bluuebunny/crossref_metadata_2025 huggingface dataset:
A Pseudo-Outbreak of Mycobacterium chelonae Infections Related to Bronchoscopy
Authors: Cox Ronald , deBorja Karen , Bach Michael C.
Published: September 2009

Mycobacterium gordonae and rapidly growing “atypical” mycobacteria including Mycobacterium chelonae are commonly found in tap water. This article describes a pseudooutbreak of M chelonae infections related to bronchoscopy. Because patients may be treated and isolated unnecessarily when positive with acid-fast bacilli before the species are known, the financial burden for patients and hospitals may be great.
Decision Analysis: Balancing Quality and Cost
Authors: Brasel Karen J. , Weigelt John A.
Published: September 2009

Healthcare reform is a topic consuming the time and energy of many healthcare professionals, administrators, and politicians. One goal of reform is to improve value—better quality health care for less cost. Unfortunately, much of the current debate proceeds without clear definitions of quality or cost. To have profitable discussion, we must have precise definitions. With these definitions in hand, the technique of decision analysis provides a unique opportunity to evaluate quality and costs of healthcare decisions simultaneously. We believe it is imperative for physicians to become familiar with this important and powerful tool.
Susceptibility of Vancomycin-Resistant Enterococci to Environmental Disinfectants
Authors: Anderson Roger L. , Carr Janice H. , Bond Walter W. , Favero Martin S.
Published: September 2009

Objective:

To determine the susceptibilities of vancomycin-resistant and -sensitive enterococci (VRE and VSE) to various concentrations of commonly used, commercial, hospital-grade disinfectants.

Design:

A microbial suspension test using inocula of 108 cells per mL in a disinfectant test dilution was used to determine inactivation kinetics of the test strains. In each test, 1-mL aliquots were removed from the cell-disinfectant mixtures at 15 and 30 seconds and then at 1-minute intervals for 5 minutes and neutralized. Appropriate serial dilutions were plated on agar medium for enumeration of survivors.

Results:

VRE and VSE challenge inocula (in the absence of any additional protein or serum challenge) were below the limit of detection (5 colony-forming units/mL) after 15 seconds' exposure to the manufacturers' suggested use-dilutions of quaternary ammonium, phenolic, or iodophor germicidal detergents. In subsequent tests, when the disinfectants were diluted far beyond the recommended use-dilutions (extended dilution), no differences were demonstrated between the susceptibilities of VRE and VSE.

Conclusions:

VRE and VSE are sensitive to a spectrum of commonly used environmental disinfectants and have parallel inactivation rates when challenged with extended dilutions of these products. Our findings did not demonstrate a relationship between antibiotic and germicide resistance. Routine disinfection and housekeeping protocols presently used in hospitals need not be altered due to concerns about the potential for environmentally mediated transmission of antibiotic-resistant microorganisms.
Changing the Infection Control Paradigm From Off-Line to Real Time The Experience at Millard Fillmore Health System
Authors: Carr James R. , Fitzpatrick Paul , Izzo Joseph L. , Cumbo Thomas J. , Birmingham Mary C. , Adelman Martin H. , Paladino Joseph A. , Hanson Stephen C. , Schentag Jerome J.
Published: September 2009

In 1993, several departments at Millard Fillmore Health System joined efforts to initiate a new approach to infection control. The main emphasis of this program is to move infection control to a real-time mode to manage patient outcomes daily. The principal objective was to decrease the number of nosocomial infections by 10%, with a particular emphasis on surgical-site infections. Besides real-time surveillance, we are critically evaluating several aspects of the management of nosocomial infections.

High-level computer support has been the framework upon which this program was built. We have micro-computers that are linked directly to microbiology, pharmacy, billing, and admissions, downloading data several times daily. An expert software system merges all of the data, and from this we can target patients for real-time interventions. The computer system allows all inpatients to be screened for either infection control or antibiotic management inter ventions on a daily basis, with minimal time being spent on data collection and maximal efforts devoted to inter ventions at the bedside.

Additionally, the infection management program will assist in maintaining the extraordinarily low expenditures on antimicrobial agents. During 1993, the Millard Fillmore Health System spent $924,884 on antibiotics, an amount approximately 50% that of comparably sized hospitals.
An Introduction to Time-Trend Analysis
Authors: Birnbaum David , Ely John W. , Dawson Jeffrey D. , Lemke Jon H. , Rosenberg Jon
Published: September 2009

Healthcare professionals often are presented with data that appear to indicate an upward or downward trend over time. For example, admissions of acquired immunodeficiency syndrome (AIDS) patients appear to be increasing, cesarean section rates appear to be decreasing, or nosocomial pneumonia rates appear to be increasing. Critical decisions sometimes are based on such trends, which often are presented without a statistical analysis. Those responsible for decision making may be left wondering whether these apparent trends represent only chance variation. Graphs showing trends over time generally present one of three kinds of outcome data: counts (eg, three AIDS admissions), proportions (eg, 10 cesarean sections per 100 total deliveries), or person-time data (eg, 13 cases of nosocomial pneumonia per 10,000 patient days). Using familiar examples and a minimum of technical language, we illustrate the analysis of time trends.
Nosocomial Transmission of Trichophyton tonsurans Tinea Corporis in a Rehabilitation Hospital
Authors: Lewis Steven M. , Lewis Barbara G.
Published: September 2009

Objective:

Investigate the nosocomial transmission of Trichophyton tonsurans tinea corporis.

Design:

Descriptive study of a nosocomial epidemic of tinea corporis.

Setting:

A free-standing inpatient rehabilitation facility.

Participants:

Patients and healthcare workers present on an inpatient rehabilitation ward at the time of transmission of tinea corporis.

Results:

T tonsurans tinea corporis was transmitted from one patient to four healthcare workers despite early diagnosis and treatment. Infection rates for healthcare workers having major, moderate, and minor contact with the index case were 30%, 17%, and 0%, respectively (overall rate, 25%).

Conclusions:

This study identifies rehabilitation inpatients as another population in which nosocomial transmission of T tonsurans tinea corporis can occur. The high attack rate and transmission, despite early diagnosis and treatment, emphasizes the need for isolation precautions.
Intravascular Catheter Colonization in Critically Ill Children
Authors: Schlager Theresa A. , Hidde Markley , Rodger Pamela , Germanson Teresa P. , Donowitz Leigh G.
Published: September 2009

In a prospective study, cultures were obtained of all intravascular catheters removed from children in an intensivecare unit. Of 366 catheters removed from 217 children, 110 (30%) were found to be colonized, most commonly with coagulase-negative staphylococci. Despite the high rate of colonization, there were only nine instances (2%) of catheter-related bacteremia.
A Survey of Policies at Children's Hospitals Regarding Immunity of Healthcare Workers: Are Physicians Protected?
Authors: Lane Natalie E. , Paul Ronald I. , Bratcher Denise F. , Stover Beth H.
Published: September 2009

Objective:

To determine policies at children's hospitals regarding immunizations, annual tuberculosis (TB) screening, and blood or body fluid exposure follow-up, particularly as they apply to physicians.

Design and Participants:

A three-page survey was sent to infection control practitioners (ICPs) in April 1994 at hospitals affiliated with the National Association of Children's Hospitals and Related Institutions. One follow-up mailing was sent to nonresponding ICPs.

Results:

Responses were received from 62 (67%) of 93 ICPs. Thirty-five (66%) of 53 children's hospitals had an immunity policy that applied to medical students, 42 (79%) of 53 to resident physicians, 32 (52%) of 62 to hospital-based physicians, and 18 (29%) of 62 to private or community physicians (who admit patients to one hospital). Physicians were required to show evidence of an annual TB screen at 36 hospitals (58%). Immunity policies or TB screening were provided for the following physician groups: medical students, 13 (21%); resident physicians, 43 (69%); hospital-based physicians, 50 (81%); and private or community physicians, 23 (37%). Infection control practitioners reported that the following diseases had been identified within the past 5 years at their hospitals: measles, 82%; mumps, 40%; rubella, 31%; TB, 94%; hepatitis B, 94%; pertussis, 90%; varicella, 98%; and influenza, 94%. Physicians in these institutions were reported to have contracted the following diseases from patient exposure: measles, hepatitis B, TB, pertussis, varicella, and influenza.

Conclusion:

Children's hospitals vary widely in their policies regarding healthcare-worker immunity, and, in many cases, physicians may not be protected from nosocomial transmission of community infections.
Varicella Vaccination for Healthcare Workers at a University Hospital An Analysis of Costs and Benefits
Authors: Tennenberg Alan M. , Brassard Juanita E. , Van Lieu Jaclyn , Drusin Lewis M.
Published: September 2009

Objective:

To demonstrate the costs and benefits of vaccinating varicella-susceptible healthcare workers at a university hospital with live, attenuated varicella-zoster virus vaccine.

Design:

Retrospective review of employee medical records and data on the cost of special paid absence for susceptible healthcare workers after exposure to varicella or herpes zoster.

Setting:

A 988-bed tertiary-care university hospital.

Results:

In 1994, 224 hospital employees (3.4%) were susceptible to the varicella-zoster virus. There were 40 exposures to varicella and herpes zoster in that year, involving 29 of the susceptible employees. Nine (31%) of the exposed susceptibles became varicella immune by indirect fluorescent antibody testing subsequent to exposure. Seventeen (59%) have had multiple varicella exposures and special paid absences while employed by the hospital. In 1994, wages paid to healthcare workers while furloughed for the communicable period following varicella exposure totaled $38,463.93. An additional $24,748.74 was paid to replacement workers during that same time. Varicella vaccine to immunize all 224 susceptibles in 1994 would have cost $17,920. Absences due to varicella and herpes zoster exposure also result in disruptions to patient care.

Conclusions:

Varicella vaccination for varicella-susceptible healthcare workers at a university hospital would result in financial savings and improved patient care. We recommend that other institutions consider the costs and benefits of adopting a varicella immunization program for their susceptible employees.
Evaluation of Integrity of Gloves Used in a Flow Cytometry Laboratory
Authors: Cappuccio William R. , Lees Peter S.J. , Breysse Patrick N. , Margolick Joseph B.
Published: September 2009

This study was conducted to evaluate the effect of normal use on latex glove integrity in a flow cytometry laboratory. The gloves were tested using the 1,000 μL watertight test and met industrial standards (less than 4% leakage) before, but not after, use. More durable gloves, or more frequent changes of gloves, may be needed to ensure adequate barrier protection for laboratory workers during routine procedures.
The Challenge of Postoperative Infections Does the Surgeon Make a Difference?
Authors: Holzheimer René G. , Haupt Werner , Thiede Arnulf , Schwarzkopf Andreas
Published: September 2009

Postoperative infections remain a challenge in many surgical procedures despite improved surgical technique and powerful antibiotics. The number of sepsis cases has tripled from 1979 to 1992 due to increased invasive procedures in older and immune-suppressed patients. Increasingly, in recent years, outbreaks of resistant pathogens have been published, provoking the question of how postoperative infections and resistant pathogens should be dealt with.

Wound classification and risk stratification were developed to identify patients at risk for postoperative infection. However, other important intrinsic factors of the patient were not included, and further attempts have been made to increase sensitivity and specificity (eg, Study on the Efficacy of Nosocomial Infection Control project, National Nosocomial Infection Surveillance System score); the American Society of Anesthesiologists preoperative assessment score and the operation duration for specific procedures were introduced into the system as risk stratifiers.

Advances in immunology have identified new ways in which the surgeon can moderate the immune response (eg, hemorrhage and blood transfusion-induced immune suppression). The increased rate of resistance in enterococci and staphylococci has refocused attention on infection control in surgery. However, there are recent reports from both sides of the Atlantic indicating that guidelines for infection control and antibiotic policy have not become reflected in standard procedures in many hospitals.

New antibiotics may be developed, but resistance soon may follow. Sound techniques in surgery, with careful infection control and antibiotic policies, may be the only strategy to prevent further increases in resistance of pathogens in postoperative infections.
Nosocomial Infections in HIV-Infected Patients Preliminary Results from a Multicenter Surveillance System (1989-1995)
Authors: Stroud Leonardo , Srivastava Pamela , Culver David , Bisno Alan , Rimland David , Simberkoff Michael , Elder Harvey , Fierer Joshua , Martone William , Gaynes Robert
Published: September 2009

Objective:

To describe the characteristics of and trends in nosocomial infection among human immunodeficiency virus (HIV)-infected patients.

Design:

Multicenter prospective cohort study.

Setting/Patients:

HIV-infected patients were enrolled at time of first inpatient admission at five Veterans' Administration Medical Centers (VAMCs).

Results:

As of March 1995, 2,541 patients with 6,625 inpatient admissions had been monitored in the five VAMCs. A total of 530 nosocomial infections were detected using standard Centers for Disease Control and Prevention definitions. Overall distribution by infection site was 31% for primary bloodstream infections (BSIs), 28% for urinary tract infections, 15% for pneumonia, and 26% for all other sites. Of BSIs, 63% were central line-associated bloodstream infections (CLABs). The rate of CLABs per 1,000 central line days was 6.5 (range, 2.3-8.3) for all patients from participating hospitals, similar to the median CLAB rate of 6.0 for patients in medical intensive-care units (ICUs) of National Nosocomial Infections Surveillance (NNIS) System hospitals from January 1990 through September 1994. For ICU-specific CLABs, the rate from hospitals reporting at least one ICU CLAB was 12.7 (range, 12.1-13.1), comparable to the 90th percentile of NNIS hospital medical ICUs (13.1). Staphylococcus aureus, associated with 35% of BSIs, was the most common nosocomial BSI pathogen. Our data demonstrated the following: 13 (10%) of 134 patients with CD4 counts ≥200 cells/mm3 had a CLAB, compared with 61 (6%) of 1,011 patients with CD4 counts <200 cells/mm3, P=.08; the per-day risk of CLABs did not change with increased duration of catheterization (P=.4); and the per-day risk of a temporary (ie, short-term) CLAB was greater than that of a permanent CLAB (P<.001).

Conclusions:

The data suggest that HIV-infected patients were at higher risk of acquiring a BSI than were patients in the NNIS population; patients with CD4 counts ≥200 cell/mm3 and temporary central lines were at increased risk for BSI, perhaps reflecting widespread prophylaxis with trimethoprim-sulfamethoxazole among patients with CD4 counts <200 cells/mm3; and, in contrast to most studies, S aureus, not coagulase-negative Staphylococcus, was the most common BSI pathogen.
Automated Entry of Hospital Infection Surveillance Data
Authors: Smyth Edward T.M. , McIlvenny Gerard , Barr Jack G. , Dickson Lorna M. , Thompson Irene M.
Published: September 2009

Objective:

To assess the accuracy of an automated data entry system employing optical scanning technology and to provide an analysis of its costs as compared to manual data entry.

Design:

The accuracy and cost of automated data entry of 100 surgical-wound infection surveillance questionnaires was compared to manual entry.

Setting:

The Surgical Directorate, The Royal Hospitals, Belfast, Northern Ireland.

Results:

The use of optical scanning technology greatly improved the speed and accuracy of data entry. The time spent by the keyboard operator on data entry was reduced substantially.

For each surgical-wound infection questionnaire automatically processed, there was a saving in clerical time equivalent to $0.63. The automated data entry process resulted in a 22-fold productivity increase compared to manual data entry with validation. After validation, an error rate of <0.2 errors per 1,000 responses was detected in automatically entered data compared to a rate of 12.4 errors per 1,000 responses for manually entered data. The automated system, including validation, provided a sevenfold productivity increase compared to “quick-and-dirty” manual data entry without validation.

Conclusion:

Hospital information technology systems may achieve total integration of data management, but realistically this would appear to be very much in the future. Until then, in view of the accuracy and substantial savings in time and money, we recommend the use of automated data entry technology. This system would be especially useful where data are transported from outlying hospitals to a central receiving center for collation and analysis.
Evidence of Interhospital Transmission of Extended-Spectrum β-Lactam-Resistant Klebsiella pneumoniae in the United States, 1986 to 1993
Authors: Monnet Dominique L. , Biddle James W. , Edwards Jonathan R. , Culver David H. , Tolson James S. , Martone William J. , Tenover Fred C. , Gaynes Robert P. ,   The National Nosocomial Infections Surveillance System
Published: September 2009

Background:

In addition to single-hospital outbreaks, interhospital transmission of extended-spectrum β-lactam-resistant (ESBLR) Klebsiella pneumoniae has been suspected in some reports. However, these studies lacked sufficient epidemiological information to confirm such an occurrence.

Methods:

We reviewed the surveillance data reported to the National Nosocomial Infections Surveillance (NNIS) System during 1986 to 1993 for K pneumoniae isolates and their susceptibility to either ceftazidime, cefotaxime, ceftriaxone, or aztreonam. Pulsed-field gel electrophoresis (PFGE) was used to study available ESBLR K pneumoniae isolates.

Results:

Among 8,319 K pneumoniae isolates associated with nosocomial infections, 727 (8.7%) were resistant or had intermediate-level resistance to at least one of these antibiotics. One hospital (hospital A) accounted for 321 isolates (44.2%) of ESBLR K pneumoniae. During 1986 to 1993, the percentage of K pneumoniae isolates that were ESBLR increased from 0 to 57.7% in hospital A, from 0 to 35.6% in NNIS hospitals 0 to 20 miles from hospital A (area B), and from 1.6 to 7.3% in NNIS hospitals more than 20 miles from hospital A, including hospitals located throughout the United States. Analysis of PFGE restriction profiles showed a genetic relationship between a cluster of isolates from hospital A and some isolates from one hospital in area B, and consecutive admission in these two hospitals was confirmed for two patients from whom isolates were available.

Conclusions:

These data provide evidence of interhospital transmission of ESBLR K pneumoniae in one region of the United States and stress the interrelationship between hospitals when trying to control antimicrobial resistance.
A Pseudo-Outbreak of Purified Protein Derivative Skin-Test Conversions Caused by Inappropriate Testing Materials
Authors: Grabau John C. , Burrows Daniel J. , Kern Michelle L.
Published: September 2009

Objective:

To investigate a cluster of newly identified tuberculosis infections.

Design:

A field study was conducted including interviews; medical record reviews; checking of bills and invoices, pharmacy records, and drug manufacturer information; and clinical retesting.

Setting:

Community residential facilities providing comprehensive services to retarded adults.

Participants:

Twenty residential facility staff (not previously known to be purified protein derivative [PPD] positive).

Results:

Staff had been tested with 250 TU of PPD, and 9 of 20 were tuberculin positive. Retesting with 5 TU yielded no reaction.

Conclusions:

Reactions were attributable to testing with a product not recommended for routine PPD screening. Healthcare workers planting PPD Mantoux tests always should check the vials to ensure that the appropriate strength solution is being used.
Infection Control Issues in Construction and Renovation
Authors: Carter Cheryl D. , Barr Brenda A.
Published: September 2009

Construction or renovation projects in hospitals pose special challenges. Infection control personnel should be involved in all phases of these projects to ensure that patients, visitors, and staff are protected from unnecessary exposure to infectious agents. Infection control personnel must identify the infection risks posed by each project and must plan ways to minimize the risk. Infection control personnel also must ensure that municipal, county, state, and federal infection control guidelines and regulations are met. This article will discuss basic infection control issues encountered during construction and renovation, offer practical suggestions for addressing these issues, discuss common questions that infection control personnel must address, and describe outbreaks related to construction and renovation.
Clostridium difficile-Associated Diarrhea: Epidemiology, Risk Factors, and Infection Control
Authors: Lai Kwan Kew , Melvin Zita S. , Menard Mary Jane , Kotilainen Helen R. , Baker Stephen
Published: September 2009

Objectives:

To evaluate the effectiveness of specific infection control measures on the incidence of Clostridium difficile-associated diarrhea (CDAD) and to identify risk factors for its development.

Setting:

370-bed, tertiary-care teaching hospital with approximately 12,000 to 15,000 admissions per year.

Methods:

Several infection control measures were implemented in 1991 and 1992, and the attack rates of CDAD were calculated quarterly. Antibiotic use for 1988 through 1993 was analyzed. A case-control study was conducted from January 1992 to December 1992 to identify risk factors for acquisition of CDAD.

Results:

From 1989 to 1992, the attack rate of CDAD increased from 0.49% to 2.25%. An increase in antibiotic use preceded the rise in the incidence of CDAD in 1991. Despite implementation of various infection control measures, the attack rate decreased to 1.32% in 1993, but did not return to baseline. Ninety-two cases and 78 controls (patients with diarrhea but with negative toxin assay) were studied. By univariate analysis, history of prior respiratory tract infections (odds ratio [OR], 3.6; 95% confidence interval [CI95], 1.2-10.4), the number of antibiotics, and the duration of exposure to second-generation cephalosporins (OR, 3.55; CI95, 1.47-9.41) and to ciprofloxacin (OR, 7.27; CI95, 1.13-166.0) were related significantly to the development of CDAD. By stepwise logistic regression analysis, only exposure to antibiotics and prior respiratory tract infections (P=.0001 and .0203, respectively) were found to be significant.

Conclusion:

Antibiotic pressure might have contributed to failure of infection control measures to reduce the incidence of CDAD to baseline.
When the Biological Indicator Is Positive: Investigating Autoclave Failures
Authors: Bryce E.A. , Roberts F.J. , Clements B. , MacLean S.
Published: September 2009

A series of positive biological indicators in steam autoclaves from different hospital departments within the same building were traced to blocked steam traps on building condensate lines. The steps taken during the investigation and a protocol for management of positive biological indicators are described.
Exclusion of Noninfectious Medical Waste From the Contaminated Waste Stream
Authors: Francis Michael C. , Metoyer Lana A. , Kaye Alan D.
Published: September 2009

The purpose of this study was to determine whether any waste was labeled incorrectly as infectious or contained material that could be recycled. Waste generated in preparation for surgery was separated and weighed. Of 530 lbs of operating room waste, 40 lbs were noninfectious, largely plastic and paper. The results of the present study suggest a segment of waste can be removed from the contaminated stream, potentially reducing hospital costs and improving our environment.
Surgical-Site Infection Rates in Patients Who Undergo Elective Surgery on the Same Day as Their Hospital Admission
Authors: Manian Farrin A. , Meyer Lynn
Published: September 2009

Objective:

To follow over time surgical-site infection (SSI) rates in patients admitted to the hospital on the same day as their elective surgery (group I), and to compare these rates with those of other surgical patients who also required postoperative hospitalization but either were hospitalized for 1 or more days immediately prior to surgery or underwent surgery on a nonelective basis (group II).

Design:

Observation of overall SSI rates over time for group I and II patients and study of risk factors associated with increased SSI rate among group I neurosurgical patients.

Setting:

A 900-bed, tertiary-care community hospital with >10,000 surgical procedures performed each year on patients requiring postoperative hospital stay.

Patients:

A total of 48,464 surgical procedures were performed on consecutive patients from 1990 to 1994, with 18,794 (39%) involving group I patients. In addition, 511 consecutive procedures performed on neurosurgical patients requiring postoperative hospitalization from July 1994 to May 1995 were analyzed.

Results:

In 1990, the overall SSI rate of group I patients was significantly lower than that of group II patients (0.4% vs 1.3%, relative risk [RR], 3.6; 95% confidence interval [CI95], 2-6.4; P<.0001), but, by 1994, there was no longer any significant difference between the SSI rates of group I and II patients (1.8% and 1.6%, respectively; P=.38). In 1994, the SSI rate in group I neurosurgical patients was significantly greater than that of group II patients (3.4% vs 0.4%; RR, 8.3; CI95, 1.05-66; P=.02). During the period April through September 1994 (warm months), group I neurosurgical patients were associated with a significantly lower American Society of Anesthesiologists score and SSI risk index (based on National Nosocomial Infection Surveillance System data) and a higher likelihood of having “clean-class” wounds, but significantly greater-than-expected SSI rate when adjusted for patient risk index and type of procedure (4.7% vs 1.4%; RR, 3.3; CI95, 1.3-8.6; P=.02). During the same period, the observed and expected SSI rates were not significantly different for group II neurosurgical patients.

Conclusions:

As a whole, the SSI rates among patients undergoing elective surgery on the same day of their hospital admission is no longer significantly lower than that of other patients who also require postoperative hospitalization. For certain procedures, such as those commonly performed on the neurosurgical service, elimination of preoperative hospital stay may be associated with greater-than-expected risk of SSI.
Increased Bloodstream Infection Rates in Surgical Patients Associated with Variation from Recommended Use and Care Following Implementation of a Needleless Device
Authors: Cookson Susan Temporado , Ihrig Melanie , O'Mara Edward M. , Denny Mark , Volk Helen , Banerjee Shailen N. , Hartstein Alan I. , Jarvis William R.
Published: September 2009

Objective:

To determine if an apparent increase in bloodstream infections (BSIs) in patients with central venous catheters (CVCs) was associated with the implementation of a needleless access device.

Design:

Retrospective cohort study using a derived CVC-days factor for estimating appropriate denominator data.

Setting:

A 350-bed urban, acute, tertiary-care hospital.

Methods:

BSI surveillance data were obtained, and high-risk areas for BSIs were determined. A random 5% sample of medical records was used to estimate CVC days, and a cohort study was conducted to compare BSI rates before and during needleless device use. A survey was conducted of nursing needleless-device practices.

Results:

The surgical intensive-care unit (SICU), the medical intensive-care unit, and the solid organ transplant unit (OTU) were identified as high-risk units. Using existing surveillance BSI data and the estimated CVC days, the catheter-related BSI rates in the high-risk surgical patients were significantly higher during the needleless-device period compared with the preneedleless-device period (SICU, 9.4 vs 5.0/1,000 CVC days; OTU, 13.6 vs 2.2/1,000 CVC days). A survey of the nurses revealed that 60% to 70% were maintaining the needleless devices correctly.

Conclusion:

We observed a significant increase in the BSI rate in two surgical units, SICU and OTU, associated with introduction of a needleless device. This increase occurred shortly after the needleless device was implemented and was associated with nurses' unfamiliarity with the device, and needless-device use and care practices different from the manufacturer's recommendations.
Mycobacterium avium Complex Common-Source or Cross-Infection in AIDS Patients Attending the Same Day-Care Facility
Authors: Carbonne Anne , Lemaitre Nadine , Bochet Marie , Truffot-Pernot Chantal , Katlama Christine , Grosset Jacques , Bricaire François , Jarlier Vincent
Published: September 2009

To delineate the epidemiology of Mycobacterium avium complex (MAC) infection in acquired immunodeficiency syndrome patients, we studied 32 case patients with disseminated MAC infection who attended the same daycare facility during a period of 13 months. Pulsed-field gel electrophoresis analysis showed very low similarity between MAC strains, suggesting that, despite close contacts between the patients, nosocomial cross-transmission or exposure to a common source of MAC did not occur
Central Venous Catheter-Related Corynebacterium minutissimum Bacteremia
Authors: Rupp Mark E. , Stiles Karen G. , Tarantolo Stefano , Goering Richard V.
Published: September 2009

Although Corynebacterium minutissimum is well-known as the cause of erythrasma, it is noted as the etiologic agent of nondermatologic disease only rarely. We document this organism as a cause of central venous catheter-associated bacteremia and report the use of pulsed-field gel electrophoresis to characterize its molecular epidemiology
An Outbreak of Serratia marcescens Infections Related to Contaminated Chlorhexidine
Authors: Vigeant Patrice , Loo Vivian G. , Bertrand Céline , Dixon Catherine , Hollis Richard , Pfaller Michael A. , McLean A. Peter H. , Briedis Dalius J. , Perl Trish M. , Robson Hugh G.
Published: September 2009

An outbreak of Serratia marcescens infections occurred in a university tertiary-care hospital. Alcohol-free chlorhexidine solutions were contaminated with S marcescens. The majority of patient and chlorhexidine strains had similar pulsed field-gel electrophoresis banding patterns. Chlorhexidine was recalled, and the rate of S marcescens isolation returned to baseline. Chlorhexidine without alcohol should not be used as an antiseptic
Standardized Management of Patients and Employees Exposed to Pertussis
Authors: Haiduven Donna J. , Hench Carmen P. , Simpkins Sandy M. , Stevens David A.
Published: September 2009

Waning pertussis immunity and spread of pertussis by asymptomatic adults contributes to increased pertussis exposures of vulnerable children. The Santa Clara Valley Medical Center had 49 pertussis exposures between July 1, 1989, and June 30, 1997, which originated in pediatric units or clinics and had an impact on the Employee Health Service (EHS) and Emergency Department (ED). We have developed a standardized protocol for management of employees and patients exposed to pertussis. The protocol includes a checklist for infection control staff; memoranda to exposed units conveying exposure information, instructions for employees to report to EHS or ED, and disease symptom information; written guidelines for physician management of patient exposures (prophylaxis and isolation) and EHS or ED management of employee exposures; and prophylaxis recommendations. We allow exposed employees to work while wearing a mask (worn until 5 days of prophylaxis are completed or for the entire potential contagious period if prophylaxis was refused). Employees who develop pertussis are restricted from work. Our protocol and standardized forms provide consistent management of pertussis exposures in both patients and employees.
Carriage of Methicillin-Resistant Staphylococcus Aureus at Hospital Admission
Authors: Troillet Nicolas , Carmeli Yehuda , Samore Matthew H. , Dakos Joanna , Eichelberger Karen , DeGirolami Paola C. , Karchmer Adolf W.
Published: September 2009

Objectives:

To measure the prevalence of, and to establish predictors for, the nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission. To evaluate mannitol-salt agar with oxacillin for the simultaneous detection and identification of MRSA from nasal swabs.

Design:

Three-month prospective case-control survey, with data collected from interviews and computerized databases. The criterion standard for MRSA detection was culture on Mueller-Hinton agar with oxacillin 6 μg/mL (National Committee for Clinical Laboratory Standards method).

Setting:

320-bed tertiary-care hospital.

Patients:

387 patients screened within 24 hours after admission, including 10 MRSA carriers (cases), 291 patients with no S aureus, and 86 patients with methicillin-susceptible S aureus.

Results:

The prevalence of MRSA nasal carriage was 2.6%, whereas the prevalence of carriage was 3.1% when both nasal and wound cultures were performed. The significant predictors of carriage were a prior detection of MRSA, open wounds, diabetes mellitus, treatments by injection, prior nursing home stays, visits at home by a nurse, and prior antibiotic treatments. Cases had stayed for longer periods in hospitals and had received longer antibiotic treatments within a year. Eighty patients (including the 10 cases) had diabetes, had been exposed to healthcare facilities within a year, and had antibiotics within 6 months. The sensitivity and negative predictive value of nasal swabs on mannitol-salt agar with oxacillin were 60% and 71%, respectively.

Conclusion:

MRSA carriage on admission to the hospital may be an increasing and underestimated problem. Further studies are needed to develop and validate a sensitive and specific prediction rule.
Colonization by Acinetobacter baumanii in Intensive–Care–Unit Patients
Authors: Lortholary Olivier , Fagon Jean-Yves , Hoi Annie Buu , Mahieu Geneviève , Gutmann Laurent
Published: September 2009

We prospectively studied the value of systematic rectal swabs performed for the detection of colonization and the prediction of infections by Acinetobacter baumanii in 751 consecutive patients admitted to five intensive-care units (ICUs) over an 8-month period. Gastrointestinal tract colonization was found in 8.7% of ICU admissions. The positive and negative predictive values of rectal swabs for the detection of subsequent infection were 17% and 99%, respectively. Sensitivity and specificity were 55% and 93%, respectively. We also determined the comparative values of rectal or nasal swabs and skin cultures for the detection of A baumanii colonization in 25 patients already colonized or infected with A baumanii. The combination of rectal and nasal swabs was positive in 20 (80%) of 25. The results of the present study suggest that detection of gastrointestinal tract A baumanii colonization is not an accurate predictor of subsequent A baumanii infection and that combined rectal and nasal swabs might be used for the detection of A baumanii colonization in ICU patients.
Staphylococcus aureus Nasal Colonization in Patients with Cirrhosis: Prospective Assessment of Association with Infection
Authors: Chang Feng Yee , Singh Nina , Gayowski Timothy , Wagener Marilyn M. , Marino Ignazio R.
Published: September 2009

OBJECTIVE: To determine if Staphylococcus aureus colonization of the anterior nares was a risk factor for S aureus infection in patients with cirrhosis and to determine the predictors of S aureus infection in colonized patients.

DESIGN: Prospective cohort study.

PATIENTS: 84 consecutive patients with cirrhosis admitted to the liver transplant unit of a university-affiliated Veterans' Affairs Medical Center.

RESULTS: Overall, 39 (46%) of the 84 patients were nasal carriers of S aureus, of which 24 (29%) were methicillin-resistant Staphylococcus aureus (MRSA) and 15 (18%) were methicillin-sensitive Staphylococcus aureus (MSSA). Only MRSA, but never MSSA, carriage was acquired in the hospital; all 15 of the MSSA versus 14 (58%) of the 24 MRSA carriers were nasal carriers on first (admission) culture (P=.001). Of the 10 (42%) of 24 MRSA carriers who were not colonized on admission, 3 became MRSA carriers within 1 month, and 7 acquired MRSA carriage more than a month later. Higher Child-Pugh score was independently associated with MRSA carriage (odds ratio [OR], 1.54; 95% confidence interval [CI95], 1.1-2.3). S aureus nasal carriers (9 [23%] of 39) were significantly more likely to develop S aureus infections than noncarriers (2 [4%] of 45; P=.02). Central venous catheter use was associated independently with S aureus infections in the carriers (OR, 4.1; CI95, 2.8-6.1). Mortality was significantly higher in carriers who developed S aureus infections as compared to those who did not (57% vs 13%; P=.022); S aureus infection was an independent predictor of mortality in the carriers (OR, 8.7; CI95, 1.2-63.8).

CONCLUSIONS: Colonization of the anterior nares was a significant predictor of S aureus infection in patients with cirrhosis
Report of the Council on Scientific Affairs American Medical Association: Immunization of Healthcare Workers With Varicella Vaccine
Authors: Lyznicki James M. , Bezman Rebecca J. , Genel Myron ,   Council on Scientific Affairs, American Medical Association
Published: September 2009

OBJECTIVE: In June 1996, a resolution was introduced to the House of Delegates of the American Medical Association (AMA) asking the AMA to advocate that healthcare workers be given the informed option of receiving the varicella vaccine. The AMA Council on Scientific Affairs studied this issue and presented this report to the House of Delegates in June 1997.

METHODS: Information for the report was derived from published literature and from personal communications with medical and public health experts and the vaccine manufacturer.

FINDINGS: Nosocomial outbreaks of varicella-zoster virus (VZV) can result in serious morbidity and mortality. Sero-logical testing of healthcare workers and immunization of nonimmune individuals is recommended by infection control and infectious disease experts to prevent nosocomial transmission of VZV. While current data indicate that the vaccine is safe and poses minimal risks to both adults and children, ongoing research should address various concerns about the long-term safety, efficacy, and epidemiological impact of more widespread use of the vaccine.

CONCLUSION: Unless contraindicated, all susceptible healthcare workers should receive the varicella vaccine. Whereas individuals with a definite history of VZV infection can be considered immune, those with a negative or uncertain history should undergo serological testing and, if seronegative, should be immunized
Emerging Infectious Diseases: Introduction
Authors: Strausbaugh Larry J. , Pinner Robert W.
Published: September 2009

The following article, “Microbiological Hazards Related to Xenotransplantation of Porcine Organs in Man” inaugurates this section of the Journal, which will focus on the interface between the world of emerging infectious diseases and the delivery of healthcare. Emerging infectious diseases, that is, diseases of infectious origin whose incidence in humans has increased within the past 2 decades or threatens to increase in the near future, are of great importance to hospital epidemiologists and infection control practitioners. Many of the diseases in this category, eg, Clostridium difficile colitis, infections caused by methicillin-resistant Staphylococcus aureus or van-comycin-resistant enterococci, and legionellosis, are well-recognized causes of nosocomial infections. Others, such as hepatitis C virus, human immunodeficiency virus, and Ebola virus, are potential threats to healthcare workers in certain occupational settings. Still others, group B streptococcal infections in neonates, for example, may be prevented by implementation of strategies that infection control programs can promote.
Postexposure Prophylaxis for Human Immunodeficiency Virus: Frequency of Initiation and Completion of Newly Recommended Regimen
Authors: Sepkowitz Kent A. , Rivera Pedro , Louther Joyce , Lim Suzanne , Pryor Betty
Published: September 2009

Recent evidence demonstrating the efficacy of zidovudine, as well as experience with protease inhibitors, led to revision of recommendations for occupational exposures to human immunodeficiency virus-infected blood. At our hospital, this resulted in significant increases in rates of reported exposures and prophylaxis initiation. Among 10 healthcare workers given three-drug, protease-inhibitor-containing regimens, five completed 4 weeks, two completed 4 weeks of two drugs, and three stopped due to intolerance. Three workers missed work due to side effects
Identification and Voluntary Reduction of Vancomycin Use for Perioperative Antibiotic Prophylaxis During Coronary Artery Bypass Graft Surgery
Authors: Pear Suzanne M. , Goldsmith Deborah L. , Williamson Theresa H. , Mandel David , Sethi Gulshan K. , Arzouman David A. , Ampel Neil M.
Published: September 2009

Vancomycin prophylaxis for coronary artery bypass graft surgery without prosthetic valve implantation voluntarily decreased from 94% to 18% in one medical center. Median hospital stay (10 vs 9 days, P=.30) and number of postoperative infections (17.0% vs 14.3%, P=.60) did not differ among patients who received vancomycin and those who did not.
Vancomycin-Resistant Enterococci in Long-Term—Care Facilities
Authors: Crossley Kent ,   Long-Term—Care Committee of the Society for Healthcare Epidemiology of America
Published: September 2009

The Society for Healthcare Epidemiology of America (SHEA) Committee on Long-Term Care decided in 1996 that there was need to develop a position document about vancomycin-resistant enterococci (VRE) in long-term—care facilities (LTCFs). This document is intended to complement the two previous position statements from our committee that discuss antibiotic use and antibiotic resistance in LTCFs. It is designed to supplement Hospital Infection Control Practice Advisory Committee (HICPAC) recommendations and to provide realistic guidelines for the LTCF.
Nosocomial Transmission of a Drug-Sensitive W-Variant Mycobacterium tuberculosis Strain Among Patients With Acquired Immunodeficiency Syndrome in Tennessee
Authors: Haas David W. , Milton Scott , Kreiswirth Barry N. , Brinsko Vicki L. , Bifani Pablo J. , Schaffner William
Published: September 2009

Objective:

To use DNA fingerprinting to characterize nosocomial spread of Mycobacterium tuberculosis following hospitalization of a patient with acquired immunodeficiency syndrome and active pulmonary tuberculosis, for whom respiratory isolation was not initiated promptly.

Design:

Epidemiological investigation.

Setting:

A tertiary-care medical center in Tennessee.

Participants:

Patients and healthcare workers potentially exposed to the infectious patient in 1992.

Results:

Of 172 healthcare workers exposed, 35 (20%) were judged to have acquired tuberculous infection. Risk of acquisition was greatest for nurses and medical receptionists. Active tuberculosis later developed in one healthcare worker and one hospitalized patient. Nosocomial transmission was supported by epidemiological evidence and DNA fingerprinting. The outbreak strain of Mycobacterium tuberculosis differed from other isolates at this hospital, but its DNA hybridization pattern was highly similar to that of the multidrug-resistant outbreak strain W that has been prevalent in New York City, suggesting a common strain ancestry. However, the Tennessee isolates were susceptible to all first-line antituberculous agents.

Conclusions:

This report suggests the possibility that a molecular characteristic(s) shared by these successful outbreak strains is associated with increased transmissibility or pathogenicity and emphasizes the need for continued vigilance for tuberculosis in the nosocomial setting.
Klebsiella Pneumoniae Bloodstream Infections in Neonates in a Hospital in the Kingdom of Saudi Arabia
Authors: Al-Rabea Ayman Abdulaziz , Burwen Dale R. , Eldeen Mariam A. Fath , Fontaine Robert E. , Tenover Fred , Jarvis William R.
Published: September 2009

Objective:

To identify risk factors for Klebsiella pneumoniae bloodstream infections (BSI) in neonates in a hospital in the Kingdom of Saudi Arabia (KSA).

Design:

Two case-control studies among hospitalized neonates during February 15-May 14, 1991, and a procedural and microbiological investigation.

Setting:

Hospital A, a maternity and children's hospital in KSA.

Patients:

Case patients had a blood culture positive for K pneumoniae after >2 days of hospitalization and had no evidence of a nonblood primary site of infection.

Results:

When the 20 case patients were compared with controls, hospitalization in a critical-care unit (odds ratio [OR], 5.5; 95% confidence interval [CI95], 1.20-51.1; P=.03) was identified as a risk factor. When the case patients were compared with a second set of controls matched by critical-care status, receipt of a particular intravenous fluid (D10%/0.2NS; OR, 11.0; CI95, 1.42-85.2; P=.009) or a blood product (OR undefined; P=.04) were identified as risk factors. Infusates were administered via umbilical catheters for most case and control patients (19/20 vs 15/20, P>.05); catheters were manipulated more frequently in patients in criticalcare units. Umbilical catheter tip, skin, or mucus membrane K pneumoniae colonization occurred in 47% and 53% of evaluated case and control patients, respectively. Available K pneumoniae isolates from blood cultures and colonization sites had identical antimicrobial susceptibility patterns. Emphasis on handwashing, careful preparation and administration of infusates, and aseptic technique for catheter insertion, maintenance, and manipulation was temporally associated with resolution of the epidemic.

Conclusions:

This outbreak was probably due to infusion therapy practices that led to BSI in nursery patients colonized with K pneumoniae. Both catheter-related infections and extrinsic contamination of infusates may have occurred. Hospital personnel should be aware of their potential to spread nosocomial pathogens from person to person and should implement Centers for Disease Control and Prevention recommendations to decrease nosocomial BSIs.