bluuebunny/crossref_metadata_2025 huggingface dataset:
Retinoic acid can enhance conversion of naive into regulatory T cells independently of secreted cytokines
Authors: Nolting Jens , Daniel Carolin , Reuter Sabine , Stuelten Christina , Li Peng , Sucov Henry , Kim Byung-Gyu , Letterio John J. , Kretschmer Karsten , Kim Hye-Jung , von Boehmer Harald
Published: September 2009

It has been reported that retinoic acid (RA) enhances regulatory T (T reg) cell conversion by inhibiting the secretion of cytokines that interfere with conversion. This report shows that these conclusions provide a partial explanation at best. First, RA not only interfered with cytokine secretion but also with the ability of these cytokines to inhibit T reg cell conversion of naive T cells. Furthermore, RA enhanced conversion even in the absence of inhibitory cytokines. The latter effect depended on the RA receptor α (RARα) but did not require Smad3, despite the fact that RA enhanced Smad3 expression. The RARα1 isoform was not essential for RA-dependent enhancement of transforming growth factor β–driven conversion, suggesting that conversion can also be mediated by RARα2. Interleukin (IL)-6 strongly reduced RARα expression levels such that a deficiency of the predominant RARα1 isoform leaves too little RARα2 for RA to inhibit the generation of Th17 cells in the presence of IL-6.
Crohn's disease adherent-invasive Escherichia coli colonize and induce strong gut inflammation in transgenic mice expressing human CEACAM
Authors: Carvalho Frédéric A. , Barnich Nicolas , Sivignon Adeline , Darcha Claude , Chan Carlos H.F. , Stanners Clifford P. , Darfeuille-Michaud Arlette
Published: September 2009

Abnormal expression of CEACAM6 is observed at the apical surface of the ileal epithelium in Crohn's disease (CD) patients, and CD ileal lesions are colonized by pathogenic adherent-invasive Escherichia coli (AIEC). We investigated the ability of AIEC reference strain LF82 to colonize the intestinal mucosa and to induce inflammation in CEABAC10 transgenic mice expressing human CEACAMs. AIEC LF82 virulent bacteria, but not nonpathogenic E. coli K-12, were able to persist in the gut of CEABAC10 transgenic mice and to induce severe colitis with reduced survival rate, marked weight loss, increased rectal bleeding, presence of erosive lesions, mucosal inflammation, and increased proinflammatory cytokine expression. The colitis depended on type 1 pili expression by AIEC bacteria and on intestinal CEACAM expression because no sign of colitis was observed in transgenic mice infected with type 1 pili–negative LF82-ΔfimH isogenic mutant or in wild-type mice infected with AIEC LF82 bacteria. These findings strongly support the hypothesis that in CD patients having an abnormal intestinal expression of CEACAM6, AIEC bacteria via type 1 pili expression can colonize the intestinal mucosa and induce gut inflammation. Thus, targeting AIEC adhesion to gut mucosa represents a new strategy for clinicians to prevent and/or to treat ileal CD.
Validation of a Bacteremia Prediction Model
Authors: Mylotte Joseph M. , Pisano Mario A. , Ram Sanjay , Nakasato Sharlene , Rotella Denise
Published: September 2009

Objective:

To validate a previously published model for predicting bacteremia in hospitalized patients.

Design:

Application of a published bacteremia prediction model to a prospective validation cohort of patients and comparison of its predictability to that found in the derivation cohort.

Setting:

Urban, university-affiliated, 550-bed public hospital.

Patients:

The validation cohort consisted of 342 patients with 559 blood culture episodes between October 14, 1992, and December 5, 1992. Each blood culture episode was scored based on the presence or absence of seven predictors of bacteremia and the findings compared with published results (derivation cohort).

Interventions:

None.

Results:

Application of the bacteremia prediction model to the validation cohort identified episodes with a low risk (3%) and a high risk (17%) for true bacteremia, similar to the findings in the derivation cohort (1% and 16%, respectively). Comparison of the predictions of the model in the two cohorts by receiver operator characteristic curve analysis revealed that the overall predictability of the model in the validation cohort was not as good as in the derivation cohort.

Conclusions:

Although the bacteremia prediction model did not perform as well overall in the validation cohort, the model still was able to clearly define two extreme groups: those with a low risk and those with a high risk for true bacteremia. This predictive capability may aid physicians in prescribing empiric antimicrobial therapy and also may be useful to hospital epidemiologists in assessing quality of care
FDA Labeling Requirements for Disinfection of Endoscopes: A Counterpoint
Authors: Rutala William A. , Weber David J.
Published: September 2009

Endoscopes are used widely for the diagnosis and therapy of medical disorders. To prevent spread of nosocomial infection, all endoscopes should undergo thorough cleaning and high-level disinfection following each use. The Food and Drug Administration (FDA) has approved a user-friendly package label for one liquid chemical germicide that requires a 45-minute immersion at 25°C to support a high-level disinfection label claim. Scientific data reviewed here suggest that one can achieve at least an 8-log reduction in M tuberculosis contamination with cleaning (4 logs) followed by chemical disinfection for 20 minutes (4 to 6 logs). The FDA should modify the label to state that if cleaning is accomplished using a standardized cleaning protocol, then a 20-minute immersion at 20°C will be sufficient to achieve high-level disinfection.
Lessons from a Nursing Home Outbreak of Influenza A
Authors: Morens David M. , Rash Valerie M.
Published: September 2009

Objective:

To characterize risk factors for outbreak-associated influenza illness and death in a nursing home.

Design:

Outbreak investigation with predetermined and concurrently determined risk information.

Setting:

A nursing home service in a multiward chronic care hospital, Honolulu, Oahu, 1989 to 1990.

Patients:

Elderly nursing home patients receiving long-term care.

Interventions:

Influenza vaccination, amantadine administration, and infection control measures.

Results:

Neither routine infection control measures nor vaccination prevented illness, complications, or death in a nursing home outbreak of influenza A. The 55% case-fatality rate resulted from severe pneumonia. Influenza transmission may have been mediated by staff via either contaminated hands or fomites.

Conclusions:

Data from this and other outbreaks suggest that recommendations for preventing nosocomial influenza in the nation’s 1.5 million nursing home residents should be reconsidered.
The Association for Professionals in Infection Control and Epidemiology, Inc
Authors: Russell Barbara
Published: September 2009

The Association for Professionals in Infection Control and Epidemiology, Inc (APIC) is a multidisciplinary voluntary international organization with over 10,000 members. Its purpose is to influence, support, and improve the quality of healthcare through the practice and management of infection control and the application of epidemiology in all health settings. The organization, which is based in Washington, DC, is led by an elected board of members who volunteer their time and expertise.
Prevention of Nosocomial Influenza
Authors: Adal Karim A. , Flowers Richard H. , Anglim Anne M. , Hayden Frederick G. , Titus Maureen G. , Coyner Betty J. , Farr Barry M.
Published: September 2009

Objective:

To study compliance with preventive strategies at a university hospital during an outbreak of nosocomial influenza A during the winter of 1988, and the rates of vaccination of healthcare workers and of nosocomial influenza following changes in vaccine practices after the outbreak.

Design:

Retrospective review of employee health, hospital epidemiology, hospital computing, and clinical microbiology records.

Setting:

A university hospital.

Interventions:

Unvaccinated personnel with exposure within the previous 72 hours to an unisolated case of influenza were offered influenza vaccine and 14 days of amantadine hydrochloride prophylaxis. Personnel with exposure more than 72 hours before evaluation were offered vaccine. A mobile cart was introduced for vaccinating personnel after the 1988 outbreak.

Results:

An outbreak of influenza with 10 nosocomial cases occurred in 1988. Only 4% of exposed employees had been vaccinated previously and 23% of exposed, unvaccinated employees agreed to take vaccine, amantadine, or both. A mobile-cart vaccination program was instituted, and annual vaccination rates steadily increased from 26.3% in 1989 to 1990 to 38% in 1993 to 1994 (P<.0001). The relative frequency of documented cases of influenza in employees with symptoms of influenza decreased significantly during this period (P=.025), but nosocomial influenza rates among patients did not change significantly.

Conclusion:

A mobile-cart influenza vaccination program was associated with a significant increase in compliance among healthcare workers, but a majority still remained unvaccinated. The rate of nosocomial influenza among patients was not reduced by the modest increase in the vaccination rate, but influenza rates remained acceptably low, perhaps due to respiratory isolation of patients and furlough of employees with influenza.
Colonization by Staphylococcus Aureus Resistant to Methicillin and Ciprofloxacin During 20 Months' Surveillance in a Private Skilled Nursing Facility
Authors: Lee Yee-Lean , Gupta Geeta , Cesario Thomas , Lee Richard , Nothvogel Sandra , Nassar James , Flionis Leo , Thrupp Lauri
Published: September 2009

Objective:

To evaluate endemic colonization with Staphylococcus aureus resistant to methicillin, ciprofloxacin, or both among patients of a private skilled nursing facility, with regard to colonization rate and site, and relation to infection and prior antibiotic use.

Design:

Prospective quarterly culture surveillance of nares and rectal specimens over 20 months' observation.

Results:

The mean prevalence was 3.8% in new admissions and 5.4% for in-house patients; cumulatively, 7.5% of the patients were colonized during the study period. The colonization rate remained stable during the study period. Screening of rectal, as well as nares, specimens detected substantially more colonized patients than would have been detected by nasal cultures alone. Five to seven percent of the colonized patients developed later infection with methicillin-ciprofloxacin-resistant S aureus. Colonized patients did not differ significantly from the noncolonized group in prior use of quinolones, but the colonized group was exposed significantly more frequently to other antibiotics than the noncolonized group. Eighty-three percent of methicillin-resistant S aureus (MRSA) isolated from infections and 89% from colonization were also ciprofloxacin resistant.

Conclusion:

Although all infecting and most colonizing isolates of MRSA were resistant to quinolones, the overall rate of colonization remained low and stable despite the continued use of quinolones. The findings suggest that good infection control practice has prevented broader spread of such strains in this facility.
Monitoring Persistence of Coagulase-Negative Staphylococci in a Hematology Department Using Phenotypic and Genotypic Strategies
Authors: van Belkum Alex , Kluijtmans Jan , van Leeuwen Willem , Goessens Wil , ter Averst Ellen , Wielenga Jenne , Verbrugh Henri
Published: September 2009

Objective:

To determine persistence of coagulase-negative staphylococci (CNS) on a hematology-oncology ward and to determine the value of phenotypic and genotypic procedures for establishing clonality among CNS isolates.

Design:

Strains of CNS isolated from bacteremic patients (n=139) were typed by biochemical reactivity, antibiotic susceptibility, DNA macrorestriction analysis by pulsed-field gel electrophoresis (PFGE), and arbitrary primed polymerase chain reaction (AP PCR). Coagulase-negative staphylococci were subgrouped in a random collection (n=20) used for the evaluation of the typing procedures and a collection of 119 CNS isolates from hematologic patients displaying multiple bacteremic episodes.

Results:

Analysis of the reference collection demonstrated the usefulness of the DNA typing procedures, indicating that AP PCR and PFGE can be used for epidemiologic typing of CNS in a concordant fashion. Certain strains appeared to be permanent colonizers of the hematology ward or ward-related personnel. In individual patients, persistent colonization by a single type was demonstrated. However, a number of patients also experienced bacteremic episodes caused by CNS belonging to different types.

Conclusion:

We conclude that monitoring of CNS infections on a hematology ward by various genotypic techniques provides insight into nosocomial epidemiology and elucidates the complexity of the infections taking place. DNA typing is preferred over phenotypic procedures and can identify persistent CNS strains in a given location.
Proposed Antiretroviral Therapy Guidelines for Prophylaxis of Occupationally Related HIV Seroconversion A Practical Approach
Authors: Glatt Aaron E.
Published: September 2009

Recent research indicates that antiretroviral prophylaxis significantly reduces occupationally related human immunodeficiency virus (HIV) seroconversion. This article outlines principles on which guidelines were based for treating aggressively those healthcare workers (HCWs) exposed to HIV occupationally at the Catholic Medical Center in Jamaica, New York. These recommendations attempt to provide HCWs with the best possible available antiretroviral therapy to treat occupational HIV seroconversion. New options must continue to be explored as new information becomes available.
Basics of Stratifying for Severity of Illness
Authors: Gross Peter A.
Published: September 2009

Conventional wisdom suggests that those who assess healthcare processes and outcomes always should stratify cases by severity of illness; however, infection control personnel should analyze each quality assessment tool with and without severity adjustment and determine whether such adjustment is necessary. This article briefly reviews severity adjustments for diseases or procedures involving specific organ systems, as well as those applicable to all diseases, including the commercially available systems. Also discussed is whether and how these various systems for severity adjustment can be compared. Finally, the article will provide selected references for individuals who will use these scoring systems and need more information.
Nosocomial Colonization and Infection in Persons Infected With Human Immunodeficiency Virus
Authors: Mayhall C. Glen , Craven Donald E. , Steger Kathleen A. , Hirschhorn Lisa R.
Published: September 2009

Nosocomial infections appear to be increased in patients with acquired immunodeficiency syndrome (AIDS), compared to individuals with asymptomatic infection due to human immunodeficiency virus (HIV). Risk factors for bacterial colonization and infection include immunosuppression, prior treatment with some antibiotics, increased hospitalizations with longer lengths of stay, greater exposure to invasive devices such as indwelling intravenous or urinary catheters, and the degree of immunosuppression. Data suggest that other infectious agents such as Pneumocystis carinii, Mycobacterium tuberculosis, Mycobacterium avium complex, and Cryptosporidium may be acquired in healthcare facilities. Diagnosis and management of nosocomial infections in HIV-infected persons may be complicated by an atypical presentation, increased rates of relapse following treatment, presence of multiple infections, and early discharge from the inpatient setting. Accurate assessment of nosocomial infections and outbreaks in the hospital is complicated by limited data on the risk of transmission of both traditional and unusual pathogens in this population. Furthermore, some patients may acquire nosocomial pathogens during their initial hospitalization and present later with infections that normally would be classified as community acquired. Therefore, there probably is an underestimation of current nosocomial infection rates, and perhaps “hospital-associated” or “healthcare-facility–associated” might be more accurate terms for these infections (Infect Control Hosp Epidemiol 1996;17:304-318).
The Analysis of Disease Clusters, Part I: State of the Art
Authors: Birnbaum David , Jacquez G.M. , Waller L.A. , Grimson R. , Wartenberg D.
Published: September 2009

Public health professionals often are asked to investigate apparent clusters of human health events, or “disease clusters.” A cluster is an excess of cases in space (a geographic cluster), in time (a temporal cluster), or in both space and time. This is part I of an introductory-level review of the analysis of disease clusters for physicians and health professionals concerned with infection surveillance in hospitals. It reviews the status of the field with the hope of expanding the use of cluster analysis methods for the routine surveillance of infectious diseases in the hospital environment.
Tuberculin Positivity and Patient Contact in Healthcare Workers in the Urban United States
Authors: Rattner Susan L. , Fleischer Julie A. , Davidson Bruce L.
Published: September 2009

We performed tuberculin and anergy testing in 91 healthy volunteer employees from the patient transport and housekeeping units at an urban tertiary-care hospital, stratifying results by the risk factor of patient contact. Tuberculin positivity was highly prevalent in this group; patient contact was not a predictor of tuberculosis infection risk, and anergy was rare.
The Analysis of Disease Clusters, Part II: Introduction to Techniques
Authors: Birnbaum David , Jacquez G.M. , Grimson R. , Waller L.A. , Wartenberg D.
Published: September 2009

Public health professionals often are asked to investigate apparent clusters of human health events or “disease clusters.” A cluster is an excess of cases in space (a geographic cluster), in time (a temporal cluster), or in both space and time. This is the second part of an introductory-level review of the analysis of disease clusters for physicians and health professionals concerned with infection surveillance in hospitals. It reviews the status of the field with the hope of expanding the use of cluster analysis methods for the routine surveillance of infectious diseases in the hospital environment.
Implementation and Evaluation of an Algorithm for Isolation of Patients With Suspected Pulmonary Tuberculosis
Authors: Pegues Clare F. , Johnson Douglas C. , Pegues David A. , Spencer Maureen , Hopkins Cyrus C.
Published: September 2009

Objective: To implement and evaluate an algorithm designed to assist in the consistent placement of patients with suspected pulmonary tuberculosis into negative-pressure isolation rooms (NPIRs).

Design: A standard algorithm was designed for the appropriate room placement of patients with suspected pulmonary tuberculosis using clinical, radiographic, and laboratory criteria and reported risk factors. A case-patient was defined as an inpatient who had at least one Mycobacterium tuberculosis culture-positive respiratory specimen from January 1, 1993, through December 31, 1994. Demographic, clinical, laboratory, case contact, and isolation and room placement data were collected prospectively on all case-patients.

Setting: A 900-bed university teaching and referral center.

Results: During 1993 and 1994, 69 patients were evaluated for possible pulmonary tuberculosis, and 31 case-patients were identified. Of the 31 case-patients, 26 (84%) were placed on respiratory isolation in NPIRs, including 19 (61%) who were isolated within 24 hours of admission (1993, 14 of 20 [70%]; 1994, 5 of 11 [45%]). Seven case-patients (23%) were isolated in NPIRs following delays that ranged from 2 to 31 days (median, 9 days), and five case-patients (16%) never were isolated during admissions of from 3 to 28 days (median, 4 days). These 12 case-patients contributed a total of 136 patient-exposure days during their hospitalizations. Misclassification of patient risk status by user error delayed isolation of five (42%) of the 12 improperly isolated case-patients.

Conclusions: The use of an algorithm incorporating radiographic, laboratory, and clinical criteria and reported risk factors may assist in the rapid isolation of patients with suspected pulmonary tuberculosis.
The Historical Faith of William Tyndale: Non-Salvific Reading of Scripture at the Outset of the English Reformation*
Authors: Baker David Weil
Published: September 2009

This essay argues that for William Tyndale, not only was scripture notsola,but it did not have to be read solely as scripture, that is, the salvific word of God. It could also be read withhistorical faith,a term that Tyndale borrowed from the German Reformer Philip Melanchthon and used to signify “believing in scripture as one would a non-scriptural history.” Tyndale did not exactly advocate this approach to scripture, but he recognized it as having at least some validity, given the role of human agency and authority in the transmission of God's word. More broadly, the notion of historical faith in scripture reflects the Reformation elevation of what John Foxe called the “truth of history” along with that of scripture. In the polemical writings of Tyndale and later English Protestant Reformers, scripture served both as a means of personal salvation and as a source of historical evidence against the Catholic Church. As a source for this kind of evidence, scripture was cited in conjunction with non-scriptural histories and in ways not discernibly different from those in which such histories were cited. Tyndale's historical faith is not, then, as his opponent Thomas More dubbed it, an “evasion” borrowed from Melanchthon, but rather a part of the complex and developing relationship between scripture and history during the English Reformation.
An Outbreak of Fatal Nosocomial Infections Due to Group A Streptococcus on a Medical Ward
Authors: Ramage L. , Green K. , Pyskir D. , Simor A.E.
Published: September 2009

Group A streptococcus is an uncommon but important cause of nosocomial infections. Outbreaks of infection most often have occurred in surgical or obstetrical patients. We describe an outbreak of severe group A streptococcal infections that occurred on a medical unit of a community hospital. Within an 8-day period, three patients developed fatal nosocomial skin and soft-tissue infection due to group A streptococcus. Three nurses who had provided care to one or more of these patients subsequently developed strepto-coccal pharyngitis, and three other nurses were treated with antibiotics for pharyngitis (cultures not obtained). Patient isolates were serotype M-nontypeable, T-11, opacity factor-positive, and shared identical DNA profiles when typed by pulsed-field gel electrophoresis; staff isolates were not available for typing. To prevent further spread of infection, the ward was closed to new admissions, and symptomatic staff were treated with antibiotics and relieved of patient-care duties. This outbreak demonstrates the ability of group A streptococcus to spread rapidly in a hospital setting and to cause severe life-threatening disease in hospitalized patients.
Textual Collaboration and Spiritual Partnership in Sixteenth-Century Italy: The Case of Ortensio Lando and Lucrezia Gonzaga*
Authors: Ray Meredith K.
Published: September 2009

The sixteenth-century writer Ortensio Lando (ca. 1512–ca. 1553) wrote many of his works pseudonymously and borrowed liberally from the works of others. Part of a community of professional writers who experimented with collaborative modes of literary production, Lando was also deeply invested in the currents of religious reform that swept through sixteenth-century Italy. In his extensive literary recourse to female personas, Lando privileged contemporary women who shared his own heterodox religious views. This essay examines Lando's female impersonations with particular attention to his use of Lucrezia Gonzaga da Gazzuolo (ca. 1521–76), whose complex literary relationship with Lando is illustrated by her presence throughout his literary corpus, and by his role in the book ofLetterepublished under her name. It argues that the relationship between these two figures can be best understood as a literary and spiritual partnership, one that meshed Lando's editorial expertise with Gonzaga's fame as a woman of extraordinary virtue and spiritual authority, a reputation that Lando himself helped to create. In an era when print publication by women was still far from common, such collaboration constituted an alternative path to literary expression.
Preventing the Emergence of Multidrug-Resistant Microorganisms Through Antimicrobial Use Controls: The Complexity of the Problem
Authors: Jarvis William R.
Published: September 2009

Widespread use of antimicrobials in the inpatient and outpatient setting has been associated with the emergence of multidrug-resistant microorganisms. A variety of methods exist to improve the appropriateness of antimicrobial use in the inpatient setting, including guidelines, antimicrobial use evaluations, microbiology laboratory guidance, formulary development and antimicrobial restriction, use of antimicrobial order or automatic stop order forms, and antimicrobial audits. To decrease the selective pressure that leads to development of pathogen resistance and to reduce antimicrobial expenditures, infectious disease, infection control, pharmacy, and administrative staff need to improve clinician use of antimicrobials through development and implementation of antimicrobial use committees. Through the implementation of a comprehensive, multidisciplinary approach to antimicrobial use and development of clinician education programs, inappropriate antimicrobial use can be reduced, patient care can be improved, and substantial cost savings can be realized.
Methicillin-Resistant Staphylococcus aureus Epidemiology and Control in Belgian Hospitals, 1991 to 1995
Authors: Struelens Marc J. , Ronveaux Olivier , Jans Béatrice , Mertens Raf ,   Groupement pour le Dépistage, l'Etude et la Prévention des Infections Hospitalières
Published: September 2009

Objectives: To describe the Belgian methicillin-resis-tant Staphylococcus aureus (MRSA) surveillance network, the evolution of methods used in Belgian hospitals for MRSA detection and control, and MRSA incidence from 1994 to1995.

Design, Setting, and Participants: Questionnaire surveys; infection control physicians from acute-care hospitals in Belgium.

Intervention: Publication of national guidelines for MRSA control in 1993.

Results: The participation rate in surveys ranged from 42% to 57% of hospitals. In 1995, 88% of participants detected MRSA strains by disk diffusion tests, with little improvement in standardization since 1991. More centers employed the oxacillin agar screen method (27%), automated systems (29%), or a combination of methods (29%) than in 1991 (P<.005). Between 1991 and 1995, the proportion of hospitals reporting MRSA control measures increased from 68% to 95% (P<.01). Practices that were used increasingly included patient placement in private room (from 50% to 93%, P<.01) and hand decontamination with antiseptic (from 43% to 87%, P<.01). The proportion of centers that reported screening MRSA carriers and treating them topically increased two- and threefold, respectively (P<.05). Surveillance data from 1994 to 1995 showed that MRSA represented a mean of 21.3% of S aureus clinical isolates (range, 1.6% to 62.4%). The median incidence of nosocomial MRSA acquisition was 2.8 per 1,000 admissions, with a wide range (0 to 13.7 per 1,000 admissions) across hospitals of all sizes. The median incidence decreased over the first three semesters of surveillance in hospitals with continuous participation.

Conclusion: MRSA detection and control measures have improved in Belgian hospitals after publication of national guidelines. However, MRSA incidence rates show the persistence of nosocomial transmission, with large variations between centers. The national MRSA surveillance network should indicate whether control efforts eventually will curb the problem.
Methicillin-Resistant Staphylococcus aureus Control in Hospitals: The Dutch Experience
Authors: Vandenbroucke-Grauls C.M.J.E.
Published: September 2009

The Netherlands is one of the few countries where methi-cillin-resistant Staphylococcus aureus (MRSA) still is uncommon. In 1988, the Werkgroep Infectie Preventie (Working Party on Infection Prevention) issued guidelines on the control of MRSA that could be applied nationwide. The mainstay of the guideline is that all patients who carry MRSA are strictly isolated in single rooms. In 1989, a surveillance study was started by the National Institute of Public Health and the Environment. This study showed that approximately 200 new cases of MRSA colonization or infection occur each year. Small outbreaks of MRSA occur occasionally in The Netherlands, but the surveillance data confirm the success of the Dutch policy.
How to Limit the Spread of Creutzfeldt-Jakob Disease
Authors: Dormont Dominique
Published: September 2009

Transmissible spongiform encephalopathies are rare lethal diseases induced in humans and animals by unconventional agents called transmissible spongiform encephalopathy agents (TSEAs), virions, or prions. Several cases of iatrogenic Creutzfeldt-Jakob disease (CJD) have been reported in the literature after neuro-surgery, treatment with pituitary-derived hormones, corneal grafting, and use of dura mater lyophilisates. In a given infected individual, TSEA-associated infectiousness depends on the nature of the organ: the central nervous system has the highest infectiousness, spleen and lymph nodes a medium infectiousness, and organs such as bone, skin, or skeletal muscles do not harbor any detectable infectiousness in experimental models. Transmissible spongiform encephalopathy/prions have unconventional properties; in particular, they resist almost all the chemical and physical processes that inactivate conventional viruses. Therefore, prevention of CJD agent transmission must be taken into account in daily hospital practice. Efficient sterilization procedures should be determined. In tissue and blood donation, donors with a neurologic history must be excluded, and patients treated with pituitary-derived hormones should be considered potentially infected with TSEA and excluded.
AIDS, Emergency Operations, and Infection Control
Authors: Wittmann Mark Matthias , Wittmann Annemarei , Wittmann Dietmar H.
Published: September 2009

Acquired immunodeficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV) may turn out to be the largest lethal epidemic of infection ever. The estimated global number of HIV-infected adults in 1993 was 13 million, with projections of up to 40 million by the year 2000. Human immunodeficiency virus infections and AIDS are relevant to surgeons with respect to the surgical management of AIDS patients in general, the treatment of the increasingly long list of surgical complications specific to AIDS patients in particular, and the risks of patient-to-surgeon and surgeon-to-patient HIV transmission. Because of migration of individuals and populations throughout the world, even surgeons practicing in relatively unaffected regions should be familiar with the potential surgical implications of AIDS. Ethical considerations arise, as well. Are surgeons obliged to operate on HIV-positive or AIDS patients? Some surgeons adhere strictly to the Hippocratic Oath, whereas others reserve the right to be selective on whom they operate, except in emergencies. Other common ethical considerations in the AIDS patient are similar to those arising in the terminal cancer case: whether to operate or not; whether to provide advanced support such as total parenteral nutrition or hemodialysis. Answers are not simple and require close collaboration between the surgeon, the AIDS specialist, and involved members of other specialties. Emergency operations become necessary to treat AIDS independent disease such as acute cholecystitis and appendicitis or AIDS-related life-threatening conditions such as gastrointestinal bleeding, obstruction, perforation, or ischemia complicating Kaposi's sarcoma, lymphoma, and cytomegalovirus or disseminated nontuberculous mycobacterial infections. Delays and errors in diagnosis are frequent. Poor nutritional state with weight loss, low serum albumin, and leukocyte count prevails in most patients requiring emergency operations and account for a high mortality. By applying solid judgment and selecting management appropriately, the surgeon has the ability to prolong life and to improve the quality of life for these unfortunate patients, and to do so with extremely minimal risk to himself and his team.
Initial Worker Evaluation of a New Safety Syringe
Authors: Mulherin Stephanie , Rickman Leland S. , Jackson Marguerite McMillan
Published: September 2009

A prospective evaluation of a new safety syringe requiring a one-step activation was carried out at the University of California, San Diego Medical Center. Only 59.5% of 390 syringes were activated, and user acceptance and satisfaction were unfavorable. The development of safety devices should incorporate passive activation and take end-user satisfaction into consideration.
Surgical Outcome Information and the Media
Authors: Lee James T.
Published: September 2009

There is increased media attention to healthcare outcome in the current reform atmosphere. Surgical care is a natural target for both print and electronic coverage. Hospital public relations departments often will be the interface with media representatives. Because surgical care outcome interpretation requires thoughtful evaluation of both single-patient and grouped-patient data, as well as knowledge of realistic risk-benefit ratios, it always is prudent to work with your local surgeon when the request for a story comes to the public relations department.
Effect of a Comprehensive Program to Reduce Needlestick Injuries
Authors: Zafar Abdul B. , Butler R. Christopher , Podgorny Judith M. , Mennonna Patricia A. , Gaydos Larry A. , Sandiford John A.
Published: September 2009

The Arlington Hospital Needlestick Injury (NSI) Prevention Program was created to protect healthcare workers from NSI and to assess the effectiveness of our interventions. Interventions included revising NSI policy and procedures. The average NSI rate dropped from 109 to 43 per year after the interventions, over a period of 4 years.
Respiratory Isolation of Tuberculosis Patients Using Clinical Guidelines and an Automated Clinical Decision Support System
Authors: Knirsch Charles A. , Jain Nilesh L. , Pablos-Mendez Ariel , Friedman Carol , Hripcsak George
Published: September 2009

Objective:

To evaluate a clinical guideline and an automated computer protocol for detection and respiratory isolation of tuberculosis (TB) patients.

Design:

An automated computer protocol was tested on a retrospective cohort of adult culture-positive TB patients admitted from 1992 to 1993 to Columbia-Presbyterian Medical Center and evaluated prospectively from July 1995 until July 1996.

Setting:

A large teaching hospital in New York City.

Patients:

171 adult patients admitted from 1992 to 1993 and 43 patients admitted between July 1995 and July 1996.

Interventions:

The 1990 Centers for Disease Control and Prevention guidelines for preventing transmission of TB were adapted to formulate clinical guidelines to ensure early isolation of TB patients at Columbia-Presbyterian Medical Center.

Results:

Implementation of a clinical respiratory isolation protocol resulted in a significant improvement in TB patient isolation rates, from 45 (51%) of 88 in 1992 to 62 (75%) of 83 in 1993 (P<.001). In testing automated protocols, the theoretical improvement would have identified an additional 27 patients not isolated by clinicians, making the overall isolation rate 134 (78%) of 171.

For the prospective evaluation, 30 (70%) of 43 TB patients were isolated by clinicians adhering to the clinical protocol. Four additional patients were identified by the automated TB protocol, making the combined isolation rate 34 (79%) of 43.

Conclusions:

A clinical policy to isolate TB patients and suspected human immunodeficiency virus-infected patients with cough, fever, or radiographic abnormalities improved isolation of culture-documented TB patients from 1992 to 1993. Automated computer protocols were successful in identifying additional potentially infectious patients that clinicians failed to place on respiratory isolation. Clinical and automated protocols combined resulted in better isolation rates than a clinical protocol alone.
Difference in Incidence and Transmission Mode of Methicillin-Resistant Staphylococcus aureus Among Surgery, Orthopedics, and Pediatrics Wards: A Prospective Study at a University Hospital
Authors: Nishi Jun-Ichiro , Shirao Kazusada , Ito Hiroshi , Yoshinaga Masao , Yoshinaka Heiji , Miyanohara Hiroaki , Hirata Shingo , Ogawa Hiroki , Kitajima Isao , Maruyama Ikuro , Miyata Koichiro , Aiko Takashi , Sakou Takashi
Published: September 2009

The incidence and circumstances of colonization by methicillin-resistant Staphylococcus aureus were prospectively investigated. Among 404 patients, 15 (3.7%) were carriers on admission, and 43 (10.6%) became colonized, mainly after surgical operation. A different mode of transmission was suggested in each ward.
An Outbreak of Burkholderia cepacia With Septicemia on a Cardiology Ward
Authors: van Laer Frank , Raes David , Vandamme Peter , Lammens Christine , Sion Jean Paul , Vrints Chris , Snoeck Jozef , Goossens Herman
Published: September 2009

During a 3-day period, eight patients developed septicemia with Burkholderia cepacia. Heparin injection was found to be a risk factor. Heparin was diluted with dextrose solution, which was aspirated from a 1-L bag. B cepacia, genotypically identical to the blood isolates, was isolated from this bag.
Hospital Infection Prevention and Control: A Model for Improving the Quality of Hospital Care in Low- and Middle-Income Countries
Authors: Huskins W. Charles , Soule Barbara M. , O'Boyle Carol , Gulácsi László , O'Rourke Edward J. , Goldmann Donald A.
Published: September 2009

Continuous quality improvement (CQI) is a powerful methodology for improving clinical outcomes and patient satisfaction while reducing inefficiency and costs. However, most hospitals in low- and middle-income countries have little experience with CQI methods. Hospital infection prevention is an ideal model for nascent efforts to improve the quality of hospital care because of its proven efficacy in reducing the occurrence of infections that compromise patient outcomes and increase costs. This article describes the design and implementation of a demonstration project to reduce the incidence of surgical-site infections (SSIs) for hospitals with little experience with quality-improvement methods. The project has a high likelihood of producing measurable reductions in SSI rates and hospital costs related to inefficient use of perioperative antimicrobial prophylaxis. Moreover, participating staff will gain experience that can be applied to efforts to improve the quality of other aspects of hospital care.
Comparison of Vancomycin and Cefuroxime for Infection Prophylaxis in Coronary Artery Bypass Surgery
Authors: Vuorisalo Sailaritta , Pokela Risto , Syrjälä Hannu
Published: September 2009

OBJECTIVE: To investigate clinically significant differences between vancomycin and cefuroxime for perioperative infection prophylaxis in coronary artery bypass surgery.

DESIGN: A total of 884 patients were randomized prospectively to receive either cefuroxime (444) or van-comycin (440) and were assessed for infectious complications during hospitalization and 1 month postoperatively.

SETTING: A university hospital.

RESULTS: The overall immediate surgical-site infection rate was 3.2% in the cefuroxime group and 3.5% in the vancomycin group (difference, −0.3; 95% confidence interval, −2.6-2.1).

CONCLUSIONS: The data suggest that vancomycin has no clinically significant advantages over cephalosporin in terms of antimicrobial prophylaxis. We suggest that cefuroxime (or first-generation cephalosporins, which were not studied here) is a good choice for infection prophylaxis in connection with coronary artery bypass surgery in institutions without methicillin-resistant Staphylococcus aureus problems. In addition to the increasing vancomycin-resistant enterococci problem, the easier administration and usually lower price of cefuroxime make it preferable to vancomycin.
Vancomycin Control Measures at a Tertiary-Care Hospital: Impact of Interventions on Volume and Patterns of use
Authors: Singer Mary V. , Haft Rachel , Barlam Tamar , Aronson Mark , Shafer Amy , Sands Kenneth E.
Published: September 2009

OBJECTIVE: Evaluate vancomycin prescribing patterns in a tertiary-care hospital before and after interventions to decrease vancomycin utilization.

DESIGN: Before/after analysis of interventions to limit vancomycin use.

SETTING: 420-bed academic tertiary-care center.

INTERVENTIONS: Educational efforts began August 10, 1994, and involved lectures to medical house staff followed by mailings to all physicians and posting of guidelines for vancomycin use on hospital information systems. Active interventions began November 15, 1994, and included automatic stop orders for vancomycin at 72 hours, alerts attached to the medical record, and, for 2 weeks only, computer alerts to physicians following each vancomycin order. Parenteral vancomycin use was estimated from the hospital pharmacy database of all medication orders. Records of a random sample of 344 patients receiving van-comycin between May 1, 1994, and April 30, 1995, were reviewed for an indication meeting published guidelines.

RESULTS: Vancomycin prescribing decreased by 22% following interventions, from 8.5 to 6.8 courses per 100 discharges (P<.05). The estimated proportion of van-comycin ordered for an indication meeting published guidelines was 36.6% overall, with no significant change following interventions. However, during the 2 weeks that computer alerts were in place, 60% of vancomycin use was for an approved indication.

CONCLUSIONS: Parenteral vancomycin prescribing decreased significantly following interventions, but the majority of orders still were not for an indication meeting published guidelines. Further improvement in the appropriateness of vancomycin prescribing potentially could be accomplished by more aggressive interventions, such as computer alerts, or by targeting specific aspects of prescribing patterns.
Incidence and Distribution of Iris yellow spot virus on Onion in Serbia
Authors: Bulajić Aleksandra , Djekić Ivana , Jović Jelena , Krnjajić Slobodan , Vučurović Ana , Krstić Branka
Published: September 2009

In a survey to determine the presence and distribution of Iris yellow spot virus (IYSV) in greenhouse ornamentals and onion field crops in 14 districts of Serbia as well as on imported ornamental plants, 1,574 samples were collected and analyzed by double-antibody sandwich enzyme-linked immunosorbent assay (DAS-ELISA). IYSV was not detected in nearly 1,200 plant samples collected from 39 genera of ornamentals grown in greenhouses in Serbia or imported from other countries during 2005 to 2007. The virus was detected in samples from an onion seed crop in the Sirig locality (South Bačka District) that showed symptoms resembling those caused by IYSV and in samples without IYSV-like symptoms from an onion bulb crop in the Obrenovac locality (City of Belgrade District). Mechanical transmission of IYSV isolates was difficult, and only the isolate 605-SRB could infect four plant species, but not in all replications. No virus transmission could be demonstrated in 5,000 tested seeds originating from IYSV-infected onion crops. For further confirmation of IYSV, the nucleotide sequence of its nucleocapsid (NC) gene was obtained by reverse transcription–polymerase chain reaction (RT-PCR) in symptomatic onion samples as well as in symptomless leaves of Nicotiana benthamiana. Four previously developed primers were tested to determine their suitability for routine detection of Serbian IYSV isolates. Phylogenetic analysis showed clustering of isolates 605-SRB and 622-SRB from the onion seed crop and isolate 283-SRB from the onion bulb crop into two distant clades. The analysis indicated that Serbian isolates of IYSV do not share a recent common ancestor and that they represent two distinct lineages of IYSV in Serbia. Considering that onion is one of the most important and traditionally grown vegetable crops in Serbia, IYSV represents a potentially devastating pathogen in this country.
Assessing the Accuracy of Simulation Model for Septoria Leaf Blotch Disease Progress on Winter Wheat
Authors: El Jarroudi M. , Delfosse P. , Maraite H. , Hoffmann L. , Tychon B.
Published: September 2009

A mechanistic model, PROCULTURE, for assessing the development of each of the last five leaf layers and the progress of Septoria leaf blotch, caused by Septoria tritici (teleomorph Mycosphaerella graminicola), has been applied on susceptible and weakly susceptible winter wheat (Triticum aestivum) cultivars in two locations (Everlange and Reuland) in Luxembourg over a 3-year period (2000 to 2002). A double performance assessment of PROCULTURE was conducted in this study. First, the capability of PROCULTURE to correctly simulate S. tritici incidence was checked. Second, the model's ability to accurately estimate disease severity was assessed on the basis of the difference between simulated and observed levels of disease development at each leaf layer. The model accurately predicted disease occurrence in the 2000 and 2002 seasons, on susceptible and semi-susceptible cultivars, with a probability of detection (POD) exceeding 0.90. However, in 2001, even though the POD never fell below 0.90, the false alarm ratio (FAR) was too high to consider the simulations satisfactory. Concerning the evaluation of disease severity modeling, statistical tests revealed accurate simulations performed by PROCULTURE for susceptible cultivars in 2000 and 2002. By contrast, for weakly susceptible cultivars, the model overestimated disease severity, especially for the upper leaves, for the same period.
DNA-Dependent Detection of the Grapevine Fungal Endophytes Aureobasidium pullulans and Epicoccum nigrum
Authors: Martini M. , Musetti R. , Grisan S. , Polizzotto R. , Borselli S. , Pavan F. , Osler R.
Published: September 2009

Aureobasidium pullulans and Epicoccum nigrum are frequently reported as endophytes of various crops, including grapevine (Vitis vinifera). Because of their potential role as biological control agents against grapevine pathogens, we examined the occurrence of A. pullulans and E. nigrum in two grapevine varieties (Merlot and Prosecco) in Italian vineyards where spontaneous recovery from phytoplasma disease is recurrent. Species-specific primers for A. pullulans and two genetically distinct strains of E. nigrum were designed in variable regions of ITS1 and ITS2. Primer specificity was confirmed by polymerase chain reaction using purified DNA from other fungal endophytes that are usually encountered during isolation attempts from grapevine tissues and from several other strains of A. pullulans and E. nigrum isolated from other sources. In order to determine the occurrence of the two endophytes in grapevine plants, DNA was extracted from shoots of 44 grapevines collected in six vineyards from different localities of northeast Italy. Both endophytes were detected and their identity was confirmed by restriction fragment length polymorphism (RFLP) patterns obtained from reference strains. RFLP analyses confirmed the presence of two E. nigrum strains belonging to different RFLP groups in grapevine. The molecular methods described allowed a sensitive, specific, and reliable identification of the two endophytes in grapevine.