bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatitis C Virus Infection in Employees of a Large University Hospital in Israel
Authors: Sermoneta-Gertel Simona , Donchin Milka , Adler Ruth , Baras Mario , Perlstein Tamar , Manny Noga , Shouval Daniel , Galun Eithan
Published: February 2006

Objective:

To assess whether hospital work constitutes a risk factor for hepatitis C virus (HCV) infection among employees of a large hospital in Israel.

Design:

Seroprevalence survey.

Setting:

A 1,006-bed, tertiary-care university hospital in Jerusalem.

Participants:

All 5,444 employees (18-65 years old) were eligible; 4,287 (79%) participated in the survey.

Methods:

Sera were tested for antibodies to HCV (anti-HCV) using a third-generation enzyme immunoassay. A third-generation strip immunoblot assay was used for confirmation. Participants were interviewed regarding their occupational history, and they completed a self-administered questionnaire covering history of non-occupational exposure to blood and country of birth. Other demographic information was obtained from the personnel department. Rates and odds ratios (ORs) were calculated, and multivariate logistic-regression analyses were performed to adjust for potential confounding variables.

Results:

Anti-HCV was found in 0.9% of employees (37/4,287; 95% confidence interval, 0.6-1.1), ranging from 0.1% among those born in Israel to 5.7% among those born in Central Asia. After age, gender, social status, country of birth, and history of blood transfusion were controlled for in a logistic regression, occupational exposure to blood ≥10 years was significantly associated with the presence of antibodies (OR, 2.6; P=.01). Presence of anti-HCV also was associated with country of birth (range: Israel OR, 1; West OR, 3.8 [P=.1]; Central Asia OR, 48.6 [P<.0001]) and history of blood transfusion (OR, 2.7; P=.01). No significant associations were found between anti-HCV and age, gender, social status, history of tattoo, acupuncture, current occupation, department, exposure to blood in current occupation, adherence to safety precautions, or history of percutaneous injury. The association with length of exposure was stronger (OR, 3.6; P=.01) when the same logistic regression was run excluding the outlier ethnic group of Central Asia.

Conclusions:

Hospital work does not seem to constitute a major risk factor for HCV infection in Israel today. A higher prevalence of anti-HCV among employees with longer versus shorter lengths of occupational exposure may be due to a cumulative effect of exposure over the years. Infection control efforts in recent years may have contributed to this association.
Nosocomial Infections in Pediatric Cardiac Surgery, Italy
Authors: Valera Mariangela , Scolfaro Carlo , Cappello Nazario , Gramaglia Elena , Grassitelli Sergio , Abbate Maria Teresa , Rizzo Alberta , Abbruzzese Piero , Valori Andrea , Longo Stefano , Tovo Pier Angelo
Published: February 2006

Objective:

To evaluate the incidence of nosocomial infection (NI) in pediatric patients who received cardiothoracic surgery and to identify possible associated risk factors.

Design:

Prospective observational study.

Setting:

The cardiac surgery and cardiac intensive care units at the Regina Margherita Children's Hospital, Turin, Italy.

Patients:

All patients who underwent surgery from July 20,1998, to July 19,1999, were enrolled, except patients with operative catheterization only.

Methods:

Clinical data were collected daily from July 20, 1998, to July 19, 1999. NIs were diagnosed according to US Centers for Disease Control and Prevention criteria.

Results:

104 patients were included in the present study, 80 (76.9%) of whom underwent extracorporeal circulation. The NI ratio was 48.1% (50/104); the percentage of patients with NI was 30.8% (32/104): 23.1% developed one infection, 7.7% two or more. The rate of NI was 2.17 per 100 days of hospitalization (50/2,304). The most common pathogen wasPseudomonas aeruginosa,Important risk factors were length of preoperative admission >5 days, total length of admission >10 days, open chest during postoperative phase, and cyanotic heart disease. There was a significant association between sepsis and central venous catheterization for 3 days or more. Rate of sepsis was 19 per 1,000 catheter days (16/852).

Conclusion:

NIs represent a frequent complication for children who undergo heart surgery. Based on our data, we suggest decreasing the preoperative stay as much as possible. The higher NI incidence in patients with an open chest postoperatively suggests that an alternative antibiotic strategy should be considered for these patients.
Nasal MRSA Colonization of AIDS Patients Cared for in a Brazilian University Hospital
Authors: Padoveze Maria Clara , Tresoldi Antonia Teresinha , vonNowakonski Angela , Aoki Francisco Hideo , Branchini Maria Luiza Moretti
Published: February 2006

Weekly culture surveillance was conducted over a 2-year period to determine the incidence of methicillin-resistantStaphylococcus aureusnasal colonization among acquired immunodeficiency syndrome patients cared for in a day-care unit and in an infectious diseases unit. Analysis of genomic DNA profiles showed a predominant pattern in both units.
Impact of Nosocomial Infection on Length of Stay and Functional Improvement Among Patients Admitted to an Acute Rehabilitation Unit
Authors: Mylotte Joseph M. , Graham Robin , Kahler Lucinda , Young B. Lauren , Goodnough Susan
Published: February 2006

Objective:

To identify factors predictive of length of stay (LOS) and the level of functional improvement achieved among patients admitted to an acute rehabilitation unit for the first time, with special reference to the role of nosocomial infection.

Setting:

A 40-bed acute rehabilitation unit within a 300-bed, tertiary-care, public, university-affiliated hospital.

Study Population:

All patients admitted to the unit between January 1997 and July 1998.

Design:

Prospective cohort study in which demographic and clinical data, including occurrence of nosocomial infection, were collected during the entire unit admission of each patient. Multivariate linear regression analysis was used to identify factors predictive of unit LOS or improvement in functional status as measured by the change in the Functional Independence Measure (FIM) score between admission and discharge (ΔFIM).

Results:

There were 423 admissions to the rehabilitation unit during the study period, of which 91 (21.5%) had spinal cord injury (SCI) as a principal diagnosis. One hundred seven nosocomial infections occurred during 84 (19.9%) of the 423 admissions. The most common infections were urinary tract (31.8% of all infections), surgical-site (18.5%), andClostridium difficilediarrhea (15%). Only one patient died of infection. After controlling for severity of illness on admission, functional status on admission, age, and other clinical factors, the significant positive predictors of unit LOS were as follows: SCI (P<.001), pressure ulcer (.002), and nosocomial infection (<.001). Significant negative predictors of ΔFIM were age (P<.001), FIM score on admission (<.001), prior hospital LOS (.002), and nosocomial infection (.007).

Conclusions:

Several variables were identified as contributing to a longer LOS or to a smaller improvement in functional status among patients admitted for the first time to an acute rehabilitation unit Of these variables, only nosocomial infection has the potential for modification. Studies of new approaches to prevent infections among patients undergoing acute rehabilitation should be pursued.
Bacteriological Validation of a New Apparatus for Disinfection of Hospital Waste at the Point of Disposal
Authors: Eveillard Matthieu , Sarnel Claude , Fourniat Clotilde , Rivoal Florence , Daroukh Abla , Huchet Jacqueline , Chaty Michel , Hauss Serge , Bourlioux Pierre
Published: February 2006

Objectives:

To evaluate the ability of a new apparatus (Dipsys 25, Société SGN, Bagnols sur Cèze, France) to disinfect biomedical waste, including both potentially infectious agents and the normal saprophytic flora of the waste.

Methods:

Disinfection was assessed using standard methods (reference strains were fixed on reference carriers according to the French AFNOR methods) and nonstandard assays. Assays in conditions of hospital use, evaluations of bacterial survival during storage, sporicidal effect, and spore survival during storage were performed in parallel. Finally, bactericidal effect in extreme conditions (association of high contamination and high bacterial protection conditions) was tested with normal fecal flora. Bacterial counts were performed after treatment by the apparatus and without treatment (controls). All tests were carried out in triplicate.

Results:

In all treated carriers, a bacterial population decrease of at least 5 log10was obtained. Assays performed in hospital-use conditions did not show any bacterial growth. Concerning the evaluation of sporicidal effect and spore revival during conservation, a minimum reduction of 5 log10was observed in all assays performed, without survival. Finally, concerning assays in extreme conditions, the decrease of bacterial population was between 5 log10and 10 log10for vegetative anaerobes of normal fecal flora.

Conclusion:

Under our study conditions, the study apparatus reduced the tested microbial populations by a minimal factor of 5 log10. The main advantage of the apparatus is the opportunity to treat contaminated waste inside hospital wards, at the point of initial collection, without pulverization, by nonspecialized staff.
Multidrug-Resistant Bacteria Infection Control: Study of Compliance With Isolation Precautions in a Paris University Hospital
Authors: Vidal-Trecan Gwenaëlle M. , Delamare Natalie , Tcherny-Lessenot Stephanie , Lamory Jacqueline , Baudin François , de Prittwitz Michel , Salmon-Ceron Dominique
Published: February 2006

Isolation practices in a university hospital were analyzed for 137 patients with multidrug-resistant bacteria. Isolation was ordered in writing by physicians for 40% and instituted by nurses for 60%; 74% were isolated. Compliance depended on physician ordering in writing (odds ratio, 36.3; 95% confidence interval, 4.8-274.9). Nurses complied best with hand washing.
Hepatitis B Prevention Strategies Among Pediatric Hemodialysis Centers
Authors: Toma Michelle , Challapalli Malliswari
Published: February 2006

We surveyed pediatric hemodialysis centers (PHDCs) concerning their hepatitis B virus (HBV) prevention strategies. One hundred thirty-one patients were being dialyzed in these PHDCs in December 1996. Although all centers immunized HBV-susceptible hemodialysis patients and had infection control policies to curtail the spread of HBV infection, most centers were not in compliance with all of the Centers for Disease Control and Prevention recommendations for isolating hepatitis B surface antigen-positive patients.
Nosocomial Colonization of Premature Babies With Klebsiella oxytoca: Probable Role of Enteral Feeding Procedure in Transmission and Control of the Outbreak With the Use of Gloves
Authors: Berthelot Philippe , Grattard Florence , Patural Hugues , Ros Alain , Jelassi-Saoudin Hénia , Pozzetto Bruno , Teyssier Georges , Lucht Frédéric
Published: February 2006

Objective:

To investigate the persistence of colonization of premature babies byKlebsiella oxytoca, with special emphasis on the mode of transmission of the bacterium and evaluation of Standard Precautions to stop the epidemic.

Design:

Retrospective analysis of cases and prospective study of systematic bacteriological samples (stools and throat) from babies, healthcare workers (HCWs), and environment, with genotyping of strains by arbitrarily primed polymerase chain reaction.

Setting:

A premature baby unit (PBU) and a neonatal intensive care unit in the university hospital of Saint-Etienne, France.

Results:

An outbreak ofK oxytocawas suspected in two pediatric wards after the occurrence of a fatal bacteremia in a newborn hospitalized in the PBU and the colonization of other babies 2 months later. Retrospective analysis showed that 24 babies' digestive tract had been colonized. No environmental reservoir was recovered in the units nor in enteral feeding. NoK oxytocawas isolated from HCW samples. Genotyping confirmed the presence of epidemic strains, although independent clones were responsible for infections or colonizations in each of the two units. The chronology and the site of babies' colonization (isolation ofK oxytocain stools before throat) were determined during a prospective study and suggested that enteral feeding procedures could be the source of contamination. Therefore, use of gloves during this practice by HCWs was recommended and, after readjustment of Standard Precautions, stopped the outbreak.

Conclusion:

To prevent cross-contamination among high-risk babies, careful attention must be paid to Standard Precautions. Bacteriological surveillance of the digestive tract of neonates could help to check compliance with these guidelines.
Reality Check: Should We Use Vancomycin for the Prophylaxis of Intravascular Catheter-Associated Infections?
Authors: Grohskopf Lisa A. , Maki Dennis G. , Sohn Annette H. , Sinkowitz-Cochran Ronda L. , Jarvis William R. , Goldmann Donald A.
Published: February 2006

The use of intravascular catheters is associated with increased risk of bloodstream infections, principally caused by coagulase-negative staphylococci. This “Reality Check” session, held at die 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections, focused on the question of whether, and in what manner, vancomycin should be used for the prophylaxis of these infections.
Guidelines for the Management of Intravascular Catheter-Related Infections
Authors: Mermel Leonard A. , Farr Barry M. , Sherertz Robert J. , Raad Issam I. , O'Grady Naomi , Harris JoAnn S. , Craven Donald E.
Published: February 2006

These guidelines from the Infectious Diseases Society of America (IDSA), the American College of Critical Care Medicine (for the Society of Critical Care Medicine), and the Society for Healthcare Epidemiology of America contain recommendations for the management of adults and children with, and diagnosis of infections related to, peripheral and nontunneled central venous catheters (CVCs), pulmonary artery catheters, tunneled central catheters, and implantable devices. The guidelines, written for clinicians, contain IDSA evidence-based recommendations for assessment of the quality and strength of the data. Recommendations are presented according to the type of catheter, the infecting organism, and the associated complications.

Intravascular catheter-related infections are a major cause of morbidity and mortality in the United States. Coagulase-negative staphylococci,Staphylococcus aureus, aerobic gram-negative bacilli, andCandida albicansmost commonly cause catheter-related bloodstream infection. Management of catheter-related infection varies according to the type of catheter involved. After appropriate cultures of blood and catheter samples are done, empirical iv antimicrobial therapy should be initiated on the basis of clinical clues, the severity of the patient's acute illness, underlying disease, and the potential pathogen (s) involved. In most cases of nontunneled CVC-related bacteremia and fungemia, the CVC should be removed.
A Comparison of Multifaceted VersusClostridium difficile-Focused VRE Surveillance Strategies in a Low-Prevalence Setting
Authors: Kate Kevin C. , Gardam Michael A. , Burt JoAnne , Conly John M.
Published: February 2006

We compared our current screening strategy for vancomycin-resistantEnterococcus(VRE) with a focused strategy that screens all stool samples sent forClostridium difficiletoxin assay but limits rectal swab screening to wards with new VRE cases detected viaC difficilesamples. The proposed strategy detects 72.7% of new VRE cases, with substantial cost savings.
Assessing Excess Nurse Work Load Generated by Multiresistant Nosocomial Bacteria in Intensive Care
Authors: Saulnier Fabienne F. , Hubert Hervé , Onimus Thierry M. , Beague Sébastien , Nseir Saad , Grandbastien Bruno , Renault Catherine Y. , Idzik Myrian , Erb Martine P. , Durocher Alain V.
Published: February 2006

Objective:

To compare three methods for assessing the excess nurse work load related to recommended procedures for managing nosocomial infections (NI) due to multiresistant bacteria (MRB): two activity scores, the Omega score and the Projet de Recherche en Nursing (PRN) system, and a specific evaluation based on functional analysis of nursing procedures.

Setting:

10 beds in a medical intensive care unit (MICU).

Patients:

Patients admitted from November 15,1995, to June 15, 1996, were included and divided in two groups based on presence of MRB colonization or infection (MRB+ and MRB− groups).

Methods:

Data were collected regarding length of stay (LOS) in days; Omega score for the entire stay; PRN score for the entire stay and per day; and time required to perform correctly four nursing procedures related to MRB NI, as evaluated specifically by the nursing staff, using a detailed functional analysis document that described all elementary nursing tasks in chronological order and all material needed to carry out those tasks.

Results:

The LOS and total Omega and PRN scores were higher in the MRB+ group than in the MRB− group: LOS, 23±20.6 versus 12±15.3 days, (P<.001); Omega score, 164±103.4 versus 123±93.7 points (P<.001); PRN score, 3,606±3,187 versus 1,854±2,356 points (P<.001), respectively. The daily PRN score was also higher in MRB+ group (PRN, 160±25 vs 146±34 points in the MRB− group; P<.028). Four nursing procedures made necessary by MRB acquisition were identified: isolation precautions, with two levels according to whether the risk of contamination was mild-moderate or high; bathing the patient with antiseptic solution;, bedpan management; and microbiological screening. The functional analysis indicated that the time needed to carry out these four procedures correctly was 245 minutes per patient per day, as compared to 85 minutes according to the PRN system.

Conclusions:

Our data confirm that MRB NIs are responsible for an increase in nurse work load, as estimated by LOS, Omega, and PRN scores. However, the daily excess nurse work load related directly to recommended procedures for managing MRB NIs in MICUs is underestimated by these activity scores, as compared to a specific functional analysis of nursing tasks. This may be of importance in evaluating potential links between nurse work load and MRB NIs and in determining the number of nurse hours needed to comply with infection control recommendations.
Outbreak of Vancomycin-ResistantEnterococcus faeciumin a Neonatal Intensive Care Unit
Authors: Rupp Mark E. , Marion Nedra , Fey Paul D. , Bolam David L. , Iwen Peter C. , Overfelt Christine M. , Chapman Lucinda
Published: February 2006

An outbreak of vancomycin-resistantEnterococcus faeciuminvolving 28 infants in a neonatal intensive care unit was observed. Successful control of the outbreak was achieved following use of patient and staff cohorting, contact isolation precautions, patient and environmental surveillance cultures, environmental decontamination, molecular typing, introduction of an alcohol-based hand disinfectant, and decreased use of vancomycin.
The Emerging Nosocomial PathogensCryptosporidium, Escherichia coli0157: H7,Helicobacter pylori, and Hepatitis C: Epidemiology, Environmental Survival, Efficacy of Disinfection, and Control Measures
Authors: Weber David J. , Rutala William A.
Published: February 2006

New and emerging infectious diseases pose a threat to public health and may be responsible for nosocomial outbreaks.Cryptosporidium parvumandEscherichia coliare gastrointestina pathogens that have caused nosocomial infections via person-to-person transmission, environmental contamination, or contaminated water or food.Helicobacter pylorihas been transmitted via inadequately disinfected endoscopes. Finally, hepatitis C may be acquired by healthcare personnel by percutaneous or mucous membrane exposure to blood or between patients by use of contaminated blood products or via environmental contamination. Rigorous adherence to Standard Precautions, Contact Precautions for patients with infectious diarrhea, disinfection of environmental surfaces, and appropriate disinfection of endoscopes are adequate to prevent nosocomial acquisition of these pathogens.
Factors Associated With Postoperative Infection
Authors: Scott James D. , Forrest Alan , Feuerstein Steve , Fitzpatrick Paul , Schentag Jerome J.
Published: February 2006

Objective:

We have developed and analyzed a large surgical prophylaxis database and now report the factors significantly associated with early infection, readmission due to infection, and death within 28 days of surgery. This study is intended to be a stepping-stone for further studies using our clinical database.

Design and Setting:

A computerized database of 9,016 surgical patients from a 400-bed community hospital was examined. Multivariate logistic regression and tree-based modeling were used to identify factors associated with the outcomes. Factors considered included surgical procedure, prophylactic antibiotic, age, gender, serum creatinine, and albumin.

Results:

12.6% had an early infection, 2.5% were read-mitted due to infection, and 2.5% died within 28 days. Most combination prophylactic antibiotics were associated with an increased probability of an early infection. Decreased albumin and increased age were associated with an increased probability of an early infection. Tracheostomy and amputations were associated with an increased probability of an early infection, whereas gallbladder and orthopedic procedures involving the arm were associated with a decreased probability. Factors associated with readmission due to infection included dialysis shunt, vascular repair, and an early infection. Factors associated with increased probability of death within 28 days included age, albumin, serum creatinine, and an early infection. Gallbladder procedures and obstetric-gynecologic procedures were associated with a decreased probability of death within 28 days.

Discussion:

Older patients and those with a decreased albumin were most likely to have an early infection. To the extent that an early infection was a significant risk factor for readmission due to infection, the impact of age and albumin on the probability of readmission due to infection is demonstrated by their effects on early infections. Interestingly, albumin and age were significantly associated with death within 28 days, in addition to early infection, showing the predictive association between these factors and early death.
Microbiology and Risk Factors for Catheter Exit-Site and -Hub Colonization in Neonatal Intensive Care Unit Patients
Authors: Mahieu Ludo M. , De Dooy Jozef J. , De Muynck Aimé O. , Van Melckebeke Guillaume , Ieven Margareta M. , Van Reempts Patrick J.
Published: February 2006

Objective:

To identify risk factors and describe the microbiology of catheter exit-site and hub colonization in neonates.

Design:

During a period of 2 years, we prospectively investigated 14 risk factors for catheter exit-site and hub colonization in 862 central venous catheters in a cohort of 441 neonates. Cultures of the catheter exit-site and hub were obtained using semiquantitative techniques at time of catheter removal.

Setting:

A neonatal intensive care unit at a university hospital.

Results:

Catheter exit-site colonization was found in 7.2% and hub colonization in 5.3%. Coagulase-negative staphylococci were predominant at both sites. Pathogenic flora were found more frequently at the catheter hub (36% vs 14%;P<.05). Through logistic regression, factors associated with exit-site colonization were identified as umbilical insertion (odds ratio [OR], 8.1; 95% confidence interval [CI95], 2.35-27.6;P<.001), subclavian insertion (OR, 54.6; CI95, 12.2-244;P<.001), and colonization of the catheter hub (OR, 8.9; CI95,3.5-22.8;P<.001). Catheter-hub colonization was associated with total parenteral nutrition ([TPN] OR for each day of TPN, 1.056; CI95,1.029-1.083;P<.001) and catheter exit-site colonization (OR, 6.11; CI95, 2.603-14.34;P<.001). No association was found between colonization at these sites and duration of catheterzation and venue of insertion, physician's experience, postnatal age and patient's weight, ventilation, steroids or antibiotics, and catheter repositioning.

Conclusion:

These data support that colonization of the catheter exit-site is associated with the site of insertion and colonization of the catheter hub with the use of TPN. There is a very strong association between colonization at both catheter sites.
The Epidemiology of Invasive Pulmonary Aspergillosis at a Large Teaching Hospital
Authors: Pegues Clare F. , Daar Eric S. , Murthy A. Rekha
Published: February 2006

Objective:

To characterize the epidemiology of invasive pulmonary aspergillosis (IPA).

Design:

A retrospective case series.

Setting:

An 850-bed, academic, tertiary-care medical center.

Participants:

Adult inpatients, between January 1, 1990, and December 31, 1998, with either a histopathology report consistent with IPA or a discharge diagnosis of aspergillosis.

Methods:

We reviewed medical records and categorized case-patients as definitive or probable and acquisition of IPA as nosocomial, indeterminate, or community using standard definitions. To determine the rate of aspergillus respiratory colonization, we identified all inpatients who had a respiratory culture positive forAspergillusspecies without a histopathology report consistent with IPA or a discharge diagnosis of aspergillosis. Three study intervals were defined: interval 1,1990 to 1992; interval 2,1993 to 1995; and interval 3,1996 to 1998. Carpeting in rooms for patients following heart-lung and liver transplant was removed and ceiling tiles were replaced during interval 1; a major earthquake occurred during interval 2.

Results:

72 case-patients and 433 patients with respiratory colonization were identified. Acquisition was nosocomial for 18 (25.0%), indeterminate for 9 (12.5%), and community-acquired for 45 (62.5%) case-patients. Seventeen (23.6%) of the 72 case-patients had prior transplants, including 15 solid organ and 2 bone marrow. The IPA rate per 100 solid organ transplants (SOTs) decreased from 2.45 during interval 1 to 0.93 during interval 2 and to 0.52 during interval 3 (chi-square for trend, 5.44;P<.05). The hospitalwide IPA rate remained stable at 0.03 per 1,000 patient days.

Conclusions:

The SOT IPA rate decreased after intervals 1 and 2, although the hospitalwide IPA rate remained stable during the study period. Post-earthquake hospital demolition and construction occurring after interval 2 was not associated with an increase in the rate of IPA at our institution.
Isolation in Brazil of NosocomialStaphylococcus aureusWith Reduced Susceptibility to Vancomycin
Authors: Oliveira Geraldo A. , Dell'Aquila Adriana M. , Masiero Rita L. , Levy Carlos E. , Gomes Marcia S. , Cui Longzhu , Hiramatsu Keiichi , Mamizuka Elsa M.
Published: February 2006

Objective:

To evaluate the possible presence of vancomycin-resistantStaphylococcus aureus(VRSA) in a Brazilian hospital.

Design:

Epidemiological and laboratory investigation of nosocomial VRSA

Methods:

140 methicillin-resistantS aureusstrains isolated between November 1998 and October 1999 were screened for susceptibility to vancomycin. The screening was carried out by using brain-heart infusion agar (BHIA) supplemented with 4, 6, and 8 μg/mL of vancomycin. The minimum inhibitory concentration (MIC) determination was carried out as standardized by the National Committee for Clinical Laboratory Standards using the broth macrodilution, agar-plate dilution, and E-test methods.

Patients:

Hospitalized patients exposed to vancomycin.

Results:

5 of the 140 isolates had a vancomycin MIC of 8 μg/mL by broth macrodilution, agar plate dilution, and E-test methods. Four VRSA strains were isolated from patients in a burn unit who had been treated with vancomycin for more than 30 days, and one from an orthopedic unit patient who had received vancomycin treatment for 7 days. Pulsed-field gel electrophoresis characterized four of the VRSA strains as belonging to the Brazilian endemic clone. All five strains were negative forvanA,vanB, andvanC genes by polymerase chain reaction. Transmission electron microscopy of the five strains revealed significantly thickened cell walls. One patient died due to infection caused by the VRSA strain.

Conclusions:

This is the first report of isolation of VRSA in Brazil and the first report of isolation of multiple VRSA strains from one facility over a relatively short period of time. This alerts us to the possibility that VRSA may be capable of nosocomial transfer if adequate hospital infection control measures are not taken.
The Role of the Laboratory in Infection Prevention and Control Programs in Long-Term–Care Facilities for the Elderly
Authors: Simor Andrew E.
Published: February 2006

Hospital infection prevention and control programs rely extensively on diagnostic microbiology laboratory testing. However, specimens for microbiological evaluation are less likely to be obtained from elderly residents of long-term–care facilities (LTCFs). In this article, issues regarding laboratory utilization and the potential role of the microbiology laboratory in infection prevention and control programs in LTCFs are reviewed. The role of the laboratory in infection surveillance, in the management of antimicrobial resistance, and in outbreak investigation are highlighted.
Tuberculosis and Tuberculin Quality: Best Intentions, Misleading Results
Authors: Rangel-Frausto M. Sigfrido , Ponce-de-León-Rosales Samuel , Martinez-Abaroa Claudia , Hasløv Kaare
Published: February 2006

Objective:

To compare the performance of three purified protein derivative (PPD) formulations: Tubersol (Connaught); RT23, Statens Serum Institut (SSI); and RT23, Mexico, tested in Mexican populations at low and high risk for tuberculosis (TB).

Design:

A double-blinded clinical trial.

Setting:

A university hospital in Mexico City.

Participants:

The low-risk population was first or second-year medical students with no patient contact; the high-risk population was healthcare workers at a university hospital.

Methods:

Each of the study subjects received the three different PPD preparations. Risk factors for TB, including age, gender, occupation, bacille Calmette-Guerin (BCG) status, and TB exposure, were recorded. A 0.1-mL aliquot of each preparation was injected in the left and right forearms of volunteers using the Mantoux technique. Blind readings were done 48 to 72 hours later. Sensitivity and specificity were calculated at 10 mm of induration using Tubersol as the reference standard. The SSI tested the potency of the different PPD preparations in previously sensitized guinea pigs.

Results:

The low-risk population had a prevalence of positive PPD of 26%. In the low-risk population, RT23 prepared in Mexico, compared to the 5 TU of Tubersol, had a sensitivity of 51%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 86%. The RT23 prepared at the SSI had a sensitivity of 69%, a specificity of 99%, a positive predictive value of 95%, and a negative predictive value of 90%. In the high-risk population, the prevalence of positive PPD was 57%. The RT23 prepared in Mexico had a sensitivity of 33%, a specificity of 100%, and a positive predictive value of 53%; the RT23 prepared at the SSI had a sensitivity of 91%, a specificity of 98%, a positive predictive value of 98%, and a negative predictive value of 89%. RT23 used in Mexico had a potency of only 23% of that of the control. There was no statistical association among those with a positive PPD, irrespective of previous BCG vaccination (relative risk, 0.97; 95% confidence interval, 0.76-1.3; P=.78).

Conclusions:

Healthcare workers had twice the prevalence of positive PPD compared to medical students. RT23 prepared in Mexico had a low sensitivity in both populations compared to 5 TU of Tubersol and RT23 prepared at the SSI. Previous BCG vaccination did not correlate with a positive PPD. Low potency of the RT23 preparation in Mexico was confirmed in guinea pigs. Best intentions in a TB program are not enough if they are not followed by high-quality control.
Postdischarge Nosocomial Infections in Primary Care
Authors: Letrilliart Laurent , Guiguet Marguerite , Hanslik Thomas , Flahault Antoine
Published: February 2006

Objective:

To study both surgical and nonsurgical nosocomial infections (NIs) seen by primary-care physicians (general practitioners [GPs]) in France.

Design:

Ongoing surveillance of postdischarge NIs by an organized group of GPs, from August 1997 to July 1999. Both the GP who personally examined the case spontaneously presenting with NI and the responsible hospital physician or surgeon were interviewed by telephone.

Setting:

305 general practices from all French regions.

Results:

2,199 (29%) of 7,540 patients referred for hospitalization reconsulted the GP within 30 days of discharge. In 21 (1%) of the 2,199 cases, an NI was diagnosed by the GP and confirmed as plausible by the responsible hospital physician. We diagnosed an NI in 8 (1.3%) of the post-surgical patients and in 13(0.8%)of the non-surgical cases within the cohort We saw eight urinary tract infections, seven surgical-site infections, three soft-tissue infections, two respiratory tract infections, and one primary bloodstream infection. In 19 patients (90%), clinical signs of NI appeared within 7 days of discharge. Assuming that all 5,431 patients who were missed for follow-up did not experience any NI, an attack rate of 0.3 per 100 admissions may be estimated for the whole group.

Conclusion:

We diagnosed 1% of NIs following discharge from a hospital in a cohort of 2,199 patients, of which 1.3% were seen post-surgery and 0.8% following nonsurgical admissions. The percentage of postdischarge visits that were for an NI in nonsurgical patients warrants a major effort with feedback to the hospital physician to reduce infection rates.
Quinolone Use as a Risk Factor for Nosocomial Clostridium difficile-Associated Diarrhea
Authors: Yip Clarwyn , Loeb Mark , Salama Suzette , Moss Lorraine , Olde Jan
Published: February 2006

Objective:

To determine modifiable risk factors for nosocomial Clostridium difficile-associated diarrhea (CDAD).

Design:

Case-control study.

Setting:

300-bed tertiary-care hospital.

Participants:

Hospital inpatients present during the 3-month study period.

Methods:

Case-patients identified with nosocomial CDAD over the study period were compared to two sets of control patients: inpatients matched by age, gender, and date of admission; and inpatients matched by duration of hospital stay. Variables including demographic data, comorbid illnesses, antibiotic exposure, and use of gastrointestinal medications were assessed for case- and control-patients. Conditional logistic regression was performed to identify risk factors for nosocomial CDAD.

Results:

27 case-patients were identified and were compared to the two sets of controls (1:1 match for each comparison set). For the first set of controls, use of ciprofloxacin (odds ratio [OR], 5.5; 95% confidence interval [CI95], 1.2-24.8; P=.03) was the only variable that remained significant in the multivariable model. For the second set of controls, prior exposure to cephalosporins (OR, 6.7; CL,5, 1.3-33.7; P=.02) and to ciprofloxacin (OR, 9.5; CI95, 1.01-88.4; P=.05) were kept in the final model.

Conclusions:

Along with cephalosporins, prior quinolone use predisposed hospitalized patients to nosocomial CDAD. Quinolones should be used judiciously in acute-care hospitals, particularly in those where CDAD is endemic.
Molecular Typing and Antimicrobial Susceptibility of Vancomycin-ResistantEnterococcus faeciumin Brazil
Authors: Cereda Rosangela F. , Gales Ana C. , Silbert Suzane , Jones Ronald N. , Sader Helio S.
Published: February 2006

Objectives:

To characterize vancomycin-resistant enterococci (VRE) isolates and to evaluate the mode of dissemination of this pathogen in Brazil.

Design:

We collected 22 vancomycin-resistantEnterococcus faeciumisolates from 6 medical centers in Sao Paulo, Brazil, and 1 isolate from a medical center in Curitiba, Brazil.

Participants:

All Brazilian hospitals that had identified vancomycin-resistantE. faeciumup to the beginning of this study (late 1999) contributed isolates to the study.

Methods:

The isolates were susceptibility tested using the broth microdilution method and the E-test. The presence of vancomycin resistance genes (vanA,vanB,vanC1,vanC2-3, andvanD) was evaluated by polymerase chain reaction; molecular typing was performed by pulsed-field gel electrophoresis (PFGE).

Results:

ThevanA gene was demonstrated in all vancomycin-resistantE. faecium, except for 1 isolate. None of the vancomycin resistance genes cited above was detected in the isolate from Curitiba, which was the first vancomycin-resistantE. faeciumdescribed in Brazil. All isolates were resistant to ampicillin and teicoplanin. The main clone remains susceptible to doxycycline and chloramphenicol, but intermediate to quinupristin-dalfopristin. PFGE analysis demonstrated 7 major PFGE patterns. A unique PFGE pattern with 4 subtypes was detected in 17 isolates from 4 different hospitals.

Conclusion:

The results of our study indicate the occurrence of intra- and interhospital dissemination of VRE in Sao Paulo, Brazil.
Sixteen Years' Surveillance of Surgical Sites in an Irish Acute-Care Hospital
Authors: Creamer Eilish , Cunney Robert J. , Humphreys Hilary , Smyth Edmond G.
Published: February 2006

Objective:

To report a program of continuous surveillance of surgical-site infections (SSIs) using basic surveillance methods.

Design:

Analysis of routine prospective surveillance data.

Setting:

Two hospitals in Ireland (300 and 350 beds) that merged and moved to a new 650-bed hospital in 1987.

Patients:

59,335 surgical sites of postoperative patients.

Interventions:

Surgical sites were surveyed by one infection control nurse and SSI rates were produced for selected operations and surgical services. The program was conducted in general accordance with the 1999 HICPAC guidelines, but differed in surveillance strategy. Operations were limited to two to three risk classifications, assigned by the infection control nurse.

Results:

The overall SSI rate was 4.5%, with 2.4% in clean surgery. Apart from increases in the 3rd, 4th, 13th, and 14th years, rates remained relatively stable during the 16 years. Few significant decreases in SSI rates in surgical services or specific operations were shown, apart from the following: vascular surgery, 8.1% to 5% between the first 8 years and the last 8 years; general surgery services, 9% to 5%, and gynecology, 15.8% to 1.7%, both in the first year compared with in subsequent years; and gastric operations, 21% to 4.3% between the first year and the second year. Organ/space infection was identified in 0.5% of 17,804 operations, including 0.4% meningitis after neurosurgical procedures, 3% graft infections after vascular bypass operations, and 0.2% intra-abdominal infections after abdominal surgery.

Conclusions:

With the use of basic principles of surveillance and modest resources, procedure-specific SSI rates were produced, with little significant change during the 16 years. Despite limitations in case-finding, risk stratification, feedback, and surveillance methods, the overall SSI rates were comparable with other published data.
A Quality Management Project in 8 Selected Hospitals to Reduce Nosocomial Infections: A Prospective, Controlled Study
Authors: Gastmeier Petra , Bräuer Helga , Forster Dietmar , Dietz Eckehard , Daschner Franz , Rüden Henning
Published: February 2006

Objective:

To reduce the number of nosocomial infections (NIs) in surgical patients by a quality management approach.

Design:

Prospective, controlled study in 8 medium-sized hospitals during a 26-month period.

Setting:

Four study hospitals and 4 control hospitals.

Methods:

In two 10-month intervention periods, 4 external physicians introduced quality circles and ongoing surveillance in the 4 study hospitals. There were three 8-week observation periods in all 8 hospitals with the same physicians before, during, and after the intervention periods.

Results:

During the first observation period, almost identical overall incidence densities were found for the study hospitals and the control hospitals. During the course of the study, the overall incidence density decreased significantly in the study hospitals (risk ratio [RR], 0.74; 95% confidence interval [CI95], 0.59 to 0.94) and nonsignificantly in the control hospitals (RR, 0.90; CI95 0.70 to 1.16). With the use of a Cox regression model to evaluate the impact of the intervention periods while taking into account the distribution of risk factors for NI in both groups, a significant risk reduction (RR, 0.75; CI95, 0.58 to 0.97) was observed after the first intervention period when comparing study and control hospitals. At the end of the study (ie, after the second intervention period), the difference between the study hospitals and the control hospitals was not significant (RR, 0.78; CI95, 0.60 to 1.01). This was due to no further improvement at the end of the study in the study hospitals and a decrease in the control hospitals.

Conclusion:

This study demonstrates that NI rates can be significantly reduced by appropriate intervention methods in hospitals that are interested in quality management activities. However, continuous intense efforts are necessary to maintain these improvements.
Risk Factors for Vancomycin-ResistantEnterococcus(VRE) Infection in Colonized Patients With Cancer
Authors: Husni Rola , Hachem Ray , Hanna Hend , Raad Issam
Published: February 2006

To determine the risk factors for vancomycin-resistantEnterococcus(VRE) infection in colonized patients with cancer, we conducted a case–control study. According to multivariate analysis, the only significant factors were neutropenia (< 500 cells/mm3) for more than 1 week and the use of oral vancomycin. Therefore, colonized neutropenic patients with cancer who have previously used oral vancomycin are most prone to VRE infection.
Limited Impact of Sustained Simple Feedback Based on Soap and Paper Towel Consumption on the Frequency of Hand Washing in an Adult Intensive Care Unit
Authors: Bittner Marvin J. , Rich Eugene C. , Turner Paul D. , Arnold William H.
Published: February 2006

Objective:

To determine whether hand washing would increase with sustained feedback based on measurements of soap and paper towel consumption.

Design:

Prospective trial with a nonequivalent control group.

Setting:

Open multibed rooms in the Omaha Veterans Affairs Medical Center's Surgical Intensive Care Unit (SICU) and Medical Intensive Care Unit (MICU).

Subjects:

Unit staff.

Intervention:

Every weekday from May 26 through December 8,1998, we recorded daytime soap and paper towel consumption, nurse staffing, and occupied beds in the SICU (intervention unit) and the MICU (control unit) and used these data to calculate estimated hand washing episodes (EHWEs), EHWEs per occupied bed per hour, and patient-to-nurse ratios. In addition, from May 26 through June 26 (baseline period) and from November 2 through December 8 (follow-up period), live observers stationed daily for random 4-hour intervals in the MICU and the SICU counted actual hand washing episodes (CHWEs). The intervention consisted of posting in the SICU, but not in the MICU, a graph showing the weekly EHWEs per occupied bed per hour for the preceding 5 weeks.

Results:

Directly counted hand washing fell in the SICU from a baseline of 2.68 ± 0.72 (mean ± standard deviation) episodes per occupied bed per hour to 1.92 ± 1.35 in the follow-up period. In the MICU, episodes fell from 2.58 ± 0.95 (baseline) to 1.74 ± 0.69. In the MICU, the withdrawal of live observers was associated with a decrease in estimated episodes from 1.36 ± 0.49 at baseline to 1.01 ± 0.36, with a return to 1.16 ± 0.50 when the observers returned. In the SICU, a similar decrease did not persist throughout a period of feedback. Estimated hand washing correlated negatively with the patient-to-nurse ratio (r= -0.35 for the MICU,r= -0.46 for the SICU).

Conclusions:

Sustained feedback on hand washing failed to produce a sustained improvement. Live observers were associated with increased hand washing, even when they did not offer feedback. Hand washing decreased when the patient-to-nurse ratio increased.
Morbidity, Mortality, and Healthcare Burden of NosocomialClostridium Difficile-Associated Diarrhea in Canadian Hospitals
Authors: Miller Mark A. , Hyland Meagan , Ofner-Agostini Marianna , Gourdeau Marie , Ishak Magued ,   Canadian Hospital Epidemiology Committee,   Canadian Nosocomial Infection Surveillance Program
Published: February 2006

Objective:

To assess the healthcare burden, morbidity, and mortality of nosocomialClostridium difficile-associated diarrhea (N-CDAD) in Canadian hospitals.

Design:

Laboratory-based prevalence study.

Setting:

Nineteen acute-care Canadian hospitals belonging to the Canadian Hospital Epidemiology Committee surveillance program.

Patients:

Hospitalized patients in the participating centers.

Methods:

Laboratory-based surveillance was conducted forC. difficiletoxin in stool among 19 Canadian hospitals from January to April 1997, for 6 continuous weeks or until 200 consecutive diarrhea stool samples had been tested at each site. Patients with N-CDAD had to fulfill the case definition. Data collected for each case included patient demographics, length of stay, extent of diarrhea, complications of CDAD, CDAD-related medical interventions, patient outcome, and details of death.

Results:

We found that 371 (18%) of 2,062 tested patients had stools with positive results forC. difficiletoxin, of whom 269 (13%) met the case definition for nosocomial CDAD. Of these, 250 patients (93%) had CDAD during their hospitalization, and 19 (7%) were readmitted because of CDAD (average readmission stay, 13.6 days). Forty-one patients (15.2%) died, of whom 4 (1.5% of the total) were considered to have died directly or indirectly of N-CDAD. The following N-CDAD-related morbidity was noted: dehydration, 3%; hypokalemia, 2%; gastrointestinal hemorrhage requiring transfusion, 1%; bowel perforation, 0.4%; and secondary sepsis, 0.4%. The cost of N-CDAD readmissions alone was estimated to be a minimum of $128,200 (Canadian dollars) per year per facility.

Conclusion:

N-CDAD is a common and serious nosocomial infectious complication in Canada, is associated with substantial morbidity and mortality, and imposes an important financial burden on healthcare institutions.
Scissors: A Potential Source of Nosocomial Infection
Authors: Embil John M. , Zhanel George G. , Plourde Pierre J. , Hoban Daryl
Published: February 2006

This point-prevalence survey of healthcare workers' scissors demonstrates that of 232 scissors sampled, 182 (78.4%) were colonized with bacteria. The scissors of nurses and those for communal use were most frequently contaminated. Cleaning of scissors occurred infrequently, but wiping scissors with an alcohol swab effectively disinfected them. The suspicion that scissors may harbor and potentially transmit microorganisms, including antibiotic-resistant bacteria, has been confirmed.