSSA included prior antibiotic therapy for a prolonged period of time (p = 0.0001), number of risk factors per patient (p = 0.0001), days hospitalized prior to diagnosis of pneumonia (p = 0.002) and number of associated diseases per patient (p = 0.002).

Despite the epidemiologic differences between GMSSA and GMRSA pneumonia, there were no differences in the clinical presentation, course of illness, complications, response to appropriate therapy or outcome between the two groups. Survival was adversely affected by age only among the GMSSA patients (p = 0.02) and by the number of associated diseases (p = 0.005).
Selection of Closed Urinary Drainage Systems—An Update
Authors: Gurevich Inge
Published: August 2016

Recent clinical experience has added Mycobacterium fortuitum and Mycobacterium chelonei to the expanding list of nosocomial pathogens. These rapidly growing mycobacteria were first isolated 80 years ago from frogs (M. fortuitum) and sea turtles (M. chelonei). Obtained occasionally from human sources as early as 1904, they were generally regarded as commensals in man. Friedmann was so convinced of the non-pathogenicity of M. chelonei that he introduced the “turtle vaccine” as a means of preventing and treating tuberculosis. Contemporary medical literature firmly establishes these organisms as human pathogens with particular importance in nosocomial infections.
Postoperative Infections Following Cardiac Surgery: Association with an Environmental Reservoir in a Cardiothoracic Intensive Care Unit
Authors: Dandalides Peter C. , Rutala William A. , Sarubbi Felix A.
Published: August 2016

During 1981, 39 nosocomial infections occurred in 27 of 223 patients undergoing cardiac surgery in the North Carolina Memorial Hospital. The peak attack rate (23.7%) occurred in August and September compared to 10.1% in January through July. A case-control study demonstrated that the only risk factor common to poor and stable health groups compared to controls was duration of stay in the cardiothoracic intensive care unit (CTICU). Microbiologic studies of the environment, personnel and patients showed that colonization or infection of patients occurred 1 to 6 days after admission to the CTICU and that nosocomial pathogens were found: 1) in and around the unit's soiled utility sink, 2) in pooled handwashing cultures of unit personnel, and 3) on contaminated clean hands and air near the soiled utility sink, plus nearby bedside air only while the water in the sink was running. Environmental and personnel hand contamination by soiled utility sink aerosols likely contributed to these infections. Infection control measures, including discontinued use of the soiled utility sink, resulted in a significantly lower infection rate (5.6%).
Epidemic Keratoconjunctivitis: Report of an Outbreak in an Ophthalmology Practice and Recommendations for Prevention
Authors: Buehler James W. , Finton Robert J. , Goodman Richard A. , Choi Keewhan , Hierholzer John C. , Sikes R. Keith , Elsea William R.
Published: August 2016

In Fall 1981, an outbreak of acute infectious conjunctivitis with keratitis (EKC) occurred in patients who had visited a private ophthalmology clinic just prior to onset of illness. Among an estimated 2,200 patient visits to the office from August 10 to October 15, 1981 for problems unrelated to infectious conjunctivitis, 39 (1.8%) persons subsequently developed EKC. The median incubation period was 6.5 days (range, 1 to 14 days). A case-control study was done to identify risk factors associated with contracting EKC; patients with EKC were more likely than control patients to have been examined by one or the other of two of the four ophthalmologists at the clinic and to have undergone procedures such as tonometry or foreign body removal. Adenovirus was isolated from conjunctival swabs from four of five persons with conjunctivitis; three were type 8 and one was type 7. Recognition of the problem and improved handwashing practices were associated with terminating the outbreak. This outbreak illustrates the potential for transmission of adenovirus infection during the provision of eye care. Infection control practitioners should be familiar with measures for the prevention of such infections among ophthalmology patients.
A Multi-Hospital Hepatitis B Vaccine Program: Prevalence of Antibody and Acceptance of Vaccination Among High-Risk Hospital Employees
Authors: Klimek Joseph J. , Brettman Lee , Neuhaus Ellen , Garibaldi Richard A.
Published: August 2016

In July 1982, five Hartford hospitals embarked on a joint hospital-sponsored program to immunize high-risk employees against hepatitis B virus (HBV). The program included a questionnaire to characterize relative risk, serology for anti-HBs, vaccination and a follow-up survey of vaccine non-recipients.

Of 2,065 employees who were considered to be at high-risk for infection with HBV, 1,894 (91.7%) responded to the screening questionnaire and 1,279 (67.5%) were tested for anti-HBs serology. The prevalence of antibody varied from hospital to hospital; the highest prevalence (10.9%) was observed at one of the urban university-affiliated community hospitals and the lowest prevalence (4.1%) was reported from the smaller, rural hospital. The prevalence of antibody also varied greatly within the high-risk groups; the highest prevalence of antibody was seen among surgical house officers (15%). The rate of acceptance of vaccine among hospitals ranged from 57.5% to 23.7%. Reasons for vaccine non-acceptance included fear of as yet unknown side effects, perceived low risk of hepatitis acquisition and possible effects on present or future pregnancies.

Our experience illustrates some of the epidemiologic and practical aspects that must be addressed in administering a hospital-based HBV vaccine program. Among the five hospitals, we saw marked inter- and intra-hospital variations in the prevalence of anti-HBs among high-risk employees. More significantly, we observed unexpectedly low rates of vaccine acceptance among high-risk personnel.
Habitat Association ofKlebsiellaSpecies
Authors: Bagley Susan T.
Published: August 2016

The genusKlebsiellais seemingly ubiquitous in terms of its habitat associations.Klebsiellais a common opportunistic pathogen for humans and other animals, as well as being resident or transient flora (particularly in the gastrointestinal tract). Other habitats include sewage, drinking water, soils, surface waters, industrial effluents, and vegetation. Until recently, almost all theseKlebsiellahave been identified as one species, ie,K. pneumoniae.However, phenotypic and genotypic studies have shown that “K. pneumoniae” actually consists of at least four species, all with distinct characteristics and habitats. General habitat associations ofKlebsiellaspecies are as follows:K. pneumoniae—humans, animals, sewage, and polluted waters and soils;K. oxytoca—frequent association with most habitats;K. terrigena— unpolluted surface waters and soils, drinking water, and vegetation;K. planticola—sewage, polluted surface waters, soils, and vegetation; andK. ozaenae/K. rhinoscleromatis—infrequently detected (primarily with humans).
Klebsiella pneumoniae:Selected Virulence Factors that Contribute to Pathogenicity
Authors: Highsmith Anita K. , Jarvis William R.
Published: August 2016

Klebsiella pneumoniaeinfections occur in humans of all ages, however the highest risk groups appear to be infants, the elderly and the immunocompromised. One or more virulence factors may contribute to pathogenicity in humans. In this article we review three factors that may mediate virulence: cell wall receptors, capsular polysaccharide, and endotoxin.

First, the presence of cell wall receptors enablesK. pneumoniaeto attach to the host cell, thereby altering the bacterial surface so that phagocytosis by polymorphonuclear leukocytes and macrophages is impaired and invasion of the non-phagocytic host cell is facilitated. Second, invasion of the host cell is also facilitated by the large polysaccharide capsule surrounding the bacterial cell; in addition this capsule acts as a barrier and protects the bacteria from phagocytosis. Third,K. pneumoniaeproduces an endotoxin that appears to be independent of factors that determine receptors and capsular characteristics. Marked interspecies differences in endotoxin production may correlate with virulence. Although some or all of these factors may ultimately determine virulence, the interaction of these factors in vivo has made it difficult to assess the relative contribution of any one of these virulence factors. The pathogenic mechanisms ofK. pneumoniaethat ultimately determine virulence remain unclear and will require further study.
The Cephalosporin Antibiotic Agents— III. Third-Generation Cephalosporins
Authors: Marsh T. Donald
Published: August 2016

The third-“generation” cephalosporin antibiotics (Table 1) represent a class of agents with an expanded gram-negative spectrum of activity beyond that of the first- and second-“generation” cephalosporins. Greater stability to beta-lactamases produced by gram-negative organisms confers to these agents a greater bactericidal action against the Enterobacteriaceae. Large bacterial inocula (105/ml) in vitro significantly increase the minimum inhibitory and bactericidal concentrations (MIC and MBC) explaining treatment failures with these agents in infections associated with large numbers of organisms. The pharmacokinetic features of some of the agents allow prolongation of dosing intervals, and enhanced tissue penetration amplifies their clinical utility in infections distant from the bloodstream (eg, meningitis).
Genotypic Approaches to the Diagnosis of Bacterial Infections: Plasmid Analyses and Gene Probes
Authors: Wachsmuth Kaye
Published: August 2016

Practical genetic approaches have been helpful in the diagnosis, epidemiology, and taxonomy of bacterial pathogens encountered in our laboratory at the Centers for Disease Control. There are many examples in which plasmid profiles have been used to define epidemic strains of enteric bacteria, staphylococci, pseudomonads, vibrios, and other pathogenic bacteria. Current methodologies should allow the microbiology laboratory to use plasmid profiles routinely and to identify plasmids associated with bacterial pathogenesis.

Simplified DNA-DNA hybridization procedures have been used in our laboratory to survey or “probe” thousands ofEscherichia colicolonies for the presence of enterotoxin genes, eliminating traditional tissue culture or animal assays. Research scientists continue to develop gene probes for a number of bacterial toxins and hemolysins and for the identification of pathogens such as legionellae and salmonellae. These and other probes as well as hybridization “kits” may be commercially available to diagnostic laboratories within the next few years.
Acceptance of Hepatitis B Vaccine by Hospital Personnel
Authors: Crossley Kent B. , Gerding Dale N. , Petzel Robert A.
Published: August 2016

Personnel at high risk of acquiring hepatitis B in two university-affiliated teaching hospitals were offered immunization against this disease. Of the 1,193 employees, 454 (38%) requested immunization. Individuals who declined or deferred immunization were sent questionnaires requesting the reasons for their decisions. Responses to the questionnaire were received from 487 of 674 personnel (72%). Most respondents (>90%) indicated that they: 1) were aware of being at risk of acquiring hepatitis B, and 2) recognized the potential danger of the disease. A majority of respondents (56%) indicated that they had decided not to be immunized because they wanted to wait until more was known about the vaccine. Concern about specific side effects (eg, Guillain-Barré syndrome or acquired immunodeficiency syndrome) was cited much less often as a reason for declining immunization. Nearly one-fifth of questionnaire respondents either did not know the date of their last tetanus-diphtheria immunization or had not received a booster within the past decade.
A Comparison of Antibiotic Susceptibility Profiles Using Single and Multiple Isolates per Patient
Authors: Bennett William P. , O'Connor Michael L. , Wasilauskas Benedict L.
Published: August 2016

We compared the antibiogram statistics generated by including all clinical isolates to those obtained by tabulating no more than one isolate of a particular organism from a given patient. We found that 48.3% of the isolates presented multiple occurrences in individual patients but found no practical differences in the profiles obtained by the two methods. We also tabulated the occurrence of minimum inhibitory concentration (MIC)-distinct organisms among the sets of multiple isolates of E. coli and of S. aureus and found that only 20.9% of those isolates represented duplicate organisms by MIC profile. This heterogeneity of MIC sensitivity that occurs in multiple isolates from individual patients was not expected but provides an explanation for the lack of difference between the two methods of tabulating antibiotic susceptibility statistics.
Evaluation of a Skin Test for Chicken Pox
Authors: Florman Alfred L. , Umland Edith I , Ballou Denise , Cushing Alice H. , McLaren Leroy C. , Gribble T. John , Duncan Marilyn H.
Published: August 2016

Results with a VZV skin test as a marker of past infection were compared with histories of chicken pox and specific antibody detected by ELISA in 100 individuals—25 of whom were pediatric patients with malignant diseases. A negative or uncertain history was not reliable, neither were the skin test results among the oncology patients. However, among the normal individuals, the skin test when compared with the ELISA had a sensitivity of 85%, a specificity of 100%, and a positive predictive value of 100%.
Cost Containment in Infection Control: Effect of DRGs on Utilization of the Microbiology Laboratory
Authors: Bartlett Raymond C.
Published: August 2016

Prospective reimbursement is changing hospital laboratories from profit centers to cost centers. As a result, hospital administrators will try to reduce expenses for operating laboratories. Clinical microbiology could suffer more seriously than other sections because these laboratories are least able to use automation to increase productivity. Both the volume of specimens submitted and the complexity of processing specimens continue to increase in most clinical microbiology laboratories and the only immediate solution, although unlikely, will be increases in personnel. Freezes on replacement hiring and elimination of vacated positions are already occurring in some laboratories. Increased work can be controlled by reducing the numbers of clinically unnecessary specimens that are submitted and the numbers of specimens that are of a type or of such quality that they would not be likely to produce clinically useful information. Secondly, the amount of work expended on certain types of specimens may be reduced both to eliminate unnecessary labor and produce reports that are actually more useful clinically. Eventually changes in the way in which hospitals and physicians are reimbursed may create a greater incentive for physicians to minimize laboratory use. In the meantime, the burden of living within available resources will fall on the clinical microbiologist.
Product Commentary: Selecting an IV Tubing System
Authors: Chrystal Cynthia
Published: August 2016

Intravenous (IV) therapy as a nursing specialty is based on principles of anatomy, physiology, pathophysiology, pharmacology, and infection control. Since IV therapy is an invasive procedure, it is germane that nurses strictly adhere to the fundamental principles that govern this area to assure patient protection. The focus of this article is to assimilate clinical expertise into a process for selecting IV tubing systems that are suitable for the delivery of the prescribed IV therapy.

The first principle that governs the selection of IV tubings is to choose a system that will deliver the prescribed therapy and minimize the risk of infection. The National Intravenous Therapy Association (NITA) Standards of Practice states that 0.22 μm filters shall be utilized for the delivery of IV therapy unless contraindicated. The 0.22 μm filters provide the following four safeguards to patients: 1) they remove particulate matter than could impede circulatory flow through the pulmonary vascular system. 2) They eliminate air from the system and consequently protect patients from the risk of air embolism. The design of the 0.22 μm filter allows air to be automatically vented from the system; therefore, no entry into the sterile IV system is required to remove the air. Because every entry into the IV system may result in inadvertent contamination, the air-eliminating capabilities of the 0.22 μm filter may also be classified as an infection control measure. 3) They will retain virtually every pathogen bacterium or fungus that may have entered the system.
Needlecaps to Prevent Needlestick Injuries
Authors: Sumner Walton
Published: August 2016

Hospital employees are at risk for numerous possible complications of accidental needlesticks. The mechanisms of such accidents suggest that many are preventable. This article presents a simple but novel revision of the needlecap which facilitates resheathing of a used needle. With routine use the hospital environment could be made safer for virtually all employees at almost no additional cost. Ultimate hospital savings could be significant through prevention of injury.
Alteration of Normal Gastric Flora in Critical Care Patients Receiving Antacid and Cimetidine Therapy
Authors: Donowitz Leigh G. , Page M. Carol , Mileur Betty Lou , Guenthner Sharon H.
Published: August 2016

One hundred fifty-three critical care patients with documented cimetidine and antacid use were prospectively studied with serial gastric pH determinations and semiquantitative gastric fluid cultures. This study documents the abnormal gastric colonization of patients with therapeutically altered gastric acidity by hospital acquired gram negative rods (GNR). Three hundred twenty-four gastric fluid cultures from 153 patients revealed 152 (47%) positive cultures for GNR, 78 (24%) sterile specimens, and 94 (29%) positive for mixed oropharyngeal flora. One hundred forty (59%) of the 236 cultures at a pH of 4 or greater were positive for GNR. In contrast, only 12 (14%) of the 88 cultures at a pH of less than 4 were positive for GNR (p<.001). Forty-six (52%) of 88 cultures at a pH of less than 4 were sterile as compared to only 32 (14%) of 236 sterile cultures at a pH of 4 or greater (p<.001). At low pH, cultures are predominately sterile and at a pH of 4 or greater the flora dramatically changes to hospital acquired GNR. This artificially maintained reservoir of gram negative rods in the critically ill patient is a potential reservoir of organisms causing nosocomial bacteremia or pneumonia in this high risk population.