bluuebunny/crossref_metadata_2025 huggingface dataset:
Peritonitis From Automated Peritoneal Dialysis
Authors: Hamory Bruce H. , Neviakias James M. , Pearson Steven K.
Published: August 2016

Three consecutive patients undergoing automated peritoneal dialysis developed peritonitis with a nonfermenting gram-negative rod. The same organism was recovered from the dialysate produced by the machine and from its tap water supply. This is the first such outbreak in which the causative organism was also recovered from the tap water supply to the machine. The organism persisted in the machine following standard 3% formaldehyde disinfection, but was eradicated by 10% formaldehyde disinfection.
Wound Infection After Simple Suture at the Emergency Ward
Authors: Alkan Michael , Gefen Ziva , Golcman Louis
Published: August 2016

Of 386 consecutive patients whose wounds were sutured at the emergency ward of the Soroka Medical Center, 228 returned for a follow-up visit during which pus was observed in 40 sutured wounds. Most of the patients were males, 50% lived in the city, and 13% were Beduin. Fifty percent of the wounds were dressed prior to admission. All wounds were rinsed prior to suture, 78% in a cetrimide-chlorhexidine HC1 solution and in 71% an irrigation with a povidone-iodine solution was performed. The physicians who performed the procedure were graded by their medical experience; 43% of the sutures were performed by interns, 32% by junior residents, 19% by senior residents and 6% by a specialist. Silk thread was the most commonly used suture material (79%). Wounds were classified according to size, depth and state of the margins of the wound. It was noted whether an excision was performed and the type of treatment that was prescribed after the procedure. None of the above-mentioned criteria identified a group as high-risk. Experienced physicians sutured the more serious wounds, but their infection rate did not differ significantly from other physicians.
Nosocomial Mycobacterial Pseudoinfection in a Georgia Hospital
Authors: Goodman Richard A. , Smith J. David , Kubica George P. , Dougherty Ellen M. , Sikes R. Keith
Published: August 2016

Nosocomial pseudoepidemics may be detected when clustering of pseudoinfections occur or when artificial clusters of real infection are observed. Nontuberculous mycobacteria were reportedly isolated from specimens obtained from seven patients at one hospital from October 1980 to January 1981. Because the patients' clinical illnesses were not uniformly consistent with mycobacterial disease, we hypothesized that pseudoinfections had occurred and searched for a common source of contamination. The investigation suggested that specimen contamination was associated with one microbiology laboratory technician: 6 of 22 (27%) specimens processed by that person were positive compared with 1 of 103 (1%) specimens processed by the other five technicians. However, a specific mechanism of contamination was not identified. Nosocomial pseudoepidemics associated with false infections should be suspected and investigated when clinical features and laboratory findings do not agree.
Should Routine Throat Cultures Be Done in Hospital Personnel Complaining of a Sore Throat?
Authors: Watanakunakorn Chatrchai
Published: August 2016

In a 750-bed community-teaching hospital with 3,200 employees, throat cultures were routinely done in hospital personnel complaining of a sore throat. During a 3-month period, 323 employees had throat cultures; only 20 (6.2%) of these throat cultures grew group A streptococcus. The prevalence of positive throat cultures was similarly low in employees (6.2%) and adult patients (7.3%). There was no evidence that employees either had higher prevalence of group A streptococcal pharyngitis or that they spread the infection to patients. It is concluded that routine throat cultures are not warranted in employees complaining of a sore throat, and that throat cultures should be done only selectively in hospital personnel with a high probability of group A streptococcal pharyngitis.
Prolonged Hospital Epidemic of Salmonellosis: Use of Trimethoprim-Sulfamethoxazole for Control
Authors: Linnemann Calvin C. , Cannon Constance G. , Staneck Joseph L. , McNeely Bonnie L.
Published: August 2016

The occurrence of a foodborne outbreak of Salmonella drypool, an uncommon serotype, led to the recognition of hospital-acquired cases occurring over a 5-year period. In late 1981, a catered luncheon resulted in an epidemic of S. drypool, and in retrospect, cases were found to have been occurring in hospital patients from 1977 until 1981. Over the next 4 months, patients, employees, and 50% of the kitchen workers became infected, despite repeated culture surveys of the staff and removal of all infected workers. Food and environmental cultures failed to reveal the source of infection, but infected workers were observed to have multiple negative cultures over several months and then to become positive again. Closing of the kitchen for 2 weeks failed to stop the epidemic. Finally, all kitchen employees, both infected and uninfected, were treated with trimethoprim-sulfamethoxazole for 2 weeks. After treatment, no new kitchen workers became infected, although two workers who had had positive cultures earlier in the epidemic began to excrete S. drypool again, and the epidemic ended.
Evaluation of H2O2 Prophylaxis of Bacteriuria in Patients with Long-Term Indwelling Foley Catheters: A Randomized Controlled Study
Authors: Sweet Donna E. , Goodpasture Hewitt C. , Holl Katherine , Smart Sharon , Alexander Holly , Hedari Ahmad
Published: August 2016

Since the long-term catheterized patient is at significant risk of urinary tract infection, and the catheter drainage bags of these patients are at significant risk of becoming reservoirs for nosocomial pathogens, we carried out a randomized, controlled study to determine the efficacy of intermittent drainage bag instillation of hydrogen peroxide (H2O2) in patients requiring indwelling Foley catheters for 5 days or more. Herein we report the effects of this technique on the rates of catheter and bag bacteriuria, the duration to positive culture, the temporal relationships observed, and the spectrum of organisms recovered. Bag source bacteriuria was found with the same frequency in both control and H2O2 groups. H2O2 did reduce contamination of the drainage bag but did not reduce catheter-associated bacteriuria or frequency of symptomatic urinary tract infection. Furthermore, H2O2 did not reduce the frequency of bag contamination with most of the common nosocomial urinary pathogens.
Evidence for the Non-Infectious Etiology of Early Postoperative Fever
Authors: Garibaldi Richard A. , Brodine Susan , Matsumiya Sego , Coleman Miki
Published: August 2016

In a prospective study of infections in 871 general surgery patients, we identified 81 patients who developed unexplained postoperative fevers. The majority of these episodes (72%) occurred early (within the first 48 hours) following surgery. Patients who developed early, unexplained fevers differed significantly from patients who developed documented postoperative infections. Patients with unexplained fevers were younger, had less severe underlying disease and underwent less extensive surgeries than patients who subsequently developed infections. In these respects, they were more similar to non-infected, non-febrile patients.

We concluded that episodes of early, unexplained postoperative fever occur frequently in a wide range of general surgery patients. Most of these episodes are non-infectious in origin. Patients with early postoperative fevers should be evaluated to identify any obvious sources of infection. If no focus is identified, empiric antibiotic therapy should not be initiated nor should prophylactic antibiotics be extended for prolonged durations. Unexplained fevers will resolve in time without specific therapeutic interventions.
Nosocomial Fungal Infection During Hospital Renovation
Authors: Krasinski Keith , Holzman Robert S. , Hanna Bruce , Greco M. Alba , Graff Michael , Bhogal Madhu
Published: August 2016

Nosocomial fungal pulmonary infections (Zygomycetes, Aspergillussp.) developed in two premature infants in a special care unit (SCU) adjacent to an area of renovation. Inspection showed that inadequate barriers permitted the passage of airborne particles between the two areas, and cultures confirmed a significantly higher (p≤0.05) density of mold spores in the SCU (0.88 cfu per hour per settling plate) compared to a construction-free comparison area (0.22 cfu per hour per settling plate). The major source of mold was the dust above the hospital's false ceiling. In another construction area, impervious barriers were shown to effectively restrict the dispersal of mold. Our experience addsRhizopustoAspergillusas a possible cause of construction-related nosocomial infection. Sporadic episodes will continue to occur until the hazards of renovation are appreciated and effective preventive measures are routinely instituted.
Handwashing and Skin Physiologic and Bacteriologic Aspects
Authors: Larson Elaine
Published: August 2016

Handwashing practices are often based on tradition and belief. To develop sound rationale for handwashing practices, the physiologic and bacteriologic effects of handwashing must be examined. The purposes of this article are to review the three major microenvironments of the skin with their bacterial flora, to discuss physiologic and bacteriologic characteristics of the skin with particular reference to handwashing, and to describe current handwashing recommendations and practices.
A Rubella Outbreak Among Dental Students Description of the Outbreak and Analysis of Control Measures
Authors: Storch Gregory A. , Gruber Carol , Benz Bette , Beaudoin Janine , Hayes Joyce
Published: August 2016

From February to April 1982, rubella was diagnosed in 17 Washington University dental students. The affected students represented 4.8% of all dental students and 21% of susceptible students. Because a high likelihood of rubella transmission was perceived, three adjacent university hospitals undertook an emergency program to ensure immunity to rubella in all personnel. The program reached 84.6% of all target personnel, but only 36% of physicians (p<0.001). We estimated that the program increased the level of rubella immunity from 92.2% to 98.1%, at a total cost of $140,274 of which $29,990 was in excess of ordinary expenditures. Our experience indicates that schools training health professionals face the possibility of rubella outbreaks unless they ensure rubella immunity in all students. The experience also supports the value of ongoing programs to ensure rubella immunity in hospital personnel. Without such programs, hospitals may be forced to undertake emergency programs that are likely to be disruptive and expensive and may have relatively little immediate measurable impact.
The Relationship Between Intravenous Fluid Contamination and the Frequency of Tubing Replacement
Authors: Josephson Adele , Gombert Myles E. , Sierra Marcelino F. , Karanfil Lynne V. , Tansino Gary F.
Published: August 2016

Medical patients receiving IV therapy were randomly assigned to one of two IV tubing change groups. One group had a 48-hour tubing change and the other had no tubing change for the remainder of the cannula placement. A daily IV fluid specimen was processed microbiologically. To complete the study, a minimum of 3 continuous days of therapy and three fluid specimens was required. There were two contaminated specimens, one in each tubing change group. The contamination rate in the 48-hour change group was 0.87% and 0.96% in the no change group. The rate difference of 0.09% has a 95% confidence interval (−0.035 to +0.036) which includes zero. Survival analysis also revealed no significant difference in the cumulative probability of survival, however the mean duration of continuous tubing use of 4.3 days in the no change group and 1.8 days in the 48 hour change group were significantly different (p<0.05). The cumulative probability of surviving contamination free was 0.988 in the 48-hour group and 0.987 in the no-change group. We conclude that it is safe to change IV tubing at intervals up to but not exceeding 4 days.
Infections Related to Summer Recreational Activities
Authors: Gray Beverly J. , Haley Charles E.
Published: August 2016

Unusual infections, many of which are easily preventable, may occur during the summer months as a result of travel and recreational activities. Infection Control Practitioners may be consulted for isolation recommendations, but more importantly may have opportunities to educate patients and personnel about preventive measures.

During the summer months, Americans of all ages travel extensively and participate in a variety of outdoor recreational activities such as swimming, boating, camping, hiking, and gardening, which may result in exposure to unusual pathogens. Climatic factors, poor immunity to these pathogens, and lack of attention to hygiene may increase the risk for infections caused by these organisms. They may be transmitted by ingestion of contaminated food or water, contact with contaminated water, soil, or vegetation, or by insect bites. Basic preventive measures are effective against many infections related to recreational activities. Persons traveling to underdeveloped areas should consult a physician about the need for immunization or prophylactic medication.
Candidal Suppurative Peripheral Thrombophlebitis Recognition, Prevention, and Management
Authors: Walsh Thomas J. , Bustamente Carlos I. , Vlahov David , Standiford Harold C.
Published: August 2016

Candidaspecies are seldom considered as a cause of suppurative peripheral thrombophlebitis. During a 15-month period in a 291-bed acute-care hospital, candidal suppurative peripheral thrombophlebitis developed in seven patients. All patients had fever, a tender palpable cord, andCandidaspecies isolated from resected veins and/or pus expressed at the catheter entrance site. Four patients had candidemia. None were neutropenic or recipients of corticosteroids. All had concomitant or preceding bacterial infections, and had received a median of 5 antibiotics (range 3 to 9) for at least 2 weeks. Five of seven had documented preceding candidal colonization associated with broad spectrum antibiotic therapy. Catheter sites had not been routinely rotated and local catheter site care was deficient. Risk factors of antibiotics and duration of hospitalization were fewer in patients with bacterial suppurative thrombophlebitis. Combined segmental venous resection and intravenous amphotericin B appears to be the most rational therapy for this nosocomial fungal infection.
Physiologic and Microbiologic Changes in Skin Related to Frequent Handwashing
Authors: Larson Elaine , Leyden James J. , McGinley Kenneth J. , Grove Gary L. , Talbot George H.
Published: August 2016

Handwashing practices may be adversely influenced by the detrimental effects of handwashing on skin. A protocol was developed to assess the physiologic and microbiologic effects of frequent handwashing. Fifty-two female volunteers washed their hands 24 times per day for 5 days. Five agents were tested: water alone, non-medicated bar soap, a chlorhexidine-containing antiseptic, and two agents containing povidone-iodine (one currently available on the market and one being tested for possible marketing). Some damage to the outer membrane of skin, the stratum corneum, occurred in all groups. There were significant changes in the amount of evaporation water loss (p=.001) and in self assessments of skin condition (p=.005) from pre-to-post test for the entire group. Skin damage was also assessed by visualizing desquamating stratum corneum cells, which are shed in large aggregates when detergents injure skin. Significantly less such shedding occurred in subjects using water alone, bar soap, and the Chlorhexidine formulation (p=.02). Greater antimicrobial activity of an agent was not correlated with increased skin trauma. We have quantitated, using objective physiologic parameter, the skin damage that occurs during even a short period of frequent handwashing. We recommend that further studies using the methods described be conducted to quantitate skin damage over longer periods of time, more closely resembling handwashing practices of health care personnel.
NosocomialMycobacterium gordonaePseudoinfection From Contaminated Ice Machines
Authors: Panwalker Anand P. , Fuhse Elizabeth
Published: August 2016

Thirty-two clinical specimens submitted to the laboratory during a 12-month period from July 1980 to June 1981 were reported to be culture-positive forMycobacterium gordonae,an organism generally considered to be a slow-growing saprophyte with natural habitats which include soil and water. Only seven similar isolates had been recovered in the preceding4½year period. The discordance between clinical findings and the mycobacterial cultures suggested extrinsic contamination of the specimens. Contamination in the laboratory was believed unlikely because: 1) clinical samples obtained in an aseptic manner were never contaminated; 2) various surveillance cultures of reagents and deionized water used in the laboratory were negative; and 3) substitution of deionized water with sterile water did not control the outbreak. Extensive hospital-wide cultures of water sources implicated the use of ice and ice water from contaminated ice machines as the source of this pseudoepidemic. Cleaning of the ice machines resulted in a sharp decrease in the number ofM. gordonaeisolates. Pseudoinfection by M.gordonaefrom improperly maintained ice machines has not been reported before.
Brief Report Susceptibility of Filipino Nurses to the Varicella-Zoster Virus
Authors: Nassar Nabil T. , Tourna Helen C.
Published: August 2016

Following an outbreak of varicella, 18% of a group of 174 young female Filipino nurses ranging in age from 20 to 25 years and working at the American University of Beirut Medical Center (AUMC) were found susceptible to the varicella-zoster virus; as compared to 3% of a matched group of 133 of their Lebanese colleagues. The level of antibody was determined by the Enzyme Linked Immunosorbent Assay (ELISA). Those susceptible were assigned duties in low-risk areas to varicella-zoster in the hospital.
Infection Control and Employee Health Hepatitis B Prevention Part 1 A Review of AC IP's Newest Guidelines
Authors: Valenti William M.
Published: August 2016

Since the introduction of hepatitis B immune globulin (HBIg) and more recently, the hepatitis B vaccine, programs for hepatitis B prevention have become a major part of most employee health/infection control programs. In fact, hepatitis B prevention activities have probably been responsible for increased collaboration between the two programs. Hepatitis B prevention is a very fluid process and is constantly changing as we develop a greater understanding of the creative uses of both HBIg and the vaccine. On e important trend that has emerged from the introduction and widespread use of HBIg and vaccine has been a greater emphasis on pre-exposure prevention of hepatitis B infection. In the past, programs for hepatitis B prevention consisted of periodic hepatitis B screening in dialysis units and some laboratories. Unfortunately, screening only monitors introduction of infection and does very little to prevent hepatitis B virus (HBV) infection.
Methicillin-ResistantStaphylococcus aureus:How Reliable is Laboratory Reporting?
Authors: Fleming David W. , Helgerson Steven D. , Mallery Barbara L. , Foster Laurence R. , White Mary C.
Published: August 2016

Microbiology laboratories in Oregon were surveyed in 1981 to determine how often methicillin-resistantStaphylococcus aureus(MRSA) was being reported to physicians in the state. Results of this survey were surprising in three respects. First, the mean percent of S.aureusisolates reported by laboratories as methicillin-resistant was 8.3%. Second, a significant inverse correlation was found between the percent of reported MRSA and laboratory size (p=0.0001). Finally, laboratories which retested initially resistant isolates reported significantly less MRSA (mean 3.3%, median 1%) than those laboratories which accepted initial results (mean 20%, median 12%) (p=0.0001). Independent testing by the Centers for Disease Control of isolates reported to be MRSA confirmed that some misideiitification was occurring. Participating laboratories were notified of our initial findings and their potentially serious clinical ramifications. Laboratories were resurveyed in 1982, and a significant decrease in the reported MRSA to a mean percentage of 3.4% was observed (p=<0.002). It is unlikely that this situation is unique to Oregon, and similar misreporting of MRSA to physicians in other areas of the country may be compromising the safe and effective treatment ofS. aureusinfections.
An Outbreak of Group A Streptococcal Bacteremia in an Intensive Care Unit
Authors: Nicolle L.E. , Hume K. , Sims H. , Rosenal T. , Sandham D.
Published: August 2016

Admission of a patient with group A streptococcal cellulitis and bacteremia to the intensive care unit of a tertiary care teaching hospital was followed by two subsequent cases of group A streptococcal bacteremia with pneumonia in the unit. All streptococcal isolates were the same M- and T-type. Endotracheal intubation with respiratory ventilation was a risk factor for disease acquisition. The characteristics of onset of the two nosocomially acquired cases suggested that a staff member may have been, at least transiently, a streptococcal carrier, but no such carrier was identified. No further cases occurred subsequent to a period when all patients in the unit received antibiotics effective for group A streptococcal therapy.
Category 1, 2, 3 and 4 A Procedure-Oriented Isolation System
Authors: Gilmore Donna S. , Montgomerie John Z. , Graham Irene E.
Published: August 2016

A procedure-oriented isolation system, Category 1, 2, 3, and 4, was introduced at a 547-bed, acute and rehabilitative medical center. The system consisted of four categories of isolation which followed a numerical sequence that represented the necessary attire needed to complete the procedure. After 1 year of use, personnel compared the procedure-oriented system with the previously-used system (Strict, Respiratory, Wound and Skin, Enteric, and Limited Barrier). Personnel found the procedure-oriented system easier to understand (84%) and follow (83%). Seventy-six percent felt their isolation techniques had improved with the new system. A reduction in the cross-infection rate with methicillin-resistantStaphylococcus aureusdid coincide with the use of the new isolation system, however, no causal relationship was established. The Category 1, 2, 3, and 4 isolation system was well received by personnel and was found to be an effective alternative to the previous, more complicated system used in this setting. Further evaluation of this system in other settings would seem warranted.
Cost Containment in Infection Control: DRGs and Outpatient Antibiotics
Authors: Gross Peter A. , Iannini Paul B.
Published: August 2016

The advent of a non-cost reimbursement system has served as an impetus for the re-examination of the methods by which infectious processes are treated. This system prospectively sets payment rates for illnesses that require hospitalization. Diagnostic-Related Groups (DRGs) are the basis of this new system. DRGs attempt to link reimbursement to the broad category of clinical diagnosis by separating diagnoses into nearly 500 groups; each with a defined reimbursement rate. This rate does not substantially vary with regard to the length of hospital stay, the number of diagnostic tests performed or the cost of therapy employed.
Commentary: Dissemination of a Plasmid Determining Multiple Antibiotic Resistance Between Two Veterans Administration Medical Centers
Authors: Shlaes David M. , Currie-McCumber Charlotte
Published: August 2016

The endemic R-plasmids mediating resistance to gentamicin and multiple other antibiotics among many species of Enterobacteriaceae from the Minneapolis and Cleveland Veterans Administration Medical Centers were compared by restriction endonuclease digestion profiling and by phenotype expressed in sensitiveE. colirecipients. Southern hybridizations were also performed. Our data indicate that these plasmids demonstrate some microheterogeneity, but are very closely related. Both are self-transferable and mediate resistance to ampicillin, carbenicillin, chloramphenicol, gentamicin, tobramycin, neomycin and kanamycin. These results suggest the dissemination of a conjugal R-plasmid or of Enterobacteriaceae bearing the plasmid between two midwestern Veterans Administration Medical Centers. The most likely mechanism of transmission may be the frequent transfer of patients between midwestern Veterans Administration Medical Centers.
Infection Control Programs in Twelve North Carolina Extended Care Facilities
Authors: Price Loraine E. , Sarubbi Felix A. , Rutala William A.
Published: August 2016

To assess the scope of infection control programs in extended care facilities, 1-day surveys were conducted in 12 North Carolina facilities over an 8-month period using a standardized questionnaire. All 12 facilities had a designated infection control practitioner (ICP), although none had attended an infection control education course. Eleven had an Infection Control Committee of which 8 (73%) met regularly. The Director of Nurses generally (58%) was the ICP and spent about 2 hr/wk on infection control. Ten (83%) facilities conducted infection surveillance among residents but did not accurately compute nosocomial infection rates. Eleven (92%) facilities had employee health programs that included preemployment and annual tuberculosis screening. None had a comprehensive resident health program. Infection control aspects of patient care practices often varied from facility to facility. Nosocomial infection surveillance among 336 residents in 9 facilities using modified CDC criteria revealed an overall prevalence rate of 5.4%. Additional infections were suspected but not included because of limitations of laboratory data and chart documentation.
Brief Report: Inactivation of Herpesvirus on CPR Manikins Utilizing a Currently Recommended Disinfecting Procedure
Authors: Cavagnolo Robert Z.
Published: August 2016

The adequacy of a currently recommended protocol for disinfecting CPR manikins was investigated. Known quantities of Herpes simplex type 1 virus were applied to various sites on both adult and infant manikin heads, exposed to disinfectant under simulated classroom conditions, and then assayed for infectious virus. Results indicate that the disinfecting protocol and disinfectant are adequate for inactivating herpesvirus on CPR manikins, but that care must be exercised to ensure thorough cleaning.
Outbreak of Staphylococcal Infection in Two Hospital Nurseries Traced to a Single Nasal Carrier
Authors: Belani Anusha , Sherertz Robert J. , Sullivan Marsha L. , Russell Beverly A. , Reumen Peter D.
Published: August 2016

In late January and early February 1983, an outbreak of skin infections (7 of 145 infants) caused by a penicillin/erythromycin resistant strain ofStaphylococcus aureus(SA), phage type 3A/3C, occurred in our newborn nursery. A week following the first cluster of infections, another nursery outbreak due to SA with the same antibiogram occurred in a nearby community hospital (11 of 114 infants). Subsequently, a second cluster of infections with the same SA was identified at our nursery. The epidemic strain was carried in the anterior nares of a single nurse who worked at both hospital nurseries on alternate weeks. Investigation revealed that the nurse had an upper respiratory tract infection during each of these outbreaks—simulating “a cloud baby.” No further infections have occurred since this nurse was treated and her SA nasal carrier state eliminated.
Double-Bagging of Items from Isolation Rooms is Unnecesary as an Infection Control Measure: A Comparative Study of Surface Contamination with Single- and Double-Bagging
Authors: Maki Dennis G. , Alvarado Carla , Hassemer Carol
Published: August 2016

In many hospitals, waste materials and used linens from the rooms of patients in isolation or the clinical laboratories are routinely double-bagged to reduce contamination of the external surface of the bag that could be transmitted to hospital personnel subsequently handling them. No studies have prospectively examined the value, if any, of double-bagging. We randomly assigned waste and linens from the rooms of 42 patients in contact isolation to be transported in single bags or double bags. Shortly after a single (or double) bag had been set outside the patient's room, the surface was cultured quantitatively in two locations near the knot; over 2 months, 209 bags were cultured. Surface contamination by Staphylococcus aureus (3% to 5%), enteric gram-negative bacilli (6% to 7%), or either (9% to 12%) was infrequent and comparable in both groups; moreover, quantitative levels of contamination in the two groups were almost identical (mean, 27 and 29 colony forming units [cfu] per bag). These data suggest that there is no advantage, as regards asepsis, to double-bagging potentially contaminated items from isolation rooms or clinical laboratories as compared with using a single bag. The use of a single-bag system with a heavyduty bag, as compared with double-bagging, saved our hospital $9,400 in 1985.
Nosocomial Bloodstream Infections: Secular Trends in a Statewide Surveillance Program in Virginia
Authors: Morrison Allan J. , Freer Carol V. , Searcy Mary Ann , Landry Sandra M. , Wenzel Richard P
Published: August 2016

Over a 7-year period (1978-1984) the authors studied the rates of nosocomial bloodstream infections in acute-care hospitals participating in a statewide surveillance network in Virginia. A total of 4,617 hospital-acquired bloodstream infections were documented among 1,807,989 patients at risk for an overall rate of 25.5 cases per 10,000 patient admissions/discharges (annual range = 22.1 to 30.7). Compliance of reporting for Virginia hospitals averaged 58% (1 to 5 monthly reports in a study year), and 39% (≥6 monthly reports annually). Significant changes in bloodstream infection rates (cases per 10,000 patient admissions/discharges) due to specific pathogens included the following: coagulase-negative staphylococci increased from a rate of 1.3 to 4.5 (P=.0003), and those due to all gram-positive cocci increased from a rate of 7.5 to 11.4 (P=.03).Candidaspecies increased from a rate of 0.1 to 1.5 (P=.005). The data show a continuing rise of nosocomialCandidaBSI and clearly document the re-emergence of gram-positive cocci as major nosocomial bloodstream pathogens.
Brief Report: Influence of Country of Origin on Prevalence of Hepatitis B Markers Among Employees in a Small Suburban Hospital
Authors: Kiel Frank Wilson
Published: August 2016

Hepatitis risk in a small suburban hospital was evaluated by laboratory screening of all hospital employees for hepatitis immunologic markers. Excluding four U.S.-born subjects who had received hepatitis vaccination, the laboratory screening revealed 21% of those tested had some hepatitis B antigen or antibody. Positive markers were found in 46% of foreign-born compared to 10% of native-born (P<0.001). Foreign-born participants accounted for 68% of the employee population. The country of origin appeared to have a statistically significant greater importance as a determinant of hepatitis B status than occupational area in this particular hospital setting.
Nosocomial Bacteriuria: Estimating the Potential for Prevention by Closed Sterile Urinary Drainage
Authors: Burke John P. , Larsen Robert A. , Stevens Lane E.
Published: August 2016

Urinary tract infections associated with the temporary use of indwelling bladder catheters remain a vexing problem in acute care hospitals. The appreciable morbidity and mortality from these infections are still under active investigation. Because of the large numbers of patients at risk, increased attention is also being given to the costs for prevention, detection, treatment, and follow-up of catheter-associated infections.

Before the advent of commercially available systems for maintaining closed sterile urinary drainage, infection was believed to be inevitable. In the past 25 years, the successful prevention of infection in 70% to 80% of catheterized patients by aseptic methods has undoubtedly prevented thousands of deaths from gram-negative bacteremia and stimulated efforts to further reduce the infection rate.
The Sources of Pneumonia in ITU Patients
Authors: Sanderson Philip J.
Published: August 2016

Much attention has been given to ventilators, respiratory tubing and humidifiers as sources of bacteria causing pneumonias in intensive therapy unit (ITU) patients. However, efficient decontamination and safe storage of ventilators and humidifiers between patients, with frequent changing of respiratory tubing and the use of Chlorhexidine in humidifier reservoirs, are now undertaken in most ITUs. In addition, chest aspiration, which is an important route for bacterial entry to the chest, is performed by trained ITU staff, who are well aware of this danger and wear gloves and use meticulous techniques. As a result, it can be argued that infection of the lungs in ITU patients from these sources and routes has reached an “irreducible minimum.”

Unfortunately, many patients in ITUs continue to develop pneumonias. In my own experience patients yielded Pseudomonas in tracheal aspirates as frequently after the introduction of these techniques, together with the insertion of efficient bacterial filters, between the patient and the ventilator in both the inspiratory and expiratory lines, as before their adoption. What other sources and routes of infection of the lungs should be considered?
Transmission of Hepatitis B and AIDS
Authors: Garibaldi Richard A.
Published: August 2016

Hepatitis B virus and HTLV-III are quite dissimilar in virology, organ tropism and clinical consequences. However, they are remarkably similar in epidemiology, modes of transmission, affected risk groups, and potentials for nosocomial infection. Presently, the two diseases pose much different problems for hospital epidemiologists. Over the past 10 years, the risks of nosocomial hepatitis B have dropped off sharply. In fact, hepatitis B is now theoretically a totally preventable disease. On the other hand, the epidemic of HTLV-III infection in high-risk groups continues unabated. The fear of acquiring infection has precipitated panic reactions among some groups of health care workers and the lay public.
Evaluation of the Skin Disinfecting Activity and Cumulative Effect of Chlorhexidine and Triclosan Handwash Preparations on Hands Artificially Contaminated with Serratia marcescens
Authors: Bartzokas C.A. , Corkill J.E. , Makin T.
Published: August 2016

The initial and cumulative efficacy of two antiseptic handwash preparations in eliminating Serratia marcescens from hands was evaluated on volunteers. Two antiseptics with persistent skin antibacterial activity, 4% chlorhexidine gluconate in detergent and 1.5% triclosan in natural soap, were studied in a new protocol designed according to Food and Drug Administration guidelines. After a single handwash, both preparations exhibited a degerming action statistically superior to the mechanical elimination of the marker organism that was achieved by the nonmedicated controls. Following a further nine hand recontamination sequence with 109 colony-forming units (cfu)/mL S marcescens (mean pre-disinfection baseline, log10 6.6), the efficacy of chlorhexidine and triclosan was significantly augmented: the mean log10 reduction factors were 4.15 and 3.78, respectively. In the absence of internationally accepted testing standards for antiseptic handwash products, the significance of protocol variables is discussed. The advantages to preventative microbiology of antiseptics with persistent skin antibacterial activity are highlighted.
Methicillin-resistantStaphylococcus aureusin Veterans Administration Medical Centers
Authors: Preheim Laurel C. , Rimland David , Bittner Marvin J.
Published: August 2016

To determine the frequency of isolation of methicillin-resistantStaphylococcus aureus(MRSA) at Veterans Administration Medical Centers, 163 hospitals were surveyed; 137 responded. Between 1975 and 1984, the number of Veterans Administration Medical Centers with known MRSA increased from 3 to 111. This increase was geographically widespread and occurred in hospitals of all sizes. In Veterans Administration Medical Centers, isolation policies for MRSA-infected patients were (% of hospitals using): strict (19%), contact (52%), site-related (28%), no isolation (1%). For patients colonized with MRSA policies were: strict (15%), contact (44%), site-related (35%), and no isolation (6%). Only 41% of Veterans Administration Medical Centers reported discharging known MRSA-colonized patients to nursing homes. Most attempts to eradicate MRSA carriage used trimethoprim-sulfamethoxazole plus rifampin with or without bacitracin ointment; success rates were low. MRSA incidence is increasing at Veterans Administration Medical Centers across the United States. Improved regimens to eliminate MRSA carriage are needed.
Community Hospital Surgeon-Specific Infection Rates
Authors: Collier Caryl , Miller Donald P , Borst Marguerite
Published: August 2016

A one-year prospective study of surgeon-specific nosocomial infection rates was done in two community hospitals. Hospital A (93 beds) and Hospital B (158 beds) have nearly identical surgical staffs. Unified criteria for the diagnosis of infections, methods of data collection, and coding were used. Data were processed with an IBM 370 computer using Statistical Analysis System (SAS). Each surgeon received semiannual reports of 1) overall infection rate by site, 2) number of surgical wound infections by wound class and type of procedure, 3) pathogens for each deep and incisional infection, and 4) quarterly wound infection rates by wound class. Analysis of reports revealed high Class I surgical wound infection rates for both general and orthopedic surgeons. One person in each group had inordinately high infection rates. These data serve as an objective incentive to reduce surgical wound infections, identify individual problems, and suggest surgical privileges be evaluated by performance.
Therapy of Ocular Herpes Simplex Infections
Authors: Eggleston Mark
Published: August 2016

Herpes simplex viral infection is a common cause of infection involving the eye and skin adjacent to the eye. Acute keratoconjunctivitis is a frequently observed herpetic manifestation often accompanied or exacerbated by stress factors, including fever (especially when associated with respiratory or intestinal infection), stress, trauma, environmental exposure, drugs, and menstruation. Each year approximately 300,000 to 500,000 cases of corneal herpes are reported. Complications such as decreased or lost vision may be associated with attacks of ophthalmic herpes infections. Therefore, effective treatment is imperative.1 Experts estimate that nearly 25% of patients with a primary ocular infection will have a recurrence of the infection, and approximately 50% of these patients will have a recurrence within two years. Herpes viral infections are a significant cause of blindness and a primary indication for corneal transplants.
Inactivation of Human Immunodeficiency Virus by Betadine
Authors: Kaplan Joan C. , Crawford David C. , Durno Amy G. , Schooley Robert T.
Published: August 2016

Human immunodeficiency virus (HIV), the etiological agent of the acquired immunodeficiency syndrome (AIDS), was treated with either Betadine® (povidone-iodine) Solution or Betadine Surgical Scrub®. HIV inactivation was analyzed using the viral reverse transcriptase assay or by observing the cytopathic effect produced in HIV-infected, H-9, T-cell cultures. The minimum effective Betadine dose was 0.25% for complete inactivation of HIV that was treated for various time intervals (immediate vortex to ten minutes). The titer of HIV stocks used in these experiments (105 TCID50per mL) was greater than amounts generally detected in clinical specimens. Our results provide a rationale for the use of povidone-iodine as a topical antiseptic against HIV in the clinic or laboratory.
Brief Report: An Outbreak of Scabies Among Employees in a Hospital-associated Commercial Laundry
Authors: Thomas Michelle C. , Giedinghagen Dale H. , Hoff Gerald L.
Published: August 2016

The acquisition of scabies in either the community or the health care setting is not uncommon, although it is infrequently documented. In Missouri, individual cases of scabies infestation are not reportable, but outbreak notification is required. Outside of the nursing home environment, where three to six outbreaks of scabies per year require assistance from the nosocomial disease subprogram of the Kansas City Health Department, only two other outbreaks have been recorded in the community since August 1977. One involved a school with 93 cases and the other a commercial laundry, which is reported here. The latter outbreak illustrates the difficulty encountered when attempting to classify an outbreak as either nosocomially acquired or community-acquired.
Prospective Microbiologic Surveillance in Control of Nosocomial Methicillin-ResistantStaphylococcus aureus
Authors: Walsh Thomas J. , Vlahov David , Hansen Sharon L. , Sonnenberg Edda , Khabbaz Rima , Gadacz Thomas , Standiford Harold C.
Published: August 2016

A prospective microbiological surveillance (PMS) program was developed in a comprehensive hospital-wide effort for control of nosocomial methicillin-resistantStaphylococcus aureus(MRSA). This PMS program entailed: 1) active identification of colonized and infected patients; 2) application of a screening microbiologic system for MRSA; 3) isolation of colonized and infected patients; 4) antibiotic decolonization of MRSA; and 5) educational efforts. The PMS program was studied over three and one half years for its contribution to infection control of MRSA, early identification of nosocomial MRSA outbreaks, use of the highest yield surveillance culture sites, and cost effectiveness. Following initiation of the PMS program in December 1982, during an MRSA outbreak, the frequency of new MRSA cases declined from 14 to none by the end of a 3-month pilot study. The frequency of new MRSA cases stabilized at approximately 2 per month until October 1983, when the PMS system allowed prompt detection of a new outbreak of 11 cases. Following isolation and antibiotic decolonization, the frequency of cases again declined to 3 per month. A third outbreak in December 1985 again was promptly detected and controlled. Infection to colonization ratio decreased from a maximum of 1.5 during outbreaks to a minimum of 0.17 after outbreaks. Wounds and tracheostomy sites provided the greatest yield of detection of new cases of MRSA. During one 15-month period, 35 of the 43 new cases were detected initially at wounds and tracheostomy sites. No new MRSA cases were detected by a positive axillary or nares site alone. The estimated quarterly cost of outbreaks and infection paralleled the quarterly frequency of new MRSA cases. The cost of managing MRSA outbreaks and treating MRSA infections versus the cost of implementing the PMS program suggested that the PMS program may be cost effective. This prospective microbiological surveillance program may be applicable to other institutions for hospital-wide infection control of MRSA.
Outbreak Due to Methicillin- and Rifampin- ResistantStaphylococcus aureus:Epidemiology and Eradication of the Resistant Strain from the Hospital
Authors: Bitar Cynthia M. , Mayhall C. Glen , Lamb V. Archer , Bradshaw Thomas J. , Spadora Alice C. , Dalton Harry P.
Published: August 2016

A methicillin- and rifampin-resistant strain ofStaphylococcus aureuswas introduced into a university hospital by interstate transfer of an infected surgical patient. An outbreak occurred, and 17 patients became infected or colonized with the epidemic strain. Reservoirs appeared to be patients who were infected or colonized with the resistantS aureusand possibly two nurses who were nasal carriers. The outbreak isolate was likely spread by contact with contaminated hands of personnel. A retrospective case-control study identified tracheostomy, debridement, and irrigation of wounds by power spray and prolonged nasogastric intubation as risk factors for acquisition of the epidemic strain. Analysis of factors by groups indicated that surgical procedures, wound care procedures and instrumentation of the respiratory tract were significantly associated with cases. The nasal carrier state was eradicated in two nurses by topical application of 5% vancomycin. The epidemic strain was eradicated from the hospital 8 months after it was introduced.
Methicillin-Resistant Staphylococcus aureus in a Nursing Home
Authors: Storch Gregory A. , Radcliff Jan L. , Meyer Patricia L. , Hinrichs James H.
Published: August 2016

During a 13-month period, 25 residents of a nursing home were found to have positive cultures for methicillin-resistant Staphylococcus aureus (MRSA), including 17 with clinically significant infections. The outbreak came to attention in February 1985 when pneumonia was diagnosed in five residents during a 10-day period, and sputum cultures from all five were positive for MRSA. A survey revealed that nine (12%) of a sample of 74 residents and nine (7%) of 130 personnel had positive cultures for MRSA. Six of nine residents with MRSA detected in the culture survey had not been hospitalized for 6 or more months before the survey, suggesting acquisition of MRSA in the nursing home. Implementation of control measures was associated with a decreased occurrence but not complete elimination of new cases. MRSA in nursing homes is of concern because these institutions might serve as reservoirs for MRSA in the community. Further studies are required to define the magnitude of the problem, as well as optimal control measures.
Beta-Lactamase Inhibitors: Another Approach to Overcoming Antimicrobial Resistance
Authors: Parker Richard H. , Eggleston Mark
Published: August 2016

Resistance of most clinical pathogens to beta-lactam antimicrobial agents is currently primarily mediated by the microorganisms' ability to product beta-lactamases. There are a variety of beta-lactamases which are primarily differentiated by whether they are plasmid- or chromosome-mediated and by their substrate and inhibition profiles. The most common group of beta-lactamases produced by clinical isolates are the plasmid-mediated TEM enzymes (Richmond-Sykes type III a) which exist in many Enterobacteriaceae, Hemophilus influenzae, and Neisseria species. Development of new beta-lactam antimicrobial agents during the past decades has resulted in a number of drugs with increased, albeit not total, resistance to beta-lactamases. Another approach has been the development of beta-lactamase inhibitors that can be used with a beta-lactam drug to overcome the resistance created by the beta-lactamase.